Prevençäo de dor por injeçäo venosa de etomidato: efeito da associaçäo fentanil/lidocaina / Prevention of pain by intravenous administration of etomidate: the effect of previous injection of fentanyl followed by lidocaine

Los autores testaron la eficacia de la administración secuencial de pequeñas dosis de fentanil (2 microng.Kg-1) y lidocaína (1 ml de una solución al 2%) previa a la inyección de etomidato al 0.2% en propilenoglicol al 35% en venas del dorso de la mano en estudio doble ciego. El grupo control recibió fentanil en la misma dosis y la lidocaína fue substituída por solución salina isotónica. La ocurrencia de dolor entre los pacientes del grupo control fue del 60%. En el grupo que recibió fentanil seguido por lidocaína la ocurrencia de dolor desencadenada por la inyección por la inyección venosa del etomidato fue de 23,3% (x2 = 6,47; p < 0,05). Se concluyó que la adminsitación de fantanil y lidocaína en la secuencia y dosis utilizadas en este estudio redujo substancialmente la incidencia del dolor causada por la inyección de etomidato en venas de pequeño calibre en el dorso de la mano

[Anterior ligamentoplasty of the knee under arthroscopic control]. / Ligamentoplastie antérieure du genou sous contrôle arthroscopique.

In the technique reported here an anterior cruciate ligament of the knee made of Dacron is inserted under arthroscopy, thus avoiding the usual wide tissue damage and delay in recovery. The very small incisions make it possible to install the prosthesis within an isometric, and therefore reliable, framework. Dacron is used alone for patients who underwent several unsuccessful operations on the knee, and Dacron wrapped in fascia lata, as suggested by Mansat, for patients operated upon for the first time. The results are very encouraging, with no post-operative complications, but the future of this technique will depend on the discovery of a better prosthetic material. This approach to reconstruction of the cruciate ligament might be considered a breakthrough in the treatment of chronic laxity of the knee.

Nerve complications in closed fractures of the lower end of the radius.

Nineteen cases of nerve complications following closed fractures of the lower end of the radius (17 lesions of the median nerve, 4 of which were associated with lesions of the ulnar nerve, and 2 isolated lesions of the ulnar) were observed. A therapeutic approach may be suggested for lesions of the median nerve and/or the ulnar nerve: immediate lesions: immediate reduction, gently if possible and avoiding the position of volar flexion and ulnar deviation. Early secondary lesions associated with immobilization in flexion and ulnar deviation: modify the position and complementary pinning when necessary. Deterioration----neurolysis: no improvement----neurolysis at the 6th month. Early secondary lesions following immobilization in a neutral position: same approach as previous case. Late cases: in absence of malunion or in presence of a minimal malunion: division of the carpal tunnel and/or Guyon's canal. Exceptionally associated fascicular neurolysis. In presence of malunion: corrective osteotomy, completed in serious cases of compression syndrome by a division of the canals.

[Epiperineural nerve sutures and neurilemmatic sutures. Comparative clinical results about 109 cases (author's transl)]. / Résultats cliniques comparés des sutures nerveuses "mixtes" épipérineurales et des sutures névrilemmatiques. A propos d'une série de 109 cas de plaies de nerfs de la main.

During the last ten years, 109 medical cases of traumatic hand nerve lesions have been observed, implicating 78 big nerves (median 35, cubital 42, radial 1) and 37 little nerves (median 35, cubital 42, radial 1) and 37 little nerves (interosseous, collateral, digital). 81 "mixte" epiperineural sutures have been realized (according to a technical proceeding purposed by one of the authors since 1970, and practised with the only aid of a simple optical increase by dissection's magnifying-glasses) : In the same time, 38 neurilemmatic sutures have been seen at second hand and their clinical results noted. 64+ of the global results are very good or "good" concerning the "mixte" epiperineural sutures against 34% for the neurilemmatic sutures. To note : the best quality of the results for the median nerve as well for the primitive sutures, and unfavourable influence of the associated lesions.

[Nerve "mixed" suture. A new technique (author's transl)]. / Suture nerveuse "mixte". Technique originale.

A critical evaluation of the various methods of nerve suture, followed by the description of a new personal method of "mixed suture" taking up the neurolemma and the perineurium in the same stitch. It may be used under emergency conditions or not, at all levels of nerve trunk interruption (and in particular in the region of the plexi) without the need for costly optical equipment. The technique is simple and may be used under all circumstances, even by the non-specialised surgeon. Results obtained over more than 10 years, involving the treatment of 109 nerve lesions confirm the value of this type of suture.

[Pott's disease in African (author's transl)]. / Le mal de Pott chez l'Africain.

A study of anatomical clinical, and therapeutic features of Pott's disease in Africans from 131 cases treated by the same team and compiled from the principal series published during the last ten years in Black Africa. Anatomical features are related to the frequency of the disease (70 p. 100 of tuberculous osteo-arthritis), the elective lumbodorsal localization involving several vertebrae (gpenerally 3 or 4) and being sometimes multifocal. Clinical features are in part explained by the delay with which patients report to the hospital for the first time so that 80 to 90 p. 100 of the patients suffer from severe lesions (which are in their destructive phase in 30 p. 100 of the cases), with associated-complications (gibbosity, abcess, 50 p. 100; fistulae, 2 to 6 p. 100; paraplegie 23 to 25 p. 100; multiplefoci, 4 to 13 p. 100). Diagnostic difficulty mainly raised by "False Pott's diseases" (P. Bourrel), is considered. Therapeutics is studied; importance and place of the surgical treatment is emphasized; its various approaches are discussed. The authors report their surgical interventions on 89 patients out of 181 admitted: 64 direct approaches for simple Pott (with 70 p. 100 of good results and 20 p. 100 of satisfactory results), 25 operations for complicated cases of Pott (18 approaches for antero-lateral decompression and 5 laminectomies, with 22 satisfactory results).

[Drepanocytic osseous infections (osteitis and osteomyelitis) (author's transl)]. / Les infections osseuses drepanocytaires (ostéites et ostéomyélites).

Osseous infections have a special importance among the various polymorphic osteoarticular troubles of drepanocytemia. From 92 cases, the authors emphasize 4 points: --Osteitis and osteomyelitis are frequent, specially in the homozygotic form. --Salmonellae are the prevailing pathogenic bacterias. --Osteomyelitis caused by staphylococcus have, in drepanocytic patients, a more serious and more expanding evolution than in other patients. --Anatomic and radiologic features as well as evolution are different in the staphylococcal forms and in the salmonellal ones in which, most often, surgery may be discarded.

[Drepanocytic osseous complications: dystrophia and osteonecrosis (author's transl)]. / Les complications osseuses de la drépanocytose. (Dystrophies et osteonécroses).

Osseous troubles are the most frequent and earliest signs of drepanocytemia. They are due to the bone dystrophia observed in any chronic hemolytic anemia, to aseptic infarcts and to bacterial infections. These syndromes are described according to age and localizations, and proper surgical tactics are proposed.