Incidence and clinical significance of bacterial and fungal contamination of the preservation solution in liver transplantation.

A perfusion fluid used in the preservation of the grafted liver represents a medium suitable for microorganism growth. In this observational study, a sample of 232 transplanted livers was collected. Perfusion fluid samples were stored for microbiological analysis from harvested donors. Bacteria were isolated in 91 out of 232 samples, post-operative infections related to contaminated perfusion solution occurred in 13 cases. The contamination rate of the preservation medium appears to be high, but postoperative infections occurs rarely. We suggest periodic detection and a protocol in place designed for antibiotic use for transplanted patients exposed to contaminated perfusion solution.

Gestational choriocarcinoma transmission following multiorgan donation.

An accidental transmission of placental choriocarcinoma (CC) from a multiorgan donor to four recipients is reported. The donor was a 26-year-old pregnant woman, died from a cerebral hemorrhage. Histological examination demonstrated the presence of a placental CC. Diagnosis of CC transmission was established on the basis of an increase of human chorionic gonadotrophin hormone (hCG) level. The recipient of combined pancreas-kidney is still in complete remission 2 years after the beginning of chemotherapy without removal of the grafted organs which show optimal function. The recipient of a single kidney was rapidly transplantectomized and treated with actinomycin. At 2 years, she remains in remission. Liver recipient showed intestinal metastasis and died from digestive hemorrhage after an initial response to chemotherapy. Heart recipient had an initial remission under EMA-CO, but at the last report, he showed diffuse metastasis. Published reports on CC transmission are rare. The long-lasting remission of our pancreas-kidney recipient and her good outcome after 2 years make our observation original. Moreover, the high rate of transmission demonstrates the high malignant potential of CC in immunosuppressed patients. Chemotherapy combined or not with transplantectomy in case of nonvital organ, should be discussed.

[Inhalation anesthesia in unusual situations: the Eole 2 NA ventilator]. / Anesthésie par inhalation en situation d'exception: le respirateur Eole 2 NA.

The volumetric ventilator Eole 2 NA has been adapted to work as an anaesthesia machine with low flow or closed system. This modified device is very easy to use in exceptional situations: because of its strength and reliability; its favorable quality/price ratio; versatile electrical supply: mains (220 volts) or 24 D.C.V. from internal battery (2 hours autonomy) or external battery (8 hours autonomy); gas economy: less than 1 L.min-1 of fresh gas flow, whether O2/N2O = 0.5 L.min-1 of each gas or 1 L.min-1 delivered by an oxygen concentrator. Clinical trials are discussed.

[Is the malleable mattress harmful for the spinal cord?]. / Le matelas coquille met-il la moelle en péril?

When the inside pressure of mouldable mattress is lowered isotropic deformation can be harmful for spinal cord. The axial force is measured placing stress gauge in a metallic manikin and in corpse (T2-L1), then on the cephalic top of volunteers. When soles and head are included in an usual mattress, during the retraction stress values raise up to 484 N at 262 mbar for manikin, to 150 N at 315 mbar for corpse, to 102 N at 310 mbar for cephalic top of the volunteers. In comparison, a prototype was tested. Results were improved on metallic models but not on human corpses or volunteers. This test allowed us a better understanding of the mechanism of the stress. It is possible to propose precautionary measures during patient immobilization (to provide a space between soles, head and mattress) and to build a new stressless mattress.

[Emergency anesthesia with halothane-air. Techniques; indications; limits]. / Anesthésie par halothane-air en urgence. Techniques; indications; limites.

A new apparatus for anaesthesia has been developed for disaster situations. A turbine pushes room air through a halothane vaporizer to a modified D. Mapleson system. A battery provides an autonomy of two hours with an air flow of 5 liters per minute. Electrical current used is 220 volts external or 12 volts. Oxygen can be added during inductions and when there is imbalance in the hemodynamic or respiratory function. One series of 20 patients successfully underwent this procedure. Oxygen monitoring was performed with percutaneous PO2, SaO2, FiO2. Only one patient with cardiac disease needed oxygen adjonction (2 l.min-1) to raise his SaO2 level above 95%. Thus it is possible to have the optimum FiO2 with the lowest amount of halothane and oxygen.

[Arrhythmia in anesthesia and intensive care]. / Troubles du rythme en anesthésie-réanimation.

There is a high incidence of dysrhytmias in the operating room and I.C.U. Calling again diagnosis criteria using common leads of the E.E.G. leads to suggest a treatment approach taking the main effect of non cardiac factors in account, before the use of antiarrhythmic drugs. The Puech classification takes many data into consideration: electrophysiological properties, cardiac disease and trigger mechanism of dysrythmias. So, it is a better practice in a dysrythmia therapy to examine all these characteristics in order to choose an adjusted treatment.

[Value of the radionetwork of the transportation company in Besançon for alarm forwarding]. / Intérêt du réseau radio de la compagnie des transports bisontins (CTB) dans le cheminement de l'alerte ("CB or CTB").

The C.B. users offered for a few years a way for putting-out the distress on the highway. There were 2,000 in Besançon and surroundings in 1982. Today they are becoming no existent. Since then a new system of alarm run is born with 150 buses, 178 kilometers of net-travel and a sweep frequency of 10 min from 6h30 a.m., to 8h p.m, and of 30 min until 12h p.m. The 250 "C.T.B." drivers assume a regular surveillance of the urban and suburban highways. A standard message in used between the C.T.B. (Besançon Company of Buses.) regulation and Samu 25, regulation which allows to fix circumstances, place of road accident and inventory of casualties: 27 emergency calls are received in 1987, 50 in 1988. It might be possible to use other private or public radiotelephonic network.

