[Transfusion-associated HIV contamination between January 1980 and September 1985]. / Contamination transfusionnelle par le VIH de janvier 1980 à septembre 1985.

This study reports the results of a retrospective survey of transfusion-related HIV-contamination in patients who were admitted in our neurosurgery department, between the 1st January 1980 and the 30th September 1985. In our area of France, the risk of HIV-contamination is low. During this 5-year-period the blood donors were not tested for HIV. Six hundred twenty-one patients were identified from the operating room registers. The administered blood components were always noted in these registers for each patient. Among these 621 patients, 233 died rapidly. Three hundred eighty files were taken out from the central archives' department. Eight files could not be found. These 380 files were examined for the patient's address, or the family's one, or the regular doctor's name and address. A letter was sent to the latter in order to inform him about the patient's transfusion. The doctor had to ask the patient to order a HIV-test. A recall letter was sent 8 months later as required. The patients who did not have a regular doctor were contacted directly by phone or letter, or indirectly through their family. Thirteen months after the beginning of this survey it was established that 334 patients died (53.5%) and only 151 patients were found and tested. One of them was HIV-positive. As this patient suffered from a hemophilia B, he had been medically followed and his positive serology was known since 1988. It was impossible to get any answer from 136 other patients who represent 22% of all patients and 47% of still alive patients or supposed to be so.(ABSTRACT TRUNCATED AT 250 WORDS)

[Retrospective multicenter study of prevention of thromboembolic complications after lumbar disk surgery]. / Etude multicentrique rétrospective de la prévention des complications thromboemboliques après chirurgie discale lombaire.

A retrospective study of thromboembolic complications after lumbar disc surgery has been performed. It included 16,656 patients from fifty neurosurgical units, operated on over the year 1989. The average number of operations was 333 +/- 19.5 in each unit, their average duration 55.2 +/- 20 minutes, and the hospital care 6.2 +/- 1.7 days. Surgery was performed using the genupectoral position in 64% of the cases, the supine position in 28%, and the lateral position in 8%. Two groups of patients have been individualized: a first group of patients with no preventive antithrombic treatment (46% of the units) including 10,351 patients, a second group (54% of the units) including 6,305 patients and receiving a systematic treatment with low molecular weight heparin (4,304 patients) or calciparin (1,001 patients) or antiplatelet agents or pentosane polysulfate (1,000 patients). 0.63% of the patients (105) had a thromboembolic accident: 0.65% in the first group (68 cases) and 0.58% in the second (37 cases). No statistically significant difference was noticed between the two groups concerning pulmonary embolism and/or lower-limb thrombophlebitis. Nevertheless, a prospective randomized study would be usefull to corroborate this first data.

[Auditory evoked potentials of the brain stem in brain death]. / Potentiels évoqués auditifs du tronc cérébral dans la mort cérébrale.

Brainstem auditory evoked responses were recorded in a neurosurgical intensive care unit in 38 patients who had all the clinical criteria for brain death. Of the brain-dead patients, 65.8% never showed a response. 3.42% showed a type I wave, which was unilateral in 26.3% and bilateral in the other 7.9%. Types II to VII waves were never seen. An increase in latency of type I waves (2.25 +/- 0.24 ms) was noted. The interest and the limits of this non invasive electrophysiologic technique for the diagnosis of brain death are discussed.

[Deglutition disorders caused by an injury to the foramen lacerum posterior]. / Troubles de la déglutition secondaires à une lésion traumatique du trou déchiré postérieur.

Dysphagia due to a traumatic lesion of the foramen lacerum posterior is relatively rare. Two cases are described in which swallowing troubles were perceived when the post-traumatic coma improved; these were ascribed to a traumatic lesion of the foramen lacerum posterior injuring the cranial nerves. Treatment involves preventing inhalation and nasogastric feeding whilst starting active and early rehabilitation of swallowing. Recovery is possible in most cases without surgery.

[Hypotension induced by isoflurane for the treatment of intracranial aneurysm in late pregnancy]. / Hypotension à l'isoflurane pour cure d'anévrysme intracrânien en fin de grossesse.

A 31-year old primigravida was admitted at 31 week gestation for subarachnoid haemorrhage. Cerebral angiography revealed an aneurysm on the left middle cerebral artery. Eleven days later, the aneurysm was clipped off. General anaesthesia was induced with thiopentone, pancuronium and fentanyl, and maintained with fentanyl (40 micrograms.kg-1) and isoflurane in air/O2 with a non-rebreathing circuit. The patient was mechanically ventilated to maintain mild hypocapnia. Arterial hypotension was induced by increasing the inspired isoflurane concentration from 1 to 3 vol%. The response was immediate and a mean arterial pressure of 60 mmHg was maintained for 80 min with an inspired isoflurane concentration of 2.5 vol%. Foetal heart rate was monitored before, during and after general anaesthesia. Loss of beat to beat variation was observed after induction, and foetal heart rate slowly decreased from 150 to 115 b.min-1 at the end of the operation. Postoperative state was good, except for transitory aphasia. At 35 week gestation, the patient went into premature labour, with hypothermia of 39.5 degrees C; an emergency caesarean section was performed. The 2,340 g female infant had a 10 min Apgar score of 8. One month later, clinical examination of the mother and daughter was quite normal. The precautions and anaesthetic management of patients suffering from ruptured cerebral aneurysm during the end of pregnancy are reviewed. Hypotensive agents are discussed.