-The clinical use of the cuffed oropharyngeal airway (COPA)-. / Utilisation clinique du COPA (cuffed oropharyngeal airway).

OBJECTIVE: To assess the performance of the COPA device during general anaesthesia. STUDY DESIGN: Prospective, clinical, open study. PATIENTS: Eighty patients scheduled for short elective surgical procedures under general anaesthesia not requiring tracheal intubation. METHOD: After premedication (midazolam, atropine), anaesthesia was induced with propofol (154 +/- 40 mg = 2.47 +/- 0.8 mg.kg-1) and alfentanil (1.14 +/- 0.43 mg). The COPA device was inserted in a fashion similar to a Guedel airway device. The device was evaluated on the following criteria: correct choice of COPA size, ease of insertion, ability to obtain or maintain patent airway. Adverse reactions were noted, such as coughing, nausea, regurgitation, inhalation, and sore throat. The overall rating of the COPA as a "hand free device" was evaluated on the basis of excellent, good, fair, and poor. RESULTS: Insertion of the device was easy and in 70 cases successful on the first attempt. Jaw thrust on head tilt was necessary in half the cases. No patient necessitated intubation because of hypoxaemia or airway obstruction. Adverse reactions occurred in few cases and consisted of sore throat (always moderate) in 10% of the cases. COPA was evaluated as excellent or good in 80% of the cases. CONCLUSION: COPA is a convenient device for airway management in fasting patients undergoing general anaesthesia for elective surgery in the supine position, in whom tracheal intubation is not indicated.

[Willebrand's disease and pregnancy. Fifteen cases]. / Maladie de Willebrand et grossesse. A propos de 15 cas.

Willebrand's disease, the most frequent inborn coagulopathy, is defined as a deficiency in Willebrand's factor required for normal hemostasis as a mediator in platelet adhesion to the subendothelium and which also contributes to plasma coagulation pathway (by preserving the coagulating activity of factor VIII). Classically, Willebrand's disease improves somewhat during pregnancy. We followed 15 pregnancies in 12 patients with Willebrand's disease in an attempt to determine the best management strategy to reduce the risk of bleeding during delivery. This risk can be assessed on the basis of prior history of bleeding and the laboratory tests and reduced by administration of concentrated Willebrand's factor at 8 months gestation. In patients with type I disease, desmopressin is proposed as curative treatment during the post partum period. Antenatal diagnosis is possible in the most severe forms. Programmed delivery is recommended. Spinal analgesia is contraindicated.

[Infarction and pregnancy. Review of the literature. A case report]. / Infarctus et grossesse. Revue de la littérature, à propos d'une observation.

UNLABELLED: BUT: Assess risk factors and pathogenesis of myocardial infarction in young women and evaluate cardiologic and obstetrical management of myocardial infarction during pregnancy as well as assess the prognosis of pregnancy in patients with a prior myocardial infarction. METHODS: Fra a personal observation of pregnancy after myocardial infarction, we reviewed the literature on two distinct themes: myocardial infarction during pregnancy and pregnancy after myocardial infarction. RESULTS: Pregnancy was deliberately authorized in a 21-year-old who had myocardial infarction 3 years earlier. The pregnancy was uneventful and cesarean section with epirual analgesia at 37 weeks gestation delivered a healthy 2,350 g boy. Unfortunately the patient died at her home 18 month later. Acardiac cause was retained although death due to ventricular rhythm disorder or recurrent myocardial infarction could not be confirmed due to lack of an autopsy. The prognosis of pregnancies after myocardial infarction would not appear to be catastrophic although this case raises some doubts as to whether pregnancy should be authorized in these patients. The major difference in mortality according to whether the infarction occurs before or during pregnancy would suggest that risk might be reduced by a haling period after the infarction. CONCLUSION: It appears that pregnancy in women with a prior myocardial infarction would be possible if sufficient precautions are taken. All situations increasing cardiac work should be avoided. Stress and pain must be avoided during delivery and the post-partum period. Intensive cardiological and obstetrical supervision supervision are required for correct management of the pregnancy.

[Physiopathology of pre-eclampsia: the role of immunology]. / Physiopathologie de la pré-éclampsie: place de l'immunologie.

Preeclampsia complicating 3% of all births is an important cause of maternal death and is associated with an increased risks of neonatal morbidity and mortality. Among the numerous theories proposed to explain this syndrome, the concept of placental ischaemia resulting in a generalized disturbance of endothelial physiology is receiving increasing support. Maternal immunological systems is often solicited during normal pregnancy. Most likely the immunological system is implicated in preeclampsia. Its responsibility is protean. Trophoblastic antigens may not be properly recognized by maternal immunologic system, resulting in a defect of trophoblastic invasion of the myometrial segment of the spiral arteries. Preeclampsia does not seem to be accompanied with trophoblast immunological rejection by the mother. Some cases of preeclampsia are associated with autoimmune phenomena. The autoantibodies could be directed against phospholipids or/and trophoblastic membrane components. Activated neutrophils release a variety of substances, capable of mediating vascular damage. An imbalance between the protective antioxidant activity and aggressive oxidant mechanisms could initiate the endothelial lesions. Preeclampsia could be one presentation of immunodystrophism with local excess of harmful cytokines. The immunologic system is probably not the initiator of preeclampsia, but its role is ambiguous: either the protective immunologic mechanisms usually operating during pregnancy can be surpassed, or immunologic responses are inadequate and directly aggressive. A better understanding of the underlying immunologic anomalies will improve the nosologic classification of preeclampsia syndrome.

Pregnancy after myocardial infarction.

UNLABELLED: The occurrence of pregnancy in a patient after myocardial infarction remains a dilemma for both the cardiologist and the obstetrician. The majority of obstetricians and cardiologists are very reticent about pregnancy in a woman suffering from coronary disease. AIMS: The aims of this study are to evaluate the risks, the prognosis of pregnancy for women who had suffered from myocardial infarction and to propose guidelines for pre-pregnancy counselling and medical supervision of the pregnancy and delivery. METHODS: A review of literature has revealed 30 cases, 14 of which are sufficiently documented. Only one of these patients requested pre-pregnancy counselling. We add to this experience the case of a patient who, having had an infarction, was authorized to begin pregnancy. RESULTS: Most of the pregnancies in these patients evolve satisfactorily if the more frequent cardiovascular complications are diagnosed and treated rapidly. During the pregnancy, rest is the rule and any situation which risks to increase the myocardial work-load should be avoided. Normal vaginal delivery with epidural anesthesia is the preferred method. CONCLUSION: The maternal and fetal prognosis is good on condition of performing a pre-pregnancy examination and of setting up a multi-discipline surveillance of the pregnancy. The review of the literature does not confirm the surrounding pessimism concerning the patients becoming pregnant after myocardial infarction.

[Acute liver failure and pregnancy. A case report]. / Insuffisance hépato-cellulaire aiguë et grossesse. A propos d'un cas.

Acute liver failure occurred in a 33 WA pregnant 4th parity woman. Transfer to intensive care was required and liver transplantation was discussed. Search for the causal mechanism revealed viral hepatitis A. On the basis of this observation, the different hypotheses concerning this clinical situation are presented in addition to different aspects of an association with viral hepatitis (particularly hepatitis A).