[Hospital infections in the maternity department at Brest Hospital over a period from 2000 to 2005]. / Infections nosocomiales en maternité au centre hospitalier universitaire de Brest du 01/01/2000 au 31/12/2005.

Hospital infections are at stake in terms of public health. They are responsible for increase in morbidity and involve the community in high costs. Epidemiologic surveillance has been initiated in the departments of gynecology, obstetrics and maternity with a view to making out the rate of hospital-acquired infections and the risk factors associated to them. It is an incidence survey over a period from 2000 to 2005. Surveillance slips are filled in for every childbirth. All suspicions of hospital infections are analysed in morbidity reviews every trimester. A request to the Medical Information Department of the hospital has allowed to look for variables which were not mentioned on the initial questionnaire and so carry out a more complete analysis. The number of hospital infections amounts to 118 over 9526 childbirths, corresponding to an incidence rate of 1.24%. After vaginal delivery the encountered risk factors are: episiotomy or perineal trauma, epidural anesthesia, urinary infection and the use of tools. After a caesarean section the risk factors are: general anesthesia and lack of antibioprophylaxy. The rate of hospital infections in the maternity department at Brest's centre hospitalier universitaire (CHU) during the considered period and the observed tendency to a decreasing of hospital infections over the same period apparently denotes the interest of surveillance in matter of hospital infections in maternity.

[Evaluation of ambulatory anesthesia at CHU, Brest]. / Evaluation de l'anesthésie ambulatoire au CHU de Brest.

Outpatient anaesthesia was investigated for a two-month period by means of a questionnaire filled from the preoperative anaesthesia consultation to the surgical procedure and the discharge of the patient. 868 consultations led to schedule 260 ambulatory procedures. ENT (88 patients), paediatric surgery (73 patients) and gynaecology (63 patients) were most frequently concerned. Indications of ambulatory practice could probably be enlarged provided that recovery rooms and surgical schedules were fully adapted.

[Abnormalities of respiratory function in civil defence firefighter-submarine divers. Respective role of diving and occupational exposure related to occupational firefighter's functions]. / Anomalies de la fonction respiratoire chez les pompiers-plongeurs sous-marins de la protection civile. Rôles respectifs de la plongée et des agressions liées aux fonctions de pompier professionnel.

Lung function was studied in 20 firemen-submarine divers (mean age 36 +/- 1.2 years) of the French civil defence undergoing the medical check-up compulsory for professional divers (lung function tests are not systematically performed in ordinary firemen). Compared with the CECA standards: (1) vital capacity (VC) was increased, residual volume (RV) was decreased and total lung capacity (TLC) was unchanged; (2) with the exception of peak respiratory flow, all expiratory flow values (FEV1, MEF50, MEF25) were decreased; (3) the permeability factor (KCO) was decreased. These functional abnormalities were moderately worse in subjects who smoked. Some abnormalities (increased VC, decreased RV) are typical of diving activities, but the deterioration of effort-dependent expiratory flow values and alveolar-capillary diffusion must be ascribed to specific nuisances (fumes, polluants, toxic substances) associated with fireman's activities. Monitoring lung function in all professional firemen therefore seems to be necessary, if not indispensable.

[Pediatric ECG monitoring. 2,500 pediatric patients under anaesthesia (author's transl)]. / Intérêt du monitorage ECG systématique chez l'enfant. A propos d'une série de 2500 anesthésies monitorées.

The authors report 98 cases of cardiac arrhythmia observed in the course of 2,500 pediatric anesthesias performed with constant electrocardiographic monitoring. The patients, aged 0 to 18 years, were in most cases healthy. Anesthesia was performed by different techniques for both surgical and non-surgical interventions for a variety of conditions, both serious and routine. Other than 3 cases of cardiac arrest (1 death) cardiac arrhythmias usually followed a benign course without hemodynamic repercussions. The authors emphasize the value of early detection of cardiac arrhythmias as well as vigorous treatment of predisposing conditions such as inadequate ventilation, acidosis and pain. The absence of correlation between the degree of rick, as estimated preoperatively (related to patient or procedure risk factors), and the frequency of occurrence seems to point to the value of more widespread use of ECG monitoring of pediatric patients undergoing anesthesia.

[Clinical and therapeutic problems posed by hangings. Apropos of 67 cases]. / Problèmes cliniques et thérapeutiques posés par les pendaisons. A propos de 67 cas

Starting from a collection of 67 cases of hanging taken over by the Anesthesia Resuscitation Department belonging to Reims Hospital University Centre, the authors report their clinical observations and make an analytical confrontation of this type of accident according to various criteria such as: - the initial physical condition of the victims; - the evolution of the symptoms; - the various medical treatments used. The immediate consequences of miscarried hangings lead to a physio-pathological argument dealing mainly with the neurological and breathing manifestations. The elements of this argument enable the writers to back up certain therapeutic orientations among which hyperbaric oxygen therapy and early prescription of which seems to be wished for in the most severe forms of hanging.

[Pulmonary edema in hangings]. / Oedème pulmonaire des pendus

The authors present two cases of unsuccessful hanging which hat lead to a very severe neurological picture and especially the very rapid appearance of acute pulmonary edema resulting in a vertiable flooding of the alveoli. The victims, aged respectively 21 and 15 years, were free from any pre-existing cardiopathy. These cases of pulmonary edema, resistant to depletive therapy (bleeding, diuretics) and cardiotonic agents (Cedilanid) should only be jugulated after a one hour session of oxygen at 3 ATA with a baro-assisted respirator. The following are discussed with reference to these two cases: 1- The mode of occurrence of this type of pulmonary edema: - implication of sub-acute anoxic cerebral damage; - high negative alveolar pressures owing to a gasp-type ventilation with a closed glottis. 2- The opportunity for the very early treatment of the oxygen deficit contracted by the brain and myocardium.