[Coronary surgery in patients aged 70 years and older. 65 cases]. / Chirurgie coronaire chez le sujet âgé de 70 ans et plus. 65 cas.

Out of 428 patients operated upon for coronary disease between December 1984 and November 1989, sixty-five (15.18 percent) were 70 to 80 years' old. All were suffering from a more or less invalidating stage II, III or IV angina. Coronary arteriography showed severe lesions of two or three main vessels (24.6 and 60 percent respectively). Each patient underwent 2.06 bypasses on average. Perioperative mortality was 7.7 percent, and late mortality 1.53 percent. The postoperative myocardial infarction rate was 4.61 percent, and 83 percent of these patients became asymptomatic. There was no deterioration. These satisfactory results are the consequences of numerous technical advances in cardiovascular surgery, anaesthesia and intensive care. As more and more elderly patients undergo coronary surgery, the desire of other elderly patients to be operated upon and their comfort after coronary surgery, the desire of other elderly patients to be operated upon and their comfort after coronary bypass are two additional reasons to opt for surgery. In spite of new vascular recanalization techniques, coronary surgery remains of considerable value. Close cooperation between surgical and medical teams should clarify the respective indications for coronary angioplasty and direct coronary bypass, thereby making these two procedures complementary and no longer competitive.

[A case of survival after 65 hours of immersion in the Mediterranean]. / A propos d'un cas de survie aprés 65 heures d'immersion en Méditerranée.

Survical time of a man immerged in sea water at a mean temperature of 20 degrees C was 65 hours. This remarkable tolerance of a professional diver to hypothermia is attributed to his adapted clothing and safety equipment, and to favourable atmospheric conditions. On the light of this accidental immersion, one must reconsider out of date concepts concerning sea rescue with respect to water temperature, clothing equipment of the ship-wrecked, meterological conditions and circonstances of accident.

[Admission and treatment of 592 patients over 70 years in an intensive care unit]. / Bilan du traitement de 592 sujets de plus de 70 ans hospitalisés dans un service de réanimation.

Using an IBM 3741 computer, the authors analysed 592 case records of patients aged over 70 years, admitted to hospital on an intensive care unit, age appears to be an important factor in determining the prognosis of numerous diseases without, however, being a criteria for rejection of admission of these patients to an intensive care unit. The fragility of these patients leads one to consider the following parameters: 1--the degree of resuscitation is assessed by quantification of the therapeutic means. As for other patients, survival varies inversely in relation to the important of the therapeutic means, but in the case of the elderly patient, there is a definite difference in the correlation mortality-therapeutic index towards aggravation, so one may determine a ceiling above which survival is not possible; 2--duration of the intensive care is very important. In most cases, the decisive point is situated on the 3rd or 4th day of care, at which time the decision to continue or stop treatment may be considered in the light of the patient's progress.

[Routine comparison of trace element deficiencies during parenteral alimentation]. / Essai de comparaison systématique des carences en oligo-éléments au cours de l'alimentation parenterale.

In 50 patients aged between 3 and 84 years treated in a multidisciplinary Intensive Care Unit and receiving parenteral alimentation, deficiency in certain trace elements or electrolytes (Cu++, Zn++, Mn++, Co++, PO-4, Mg++) was prevented or treated by the administration of a glucose solution (MB 147 G) enriched in trace elements. The aim of the present study was to demonstrate, on the basis of assay of serum levels of the trace elements involved, with the exception of Mn and Co, the effectiveness of treatment. Reference values were determined on the one hand in healthy individuals for normal figures and secondly on subjects included in the study, already on parenteral alimentation for several days, before treatment with MB 147 G, in order to demonstrate the existence of a deficiency (patient control values). In the case of PO--4, however, the patient control values concerned at one and the same time subjects in the study before treatment with MB 147 G and other patients receiving parenteral alimentation who were not part of the trial. MB 147 G solution was presented in units of 500 ml associated with glucose of varying concentrations (15 p. 100, 30 p. 100, 50 p. 100). The average daily amount administered, over a period of 236 days, was 3 unites per 24 hours, corresponding to an intake of copper of 3.78 mg, 3.90 mg of zinc, 0.20 mg of manganese, 0.24 mg of cobalt, 363 mg of magnesium, 240 mg of calcium and 15 mEz of phosphates. The results show that levels of copper, zinc, magnesium and phosphates were low during parenteral alimentation. The administration of MB 147 G resulted in a significant increase in these values, without there being any evidence of accumulation.

