High Levels of Cerebrospinal Fluid Kappa Free Light Chains Relate to IgM Intrathecal Synthesis and Might Have Prognostic Implications in Relapsing Multiple Sclerosis.

Cerebrospinal kappa free light chain (KFLC)-index is a marker of intrathecal immunoglobulin synthesis that aids in the diagnosis of multiple sclerosis (MS). However, little evidence exists on its prognostic role. Our aim is to analyze the relationship between KFLC-index and other MS biomarkers and to explore its prognostic role.

Humanitarian Surgical Missions in Times of COVID-19: Recommendations to Safely Return to a Sub-Saharan Africa Low-Resource Setting.

Background: Since the declaration of the pandemic, humanitarian medicine has been discontinued. Until now, there have been no general recommendations on how humanitarian surgical missions should be organized.

Methods: Based on our experience in the field of humanitarian surgical missions to Sub-Saharan Africa, a panel of recommendations in times of COVID-19 was developed.

Acute Cardiovascular Responses after a Single Bout of Blood Flow Restriction Training.

Different types of exercise might produce reductions in blood pressure (BP). One physiological mechanism that could explain the lowering adaptation effect on BP after an exercise program is an improved in baroreflex control of muscle sympathetic nerve activity. Consequently, exploring the different methods of training and their post-exercise hypotension (PEH) becomes of interest for healthcare providers.

The Usefulness of International Cooperation in the Repair of Inguinal Hernias in Sub-Saharan Africa.

Introduction: The burden of disease and mortality associated with inguinal hernia in Africa, especially in sub-Saharan Africa, is very high. The purpose of this study is to show that International Cooperation work in the field of hernia repair is effective; it minimizes the delay in hernia repairs in the targeted population, and can prevent a large number of disability-adjusted life years (DALYs).

Materials And Methods: As a part of an International Cooperation program, a total of 990 black patients with inguinal hernias were studied, in whom hernioplasty was performed using polypropylene mesh.

Surgical treatment of endemic goiter in a nonhospital setting without general anesthesia in Africa.

Background: Endemic goiter remains a serious public health problem and 75 % of people affected live in underdeveloped countries where treatment is difficult for various reasons. The aim of this article is to report our experience in African countries with the management and surgical treatment of endemic goiter, performed in a nonhospital setting and without general anesthesia in the context of a collaborative development project by experienced endocrine surgeons.

Methods: Fifty-six black African patients with a goiter were studied.

One or two types of death? Attitudes of health professionals towards brain death and donation after circulatory death in three countries.

This study examined health professionals' (HPs) experience, beliefs and attitudes towards brain death (BD) and two types of donation after circulatory death (DCD)--controlled and uncontrolled DCD. Five hundred and eighty-seven HPs likely to be involved in the process of organ procurement were interviewed in 14 hospitals with transplant programs in France, Spain and the US. Three potential donation scenarios--BD, uncontrolled DCD and controlled DCD--were presented to study subjects during individual face-to-face interviews.

[Ethical issues raised by 2 kinds of protocols for organ donation after cardiac death: aspects particular to France, Spain and the United States].

France, Spain and US are three leader countries in activity of organ procurement and transplantation. Donation after cardiac death is one of the strategies they have been implemented in order to face organ shortage. Donation after cardiac death is internationally considered to be an encouraging source of organs for transplantation both because of its capacity to significantly increase the donor pool and because of the quality of the organs obtained from non-heart-beating organ donors.

[Anaesthesic management of vaginal delivery in a parturient with C1 esterase deficiency].

Hereditary and acquired angioedema (HAE/AAE) are the clinical translation of a qualitative or a quantitative deficit of C1 esterase inhibitor (C1 INH). The frequency and severity of clinical manifestations vary greatly, ranging from a moderate swelling of the extremities to obstruction of upper airway. Anaesthesiologists and intensivists must be prepared to manage acute manifestations of this disease in case of life-threatening laryngeal edema.

Oral anticoagulant treatment: risk factors involved in 500 intracranial hemorrhages.

Intracranial bleeding is the most severe complication caused by anticoagulant or antiplatelet treatment. The increasing use of this therapy, especially in older people, makes the balance between clinical benefit and bleeding risk an important consideration. A retrospective study of all consecutive 500 intracranial hemorrhages in the West Valladolid area, approximately 220,000 people, during the period 1998 to 2004, was performed.

Hydrocephalus in intraspinal dermoids and dermal sinuses: the spectrum of an uncommon association in children.

