[Postpartum perineal pain: effectiveness of local ropivacaine infiltration]. / Douleur périnéale du post-partum: intérêt de l'infiltration locale de ropivacaïne.

GOAL: To assess efficiency of local ropivacaine infiltration in perineal pain after episiotomy and perineal tear during the first 24 h after vaginal delivery. MATERIALS AND METHODS: Case control survey, including 62 consecutive patients with episiotomy and/or perineal tear during two consecutive periods: the ropivacaine group from February 2, 2008 to March 27, 2008 (n=31) and the control group from December 27, 2007 to January 1, 2008 (n=31). In the ropivacaine group, patients received 10 ml of ropivacaine 7,5mg/ml as a local infiltration along the perineal damage. In the control group no injection was done. A numerical pain rating scale (0-10) at four (H4), eight (H8), 12 (H12) and 24 h (H24) was used to evaluate patients post-partum perineal pain. A numerical rating scale was used to evaluate patients satisfaction (0: no satisfied, 5: very satisfied). RESULTS: Numerical pain rating scale for perineal pain evaluation was significantly lower in the ropivacaine group than in the control group at H4 (1.9+/-0.3 versus 3.6+/-0.5, p=0.006), H8 (3.3+/-0.4 versus 5.2+/-0.4, p=0.003), H12 (2.8+/-0.4 versus 5.2+/-0.4, p=0.0001) and H24 (2.6+/-0.4 versus 4.3+/-0.4, p=0.006). Numerical rating scale for satisfaction evaluation was significantly higher in the ropivacaine group (4.2+/-0.2 versus 3.5+/-0.2, p=0.004). CONCLUSION: Local ropivacaine infiltration in episiotomy and/or perineal tear reduce post-partum perineal pain within the first 24 h.

[A case of primary mediastinal germ cell tumor, successfully treated with chemotherapy and curative resection].

A 20-year-old man was admitted to our hospital because of an abnormal shadow on chest X-ray Laboratory data revealed a high serum alpha-fetoprotein (AFP) and LDH level. Percutaneous needle biopsy of the tumor suggested primary mediastinal germ cell tumor. Curative resection was performed after three courses of combination chemotherapy (cis-platinum, VP-16, bleomycin and adriamycin). A post-operative histological examination of the mass revealed total necrosis. Post-operative course was uneventful, and he has been free of recurrence for the last six months.

[Coronary reoperation--report of 16 cases].

Between January 1975 and July 1992, coronary artery reoperation was performed in 16 of 333 patients who had undergone primary bypass grafting. The interval between the operations ranged from 2 to 147 months. Reoperation was done within one year in two patients, within one to five years in five patients and after more than five years in nine patients. The mean number of bypass grafts was 2.31 per patient in the first operation and 1.75 in the reoperation. The main reasons for the reoperation were an occlusion of the graft in 12 cases and both graft occlusion and new coronary artery disease in 3 cases. In one other case, an emergency right coronary bypass graft done for an acute occlusion during PTCA to an area of right coronary artery stenosis 13 months after two bypass graftings to the LAD and circumflex coronary artery. Fourteen cases had vein graft disease bypassed to the LAD or new coronary artery disease in the LAD and required reoperations of the LAD. In the case with a recurrence of myocardial ischemia after coronary bypass surgery and with bypass grafts to the LAD that were patent, there were no cases requiring reoperation. These findings demonstrate that patency of the grafts to the LAD is an important factor for reoperation after myocardial revascularization surgery.

Maximum venous outflow and development of deep vein thrombosis.

To evaluate the relationship between maximum venous outflow (MVO) of the leg and development of deep vein thrombosis (DVT), venous occlusion plethysmography (VOP) using a Mercury strain gauge was carried out in 56 unilateral DVT patients. The data from these patients were compared with those obtained from several control groups. Then, the relationship between plethysmographic and 9 clinical variables was statistically analysed in the normal legs of these patients. The mean MVO of the normal legs of these patients was significantly higher than that of the affected legs, but it was significantly lower than those of normal controls and patients with mild congestive heart disease. However, it was similar to those in patients with lymphedema and obese men. A decrease in the MVO of the normal legs of these patients was noted in older females with femoral vein obstruction of the left leg, with a shorter number of days from the onset of symptoms or with higher values for the obesity index and calf circumference. Significant correlations between the MVO and the obesity index (r = -0.59), venous capacitance (VC, r = 0.49) and the number of days from the onset of symptoms (r = 0.40) were found in the normal right legs of these patients (n = 40). In the normal left legs (n = 16), on the other hand, significant correlations were found between the MVO and the VC (r = 0.65) and the MVO and age (r = -0.65).(ABSTRACT TRUNCATED AT 250 WORDS)

[Two cases of miliary tuberculosis following prosthetic valve replacement].

