L'asphyxie pennatale estune pathologie encore frequente dans natre pays.La paralysie crebrate sequellaire en est une manifestationredoutableNotre etude est retrospective. etalee aur une anee (110 cas); son but etait de relever les facteurs pronostiques de cette pathologie. L'enceptialopathic anoxo ischemique arepesente 11,8 % des admissions au service de reanimation neonatale de l'Hopital d'Enfants de Rabat; son incidence etait de 0,9% des nalssances d'enfants vivants L'age maternel moyen etait de29.3±±6,8 ans. Des pathologies medicales associees ont ete retrouve chez 28 parturintesLa voie basse a predomine pour lemode d'accouchement (61% des cas). Du liquide meconial a ete (suite page 86) inhale par 27 nouveau-nes. Le poids de naissance variait de 1 800 a 5 450 g. Quatre-vingt-quatre pour cent des-nouveau. nes etaient a terme, 10 % etaient post-matures. Au terme de notre etude, nous avons retanu les-facteurs pronostiques suivants : un score de Glasgow 7, la presence d'un etat de choc, l'inhalation meconiale, le recours a la ventilation artificielle et l'insuffisance renale. La prevention de l'asphyxie perinatale passe par la sur«et rappochee des grossesses, et surtout de celles a risque.
L'embolie pulmonaire est une complication classique et connue de la chirurgie abdominaie et orthopedique, mais par comparaison, rarement decrite apres chirurgie thoracique. Nous rapportons un cas d'embolie pulmonaire post-pneumonectomie, chez une jeune patiente de 30 ans, diagnostique a l'angioscanner et traite avec succes par les anticoagulants. Nous discutons essentiellement les particularites physio-pathologiques et les difficultes diagnostiques de cette entite pathologique particuliere sur poumon unique.
But de l'etude des Rechercher des facteurs Be risque d'infection des catheters arterels penpheriques. Methode d'etude ; Prospective. Lieu de l'etude ; Reanimation polyvalente Selection des participants; 192 catheters/150 patients sut 11 mois (moyenne d'age 58 ans ; d'IGSI 18,4 : de sejour 15.2 jours : de ventilation 13 jours ; de catheterisme 4.5 jours: mortalite 40.8%). Methode ; Les lacteurs de risque recherches etaient: durce de cathefensme, site du catheter (radial, femoral, pedieux), aspect local au tetrait (normal, infiammatoire, purufent), type de reammation (enirurgicale. medicale, traumatologie), âge. IGS1. duree d'hospitalisation duree de ventilation, infections nosocomiales associees (voies veineuses centrales, pneumopathies, bacteriemies, infections urinaires). Resultas: 21 catheters etaient colonis's (10,6%) par un staphylocoque coaglase-negatif (8/21). Le risque etait lie a la duree de catheterisme (risque cumule de 2% a J4, 5,7% J5, 10,9 % J6, duree mediane de 5 jours (catheters infectes)/4 jours (non infectes). Il n'existait pas de correlation avec : le site d'implantation, l'aspect inflammatoire au retrait, la cause de retrait, le type de reanimation, l'âge, l'IGS, la mortalite. La duree de sejour et de ventilation, la frequence des infections nosocomiales associees etaient significativement plus elevees dans le groupe des catheters infectes. Conclusion: Nous preconisons, dans notre service, le retrait systematique au 4e jour, mais cette attitutde est a evaluer pour chaque service. Le risque de contamination pourrait etre d'avantage lie au terrain et a la pathologie sous-jacente qu'a la duree du catheterisme elle-meme.
Le syndrome de Rett est une atteinte neurologique progressive, qui touche presque exclusivement des sujets de sexe feminin. II associe une regression psychomotrice, un comportement autistique, des mouvements anormaux, des modifications electrocardiographiques inconstantes (QT long et modifications des ondes T) et des anomalies du controle ventilatoire (hyperyentillation, apnee, hypoxemie). Ces dernieres surviendraient chez les patients eveilles et disparaitraient lors du sommeil. Toutes ces anomaiies justifient une surveillance rigoureuse peroperatoire.
Spontaneous unilateral haematoma of the adrenal gland in post-partum is a rare event. We report a case in a 20 year-old woman without any medical history. The diagnosis could be suspected on upper abdominal pain and confirmed by sonography and CT-scan. There was no sign of endocrine dysfunction. Laboratory data were helpful to eliminate a phaeohromocytoma and histologic examination revealed only unilateral adrenal haemorrhage without tumour. Haematoma of the adrenal gland should be suspected in patients with upper abdominal pain without previous trauma, stress, or infection: however it occurs more frequently after severe stress and in association with other conditions. Surgery should be as conservative as possible.
