[Inflammatory pseudo-tumors of the liver. Apropos of 2 cases]. / Les pseudo-tumeurs inflammatoires du foie. A propos de deux cas.

Inflammatory pseudotumors of the liver (IPTL) are a reaction pathology of most often mysterious etiology. This is an ill-known clinicopathological entity, of which 13 cases only have been reported. The authors report about 2 cases for which an infectious or parasitic etiology can be suggested. They sum up the characteristics of these pseudotumors, which are most often single, solid, preferentially developing in the right liver. The clinical signs of these lesions are pain and fever, associated to jaundice in case of pedicular extension. From a morphological and macroscopic point of view, IPTLs have the features of a primary or secondary malignant tumor. Cytological puncture usually fails. The diagnosis can be based only on an extensive surgical biopsy or the study of the specimen of liver exeresis. Finally, IPTLs are characterized by a spontaneously regressive evolution. This notion justifies a prudent, even conservative surgical attitude.

[Gastric fundus necrosis following acute gastric dilatation]. / Nécrose gastrique, fundique, consécutive à une dilatation gastrique aiguë.

Total gastrectomy with immediate re-establishment of digestive continuity successfully treated a patient with gastric fundus necrosis due to acute dilatation of stomach. The very particular circumstances of onset of this major complication are outlined, diagnosis being dependent on radiological and endoscopic findings. In cases with necrosis of the fundus the extensive nature of the ischemic lesions as shown by results of histopathology strongly suggests the need for total gastrectomy in these patients.

[Bilateral adrenal pheochromocytoma associated with pregnancy. Simultaneous cesarean section and adrenalectomy]. / Association phéochromocytome surrénalien bilatéral et grossesse. Césarienne et surrénalectomies simultanées.

An-25-year-old primigravida with bilateral phaeochromocytomas was managed from 6 weeks' gestation until 2 years following combined caesarean section and removal of adrenal tumours. Preoperative alpha-blockade was achieved by oral prazosin without deleterious effects. Intraoperative management comprised neuroleptanalgesia, arterial and pulmonary pressures monitoring, adequate heart loading with fluid replacement and sodium nitroprusside. Postoperatively mother and baby remained normotensive.

[Postoperative respiratory complications of myotonia dystrophica (Steinert's disease)]. / Complications respiratories postopératoires de la myotonie dystrophique (maladie de Steinert).

Respiratory difficulties have long been recognized to be a major risk in patients with myotonia dystrophica, but postoperative pulmonary complications have only rarely been considered. Two cases of postoperative pulmonary complications which led to the patients's death stressed the severity and difficulty of treatment of these complications. A third case of postoperative respiratory failure revealed the underlying disease. These cases showed all the more the importance of preventing pulmonary complications. Pre-, per- and postoperative measures, chosen with respect to the severity of the myotonia and the seat of the surgical procedure, are suggested.

[Development of blood sugar and insulinemia in the first 12 postoperative hours. Effects of glucose and insulin intake]. / Evolution de la glycémie et de l'insulinémie au cours des douze premières heures post-opératoires. Influence des apports de glucose et d'insuline.

Serum levels of glucose and insulin are studied during 12 hours in the early post-operative period after intra-abdominal surgery. Five groups of non diabetic patients are perfused with incremental doses of glucose, G. I: no glucose, G. II: 8,33 g . h-1 of glucose during 6 hours, G. III: 16,66 g . h-1 of glucose during 6 hours, G. IV: 16,66 g . h-1 of glucose with 20 mu insulin; G. V: 16,66 g . h-1 of glucose with 40 mu insulin. In all groups a significant rise in serum levels of glucose is observed (10,5-15,6 mmol . l-1). At the same time serum level of insulin remains unchanged except when insulin is infused. However exogenous insulin is unable to prevent the serum level of glucose to rise post-operatively.

[Comparison of the hemodynamic effects of fazadinium, pancuronium and alcuronium in coronary insufficiency (30 cases)]. / Comparaison des effets hémodynamiques du fazadinium, du pancuronium et de l'alcuronium chez l'insuffisant coronaire (trente observations).

Cardiovascular effects of neuromuscular blocking agents mainly guide the choice of these relaxants in patients with cardiovascular disease. The purpose of this study was to compare the hemodynamic effects of fazadinium (1 mg . kg-1), pancuronium (0,08 mg . kg-1) and alcuronium (0,2 mg . kg-1) in 30 coronary patients without beta-blocking therapy. No hemodynamic changes were observed after pancuronium. Fazadinium induced at the fifth minute a mean five p. 100 decrease in mean arterial pressure, cardiac index, stroke volume and systemic vascular resistance. At the fifth minute with alcuronium, mean arterial pressure decreased (22 p. 100) (p less than 0.01) with a decrease in cardiac index (12 p. 100), stroke volume (8 p. 100) and systemic vascular resistance (10 p. 100). This study shows that pancuronium and fazadinium are well tolerated. Alcuronium induces at the fifth minute a significant decrease in arterial pressure. This effect does not seem to be deleterious in normovolemic patient with coronary artery disease without beta-blocking therapy.

Comparison of effects of balanced anaesthesia and neuroleptanalgesia on postoperative cardiovascular function in patients with coronary artery disease.

Patients with chronic ischaemic heart disease and a history of myocardial infarction or who present with exertional or spontaneous angina suffer a decrease in left ventricular pump function during recovery from anaesthesia and in the period immediately after operation. This decrease is reflected in an increase in pulmonary capillary wedge pressure and in a decrease in stroke volume and cardiac output. Two groups of 10 such patients, clinically and haemodynamically comparable in the preoperative period, were studied: 10 patients received balanced anaesthesia, and 10 neuroleptanalgesia. The disturbance in left ventricular function was less pronounced with neuroleptanalgesia. A significant difference was noted between the groups with regard to pulmonary capillary wedge pressure during recovery from anaesthesia (balanced anaesthesia 15.8 +/- 4.4 mm Hg; neuroleptanalgesia 10.7 +/- 4.4 mm Hg; P less than 0.02). There was a relationship between type of anaesthesia and pulmonary capillary wedge pressure variations (P less than 0.01).

[Hemodynamic effects of a new antidepolarizing agent: fazadinium bromide]. / Effets hémodynamiques d'un nouvel agent antidépolarisant: le bromure de fazadinium.

Studies concerning the hemodynamic effects of this new antidepolarizing agent are scarce and difficult to interpret because of drug interactions, and of an accentuation of vagal tonus related to the use of morphinomimetic analgesics. For a better approach of the effects proper to fazadinium, we have tried to perform a study freed, to a maximum, from any drug interference. We studied the hemodynamic effects to a single dose of 1 mg.kg-1 of fazadinium bromide during 35 minutes in coronary patients normal hemodynamically or rhythmically, non-premedicated, ventilated with 50 p. 100 nitrous oxide in oxygen, and bebore any surgical procedure. All hemodynamic modifications are moderate and maximal 10 minutes after injection. The stroke index decreases 16 p. 100, heart rate increases 6 p. 100 and cardiac index falls 10 p. 100. Total peripheral resistance remains unchanged and mean arterial pressure drops 10 p. 100. Finally pulmonary wedge pressure decreases slightly. None of these modifications are statistically significant. One may, therefore, conclude that fazadinium tolerance, when the drug is freed from any drug interference, in coronary patients normal hemodynamically and free from rhythm disorders is excellent from a hemodynamic and rhythmic point of view. However, other isolated observations of hypovolemic subjects, or patients with atrial fibrillation receiving fazadinium and studied hemodynamically suggest a poorer tolerance in these cases.