Optimization of cerebral oxygenation based on regional cerebral oxygen saturation monitoring during carotid endarterectomy: a Phase III multicenter, double-blind randomized controlled trial.

Background: Whether the optimization of cerebral oxygenation based on regional cerebral oxygen saturation (rSO) monitoring reduces the occurrence of cerebral ischemic lesions is unknown.

Methods: This multicenter, randomized, controlled trial recruited adults admitted for scheduled carotid endarterectomy. Patients were randomized between the standard of care or optimization of cerebral oxygenation based on rSO monitoring using near-infrared spectroscopy.

Evaluation of the impact of HMS Plus on postoperative blood loss compared with ACT Plus in cardiac surgery.

Background: The standardized management of anticoagulation during the cardiopulmonary bypass seems inaccurate because of patients and surgeries variability. This study evaluates if an individualized management of heparin and protamine guided by the HMS Plus system during cardiopulmonary bypass could reduce postoperative blood loss.

Methods: We conducted a prospective, controlled, unblinded, single-center study.

Predictive Factors of Silent Brain Infarcts after Asymptomatic Carotid Endarterectomy.

Background: The optimization of medical treatment regularly challenges the role of carotid surgery for asymptomatic patients. Current research seeks to determine which of these patients will benefit most from surgery. The goal of this study was to identify in a multicenter study, using magnetic resonance imaging (MRI), the risk factors for postoperative silent cerebral ischemic lesions after carotid surgery for asymptomatic stenosis.

Evaluation by Magnetic Resonance Imaging of Silent Brain Infarcts in Preoperative and Postoperative Asymptomatic Carotid Surgery.

Background: To report the prevalence of silent brain infarcts (SBI) at magnetic resonance imaging (MRI) before and after surgery for asymptomatic high grade carotid stenosis.

Methods: This is a single center retrospective observational study. Asymptomatic patients who underwent carotid endarterectomy between October 2012 and October 2014 were included.

[Epidemiology of cerebral perioperative vascular accidents].

Objectives: Stroke is a well-described postoperative complication, after carotid and cardiac surgery. On the contrary, few studies are available concerning postoperative stroke in general non-cardiac non-carotid surgery. The high morbid-mortality of stroke justifies an extended analysis of recent literature.

[Use of heparin and platelet GPIIbIIIa inhibitor tirofiban for cardiac surgery in patients for suspicion of heparin-induced thrombocytopenia].

In a patient with heparin-induced thrombocytopenia few antithrombotic alternate treatments are proposed for cardiac surgery with or without cardiopulmonary bypass: danaparoid, lepirudine or powerful antiplatelet agent. Recently, the platelet GPIIbIIIa antagonist tirofiban (Aggrastat) was tested in humans. We reported two cases of patients operated upon for cardiac surgery with unfractionnated heparin (UFH) and tirofiban.

[Body mass index and albuminemia in patients under mechanical circulatory assistance before cardiac transplantation].

Objective: To evaluate the prognostic influence of peri-implantation nutritional status of patients under mechanical circulatory assist (MCA) prior to cardiac transplantation (CT).

Study Design: Retrospective analysis of patients with cardiogenic shock included from June 1997 to December 2002.

Patients And Methods: Evaluation at MCA's implantation, at day (D) 30 and at CT or patient's death (D) of body mass index (BMI=body weight (kg)/size (m(2)), albuminemia (Alb g/l), expressed as median values (med) and range (min-max).

Postoperative analgesia by epidural methylprednisolone after posterolateral thoracotomy.

The aim of this study was to evaluate the potential analgesic effect of epidural methylprednisolone (MP) after posterolateral thoracotomy (PLT). Adult male patients undergoing PLT for lung surgery were included in a prospective, randomized, double blind study. Peroperative analgesia (bupivacaine plus sufentanil) was given by a thoracic epidural catheter associated with general anaesthesia.

Transesophageal echocardiography diagnosis of tricuspid obstruction by a vena cava tumour.

Purpose: To present the anesthetic management for excision of a primary tumour of the inferior vena cava.

Clinical Features: Resection of a primary tumour of the inferior vena cava without extension to the right atrium was scheduled without extra-corporeal circulation (ECC). The operation consisted of tumour excision with transtumoral clamping.

[The use of propofol does not increase the cost of the management of patients in heart surgery with extracorporeal circulation].

Objectives: Evaluation of the cost of propofol used for fast-track in cardiac surgery and its impact on global cost of management for anaesthesia and intensive care.

Study Design: Case-control study, prospective (1998) and retrospective (1994).

Patients: Twenty patients operated for cardiac surgery in 1998 and scheduled for fast-track anaesthesia.

Early and late outcome after elective cardiac surgery in patients with cirrhosis.

Background: A prospective study was performed to evaluate the early and late outcome after elective cardiac surgery in patients with cirrhosis.

Methods: All patients who underwent elective cardiac surgery between 1995 and 1997, and were suspected of having a history of cirrhosis, were followed in the intensive care unit (ICU), during hospitalization and after hospital discharge. All patients received high doses of aprotinin during surgery.

[Severe acute asthma in adults in black Africa].

A prospective study has been conducted in an intensive care unit of West Africa in order to determine the clinical and laboratory features of severe acute asthma in black Africans. The study concerned 55 episodes of severe acute asthma, with PaCO2 above 45 mmHg, in 42 patients (26 men and 16 women, mean age 35 +/- 3 years). A triggering factor was found in only 36 percent of the cases.

[Severe malaria in Black Africa].

Severe and complicated malaria is a fatal from a human Plasmodium falciparum infection. In clinical practice cerebral malaria in children, with unrousable coma, hyperthermia, generalized convulsions, frequently hypoglycemia, is different of severe in non immunized adults resulting in multiple organ failure with degree of impaired consciousness less important. Specific treatment requires quinine with loading dose: 16.