[Adjusting the dosage of netilmicin from two measurements. Program validation]. / Adaptation des posologies de la nétilmicine à partir de deux points. Validation d'un programme.

The aim of this study is to give to clinicians a well validated usefull tool allowing an increase of safety in the monitoring of netilmicin. During the first administration of the drug, two plasmatic concentrations are measured, and input in a preprogrammed hand-held calculator. A posology and a rythm of administration are returned by the calculator. After six days of this dosage regiment, the peak and the valley concentrations are compared with those previously given by the computer as values at equilibrium. No significant difference can be observed. There is no change in plasmatic creatinine level from the first to the sixth day of treatment. So, a preprogrammed hand-held computer can be convenient and safe to monitor netilmicin.

[Influence of epidural anesthesia on postoperative nitrogen sparing in major digestive surgery]. / Influence de l'anesthésie péridurale sur l'épargne azotée postopératoire en chirurgie viscérale majeure.

In order to determine the role of epidural anaesthesia on protein sparing, eighteen patients undergoing major visceral surgery were randomly divided into three different groups according to the mode of anaesthesia used (general anaesthesia, epidural anaesthesia, continuous epidural anaesthesia for 24 h). These patients were intravenously fed for five days postoperatively; their nitrogen balance was studied. Compared with the "general anaesthesia" group, only the daily averages of nitrogen balance of the "continuous epidural" group were significantly better. IN order to correlate stress with nitrogen saving, the early evolution of several parameters (cortisol, glucose, prolactin) used as "stress markers" was studied : there was no evidence of any significant difference between the three groups.

[Muscle calcium deposits in an acute alcoholic rhabdomyolysis with renal failure]. / Dépôts calciques musculaires au cours d'une rhabdomyolyse alcoolique aiguë avec insuffisance rénale.

A 41 year old man was admitted to hospital for acute alcoholic rhabdomyolysis and renal failure. Calcium deposits in the damaged muscles of the inferior limbs were detected by technetium-99 m methylene diphosphonate. Repeat bone imaging studies showed a decrease in the deposits with time. The mechanisms responsible for the rhabdomyolysis and the characteristic disturbances in serum calcium and phosphorus concentrations during such renal failure are recalled. The interest of 99mTc-MDP is reviewed. Early dialysis is advocated, in particular in case of extensive muscular damage.

[Severe anaphylactoid complications in anesthesia. Apropos of 35 cases]. / Les accidents anaphylactoïdes graves en anesthésie. A propos de trente-cinq cas.

35 cases of severe anaphylactoid accidents during anesthesia are reported. Clinical symptomatology is dominated by cardiovascular collapse and/or bronchospasm and/or cutaneous and mucous manifestations. The course is always favourable. The usual risk factors (drug allergy, atopic background, spasmophilia, multiple anesthesia) are found. Pentothal alone or added to succinylcholine is most incriminated, followed by C-T 1341, curare-like agents, propanidid and macromolecular solutions. The immunoallergic investigation is incomplete, founded on the inhibition of leukocyte migration test TIML. The principal mechanisms responsible for these accidents and the most frequent causal products are recalled. Laboratory tests are reviewed. In conclusion, the authors propose a curative and preventive action to be taken when faced with this severe and non-exceptional accident of anesthesia.

[Transthoracic electrical impedance plethysmography and thermodilution: comparative evaluation of two methods for cardiac output measurement in man]. / Pléthysmographie électrique d'impédance et thermodilution. Etude comparative chez l'homme de deux méthodes de mesure du débit cardiaque.

The measurement of cardiac output by electrical impedance plethysmography (non invasive technic) seems to be attractive but is still the subject of a certain number of critics. The authors have tried to compare it with a method which validity is well documented, the thermodilution. By these two methods, 87 measures of cardiac output have been performed in 14 hospitalized patients in intensive care, attained of various affections but exempts of cardiac or pulmonary lesions and in stable hemodynamic state. The stroke volume measured by electrical impedance plethysmography is calculated using Kubicek's formula: SV = Q (L2/Zo2) (dz/dt min) t. Results were as follows: absence of significative difference between the coefficients of variation of each series of measures (coefficient of mean variation, 5,6 +/- 3,4 p. cent for impedance and 3,8 +/- 3,2 p. cent for thermodilution); absence of significative difference between the mean values of cardiac output (7,59 +/- 2,69 l . min-1 for impedance and 7,72 +/- 1,99 l . min-1 for thermodilution); highly significant correlation between values for cardiac output obtained for each of these two methods )r = 0,804; n = 87; p less than 0,001). The authors conclude that in patients in intensive care whose pulmonary or cardiovascular system is not in critical situation, the electrical impedance plethysmography appear as a secure method for cardiac output measurement. However its generalisation still require other works.

[Postoperative gas gangrene. Apropos of 22 cases]. / Gangrènes gazeuses post-opératoires. A propos de 22 cas.

The authors report twenty two cases of post-operative gas gangrene. In the series studied mortality was 40.9 p. 100, independent of age and sex. Rapidly progressive forms were the most severe. The delay before effective treatment was prescribed influenced prognosis. In clinical terms, shock and associated renal insufficiency were grave, as well as a picture of respiratory distress which led, in certain cases, to contra-indication of one of the therapeutic possibilities, i.e. that of hyperbaric oxygen. Responsible organisms could be isolated in nineteen cases from local samples. There was a marked predominance (15 cases) of clostridium perfringens. Contamination with aerobic flora was common. Examination to assess favourizing circumstances led essentially to a conclusion of the role of microbial contamination, ischemia, broad spectrum antibiotics, absence of appropriate antibiotics and underlying immuno-depression. Treatment was based in the majority of cases on the triple combination of antibiotics, surgery and hyperbaric oxygen, as well as the correction of any general systemic disorders. Mortality was markedly reduced (31 p. 100) in patients receiving complete and early treatment. The gravity and recrudescence of disorders due to anaerobic organisms lead the authors to review current therapeutic possibilities. Appropriate treatment should be prescribed in all situations where an infection due to anaerobic organisms is feared, and should cover the risk of clostridial infection (penicillin 200,000 mu/kg/24 h) as well as the risk of bacteroides (metronidazole 25 mg/kg/24 h). Curative treatment should be prescribed, even in the absence of bacteriological proof, on the basis of presumptive clinical evidence, this being a true emergency which should not be delayed under any circumstances.

[Measurement of cardiac output by electrical impedance plethysmography during respiration and in apnea]. / Mesure du débit cardiaque par pléthysmographie électrique d'impédance au cours de la respiration et en apné.

The measurement of cardiac output by electrical impedance plethysmography (non-invasive technique) may be disturbed by a certain number of factors, including respiration. The authors sought to demonstrate that this factor could be eliminated during measurement calculations. By this method, in 18 adult subjects with coronary artery disease, 50 measurements during respiration and 50 measurements in apnoea (paired measurements) of stroke volume and of cardiac output were performed. Stroke volume was calculated using Kubicek's formula: SV = P(L2/Zo2) (dz/dt min)t Results were as follows: highly significant correlation between values for stroke volume obtained during respiration and in apnoea (r ;.9767; n=50; P < 0.001); highly significant correlation between values for cardiac output obtained under the same conditions (r = 0.9744; n=50; P < 0.001). The authors conclude that with the limits of certain technical conditions of measurement, respiration does not disturb measurements of stroke volume and of cardiac output by electrical impedance plethysmography.