Asunto(s)
Anestesia Obstétrica , Anestesiología , Adulto , Femenino , Humanos , Mala Praxis , EmbarazoAsunto(s)
Anemia/etiología , Anestesiología/legislación & jurisprudencia , Artroplastia de Reemplazo de Rodilla , Ceguera/etiología , Pérdida de Sangre Quirúrgica , Transfusión Sanguínea/economía , Cuidados Intraoperatorios/legislación & jurisprudencia , Complicaciones Intraoperatorias/etiología , Mala Praxis/legislación & jurisprudencia , Neuropatía Óptica Isquémica/etiología , Ortopedia/legislación & jurisprudencia , Cuidados Posoperatorios/legislación & jurisprudencia , Complicaciones Posoperatorias/etiología , Anciano , Anemia/sangre , Anemia/diagnóstico , Ceguera/epidemiología , Transfusión Sanguínea/estadística & datos numéricos , Transfusión de Sangre Autóloga , Control de Costos , Deber de Advertencia , Recuento de Eritrocitos , Femenino , Francia , Hemoglobinometría , Hemoglobinas/análisis , Humanos , Derivados de Hidroxietil Almidón/administración & dosificación , Hipotensión/diagnóstico , Hipotensión/etiología , Consentimiento Informado/legislación & jurisprudencia , Complicaciones Intraoperatorias/sangre , Complicaciones Intraoperatorias/diagnóstico , Atrofia Óptica/etiología , Sustitutos del Plasma/uso terapéutico , Complicaciones Posoperatorias/sangre , Complicaciones Posoperatorias/epidemiología , Hemorragia Posoperatoria/complicaciones , Reoperación , Factores de Tiempo , TorniquetesAsunto(s)
Adenoidectomía , Anestesia por Inhalación/efectos adversos , Anestesiología/legislación & jurisprudencia , Adhesión a Directriz/legislación & jurisprudencia , Paro Cardíaco/etiología , Homicidio/legislación & jurisprudencia , Complicaciones Intraoperatorias/etiología , Mala Praxis/legislación & jurisprudencia , Enfermeras Anestesistas/legislación & jurisprudencia , Otolaringología/legislación & jurisprudencia , Servicio Ambulatorio en Hospital/legislación & jurisprudencia , Grupo de Atención al Paciente/legislación & jurisprudencia , Anestésicos por Inhalación , Preescolar , Diagnóstico Precoz , Electrocardiografía , Falla de Equipo , Resultado Fatal , Francia , Halotano , Paro Cardíaco/diagnóstico , Paro Cardíaco/terapia , Humanos , Hiperplasia , Complicaciones Intraoperatorias/diagnóstico , Complicaciones Intraoperatorias/terapia , Masculino , Monitoreo Intraoperatorio/instrumentación , Quirófanos/normas , Servicio Ambulatorio en Hospital/normas , Oximetría/instrumentación , Tonsila Palatina/patología , Grupo de Atención al Paciente/normas , Resucitación/métodosRESUMEN
This study on surgeons' medical-legal responsibility was based on a retrospective analysis of closed files involving surgeons insured by Le Sou Médical. A total of 122 files of bodily injury settled during 1998 were studied; 32% of the files in this series which had been settled in or out of court were found to be at fault; the total cost was over 7 million francs. The analysis of these files has shown that the majority of accidents resulting in legal proceedings could have been avoided.
Asunto(s)
Cirugía General/legislación & jurisprudencia , Responsabilidad Legal , Mala Praxis , Procedimientos Quirúrgicos Operativos/economía , Procedimientos Quirúrgicos Operativos/legislación & jurisprudencia , Francia , Cirugía General/economía , Cirugía General/normas , Costos de la Atención en Salud/estadística & datos numéricos , HumanosRESUMEN
Informing the proper authorities of any case of child abuse, and in particular sexual abuse in a minor, 15 years old or less, is a legal and ethical obligation for the physician. In this field, voluntary failure to do so may constitute a failure to assist a person in danger. The description should be set out in the form of a certificate, which should only be drafted after the child has been seen and examined. Personal opinions and any references to third parties should be avoided in relation to the facts observed. The certificate may be sent to legal, medical or administrative authorities but preferably, especially in case of emergency, should be sent to the Attorney General.
Asunto(s)
Abuso Sexual Infantil/legislación & jurisprudencia , Notificación Obligatoria , Política Pública , Adolescente , Niño , Preescolar , Ética Médica , Femenino , Francia , Humanos , Lactante , Recién Nacido , Masculino , PediatríaRESUMEN
We report the case of an adult patient affected by acute syncytial giant cell hepatitis which had a subfulminant course leading to liver transplantation. Syncytial giant cell hepatitis recurred after transplantation and was efficiently treated with ribavirin. In this patient, the recurrence of the disease, the presence of filamentous strands on electron microscopy during both bouts of hepatitis and the efficacy of ribavirin on post-transplantation hepatitis suggest that the disease was caused by an original virus. This observation also suggests that early administration of ribavirin in patients affected by acute syncytia; giant cell hepatitis of unknown origin could avoid liver transplantation.
