[Multidisciplinary approach to pain and institution of analgesic treatment]. / Approche multidisciplinaire de la douleur et mise en place d'un traitement antalgique.

Pain is a complex sensory response to tissue damage but also mental functioning. Patients with chronic pain require an interdisciplinary model of care after a careful evaluation and understanding of pathophysiology. Therapy may include medications, nerve blocks and behavioural interventions.

[Celiac plexus block: value of x-ray computed guidance]. / Bloc coeliaque: intérêt du guidage tomodensitométrique (TDM).

Celiac plexus block is a good alternative of pain treatment in upper abdominal pain. Neurolysis of the celiac plexus by the percutaneous posterior route used CT guidance in 8 patients. Pain relief was obtained in 5 of 7 patients (70 per cent); no complication occurred.

[Postoperative cervicofacial subcutaneous emphysema]. / Emphysème sous-cutané cervico-facial post-opératoire.

Two cases of post-operative subcutaneous emphysema are reported. After excessive airway pressure, air or anaesthetic gases may spread to the neck, mediastinum, abdomen or pleural cavity. Pathogenesis and mechanisms are discussed. Possible aetiologic factors are outlined. The consequences of this condition are limited after adequate emergency treatment.

Visceral revascularization by anastomosis between the left renal and Drummond's marginal artery.

Drummond's marginal artery was revascularized by anastomosis with the left renal artery in two patients with visceral ischemia due to occlusion of the celiac and superior mesenteric arteries. In this manner, the authors avoided entering an infected abdominal cavity, interposition bypass and aortic clamping. In both cases, visceral arterial supply was improved. In one case, a left renal steal syndrome was observed. Because of possible renal involvement, indications for this technique should be carefully chosen.

Catheter obstruction during prolonged parenteral alimentation. Are lipids responsible?

Catheter obstruction is a serious incident during prolonged parenteral nutrition (PN). This retrospective study was carried out in order to compare the frequencies of catheter obstruction with nutritive mixtures in bags according to whether or not lipids were mixed with the entire 24 h nutritional supply (Group I, n=33) or infused separately (Group II, n=30). Our results show that obstructions are significantly more frequent in Group I (11 13 ) than in group 2 (3 10 ), appearing within a mean interval of 29 days after inserting the catheter. The global percentages of patients undergoing cyclic PN were the same in both patient groups. In group I, however, the percentage of patients on cyclic PN was significantly higher for the obstructed catheters (100%) than for the unobstructed catheters (59%). In conclusion, the mixture of lipids with the remainder of the nutrients in the conditions of this study is the prime cause of catheter obstruction, although the exact mechanism is not elucidated. The role of cyclic PN appears to be accessory.

[Prevention of the thromboembolic risk during the operative period in a patient with a congenital antithrombin III deficiency]. / Prévention du risque thrombo-embolique en période opératoire chez une patiente atteinte d'un déficit congénital en antithrombine III.

The case of a woman with congenital antithrombin III (AT III) deficiency undergoing elective hysterectomy is reported. AT III deficient patients have high risks of thromboembolic disease, especially developing during and after surgery. It is usual practice to discontinue oral anticoagulants with antivitamin K activity and to obtain effective AT III activity by the transfusion of freeze-dried concentrates of AT III and/or fresh frozen plasma (FFP). Heparin is prescribed as soon as AT III activity reaches 70%. The oral anticoagulant regimen is reinstituted in the late postoperative period. In our case, transfusion of FFP, in the pre- and postoperative periods, results in an AT III activity of 63%. Heparin was not used because oral anticoagulants were readministered early, 12 h after operation. No clinical thrombo-embolic complication was observed.

[Value of per-operative measurement of the blood flow in vascular surgery (author's transl)]. / Intérêt de la mesure per-opératoire du débit en chirurgie artérielle restauratrice.

Post-operative thrombosis in vascular surgery results from either technical error of deficient arterial outflow and can be avoided by checking, during the operation, that the new circulatory conditions created are adequate. Among the most frequently used control methods arteriography occupies a prominent place but requires a sophisticated equipment to be truly reliable. Per-operative measurement of the blood flow is much simpler. It objectively assesses the haemodynamic value of the arterial reconstruction and provides useful information on the short-and medium-term patency of the vessels.

[Traumatic chylothorax with dorsal spinal fracture. A case report (author's transl)]. / Rupture du canal thoracique et fracture du rachis dorsal. A propos d'un cas.

We related there a traumatic chylothorax due to a thoracic vertebral fracture. It has been recognized at the 13st day, after a lost of 11 liter of lymph and a down of albuminemia by lymphography. The direct ligature has been only partly successful leaving still a tiny lymph leak during a fortnight.

[Acute dyspnoea by acute thyroid abscess (author's transl)]. / Dyspnée aiguë par thyroïdite aiguë suppurée.

Infection is extremely rare in the pathology of the thyroid gland. One case is reported, and a review of the literature has helped to emphasize some specific points. Acute thyroiditis can be misdiagnosed in its initial phase because a fever by itself may not lead to a through examination of the neck, even if a goitre is present; the latter being the site of infection in the case reported. Dyspnoea of laryngeal origin proves to be a dangerous complication of thyroid abscesses. Treatment is always surgical, linked with appropriate antibiotic therapy. In the long run, thyroid function is unaffected.

When can revascularization be limited to the profunda femoris alone?

Dealing with lower limbs arteriopathies with combined aorto iliac and superficial femoral occlusive diease and when ischemia leads to operation should an extension bypass to the popliteal or tibial artery be associated every time it is possible? The authors have investigated the results of revascularizing operation above the profunda femoris on 35 limbs (27 patients). On 19 limbs only, has the revascularization been sufficient to cure the distal ischemia. On the other 16 limbs, a second operation was necessary 7 times an extension bypass to the popliteal or tibial artery, once an above knee amputation, twic a below knee amputation. From the comparison of these results with the degree of ischemia and the arteriographic aspect of the profunda femoris, the author's conclusion is that revascularization must extent below the profunda femoris unless the profunda is in good condition and there is no rest ischemia.