Epicardial cavernous hemangioma: a two-case report

We report two-cases of cavernous hemangiomas arising from the epicardium in two women aged respectively 24 and 79 years old. The first patient was symptomatic and presented with palpitations. The second patient was referred after a random discovery at echocardiography. Chest CT and MRI were performed in the two cases and showed a mass located in the pericardial cavity. Coronary CT was necessary in the first case to ascertain the degree of coronary artery involvement. Both of our patients underwent surgical resection under cardiopulmonary bypass with an uneventful postoperative course for the first case. The second one, died postoperatively from pneumonia. Cardiac cavernous hemangiomas, although rare and well tolerated require prompt management and surgery at discovery to avoid further complications which may put at risk the patient's life prognosis

[Meningitis after spinal anesthesia [cases reports and litterature review]]

Meningitis is a rare complication after spinal anesthesia. We report 4 cases of meningitis occurred after spinal anesthesia. These meningitis were diagnosed during tow months and with 3 different operators. The first symptoms appeared 4 to 6 hours after surgery and were represented especially by headaches and fever. Cyto-chimic analysis of cerebrospinal fluid [CSF] indicates bacterial meningitis but soluble antigens and culture were negative. Evolution was favorable in all cases under or without antibiotics. The exactly cause of these meningitis remained unknown and an insufficient asepsis was the principle risk factor found in all cases. Prevention of this risk consists on hygienic rules and perfect skin disinfection

[Beating heart coronary artery bypass:100 case]

Coronary artery revascularization with cardiopulmonary bypass has been reported to carry several risks. Off-pump coronary artery bypass grafting has been proposed to result in a better outcome. The aim of this study is to assess the effect of off-pump cardiopulmonary bypass. In a 7-year period, a total of 100 patients undergoing isolated first-time off-pump coronary artery bypass graft were studied. The mean ejection fractions was 48% and the EUROSCORE mean was 4.9. The average number of grafts was 1.55 per patient. The postoperative outcomes were simple for most patients with little use of inotropes after 24 hours [42%], few cases of atrial fibrillation [9.4%], and transfusion [27.3%]. Time to extubation was less than 48 hours in most cases [94.7%] and hospital mortality rate was 10.5%.The beating heart bypass surgery allows good immediate results including multi-vessel disease and in patients at high risk

[Evaluation of a protocol of spinal anesthesia for Cesarean in Tunisian maternity: hemodynamic repercussions and risk factors of hypotension]

To evaluate hemodynamic repercussion of a protocol of spinal anesthesia [SA] for cesarean and release the predictive factors of maternal arterial hypotension post spinal anesthesia. We included parturients proposed for Cesarean under SA. They were not included the women of statute ASA > II, preeclamptics, eclamptics and/or having counter-indications of SA. We excluded the cases where there were technical difficulties at the time of the realization of SA, a failure or a complication of this SA. We injected 10 Mg of bupivacaïne 0.5% isobar, 10 micro g of fentanyl and 100 micro g of morphine. The data were collected before the realization of SA [anthropometric parameters; antecedents; basic systolic and diastolic blood pressures [BSBP and DSBP] and basic heart rate [BHR]] and after SA [systolic and diastolic blood pressure [SBP and DBP], heart rate [HR]; occurred or not of a sympathetic block [falls of the SBP of more than 20% of its basic value or a SBP<90 mm Hg]; the time of installation of the sympathetic block and the duration of hypotension. The full number of parturients included was 1016 among whom 16 were excluded. Only 1000 parturients finished the study and were divided into 2 groups [group 1: 500 emergency cesarean and group 2: 500 elective cesarean]. The incidence of the sympathetic block was of 44.2% as a whole and this block was significantly more frequent in group 2 [p=0.0001]. There was a significant relation between the incidence of a sympathetic block and the advanced age of the parturient [p=0.0001], the important weight [p=0.047], high ASA statute [p=0.0001], the presence of hypertension [p=0.0001], diabetes [p=0.001] or cesarean [p=0.00015] in the antecedents and the low BSBP [p=0.015]. In spite of the beneficial effect of the reduction in the amounts of local anesthetic in the SA, the sympathetic block remains frequent after SA for Cesarean. Thus, it is essential to detect the high risk women of occurred of sympathetic block after SA, and to propose strategies of prevention, monitoring and management for this population

[N-acetylcysteine in septic shock]

To focus on the various studies evaluating the effects of Nacetylcysteine in septic shock. Main references obtained from the medical database Medline using the keywords: N-acetylcysteine; septic shock, free radicals. Septic shock remains the leading cause of mortality in intensive care units. The progressive knowledge of the pathophysiology of septic shock, underline the production of free radicals and their cellular and microcirculatory effects. The Nacetylcysteine used mainly in paracetamol poisoning, has properties to control free radicals. The explosion of free radicals in septic shock has led to multiple studies assessing the role of N-acetylcysteine as an anti radical, and for its anti inflammatory action. NAC seems to play an important role in septic shock to control free radicals and the inflammatory response. But these results remain contradictory. Some larger and more standardized studies should allow to evaluate the actual effects of NAC in septic shock

[ prophylaxis of the thromboembolic disease in the head trauma]