Background: Hydrocephalus associated with intraspinal tumors constitutes a well-documented occurrence. The accepted mechanisms for this association seem to be well established. On the contrary, hydrocephalus in the context of intraspinal dermoids has been rarely recognized and its pathogenetic mechanism appears to be different.

[Organization of an operational site. Comparison of the durations of intervention planned and real].

Objective: To improve planning of our operational site by comparing the durations of intervention scheduled by the surgeons and the real durations of occupation of room of intervention, surgical procedure and surgical operation.

Study Design: Prospective study carried out of December 8, 2003 to February 27, 2004.

Patients And Methods: Anaesthetic and surgical times of the interventions of visceral and gynaecological surgery were raised.

[Syndromes of overdrainage of ventricular shunting in childhood hydrocephalus].

Overdrainage in ventricular shunting constitutes a difficult to prevent and to treat complication. The authors reviewed a retrospective series of 512 children submitted to a ventricular shunting procedure aimed at analysing factors influencing this type of complication. The causes for the hydrocephalus were congenital (n=172), post-myelomeningocele (n=123), posthemorrhagic (n=103), tumoral (n=64), postmeningitis (n=40) and posttraumatic (n=10).

Intraperitoneal application of bupivacaine plus morphine for pain relief after laparoscopic cholecystectomy.

Background And Objective: Intraperitoneal administration of a local anaesthetic in combination with an opioid, for the relief of postoperative pain, has already been reported except after laparoscopic cholecystectomy. This study was aimed at assessing the analgesic effect of the intraperitoneal administration of bupivacaine and morphine in patients undergoing laparoscopic cholecystectomy.

Methods: At the end of laparoscopic cholecystectomy, in a double-blind, randomized manner, one of the following injections was given intraperitoneally.

Efficacy of augmentation of epidural analgesia for Caesarean section.

Background: Extension of a labour epidural for Caesarean delivery is thought to be successful in most cases and avoids the use of general anaesthesia. However, most previous studies that have estimated the failure rate of pre-existing epidural catheters were performed in small numbers of patients.

Methods: Therefore, we undertook to retrospectively measure the failure rate of indwelling epidural catheters in a large number of patients.

Anesthetic technique and development of pneumocephalus after posterior fossa surgery in the sitting position.

Objective: Pneumocephalus is a well-known complication of surgical procedures performed with the patients placed in the sitting position. Its incidence and intensity were prospectively studied in 90 consecutive patients undergoing a posterior fossa procedure in this position. Various anesthetic agents, with different effects on cerebral hemodynamics, were used.

Lumbar spondylodiscitis caused by Propionibacterium acnes after epidural obstetric analgesia.

We report a case of Propionibacterium acnes spondylodiscitis after the placement of an epidural catheter for obstetric analgesia. This observation should alert the anesthesiologist to the fact that infection, although rare, may occur after uneventful epidural analgesia in the healthy parturient and reinforces the importance of aseptic technique during epidural catheter insertion.

Intravenous administration of propacetamol reduces morphine consumption after spinal fusion surgery.

We sought to determine the analgesic efficacy, opioid-sparing effects, and tolerability of propacetamol, an injectable prodrug of acetaminophen, in combination with morphine administered by patient-controlled analgesia (PCA) after spinal fusion surgery. Forty-two patients undergoing spinal stabilization surgery were randomized into two groups, which were given either an IV placebo or an IV injection of 2 g propacetamol every 6 h for 3 days after surgery. The postoperative opioid analgesic requirement was assessed with a PCA device used to self-administer morphine.

Rocuronium-induced neuromuscular blockade is affected by chronic phenytoin therapy.

Patients receiving chronic anticonvulsant therapy have been reported to show resistance to certain nondepolarizing neuromuscular blockers. In this study, the effects of chronic phenytoin therapy on the onset, duration, and recovery of rocuronium action was assessed. Thirty-six patients scheduled for various neurosurgical procedures were studied: 18 receiving chronic phenytoin therapy (Group I) and 18 controls (Group II).

Anesthesia for ruptured cerebral aneurysm surgery associated with chronic renal failure.

The management of patients with chronic renal failure (CRF) undergoing cerebral aneurysm surgery has been documented on only a few occasions. We report a 58-year-old man with CRF and subarachnoid hemorrhage (SAH) due to aneurysm rupture. We describe the patient's perioperative anesthetic management, discussing the current methods for maintaining an appropriate cerebral perfusion pressure and for preventing rehemorrhage from the aneurysm.