[Headaches after spinal anesthesia: prospective multicenter study of a young adult population]. / Céphalées postrachianesthésie: étude prospective multicentrique dans une population d'adultes jeunes.

OBJECTIVE: We assessed the occurrence of post-dural puncture headache (PDPH) in a group of young adults following spinal anaesthesia using a 24-gauge Sprotte needle. STUDY DESIGN: Prospective, multicentre, non-randomized study. PATIENTS: This 9 month-long study, included 1,122 patients less than 50 years-old, consisting of 502 women and 620 men. METHODS: Assessment of PDPH after 48 hours and 7 days. RESULTS: PDPH occurred in 0.8 percent of patients. There was no statistically significant difference in terms of age group or gender between the patients. Incidence of PDPH did not depend on type of anaesthetic solution, puncture level or ease of puncture. DISCUSSION: The use of 24-gauge Sprotte needles was associated with a low rate of puncture difficulties. Usual predisposing factors for PDPH, such as age below 50 years and female gender do no longer apply with this type of needle. The rate of puncture difficulties was low (6.7 percent), in contrast with ultra-fine 27 or 29 gauge needles, which sometimes result in puncture failure. Acceptance of the technique was excellent, as 99.38 percent of patients were satisfied. CONCLUSION: The indications of spinal anaesthesia could be extended to young patients, whatever their gender, using a non-traumatic 24-gauge Sprotte needle.

[A case of acute acrolein poisoning]. / Intoxication aiguë par l'acroléine. Une observation.

A four and a half year old boy was hospitalised with acute respiratory failure due to the inhalation during two hours of the smoke from an overheated frier. Oxygen, corticosteroids and furosemide led to clinical stabilisation but after 24 hours asphyxia developed. The trachea was found to be obstructed by a firm elastic substance which prevented intubation or bronchoscopy. Autopsy revealed massive cellular desquamation of the bronchial lining. The lumen was occupied by miscellaneous debris. There were multiple pulmonary infarcts. This is the second case of acute intoxication by acroleine. In the light of these two cases, treatment should consist of corticosteroids, antibiotherapy, inhalation therapy, and repeated bronchial aspiration.

[Influence of the use of a video device for monitoring and visits on psychologic relations between patients, families and medical staff in an intensive care unit (author's transl)]. / Place de la vidéo dans les relations "malade-famille" en réanimation.

The use of a video device for monitoring and familial visits in a medical intensive care unit has various effects on psychologic relations between the patient, his family and the medical staff. Such a device is used since 1972 in Lille and has concerned more than 10,000 patients. On one hand, the monitoring of the patient is facilitated. His dependence to the staff is enhanced and allows a better taking of responsibility from the nurses and a good adhesion to the cares. At last, the video device gives to the patient and his family a real feeling of security during the early phase of the hospitalization. On the other hand, and particularly after this early phase, the use of a video device has deleterious effects on the psychologic relations of the patient with his family: enhancement of the psychologic regression, creation of an additional agression which jeopardizes the restoration of normal relations after attempt of suicide or prolonged artificial ventilation. This underlines the need for a real psychologic management of the video device in the reception of the families and the frequency of the relations with the medical staff.

[Value of determining trace elements in septicemia. Clinical correlations, prognostic value]. / Intérêt du dosage des oligo-éléments au cours des septicémies. Corrélations cliniques, valeur pronostique.

Among 17 septicemic patients, a statistically decrease of seric oligo-elements is demonstrated. The longitudinal study shows the rapid correction of these perturbations in the surviving group and the lack of correction among the non survivors. The level of phosphorus is the most interesting one. The importance of S.R.E. activity is probably the physiopathologic support of seric oligo-element modifications in sepsis.

[Current aspects of gas gangrene, apropos of 47 cases collected over a 3-year period (1974-1976)]. / Actualité de la gangrène gazeuse à propos de 47 observations recueilleies en trois ans (1974-1976).

On the basis of 47 cases of gas gangrene collected over the three year period between 1974 and 1976, the authors review the circumstances surrounding its development, the clinical features and the prognosis of the disorder which remains grave despite a well-defined therapeutic protocol combining surgery, antibiotics and hyperbaric oxygen. There would appear to be a real resurgence of the disease at the present time. Post-traumatic and surgical aetiologies predominate, giving rise to two types of gangrene: clostridial gas gangrene secondary to contamined wounds, with a quasi-constant vascular element, affecting predominantly the limbs, and nonclostridrial gangrene, the increasing prevalence of which involves essentially spetic abdomino-pelvic surgery. In the light of this study, prognosis would appear to be related to the underlying terrain in which the gangrene occurs, to certain features of the clinical picture and, above all, to the possibilities of early application of the complete therapeutic protocol. Strict prophylactic measures would alone seem capable of preventign the worrying increase in the number of cases of gas gangrene.

[Disorders of hemostasis during intake of lipids]. / Les troubles de l'hémostase au cours de l'apport des lipides.

Lipid emulsions based upon soya triglycerides and widely used in parenteral nutrition. Haematological surveillance of the patients, and in particular the study of coagulation, shows slight changes in platelet adhesiveness and a transient hypercoagulability state proportional to the concentration of the lipid emulsion. Nevertheless, these findings must be interpreted with the greatest caution, inasmuch as the laboratory tests involved are technically delicate. The results obtained may be contradictory according to the protocol used. Finally, in patients receiving intensive therapy, there are multiple factors (stress, prolonge;d bedrest, hypercatabolism) which may alter coagulation quite independently of the prescription of lipids.