[IgE allergy due to formaldehyde paste during endodontic treatment. Apropos of 4 cases: 2 with anaphylactic shock and 2 with generalized urticaria]. / Allergie IgE dépendante au formol de pâte canalaire lors du traitement endodontique. A propos de 4 cas: 2 chocs anaphylactiques et 2 urticaires généralisées.

We report 4 cases of allergic reaction to formaldehyde-containing root canal sealant after endodontic care: 2 anaphylactic shocks and 2 local reactions with generalized urticaria. Allergic IgE mediated mechanisms were suggested by the clinical presentation, skin tests and high levels of anti-formaldehyde IgE. These infrequent but potentially severe reactions after canal treatment led us to examine the involved mechanisms, the diagnostic procedure and the possibility of prevention in odontostomatology.

[Bilateral subdural hematoma following epidural anesthesia]. / Hématome sous dural bilatéral après analgesie péridurale.

PURPOSE: The authors report a case of bilateral subdural hematoma (SDH) which occurred following epidural analgesia for labour, complicated by post dural puncture headache (PDPH). Physiopathological mechanisms are discussed. CLINICAL FEATURES: A 27-yr-old woman displayed typical PDPH following epidural anaesthesia. On the fifth day she was given a blood patch (BP) which proved immediately effective. Further developments were marked by late recurrence of PDPH and by administration of a second BP on the 24th day. With the aggravation of the headaches, the disappearance of their postural nature and with the appearance of transitory focal neurological signs on the 30th day, a CT-Scan was done and showed bilateral subdural haematoma. Following surgical drainage, the patient made an uneventful recovery. CONCLUSION: The presence of PDPH complicated by a typical neurological deterioration should prompt the anaesthetist to seek an immediate clinical and x-ray diagnosis in order to look for the existence of intracranial complications.

[Anesthetics responsible for anaphylactic shock. A French multicenter study]. / Substances anesthésiques responsables de chocs anaphylactiques. Enquête multicentrique française.

Combined allergological and anaesthetic consultations have been started in the last few years in eight French Teaching Hospitals so as to explore peranaesthetic anaphylactoid shocks. A survey was carried out in these centers in order to collect patients investigated with the same protocol, for the assessment of the incidence of anaphylaxis in France, as well as the involved drugs. Investigations were always carried out at least 6 to 8 weeks after the accident. The tests used to diagnose IgE-dependent anaphylaxis were skin tests (prick and intradermal tests, carried out in all eight centers), the radioimmunological assay of specific anti-quaternary ammonium IgE, together with an inhibition test with thiopentone and propofol (six centers), leukocyte histamine release (five centers) and human basophil degranulation tests (three centers) for those drugs for which no specific antibody assay exists. The collected data involved 1,240 patients, investigated within the last four years. Anaphylaxis was diagnosed in 821 patients (66.2%). Muscle relaxants were responsible in 668 cases (80% of cases of anaphylaxis). Suxamethonium was the main cause (54.3% of shocks due to muscle relaxants), followed by vecuronium (15.3%). General anaesthetics (hypnotics and benzodiazepines) were responsible for 9.2% of all cases of anaphylaxis opioids for 2.6%. There were only three cases of shock due to local anaesthetic agents. Latex and ethylene oxide are becoming increasingly involved. It would therefore seem mandatory to carry out after any anaphylactoid accident an assessment with sensitive and specific tests for anaphylaxis. Diagnosing anaphylaxis means that the involved drug should be used never again in that patient. Because muscle relaxants are by far the most involved drugs, anaesthetists should use them only when really required.