Congenital prekallikrein deficiency is an infrequent condition sometimes diagnosed upon routine preoperative clotting tests. The study of a French family is reported herein. Results were consistent with autosomal recessive inheritance and suggested that only homozygous individuals can be detected based on an Increase in the activated partial thromboplastin time.

French jurisprudence about outpatient anaesthesia is resolutely unfavorable. It is principally based on the June 22nd 1972 decision of the cessation court, the highest court of justice in France. Preoperative non hospitalisation has been considered as a fault by negligence/carelessness of the practitioners. It resulted in their penal condemnation for involuntary injuries and compensation for the harm. This decision is linked with the evolution of the fault and the responsibility share between surgeon and anaesthetist. The post-operative phase seems to involve "theory of missing luck" (causality linkage or the detriment in itself), excluding a penal condemnation but not a partial compensation. Though some new legal considerations could be put forward, a written contract between physicians and patients is necessary in outpatient surgery, whereas the medical files and the organisation of the unit can prove the quality of medical care.

Bacterial meningitis following spinal anaesthesia is a rare but serious complication. We describe a case in which an old woman received spinal anaesthesia for hip replacement. Diagnosing the aetiologic agent is a major medical challenge. The possible aetiological causes of this complication are discussed and the difficulty in differentiation between aseptic and bacterial meningitis noted.

A specialized unit in outpatient anaesthesia and surgery needs an adapted planning. During the preoperative period, it is particularly important to preserve the time of the patients. Different types of structures are possible for the intraoperative period depending on their degree of independence to a hospital. The hospital based unit, with independent facilities, offers various advantages. Its size and its conception must be adapted to the constraints of ambulatory technique, and to the expected needs. During the postoperative period, a special medical organization must be planned to help the patient if necessary. The part of the secretarial work is important for the success of such a unit. Its efficiency may be improved by computerised treatment of part of the information.

Sulfiting agents are antioxidants widely used in both food and pharmaceutical industries. They have been identified as responsible for adverse severe reactions. A case is reported of anaphylactoid shock during epidural anaesthesia for caesarean section. The responsible agent was metabisulfite, additive agent of local anesthetics containing epinephrine.

Several animal studies have demonstrated that pain is modulated by spinal mechanisms involving prostaglandins and that acetylsalicylic acid (ASA) administered intrathecally has an analgesic effect. We report our experience of this treatment in 60 patients with proven and advanced cancer. An isobaric solution of lysine acetylsalicylate was administered by lumbar puncture in doses ranging from 120 to 720 mg of ASA. The results were evaluated using the habitual criteria: scoring system, behaviour, consumption of analgesic drugs. In this trial the method proved astonishingly effective (78% of the cases). Analgesia was strong, almost immediate and without influence on motricity. No thermic or neurovegetative changes were noted. The effect of one injection lasted from 3 weeks to 1 month on average; it was reproduced and often more prolonged after a repeat injection. Pain associated with bone metastases seems to constitute the best indication, notably in breast and lung cancer and in myeloma. Visceral (pancreas) or neural pain requires higher doses to respond. Failures (22%) were due to such factors as insufficient dosage at the very beginning of our experience or severe depressive syndrome. The perineal and sphincteral pain of rectal cancer often resists treatment. This simple, inexpensive and very effective method with no other complication than a frequent tendency to fatigue should rank among other analgesic measures in cancer. The lack of respiratory depression is a major advantage over catheter spinal opiate analgesia. We consider that its main indications are pain associated with osteolytic metastases of adenocarcinomas, and myelomas. Owing to the absence of formal toxicological data, its use must be limited to cancer pain and to patients with a life expectancy of less than 2 years.

Oral ketamine (7.5 mg X kg-1) was used to induce general anaesthesia in fourty seven young women undergoing voluntary abortion. Additional anaesthesia was necessary eight times because pre operative consciousness remained normal, and nine times because of important intra operative reactions. A majority (78.8%) of patients appreciated this technique of anaesthesia. Absence of narcosis (17%) and intra operative analgesia (23%) and frequency of post operative nightmares may require some modifications of the method.

AnaesthesiaVolume 41, Issue 5 p. 560-560 Free Access External jugular vein catheterization P. Bouju, P. Bouju Departhént d'Anesthesie–Reanimation, Centre Hospitalier General, Robert Ballanger, 93602 Aulnay-sous-bois, FranceSearch for more papers by this authorH. Dreux-Boucard, H. Dreux-Boucard Departhént d'Anesthesie–Reanimation, Centre Hospitalier General, Robert Ballanger, 93602 Aulnay-sous-bois, FranceSearch for more papers by this authorJ.-F. Amiot, J.-F. Amiot Departhént d'Anesthesie–Reanimation, Centre Hospitalier General, Robert Ballanger, 93602 Aulnay-sous-bois, FranceSearch for more papers by this authorJ.H. Palacci, J.H. Palacci Departhént d'Anesthesie–Reanimation, Centre Hospitalier General, Robert Ballanger, 93602 Aulnay-sous-bois, FranceSearch for more papers by this author P. Bouju, P. Bouju Departhént d'Anesthesie–Reanimation, Centre Hospitalier General, Robert Ballanger, 93602 Aulnay-sous-bois, FranceSearch for more papers by this authorH. Dreux-Boucard, H. Dreux-Boucard Departhént d'Anesthesie–Reanimation, Centre Hospitalier General, Robert Ballanger, 93602 Aulnay-sous-bois, FranceSearch for more papers by this authorJ.-F. Amiot, J.-F. Amiot Departhént d'Anesthesie–Reanimation, Centre Hospitalier General, Robert Ballanger, 93602 Aulnay-sous-bois, FranceSearch for more papers by this authorJ.H. Palacci, J.H. Palacci Departhént d'Anesthesie–Reanimation, Centre Hospitalier General, Robert Ballanger, 93602 Aulnay-sous-bois, FranceSearch for more papers by this author First published: May 1986 https://doi.org/10.1111/j.1365-2044.1986.tb13307.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume41, Issue5May 1986Pages 560-560 RelatedInformation