[The breakdown of anesthesia equipment survey]. / Enquête sur les pannes des appareils d'anesthésie.

OBJECTIVE: To assess the incidence and the causes of failures of anaesthesia machines. STUDY DESIGN: Prospective survey from August 1995 to September 1997. MATERIAL: Check-list and machine failure forms. METHODS: Failures of anaesthetic machines have been collected and entered into a database. Causes and treatment of each failure have been analysed. RESULTS: Of 5,096 foreseen forms, 3,926 (77%) have been completed after check-list or anaesthesia machine failure. Overall, 233 incidents have been declared (4.5%). Failures identified during the preoperative check-list (n = 96) were mainly related to mechanical problems, especially the gas proportioning device (35%). Perioperative failures (n = 137) were mostly related to electronic problems (ventilator: 27% and monitor: 57%). In more than half of the cases, a specially trained anaesthetic nurse was able to correct the failure in the operating theatre. Using 14 anaesthetic machines for 12 operating rooms, no procedure was cancelled because of a technical failure of a machine. CONCLUSIONS: This study emphasizes the value of the check-list and the failure report. The presence of a specially trained anaesthetic nurse allows immediate correction of the majority of technical problems.

[Quality control of anesthesia equipment after maintenance procedure]. / Contrôle-qualité des appareils d'anesthésie après opération de maintenance.

OBJECTIVE: To assess the value of quality control tests after routine maintenance procedures of anaesthesia machines. STUDY DESIGN: Prospective laboratory study. MATERIAL AND METHODS: Over a 4-year-period, anaesthesia machines were checked after regular maintenance procedures, in order to detect unrecognized dysfunctions before clinical use. RESULTS: Overall 106 tests were performed on 14 machines and five dysfunctions were identified. Three of them concerned gas proportioning devices, which delivered a hypoxic gas mixture (FO2 < 15%). This defect was recognized by gas analysis at their outlet, whereas mechanical controls were satisfactory. The last two concerned pressure relief valve linearity and gas leak at PEEP valve. CONCLUSIONS: This study underlines the necessity of both postmaintenance controls and gas analysis at the outlet of the gas proportioning device. These controls should be performed by hospital technicians, independent from those involved in regular maintenance procedures.

Treatment of peritoneal carcinomatosis by intraperitoneal chemo-hyperthermia: reliable and unreliable concepts.

Intraoperative peritoneal chemo-hyperthermia (IPCH) is a promising treatment of peritoneal carcinomatosis arising from digestive tumors. After presenting the rationale for the use of IPCH, this review reports the results published to date by different groups. Unfortunately, data with respect to technical aspects, indications and results are unclear, inhomogeneous and questionable. The discussion presents reliable and unreliable points, mainly concerning the technical aspects of IPCH: what is the maximal desirable tumor thickness before initiating treatment? What is the ideal temperature? Is central hyperthermia beneficial? What is the ideal duration? What is the most effective antimitotic drug? A new classification of peritoneal seeding before cytoreductive surgery and before the initiation of IPCH, is proposed, and a suggestion concerning the reporting of drug concentrations made. Numerous prospective studies need to be conducted to test different technical modalities and to evaluate the results of IPCH.

[Intraperitoneal hyperthermic chemotherapy (IPHC), a promising treatment of peritoneal carcinomatosis]. / La chimio-hyperthermie intrapéritonéale (CHIP), un traitement prometteur mais encore mal connu de la carcinose péritonéale.

Intraperitoneal hyperthermic chemotherapy (IPHC) appears to be a promising treatment of peritoneal carcinomatosis. This paper reports the physio-pathological background of IPHC and the various studies which have been published in the literature. It points out the heterogeneity of these series and discuss the most critical points as surgical indications, choice of the antineoplastic drugs, their doses, temperatures of the IPHC, extend of the cytoreductive surgery, morbidity and mortality. Finally, several options are proposed for those points which are not yet standardized.

Combined interstitial hyperthermia and brachytherapy: Institute Gustave Roussy technique and preliminary results.

In 1981, a protocol was developed at the Institute Gustave-Roussy, utilizing combined interstitial hyperthermia and brachytherapy, to treat recurrent tumors in previously irradiated areas. This protocol consisted of interstitial hyperthermia, 44 degrees C for 45 minutes, followed immediately by iridium 192 curietherapy, delivering 30 Gy in 2 or 3 days to the tumor volume. Fourteen implantations have been performed in 11 patients. Complete eradication of tumor has been achieved thus far in 10 cases. Two patients were not evaluable because of rapid death resulting from diffuse metastases, and two patients demonstrated a partial response (greater than 50% tumor reduction). Treatment has been generally well tolerated despite prior high dose irradiation. There has been only one serious complication-a large area of painful necrosis following retreatment of a recurrent floor of mouth carcinoma. Special "metallic-plastic" tubes were developed to improve tissue tolerance. We were able to document that a high and homogeneous temperature could be delivered throughout the tumor volume. The technical innovations, and the techniques of implantation and temperature documentation are described below.

[Perspectives of hyperthermia in the treatment of tumors of the maxillofacial region]. / Perspectives de l'hyperthermie dans le traitement des tumeurs de la sphère maxillo-faciale.

Hyperthermia used alone or in association with radiotherapy and chemotherapy opens new perspectives in the treatment of tumours. Its application in the maxillo-facial area has special features by virtue of the inhomogeneity of the tissues and the sensitivity of some of them. The region is suitable for the use of interstitial and endocavitary techniques which provide localised and uniform heating. Preliminary clinical study was aimed essentially at the improvement of the technique and the evaluation of tolerance. The effects seen on tumours are encouraging and study is being continued with more routine association of hyperthermia and irradiation.

[Hyperthermia main techniques (author's transl)]. / Techniques de chauffage pour l'hyperthermie.

Superficial tumours with a small thickness can be correctly heated by various techniques. Some difficulties arise for a uniform heating across tumours several centimeters thick; they are considerably increased for deep located tumours. The possibilities of various methods of diathermy are discussed with consideration of blood flow and controlled surface cooling. A peculiar attention is devoted to conductive methods using electrodes supplied by 1 MHz current generator, and placed in contact (tubes, plates) or inside (needles) the tumour.

[Interstitial techniques of hyperthermia (author's transl)]. / Les techniques intersitielles de l'hyperthermie.

The interstitial techniques of hyperthermia allow one to obtain a precise specific absorption rate (S.A.R.) in a well-defined volume. We have available a low-frequency prototype amplifier, that is capable of heating up to 6 needles. This device was able to heat small volumes in animals, and then was used for patients. Five superficial tumoral nodules have been treated: the first results seem positive. The next step will be the combination of the techniques of interstitial hyperthermia with brachytherapy.