[Meningitis after spinal anesthesia].

Background: Meningitis is a rare complication after spinal anesthesia. aim: We report 4 cases of meningitis occurred after spinal anesthesia.

Observations: These meningitis were diagnosed during tow months and with 3 different operators.

Mutation spectrum of primary hyperoxaluria type 1 in Tunisia: implication for diagnosis in North Africa.

Background: Primary hyperoxaluria type 1 (PH1) is an autosomal recessive inherited metabolic disease, characterized by progressive kidney failure due to renal deposition of calcium oxalate. Mutations in the AGXT gene, encoding the liver-specific enzyme alanine glyoxylate aminotransferase, are responsible for the disease. We aimed to determine the mutational spectrum causing PH1 and to provide an accurate tool for diagnosis as well as for prenatal diagnosis in the affected families.

[Evaluation of a protocol of spinal anesthesia for cesarean section in a Tunisian maternity unit: hemodynamic repercussions and risk factors for hypotension].

Aim: To evaluate hemodynamic repercussion of a protocol of spinal anesthesia (SA) for cesarean and release the predictive factors of maternal arterial hypotension post spinal anesthesia.

Methods: We included parturients proposed for Cesarean under SA. They were not included the women of statute ASA > II, preeclamptics, eclamptics and/or having counter-indications of SA.

Reduction of bupivacaine dose in spinal anaesthesia for caesarean section may improve maternal satisfaction by reducing incidence of low blood pressure episodes.

Background: Spinal anaesthesia for caesarean section exposes to high incidence of arterial hypotension which can result in maternal and neonatal morbidity. We hypothesized that the reduction of this dose from 10 mg to 7.5 mg would minimize hypotension without altering pain relief.

Combined use of crystalloid preload and low dose spinal anesthesia for preventing hypotension in spinal anesthesia for cesarean delivery: a randomized controlled trial.

Background And Objective: Spinal anaesthesia for caesarean section is commonly associated with hypotension and crystalloid preload is widely recommended. Low-dose spinal appears to cause less hypotension. The aim of this study was to investigate whether the combined use of crystalloid preload and low dose spinal anaesthesia might further reduce the rates of hypotension.

[The prophylaxis of the thromboembolic disease in the head trauma].

Background: The prophylaxis of the thromboembolic disease in the severe head trauma remains a controversy.

Aim: In this study, we are interested to the determination of under groups of patients for whom the advantages of the prophylaxis of the thromboembolic disease (TED) are higher than its disadvantages.

Methods: We proceeded to a retrospective study based on patient medical records ranging from March 2003 until March 2004, enrolling 56 consecutive patients.

[Postoperative analgesia after laparoscopic cholecystectomy: comparison of the preoperative administration of celecoxib with paracetamol?].

Objective: The goal of this study was to evaluate the preventive analgesic effectiveness of paracetamol and celecoxib in laparoscopic cholecystectomy.

Methods: Randomized prospective study was undertaken, 75 patients of class ASA I and II were included, divided into three groups: P (Paracetamol 1000 mg), C (Celecoxib 200 mg) given orally one hour before induction and group T (without preoperative analgesia). The VAS at rest and effort was noted on arrival in the recovery room then with regular intervals (T(30mn) to T(h24).

Clinical benefits related to the combination of ketamine with morphine for patient controlled analgesia after major abdominal surgery.

Background: combination of ketamine may improve morphine patient controlled analgesia (PCA) but clinical results are still equivocal.

Aim: The authors designed a powerful study to evaluate this hypothesis after major abdominal surgery.

Methods: 138 patients undergoing abdominal surgery participated in the randomized double blind study.

Efficacy of patient controlled epidural analgesia during labor analgesia--a prospective randomized study using 0.1% bupivacaine with fentanyl 2 mg/ml.

Background: Epidural analgesia is the most effective for the control of pain during labor but irregularity of analgesia, toxicity of local anesthetics (LA) and driving block are the major limits of the modalities of maintenance.

