[Is home thrombolysis of myocardial infarct realistic?]. / La thrombolyse à domicile de l'infarctus du myocarde est-elle réaliste?

Based on a 19-month experience of intravenous thrombolysis performed at home during the acute phase of myocardial infarction, we feel it is a realistic procedure, since it did not result in too many unnecessary calls: in 648 calls which seemed attributable to a coronary emergency by the Emergency Medical Services, this diagnosis was ruled out in 119 instances (18.4%) and confirmed in 529 instances (81.6%); diagnostic errors were not too frequent: 3.8 p. cent of false positive and 5.8 p. cent of false negative; it was not very hazardous: one death only from cardiogenic shock; it permitted to save time by decreasing by 30 minutes the start of the treatment; it avoided excessive costs by using already established structures.

[Thrombolysis in the pre-hospitalization phase of myocardial infarction]. / La thrombolyse à la phase préhospitalière de l'infarctus du myocarde.

In myocardial infarction (MI), the sooner thrombolysis is performed, the greater the chances of it being effective. We report a 19-month experience (July 1, 1986 to December 31, 1987) of thrombolysis performed at home prior to hospitalization by an organization called SOS Myocardial Infarction (SOS MI). Method. Throughout 24 hours, any patient may call by telephone a doctor attached to SAMU 13. If the doctor suspects a coronary emergency, he sends to the patient's home the SOS MI team (1 doctor and 1 nurse) in a medically-equipped ambulance. The diagnosis of MI is made on the finding of a nitroglycerin-resistant chest pain of more than 30 minutes duration associated with a more than 2 mm elevation of the ST segment on at least two electrocardiographic leads. Patients aged under 70 and in whom thrombolytic drugs are not contra-indicated are then treated intravenously with either streptokinase (1.5 million units over 30 min) or the tissue plasmogen activator (10 mg followed by a 90 mg infusion over 90 min). Results. During the 19-month period, 648 coronary emergencies were suspected from data given by telephone. The diagnosis made by the SOS MI doctor was non-coronary chest pain in 119 cases (18.4 p. 100), angina pectoris in 211 cases (32.6 p. 100).(ABSTRACT TRUNCATED AT 250 WORDS)

[Pulmonary edema after laryngospasm]. / Oedème pulmonaire après laryngospasme.

A case is reported of rapidly resolving pulmonary oedema following post-extubation laryngospasm in a 23 year-old healthy man who underwent emergency resection of a rectal polyp. The laryngospasm occurred immediately after extubation and resolved after administration of curare. The patient was reintubated and auscultation disclosed bilateral coarse and moist rales. Chest X-ray displayed a right pulmonary opacity. Because of the deteriorating respiratory status, mechanical ventilation was used with positive end-expiratory pressure for 18 h. Chest examination, chest X-ray and arterial blood gas levels improved steadily and the patient was discharged 24 h later. Pulmonary oedema associated with upper airway obstruction seems to be related to hypoxic pulmonary vasoconstriction and the largely subatmospheric transpulmonary pressure gradients generated while trying to breathe against a closed glottis. In addition, this increased negative intra-alveolar pressure was responsible for significant changes in cardiovascular function: right ventricular blood volume, right ventricular ejection fraction and left ventricular after-load increased, while left ventricular ejection fraction decreased. These changes favoured a rise in left atrial and pulmonary blood volumes, with transudation of fluid from the capillaries into the alveoli. Because of the severe consequences of respiratory failure, any patient who suffers acute upper airway obstruction should be observed in the recovery room for at least 3 h in order not to miss this rarely developing, but fortunately rapidly reversible, syndrome.

[Failure of gastric lavage in severe drug poisoning. Value of esophagogastric fibroscopy]. / Echec du lavage gastrique dans une intoxication médicamenteuse grave. Intérêt de la fibroscopie oeso-gastrique.

A case is reported of massive drug self-poisoning (more than 200 pills associated with slices of oranges) in which repeated gastric lavage failed to empty the stomach. An attempt to split up the amalgamated pills, adherent to the gastric mucosa, by fibre-optic gastroscopy failed and a gastrotomy was required. Endoscopy together with gastric lavage is indicated in certain situations to quickly empty the stomach and so shorten the course of the poisoning. Indications are the large number of pills swallowed, a poor result of the treatment, a worsening of the clinical condition despite treatment, and three positive gastric toxicological assays within the first 24 h.

[Is the use of lidocaine in spray form permissible during intubation?]. / L'usage de la lidocaïne en "spray" est-il licite lors de l'intubation?

