RESUMEN
This study reports the results of a retrospective survey of transfusion-related HIV-contamination in patients who were admitted in our neurosurgery department, between the 1st January 1980 and the 30th September 1985. In our area of France, the risk of HIV-contamination is low. During this 5-year-period the blood donors were not tested for HIV. Six hundred twenty-one patients were identified from the operating room registers. The administered blood components were always noted in these registers for each patient. Among these 621 patients, 233 died rapidly. Three hundred eighty files were taken out from the central archives' department. Eight files could not be found. These 380 files were examined for the patient's address, or the family's one, or the regular doctor's name and address. A letter was sent to the latter in order to inform him about the patient's transfusion. The doctor had to ask the patient to order a HIV-test. A recall letter was sent 8 months later as required. The patients who did not have a regular doctor were contacted directly by phone or letter, or indirectly through their family. Thirteen months after the beginning of this survey it was established that 334 patients died (53.5%) and only 151 patients were found and tested. One of them was HIV-positive. As this patient suffered from a hemophilia B, he had been medically followed and his positive serology was known since 1988. It was impossible to get any answer from 136 other patients who represent 22% of all patients and 47% of still alive patients or supposed to be so.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Anticuerpos Anti-VIH/sangre , Seropositividad para VIH , Encuestas Epidemiológicas , Reacción a la Transfusión , Francia/epidemiología , Humanos , Neurocirugia , Periodo Posoperatorio , Estudios RetrospectivosRESUMEN
A retrospective study of thromboembolic complications after lumbar disc surgery has been performed. It included 16,656 patients from fifty neurosurgical units, operated on over the year 1989. The average number of operations was 333 +/- 19.5 in each unit, their average duration 55.2 +/- 20 minutes, and the hospital care 6.2 +/- 1.7 days. Surgery was performed using the genupectoral position in 64% of the cases, the supine position in 28%, and the lateral position in 8%. Two groups of patients have been individualized: a first group of patients with no preventive antithrombic treatment (46% of the units) including 10,351 patients, a second group (54% of the units) including 6,305 patients and receiving a systematic treatment with low molecular weight heparin (4,304 patients) or calciparin (1,001 patients) or antiplatelet agents or pentosane polysulfate (1,000 patients). 0.63% of the patients (105) had a thromboembolic accident: 0.65% in the first group (68 cases) and 0.58% in the second (37 cases). No statistically significant difference was noticed between the two groups concerning pulmonary embolism and/or lower-limb thrombophlebitis. Nevertheless, a prospective randomized study would be usefull to corroborate this first data.
Asunto(s)
Discectomía , Desplazamiento del Disco Intervertebral/cirugía , Vértebras Lumbares , Complicaciones Posoperatorias/prevención & control , Embolia Pulmonar/prevención & control , Tromboembolia/prevención & control , Heparina de Bajo-Peso-Molecular/uso terapéutico , Humanos , Complicaciones Posoperatorias/epidemiología , Embolia Pulmonar/epidemiología , Estudios Retrospectivos , Tromboembolia/epidemiologíaAsunto(s)
Arteria Renal/lesiones , Trombosis/etiología , Adulto , Humanos , Masculino , Trombosis/patologíaRESUMEN
A case is reported of an acute intracranial subdural haematoma following an accidental dural puncture during an epidural anaesthesia. A seventy-year old man, class ASA I, was operated on for prostatic adenoma under epidural anaesthesia. Dural puncture occurred during the first introduction of the needle into the L4-L5 epidural space. Epidural anaesthesia was nevertheless obtained by introducing the catheter at the L3-L4 level. The immediate peroperative and postoperative course was uneventful, apart from persisting headache. After removing the epidural catheter at 24 h postoperatively, the patient received calcium heparinate. 26 h later, he complained of worsening headache and became rapidly deeply comatose. The computer tomographic scan showed air in the ventricles and a large right-sided subdural haematoma which was immediately discharged. Although the link between subdural haematoma and dural puncture is well known, the acuteness and rapidly fatal evolution of this case were exceptional and may have been facilitated by the big size of the needle, dehydration and hypercoagulability.
Asunto(s)
Anestesia Epidural/efectos adversos , Duramadre/lesiones , Hematoma Subdural/etiología , Heridas Penetrantes/complicaciones , Anciano , Deshidratación/complicaciones , Cefalea/etiología , Hematoma Subdural/diagnóstico por imagen , Hematoma Subdural/fisiopatología , Heparina/efectos adversos , Humanos , Masculino , Hiperplasia Prostática/cirugía , Factores de Tiempo , Tomografía Computarizada por Rayos XRESUMEN
Brainstem auditory evoked responses were recorded in a neurosurgical intensive care unit in 38 patients who had all the clinical criteria for brain death. Of the brain-dead patients, 65.8% never showed a response. 3.42% showed a type I wave, which was unilateral in 26.3% and bilateral in the other 7.9%. Types II to VII waves were never seen. An increase in latency of type I waves (2.25 +/- 0.24 ms) was noted. The interest and the limits of this non invasive electrophysiologic technique for the diagnosis of brain death are discussed.
Asunto(s)
Muerte Encefálica , Tronco Encefálico/fisiopatología , Potenciales Evocados Auditivos , Adolescente , Adulto , Anciano , Niño , Electroencefalografía , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
A case of a surgically verified neurinoma of the oculomotor nerve is presented. The diagnostic difficulties due to the parasellar localisation are discussed. Computed tomography scan data rarely allow to distinguish the nature of the tumor and in all cases are insufficient to distinguish a trigeminal nerve neurinoma of the oculomotor nerves.
Asunto(s)
Neurilemoma/diagnóstico por imagen , Nervio Oculomotor , Angiografía Cerebral , Femenino , Humanos , Persona de Mediana Edad , Neurilemoma/cirugía , Tomografía Computarizada por Rayos XRESUMEN
A 31-year old primigravida was admitted at 31 week gestation for subarachnoid haemorrhage. Cerebral angiography revealed an aneurysm on the left middle cerebral artery. Eleven days later, the aneurysm was clipped off. General anaesthesia was induced with thiopentone, pancuronium and fentanyl, and maintained with fentanyl (40 micrograms.kg-1) and isoflurane in air/O2 with a non-rebreathing circuit. The patient was mechanically ventilated to maintain mild hypocapnia. Arterial hypotension was induced by increasing the inspired isoflurane concentration from 1 to 3 vol%. The response was immediate and a mean arterial pressure of 60 mmHg was maintained for 80 min with an inspired isoflurane concentration of 2.5 vol%. Foetal heart rate was monitored before, during and after general anaesthesia. Loss of beat to beat variation was observed after induction, and foetal heart rate slowly decreased from 150 to 115 b.min-1 at the end of the operation. Postoperative state was good, except for transitory aphasia. At 35 week gestation, the patient went into premature labour, with hypothermia of 39.5 degrees C; an emergency caesarean section was performed. The 2,340 g female infant had a 10 min Apgar score of 8. One month later, clinical examination of the mother and daughter was quite normal. The precautions and anaesthetic management of patients suffering from ruptured cerebral aneurysm during the end of pregnancy are reviewed. Hypotensive agents are discussed.
Asunto(s)
Hipotensión Controlada , Aneurisma Intracraneal/cirugía , Isoflurano , Complicaciones del Embarazo/cirugía , Adulto , Cesárea , Femenino , Monitoreo Fetal , Humanos , Aneurisma Intracraneal/complicaciones , Embarazo , Tercer Trimestre del Embarazo , Hemorragia Subaracnoidea/etiologíaRESUMEN
The stability of anaesthesia and the quality of recovery obtained with low doses of enflurane were studied. Two groups of 20 patients operated for lumbar slipped disc were compared. The mean age and weight distribution of the two groups were not statistically different. Induction was the same in the two groups (diazepam, fentanyl, pancuronium and nitrous oxide). In one group, enflurane (0.4%) was added with controlled ventilation. Thiopentone was added if some spontaneous movements were observed, if arterial pressure and heart rate increased, and if the digital plethysmograph curve decreased. The quality of recovery was assessed by number-connection tests 1 and 2 h after the end of anaesthesia. Thiopentone was required five times in the group without enflurane, whilst it was never used in the group with enflurane. This difference was statistically significant (p less than 0.01) and showed a more important stability of anaesthesia when enflurane (0.4%) was used. No statistically significant difference was found in the recovery scores between the two groups 1 and 2 h after the end of anaesthesia. It was proposed that low doses of enflurane were sufficient to increase the effects of the other anaesthetic drugs without any residual effect on recovery. Low doses of enflurane could be used during anaesthesia induced with fentanyl and diazepam, giving better stability during anaesthesia without any pernicious effects on recovery.
Asunto(s)
Anestesia General/métodos , Enflurano/administración & dosificación , Adulto , Periodo de Recuperación de la Anestesia , Sinergismo Farmacológico , Femenino , Humanos , Periodo Intraoperatorio , Masculino , Persona de Mediana Edad , Tiopental/administración & dosificaciónRESUMEN
Infection of six cerebro-spinal fluid shunts in six patients were treated with daily intrashunt injections of antibiotics plus combination of intravenous or oral systemic antibiotic therapy. Three organisms were involved in the shunt infection: staphylococcus epidermidis in five, staphylococcus capitis and micrococcus varians. One patient had mixed shunt infection with micrococcus varians and staphylococcus épidermidis. All six patients received daily intrashunt injections of vancomycin and oral rifampin with a combination of trimethoprim/sulfamethoxazole (three patients), or intravenous fosfomycin (two patients), or intravenous vancomycin (one patient). Four of six cases were considered cured of their infection without shunt surgery. Their hydrocephalus will be well controlled during antibiotic therapy. Surgery was necessary for two patients with associated shunt malfunction, one of them was considered a treatment failure of antibiotic therapy.
Asunto(s)
Antibacterianos/uso terapéutico , Infecciones Bacterianas/tratamiento farmacológico , Derivaciones del Líquido Cefalorraquídeo/efectos adversos , Adulto , Anciano , Antibacterianos/administración & dosificación , Infecciones Bacterianas/etiología , Niño , Quimioterapia Combinada , Femenino , Humanos , Lactante , Masculino , Micrococcus , Persona de Mediana Edad , Infecciones Estafilocócicas/tratamiento farmacológico , Staphylococcus epidermidisRESUMEN
An automatic apparatus for the measurement of arterial pressure by a non-invasive technique is compared with direct intra-arterial measurement in patients admitted to a neurosurgical intensive care unit. A good correlation is found between the results of the two methods for the systolic and diastolic pressure.
Asunto(s)
Determinación de la Presión Sanguínea/instrumentación , Monitoreo Fisiológico/instrumentación , Diástole , Humanos , Unidades de Cuidados Intensivos , SístoleRESUMEN
The case is reported of an 18 year old patient who developed a peripheral neuropathy after being given 1.5 g ornidazole daily for 6 days and 2 g daily for 16 days (total dose: 41 g). Bilateral radial paralysis was noted clinically, whilst electrical investigations showed diffuse motor and sensitive anomalies. Three months after the drug had been stopped, all symptoms and signs had disappeared. The pathogenesis of this complication is discussed. The part played by ornidazole is suggested but cannot be proved because of the multiple disorders presented by the patient.