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A case of bilateral blindness in a 47-year-old patient after buccal tumorectomy and bilateral neck dissection is reported. The diagnosis of posterior optic ischaemia was substantiated by the features of blindness and the negativity of cerebral CT-scanography and NMR imaging. The respective roles of atherosclerosis, arterial hypotension, acute anaemia and increased intracranial pressure are discussed. Preventive measures include a strict control of blood pressure, blood loss and head position.

From 1989 to 1991, 480 patients undergoing general surgery under epidural anaesthesia were included in a multicentre, comparative, randomized, open-study designed to assess whether calcium nadroparin (Fraxiparine), one daily subcutaneous injection of 0.3 mL, i.e. 3,075 anti Xa IU per day, is more efficiency and better tolerated than a non-fragmented standard heparin (Calciparine), one subcutaneous injection of 0.2 mL t.i.d. 15,000 IU per day, for the prevention of postoperative deep vein thrombosis (DVT). The 480 patients, treated in 78 centres, were randomized in two groups (Fraxiparine, n = 241; Calciparine, n = 239). In both groups, treatment was started two hours after the end of the surgical procedure. Hernia repair and prostatic surgery accounted for 60% of operations. Thromboembolic events were detected by clinical examination performed at regular time intervals and by a systematic exam (doppler and rheoplethysmography or ultrasonogram) at the end of the treatment. Both agents demonstrated a similar efficiency. There was only one case of DVT, confirmed by phlebography in the Fraxiparine group. Tolerance was good in both groups. The proportion of patients requiring a transfusion was low (3% in each group). Hematuria was relatively frequent (33% in the Fraxiparine group and 28% in the Calciparine group), however these rates were related to prostatic and urinary incontinence surgery. This study, including a wide series of patients undergoing general surgery under epidural anaesthesia, demonstrates that efficiency and tolerance of one daily injection of Fraxiparine are similar to those of three daily injections of Calciparine. It it concluded that Fraxiparine improves of the patient's comfort and decreases the nursing work load.

Central venous catheters (CVC) have proven to be a reliable route of the administration of chemotherapy, saline, blood cells and nutritional support in patients with malignant haematological disease. However, infection remained one of the most important causes of morbidity associated with this procedure. The aims of this study were a) to evaluate the efficacy of laminar air flow to prevent CVC infections, b) to study morbidity associated with polyethylene (PE) and silicone (S) catheters, and c) to evaluate the part played by increasing staff practice. 177 CVC were inserted in 170 children during a period of 20 months. Ages ranged from 5 months to 15 years (mean: 7 years). All the S CVC were tunnelled whereas, because of their rigidity, none of the PE CVC were. At the time of their removal, bacteriological samples from the CVC skin exit site, blood drawn through the catheter and the tips of these CVC were cultured. During the first period (one year), three groups of CVC were studied: in group 1, 37 S CVC in patients placed in a non-sterile ward; in group 2, 40 S CVC in children nursed under laminar air flow; in group 3, 60 PE CVC in patients of a non-sterile ward. During the second period (8 months), 40 new S CVC were inserted in children nursed in non-sterile wards, but after nursing staff training (group 4).(ABSTRACT TRUNCATED AT 250 WORDS)

A prospective study was designed to evaluate coagulation abnormalities induced by early abortion (before ten weeks of pregnancy). Fifty-two women underwent suction abortion, under diazepam-fentanyl anaesthesia with spontaneous ventilation; they were screened for coagulation parameters before and after surgery. Eight tests were carried out: prothrombin time, activated partial thromboplastin time (APTT), thrombin time platelet count, fibrinogen levels, fibrin split products, fibrin soluble complexes and euglobulin lysis time. Results were consistent with activation. Consequences were limited and one general test (APTT) was not significantly modified. Suction abortion, even performed in early pregnancy, exposed to biological disseminated intravascular coagulation with a general risk of venous thrombosis.

The effects of phenoperidine and extradural analgesia on blood loss during and after total hip replacement were compared in 41 patients randomly divided into two statistically comparable groups. Mean blood loss in patients who received phenoperidine was 1065 +/- 316 ml and in patients who received extradural analgesia with 0.5% bupivacaine with adrenaline 1:200 000 it was 650 +/- 277 ml (p less than 0.001). There was no significant difference in postoperative blood loss between the two groups. The reduction in blood loss resulting from the extradural block may prove beneficial in decreasing the hazard and cost of blood transfusions and in facilitating autologous transfusion.