[Transfusion-associated HIV contamination between January 1980 and September 1985]. / Contamination transfusionnelle par le VIH de janvier 1980 à septembre 1985.

This study reports the results of a retrospective survey of transfusion-related HIV-contamination in patients who were admitted in our neurosurgery department, between the 1st January 1980 and the 30th September 1985. In our area of France, the risk of HIV-contamination is low. During this 5-year-period the blood donors were not tested for HIV. Six hundred twenty-one patients were identified from the operating room registers. The administered blood components were always noted in these registers for each patient. Among these 621 patients, 233 died rapidly. Three hundred eighty files were taken out from the central archives' department. Eight files could not be found. These 380 files were examined for the patient's address, or the family's one, or the regular doctor's name and address. A letter was sent to the latter in order to inform him about the patient's transfusion. The doctor had to ask the patient to order a HIV-test. A recall letter was sent 8 months later as required. The patients who did not have a regular doctor were contacted directly by phone or letter, or indirectly through their family. Thirteen months after the beginning of this survey it was established that 334 patients died (53.5%) and only 151 patients were found and tested. One of them was HIV-positive. As this patient suffered from a hemophilia B, he had been medically followed and his positive serology was known since 1988. It was impossible to get any answer from 136 other patients who represent 22% of all patients and 47% of still alive patients or supposed to be so.(ABSTRACT TRUNCATED AT 250 WORDS)

[Auditory evoked potentials of the brain stem in brain death]. / Potentiels évoqués auditifs du tronc cérébral dans la mort cérébrale.

Brainstem auditory evoked responses were recorded in a neurosurgical intensive care unit in 38 patients who had all the clinical criteria for brain death. Of the brain-dead patients, 65.8% never showed a response. 3.42% showed a type I wave, which was unilateral in 26.3% and bilateral in the other 7.9%. Types II to VII waves were never seen. An increase in latency of type I waves (2.25 +/- 0.24 ms) was noted. The interest and the limits of this non invasive electrophysiologic technique for the diagnosis of brain death are discussed.

[Acute intracranial subdural hematoma after accidental dural puncture in epidural anesthesia]. / Hématome sous-dural aigu intracrânien après brèche dure-mérienne accidentelle lors d'une anesthésie péridurale.

A case is reported of an acute intracranial subdural haematoma following an accidental dural puncture during an epidural anaesthesia. A seventy-year old man, class ASA I, was operated on for prostatic adenoma under epidural anaesthesia. Dural puncture occurred during the first introduction of the needle into the L4-L5 epidural space. Epidural anaesthesia was nevertheless obtained by introducing the catheter at the L3-L4 level. The immediate peroperative and postoperative course was uneventful, apart from persisting headache. After removing the epidural catheter at 24 h postoperatively, the patient received calcium heparinate. 26 h later, he complained of worsening headache and became rapidly deeply comatose. The computer tomographic scan showed air in the ventricles and a large right-sided subdural haematoma which was immediately discharged. Although the link between subdural haematoma and dural puncture is well known, the acuteness and rapidly fatal evolution of this case were exceptional and may have been facilitated by the big size of the needle, dehydration and hypercoagulability.

[Neurinoma of the oculomotor nerve. Apropos of a case]. / Neurinome du nerf oculomoteur. A propos d'un cas.

A case of a surgically verified neurinoma of the oculomotor nerve is presented. The diagnostic difficulties due to the parasellar localisation are discussed. Computed tomography scan data rarely allow to distinguish the nature of the tumor and in all cases are insufficient to distinguish a trigeminal nerve neurinoma of the oculomotor nerves.

[Deglutition disorders caused by an injury to the foramen lacerum posterior]. / Troubles de la déglutition secondaires à une lésion traumatique du trou déchiré postérieur.

Dysphagia due to a traumatic lesion of the foramen lacerum posterior is relatively rare. Two cases are described in which swallowing troubles were perceived when the post-traumatic coma improved; these were ascribed to a traumatic lesion of the foramen lacerum posterior injuring the cranial nerves. Treatment involves preventing inhalation and nasogastric feeding whilst starting active and early rehabilitation of swallowing. Recovery is possible in most cases without surgery.

[Low-concentration enflurane:study of anesthetic stability and quality of recovery]. / Enflurane à faible concentration: étude de la stabilité anesthésique et de la qualité du réveil.

The stability of anaesthesia and the quality of recovery obtained with low doses of enflurane were studied. Two groups of 20 patients operated for lumbar slipped disc were compared. The mean age and weight distribution of the two groups were not statistically different. Induction was the same in the two groups (diazepam, fentanyl, pancuronium and nitrous oxide). In one group, enflurane (0.4%) was added with controlled ventilation. Thiopentone was added if some spontaneous movements were observed, if arterial pressure and heart rate increased, and if the digital plethysmograph curve decreased. The quality of recovery was assessed by number-connection tests 1 and 2 h after the end of anaesthesia. Thiopentone was required five times in the group without enflurane, whilst it was never used in the group with enflurane. This difference was statistically significant (p less than 0.01) and showed a more important stability of anaesthesia when enflurane (0.4%) was used. No statistically significant difference was found in the recovery scores between the two groups 1 and 2 h after the end of anaesthesia. It was proposed that low doses of enflurane were sufficient to increase the effects of the other anaesthetic drugs without any residual effect on recovery. Low doses of enflurane could be used during anaesthesia induced with fentanyl and diazepam, giving better stability during anaesthesia without any pernicious effects on recovery.

[Intensive care in acute hemorrhagic pancreatitis. Hemodynamic aspects]. / La réanimation dans les pancréatites aiguës hémorragiques. Aspects hémodynamiques.

Hemodynamic monitoring by a balloon flotation catheter was done in eight patients suffering from acute hemorrhagic pancreatitis. This syndrome associates hypovolemia and circulatory failure. These two factors are enhanced by the "pulmonary pancreatic syndrome" which produces hypoxemia. Thus positive end expiratory pressure ventilation must be employed and could worsen circulation failure. Dobutamine may help to better hemodynamic conditions.