Rotator cuff injuries in the contact athlete.

Rotator cuff injuries in contact athletes are typically a result of a different mechanism than that seen with older patients or overhead athletes. This unique mechanism along with the extreme demands of these athletes presents special challenges to the surgeon. Special consideration should be given to in-season rehabilitation to allow the athlete to continue to compete if possible.

[Gas embolism and flexible Ecoflac type bag].

Gas embolism at the end of infusion is a well known hazard, that should have disappeared with the use of flexible bags. However, some cases have been reported after pressure infusion. This experimental study evaluates the risk for gas embolism with Ecoflac type flexible bags.

[French and foreign recommendations for the practice of anesthesia-intensive care].

Unlabelled: This article reviews the development of STANDARDS, Recommendations and Guidelines for practice in anaesthesiology in France and other countries. The French society for anaesthesia and intensive care (Sfar) has published, since 1989, 11 basic

Standards: 1) Recommendations for the monitoring of patients during anaesthesia (June 1989, amended on January 1994) [APSF Newsletter, Summer 1990, page 22]; 2) Recommendations for postanaesthesia monitoring and care (September 1990); 3) Recommendations for preanaesthesia care (September 1991); 4) Recommendations for anaesthetic apparatus and checking before use (January 1994); 5) Recommendations for the equipment of anaesthesia working places (January 1995); 6) Recommendations for the tasks of the nurse anaesthetist (January 1995); 7) Recommendations for hygiene standards in anaesthesia practice (December 1997); 8) Recommendations for outpatient anaesthesia (September 1990); 9) Recommendations for the practice of obstetrical analgesia (September 1992); 10) Recommendations for interhospital physician-accompanied transfers (December 1992); 11) Recommendations for intrahospital physician-accompanied transfers (February 1994). Additionally the Sfar produced or coproduced 9 Experts' conferences, 15 Consensus conferences and 5 Guidelines for clinical practice.

[Intraoperative ventilatory obstruction by twisting of a reusable coiled expiratory breathing tube].

A case of intraoperative subtotal obstruction of a reusable coiled expiratory breathing tube is reported. Partial occlusion by twisting was made possible by detachment of the coil from the external face of the tube after multiple reprocessings with high drying temperatures. A technique for tube checking before reuse is described.

[The "impact factor" of anesthesia and intensive care journals].

The "impact factor" (IF) of scientific journals is defined as the number of citations obtained over a one-year period of articles published during the two previous years in a journal, divided by the number of articles published in that journal during the preceding two years. The IF, initially devised as an indicator of the quality of a journal, is at present mainly considered as an indicator of the quality of an article contained in that journal. However the IF of a journal is not equivalent to the actual impact of an article.

[Anesthetic equipment: fresh gas delivery systems. II. Electronic systems].

Objectives: To analyse the design, functioning, benefits and drawbacks of electronic fresh gas delivery units (FGDUs) included in anaesthetic machines marketed in France in 1999.

Data Sources: Articles were obtained from a Medline review (1980-1999; search terms: anaesthetic machine, flowmeter, vaporizer), textbooks and personal files; specific data were also provided by manufacturers.

Study Selection And Data Extraction: The articles were analysed in considering the differences between mechanical and electronic FGDUs.

[Anesthesia equipment: fresh gas delivery systems. I. Mecanical systems with rotameters and calibrated vaporizers].

Objectives: To analyse the design, performance, failures, the checking before use of mechanical fresh gas delivery units (FGDUs) equipped with bobbin or ball-flowmeters delivering a continuous gas flow and calibrated vaporizers, marketed in France in 1999.

Data Sources: Articles were obtained from a Medline review (1960-1999; search terms: anaesthetic machine, flowmeter, vaporizer), textbooks and personal files; specific data were provided by manufacturers.

Study Selection And Data Extraction: The articles were considered for performance data, benefits and drawbacks, and characteristics, as well as the risks carried by mechanical FGDUs.

[Accessory anesthetic breathing systems: verification before use].

Accessory or ancillary anaesthesia breathing systems can be defined as all those connected to the fresh gas outlet of the anaesthetic apparatus and used instead of the circle system associated with the ventilator, which is the main circuit. They include: the Mapleson systems, the systems with a nonrebreathing valve and the disposable systems with a carbon dioxide absorber. They can be a cause of major accidents when not checked before and monitored during use.

Early assessment of transplanted liver function: lignocaine clearance test (MEGX).

