[Medical and economic evaluation of donated blood screening for hepatitis C and non-A, non-B, non-C hepatitis]. / Evaluation médico-économique du dépistage des hépatites C et non-A non-B non-C sur les dons de sang.

The aim of this study was to evaluate the cost of hepatitis C and non-A non-B non-C screening strategy in donated blood, currently used in French transfusion centres and to assess the effect in the blood transfusion centres according to the prevalence of the disease and the intrinsec values of tests. This screening strategy was based on alanine aminotransferase assay, and HBc and HCV antibodies detection. In 1993, a survey was conducted in 26 French transfusion centers to estimate the costs of the screening strategy currently used. Average expenditure on diagnostic sets, equipment, staff and administration charges for hepatitis C and non-A non-B non-C screening were calculated. From these results, we estimated the cost of the previous strategy which did not involve HCV antibody testing, so as to determine the incremental cost between the two strategies. We used clinical decision analysis and sensitivity analysis to estimate the incremental cost-effectiveness ratio with data gathered from the literature and examine the impact on blood transfusion centre. Implemented for 100,000 volunteer blood donations, the incremental cost of the new strategy was FF 2,566,111 (1992) and the marginal effectiveness was 180 additional infected donations detected. The sensitivity analysis showed the major influence of infection prevalence in donated blood on the incremental cost-effectiveness ratio: the lower the prevalence, the higher the cost-effectiveness ratio per contaminated blood product avoided.

[Tooth injuries during general anesthesia, oral endoscopy and vibro-massage]. / Les traumatismes dentaires lors des anesthésies générales, des endoscopies orales et des sismothérapies.

It is generally recognized that dental injury during and after tracheal intubation is a significant problem. Damage may occur during oro-tracheal intubation, oral endoscopy or seismotherapy. The incidence was reported in a study conducted in the contentious department of Lyon hospitals, in France, from 1978 to 1988. Results confirm that damage is relatively common and that the majority of damaged teeth (67%) were known to have been previously restored, or weakened through periodontal disease prior to the damage occurring. Maxillary incisors were the most frequently injured teeth. Fracture of crowns and roots of natural teeth (44,8%), followed by partial luxation (20,8%) and avulsion (20,8%) were the most common injury. Several cases are presented which reveal the clinical value of dental damages that occur during orotracheal intubation, oral endoscopy or seismotherapy. Besides dental or gingival complications can appear immediately but also after a few days or weeks. Some of the most recent development in dental therapy such as the butterfly bridge, titanium implants and porcelain laminate veneers are described. Tooth protective guards must be put into widespread use. Legal implications of dental lesions occurring during oro-tracheal intubation, oral endoscopy or seismotherapy are presented.

[Tooth injuries during intubation: a new preventive device]. / Traumatismes dentaires au cours de l'intubation: un nouveau dispositif de prévention.

This study analyses 126 cases of dental injuries occurring during endotracheal intubation, reported to the service of litigations of the hospitals in Lyon over a ten-year period, and giving rise to a complaint. The overall rate was 1 out of 4,000 cases of intubation. The true incidence may be greater. As expected, the upper jaw teeth are most often involved, especially the left incisors. Among them 24.3% of the involved teeth were normal. Dental fractures were the most common lesion, together with total or partial dislocations. A questionnaire was sent to 534 anaesthetists to assess the main difficulties which they encounter when carrying out endotracheal intubation. The results of this enquiry demonstrated that anaesthetists were very aware of dental risks when carrying out intubation, and that there was a lack of efficient protective measures. Among them 81.2% claimed they would use a protective device from time to time, and 17.4% routinely, if one were available. Therefore we designed such a device. It is gutter-shaped, made with two different plastics, the more rigid one being on the outside. It fits over the upper jaw teeth. There is an indentation in the front, to check whether the device is placed correctly. The inner surface is made of foam which dulls the pressure which may be exerted on the device during intubation. This device was tested in 108 patients. Intubation was easy with the device in place in 73.2% of patients; mouth opening was reduced by a mean of 4.2 +/- 0.5 mm. The device made intubation more difficult, and even impossible, in patients whose mouth opened no more than 3.5 cm.(ABSTRACT TRUNCATED AT 250 WORDS)