[Anesthesia for video-assisted surgery of the thoracic and lumbar spine: a survey of 44 patients]. / Anesthésie pour chirurgie vidéoassistée du rachis thoracolombaire.

INTRODUCTION: The development of video-assisted surgery of the dorsolumbar spine has led to the need for adaptations for appropriate anesthetic management. Data concerning anesthesia for such surgery is very sparse in the literature. AIM OF THE STUDY: The aim of this retrospective study of 44 patients was to learn more about anesthesia practices used for patients undergoing this type of surgery. PATIENTS AND METHOD: The files of 44 patients were studied retrospectively. Epidemiologic data and the perioperative phase were analysed. RESULTS: The preoperative phase was not specific with preoperative assessment adapted to each patient. Similarly, monitoring practices during the surgical procedure were not specific. The choice of the anesthetic agents depended on the patient's clinical status. For tracheal intubation, care was taken to enable lung exclusion, even if not often used. Thoracic drainage at the end of the surgery was required in the event of imperfect hemostasis and in selected patients was replaced by pneumothorax exsufflation during closure. The postoperative period was uneventful and did not require admission to intensive care; non-specific analgesia was used. DISCUSSION: Adaptations of anesthetic practices are required each time a new surgical technique is developed. Excepting lung exclusion, anesthesia for video-assisted dorsolumbar spine surgery is not specific.

[Risk assessment before non-cardiac surgery: what do anesthesiologists expect from cardiologists?]. / Evaluation du risque cardiologique en vue d'une anesthésie pour une chirurgie non cardiaque: qu'attend le médecin anesthésiste-réanimateur de la consultation spécialisée auprès d'un cardiologue?

Patients with a cardiac pathology are at high risk of perioperative cardiac complications. Therefore, an evaluation of the cardiac risk before a non-cardiac surgery has to be performed. The importance of the risk depends on the type of surgery, the patient's clinical symptoms and his adaptation to a physical effort. Exams are chosen according to the pathology, the information searched for and should be non invasive. After the evaluation, a specific preparation of the patient and the institution or an adaptation of cardioprotective medications should be discussed. The cardiologic consultation also allows a better management of antithrombotic or antiplatelet therapy. Preoperative evaluation of the cardiac risk is based on the collaboration between cardiologist and anesthesiologist to select the patients to evaluate, optimize their management, and decrease the risk of complications.

[Determination of 3-methoxy-4-hydroxyphenyethylene-glycol and its urinary conjugates. Value in the diagnosis and therapeutic follow-up of depression]. / Dosage du méthoxy-3-hydroxy-4-phényléthyléne-glycol et de ses conjugués urinaires. Intérêt dans le diagnostic et le suivi thérapeutique des dépressions.

In psychiatric illness like depression, difference is essential between noradrenergic and serotoninergic sources. Therefore the measurement of urinary excretion of MHPG (3-methoxy-4-hydroxy-phenylethylene-glycol) is interesting, because MHPG seems to be the best reflect of central noradrenergic activity. Analytical assay of MHPG includes an enzymatic hydrolysis and an extraction by ethyl acetate. Separation is conducted by HPLC with fluorometric detection for MHPG and VMA, and electrochemical detection for 5-HIAA, which measurement is simultaneous. Quality control is evaluated (detection limit, linearity, precision, reproducibility, hydrolysis and extraction efficiency). Control values of 15 healthy subjects are 18.9 +/- 8.0 mumol/24 h of total MHPG, 1.5 +/- 1.0 of free MHPG, 8.5 +/- 2.0 of sulfate, and 10.7 +/- 4.4 of glucuronide MHPG (m +/- 2 sigma). In our study on depression, the best biological witness seems to be the sulfate-MHPG: in 16 depressed patients without treatment, its rate is very lowered (1.2 +/- 1.2 mumol/24 h). Total and glucuronide MHPG decrease weaker than sulfate (respectively -51% and -65%), while free MHPG increases (+ 193%) versus controls. Urinary VMA and 5-HIAA, peripheric catabolites of respectively adrenalin and serotonin are not significantly altered. There is no correlation neither between urinary sulfate-MHPG and scale evaluation before treatment, nor between urinary sulfate-MHPG and clinic improvement after antidepressive treatment. At last, the association clomipramine + mianserine shows a clinic improvement faster than clomipramine only, although no significative difference appears in biological markers.

[The effects of Triton WR 1339 on the secretion of bile lipids in the rat]. / Effets du Triton WR 1339 sur la sécrétion des lipides bilaires chez le rat

Rats bearing a biliary fistula received i.v. a solution of Triton WR 1339. Bile and plasma lipid composition was studied every 2 hrs and compared to that of control rats injected with saline. Two hours after Triton injection a sharp decrease in the bile secretion of lecithins (-- 93%), cholesterol (-- 50%) and bile salts (-- 50%) was observed together with a fall in bile flow (-- 20%). Eight hours after Triton administration the biliary output of lecithins, cholesterol and bile salts was lowered to --73%, --50% and --34% respectively compared to control animals. At that time an accumulation of L.C.A.T. substrates (lecithins and cholesterol) was observed in the plasma of Triton group. These modifications of biliary lipids after inhibition of L.C.A.T. activity by Triton W 1339 could be the result of a decreased production of plasma lysolecithins and cholesterol esters suggesting that both lipids could be important precursors for the synthesis of bile constituents. Furthermore this support the view that the production by the liver of plasma and bile lipids follows two distinct pathways.