The prophylaxis of the thromboembolic disease in the severe head trauma remains a controversy. In this study, we are interested to the determination of under groups of patients for whom the advantages of the prophylaxis of the thromboembolic disease [TED] are higher than its disadvantages. We proceeded to a retrospective study based on patient medical records ranging from March 2003 until March 2004, enrolling 56 consecutive patients. The data collected related to the age, the gender, past medical history, the type of trauma, results of age, the gender, past medical history, the type of trauma, results of the initial CT scan, the treatment, appearance or not of the thromboembolic disease and its prophylaxis therapy. The average age was of 36 +/- 19 years. 76.8% did not have significant past medical history. All the patients profited from an elastic compression stocking. The LMWH were used among 15 patients victim of severe head trauma associated with other injuries and 72 hours after stabilization of hemorrhagic attacks. A thromboembolic disease diagnosis was based clinical or biological assumptions. Among 56 patients, 4 of them showed a TED with an incidence of 7.1 including 3 DVT and one case of pulmonary embolism. The 4 patients sustain severe multiple trauma; 3 of them received an early anti-coagulation therapy. In the group of patients with TED, the OMEGA scores and IGS are high; all of them are multiple traumatized patients with shock requiring a blood transfusion in 75 of the cases. Only the blood transfusion is correlated at the risk of TED, statistically established. The risk to develop a thromboembolic complication in the traumatic patients with head injury is high particularly in case of associated muscleskeletal injuries. Elastic compression technique is not always effective but considered as an interesting alternative to the pharmacological prevention of thrombosis. The use of the anticoagulants therapy must be careful. It is contra-indicated in case of cerebral haemorrhage in progress and must be considered upon individual case of each patient

[Iatrogenic gas embolism after use of hydrogen peroxide in the treatment of lung hydatid cyst: a report of 2 cases]

Echinococcus disease in endemic in our country. Surgical resection of the hydatid cyst with the use of a protoscolicidal solution in the operative field remains the standard treatment. The degradation of hydrogen peroxide results in considerable amounts of gaseous oxygen witch has proven protoscolicidal properties. This gas can enter the circulation and determine sever embolism. We report two cases of severe oxygen embolism with neurological signs during surgical treatment of thoracic hydatid cysts. We report 2 cases of embolic events with neurological signs. The first, during a pleural cleaning with hydrogen peroxide after cystectomy of a pulmonary hydatic cyst at the right upper lobe. The second case, after a pleural washing during the treatment of hepatitic hydatidosis complicated by a ruptured cyst in the thorax. The most important diagnostic criterion is the patient's history, because the clinical suspicion of embolism is based on the initial neurologic or cardio-respiratory symptoms and the direct relation between these symptoms and the use of hydrogen peroxide and imposes appropriate treatment before further examination including brain imaging. The treatment with hyperbaric oxygen in the first line treatment, thus, transfer to a hyperbaric oxygen facility should be accomplished without delay. The possibility of such serious complication leads us to use hydrogen peroxide with great care or to use other protoscolicidal solutions

Combined use of crystalloid preload and low dose spinal anesthesia for preventing hypotension in spinal anesthesia for cesarean delivery: a randomized controlled trial

Spinal anaesthesia for caesarean section is commonly associated with hypotension and crystalloid preload is widely recommended. Low-dose spinal appears to cause less hypotension. The aim of this study was to investigate whether the combined use of crystalloid preload and low dose spinal anaesthesia might further reduce the rates of hypotension. Sixty-two patients were randomly assigned to two groups: crystalloid preload anaesthesia [P]: received a rapid infusion of 20 mL/kg lactated Ringer's solution [LR], and no preload anaesthesia [N]. The incidence of hypotension and the amount of ephedrine used to treat it were compared. Spinal anaesthesia was performed with 0.5% isobaric bupivacaine 7.5 mg and fentanyl 10 micro g and morphine 100 micro g. The incidence of hypotension was similar in the P and N groups. Same doses of ephedrine were required to treat hypotension in the two groups. Crystalloid preload combined with low-dose spinal anaesthesia do not reduce the incidence of hypotension nor its severity

Reduction of bupivacaine dose in spinal anaesthesia for caesarean section may improve maternal satisfaction by reducing incidence of low blood pressure episodes

Spinal anaesthesia for caesarean section exposes to high incidence of arterial hypotension which can result in maternal and neonatal morbidity. We hypothesized that the reduction of this dose from 10 mg to 7.5 mg would minimize hypotension without altering pain relief. In this double-blind prospective study, 80 ASA1 women scheduled for elective caesarean section were randomized into two groups A and B receiving respectively 10 and 7.5 mg of isobaric bupivacaine both with 25 micro g of fentanyl and 100 micro g of morphine in spinal anaesthesia. Intravenous ephedrine was administered for each episode of hypotension. We recorded sensory and motor block, intraoperative pain, nausea and vomiting. In postanaesthesia care unit, sensory and motor recoveries were measured and maternal satisfaction rate was assessed. In group A, a larger dose of ephedrine was needed [32 +/- 23 vs 19 +/- 16 mg; p=0.004]. Incidence of sensory block above T4 [52 vs 10%; p<0.001], nausea [52 vs 22%; p=0.005] and vomiting [25 vs 8%; p=0.03] were all higher than in group B. Arterial hypotension was less frequent in group B [68 vs 88%; p=0.03]. The time required for recovery to T10 sensory level and motor regression were shorter than in group A [p<0.001] and the satisfaction rate was higher than in group A [excellent and good in 90% vs 67%; p=0.03]. There was no difference in pain relief. A dose of 7.5 mg of isobaric bupivacaine reduced incidence of hypotension, nausea and vomiting and improved patient satisfaction