The purpose of this study was to assess the value of lignocaine biotransformation into monoethylglycinexylidide (MEGX) and conventional liver function tests in the early post-operative period as an indicator of graft function and as a diagnostic tool for complications after hepatic transplantation. Monoethylglycinexylidide formation, plasma bilirubin, aspartate aminotransferase (ASAT), alanine aminotransferase (ALAT), factor V index (FVI) and prothrombin time index (PTI) were measured in 71 patients undergoing 80 liver transplantations respectively at 12 (T1), 24 (T2), 48 (T3) and 72 h (T4) after liver graft revascularization. Patients were divided into two group according to the post-operative outcome.

[Anesthesia ventilators].

Objective: To review anaesthesia ventilators in current use in France by categories of ventilators.

Data Sources: References were obtained from computerized bibliographic search. (Medline), recent review articles, the library of the service and personal files.

[Defective gas mixers, a cause of retro-pollution of medical gas distribution pipelines].

A defective Air/O2 mixer of a ventilator located downstream of the gas outlets of two pipelines is a potential cause of retropollution. Retropollution of O2 with Air or vice versa carries a risk of either a) a hypoxic gas mixture delivery during anaesthesia, including O2-N2O administration, when the O2 pipeline supplies Air instead of O2, or b) a hyperoxic gas mixture delivery in the intensive therapy unit for neonates during administration of a O2-Air mixture, when the Air pipeline supplies O2 instead of Air. A defective O2/N2O flowmeter-mixer of an anaesthesia machine, with N2O flow control by O2 through a differential pressure manometer, can cause retropollution of O2 supply pipeline with N2O or vice versa.

[Ventilators for anesthesia. Models available in France. Criteria for choice].

This update article discusses the criteria for the choice of an anaesthetic machine and provides a short analysis of the main components of the models commercialized in France in 1994. The following items are considered: the design of the machine, the fresh gas delivery system, the anaesthesia breathing system(s), the ventilator and the waste gas scavenging system, the monitors associated with the machine and other criteria such as facility of learning to run the machine and of its daily use, ease of "in-house" maintenance and quality of after-sales service, cost of the machine and of its use (driving gas, disposable equipment).

Predictive factors of hyperfibrinolytic activity during liver transplantation in cirrhotic patients.

Hyperfibrinolytic activity occurs frequently during liver transplantation in cirrhotic patients. In order to identify those patients at high risk for increased intraoperative blood loss before operation, we determined predictive indicators of hyperfibrinolysis. We studied 56 cirrhotic patients undergoing liver transplantation with the same anaesthetic procedure and transfusion regimen.

[Arguments for the addition of an oxygen reserve container to the anesthetic equipment].

In France, the presence of an emergency oxygen cylinder as part of every the anaesthetic machine is not made compulsory by an official regulation. This article provides arguments in favour of such a presence, as recommended by the French Society of Anaesthesia and Intensive care (SFAR).

[Pollution and retro-pollution by the distribution system of medical gases].

The anaesthetic machine, the recovery room or the ICU ventilator as well as any other simple oxygenation device can be accidentally supplied with a "wrong" gas, or a mixture of "wrong" and "true" gases, or a gas containing chemical impurities, as a result of one of the following causes: a) the source of the medical gas pipeline supply contains a "wrong" gas or impurities; b) the gas pipeline is polluted by a "wrong" gas or solvents, introduced during the installation or maintenance of the pipeline; c) the pipeline is polluted by a wrong gas at a point of inter-connection or cross-connection of two pipelines; d) supply of a "wrong" gas through wrong quick couplers connected to the pipeline; e) back flow of a gas in another pipeline supply through a defective gas mixer, which is today the most common cause of pipeline contamination or retropollution. It occurs with some types of mixers in case of absence or malfunction of non-return valves, associated with a pressure difference between the two gas lines. The means of prevention, recognition and emergency treatment of these events include: a) systematic removal of mixers and flowmeter-mixers from supplies when not in use; b) periodical checking of these devices for an accidental communication between the gases to be mixed; c) systematic use of an oxygen analyser for a continuous measurement of FIO2, especially when the machine is connected to the N2O pipeline supply; d) the presence of a reserve cylinder of oxygen connected to every anaesthetic machine.

Concentrations in plasma and tissue penetration of ceftriaxone and ornidazole during liver transplantation.

Plasma and epiploic fat drug concentrations and fat penetration of ceftriaxone and ornidazole given for antimicrobial prophylaxis were studied in 11 patients scheduled for liver transplantation. Ceftriaxone (1 g) and ornidazole (500 mg) were infused during 30 min after the induction of anesthesia. Arterial blood and epiploic fat samples were collected at 30, 60, and 120 min and then every 90 min following the end of the infusion until closure of the peritoneum.