Aim: The purpose of this work was to assess the effectiveness and adverse effects of adaptations offered with Patient Controlled Epidural Analgesia (PCEA).

Methods: 40 mono-foetal parturients were randomized in two groups: 0.

[Patient controlled epidural analgesia: interest in thoracic surgery].

Aim: To compare efficacy of pain control, the consumption of local anaesthetics and opioids as well as the side effects between continuous epidural analgesia, patient controlled analgesia and patient controlled epidural analgesia in thoracic surgery.

Methods: Prospective randomised study included 66 patients who had thoracotomy. Patients were divided into 3 groups, to receive different pain control methods.

[The end of life, euthanasia, and medical futility].

The progress in medicine transformed the issue of death. In fact, the means that can be used to prolong the life or a patient are unlimited nowadays. This infers problems, that as professional health carers, can neither ignore nor take upon oneself.

[Sedative practice in intensive care units results of a Maghrebian survey].

Objectives: sedation is central to the management of intensive care patients. The aim of this study was to establish the current sedation practice in Maghrebian intensive care units (ICUs). The use of sedation policies with or without a written protocol, the use of scoring systems, the influence of costs on drug choice, the most common drugs for sedation and the use of neuromuscular blocking agents.

[Pulmonary alveolar proteinosis in two siblings. A case report].

Pulmonary alveolar proteinosis (PAP) is a rare disorder in children. This report describes two siblings in whom PAP developed during infancy (three years for the boy and four years two months for the girl). The girl was admitted for chronic respiratory distress.

[Septic shock in a Tunisian intensive care unit: mortality and predictive factors. 100 cases].

This is a retrospective study, of 100 consecutive patients with septic shock hospitalized in the ICU of Mongi Slim Hospital La Marsa between January 1997 and December 2001. The state of shock was defined according to the criteria established by the American College of Chest physicians in conjunction with the Society of Critical Care Medicine during the consensus conference on sepsis. Our study shows that septic shock affect both sexes in the same way, that it increases with the age and with the existence of underlying diseases.

[Factors associated to maternal mortality among preeclamptic parturients. About 55 cases].

Retrospective study about 55 preeclamptic parturients. Data was collected from the medical files of the patients hospitalized during two consecutive years. Admittance of preeclamptic women in the intensive care unit was 6,37 % (55/689).

[Isolated acute renal failure is not associated to an increase in mortality of patients in intensive care units].

This study assess the prognostic factors increasing mortality of patients with acute renal failure in intensive care units. The study included 923 patients admitted to the intensive care unit over a period of two years. Acute renal failure was defined by the following criteria, a blood urea concentration of more than 30 mmol/l, a serum creatinine concentration of more than 180 micromol/l or creatinine clearance less than 50 ml/min.

[Tracheotomy or prolonged tracheal intubation for long-term ventilation].

130 critically ill patients undergoing long term mechanical ventilation were divided into two groups, tracheotomy versus translaryngeal intubation. There were no difference in demographic characteristics between the two groups. The incidence of chronic obstructive pulmonary disease (COPD) was also higher in T.

[Mechanical ventilation in intensive care units: indications, modalities and complications. Results of a prospective multicenter survey in Tunisia].

The survey was performed during the month of March 1998 and concerned 9 ICUs located in teaching hospitals. To be included each ICU had to MV for more than 12 hours were included in the study and had a 28 day follow-up in the ICU or until hospital discharge. Collected parameters were indications of MV, modalities of MV and of weaning, complication and outcome at hospital discharge.

[Malignant hyperthermia].

Malignant hyperthermia is a potentially fatal pharmacogenetic disease triggered by volatile anesthetics and/or succinylcholine. Dysregulation of intracellular calcium homeostasis is the trigger of the acute crisis. Malignant hyperthermia crisis correspond to an hypermetabolic state, which occurred acutely and interesting skeletal muscular cell.