[The use of propofol does not increase the cost of the management of patients in heart surgery with extracorporeal circulation]. / L'utilisation du propofol n'augmente pas le coût de la prise en charge des patients lors de chirurgie cardiaque avec circulation extracorporelle.

OBJECTIVES: Evaluation of the cost of propofol used for fast-track in cardiac surgery and its impact on global cost of management for anaesthesia and intensive care. STUDY DESIGN: Case-control study, prospective (1998) and retrospective (1994). PATIENTS: Twenty patients operated for cardiac surgery in 1998 and scheduled for fast-track anaesthesia. Twenty patients in 1994 matched for different criteria to the patient of 1998. METHODS: In 1998, all drugs, materials used and X-rays, biochemical assays performed were prospectively collected and their cost calculated. In 1994, similar calculations were done retrospectively. Comparison of duration of mechanical ventilation, hospitalization in intensive care and in the hospital were performed. RESULTS: Cost of anaesthesia was similar in 1994 and 1998 (2,646 FF versus 2,294 FF). Global cost of management was significantly lower in 1998 in comparison to 1994 (5,439 FF versus 8,558 FF). Duration of mechanical ventilation, hospitalization in intensive care and in the hospital were shorter in 1998 than in 1994. CONCLUSION: Despite a higher cost of propofol for anaesthesia and postoperative sedation in comparison to midazolam, the global cost of management decreased significantly in relation to a one day decrease in hospitalization in the intensive care unit.

Acute mononeuropathy with angiotropic lymphoma.

Angiotropic lymphoma can present as a vascular disease in the central nervous system. The patient described in this report had a sudden pain in the region of the right superficial peroneal nerve and a nerve biopsy showed tumoral cells in the lumen of most small blood vessels. This pathology, first described in the skin as malignant angioendotheliomatosis, can be compared with the occurrence of multiple emboli in the vasa nervorum. In recent cases, tumoral markers have evidenced a lymphomatous origin, generally of the B type.

[Effects of clonazepam taken per os by children with rebellious epileptic encephalopathies]. / Intérêt du clonazépam per-os dans les encéphalopathies épileptiques rebelles de l'enfant.

The effect of clonazepam, taken per-os and in very progressive doses, has been studied by the authors on fourteen children afflicted with evolutive epileptic encephalopathies and still presenting, in spite of heavy anti-epileptic polychemio-therapies, alarming clinical and electrical manifestations. Clonazepam proved to be an efficient contributive factor in the course of a curing process since, in 70% of the cases, it produced quite a visible amelioration. Its efficient action seems to last longer than that of other diazepines since half of their patients have now been treated with it for more than a year with, as a result, a constant clinical and electrical amelioration. As a last point, it appears to be a very useful drug when dealing with type of rebellious epilepsies since, when combined with other benzodiazepines, seldom side-effects and no "crossed resistances" can be observed.