Search

Estimates the incidence, mortality and causes of carbon monoxide intoxication in France. Contribution of fires and car exhausts to intoxication; Mechanisms of intoxication; Signs and symptoms of carbon monoxide poisoning.

The use of hydrogen peroxide (H2O2) in surgery for its antiseptic properties has been associated with life-threatening complications. We report a case of severe oxygen embolism after wound irrigation with H2O2 in a 17-year-old boy undergoing surgical dressing of a large thigh trauma under general anaesthesia. During muscle lavage with 400 mL of H2O2 3%, severe shock suddenly occurred. On the basis of clinical presentation, the diagnosis of pulmonary gas embolism was strongly suspected. Symptomatic treatment initiated immediately, restaured a normal haemodynamic state within a few minutes and the patient recovered without sequelae. The degradation of H2O2 results in considerable amounts of gaseous oxygen. One mL of H2O2 can produce in the tissues 10 mL of oxygen. This gas can enter the circulation and determine severe embolism. The treatment should be initiated without delay. The administration of H2O2 under pressure is contraindicated during surgery.

To determine the efficacy of motor evoked potentials (MEP) and sensory evoked potentials (SEP) in the assessment of severe cervical injury, 17 subjects with severe cervical injury were studied. During the 1st week post-injury and post-surgical treatment, all subjects were submitted to electromyogram (EMG) recordings, dermatomal somatosensory evoked potentials (D.SEP), posterior tibial nerve somatosensory evoked potentials (PTN.SEP), MEP and bilateral cervical electrical stimulations with recording of the diaphragm. For the D.SEP, the latencies of the N9 and N20 responses and the conduction time (N9-N20) were measured in the upper limbs; the latencies of the P40 and P60 responses were measured in the lower limbs. MEP were recorded from distal upper and lower limb muscles following transcranial electrical stimulation of the cortex. (Magnetic stimulation was not indicated because of implanted metallic material in the cervical skull of many patients.) A SEP and MEP grading system was used to improve the assessment of different root neurological levels. In patients with incomplete lesions PTN.SEP, D.SEP and MEP responses could be recorded in territories that were clinically deficient. Patients with complete lesions and absent SEP and MEP responses had a poor outcome. A good correlation was found between the severity of the spinal cord injury and SEP grading. For MEP, the presence or absence of intercostal responses (C4) to cervical and cortical stimulation was the best prognostic indicator. The combined electrophysiological exploration of MEP and SEP proved to be a useful tool for monitoring patients with severe spinal cord injury.

Six cases of grave hypothermias are reported, having arisen during surgical interventions which necessitated a rapid and abundant transfusion of badly warmed blood. The role of favouring factors, surrounding cold due to the air-conditioning, anaesthesia, extent of the area of operation, seems important. The symptomatology permits the individualization of a hypothermic syndrom neighbouring the picture described in toxic accidental hypothermias. Accidents during the warming process associate collapse and disturbances in coagulation. It is therefore necessary to consider certain signs of alarm as important and generalize the conditions for prevention of thermolysis in the operating theatre.

Post-traumatic preoperative deep vein thrombosis (DVT) was studied by routine bilateral venography in 98 orthopaedic patients admitted more than 48 h (mean: 7 days) after the limb trauma, who had not been given prophylactic anticoagulation. All these patients had undergone long distance travel under medical supervision, having been injured a long way from the medical centre. Ages ranged from 15 to 77 years (mean age: 38 years). 85 patients had been previously free of any of the usual risk factors for DVT. Routine venography showed up DVT in 39 patients (40%). Four DVT were bilateral; only seven were symptomatic. When DVT was proved, heparin treatment by infusion pump was given for 15 days before surgery was performed.

In a previous paper, meteorological circumstances of myocardial infarctions, cerebrovascular attacks, and suicidal attempts were studied by a univariate method. The present work used the same clinical reports, collected by the Medical Emergency Assistance System (SAMU) in the Paris area from 1975 to 1977, but with multivariate calculations. 150 potential predictive indicators were submitted to "progressive ascending selection". Selected indicators were then combined into a composite index by "linear canonic discrimination". This index was tested in terms of successful prediction. The 150 indicators were: 1) meteorological variables, recorded at ground level, such as wind and temperature (expressed respectively in 28 and 24 ways), airpressure, moisture; 2) variables computed from data recorded in altitude; 3) pollutants; 4) non-meteorological indicators, such as day of the week, season, solar activity; 5) the "past of the predictand", i.e. the frequency of infarctions during the previous days; 6) types of weather, defined after confronting meteorological maps with clinical data. The coding of qualitative data required a new procedure. The event to be predicted, which occurred only one day a week, was an incidence of infarctions of at least twice the average. The percentage of successful prediction was 78.7%. The type of weather was by far the best indicator. Detrimental circumstances were changing weathers, with in the order of decreasing correlations, atmosphere fluxes coming from S-SE, E, SW, and NW. These results complete those of univariate analysis. They validate a simple and efficient predictive method, similar in its principle to that used in Germany.

This study analyses 57 cases of abdominal trauma occurring in patients with multiple injuries admitted to the accident unit in Garches, over a period of four years. After a few remarks concerning the use of a safety belt, the authors discuss in particular: -- 25 hepatic lesions; -- 20 splenic lesions. These lesions were operated on by the surgeons on the unit with the exception of 9 cases where a specialised surgeon was called in. In the vast majority of cases, we consider the patient should not be transferred to the other units but, if possible, all lesions should be treated simultaneously in one centre.

One of the crucial factors affecting mortality and morbidity after circulatory arrest the ischemic neuronal damage following complete cessation of cerebral blood-flow. To date, no accepted pharmacologic neuroprotective therapy has emerged. