[Standard perioperative management of patients treated with lithium can lead to hyperosmolar coma]. / Une prise en charge périopératoire "usuelle" peut conduire à un coma hyperosmolaire chez les patients traités par lithium.

A 55-year-old woman with bipolar disorder who had been taking lithium for several years developed hyperosmolar coma following osteosynthesis of a hip fracture. The coma was attributed to decompensation of undiagnosed nephrogenic diabetes insipidus due to chronic lithium intake. The lengthy perioperative fasting and large fluid loading (necessitated by the anesthetic technique) led to acute hypernatremia. Closer monitoring and a different anesthetic strategy might have avoided this classical complication of chronic lithium therapy. The patient recovered after symptomatic treatment. We discuss the perioperative management of patients taking (or having taken) lithium, based on a review of the literature.

[Prospective assessment of information programme for blood transfusion in critical care patients]. / Evaluation prospective d'une procédure d'information des patients transfusés en réanimation.

OBJECTIVES: Assessment of oral and written information programme for blood transfusion in critical care patients and study of factors associated with the biological follow-up. STUDY DESIGN: Prospective study in one intensive care unit. PATIENTS AND METHODS: All blood recipients in 2000 were orally informed of transfusion process. In regard to the French haemovigilance regulation, written paper was given to the patient or passed on to the next hospital physician. Four months later, a questionnaire was proposed to the patients. RESULTS: In 2000, blood transfusion was performed for 102 patients and data were obtained for 59 patients (34 number of survivor patients, follow-up was impossible for eight and one refused the questionnaire). Quality assurance programme permit a global orally and written information of critical care patients. However, thirty-eight patients (64%) remembered oral information. Patients were younger (55 +/- 22 vs 68 +/- 13, OR = 1.04; p = 0.03). Biological follow-up was obtained for 22 patients (37%), particularly when written information was directly given to the patient (22/24 vs 2/35; OR = 335; p < 0.0001). CONCLUSION: Biological follow-up was obtained for only one third of blood recipients, because, in first, only 64% of critical care patients remembered oral information, particularly the younger patients. Perhaps, written information systematically given to the patient could permit a high biological follow-up. This study confirmed the lack of sensitivity of all hospital physician for haemovigilance.

Sensitive and specific determination of midazolam and 1-hydroxymidazolam in human serum by liquid chromatography-electrospray mass spectrometry.

A liquid chromatographic-mass spectrometric technique was designed for the determination of the anaesthetic benzodiazepine midazolam (MID) and its active metabolite 1-hydroxymidazolam (1-OHM), with the aim of conducting pharmacokinetic/pharmacodynamic studies. MID and 1-OHM were extracted from alkalinised (pH 9.5) spiked and clinical serum samples using a single step, liquid-liquid extraction procedure with diethyl ether-2-propanol (98:2, v/v). The chromatographic separation was performed on a Nucleosil C18, 5 microm (150x1 mm I.D.) column, using a gradient of acetonitrile in 5 mM ammonium formate, pH 3.0 as the mobile phase, delivered at a flow-rate of 50 microl/min. The compounds were ionised in the ionspray source of an atmospheric pressure mass spectrometer, fragmented by in-source collisions and the pseudomolecular and fragment ions detected in the selected ion monitoring mode. The recovery was between 79 and 87% for MID, between 83 and 87% for 1-OHM and 81.5% for methylclonazepam. The limit of detection was 0.2 microg/l for MID and 0.5 microg/l for 1-OHM, the limit of quantitation (LOQ) was 0.5 microg/l for both. Linearity was verified from these LOQs up to 2000 microg/l and the method was found accurate and precise over this range. It was successfully applied to a preliminary study to establish the concentration versus time curve of MID and 1-OHM in a patient administered midazolam by continuous infusion.

ROC assessment of compressed wrist radiographs.

The aim of this paper is to validate a compression scheme applied on a medical image database of digitized wrist radiographs. The compression scheme adapts itself to local statistical properties of the images. The diagnostic quality of the reconstructed images is evaluated using a ROC protocol involving five medical experts. The results of this evaluation enable us to validate the compression scheme on this database with a compression ratio of 40 (0.2 bits per pixel).