Pyrexia which occurs at late stage after prosthetic heart valve replacement must be suspected to be caused by prosthetic valve endocarditis (PVE). However, since confirmatory diagnosis is difficult, we are concerned about the treatment for so many cases. We encountered two cases who were suspected PVE at late stage after prosthetic aortic valve replacement and diagnosed miliary tuberculosis at autopsy. Here, we present a report of the two cases.

[Surgical treatment for thoracoabdominal and suprarenal abdominal aortic aneurysm].

We experienced 4 cases of thoracoabdominal and suprarenal abdominal aortic aneurysm in the last 6 months. There were 3 males and 1 female ranging in age from 43 to 66 years, 2 with an etiology of aortitis syndrome, 1 with non-specific inflammation and 1 with atherosclerosis. In all cases the modified Hardy procedure was employed. A 18 to 22mm X 9 to 11mm bifurcation, double velour woven dacron graft was sutured from the side of the lower descending thoracic aorta to the side of both common iliac arteries. Grafts of the same kind as above 6 to 7mm in size were attached from the main graft to major visceral arteries by end-to-end or end-to-side anastomosis. A permanent aortic-excluding clamp was attached to the normal aorta just proximal to the aneurysm. Another clamp, or double ligature with silk, was placed on the lower abdominal aorta or both common iliac arteries distal to the aneurysm. No renal and spinal preservation of any kind was employed, but renal failure and paraplegia were not recognized in any of the cases. One patient died 2 days and another 21 days after the operation due to uncontrollable bleeding and multiple organ failure. The other two are doing well.

[Several factors influencing the male sexual function in patients with atherosclerotic disease].

Patients with arteriosclerosis obliterans (ASO, n = 58), abdominal aortic aneurysm (AAA, n = 27) and the combined disease (n = 4) were the subjects of this study. All patients were evaluated by retrograde aortography and questioned personally as to their present male sexual function. The penile and ankle systolic pressure index (PSPI and ASPI) of patients with ASO were measured using a Doppler device, but in the patients with AAA, only the PSPI was taken. Several factors relating to male sexual function, such as, age, PSPI, ASPI, sites of the arterial occlusion or dilatation, classification of the ischemic symptoms according to Fontaine's category, numbers of pulsations of the femoral artery, were statistically analysed. All of the patients with both diseases, 66 percent of those with ASO and 52 percent of those with AAA were impotent. In the patients with AAA, the PSPI of the potent group was not significantly higher than that of the impotent group; however, in patients with ASO, the PSPI of the former group was significantly higher than that of the latter group. In the patients with ASO, a significant correlation between the PSPI and the ASPI (r = 0.49, p less than 0.01) was found. When a PSPI value (PSPI = 0,70) was chosen as a demarcation between the impotent group and the potent group, 84 percent of the patients with ASO were correctly classified. However, when the ASPI (ASPI = 0.45) was used, only 69 percent were properly classified.(ABSTRACT TRUNCATED AT 250 WORDS)

[Surgical treatment of abdominal aortic aneurysm in the elderly].

Because of the increasing longevity of man, more elderly patients of abdominal aortic aneurysm are being considered for surgical treatment. It is the purpose of this report to provide the data based on analysis of 23 patients, 70 years of age or older, compared with 26 patients, under 70 years of age, seen at our institution during the last 8-year period so that a rational decision can be made regarding abdominal aortic aneurysm operation in the elderly. Operation in the elderly group (n = 17) and in the younger group (n = 25) was associated with 5.9% and 4.0% operative mortality, respectively. Calculated actuarial survival at 5 years was 69.2% for operated elderly, 0% for non-operated elderly and 57.8% for operated younger groups. Rupture of abdominal aortic aneurysm was a high cause of death (40%) in the non-operated elderly group. Considering operative mortality, long-term survival and natural history of unoperated abdominal aortic aneurysms, our conclusion is that regardless of age of patients and size of aneurysms, operation should be recommended as a general rule for the elderly as for the younger patients.