[A new system for permanent venous access, Cathlink 20: prospective clinical study. 95 cases]. / Un nouveau système pour l'accès veineux permanent, le Cathlink 20: étude clinique prospective. A propos de 95 cas.

A prospective clinical study of Cathlink, a new venous access system, was conducted in 95 cancer patients requiring long-term venous access (three months or more). Safety and efficacy of the device were also evaluated. This single-center study was done at the Bergonié Center, Regional Cancer Control Center, Bordeaux, France, from February 1994 to June 1998. Emergency cases were excluded. All patients gave their informed consent. The protocol was approved by the Bordeaux Ethics Committee. Cathlink low and standard profile systems were implanted in the prethoracic region. The catheter was introduced into a vein of the superior vena cava system in all 95 patients. Mean number of patient days was 11,295, and mean number of days per patient was 205,3636. Of the 493 accesses, 421 (79%) were successful at the first try. As compared with conventional implantable catheter devices, flow and location were better but access was more difficult, a shortcoming that will probably be improved by use of the Cathlink 20 standard profile device. The system was perceived as providing "natural" venous access by the nurses, who are now more used to using short catheters than Huber needles. Another important consideration is the enhanced safety provided by this system (no needle recoil after removal, and therefore no risk of infection, in particular due to viral agents).

[Preventive analgesic effect of intraoperative administration of ibuprofen-arginine on postmastectomy pain syndrome]. / Effet analgésique préventif d'une administration périopératoire d'ibuprofène-arginine sur le syndrome douloureux postmastectomie.

The efficacy of preemptive analgesia on postoperative pain is discussed. From experimental neurophysiological data, the present policy of preventive analgesia aims at precluding modifications of the nervous system secondary to a nervous lesion and the appearance of chronic pain, particularly of the neurogenic kind. The post-mastectomy pain syndrome (PMPS) falls within the realm of neurogenic pain and is still poorly understood and underestimated. This study evaluated the preemptive effect of a perioperative administration of an oral non steroid anti-inflammatory, the ibuprofen-arginine, on PMPS. Thirty patients scheduled for partial or total mastectomy with axillary dissection were prospectively and randomly assigned to 2 groups. The ibuprofen-arginine group (group I) (n = 15), received an oral administration of 400 mg of ibuprofen-arginine, 90 min before surgery, 2 h after surgery and then every 8 h in the first 32 postoperative hours. The control group (group C) received in doubled blind a placebo at the same time. At 6 months, we looked after pain or dysesthesia. We confirmed the diagnosis of PMPS in presence of association of diagnosis criterias. Fourteen patients in each group have been included. Eighty-six percent of the patients (13 patients in group I and 11 patients in group C) presented at 6 months dysesthesia of the upper member ipsilateral to the mastectomy and/or the operated breast, appearing either immediately or after a laps of time. Nine patients (group I) and 6 patients (group C) had PMPS. Postoperative radiotherapy and lymphoedema were statistically associated with PMPS (p = 0.019 and p = 0.011). The perioperative preventive administration of a non-steroid anti-inflammatory drug reduces neither the incidence of pain in the first post-operative months, nor the appearance of PMPS at 6 months. These results suggest that others factors than the nervous lesion may play a role in the occurrence of PMPS, as radiotherapy, lymphoedema, but also psychosocials factors.