[Desflurane and errors of gas selection on vaporizer analyzer]. / Desflurane et erreurs de sélection de l'agent sur le moniteur de vapeur.

With monochromatic infrared gas spectrometers (MIS), the displayed concentration is computed from measured IR absorption and a gain factor specific for the selected volatile agent (VA). As MIS cannot detect which VA is actually present, the displayed concentration can be very different from the actual one. As bottles and vaporizers are very specific for desflurane, it is impossible to misfill a vaporizer; however an erroneous selection of VA on MIS remains possible. The aim of this study was to assess the displayed concentrations after erroneous vapour selection on the monitor. When either desflurane, or isoflurane or enflurane were delivered at constant concentrations, all VA measured by the MIS, namely desflurane, sevoflurane, isoflurane, enflurane and halothane were successively selected and the displayed concentrations compared with the actual vapour concentration using a Capnomac Ultima (Datex) monitor. Consequences of erroneous selection can be included in three categories: 1) dangerous error, when a displayed concentration is much lower than the actual one, e.g. desflurane or sevoflurane erroneously selected; 2) evident error, when displayed concentration is much higher than 10 vol%; 3) uncomfortable situation, when displayed and actual concentrations are similar, e.g. isoflurane erroneously selected instead of desflurane. This error can only be detected by a careful checking of the device.

Blood levels of water-soluble vitamins in pediatric patients on total parenteral nutrition using a multiple vitamin preparation.

Although guidelines for the parenteral use of vitamin preparations in pediatric patients have been published, there are very limited data on the efficiency of these preparations and on the exact needs of infants and children on total parenteral nutrition (TPN). We report here an open, prospective, study of the blood levels of water-soluble vitamins in infants and children on TPN before and during supplementation with a new water-soluble multivitamin formula containing per vial unit: B1, 3 mg; B2, 3.6 mg; B6, 4 mg; niacin, 40 mg; pantothenate, 15 mg; ascorbate, 100 mg; biotin, 60 micrograms; folic acid, 400 micrograms; B12, 5 micrograms. Thirteen children, 9 months to 15 yr old, on home TPN for 1.5 months to 7 yr, and 17 hospitalized infants and children, 1 week to 15 yr old, receiving TPN were studied for 2 weeks to 4 months. Daily doses were given according to age: 1/2 vial if less than 18 months; 1 vial if greater than 18 months and less than 10 years; 1.5 vials if greater than 10 years. Assays for B1, B2, biotin, niacin, plasma and red blood cell (RBC) folates were performed by microbiologic methods, B12 was measured by radioimmunoassay. During the study, B1 levels were consistently above the upper limit of the normal range, B2 and B12 remained in the normal range although there was a slight decrease in B12 values. Almost half of the patients had initially low levels of biotin, niacin, and folates. Biotin, after a significant sharp rise during the first month of supplementation returned to normal range. Niacin levels were initially low in infants and rose toward normal values during treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

[Acute pancreatitis and biochemical markers. Isoamylase]. / Pancréatites aiguës et marqueurs biochimiques. Isoamylase.

Amylase activity in blood and urine, lipase activity in blood, and amylase/creatinine clearance ratio have been prospectively compared in order to test these parameters against estimation of pancreatic isoamylase. Pancreatic isoamylase had been evaluated by inhibition methodology and not by electrophoresis. One hundred patients admitted for strictly sus-umbilical abdominal pain in emergency unit have been studied. Results show that we do not have in blood specific biochemical marker for acute pancreatitis. Lipase and P isoamylase activity evaluation have about the same specificity. In emergency situation the choice of routine investigation will be rather based on methodological simplicity and lower cost.

[Relief of cancer pain by daily epidural injections of morphine using an implanted subcutaneous device]. / Sédation des douleurs cancéreuses par injection péridurale quotidienne de morphine grâce à un accès sous-cutané implanté.

Epidural narcotics have been shown to produce prolonged pain relief in chronic cancer pain. The technical hazards of daily injections and risks of infection with percutaneous catheters have delayed implementing this treatment. A completely implantable daily epidural morphine delivery system has been developed. Its technique and efficiency are presented.