Asunto(s)
Antivirales/uso terapéutico , Células Gigantes/patología , Hepatitis/tratamiento farmacológico , Hepatitis/etiología , Trasplante de Hígado/efectos adversos , Ribavirina/uso terapéutico , Enfermedad Aguda , Adulto , Biopsia , Estudios de Seguimiento , Células Gigantes/efectos de los fármacos , Hepatitis/patología , Humanos , Fallo Hepático/etiología , Fallo Hepático/patología , Fallo Hepático/cirugía , Masculino , RecurrenciaRESUMEN
This article reviewed retrospectively 511 cases of dental damage reported to the French group for medical insurances from 1990 to 1995, and representing 40% of all accidents related to anaesthesia. The mean incidence rate was 9.5 accidents/100 anaesthetists/year and tended to decrease over time. The part of cases qualified as being linked to a fault was high and mainly due to the lack of dental examination and of informed consent during the preanaesthetic assessment. Although the mean cost of a dental accident is low compared with other anaesthetic accidents, the global cost is substantial considering their high incidence.
Asunto(s)
Anestesia General , Complicaciones Intraoperatorias/etiología , Intubación , Traumatismos de los Dientes/etiología , Anestesiología/economía , Francia/epidemiología , Humanos , Seguro de Salud/estadística & datos numéricos , Complicaciones Intraoperatorias/economía , Complicaciones Intraoperatorias/epidemiología , Mala Praxis/economía , Mala Praxis/estadística & datos numéricos , Estudios Retrospectivos , Traumatismos de los Dientes/economía , Traumatismos de los Dientes/epidemiologíaAsunto(s)
Enfermedades del Sistema Digestivo/cirugía , Seguro de Responsabilidad Civil , Laparoscopía/efectos adversos , Enfermedades del Sistema Digestivo/mortalidad , Francia , Humanos , Seguro de Responsabilidad Civil/estadística & datos numéricos , Laparoscopía/mortalidad , Laparoscopía/estadística & datos numéricos , Grabación en VideoRESUMEN
Although it has been established that liver failure is associated with arterial hypocapnia and alkalaemia (i.e., respiratory alkalosis), the influence of liver failure on mixed venous acid-base status has not yet been studied. Thus, arterial and mixed venous acid-base status were simultaneously measured in controls and in a large series of patients with cirrhosis. Grade B patients (n = 28) or Grade C patients (n = 21) had significantly lower arterial and mixed venous carbon dioxide tensions than controls (n = 29). Grade B or Grade C patients also had significantly higher arterial, mixed venous pH, and lower mixed venous bicarbonate concentrations than controls. Among Grade A patients (n = 27), those with the lowest Pugh's score (i.e., equal to five) had significantly lower mixed venous carbon dioxide tension than controls. The other arterial and mixed venous acid-base values did not differ significantly between Grade A patients with the lowest Pugh's score and controls. Grade A patients with a Pugh's score equal to six and Grade B patients had similar acid-base disorders. No significant differences were found between groups concerning the anion gap and plasma chloride concentrations. In conclusion, this study shows that in Grade B or C patients, respiratory alkalosis was responsible for mixed venous hypocapnia, alkalaemia and hypobicarbonataemia. In addition, in Grade A patients with the lowest Pugh's score (equal to five), analysis of arterial and mixed venous blood revealed that mixed venous hypocapnia was the sole anomaly of the acid-base status. This last finding suggests that mixed venous hypocapnia might be an early event preceding the onset of arterial hypocapnia.
