[Renal artery occlusion: surgical revascularization]. / Occlusion de l'artère rénale: revascularisation chirurgicale.

Five patients were treated for renal artery occlusion, as a result of embolism (2 patients), thrombosis of a stenosed vessel (1 patient) or acute occlusion during percutaneous transluminal angioplasty (2 patients). Three patients had poorly controlled hypertension. One patient was anuric. Patients were treated operatively in 4 cases and non operatively in 1 case. There were no death and no renal failure that necessitated chronic hemodialysis. All bypasses except one remained patent. Blood pressure increased in the patient with the bypass occlusion and was reduced in all four other patients. Renal artery occlusion does not necessarily cause renal infarction. Evaluation of renal viability is necessary before decision of revascularization. Surgical exploration seems the best predictive factor.

Interpleural analgesia with bupivacaine following thoracotomy: ineffective results of a controlled study and pharmacokinetics.

STUDY OBJECTIVE: To evaluate intrapleural analgesia with bupivacaine following partial pulmonary resection and to determine pharmacokinetic parameters of bupivacaine with epinephrine. DESIGN: Prospective, randomized study. SETTING: Thoracic surgical clinic of a university-affiliated general hospital. PATIENTS: Eighteen consecutive patients (13 men, 5 women) scheduled for pulmonary surgery by posterolateral thoracotomy. INTERVENTIONS: Bupivacaine was administered through an intrapleural catheter as a bolus dose of either 40 ml of 0.25% bupivacaine with epinephrine (0.5 mg per 100 ml of solution) (n = 10) or 20 ml of 0.5% bupivacaine with epinephrine (0.5 mg per 100 ml of solution) (n = 8) up to three times daily for a maximum time of 4 days. MEASUREMENTS AND MAIN RESULTS: Subjective evaluation of pain was performed using the visual analog scale (VAS) before and after each injection by response to spontaneous pain, coughing, deep breathing, and incision palpation. Maximum peak concentration (C Max) and maximum time to reach the peak concentration (T Max) were assessed after the first and last injections. Although VAS pain score decreased significantly, pain relief was not sufficient. C Max and T Max after the first and last injections were not significantly different between the two groups. In each group, C Max after the last injection was significantly higher than after the first injection. CONCLUSIONS: Intrapleural analgesia conducted with 40 ml of 0.25% bupivacaine with epinephrine or 20 ml of 0.5% bupivacaine with epinephrine was insufficient for pain, despite high plasma bupivacaine concentration.