Early morbidity of endoscopic ultrasound: 13 years' experience at a referral center.

BACKGROUND AND STUDY AIM: Endoscopic ultrasonography (EUS) now has an important place in the diagnosis of gastroenteropancreatic diseases. However, prospective data on the morbidity and mortality related to its use are sparse and often retrospective. We attempted to assess the acute and immediate complications of both diagnostic and interventional EUS. PATIENTS AND METHODS: At our university-affiliated tertiary care referral center, immediate (occurring during the procedure) and acute (occurring within 24 hours) complications of EUS were prospectively investigated. Over a first period, spanning 10 years, complications of diagnostic EUS involving 3207 consecutive patients were assessed. During the second period of 3 years, complications observed after EUS-guided fine-needle aspiration (FNA) biopsy were evaluated from 224 procedures. EUS was mostly done with the patient under sedation with intravenous propofol and spontaneous ventilation, and complications were evaluated by both the operator and the anesthesiologist. RESULTS: There were no deaths, and no surgery was required over the two periods of assessment. Three mild complications occurred among patients who underwent standard diagnostic EUS: two immediate complications were related to anesthesia and one to the procedure. There were five complications associated with interventional EUS; all were related to the procedure (acute pancreatitis, duodenal perforation, upper digestive bleeding, cyst, and mediastinal infection), with a mean delay of occurrence of 30 hours, and mean duration of hospitalization of 7 days. CONCLUSION: In our experience, which is the longest reported in Europe, the morbidity rates of diagnostic EUS and EUS-guided FNA biopsy were 0.093% and 2.2%, respectively, with no mortality.

[A 1993-1995 epidemiological survey of home parenteral nutrition in approved centers for adults in France]. / Données épidémiologiques 1993-1995 de la nutrition parentérale à domicile en centres agréés chez l'adulte en France.

OBJECTIVES: A 1993-1995 three year epidemiological survey of home parenteral nutrition was performed through in France in approved centers for adults. METHODS: Data were retrospectively collected each year on a standardized questionnaire focussing on indications and short term outcome. RESULTS: All centers (n = 14) participated in the study and 524 new adult patients were recruited. The overall incidence was unchanged at 3.75 patients/10(6) adults. Indications for AIDS rose (8 to 18%) whereas other indications were stable. Prevalence increased by 19%: 4.40 adults/10(6) patients at 01.01.1996. At six months, the probability to stay on treatment was 19.5% for AIDS and cancer indications but 52% for others, whereas death rates were 59% and 9% respectively. CONCLUSIONS: For both cancer and AIDS indications, short-term treatment was due to a poor prognosis. For other diagnosis, complicated with a short bowel in 51% of cases, prognosis was excellent but associated with treatment dependency. The latter point focuses on the need for additional treatments in irreversible intestinal failure.

[Double transplantation of the liver and kidney. A study of curarization using continuously perfused atracurium]. / Double transplantation hépatique et rénale. Etude de la curarisation par atracurium en perfusion continue.

We report the use of atracurium besylate with monitoring of neuromuscular function in a young women with primary hyperoxaluria and no renal function. She underwent orthotopic liver transplantation and also a kidney graft during the same operation. The bolus dose (0.5 mg.kg-1) and the mean infusion rate (0.405 mg.kg-1.h-1) were similar to those reported in references. The infusion rate decreased during anhepatic period. Spontaneous recovery time from TR 25 to 75% was 36 mn and TR 90% was 127 mn, after the end of atracurium infusion. The depression of neuromuscular function was potentiated with isoflurane use, acidemia, hypocalcemia, hypothermia but without cumulative effect. It was concluded that the administration of atracurium by infusion is suitable for long surgical procedures despite impaired hepatic and renal function.

[Anaphylactic shock caused by pancuronium and vecuronium]. / Choc anaphylactique au pancuronium et au vécuronium.

A case is reported of anaphylactic shock due to vecuronium occurring in a patient who had already had such a shock, due then to pancuronium, during a previous general anaesthesia. The need for a full immuno-allergological investigation, the occasional efficiency of the anti-histamine premedication, and crossed allergies between muscle relaxants are stressed. It is noted that an anaphylactic shock can be seen on first using a new molecule, as the patient can have been sensitized to it by other muscle relaxants. This case was the first to be described of an anaphylactic shock due to vecuronium bromide.

[The use of vasopressin during portal bypass (author's transl)]. / Utilisation de la vasopressine au cours des dérivations portales.

Vasopressin was infused intra-arterially or intravenously during 12 portal bypass operations. In comparison with a control group (without vasopressin), there was a very significant reduction in blood loss and portal pressure, and a moderate increase in arterial blood pressure.

[Tracheo-bronchial intubation for surgery of the esophagus via a thoracic approach]. / L'intubation trachéo-bronchique pour chirurgie de l'oesophage par voie thoracique.

Tracheo-bronchial intubation using a double-lumen Carlens tube provides the surgeon with a mediastinal operating field free of any obstruction by the lung and provides greater surgical ease than that of an assistant retracting a constantly invasive lung with tracheal intubation. This anaesthetic technique involving the ventilation of only one lung during the endothoracic period of the surgical procedure has not been used routinely for extra-pulmonary surgery since the shunt which is created leads to a fear of dangerous hypoxia. The aim of this study involving 30 patients is to demonstrate that the blood oxygen saturation obtained by the careful ventilation of a single lung, that of the side on which the patient is lying, is perfectly acceptable and comparable with the preoperative oxygen saturation of the subject at rest. This is obtained at the price of an increase in insufflation pressures of the order of 100 percent. Re-expansion of the collapsed lung without visual confirmation after careful endobronchial aspiration makes it possible to prevent the development of areas of micro-atelectasia and to ensure the absence of any pulmonary postoperative complications.