[Neurophysiological study of propofol (2-6 diisopropylphenol): experimental data]. / Etude neurophysiologique du propofol (2-6 diisopropylphenol): données expérimentales.

Propofol was assessed in laboratory animals using an experimental technique which leads to an over all appreciation of central nervous system function. After Bimar and Naquet, (1966) a battery of neurophysiological tests in the cat investigate specific primary pathways (visual evoked potentials), non specific pathways (arousal reaction) and hemodynamic response to painful aggression (stimulation of dentine). Propofol appears to be a powerful narco-hypnotic drug. More, it have an original property which is quite rapidly effective and unconnected with narcosis: a protective hemodynamic ("sympathoplegic or neuroleptic") effect. So, propofol, a new anesthetic agent, seems to be a progress with regard to other drugs used previously.

[Effects of isoflurane and halothane on the auditory and somatosensory evoked potentials]. / Effets de l'isoflurane et de l'halothane sur les potentiels évoqués auditifs et somesthésiques.

The effects of isoflurane and halothane anaesthesia on brainstem auditory (BEAR) and somatosensory evoked potentials (SEP) were recorded in 15 patients; eight received isoflurane and seven halothane. Atropine alone was given as premedication. After induction of anaesthesia with thiopentone, it was maintained with 50% nitrous oxide in oxygen. Ventilation was controlled. Isoflurane and halothane concentrations were gradually increased to 3%. Recordings were made at 1%, 2.5% and 3%. There were statistically significant differences in the latencies of SEP and BEAR with increasing concentrations of anaesthetic. The BEAR waves significantly affected were wave V and the latency between peaks I to V (p less than 0.001); for the SEP, it was wave N20. SEP central conduction time was prolonged with both anaesthetics (p less than 0.001). The effects of isoflurane and halothane were similar. These results could not be explained by changes in central body temperature or end-tidal carbon dioxide concentration. The study showed a dose-related direct effect of both anaesthetic agents on the brainstem auditory and somatosensory evoked responses. It may be that the measurement of changes in evoked potentials could be a useful indicator of anaesthetic depth.

[Central toxicity of local anesthetics. New data]. / Toxicité centrale des anesthésiques locaux. Nouvelles données.

The central nervous toxicity of local anaesthetics has long been thought to be limited to the generalized tonicoclonic convulsions which follow the appearance of such symptoms as sleepiness, tingling of the lips, slurred speech, numbness, etc. Also the central nervous system was considered to be more sensitive than the cardiovascular system. However, recent experimental studies would seem to indicate that at least the more potent local anaesthetics, such as bupivacaine, have deleterious effects on parts of the brain other than the cerebral hemispheres. This may point to an involvement of the central nervous system (the amygdala and vasopressor areas of the floor of the fourth ventricle) in the pathogenesis of the hypotension and arrhythmias which may be seen at the same time as central nervous system signs of systemic toxicity. This is important for the treatment of such accidents: should a convulsion occur alone, sodium thiopentone, a muscle relaxant and a benzodiazepine, with oxygen and assisted breathing, will be the treatment; should an arrhythmia occur, its treatment should also include an anticonvulsant drug, such as a benzodiazepine. The prophylactic use of benzodiazepines should also be encouraged.

[Zinc and biotin deficiency during prolonged parenteral nutrition in the infant]. / Carence en zinc et en biotine au cours d'une alimentation parentérale prolongée chez le nourrisson.

The case of a premature hypotrophic infant who, after 4 months of parenteral nutrition, presented with deficiency in both zinc and biotin is reported. The two deficiencies had similar clinical manifestations: dermatitis, alopecia and susceptibility to infection. The diagnosis was confirmed by zinc blood level measurement on the one hand and by urinary organic acids chromatography on the other. The clinical manifestations can only be prevented by an additional intake of zinc and biotin in doses adjusted to the child's age and to the underlying pathology.

[Purpura fulminans associated with a C7 deficiency]. / Purpura fulminans associé à un déficit en C7.

A patient suffering from purpura fulminans was found to have a hereditary deficiency of the C7 component of complement. The homozygous deficiency of late acting complement components increases the risk of neisserial infection. CH50 titration will detect those patients suffering from a homozygous deficiency, who should be vaccinated against Neisseria meningitidis types.

[Bacteroides fragilis meningitis. 2 cases]. / Méningites à Bacteroides fragilis. Deux observations.

In this study based on 2 personal cases and 23 cases from the literature the main clinical and therapeutic features of meningitis caused by Bacteroides fragilis are reviewed. The disease occurs in either very young or elderly people, with contributing factors in 54% of the cases. Clinically, the infectious syndrome is associated with meningoencephalitis and sometimes motor disorders. Although septicaemia is present in 80% of the cases, the patient's general condition is moderately affected. Blood leucocyte counts are definitely increased and CSF disturbances are those common to all types of bacterial meningitis. The initial focus of infection can be determined in 60% of the cases. The mortality rate is higher in adults than in children. Neurological complications are frequent. Nitro-imidazole derivatives, which are active against Bacteroides fragilis and reach high CSF concentrations, constitute the treatment of choice.

[A severe form of Mediterranean boutonneuse fever]. / Une forme grave de fièvre boutonneuse méditerranéenne.

A severe case of boutonneuse fever was reported which was only diagnosed after death. The infectious syndrome and cutaneous eruption were associated with meningitis, encephalitis, hypoxaemia and thrombocytopaenia. The absence of an initial lesion ("tache noire") and the notion of recent German measles contamination explained the late diagnosis. Serious cases of boutonneuse fever were usually rare; they were better known as Rocky Mountain spotted fever, a rickettsial infection of the same group, the clinical symptoms of which were very similar and which gave the same proteus agglutination reactions as with boutonneuse fever. An earlier diagnosis, now possible thanks to immunofluorescent techniques using skin biopsies, should enable earlier treatment.

