Brachial plexus block and upper limb regional anesthesia

The authors report their experience about 50 cases of supra clavicular plexus block realised by Kulen-Kampff method. The anesthesia obtained has been complete in 84% of cases and in the 16% remaining general anaesthesia was necessery to permit surgery. A case of moderate pleural detachment lately and a case of post anaesthesia paresthesia both spontaneously resolvent were registered. Actualy the adoption of perivascular techniques of brachial plexus anaesthesia [interscalenic, supraclavicular, axillary] have greatly improved the performance of this variety of upper limb locoregional anaesthesia, thus reducing the percentage of failure and eliminating or reducing the risk of pneumo-thorax. Locoregional anaesthesia of the upper limb should constitute a daily method in the surgery of upper limb and not a technic subordinated to the contra-indications of general anaesthesia

injury severity score: a prognosis index in multiple injuries patients. 400 cases report

For the early, objective and quantitative evaluation of prognostic in multiple injuries patients, the authors would like to introduce in their current practice the injury severity score [ISS]. This clinical score is based on the abbreviated injury scale [AIS] witch divide the human body into four parts: head, face, trunk and limbs. Mean ISS equal 35.8 while mortality rate reach 52%. The matter of fact is that mortality is proportional to ISS rise: when the ISS is between 30 and 40, mortality reach 50%; when ISS is lower, prognostic improve, but when it exceed 50, prognosis is awfull. For a best evaluation of prognossis of polytraumatised, the authors propose to group head and face injuries in a same column of cotation and to divide trunkular injuries into chest and abdominal injuries

[ treatment of acido-ketosis by small intramuscular doses of insulin]

The authors have examined 90 cases of acido-ketosis treated either by a discontinous insulin treatment with high indirect intravenous doses or small intramuscular doses, or by continuous perfusion of small doses of ordinary insulin. It is a fact that the best results on the duration of the ketosis as well as on the glycemia decrease, or on the full dose of insulin have been obtained by the continuous perfusion of insulin which was considered as a major disadvantage in the University hospitals of Morocco for many reasons: affected equipment, high cost, qualification of the medical personnel, intensive supervision. On the other hand, the intramuscular way is the way of the future in our country, first for its very good results barely inferior to the continuous perfusion, its harmlessness, its simplicity of execution and small cost. Furthermore it requires neither specialized services to the utmost, nor very qualified personnel

effect of dopamine on the renal function of shocked patients. About two observations

Two patients, representing a shock and an oligo-anuric renal insufficiency have been treated with 2.5 to 7.5 mcg/kg of dopamine. The result was a resuming of diuresis, a normalization of the hemodynamic situation with a normal heart beat rate and without any anomaly of the auriculo-ventricular conduction. This study emphasizes the effect of dopamine on the renal function during hemodynamic failures complicated with oligo-anuria

Hypomagnesemia. A danger present everyday. About 2 observations

Two cases of major hypomagnesemia were diagnosed following prolonged parenteral nutrition. The parenteral nutrients had not included this trace element because it is not locally available. The authors stress its importance and the necessity to include it in the Moroccoan therapeutic arsenal