[Hemodynamic effects of high-dosage corticoids. Their justification in the treatment of shock]. / Les effets hémodynamiques des corticoïdes a haute posologie. Leur justification dans le traitement du choc

In 61 patients in whom high doses of corticoids had been administered owing to various indications, the hemodynamic modifications caused by this injection were studied. The corticoids administered were : hydrocortisone hemisucccinate (150 mg/kg), methyl prednisolone sulfate (30 mg/kg), prednisone sodium m sulfobenzoate (50 mg/kg), prednisolone sodium m sulfobenzoate (35 mg/kg) and dexamethasone phosphate (2 mg and 6 mg/kg). The results study the modifications caused by each drug on heart rate, arterial blood pressure, cardiac output, systolic stroke volume and peripheral vascular resistance. The expression of the results is given as a percentage of the variation with statistical study. Methyl-prednisolone sulfobenzoate only leads to slightly marked hemodynamic effects : the four other compounds studied have definite hemodynamic effects, of variable intensity and duration. The most important variations are noted with dexametasone phosphate. From these results, the indications and results of the use of corticoids in states of shock are discussed.

[Hemodynamic effects of Etomidate]. / Les effects hémodynamiques de l'Etomidate

Hemodynamic variations due to Etomidate administration were studies in 10 patients submitted to artificial ventilation. Etomidate was given at a 0.37 mg/kg B.W. dosage. Cardiac rate, mean arterial B.P., C.V.P., mean arteial pulmonary pressure, mean pulmonary capillary pressure and cardiac output were investigated. From values found, systolic output, systemic vascular resistance, and pulmonary arteriolar resistance were calculated. Results show that Etomidate has little effect on hemodynamics. There is only a 5 p. 100 increase in cardiac rate, a 16p. 100 decrease in cardiac output, 1 18 p. 100 decrease in systolic output and a 12p. 100 decrease in mean arterial B.P. Variations of mean capillary pressure, of systemic vascular resistance and of pulmonary arteriolar resistance are not significant.

[Use of dopamine in acute cardiovascular distress. Its place in comparison to isoproterenol]. / Utilisation de la dopamine dans les états de détresses cardio-circulatoires aiguës sa place par rapport a l'isoprotérénol

Nineteen patients presenting cardiovascular distress were treated with dopamine. For seventeen of these, the accident occurred immediately after cardiac surgery. Dosages varied from 1 to 15 mug/kg/min and the duration of treatment from 10 minutes to three days. The efficacy of the treatment was judged according to the clinical and hemodynamic improvement of the cardio-circulatory function and the increase in urinary output. There were 15 favourable results. The positive effects of the dopamine seem to be limited in certain patients by the appearance of a cyanosis testifying to a rise in vascular resistances which increases the left auricular pressure and limits the inotropic effect. In these cases, isoproterenol or a combination of both isoproterenol and dopamine gives better results.

[Constant outflow anesthesia with the combination of alfatesine and fentanyl]. / Anesthésie à débit constant par l'association alfatésine-fentanyl

In a previous work, the authors showed the value of administering Alfatesine, in interventions of long duration, at a constant rate by using an automatic syringe, and by combining it with destromoramide. In this new work the authors present an analagous study carried out in 47 subjects, in which dextromoramide was replaced by fentanyl. The automatic syringe used was the Braun Perfusor IV equipped with a 50 ml syringe containing 0.3 ml. of CT 13.41 and 0.006 mg. of fentanyl per ml. Induction was achieved at graduation 10, 14 ml of the mixture having been injected in approximately 60 seconds. Maintenance of anesthesia was ensured at graduation 6 corresponding to an hourly administration of 27 to 30 ml of the mixture (9 ml of CT 13.41 and 0.18 mg of fentanyl). The patients were adults of average weight 64 kg., who had undergone sometimes major orthopedic surgery, of an average duration of 161 mn. The results are looked at from the angle of quality of the anesthesia and of the awakening and of the side effects. They confirm the non-accumulation under these conditions of use and these doses of CT 13.41 used and reveals an analagous behaviour of fentanyl. Reserves are however made owing to the mode of elimination of fentanyl, on the use of such a technique in anuric patients or in renal insufficiency.