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Objective: In intensive care settings, blood lactate level measurement proved to be an excellent predictor of outcomes. In patients requiring less urgent treatment, the arterial blood lactate is less sensitive and its usefulness remains to be proven. Capillary blood lactate dosing, an emergent point-of-care technique readily available should be more sensitive to changes in these settings. Method: prospective, observational, monocentric study conducted in a polyvalent internal medicine ward in a French University Hospital. The inclusion criteria were the existence of new symptoms of abrupt onset in an otherwise stable patient. All the patients had a point of care measurement of baseline capillary and venous lactate levels (EDGE, ApexBio) and standardized control before any therapeutic means were initiated. A follow-up test was performed once again within 12 to 36 hours. All the patients received standard medical care adapted to their condition. The primary outcomes were considered dying within 30 days or requiring intensive care or invasive therapeutic procedures. Results; 13 patients were analyzed. Seven patients reached the composite outcome with 3 deaths. The superimposed complication proved to be infectious in every case. The median lactate levels were at baseline (mmol/ I): capillary Mc0=5.2(2.16), venous /Wv0=2.3(2.0) and arterial Ma0=1.8(1.7) and at follow-up (mmol/I) capillary: 7Wc7=3.3(1.1), venous Mu7=1.8(1.8) and arterial Ma 7=1.3(0.7). In nonparametric analysis, the absence of normalization of capillary lactate at follow-up was correlated well with poor outcomes (p=. 05). This was not the case of arterial or venous lactate measurements. The positive lactate clearance was present in the majority of patients (83.3%) but it did not predict the outcomes (p=.435) and there was no correlation between the baseline lactate and the clinical outcome (p>.05). Conclusion: In non intensive care settings, capillary lactate level could be a more sensitive method than the classical lactate measurement for predicting the outcomes of acute conditions, especially infectious. A persistently high lactate level rather than its initial value or clearance seems to correlate better with poorer outcomes. [ABSTRACT FROM AUTHOR]

Background Fluorescence videography is a promising technique for assessing bowel perfusion. Fluorescence-based enhanced reality ( FLER) is a novel concept, in which a dynamic perfusion cartogram, generated by computer analysis, is superimposed on to real-time laparoscopic images. The aim of this experimental study was to assess the accuracy of FLER in detecting differences in perfusion in a small bowel resection-anastomosis model. Methods A small bowel ischaemic segment was created laparoscopically in 13 pigs. Animals were allocated to having anastomoses performed at either low perfusion (25 per cent; n = 7) or high perfusion (75 per cent; n = 6), as determined by FLER analysis. Capillary lactate levels were measured in blood samples obtained by serosal puncturing in the ischaemic area, resection lines and vascularized areas. Pathological inflammation scoring of the anastomosis was carried out. Results Lactate levels in the ischaemic area (mean(s.d.) 5·6(2·8) mmol/l) were higher than those in resection lines at 25 per cent perfusion (3·7(1·7) mmol/l; P = 0·010) and 75 per cent perfusion (2·9(1·3) mmol/l; P < 0·001), and higher than levels in vascular zones (2·5(1·0) mmol/l; P < 0·001). Lactate levels in resection lines with 75 per cent perfusion were lower than those in lines with 25 per cent perfusion ( P < 0·001), and similar to those in vascular zones ( P = 0·188). Levels at resection lines with 25 per cent perfusion were higher than those in vascular zones ( P = 0·001). Mean(s.d.) global inflammation scores were higher in the 25 per cent perfusion group compared with the 75 per cent perfusion group for mucosa/submucosa (2·1(0·4) versus 1·2(0·4); P = 0·003) and serosa (1·8(0·4) versus 0·8(0·8); P = 0·014). A ratio of preanastomotic lactate levels in the ischaemic area relative to the resection lines of 2 or less was predictive of a more severe inflammation score. Conclusion In an experimental model, FLER appeared accurate in discriminating bowel perfusion levels. [ABSTRACT FROM AUTHOR]

Teleoperated surgical robots could provide a genuine breakthrough in laparoscopy and it is for this reason that the development of robot-assisted laparoscopy is one of the priorities of the Strasbourg University Hospitals' strategic plan. The hospitals purchased a da Vinci S robot in June 2006 and Strasbourg has, in IRCAD, one of the few robotic surgery training centres in the world. Our experience has, however, revealed the difficulties involved in setting up robotic surgery, the first of which are organizational issues. This prospective work was carried out between December 2007 and September 2008, primarily to examine the possibility of setting up robotic surgery on a regular basis for gynaecological surgical procedures at the Strasbourg University Hospitals. We maintained a 'logbook' in which we prospectively noted all the resources implemented in setting up the robotic surgery service. The project was divided into two phases: the preparatory phase up until the first hysterectomy and then the second phase with the organization of subsequent hysterectomies. The first surgical procedure took 5 months to organize, and followed 25 interviews, 10 meetings, 53 telephone conversations and 48 e-mails with a total of 40 correspondents. The project was presented to seven separate groups, including the hospital medical commission, the gynaecology unit committee and the surgical staff. Fifteen members of the medical and paramedical team attended a two-day training course. Preparing the gynaecology department for robotic surgery required freeing up 8.5 days of 'physician time' and 12.5 days of 'nurse time'. In the following five months, we performed five hysterectomies. Preparation for each procedure involved on average 5 interviews, 19 telephone conversations and 11 e-mails. The biggest obstacle was obtaining an operating slot, as on average it required 18 days, four telephone calls and four e-mails to be assigned a slot in the operating theatre schedule, which is prepared on average 28 days in advance. It is extremely important for organising robotic surgery and assembling the surgical teams to have a series of operating slots allocated a sufficiently long time in advance. Considerable benefits would be had by setting up a team of anaesthetists and especially perioperative nurses dedicated to robotic surgery. [ABSTRACT FROM AUTHOR]