[Repetitive inhalation anesthesia in rats]. / Anesthésies itératives par inhalation chez le rat.

Inhalational anesthesia in the rat seems a good process, by a rapid induction and awakening if a steady state ventilation-perfusion ratio and no pollution are obtained. Animals are cooped up in an "induction-box" which is joined to a scavenger system. Anesthesia maintenance is assumed with a Bain circuit and allows short and frequent anesthesia. Isoflurane does not markedly decrease circulatory and respiratory factors at low concentration (2%). So any anaesthetist can do himself such a practical system.

[Flumazenil and volatile anesthetics. Study of possible interferences in rats]. / Le flumazénil et les anesthésiques volatils. Etude des interférences éventuelles chez le rat.

Many works suggest contradictory experimental or clinical results of flumazenil effects during inhalation anaesthesia. In ten rats anaesthesia was induced with 5% isoflurane or halothane during one minute and maintained during 5 minutes with 1% the same halogene anaesthetic in 50% N2O and O2. Then 0.2 mg of flumazenil or a same volume of placebo were administered intraperitoneally and during the last 5 minutes, the rats were exposed in 1% volatile anesthetic gas flow. Sleep times were measured in terms of reestablishment of the righting reflex. Each rat was anesthetized four time: halothane and isoflurane, with flumazenil or placebo. In those conditions, there were no significant changes in sleep times either the anaesthesia were associated, with flumazenil or with placebo.

[The indirect calorimeter, "do it yourself"]. / Calorimètre indirect, "do it yourself".

An original metabolic calculator is realized with common and fiable transducers: a "microgaz Roche Kontron 7640" gives the PiO2-PeO2 and PeCO2 (Clark and Stow Severinghaus electrods), a pneumotachograph Gould 17212 (or the reliable integrated flow meter of the respirator) gives the expiratory minute volume. These values are inserted in an micro computer (Sharp PC 1261). The soft is wrote so that results are not altered when high FiO2 are used. Consumption of lipids and glucids is displayed in percentage when diuresis and urea values are entered. This device is compared with a well known expenditure monitor: Deltatrac (Datex): simultaneous measures are carried out in patients with miscellaneous diseases (15 series of 10 measures). Regression curves appear to be very reliable, as well for VO2(r = 0.98), VCO2 (r = 0.94) energy expenditure (0.97) as for R.Q (r = 0.77).

[Flowmeters and safety rotametric mixers]. / Débimètres et mélangeurs rotamétriques de sécurité.

Rules and principles in choice of flowmeter take in account the advices of French National Approval Committee. Several and more frequently used and modern flowmeters are discussed, authors wishing an European harmonization of the safety guidelines in anaesthesia for 1993.

[Monitoring of gases and vapors in the anesthesia system]. / Monitorage des gaz et vapeurs dans les circuits d'anesthésie.

By now inhalation anesthesia makes anesthetic gaz and vapours analysis compulsory. This paper give an account of numerous gaz analyzers which are available today. Different kinds of oximeters (galvanic, polarographic, paramagnetic) carbon dioxide analysers, halothane, enflurane or isoflurane-meters are reviewed. Advantage/cost ratio of mass spectrometer is discussed too. Practical advices on use and site of slow and fast analysers are recalled.

[Action of ifenprodil tartrate in obliterative arteriopathies of the lower limbs. Combined studies using proximal blood flow and distal transcutaneous oxygen pressure]. / Action du tartrate d'ifenprodil dans l'artériopathie oblitérante des membres inférieurs. Mesures couplées par débitmétrie proximale et pression d'oxygène transcutanée distale.

A simultaneous analysis of both the variations of the flow in the stenosis artery and the distal PO2, was carried out during an injection of an alpha-blocker: the Tartrate d'Ifenprodil, on twenty-five patients afflicted with occlusive disease of the lower limbs requiring surgery. The measurements were taken under general anaesthesia, before any surgical operation, the hemodynamic and ventilatory balance being monitored by radial manometry and arterial gas analysis. We observe an increase of proximal arterial flow and at the same time an improvement of the distal TcPO2. Moreover, the variations of microcirculation flow measured by TcPO2 are correlated with proximal flow variations, this relation: delta TcPO2 = K delta Q + A is more true in the first and the second stages of Fontaine. With the same (Tartrate d'Ifenprodil) posology, the distal benefit measured by transcutaneous oximetry is less important in advanced stages compared with other stages (everything else being equal). The transcutaneous measurement of the distal oxygen pressure, allows an objective view of microcirculatory improvement obtained by a vasoactive substance (ifenprodil tartrate) considering the specific nature of each patient arteriopathy.

Comparision of low dose heparin and low dose heparin combined with aspirin in prevention of deep vein thrombosis after total hip replacement.

In a prospective randomised trial, two groups of 20 patients each were compared. The first group received low dose heparin (t.i.d.) and the second group received low dose heparin (t.i.d.) combined with aspirin. The incidence of deep vein thrombosis (DVT) were determined using both radioactive fibrinogen uptake test and venography. The correlation between the two methods of diagnosis was better than 90%. There was no significant difference in the incidence of DVT between the two prophylactic regimen. A significant tendancy towards increased bleeding in observed with the combination of low dose heparin and aspirin.