[Analgesic effect of continuous intravenous nefopam after urological surgery]. / Effets analgésiques de l'administration intraveineuse continue de néfopam après chirurgie urologique.

OBJECTIVES: To evaluate the efficacy of continuous infusion of nefopam. Indeed this analgesic is commonly used by continuous infusion by many anaesthetists to reduce its adverse effects. However whether the analgesic effect of an intermittent administration of nefopam has been proven, the efficacy of continuous infusion has not been established. STUDY DESIGN: Double-blind placebo controlled prospective randomised study. PATIENTS AND METHODS: Sixty patients ASA 1 to 3 undergoing planned urological surgery with laparotomy were included. At the end of surgery, bolus doses of placebo (Group 3) or nefopam 20 mg (Group 1 and 2) were administered to all the patients. Placebo (Group 3), nefopam 80 mg (Group 1) or 120 mg (Group 2) was thereafter continuously infused over 24 hours. All patients received additional analgesia with PCA morphine. We measured pain at rest and on cough with VAS. Adverse side effects such as nausea and vomiting, sedation and respiratory depression were evaluated. Mental performance was measured with mini mental status tests. RESULTS: Patients were older in the placebo group by approximately six years but anesthetic and surgical variables were not different between groups. Pain at rest and on cough was not statistically different between groups. In the placebo group, the median (interquartile range) morphine consumption reached 29 mg (13-53) whereas in patients receiving 80 and 120 mg nefopam, it levelled to 44 mg (11-54) and 35 mg (9-82) respectively (p > 0.05). Patients needed morphine during the same time period whether they received nefopam or not. Patients suffering from adverse effects were similar between groups. CONCLUSION: In this study, continuous administration of nefopam did not reduce morphine consumption nor ameliorate analgesia and thus may not be recommended in urological surgery. Nefopam pharmacokinetics when used with continuous infusion as well as surgery types and differences in age between groups may explain these results.

Pharmacokinetics of propofol and its conjugates after continuous infusion in normal and in renal failure patients: a preliminary study.

The pharmacokinetics of propofol, 2,6 diisopropylphenol, were compared in 6 end-stage renal failure patients aged 66.3 +/- 12.1 years and in 5 normal patients aged 45.5 +/- 13.5 years. Anesthesia was induced with propofol (2 and 2.5 mg.kg-1 respectively) and fentanyl (0.1 mg). Anesthesia was maintained with propofol (9 and 10 mg.kg-1 x h-1 respectively). Patients breathed spontaneously a 50 per cent oxygen in nitrous oxide mixture. Two ml blood samples were taken during anesthesia and at regular intervals until up to 24 hours after infusion. Plasma levels of propofol were determined by HPLC with electrochemical detection. Propofol conjugates were determined after hydrolysis with beta glucuronidase or HCl. Results were expressed as median [lower-upper percentiles]. Propofol clearance (1.53 [1.02-2.10] L.min-1 x kg-1 versus 1.65 [1.39-1.78] L.min-1 x kg-1 in normal patients), and half-lives elimination were not modified by renal failure. Renal failure patients exhibited a higher volume of distribution at steady state as compared to normal patients (19.28 [11.71-76.81] L.kg-1 versus 8.60 [6.58-9.81] L.kg-1, p < 0.05). Renal failure did not affect the production of conjugates but they accumulated in blood of renal failure patients. Despite this, no difference in time to eyes opening and propofol concentration were observed, confirming the absence of clinical effect of these metabolites.

[Acute pancreatitis and viral hepatitis A. Report of a case]. / Pancréatite aiguë et hépatite virale A. A propos d'un cas.

We are reporting the case of a patient with acute pancreatitis associated with viral A hepatitis with satisfactory recovery. To our knowledge, two similar cases have been reported.

[Cholestatic viral hepatitis A with hepatic portal adenopathy]. / Hépatite virale A cholestatique avec adénopathies pédiculaires hépatiques.

The authors report a case of type A viral hepatitis in an 8 year old boy in whom the clinical course was marked by prolonged cholestasis associated with porta hepatis lymphadenopathy. The positivity of anti-HVA IgM, the negativity of the other serodiagnostic tests, the parallel course of the hepatitis and the porta hepatis lymphadenopathy argus strongly in favour of the responsibility of hepatitis A in the development of this porta hepatis lymphadenopathy.

[Spinal anesthesia and morphine analgesia in prostatic surgery]. / Rachianesthésie et analgésie morphinique dans la chirurgie prostatique.

The authors compare the effects of either 0,5 or one milligram of intrathecally injected morphine on the post-operative course of 45 patients scheduled for transvesical prostatectomy. The patients were randomly assigned to three groups. Group A patients served as reference and were anesthetized by intrathecal injection of prilocaine 100 mg. Group B and C patients underwent the same anaesthetic procedure but prilocaine was injected simultaneously with either 0,5 (B) or one milligram (C) of morphine. Group A patients experienced postoperative pain for eighteen hours and requiring a mean subcutaneous dose of 20 mg of morphine. B and C patients had a satisfactory degree of analgesia. Nevertheless, there was a statistically significant difference of analgesia scores between groups C and B. The group C patients remained free of respiratory impairment. One mg of intrathecal morphine seems optimal for analgesia after prostatectomy.

[Cancer of the prostate revealed by hemospermia in a young man]. / Cancer de la prostate révélé par une hémospermie chez un homme jeune.

The authors report a case of prostatic cancer in a 50-year-old patient, for which the sole clinical manifestation was recurrent hemospermia. There was an undoubted connection, in this case, between the hemospermia and the cancer, which is rare. The treatment was endoscopic associated with cobalt therapy. The follow-up is four years.

[Continuous peridural morphine analgesia in refractory pain in urology]. / Analgésie péridurale morphinique continue dans les douleurs rebelles en urologie.

Peridural catheterization connected to a sub-cutaneous morphine reservoir can provide an effective and prolonged analgesia for certain pelvic pains of a urological origin which resist the usual sedative therapies. The authors describe the method of catheterization and the results which they have obtained in five patients treated in this way.

[Scanography of the femoropatellar space. Study plan (author' transl)]. / Examen scanographique du défilé fémoro-patellaire. Schéma d'étude.

A theoretical plan for scanographic study of the femoropatellar space is proposed, based on the examination of 60 normal knees. The investigation is conducted at 15 degrees and is adapted to the morphology of the femoropatellar space, with the assistance of a "Scout view". Patellar rolling is evaluated before and after quadriceps contraction during indifferent and external rotation. The spatial resolution of the new apparatuses and the adaptation of the plane of the section should permit valid study of the femoropatellar articular cartilages. The operative decision should be based on both the results of scanography and clinical examinations.

[Restraint during craniocerebral scannography. A new method of restraint for the newborn and infants (author's transl)]. / Contention en scanographie crânio-encéphalique. Une méthode nouvelle de contention chez le nouveau-né et le nourrisson.

A newly designed apparatus for head restraint, adapted for the newborn and infants, can frequently avoid the administration of a general anaesthetic during craniocerebral scannography examinations. The infant is placed in a block of expanded polystyrene, ensuring both restraint and maintenance of an isothermic regimen.