The association of polymyositis and cancer was first described in 1916, the most frequent cancers being mammary and gynecological for women, bronchopulmonary for men and digestive for both. This article reports a severe paraneoplastic polymyositis associated with breast cancer. The authors discuss its clinical, pathological and therapeutic particularities. [ABSTRACT FROM AUTHOR]

Copyright of Reanimation is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

OBJECTIVE: Compared with the 5HT(3) antagonist ondansetron, the NK(1) antagonist aprepitant has been shown in two double-blind trials to provide greater protection against postoperative vomiting and comparable or greater control of nausea. Post hoc analyses of pooled data from these trials were performed to more fully characterize the efficacy profile of aprepitant in terms of nausea and use of rescue therapy. RESEARCH DESIGN AND METHODS: Patients (n = 1599) scheduled for major surgery under general anesthesia (primarily gynecological surgery) were assigned to receive a preoperative dose of aprepitant 40 mg PO, 125 mg PO, or ondansetron 4 mg IV. in two randomized, double-blind, clinical trials. MAIN OUTCOME MEASURES: Post-surgery vomiting episodes, use of rescue therapy, and nausea severity (verbal rating scale). RESULTS: In the 24 hours after surgery, aprepitant 40 mg was more effective than ondansetron for all five endpoints evaluated: (1) no significant nausea (56.4% vs. 48.1%); (2) no nausea (39.6% vs. 33.1%); (3) no vomiting (86.7% vs. 72.4%); (4) no nausea and no vomiting (38.3% vs. 31.4%); and (5) no nausea, no vomiting, and no use of rescue (37.9% vs. 31.2%) (p < 0.035 for the odds ratio for each comparison). Numerically more patients receiving aprepitant 125 mg also achieved these endpoints compared with ondansetron. CONCLUSIONS: These post hoc analyses confirm the favorable efficacy profile of aprepitant for the prevention of post operative nausea and vomiting. [ABSTRACT FROM AUTHOR]

Abstract Rationale: Ketamine is an NMDA receptor antagonist with psychotogenic and cognitive effects in healthy volunteers and schizophrenic patients which has been proposed to be a useful tool to investigate neurobiological basis of schizophrenia. Objective: The present study characterized the effects of a subanesthetic dose of ketamine on memory and related subjective states of awareness in healthy volunteers. Methods: Twenty-six subjects were given either a 60-min ketamine (0.5 mg/kg per hour) or a placebo infusion. To obtain constant plasma ketamine throughout the experiment, ketamine was administered using a computer-controlled infusion system. Subjects carried out episodic memory tasks involving words presented before and during infusion. Memory performance was assessed with recognition and free recall tasks. Subjective states of awareness were assessed using an experiential approach. Levels of psychopathology were evaluated with BPRS. Results: Ketamine impaired performance in free recall and recognition of words presented during, but not before, infusion. There were no differences between groups concerning states of awareness associated with recognition memory. Subjects under ketamine had higher BPRS total scores as well as BPRS negative and positive cluster scores than control subjects. Conclusions: Ketamine decreases episodic memory performance by impairing encoding, but not retrieval processes. It does not selectively impair subjective states of awareness associated with recognition memory as it has been seen in patients with schizophrenia. Ketamine might mimic the memory impairment associated with acute, but not chronic, forms of schizophrenia. [ABSTRACT FROM AUTHOR]

The introduction of serotonin 5-HT receptor antagonists into clinical practice allowed for a dramatic improvement in the management of nausea and vomiting. Despite this, postoperative and chemotherapy-induced emesis remains a significant, unresolved issue in many patients even when a combination of antiemetic drugs is used. Numerous neurotransmitters have been implicated in triggering emesis; however, the tachykinin substance P, by virtue of its localisation within both the gastrointestinal vagal afferent nerve fibres and brainstem emetic circuitry, and its ability to induce vomiting when administered intravenously, is thought to play a key role in emetic responses. Because substance P is the most likely endogenous ligand for the neurokinin-1 (NK) receptor, the development of nonpeptide NK receptor antagonists led scientists to evaluate these compounds as antiemetics. The five NK receptor inhibitors that have been studied initially in humans are: vofopitant (GR-205171), CP-122721, ezlopitant (CJ-11974), MK-869 (L-754030) and its prodrug L-758298. Except for monotherapy in acute cisplatin-induced emesis, this new class of drugs has proven to be highly effective in the control of both chemotherapy-induced nausea and vomiting, and postoperative nausea and vomiting. No major adverse event was reported in the preliminary trials. Further investigation is mandatory in order to assess the optimal treatment regimen and to make sure the wide spectrum activity of the NK receptor inhibitors does not cause significant adverse effects in the context of the treatment of nausea and vomiting. [ABSTRACT FROM AUTHOR]

Purpose: The authors report a case of bilateral subdural hematoma (SDH) which occurred following epidural analgesia for labour, complicated by post dural puncture headache (PDPH). Physiopathological mechanisms are discussed.Clinical Features: A 27-yr-old woman displayed typical PDPH following epidural anaesthesia. On the fifth day she was given a blood patch (BP) which proved immediately effective. Further developments were marked by late recurrence of PDPH and by administration of a second BP on the 24th day. With the aggravation of the headaches, the disappearance of their postural nature and with the appearance of transitory focal neurological signs on the 30th day, a CT-Scan was done and showed bilateral subdural haematoma. Following surgical drainage, the patient made an uneventful recovery.Conclusion: The presence of PDPH complicated by a typical neurological deterioration should prompt the anaesthetist to seek an immediate clinical and x-ray diagnosis in order to look for the existence of intracranial complications. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Anaesthesia / Journal Canadien d'Anesthésie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)