[Hyperthyroidism induced by molar pregnancy]. / Hyperthyroïdie induite par la grossesse môlaire.

A case is reported of a Senegalese patient admitted for hydatiform mole. The serum human chorionic gonadotrophin concentration (hCG) was 900,000 UI.l-1. The patient was recognized to be clinically hyperthyroid with raised T4 and T3 values, but a very low TSH concentration. After two days of beta adrenergic blockade and carbimazole, a suction curettage was performed under general anaesthesia. Propranolol was again administered 6 hours after the surgery. Thyroid function returned to normal level two weeks after removal of the mole, suggesting that hCG was responsible for the thyrotoxicosis. Serum hCG concentrations closely paralleled those of free thyroxine, but the correlation was difficult to assess because of carbimazole. Clinical thyrotoxicosis is rare in molar pregnancy. The diagnosis being made in semi-urgent conditions, this raises the question of how to obtain rapid stabilization of the disease before surgery.

[Creatine phosphokinases and serum and urinary myoglobin following a procedure in prolonged knee-chest position for the treatment of spondylolisthesis]. / Etude des créatine-phosphokinases et de la myoglobine sanguine et urinaire après intervention en position génu-pectorale prolongée pour cure de spondylolisthésis.

Rhabdomyolysis following the knee-chest position was studied in 15 patients scheduled for surgery for spondylolisthesis. A comparison was made between 11 patients scheduled for orthopaedic surgery: ligamentoplasty (6 patients), total hip prosthesis (5 patients) and 11 patients scheduled for long oral surgery. The measurements carried out were blood CPK before surgery, 4, 8, 12 and 24 h after the beginning of surgery, and at days 2, 3 and 4. Blood and urinary myoglobin were measured at days 1, 2, 3 and 4 after surgery. The results were tested with the Mann and Whitney test. There was no statistical change in CPK and myoglobin in the test population. Following the knee-chest position, there was a statistical increase of CPK in all patients, with great individual variations. Myoglobinaemia and myoglobinuria were observed in six patients, these not being correlated with the variations of CPK. Nevertheless, the maximal increase of CPK and myoglobin was seen in one patient, without any modification of diuresis but with an increase of creatininaemia at 220 mmol X l-1. In this series, rhabdomyolysis was real. CPK was not a good index of the release of haematic pigments, the only dangerous ones. A qualitative search for myoglobinuria is suggested, this being followed, or not, by alkalization to prevent acute renal failure.

[Femoral nerve block as a postoperative analgesia technic in surgery of the knee]. / Le bloc du nerf crural comme technique d'analgésie postopératoire en chirurgie du genou.

A femoral nerve block was performed as a postoperative analgesic technique in 50 patients after knee surgery; this surgery is a very painful one. The technique used was the inguinal route, as described in the textbooks. Bupivacaine was used: 1.5 mg X kg-1 without exceeding 150 mg. The result was good in 46 patients, with four failures. The average duration of analgesia was 600 min, the shortest being 300 min, the longest being 1,200 min. This technique can be recommended after surgery of the knee as safe and reliable.

[Hysteria: an etiology of post-operative accident (author's transl)]. / L'hystérie. Une cause inhabituelle de réveil anormal.

Hysteria can explain some immediate post-operative accidents. We report some cases observed during these late years; all were troublesome for the anesthesiologist.