Disseminated intravascular coagulation (DIC) syndromes can be defined as the formation of fibrin deposits within the microcirculation, occurring in definite clinical situations. Their biological counterpart is a consumption coagulopathy. The clinical profiles of DIC have been well known for decades, are multiform and range from latency to overwhelming haemorrhagic diatheses, including also characteristic but rare situations, such as purpura fulminans, acral cyanosis and pictures resembling thrombotic thrombocytopenic purpura or haemolytic-uraemic syndrome. Biological tests of DIC show a consumption coagulopathy, displayed on the standard haemostasis sheet; along with signs of paracoagulation and/or of secondary fibrinolysis (FDP). New tests have recently been introduced: D-dimers are specific and sensible; Antithrombin-III, protein C and alpha 2-antiplasmin also can sometimes be useful. The knowledge of the pathophysiology of DIC has made advances with passing years. Fibrin deposits may be non-occlusive, and indeed they are swiftly removed by a secondary fibrinolysis. Except in very rare situations, such as those leading to a cortical renal necrosis, and perhaps in some ARDS, there is little evidence relating DIC to organ failure syndromes. Moreover, there is no clear relationship between the severity of the consumption coagulopathy and the prognosis. For instance, the mortality is much lower in abruptio placentae, where the coagulopathy is very severe, than in septic shock, where it is usually moderate. In septic shock, the disorders of haemostasis were related initially to a platelet activation, then to an activation of the contact system (releasing kinins and triggering complement cascade), and nowadays to the activation of the extrinsic coagulation system. The treatment of DIC is mainly the treatment of its cause. Indications for heparin therapy should be strictly limited to a few exceptional circumstances. When haemorrhagic diathesis threatens, FPC and/or platelet transfusion may be indicated. Aprotinin can be useful in rare cases of overwhelming secondary fibrinolysis. Trials with antithrombin-III or C1-esterase inhibitors are in progress.
A tracheal tube 1 has an extruded suction lumen (16, figure 3) extending along its length on the outside curvature of the tube. The suction lumen (16) opens internally to the main lumen 14 through one or a series of holes 61, which increase in size towards the patient end 11 of the tube. Towards the machine end of the tube (12, figure 1), the suction lumen (16) is connected to a suction source (3, figure 1) by which suction is applied to the suction lumen to remove secretions that collect inside the tube. The suction lumen (16) has an arcuate cross section, i.e. is elongated around part of the circumference of the major lumen 14, and may take a helical path around the major lumen of the tube. The openings 61 between the suction lumen and the major lumen can take the form of circular holes or an elongated groove.
The authors used a disposable original system to recover total blood during surgery and realized 17 transfusions of autologous blood in sheep. No biological or clinical disturbance was observed.
Coelioscopic surgery in children is today in constant progress and requires pharmacological agents which provide excellent surgical conditions for variable and unpredictable durations. The mivacurium-propofol association was clinically studied in this context in 30 ASA I patients aged from 6 to 16 years and appeared safe, efficient and easy to use. The orbicularis oculi and pollicis adductor stimulation allows simple and adapted neuromuscular blockade monitoring. Double-burst stimulation at the ulnar nerve improves the detection of a residual curarization.
AT III is a physiologic inhibitor of blood clot formation: its deficiency is manifested by venous thrombosis. The authors reported case of mesenteric venous infarction in a 42-years-old woman. AT III deficiency was transient and caused by an oral contraceptive. In patients with AT III acquired deficiency it is necessary to suppress any risk factors of venous thrombosis.
Nous rapportons une observation de pericardite purulente, originale par son etiologie, et son evolution favorable. En effet, il s'agit d'un carcinome epidermoide de l'oesophage qui s'est manifeste par une pericardite purulente a la suite d'une fistule oesopericardique. La revue de la litterature identifie seulement quelques cas semblables. Un diagnostic rapide, une antibiotherapie adaptee, un drainage chirurgical, et une cure chirurgicale de la fistule sont necessaires pour ameliorer le pronostic.
This study was performed to determine the incidence of sore throat 24 h after tracheal intubation in 1,268 patients ASA I or II, who had undergone elective surgery. A data form was completed. Nosing were age, sex, type of surgery, anaesthetic drug, muscle relaxant, number of intubation attempts, duration of intubation, and presence of sore throat. The incidence of sore throat was 15.06%. It was significantly higher in females than in males (19.29% vs 11.66%; P < 0.01). There was a significant difference between those patients who received fentanyl and those who received pethidine (P < 0.05). There was also a greater incidence after thyroid surgery (P < 0.01). There was no correlation between sore throat and variables such as age, muscle relaxant, narcotic drug, number of intubation attempts, or duration of intubation. Lidocaine jelly and the appropriate analgesic drug reduce the incidence of sore throat following tracheal intubation.
Presence of air within the cranial cavity has been described by several authors. Little attention has been paid to its significance. The goal of this study was to analyse the clinical characteristics and the evolution of patients with pneumocephalus. We reviewed the brain computed tomography scans of 167 consecutive head injury patients who were hospitalized between January 1992 and December 1993. This retrospective study revealed intracranial air in 33 cases (19%). The analysis of clinical characteristics showed that in the initial period the neurologic status was better in patients with pneumocephalus. However, 48 hours later, the proportion of patients presenting a deep coma increased We conclude that pneumocephalus is a significant risk factor in head injury patients.
