The t(8;9)(p22;p24) translocation in atypical chronic myeloid leukaemia yields a new PCM1-JAK2 fusion gene.

Several tyrosine kinase genes are involved in chromosomal translocations in chronic myeloproliferative disorders, but there are still uncharacterized translocations in some cases. We report two such cases corresponding to atypical chronic myeloid leukaemia with a t(8;9)(p22;p24) translocation. By fluorescence in situ hybridisation (FISH) on the corresponding metaphases with a bacterial artificial chromosome probe encompassing the janus kinase 2 (JAK2) gene at 9p24, we observed a split for both patients, suggesting that this gene was rearranged.

Pharmacokinetics of thiopental after single and multiple intravenous doses in critical care patients.

Thiopental was administered to neurosurgical patients for cerebral protection and its pharmacokinetic parameters were determined after a single bolus of 540, 1000 or 1500 mg (3 subjects) or after multiple doses of 250 mg (5 subjects) and 500 mg (2 subjects) every two hours for up to 7 days. The data were analysed by a two- or three-compartment model and linear kinetics. After a single iv bolus, the mean initial volume of distribution (V1) was 0.

Variability of thiopental clearance in routine critical care patients.

Thiopental was administered to neurosurgical patients as a drug for cerebral protection for up to 9 days either by continuous infusion (seven subjects) or repeated intravenous bolus (nine subjects). The efficient levels of thiopental measured at steady state ranged between 5 and 63 mg.l-1.

[Neurological pain].

Neurogenic pain is by definition linked to a lesion of the pain pathways at any level. There are many causes for the neurological pain which can be present in sympathetic disorders, in peripheral neuropathies and central nervous disorders too. In despite of these multiple aetiologies, the neurological pain is characterised by: demyelinisation at the anatomic lesion; a spontaneous firing described by the authors as related to three mechanisms, sensitivation, deafferentation and lost of inhibition; a common and specific clinical semiology very different indeed from the peripheral pain described as a surafferentation.

A comparative study of controlled-release morphine (CRM) suspension and CRM tablets in chronic cancer pain.

This study compared the efficacy and the adverse effects of controlled-release morphine (CRM) suspension (SAR 213) and CRM tablets (Moscontin) in the treatment of cancer pain. This multicenter, randomized, double-blind, double-dummy, crossover study was carried out on 52 patients. Each patient received both study treatments given at an equivalent dosage of morphine during each of two 7-day periods.

Hemodynamic effect of calcium channel blockade during anesthesia for coronary artery surgery.

Because the choice of anesthetic technique does not influence the incidence of perioperative myocardial ischemia, reduction of ischemic risk may require specific antianginal therapy. Calcium entry blockers are effective drugs in antianginal therapy. Diltiazem reduces myocardial oxygen demand through decreases in heart rate, inotropy, and systolic function, while increasing myocardial oxygen delivery through coronary vasodilation.

Mechanisms of renal hemodynamic impairment during infrarenal aortic cross-clamping.

Infrarenal aortic cross-clamping is associated with impairment of renal hemodynamics due to vasoconstriction, the mechanism of which remains under debate. To assess the renal effect of two potent renal vasodilators (enalapril, a converting enzyme inhibitor, and nicardipine, a calcium antagonist), 24 patients scheduled for reconstructive aortic surgery were randomly allocated to one of three treatment groups (n = 8 each) and received either a placebo, nicardipine, or enalapril. Anesthesia consisted of flunitrazepam, fentanyl, pancuronium, and, occasionally, droperidol.

Effects of halothane and isoflurane on transient renal dysfunction associated with infrarenal aortic cross-clamping.

Aortic cross-clamping for reconstructive aortic surgery is associated with impairment of renal function. Halothane or isoflurane was used to assess the influence of volatile anesthesia on renal hemodynamics during aortic surgery. Nineteen patients with normal preoperative creatinine clearances who were scheduled for reconstructive aortic surgery were randomly divided into two groups: halothane group (n = 9) and isoflurane group (n = 10).

Hemodynamic effects of anesthesia in patients chronically treated with angiotensin-converting enzyme inhibitors.

Angiotensin-converting enzyme inhibitors (ACEIs) are increasingly used in the treatment of cardiovascular disease, but recent reports have warned of some hemodynamic risk (hypotension and bradycardia) when associated with anesthesia. To assess the hemodynamic effects of induction of anesthesia in patients chronically treated with ACEIs, 16 hypertensive patients scheduled for coronary artery bypass graft surgery (n = 12) or vascular surgery (n = 4) were studied. Eight of them were chronically treated (for at least 1 mo) with ACEIs (ACEI group), and the remaining eight (control group) were treated with other classes of antihypertensive drugs.

