[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

[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

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

[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

Endoscopic thoracic sympatecomy for hyperhidrosis

Hyperhidrosis is a benin affection representing a social and professional problems and occupational handicaps in young patient. Endoscopic thoracic sympathectomy thus provides a radical treatment for severe palmar and axillary hyperhidrosis. We describe the technique used in our institut and present results. From 1995 to 2002, 32 patients were operated on for hyperhidrosis. There were 17 mens and 15 women raging in age from 15 to 32 years. The intervention consisting on destruction by eJectrocoaguJation to the sympathetic trunk. There was no major complication and the mean postoperative hospital stay was 2 days. The disappearance of the palmar sweating was immediately after operation. 7 patients complained of compensatory sweating. Endoscopic thoracic sympathectomy for hyperhidrosis is a safe effect technique for treating palmar and axillary hyperhidrosis. Compensatry sweeting represent the major that necessite a preable information

Facteurs associees a la mortalite maternelle chez les preeclamptiques: a propos de 55 cas

Retrospective study about 55 preeclamptic parurients. Data was collected from the medical files of the patients hospitalized during two consecutive years. Admittance of preeclamptic women in the intensive care unit was 6,37% [55/689]. Mortality rate was 11% [6 deaths]. Complications associated with the maternal death were renal failure, disseminated intravascular coagulopathy and Hemorrhagic shock after subcapsular liver hematoma. Advanced maternal age is a factor associated to maternal mortality. All these risk factors of deaths may be avoided if adequate management is performed

[Endobronchial hamartoma revealed by hemoptysis]

Hamartoma is the most frequent benign tumor of the lung. Its endo bronchial location is rare. We report two cases of endo bronchial hamartoma occurring in 2 men aged 68 and 60 years respectively. The two cases were revealed by hemoptysis. Bronchial fibroscopy showed a bud respectively in the left stump and in the lower left bronchus. Treatment consisted in a pneumonectomy and a lower lobectomy. A histological examination confirmed the diagnosis of endo bronchial hamartoma. Diagnosis of endobronchial hamartoma before surgery is difficult. Pulmonary resections are often necessary because of parenchyma lesions caused bronchial obstruction

[Pulmonary alveolar proteinosis in two siblings. A case report]

Pulmonary alveolar proteinosis [PAP] is a rare disorder in children. This report describes two siblings in whom PAP developed during infancy [three years for the boy and four years two months for the girl]. The girl was admitted for chronic respiratory distress. Chest x-ray showed a reticulonodular pattern. Her brother was asymptomatic. The diagnosis of PAP was confirmed by open lung biopsy for the boy and broncho-alveolar lavage for the girl. Therapeutic broncho-alveolar lavages were performed [six for the girl and two for the boy], the girl lost dependence on oxygen therapy. 6 years later, the brother is still asymptomatic. The sister had two episodes of respiratory distress, after two and four years, that required therapeutic lavages. The last therapeutic broncho-alveolar lavage was performed for the first time by a Tunisian team