[Statins and anesthesia: dilemma or obviousness? Is there still room for withdrawal of chronic statin therapy before surgery?]. / Statines et anesthésie: dilemme ou évidence? Faut-il arrêter ou poursuivre le traitement par statines avant une intervention chirurgicale?

Due to their action on the low-density lipoprotein-cholesterol (LDL-Cholesterol), statins efficiently take part in the treatment of coronary artery disease (CAD). Moreover, they exert various effects (called "pleiotropic") independently of their lipid lowering actions. All of these effects interact with inflammation, thrombosis and vasoconstriction during the perioperative period. However, statins may also increase the risk of rhabdomyolysis, a rare but potentially lethal complication. In this article, we will describe the advantages and disadvantages of statin therapy during the perioperative period. Although in the past, withdrawal of statins was recommended before anesthesia, there is now evidence that statins must be continued or even must be introduced before surgery. We will try to identify relevant situations were statins are still under-prescribed before surgery.

[Perioperative tobacco cessation: a crucial period to overcome clinical inertia and poor compliance]. / Sevrage tabagique en préopératoire: une période propice pour lutter contre l'inertie et le défaut d'observance.

Smoking concerns 30% of the patients scheduled to anesthesia. Tobacco is one of the most important risk factors for postoperative complications. There are two classes of complications: those induced by the smoking habits on the cardiovascular and the respiratory systems, and those that predispose to other complications by direct interference with processes required for the success of surgery: healing and immune responses. The preoperative period represents a crucial period to overcome clinical inertia and profit of a better compliance. Some strategies applicable by the general practitioner and the anesthesiologist during the preoperative consultation to establish smoking cessation and help the patient to comply with are proposed.

[Intra-osseous and intra-articular cyst of the knee. Apropos of a case associated with osteochondritis dissecans]. / Kyste synovial intra-osseux et intra-articulaire du genou. A propos d'un cas associé à une ostéochondrite disséquante.

Subchondral bone cyst, intraarticular synovial cyst, and osteochondritis dissecans arising together are analyzed: this association has so far not been reported. If we accept the theory of a mechanical origin for subchondral bone cysts (leakage of joint fluid or intrusion of the synovial membrane through a breach in the cartilage), then the osteochondritis certainly provided the port of entry that allowed formation of the intraosseous synovial cyst in this patient.

Acutely symptomatic benign mediastinal cysts.

Usually, cystic mediastinal masses are considered as benign. However, the size of the cyst is of importance, chiefly in a closed space such as the superior mediastinum. Rarely a dramatic symptomatology may develop though this was the case in the two patients we describe, who were admitted in the department. In the first case (a parathyroid cyst), the symptoms were due to a thrombosis of the left innominate vein, and in the second case (a thyroid cyst), the severity was dominated by a dramatic compression of the trachea and the vessels. The contribution of computed tomography is nowadays undisputed. It enables the diagnosis of the cystic nature before surgery. The diagnosis can easily be confirmed by percutaneous drainage.

Paramedian approach of the peridural space in obstetrics.

A retrospective study was carried out, in 1010 women during labour, to compare the midline and paramedian approaches to the peridural space. The success rate at the first attempt was slightly higher in the paramedian group (98%) than in the midline group (94.5%). The main reasons for failure were the inability of threading the catheter (34%) and the venous cannulation (24%); they are far more frequent via the median route. The incidence of paresthesias, while introducing the catheter, was definitely higher in the midline approach (48%) than in the paramedian one (24%).