[TRALI in the University Hospital of Nancy: a reevaluation of the incidence after applying strict criteria of Toronto]. / Les TRALI au CHU de Nancy : une incidence reconsidérée après l'application stricte des critères de Toronto.

"Transfusion-related acute lung injury" (TRALI) is a post-transfusion lesional pulmonary edema, potentially severe, better defined since the conference of Toronto in 2004. The incidence of TRALI reported in France remains low in part because of its ignorance by physicians. The objective of our study was to evaluate retrospectively transfusion accidents with respiratory complications that occurred in Nancy University Hospital and reported to the haemovigilance between 1996 and 2006, from the software "Traceline" listing all the blood transfusion complications from signs observed. The analysis of the files has been performed by applying rigorously diagnostic criteria of Toronto. Forty-one cases of respiratory complications were found in 34,573 blood products. Ten cases of TRALI were diagnosed while only one case had been reported to the haemovigilance. The remaining nine cases were previously labeled transfusion-associated circulatory overload (TACO). No cases of TRALI have been identified in the ICU. Our work can find an incidence of TRALI 10 times greater than previously reported. Ignorance of TRALI and the lack of consensus definition before 2004 are not sufficient to explain these results. This study demonstrates the potential interest of database and computerized declaration system based on the symptoms observed. It highlights the vulnerability of the current haemovigilance too dependent on a single medical observer. Although TRALI are recognized as serious complications, sometimes requiring resuscitative care, our work was not isolated severe TRALI in ICU. Physician awareness of TRALI to the identification and to the declaration, including ICU should be continued. Finally, the diagnostic criteria for TRALI must be adapted to the ICU.

[Anaphylactic shock after tourniquet removal in orthopedic surgery]. / Chocs anaphylactiques après levée de garrot en chirurgie orthopédique.

Case report of six patients who experienced symptoms of severe anaphylactic shock, after tourniquet release at the end of minor orthopaedic surgery of the limbs under regional anaesthesia. The immunological mechanism of the shock was confirmed by prick tests. The causative agent was rifamycin SV used for cleaning the surgical wound prior to its closure. In case of repetitive surgery and/or in allergic patients the use of another antibiotic or the simple cleaning of the wound with normal saline should be considered. In case of surgery using a tourniquet, an iv access should be maintained for 1 hour after tourniquet release and the patient closely monitored in the recovery room. The allergologic assessment should take place 3 to 6 weeks later and include all drugs administered during the 10 minutes preceding the occurrence of shock.

[Pneumatic tourniquet paralysis. A differential diagnosis after loco-regional anesthesia of the upper limb]. / Le syndrome paralytique du garrot. Un diagnostic différentiel après anesthésie locorégionale du membre supérieur.

A case is reported of a severe neurological deficit after hand surgical using pneumatic tourniquet. The 51 year old ASA I patient underwent an axillary block for hand surgery using 50 ml of mepivacaïne 1%. The tourniquet was remained at 300 mmHg for only 45 min. The following day, the patient's arm remained lumb. Electrophysiologic tests showed a severe conduction block of sensory and motor fibers, well localized to the presume lower margin of the tourniquet. As there was no improvement, epineurotomy was carried out on day 60, to liberate the median nerve which was severely compressed in the canal brachial. The patient then started to improve slowly. But many safety factors can decrease the rate complications: the accuracy and integrity of the pressure-monitoring must be verified, a tourniquet pressure above 300-500 mmHg would rarely be required in normotensive patient with compliant vessel, a pressure of 200 mmHg will almost all cases provide a bloodless field, tourniquet must be applied on diaphysis and not on bony relief.

Anaphylaxis caused by anti-cremophor EL IgG STS antibodies in a case of reaction to althesin.

The action of cremophor EL, the solubilizing agent of Althesin in a case of anaphylactic reaction which occurred during the induction of anaesthesia has been demonstrated using the Prausnitz-Küstner (P-K) test 10 weeks later. This test was positive at 2 h, with the heated serum and cremophor, proving the presence of allergic IgG STS antibodies.

[26 cases of tracheal stenosis after prolonged intubation or tracheotomy. Personal retrospective study]. / 26 cas de sténoses trachéales aprés intubation prolongée ou trachéotomie. Etude personnelle rétrospective.

A retrospective study over a period of 10 years, involving different hospital departments, revealed a total of 26 patients with post-intubation and/or post-prolonged tracheotomy stenosis which required surgical treatment. Predisposing factors included poor general condition, infection, iatrogenic factors related to intensive therapy (respiration, inadequate nursing) and the duration. Stenosis were situated from the sub-glottis to the carina. After surgical treatment, there were ten cases of restenosis, two multiple, and one inflammatory granuloma. Intubation may be life-saving, but must be performed by an individual competent in the procedure, under strictly aseptic conditions, and using non-traumatic disposable material. The patient should undergo thorough ENT examination at the time of extubation, repeated one month and six months later.

[Histamine liberation in extracorporeal circulation]. / Histaminolibération au cours de la circulation extra-corporelle

Extra-corporeal circulation (E.C.C.) has been held responsible for histamine liberation incidents, essentially by a mechanical cause. In order to prove this, the authors assayed the overall histaminaemia at different times during E.C.C. in 11 patients. The results are discussed in terms of the patients' backgrounds, temperature, hematocrit, blood gases and the acid-base balance, and electrolyte balance. Histaminaemia, corrected depending on the dilution, did not show any significant variation, even in two patients who clinically had anaphylactic manifestations.