[KTP laser in the upper airways in children: preliminary study on 27 lesions]. / Le laser KTP dans les voies aériennes superieures de l'enfant. Etude préliminaire portant sur 27 lésions.

The KTP Laser was recently introduced in otolaryngology, and is increasingly used. This report describes treatment of 27 upper airway lesions in 24 children using KTP Laser over a two year and half period at the Children's Hospital of La Timone in Marseille. Comparison of results with CO2 Laser were made for the three most frequent pathologies of the series which were choanal atresia (n = 14), laryngotracheal stenosis (n = 6) and laryngeal paralysis (n = 3). The convenience of fiber delivery, concomitant telescopic control and low grade oedematous reaction are the main advantages over the CO2 Laser. As reported in the literature, we observed that healing was longer for KTP Laser than for CO2 Laser. Delay to healing may be an advantage in the management of choanal atresias and laryngeal stenosis.

[CO2 laser in pediatric laryngology]. / Le laser CO2 en laryngologie infantile.

Carbon dioxide Laser is a recently developed instrument which has became essential in laryngology, especially in its pediatric applications. Authors report 86 cases of children with a laryngeal pathology treated by CO2 Laser at the Childrens Hospital of La Timone in Marseille. Four groups emerge from this study. They are composed of laryngomalacia (n = 34), subglottic angiomas (n = 12), laryngeal papillomatosis (n = 12) and laryngeal stenosis (n = 14). Other patients (n = 14) made up a miscellaneous population (granulomas, laryngeal paralysis, benign tumors). Post-operative data are analyzed and compared with those of literature. The result is that this therapeutic method, used within the limits of precise indications and, if necessary, with divided sequences, can offer rapid curative care with few complications.

[Laryngotracheal fissure in infants. Indications, technique, results]. / La laryngotrachéofissure chez le nourrisson. Indications, technique, résultats.

Since laryngotracheofissiure, or anterior cricotomy, has been introduced in 1980, the number of tracheotomies performed in infants has decreased as this procedure is an alternative to tracheotomy for difficult extubation. Since then, the indications of this procedure have become wider, but a number of preoperative criteria, such as the pulmonary capacity, must be strictly assessed. We report on our experience with 14 children who underwent laryngotracheofissiure during the past 4 years. The indications, the surgical technique and the results are evaluated.

Right ventricular function during positive end-expiratory pressure. Thermodilution evaluation and clinical application.

Right ventricular (RV) function was studied in 13 patients under controlled mechanical ventilation with positive end-expiratory pressure (PEEP) for adult respiratory distress syndrome. The assessment of RV function was made by the thermodilution technique. Calculations of RV ejection fraction (RVEF) and RV end-diastolic volume (RVEDV) were performed. In 11 patients, increasing PEEP was accompanied by a progressive decrease in blood pressure (BP), stroke volume (SV), RVEDV, and no change in RVEF. Increasing PEEP further was accompanied by a further decrease in RV preload. The remaining two patients exhibited a decrease in BP, SV, RVEF and an increase in RVEDV. One of these two patients exhibited a large decrease in cardiac output (CO). Thus, measurement of RVEDV (best parameter of ventricular preload) and RVEF are easily performed at the patient's bedside using a special thermodilution technique. This allows selection of the best treatment of PEEP-induced decrease in CO.

Vecuronium or suxamethonium for rapid sequence intubation: which is better?

The effects of suxamethonium, and of vecuronium given after three subparalyzing (priming) doses, on the time of onset of neuromuscular blockade and on the resultant intubating conditions were compared. This study involved five groups of 10 patients (ASA class I or II) who were premedicated with flunitrazepam 0.015 mg kg-1 i.m. Anaesthesia was induced with thiopentone 6 mg kg-1 and fentanyl 0.003 mg kg-1. In groups 2, 3 and 4 the patients were given a priming dose of vecuronium 0.01, 0.015 and 0.02 mg kg-1, respectively. Three minutes later the intubating dose of vecuronium was given: 0.1 mg kg-1 (group 1), 0.09 mg kg-1 (group 2), 0.085 mg kg-1 (group 3), 0.08 mg kg-1 (group 4). When the electromyographic response was 95% of control, the trachea was intubated. In groups 2, 3 and 4, the onset time was significantly decreased compared with group 1. Increasing the priming dose from 0.01 mg kg-1 did not offer any advantage. The duration of blockade (time from the intubating dose to 15% recovery) was not significantly increased with any priming dose. In group 5, the trachea was intubated after suxamethonium 1.5 mg kg-1. Mean onset time, which was significantly shorter than in the other groups, was half that of the groups that received a priming dose. Intubation conditions were better in group 5 than in the other groups (P less than 0.01).

[Acute fatal hepatorenal failure during treatment with mithramycin]. / Insuffisance hépato-rénale aiguë mortelle au cours d'un traitement par la mithramycine.

A case of fatal hepato-renal failure occurring during mithramycin treatment is reported. A 64 year-old female patient was admitted to hospital in a state of acute renal failure. She also presented with hypercalcaemia and bilateral pulmonary metastases. She had been operated on 10 years previously of a parathyroid cancer. Despite treatment with mithramycin (total dose 8.25 mg) and haemodialysis, the hypercalcaemia returned; it was then decided to remove the secretory lung metastases (parathormone 420 micrograms X ml-1). 48 hours before surgery, the patient was again given 1.25 mg mithramycin. Immediately after surgery, she developed hepatic failure with massive cell destruction and anuria. The patient died 48 h after the operation. The hepatic and renal complications of mithramycin are discussed.

[A new model electric syringe: sequential injector for anesthesia]. / Un nouveau modèle de seringue électrique: l'injecteur séquentiel pour l'anesthésie.

A new type of syringe injector has been studied. Its major characteristic was the ability to compute the time and drug doses required for induction of anaesthesia, as well as those doses required for its maintenance. The staggering of induction time (from 1 to 9 min) should help reduce the severity of anaphylactoid reactions and the cardiovascular effects of anaesthetic induction in critically ill patients. Because of its computerized system, all types of syringes (5 to 60 ml) could be used with this new electrical injector.