Biomedical subjects
Publications and source records attributed to M Ossart.
Auriculotherapy based on traditional Chinese cartography can be used for pain relief after laparoscopic cholecystectomy. It consists of palpating and pricking some well defined ear points corresponding to the surgical site. Relief was quickly obtained and compares favourably with minor parenteral analgesics.
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.
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The pharmacokinetics of teicoplanin infused for 30 min at a dose of 6 mg kg-1 was studied in 11 infected patients under continuous arterio-venous haemofiltration (CAVH). Serum teicoplanin levels were assayed by h.p.l.c. over 24 h. After 0.5 h, i.e. at the end of the infusion, the mean plasma concentration was 49.6 +/- 15.1 mg l-1. At the last sampling time (24 h), the mean concentration was 2.6 +/- 1.0 mg l-1. The concentration of teicoplanin was determined in the haemofiltrates. The percentage of the administered dose recovered in the haemofiltrate was low: less than 1% for seven patients, between 1.8 and 3.7% for three patients and 7% for one patient. CAVH patients should be given teicoplanin using the same dosage regimens as previously described for patients with renal impairment.
Subcutaneous emphysema and pneumomediastinum are well-known complications of barotrauma. There are no fascial barriers between the posterior mediastinum and the retropharyngeal and epidural spaces; thus, air can diffuse freely to the epidural space and produce an epidural pneumatosis. We report a case of epidural pneumatosis caused by a pneumomediastinum following nasotracheal intubation for an attempted suicide. This benign complication of air leakage was easily recognized on computed tomography (CT) scan.
77 spinal anaesthesias were performed over a 9-month period for surgical cure of herniated discs or lumbar laminectomy in knee-chest posture. Operating conditions were good or excellent in 66 patients (85.7%). Better results were obtained with lidocaine 5% than with bupivacaine 0.5% (both with fentanyl). Nine partial or total failures were recorded, eight of which in patients who underwent a preoperative radiculography and whose spinal anaesthesia was performed with bupivacaine. A likely explanation of these failures might be a leakage of local anaesthetic into the epidural space distended by radiopaque material. No intra or postoperative complications other than six transient hypotensions occurred. Despite of certain advantages, spinal anaesthesia cannot be recommended in all cases, particularly in patients at risk or if surgical time might be protracted. On the other way, ever possible failure obliges to inform preoperatively the patients that general anaesthesia cannot be excluded.
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Clinical and physical data about laryngeal mask use in eye surgery were collected in 57 patients. We observed 4 failures which required endotracheal intubation, 3 leaks during operative field installation, 4 salvations but no laryngeal spasm and no cough. There were no significative differences between body weights in laryngeal mask groups no 3 and no 4. Insufflation pressures of patients without curarisation were more important. The duration of ventilation was not correlated with salivation, leaks or increase of insufflation pressure.
Transoesophageal echocardiography (TOE) is increasingly used in cardiology, cardiac surgery and intensive care. Its complications are rare. We report a case of perforation of the oesophagus after TOE in a 71-year-old woman, scheduled for an elective aortic valve replacement. Her medical history included arterial hypertension but no pre-existing oesophageal disease. A Hewlett Packard ultrasound imaging system was used, with a 5 MHz single plane probe. After local anaesthesia, the transducer probe was inserted into the distal oesophagus, after three attempts, without any apparent incident. A few hours later, the patient complained of acute cervical and dorsal pain. Examination showed severe skin emphysema in of neck, but neither breathing difficulties, nor haemodynamic modifications. The EKG was normal and body temperature at 38.8 degrees C. The opacification of the oesophagus showed a passage of the contrast medium into the mediastinum. Emergency surgical exploration by left cervicotomy showed a perforation of 2 to 3 cm of the posterior wall of oesophagus, treated with terminal oesophagostomy and drainage. The pressure by the TOE probe on the oesophagus may explain this perforation. The outcome was uneventful. Although TOE is a semi-invasive technique with a low risks its benefit/risk ratio should be considered in each patients before using it.
Early use of magnetic resonance imaging (MRI) excluded patients needing mechanical ventilation. However magnetic resonance imaging is an innocuous investigation and affords important elements to the diagnosis of many pathologies. Improvement of anaesthetic equipment have led to enlarge MRI applications considerably. Ventilations situated outside the MRI room required very long tubing, to 9-11 m. Although the ferromagnetic charge of presently used ventilators is greatly reduced, it is still necessary to keep them at some distance from the patient, with tubing of about 3 m, even in children. Therefore the compressible gas volumes are larger than the usual ones. For a tube length of 3 m, about 2-3 ml.kg-1 should be added to the standard tidal volume (10 ml.kg-1), so as to obtain safe normoventilation.
Propanidid and methohexital were compared retrospectively to assess the possible neonatal depression following general anesthesia for caesarean section: both have rapid onset and short duration of action and their transplacental passages are similar. Anesthesia was induced with equivalent doses of the two agents in 90 women (45 in each group). For each anesthetic agent, three subgroups were defined according to the indications, depending on emergency criteria and fetal state. There was no significant statistical difference (Student test) regarding clinical and biochemical criteria except for the fetal arterial pH which was more acidic in the propanidid group. In both groups, Apgar scores, arterial and venous pH were significantly more altered when caesarean section was performed for acute fetal depression.
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Explore the source record for details and available documents.
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