[Evaluation of postoperative analgesia with continuous iliofascial nerve sheath block after total hip arthroplasty replacement: a pilot study]. / Evaluation de l'analgésie postopératoire par bloc continu iliofascial après chirurgie pour remplacement de prothèse totale de hanche: étude pilote.

OBJECTIVE: To assess the analgesic efficiency of a continuous iliofascial nerve sheath block after total hip arthroplasty replacement (RPTH). STUDY DESIGN: open and prospective pilot study. PATIENTS AND METHODS: Before induction of general anaesthesia (GA), an iliofascial catheter was inserted (group KT, n = 11) or not (group NKT, n = 10). In the KT group, 30 ml of ropivacaïne 4,75 mg/ml (maximum dose) were injected, and 14 mg/h of ropivacaïne 2 mg/ml were infused during the first 48 postoperative hours. All patients underwent a standardized GA and a multimodal postoperative analgesia with a intravenous PCA morphine, paracetamol and tramadol during the first 48 hours. Postoperative pain assessment which was achieved using visual analogic scores (VAS) at rest (EVAr) and on movement (EVAm), total morphine consumption, and side effects were collected during the first 48 hours. Statistical analysis was performed using a Mann and Whitney test for the quantitative values and a chi 2 exact test for the qualitative values. Data are expressed as median [interquartile range]. RESULTS: Total morphine consumption was lower in the KT group with a total amount of 26 mg [11-48] versus 77.5 mg [55-91] (p = 0.007) at h48. EVAr and EVAm were lower in the KT group at h4, h8, h24, h36 for the EVAr and during the 48 postoperative hours for EVAm. Three patients experienced nausea and/or vomiting in the KT group versus 6 in the NKT group (p = 0.05). CONCLUSION: After RPTH surgery, continuous iliofascial block reduces morphine consumption; provide a better pain relief at rest and on movement than IV multimodal analgesia alone.

Delayed implantation. A case report.

In cycles in which conception takes place, serum human chorionic gonadotropin (hCG) becomes detectable between 8 and 12 days after ovulation. A delayed appearance of hCG has been reported in a limited number of cases, most of them ending in spontaneous abortion. We encountered a case of ectopic pregnancy characterized by a delayed appearance of hCG and accompanied by a complete, albeit temporary, halt in the steroidogenic activity of the corpus luteum. Although the patient was at risk of developing an ectopic pregnancy, the findings made an early diagnosis extremely difficult.

Predictive value of early embryonic cardiac activity for pregnancy outcome.

The biologic variation of the embryonic heart rate was investigated by transvaginal ultrasonography during the first trimester of normal (n = 141) and abnormal (n = 29) pregnancies, and the predictive value of a repeatedly diagnosed slow heart rate for pregnancy outcome was determined. The mean heart rate increased from 82 +/- 10.3 beats/min at 5 weeks' gestation to 156 +/- 9.6 beats/min at 9 weeks. A single observation of an abnormally slow heart rate did not necessarily predict subsequent embryonic death. However, a continued decline in embryonic heart activity, observed within a few days' interval, was always associated with a first-trimester abortion.

Fetal Doppler flow measurements in the early second trimester: a correlation with fetal outcome.

In 31 women with a singleton pregnancy, abdominal duplex doppler examinations were performed at W16-W17, W26 (+/- 2 weeks) and W34 (+/- 2 weeks) in order to study the flow velocity wave (FVW) indices in the early second trimester and their predictive value for fetal outcome. 24 women with a normal pregnancy outcome were considered as the reference group. In the early second trimester, end-diastolic block occurs frequently at the 150 Hz thump filter setting (15/24 in the fetal descending aorta, 19/24 in the umbilical artery). At the 50 Hz filter setting, end diastolic block appeared in 1/24 cases in the aorta and in 2/24 cases in the umbilical artery. The finding did not persist throughout pregnancy. The flow-velocity indices in the early second trimester in the small-for-dates were comparable to the normal group. We conclude that high peripheral resistance is a common finding in the fetal circulation in early pregnancy. It is not predictive of subsequent growth retardation.

The neu-oncogene protein as a predictive factor for haematogenous metastases in breast cancer patients.

In a prospective study with a median follow-up of 13 months on a series of 71 breast cancer patients, 9 developed haematogenous metastases. The neu protein was found on the cell membranes in 27 of the 71 carcinomas (38%) by an immunohistochemical technique using a monoclonal antibody (MAb). Eight of the 9 patients with haematogenous metastases showed overexpression of the neu protein. Immunohistochemical staining of the cell membrane was inversely correlated with the oestrogen and the progesterone receptor status. There was no correlation with lymph-node involvement. The immunohistochemical detection of the neu protein in breast adenocarcinomas is an independent factor in predicting the patients at risk for haematogenous tumour spread and is therefore correlated with unfavourable prognosis.

CEA and HMFG in hyperplastic and malignant lesions of the breast.

In order to evaluate a possible transition from proliferative lesions of the breast to ductal carcinoma in situ (DCIS), an immunohistochemical retrospective analysis was carried out. Twelve patients with hyperplasia without atypia, 11 patients with hyperplastic lesions with atypia, 21 patients with DCIS and 24 patients with invasive carcinoma were studied. The expression of carcino-embryonic antigen (CEA), a dedifferentiation marker, was investigated, applying one monoclonal antibody (Amersham). The expression of human milk fat globulin (HMFG), a differentiation marker, was studied by means of three monoclonal antibodies. The results reveal that no CEA activity can be demonstrated in normal and hyperplastic breast tissue, either with or without atypia. The monoclonal antibody was positive in 48% of DCIS and 50% of the invasive carcinomas. We failed to observe a correlation between the presence of CEA and the differentiation of the tumor. The application of this antiserum adds no substantial information about the phenotypic alterations during the progression from atypical hyperplasia to DCIS. HMFG was present in benign as well as in malignant breast lesions. Therefore, we conclude that HMFG is not useful for the evaluation of the phenotypic change from atypical hyperplasia to malignancy. However, as pointed out by others, it can be used in a diagnostic panel of different antibodies in the distinction between epithelial and non-epithelial lesions.

Space plasma physics: phenomena induced by charged particle beams.

The effects of electron beam emissions from Spacelab were recorded with onboard diagnostic instruments. The variation of the Spacelab-shuttle potential with respect to the ambient plasma near the scientific air lock was investigated. Data on the waves and instabilities triggered by the electron beams are discussed. Within the electron gyrofrequency and electron plasma frequency range, strong signals were detected by both electric and magnetic antennas during the beam emissions. The frequencies of the emitted waves were compared to the characteristic plasma frequencies to enable mode identification.