The use of local anaesthetic in spray form for anaesthesia of the trachea before intubation may be the cause of changes in the wall of the balloons of endotracheal tubes. The direct application of the mixture freaon + alcohol + lidocaine to the wall of the balloon of different tubes does in fact result in appearance of herniations or fissures, explaining certain problems which have up to now imputed to the material used. It is therefore emphasised that the technique of local anaesthesia of the trachea must be carried out using material and products designed for the purpose.

[Replacement solutions and hemodilution]. / Solutés de remplissage et hémodilution.

By definition, haemodilution involves the use of filling solutions, but in this technique the role of different solutions has yet to be clearly defined. Amongst the criteria of choice used at the present time, two would seem to be essential: good tolerance, limiting the risks of complication and side effects to an absolute minimum; and a sufficiently long intravascular half-life ensuring good control of blood volume. On this basis, amongst the crystalloids Ringer lactate offers definite advantages. It is almost always used in association with a colloidal solution, very often human albumin or a dextran.

[Hemostatic disorders in septicemia. Apropos of 65 cases]. / Les troubles de l'hémostase dans les septicémies. A propos de 65 observations

In the course of a restrospective study, some hemostatic parameters were studied in connection with 65 cases of septicaemia. From this study, it follows that coagulation troubles are more frequent in septicaemiae induced by negative Gram germs, but that this frequency is actually linked with circulatory troubles. Besides, as for the biological diagnosis of the disseminated intravascular coagulation syndrome in this instance, it is not possible to take strictly into account the fibrinogen values or the rate of thrombocytes.

[Dopamine and shock. Preliminary clinical study of 7 cases]. / Dopamine et choc. Etude clinique préliminaire à propos de 7 observations

Seven patients presenting a state of shock were treated with dopamine. The authors remark an undeniable effect on arterial pressure which rises again and on the diuresis.

[Criteria for reoperation in abdominal surgery (exclusive of surgical and nephrological criteria)]. / Les critères de réintervention en chirurgie abdominale (en dehors des critères chirurgicaux et néphrologiques)

In summary, 40 p. 100 of 104 reinterventions carried out in 71 patients from the Resuscitation sector were decided upon in the absence of surgical and nephrological criteria. The authors emphasize the value of the infectious syndrome (74 p. 100 of the cases), of water and electrolyte disorders (60 p. 100 of the cases), and of hypercatabolism (83 p. 100 of the cases).

[Infectious problems in reoperations in abdominal surgery. Apropos of 104 operations]. / Problèmes infectieux dans les réinterventions en chirurgie abdominale. A propos de 104 interventions

Analysis of the problems with infection in a series of 104 reinterventions, enables one to accentuate the importance of infestation from intraperitoneal foci (70 p. 100 of the cases). Extra-peritoneal entry pathways are difficult to prove. Septicemia is found in one out of every three cases. In certain cases, preventive treatment of the extra-peritoneal entry pathways must be opposed to the effectiveness of the surgical act in the eradication of septic foci.

[Prognostic factors in reoperations in abdominal surgery. Apropos of 104 operations]. / Facteurs pronostiques dans les réinterventions en chirurgie abdominale. A propos de 104 interventions

Analysis of the prognostic factors in abdominal surgical reinterventions accentuates the disparaging character of age, associated defects and emergency. Intercurrent respiratory complications, as well as infectious and renal complications make the prognosis considerably worse.

[Evaluation of 1200 venous catheterizations in reanimation]. / Bilan de plus de 1200 cathétérismes veineux en réanimation

The authors present a series of 1247 venous catheterizations during resuscitation, the latter being carried out under particularly strict aseptic conditions. This series contains especially: - 364 internal jugular catheterizations; - 223 subclavian catheterizations; - 130 femoral catheterizations. The total number of days of infusion is 6300, of which 3,619 were of prolonged parenteral feeding. 79.5 p. 100 of the catheters cultured proved to be sterile; in the case of those cultures which were positive, 6.5 p. 100 were due to pathogenic organisms, 13.9 p. 100 were due to saprophytes. On the whole, 7 septicemies of venous origin (0.56 p. 100 of all of the catheterizations) were observed. The détailed study of each route shows that the frequency of cultures of pathogen positive catheters is practically the same in all cases. On the other hand, the frequency of cultures of catheters positive with saprophytes is evidently higher for the internal jugular vein; this being particularly true in the male where the role of the beard as a contaminating factor is evoked. The importance of asepsis in the procedure of putting venous catheters in place and in their maintenance seems to be welle demonstrated by the results presented.