[Effects on muscular and general proteolysis in burn patients of a solution enriched with branched amino acids]. / Effets sur la protéolyse musculaire et générale du brûlé d'une solution enrichie en acides aminés ramifiés.

In order to assess the effects of a branched chain amino acid (BCAA) enriched solution on urinary nitrogen loss and muscle protein breakdown, 22 burnt patients were randomly divided into two groups immediately after hospital admission: 11 patients received a 22% BCAA amino acid solution, 11 patients received a 41% BCAA amino acid solution. Nitrogen intake was 0.2 g per day during the first 4 days in each group. Urinary total nitrogen, urinary creatinine and urinary 3,methylhistidine (3,MeHis) were measured for 4 days. Nitrogen balance, 3,MeHis/nitrogen ratio and 3,MeHis/creatinine ratio were calculated in each group. The two groups were compared using Student's test. Nitrogen, creatinine and 3,MeHis urinary excretion, and nitrogen balance were not significantly different in the two groups, except for urinary nitrogen on day 3 which was slightly higher in the 41% BCAA group. The 3,MeHis/nitrogen ratio on day 1, day 2 and during the whole study period, as well as the 3,MeHis/creatinine ratio on day 2, were significantly lower in the 41% BCAA group. These results were in agreement with a decrease in muscle/whole body urinary nitrogen excretion. However, no beneficial effect upon nitrogen loss or nitrogen balance was shown by using the 41% BCAA rich amino acid solution.

Arousal reactions during anesthesia in man.

Power-spectrum analysis of the electroencephalogram and inhaled-exhaled concentrations of halothane (when used), nitrous oxide, and carbon dioxide of 36 patients during surgical operations under general anesthesia were monitored. Electroencephalographic arousal reactions were detected in 24 patients and these were accompanied by irregular respirations in nine patients. Cardiac arrhythmias occurred following an arousal reaction in eight patients. The authors conclude that this electroencephalographic arousal phenomenon occurs frequently and deserves further investigation to define its clinical implications and how it might be avoided.

[Early respiratory involvement in burns. Mechanism and prognostic significance]. / L'atteinte respiratoire précoce chez le brulé. Mécanisme et signification pronostique.

A retrospective study, on 87 flame burn patients, of arterial Pa02, chest X-ray and lactic dehydrogenase isoenzyme III revealed the very early onset (before the 24th hour) of severe respiratory problems. This involvement, with a severe prognostic significance, appears to be much more closely related to the extent of the cutaneous burn than to the inhalation of fumes or vapours, and seems to fall into the more general category of "post-aggression lung".

[Circulating lipids in prolonged postoperative parenteral feeding: their changes depending on the nature of energy intake]. / Les lipides circulants au cours de l'alimentation parentérale post-opératoire prolongée; leurs modifications selon la nature de l'apport énergétique.

Repeated estimations of circulating total lipids and various fractions were made during the postoperative period in patients receiving parenteral nutrition for more than ten days. The patients were paired in relation to the underlying pathology and divided into two group : the first receiving energy supplements in the form of carbohydrates alone, whilst the second received part of this supply in the form of lipid emulsions (Trive 1000). Total lipids and various plasma fractions, with the exception of free fatty acids, increased progressively during the postoperative period, regardless of the inital values and independently of the lipid content of the nutrition fluids given. There was no significant difference between those patients who received lipid emulsions and those who did not. Free fatty acids remained at levels slightly greater than normal in the group which did not receive lipids. They were significantly higher in the group given lipid emulsions, though it was not possible to precisely define their orgin.

[Neurophysiologic justification of the place of neuroleptics in neuroleptanalgesia]. / Justification neurophysiologique de la place des neuroleptiques en neuroleptanalgésie

We studied the action of drugs on the cortical and systemic hemodynamic responses to reticular stimulation and somatic nociceptive stimulation. Central analgesics, even in high dosage, do not suppress the awakening reaction and the attack of hypertension produced by sciatic stimulation in curarised cats. The addition of a neuroplegic, such as Droperidol or Ethrane in low dosage, abolishes completely the response to painful stimulation. The action of pure analgesic anesthesia seems to be situated, above all, at spinal level.

[Current aspects of ambulatory anesthesia for otorhinolaryngologic and stomatologic surgery in France]. / Aspect actuel de l'anesthésie ambulatoire pour la chirurgie oto-rhino-laryngologique et stomatologique en France

Ambulatory anaesthesia is becoming more popular in France for several reasons: -for humanitory reasons and greater comfort, -for reasons of economy in hospital, -professional responsibility and insurance. This change has been made possible by: -techniques of anaesthesia using drugs which are eliminated rapidly without any rebound phenomenon, -medical attitudes, such as prior examination of the patient by an anesthetist; this is much better than a rapid examination at night or in the morning on admission of the patient, thus precise control of awakening by tests of psychomotor activity. -changes in hospital structure, e.g. post-anaesthetic awakening wards with specialised personnel. Anonymous questionnaires were sent out to O.R.L. surgeons and French oral surgeons, we received 38.5% replies: -51.75% never used ambulatory anaesthesia, -48.25% used ambulatory anaesthesia almost always in hospital with a recovery room and anaesthetic consultation. Admission to hospital for one day seems rarer. It thus appears that ambulatory anaesthesia is becoming common in France and that more than 50% of surgeons remain opposed to this technique.