[Administration of ketamine during induction and maintenance of anaesthesia in postoperative pain prevention]. / Apport de l'administration de kétamine à l'induction et en entretien anesthésique dans la prévention de la douleur postopératoire Essai clinique en oncologie.

INTRODUCTION: Carcinologic breast surgery is responsible of intermediary postoperative pain and needs 30% additional morphine. Now, morphine administration generates adverse effects. Publications about morphine saving effect of ketalar as antagonist of R-NMDA, administrated in perioperative increase are discussed. OBJECTIVE: To evaluate the morphine saving effect of ketalar in carcinologic breast surgery. PATIENTS AND METHOD: This phase III randomized and double-blind study includes 208 patients during 14 months. Surgery consisted in mastectomy with or without axillary lymph node dissection or lumpectomy with axillary lymph node dissection. Group K received ketalar at induction until the end of surgery. Group P (placebo) received physiologic serum in the same condition. During the postoperative first 48h, morphine's consumption and EN are measured. RESULTS: No significant difference between two groups was observed. The EN evaluation and morphine consumption remained the same in the two groups. Our results did not find any benefit with use of ketamine between axillary lymph node dissection and no axillary lymph node dissection group. CONCLUSION: Ketalar adjunction in our analgesic protocol did not induce significant morphine saving in carcinologic breast surgery.

[Left ventricular diastolic function: physiology, physiopathology, evaluation, therapy, consequences of anesthesia]. / Fonction diastolique ventriculaire gauche: physiologie, physiopathologie, évaluation, moyens thérapeutiques, incidences en anesthésie.

With the exception of cardiac surgery, the acute disturbance of the left ventricular diastole occurs mainly in the elderly. Today it represents 30 to 40% of congestive cardiac failures, however with a lower mortality than for acute systolic disturbances. Generally indicated are relaxation anomalies, proto-mesodiastolic mechanism and problems with compliance, an indicator of the pressure/volume diastolic relationship. Invasive techniques remain the standard method. Doppler echocardiography is becoming increasingly important for the assessment of diastolic function. In most cardiopathies, relaxation anomalies occur early, whereas compliance disturbances are mainly associated with advanced cardiac diseases. During anaesthesia, adverse events (auricular fibrillation, hypovolaemia) may worsen a fragile situation. Anaesthetic agents, in particular volatile agents, act on the ventricular diastole. Long-term therapy of diastolic anomalies includes agents amending left ventricular hypertrophy. Emergency therapy has not yet been systematised.

Magnetic resonance diagnosis of an occult metastatic colon carcinoma of the calcaneus.

This is a case report which shows the potential benefit of magnetic resonance imaging in accurately visualizing occult metastatic lesions to bone. The case involves a relatively young patient with metastatic colon carcinoma to the calcaneus who ultimately required amputation.

Aneurysmal bone cyst.

Key findings that aid in the diagnosis of an aneurysmal bone cyst are: 1) typically the patients are young individuals less than 20 years old; 2) an expansile bone lesion is bordered by a thin, low signal intensity rim mass; 3) the lesion is inhomogenously increased in signal on T2-weighted images; and 4) multiple fluid-fluid levels are seen with the mass on T2-weighted magnetic resonance imaging scans.