[Reticulated telangiectasic erythema following morphine pump implantation]. / Erythème cutané télangiectasique après implantation d'une pompe à morphine.

BACKGROUND: Reticulated telangiectasic erythema is a cutaneous complication reported after in the implementation of pacemakers and cardiac defibrillators. Here we report a case occurring after the implantation of a morphine pump. PATIENTS AND METHODS: Reticulated and pigmented telangiectasic erythema was observed at the morphine pump implantation site in a 56-year-old man presenting chronic lower back pain. DISCUSSION: To date, cutaneous telangiectasic erythema has been reported following implantation of cardiac defibrillators and pacemakers although the physiopathogenesis of the condition is poorly understood. An identical case was recently described following implantation of morphine pump, as in our case. We discuss hypotheses concerning the possible physiopathogenesis of such lesions.

Postoperative extradural analgesia in children: comparison of morphine with fentanyl.

We have compared the efficacy and side effects of extradural morphine with extradural fentanyl for postoperative pain relief. Thirty children (ages 1-16 yr) were allocated randomly to receive, after extradural administration of 0.5% bupivacaine 0.75 ml kg-1 and before surgical incision, extradural morphine 0.75 microgram kg-1 (group M), with an additional dose administered 24 h later or extradural fentanyl 2 micrograms kg-1 (group F) followed by a continuous extradural infusion (during 48 h). There was no major complication (respiratory depression). Pain scores were satisfactory in both groups for 48 h. Ventilatory frequency was greater in group M 20, 21, 22, 23 and 25 h after the beginning of analgesia (P < 0.05). Pruritus, nausea and vomiting were less common with extradural fentanyl (20% vs 53%, P < 0.05 and 0% vs 33%, P < 0.05) than with morphine. Urinary retention occurred with equal frequency (25%) in the two groups. After a bolus of 2 micrograms kg-1, continuous extradural infusion of fentanyl 5 micrograms kg-1 day-1 provided analgesia comparable to that from a daily bolus of extradural morphine 0.75 mg kg-1 and produced fewer side effects.

[The sympathetic system and chronic pain in pediatrics]. / Système sympathique et douleur chronique en pédiatrie.

Sympathetic dystrophy is defined as continuous pain in a portion of an extremity after trauma not involving a major nerve. It may be exacerbated by movement, physiotherapy or stress. There are sympathetically mediated changes with initial vasodilatation and if untreated progress to a second dystrophic stage. In 2 years 48 patients (7-17 years) were evaluated and treated by the same protocol. For the majority of cases the time from the start of pain until the time of treatment was less than 60 days. The treatment was always performed by technical procedures: i.v. regional guanethidine, long-term epidural catheter or lumbar sympathetic blocks. In case of chronic pain the role of sympathic nervous system must be debatable and it is absolutely necessary to perform a treatment such as it is not a simple technic but always a safe technic.

[Intrathecal morphine therapy in children with cancer]. / Morphinothérapie intrathécale chez l'enfant cancéreux.

Five children with cancer pain were given continuous intrathecal morphine or fentanyl infusion associated with bupivacaine 0.25% without epinephrine. The morphine daily dose varied from 0.1 mg.kg-1 to 1 mg.kg-1, the maximum daily dose of fentanyl was 0.1 mg.kg-1 associated with the same dose of intravenous fentanyl, and the maximum daily dose of bupivacaine was 1 mg.kg-1. Intrathecal treatment was started after oral and epidural morphine treatment had failed. The children were at home, under the care of several nurses and physicians. A satisfactory analgesia was achieved until demise occurred. In all children, urinary retention was the only side effect of the therapy. Therefore, intrathecal opioid and bupivacaine may be indicated after oral morphine therapy has failed in children with advanced cancer refractory pain.

[Hemodynamic effects of bathing in severe burnt patients]. / Effets hémodynamiques du bain chez le patient gravement brûlé.

Repeated water immersion is currently used in France in the treatment of severe burn injury. A prospective study was carried out to assess the haemodynamic effects of immersing such patients in a half sitting position in water, the temperature of which was kept at 35 degrees C. The burn exceeded 50% of body surface area (BSA), with at least 30% being third degree burns. The study was carried out during the first bath, three days after the injury. The patients were immersed up to the clavicles. They were sedated with 2 mg.h-1 of both flunitrazepam and phenoperidine, and were mechanically ventilated. The following haemodynamic parameters were monitored: heart rate, arterial blood pressure (the transducer being level with the arterial catheter), right atrial and pulmonary arterial pressures (the transducer being level with the right atrium, level which had been marked on the chest before immersion and placed two intercostal spaces higher after immersion because of the change in position of the heart). The cardiac output was measured using the thermodilution method. The patient's temperature was monitored with the thermistance of the Swan-Ganz catheter. Values were obtained before immersion, after 15 and 30 minutes of immersion, and 5 minutes after the end of the bath. Nine patients were included, 2 women and 7 men, aged between 24 and 45 years, weighing 73.7 kg on average. Burn size was 78% of BSA (range 64 to 95%). Water immersion was maintained for 34 +/- 3 min. The right atrial, mean pulmonary arterial, and wedge pressures, and the cardiac and systolic indices increased.(ABSTRACT TRUNCATED AT 250 WORDS)

[Intraoperative and postoperative analgesia in pediatric surgery. 1 years' experience]. / Analgésie per et postopératoire en chirurgie pédiatrique. Expérience d'un an.

