[Anaphylactoid shock during intravenous urography. Possible interaction between complement and fibrinolytic systems (author's transl)]. / "Choc anaphylactoïde" au cours d'une urographie par voie veineuse. Interférence possible entre les systèmes complémentaire et fibrinolytique.

Shock associated with deep coma was induced by an injection of methylglucamine iodotalamate for descending urography to a 56-years old man without any history of atopy. Under intensive care the acute symptoms were controlled, and consciousness returned to a normal level within 15 days, but the patient remained with right-side monoplegia. Biological investigations showed a fall in total haemolytic complement (CH50) and in C1, C4, C2 and C3 components, as well as in B-factor. Acute fibrinolysis and hypocalcaemia were also present. Two main mechanisms seem to be responsible for the accident : intolerance to the drug, with direct activation of the complement and fibrinolytic systems ; and an immuno-allergic reaction where the contrast medium behaved like an hapten, which became antigenic in the body.

[Randomized controlled clinical trials with barbiturate treatment after cardiac arrest in the United States. Ethical and medicolegal aspects (author's transl)]. / Essais aléatoires cliniques des barbituriques dans le traitement de l'arrêt cardiaque aux Etats-unis. Aspects moraux et légaux relatifs.

Brain protection during ischemia by barbiturates has been clearly demonstrated in many different experiments. Only recently the therapeutic value of large doses of thiopental administered early after cerebral circulatory arrest has been demonstrated experimentally in monkey. Noncontrolled studies in humans also indicate beneficial effect, however the treatment is not without potential complication. Controlled randomized studies in humans are needed to document its beneficial effect. Such studies have several unique medico-legal and ethical implications since the treatment has to be started in an unconscious patient and as early as possible after a totally unexpected cardiac arrest. Informed consent, ethical and medicolegal consideration of randomized controlled clinical trials is discussed and a modified approach to clinical trials in humans is suggested. The modification would not alter the scientific value of the studies, but resolve the ethical and medico-legal problems.

[Pathogenesis and treatment of anoxic encephalopathy. Definition and importance of experimental animal models (author's transl)]. / Pathogénie et traitement de l'encéphalopathie anoxique. Définition et utilité des modèles expérimentaux animaux.

A reproducible noninvasive monkey model for global brain ischemia with exact insult (no flow x 16 min) to the brain, with survival and with standardized preischemic, ischemic and postischemic variables is described. This model allowed us to demonstrate for the first time: 1) that a substantial part of brain damage early postischemia is reversible and amenable especially to barbiturate treatment; 2) that the postischemic brain shows increased vulnerability for additional insults. Optimal postischemic intensive monitoring and immobilization for 24-48 hours is important for improved outcome; 3) that immediate postischemic reperfusion pressure (MAP 110-150 mm Hg) significantly improves the outcome; 4) that heparinisation during ischemia has no protective effect and 5) that postischemic heparinisation and intravenous hemodilution does not ameliorate the outcome. The protective effect of trimetaphan against neurogenic pulmonary edema can be explained by the prevention of pulmonary hypertension but its protective effect on the development of secondary cerebral edema has to be elucidated.