[Prevention of postoperative nausea and vomiting by lorazepam]. / Prévention des nausées et vomissements postopératoires par le lorazépam.

This study was carried out to assess the efficacy of oral lorazepam on postoperative nausea and vomiting in patients undergoing thyroid surgery. Twenty-six patients were randomly assigned to two groups, and receiving orally, one hour before induction of anaesthesia, either 2.5 mg of lorazepam (n = 13) or a placebo (n = 13). Lorazepam reduced the incidence and especially the intensity of nausea. The incidence of vomiting in the lorazepam group was significantly lower than in the placebo group (14.5% vs 45%). The use of lorazepam for premedication thus reduces the incidence of postoperative nausea and vomiting. The advantages of this benzodiazepine are its ease of use, low cost and very low incidence of side effects.

[Paraplegia after cardiac arrest]. / Paraplégie après arrêt cardiaque.

We report a case of a permanent flaccid paraplegia, with a sensory loss at T12 level, not associated with cerebral damage, subsequent to a cardiac arrest of 15 minutes duration, in a 67-year-old patient, undergoing haemorragic surgery for gangrenous purulent cholecystitis. Besides cardiovascular collapse and subsequent circulatory arrest, possible favouring factors include anatomical anomalies in the territory of anterior spinal artery, surgical posture with hyperlordosis generating venous stasis, emergency haemostatic maneuvers with compression of the arterial territory providing spinal blood supply. Spinal cord lesions are probably more frequent than expected, as the often associated cerebral anoxic encephalopathy impedes their recognition. Only a systematic anatomopathological examination of the spinal cord, in patients who died after a cardiac arrest, would provide the accurate incidence of spinal complications.

[Maternal prognostic factors in severe eclampsia]. / Les facteurs du pronostic maternel dans l'éclampsie grave.

Sixty cases of severe eclampsia were treated in an intensive care unit between January 1989 and September 1993. Mean age was 26, and 70% of patients were primipara. The pregnancy has been unsupervised in almost all cases. All had visceral lesions and/or hematologic problems and there was impaired conscious level in 9 cases out of 10. Medical treatment involved the control of seizures and of hypertension. Cesarean section was performed in 34 cases. The maternal death rate was 23.3%. Our experience indicates that mortality depends upon visceral lesions (cerebral, disseminated intravascular coagulation, acute pulmonary edema, Hellp syndrome). Better awareness of severity factors in preeclampsia improves both maternal and fetal prognosis by precisely indicating the best time for fetal extraction.

[Thrombosis of the right atrium disclosed by severe pulmonary embolism]. / Thrombose de l'oreillette droite révélée par une embolie pulmonaire grave.

The case of a thrombosis of the right auricle, revealed by severe pulmonary embolism in a 56-year-old patient without significant medical history is reported. He was admitted to the ICU with a haemorrhagic cerebrovascular accident. The course was characterized by the occurrence of a venous thrombosis of the right lower limb confirmed by phlebography. The treatment with a platelet antiaggregating agent was effective and the patient left hospital two weeks later. He was re-admitted after 2 months with a clinical picture of massive embolism including polypnea, tachycardia and haemoptysis. The diagnosis was confirmed by pulmonary angiography (Miller index > 65%) and echocardiography showed a floating thrombus in the right auricle with dilated right cavities. The phlebocavography displayed an extensive thrombosis in the left lower limb up to femoral, iliac and cava inferior veins. The patient was treated with heparin (500 IU.kg-1.d-1) and later with antivitamine K. The course was favourable. This is a rare case of extensive thrombosis, completely regressive with a treatment including only heparin.

[Hypertensive episode and arrhythmia with fatal outcome caused by pheochromocytoma discovered peroperatively]. / Poussées hypertensives et troubles du rythme à évolution fatale par phéochromocytome de découverte peropératoire.

The authors report a case of pheochromocytoma recognized during surgery, at the manipulation of the tumor resulting in severe arterial hypertension, arrhythmia and a final unresponsive ventricular fibrillation. The anatomopathological examination confirmed the diagnosis of the pheochromocytoma in ectopic localization.