Operative and postoperative analgesia has become in a few years a major concern for pediatric anesthesiologists. The fact that pain can have dramatic metabolic and hemodynamic consequences has been well documented. This study shows the activity in our department in the field of analgesia during 1989. 82% of the 2,675 children having undergone surgery have received analgesia during the operative period either by the way of an i.v. narcotic or an regional block. No morbidity or mortality resulted from these techniques during the operative period. When a regional block was prolonged by the mean of a catheter, there were no major complication (2 seizures). The use of oral, rectal and i.v. analgesics follows the classic recommendations. Morphine by all routes of administration is used increasingly in our department. Two moderate respiratory depressions occurred in 1989 due to error in dosage with no consequence for the child. The authors underline the importance of well established protocols which have been discussed and approved by all, the importance of emergency procedures and treatment, which only can guaranteed the necessary safety.

[Cephalhematoma infection in neonatal septicemia]. / Infection d'un céphalhématome au décours d'une septicémie néo-natale.

Most cephalhematomas resorb spontaneously; intervention by means of needle aspiration may introduce infection. In our case, a neonatal septicemia was associated with a large parietal cephalhematoma. The newborn was discharged after treatment of sepsis. Three days later, the diagnosis of infected cephalhematoma was apparent, associated with meningitis and septicemia. The authors discuss the physiopathology of the infection, antimicrobial therapy and careful aspiration when a serious infection is associated with cephalhematoma.

Pharmacokinetics of fosfomycin in normal and burn patients. Effect of probenecid.

The pharmacokinetics of fosfomycin are modified in burn patients, suggesting a net tubular secretion in such patients. In an attempt to verify this hypothesis, five healthy normal volunteers were studied The pharmacokinetics of fosfomycin were studied with and without probenecid. In the absence of probenecid, the renal clearance of the drug was equal to that of creatinine. With probenecid, the renal clearance of fosfomycin decreased, whereas creatinine clearance did not. This result suggests the existence of a tubular secretion, which might be enhanced in burn patients.

[Efficacy of teicoplanin in 25 cases of severe infections caused by gram-positive cocci]. / Efficacité de la téicoplanine dans vingt-cinq infections sévères a cocci Gram positif.

Teicoplanin was evaluated in 25 severe infections caused by Gram-positive bacteria alone [13], in combination [9], alone then in combination [3], in an open study. Of 22 infections that could be evaluated, there were 18 cures and improvements (81.8%), 2 recurrence and 2 failures. Serum concentrations are unpredictable and steady after 5 days i.v. teicoplanin. Trough and peak concentrations are respectively less than 5 mg/l and less than 20 mg/l in 13 infections and higher in 9, unrelated with success or failure. A trough concentration greater than CMI and kind of infection seem deciding. The choice of the antibiotic combined with teicoplanin warrant more data.

[Pharmacokinetics of pefloxacin in burn patients]. / Pharmacocinétique de la Péfloxacine chez le brûlé.

The aim of this study was to evaluate pharmacokinetics of pefloxacin (PFL) in burn patients (n = 11), compared with 5 non burned subjects. The role of the extent of the burn and the delay after initial thermal trauma were also evaluated. Our results suggest that neither the extent of the burn, nor the delay of the study play a role. Compared with non-burned subjects, burn patients exhibit a shorter elimination half-life, but modifications in dosage regimen are not required.

[Injuries of the liver in children. Review apropos of 30 cases]. / Les traumatismes du foie chez l'enfant. Revue à propos de 30 observations.

Between 1970 and 1983, 30 children have been treated for a liver trauma. 16 were from 5 to 10 years old. 6 had solitary hepatic lesions and 24 had visceral or polytraumatic associated lesions. All but one were operated and 27 underwent an emergency laparotomy. Superficial tears and subcapsular hematoma were found in 11 cases while penetrating wounds (14), vascular injuries (3) and ruptures (2) represent 2/3 of the whole lesions. In five cases, hepatectomy was necessary. Half of the 6 deaths result of a vascular injury, the others of the associated lesions. We have a resolutely surgical behavior when collapse or polyvisceral lesions are patent, while in isolated blunt injury a single clinical and echographic follow up is justified. A CT scan is necessary when a penetrating wound is suspected completed with an angiography.

Pharmacokinetics of intravenous and intramuscular methohexitone in dogs.

Twenty-four dogs received methohexitone, either intravenously injected (2 mg kg-1 of a 1% solution) or intramuscularly (10 mg kg-1 of a 2% solution). Plasma methohexitone concentrations were measured by gas/liquid chromatography and pharmacokinetics were obtained from the general equations of a multicompartment model. Peak blood concentrations were equivalent following i.v. (18.2 +/- 9.9 mg 1(-1); at 30 s) and i.m. (19.1 +/- 5.6 mg 1(-1); at 3 min) injections. After i.v. injection a rapid distribution phase (half-life t 1/2 lambda 1; 1.3 +/- 0.5 min) was followed by an elimination phase (elimination half-life t 1/2 lambda z; 26.4 +/- 7.8 min). After i.m. injection the distribution phase was followed by two further phases (half-lives: 10.1 +/- 3.6 min and 75.6 +/- 22.6 min). The authors conclude that an i.m. dose five times as great as the i.v. dose produces equivalent peak blood concentration 30 s after i.v. injection and 3 min after i.m. injection. In addition, after i.m. injection of 10 mg kg-1 an additional compartment was apparent, indication substantial drug uptake by poorly perfused tissues.