ABSTRACT
Molten alloys under high pressure were used to obtain fibers with long internal electrodes that are solid at room temperature. An integrated Mach-Zehnder interferometer was constructed from a twin-core twin-hole fiber that permitted application of an electric field preferentially to one of the cores. Good stability and a switching voltage of 1.4kV were measured with a 1-m-long fiber device with a quadratic voltage dependence.
Subject(s)
Bursa, Synovial/pathology , Knee Joint/pathology , Bursa, Synovial/surgery , Humans , Knee Joint/surgery , Male , Middle AgedABSTRACT
PURPOSE OF THE STUDY: Efficient peri-operative analgesia is more comfortable, allows earlier mobilisation and better functional results for lower limb arthroplasties. We report our 60 cases prospective study of combined spinal and epidural anesthesia, and expose interests of this technique to control peri-operative pain. MATERIALS: From 1994 to 1995, 60 patients ASA class 1 were operated: 45 total hip replacement (THR), 15 total knee replacement (TKR). The average age was sixty five years (range thirty nine to eighty five years). Combined spinal and epidural anesthesia was performed in every case. METHODS: In lateral decubitus position, a translucent 25 Gauge needle was introduced in L2-L3 interspace. In a first time spinal anesthesia was made with 20 mg Bupivacaine. In a second time, a lumbar epidural catheter was inserted. All patients received an epidural post-operative analgesia with 4 mg Morphine once a day during two days and intravenous Paracetamol. Visual analogue scale (0 to 10) (VAS) were recorded after the third post operative hour and every twelve hours. During this period satisfaction mark was also recorded (1 to 3). RESULTS: We didn't observe any case of respiratory depression or infection with the epidural catheter. We observed 10 cases of pruritus (one needed to stop protocol) and 18 urinary retentions. Six uretral catheters were necessary; we had one case of pyelonephritis (escherichia coli). The first micturition was obtained 13.5 hours after the end of surgery. For the fifty nine remaining patients, visual analogue scale was always inferior or equal to 2/10 and the satisfaction mark to 1/3. DISCUSSION: Different techniques allow peri-operative analgesia, but a few are efficient during the first two days. Plexus nerve blocks are simple and reliable but post-operative anesthesia is short (inferior to 15 hours). Intravenous morphine controlled by patients themselves with programmed display needs expensive and sophisticated material. The principal risk is respiratory depression. Epidural morphine has a lower respiratory depression risk, but needs a heavier technique. The principal problems is higher incidence of urinary side effects. Epidural anesthesia might tend to show a greater efficacity with the best visual analogue scale and satisfaction mark. CONCLUSION: The results indicate that combined spinal and epidural anesthesia for the management of peri-operative pain provide an excellent pain control with a daily morphine injection. For lower limb arthroplasties, visual analogue scale is always inferior or equal to 2 and satisfaction mark equal to 1.
Subject(s)
Anesthesia, Epidural/methods , Anesthesia, Spinal/methods , Hip Prosthesis , Knee Prosthesis , Adult , Aged , Aged, 80 and over , Analgesics, Opioid/administration & dosage , Anesthesia, Epidural/adverse effects , Anesthesia, Spinal/adverse effects , Female , Humans , Male , Middle Aged , Morphine/administration & dosage , Pain Measurement , Patient Satisfaction , Postoperative Period , Prospective StudiesABSTRACT
Necrotizing fasciitis is a rare form of anaerobic infection, quite different from gas forming gangrene: it affects the skin, the cellular tissue, the fascia; it doesn't diffuse in depth to the muscles and doesn't produce gas. Its microbic agents vary from haemolytic streptococcus to anaerobic bacteria in synergy. It rapidly spreads into a massive necrosis and can in a week's time lead to death by toxic shock. It spreads locally to large cutaneous areas eventually leading to the necessity of amputations. A joint treatment must be started with extreme urgency: extensive surgical excisions of all necrotic teguments, and medical treatment consisting of correcting metabolic troubles and antibiotherapy. This difficult treatment can save the patient, but it involves great loss of cutaneous and subcutaneous substance leading to local problems which are similar to serious burns, then to problems of reconstruction. An open fracture of the elbow led to an observation. A review of the literature sets out the different forms and complications.
Subject(s)
Elbow Injuries , Fasciitis/etiology , Fractures, Open/complications , Humeral Fractures/complications , Fasciitis/therapy , Female , Humans , Middle Aged , Necrosis , Skin TransplantationABSTRACT
PIP: The amnesic effect of nitrous oxide was studied in 50 women undergoing induced abortions under general anesthesia at a hospital in France. The request for general anesthesia was made by the practitioner, by psychologists working with the women, or by the women themselves. Patient ages ranged from 13-39 years and averaged 24. All patients were given 1 mg of dextromoramide. During the procedure a mixture of 50% nitrous oxide and 50% oxygen was delivered. The patient was asked to count to 200 and remember a list of 5 words, and questions were posed. The nitrous oxide was terminated at completion of the aspiration. Awakening occurred in under 5 minutes with nitrous oxide and oxygen and at around 10 minutes when halothane was added. 30 minutes after awakening the patient was questioned about the surgery and the preoperative talk and questions. None of the patients recalled insertion of the speculum. In 46 of the 50 cases a total or partial amnesia occurred. Among 20 patients given the nitrous oxide-oxygen mixture only, 15 experienced total, 4 partial, and 1 no amnesia. Among the 30 patients given the same gas mixture and halothane, 25 experienced total, 2 partial, and 3 no amnesia. Nitrous oxide has no effect on longterm memory and probably inhibits the 1st phase of memorization. There are several components of its mode of action: classic analgesia, a potentializing effect with morphinomimetics and other general anesthesias, and an amnesia of painful and disagreeable interventions.^ieng