Myocardial depressant effect of nitrous oxide after coronary artery bypass graft surgery.

We have studied the cardiovascular effects of nitrous oxide after cardiac ischaemia-reperfusion injury caused by aortic cross-clamping and unclamping during coronary artery bypass grafting (CABG). At the time of chest closure, 20 patients were allocated randomly to receive oxygen and air (FIO2 = 0.5) or 50% nitrous oxide in oxygen in addition to anaesthesia with fentanyl.

Does choice of the anesthetic influence renal function during infrarenal aortic surgery?

Reconstructive infrarenal aortic surgery is associated with impairment of renal function owing to vasoconstriction during and after aortic cross-clamping. To assess the influence of anesthetic technique on renal hemodynamics during aortic surgery, 34 patients received one of four anesthetics: isoflurane (n = 10), halothane (n = 9), droperidol (n = 8), and flunitrazepam (n = 7). Supplemental anesthesia consisted of midazolam, fentanyl, nitrous oxide in oxygen (50%), and pancuronium.

[Comparison of the effects of epsilon-aminocaproic acid and aprotinin on intra- and postoperative bleeding in heart surgery].

Excessive bleeding during and after cardiac surgery with cardiopulmonary bypass is a real problem in this kind of surgery. The use of prophylactic high doses of aprotinin (APROT) reduces blood loss in this context but this treatment is expensive. Some investigators have advocated that epsilon-aminocaproic acid (EACA), a cheaper antifibrinolytic drug, could reduce blood loss in cardiac surgery.

[Vascular effects of adenosine-triphosphate].

This study assessed the effects of adenosine triphosphate (ATP) on systemic vascular resistances during the hypothermic cardiopulmonary bypass phase of cardiac surgery. Twenty patients scheduled for cardiac surgery were randomly divided into an ATP group (n = 10), and a placebo group (n = 10). Anaesthesia was similar for all the patients (diazepam, fentanyl and pancuronium).

[The use of opioids by the regional route in the treatment of pain].

The decision to administer regional opioids either by an epidural or a subarachnoid route (intrathecal or intraventricular) necessitates a prior multiparametric analysis. When opiate therapy is definitively indicated regional opiate administration usually relays an insufficient or poorly tolerated oral route. The epidural route seems to be the best way for transient indications; the choice of the opioid drug then depends on the local or disseminated character of pain.

[Pre- and postoperative antihypertensive treatment with calcium antagonist in pheochromocytoma].

Medical preparation for pheochromocytoma surgery requires adrenergic blockade and restoration of euvolemia. Usually, this preoperative preparation consisted essentially of sequential and progressive adrenergic antagonism, alpha then beta blockade. This therapy is not easy to introduce and exposes to blood pressure collapses after tumor removal.

[Value of etomidate for the temporary clamping in early surgery, in normotension, of ruptured intracranial aneurysms. Preliminary study of 8 cases].

For 8 cases of aneurysmal ruptures in patients between twenty two and sixty-six years old, with clinical grade I or II, without diabetes neither high blood pressure, all of them underwent before the third day, with EEG monitoring, the surgical technic requires a temporary clipping of the carrying vessel (extreme times: 2 min 30 and 16 min), with a normal mean blood pressure. mean (ASBP) The circulatory cerebral brain protection is obtained with vascular filling before the clipping time and administration of Etomidate, (0.4 mg.

Effect of angiotensin converting enzyme inhibition on blood pressure and renal function during open heart surgery.

Activation of the renin-angiotensin system during open heart surgery may have consequences both beneficial in sustaining blood pressure and deleterious in compromising renal hemodynamics. The influence of short-term pretreatment with captopril on blood pressure and renal function was assessed double-blind versus placebo in 18 patients without pre-existing cardiac or renal failure, and undergoing coronary artery bypass. No difference in blood pressure and fluid requirement during the surgical period was observed between groups receiving captopril or placebo.

[Posterior spinal cord neurostimulation in lumbar radiculitis pain. Apropos of 14 cases].

In 14 patients, spinal cord stimulation in lumbar radiculopathy follow multiple exploration or iterative surgery. For 10 out of this 14 patients treatment was successful; pain relief lasted a mean time of 12.7 months in 9 out of them.

Effect of preoperative renin-angiotensin system blockade on hypertension following coronary surgery.

Renin-angiotensin system activation is suspected of being involved in postcoronary surgery hypertension, but appears to be useful in maintaining blood pressure during anesthesia and cardiopulmonary bypass. To clarify these points, 19 patients were compared: ten as a control group and nine who received captopril during two days before surgery. Anesthesia was the same for the two groups, and cardiopulmonary bypass ensured nonpulsatile flow rates.