Asunto(s)
Hipocapnia/etiología , Cirrosis Hepática/sangre , Fallo Hepático/sangre , Alcalosis Respiratoria/etiología , Bicarbonatos/sangre , Análisis de los Gases de la Sangre , Femenino , Humanos , Concentración de Iones de Hidrógeno , Cirrosis Hepática/complicaciones , Fallo Hepático/complicaciones , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVES: To examine the hemodynamic and metabolic characteristics and ICU outcome of septic shock in patients with cirrhosis. DESIGN: Prospective, comparative study. Measurements performed in the first 24 hrs of septic shock. SETTING: A general hospital ICU. PATIENTS: Twelve patients with cirrhosis and 23 patients without cirrhosis admitted for septic shock. MEASUREMENTS AND MAIN RESULTS: Arterial pressure was measured using an arterial catheter. Pulmonary arterial and right atrial pressures were measured by using a pulmonary artery catheter. Cardiac output was determined by using the thermodilution method. Pulmonary arterial L-lactate plasma concentrations were measured using an automated spectrophotometer, and blood temperature was measured using a cardiac output computer. Arterial and mixed venous PO2, PCO2, and pH values were measured by using specific electrodes. Oxygen saturations and hemoglobin concentrations were measured using a hemoximeter. Patients with cirrhosis had decompensated liver disease (grade C of the Child-Pugh classification). The number of Gram-negative infections and therapeutic interventions were similar in both groups. Patients with cirrhosis had higher cardiac indices (5.14 +/- 0.52 [SE] vs. 3.91 +/- 0.30 L/min/m2, p less than .05), plasma lactate concentrations (9.0 +/- 2.0 vs. 5.2 +/- 0.7 mmol/L, p less than .05) and ICU mortality rates (100% vs. 43%, p less than .05), and lower blood temperatures (35.5 +/- 0.6 vs. 37.6 +/- 0.2 degrees C, p less than .05) than patients without cirrhosis. Systemic vascular resistance, arterial pressure, pulmonary arterial pressure, oxygen delivery and consumption, and arterial and mixed venous acid-base status were not significantly different between the two groups. CONCLUSIONS: In patients with cirrhosis, septic shock was characterized by severe liver dysfunction, low blood temperature, marked increases in cardiac index and lactic acidemia, and a 100% ICU mortality rate. These findings should be taken into account if patients with cirrhosis are to be included in controlled studies on septic shock.
Asunto(s)
Cuidados Críticos , Cirrosis Hepática/fisiopatología , Choque Séptico/fisiopatología , Equilibrio Ácido-Base/fisiología , Distribución de Chi-Cuadrado , Cuidados Críticos/estadística & datos numéricos , Hemodinámica/fisiología , Humanos , Lactatos/sangre , Ácido Láctico , Cirrosis Hepática/sangre , Cirrosis Hepática/mortalidad , Oxígeno/sangre , Índice de Severidad de la Enfermedad , Choque Séptico/sangre , Choque Séptico/mortalidad , Resultado del TratamientoRESUMEN
During the 26th week of a first pregnancy, a 25-year-old woman presented with pruritus suggesting an intrahepatic cholestasis of pregnancy. The pruritus, however, persisted despite the premature delivery of a normal newborn at the 35th week. Moreover, aspartate aminotransferase activity increased, reaching a maximum of 38 times normal level on the 17th day after the delivery. Thus, an acute fatty liver of pregnancy was suspected and confirmed by liver biopsy. This patient appeared to have both intrahepatic cholestasis of pregnancy and acute fatty liver of pregnancy, an association not previously reported. It is suggested that intrahepatic cholestasis of pregnancy caused premature delivery, which in turn may have prevented the onset of severe maternal and fetal complications caused by acute fatty liver of pregnancy.
Asunto(s)
Colestasis Intrahepática/complicaciones , Hígado Graso/complicaciones , Complicaciones del Embarazo/diagnóstico , Adulto , Colestasis Intrahepática/diagnóstico , Hígado Graso/diagnóstico , Femenino , Humanos , Pruebas de Función Hepática , Embarazo , Prurito/diagnóstico , Prurito/etiologíaRESUMEN
In patients with cirrhosis, vasopressin infusion induces sustained vasoconstriction and elevation of arterial pressure. The vasopressor effect could be caused by impairment of mechanisms normally aimed at buffering increases in arterial pressure (reflex bradycardia and decreases in arteriolar resistance). We studied the acute effects of continuous vasopressin infusion (0.4 IU/min) on systemic hemodynamics in seven patients with cirrhosis and in six patients without cirrhosis (controls). Vasopressin effects on systemic O2 consumption were also studied. In both groups, vasopressin infusion induced similar peak increases in arterial pressure, followed by similar decreases in heart rate and cardiac output. However, cirrhotic patients and controls differed 30 min after the start of vasopressin infusion. At 30 min, mean arterial pressure, diastolic arterial pressure and systemic vascular resistance remained significantly higher than preinfusion values in patients with cirrhosis. No decrease in systemic O2 consumption occurred in cirrhotic patients. In controls, at 30 min, mean arterial pressure and diastolic arterial pressure had returned to baseline. Systemic vascular resistance was not significantly higher than the preinfusion value and systemic O2 consumption had significantly decreased to below preinfusion values. We conclude that the vasopressor effect of vasopressin is abnormally sustained in patients with cirrhosis. This might be caused by insufficient buffering of vasopressin-induced arteriolar constriction rather than by abnormal vagal control of heart rate. In turn, as suggested by the lack of a decrease in systemic O2 consumption, persistent arteriolar constriction might be related to abnormally sustained sympathetic vascular tone in patients with cirrhosis.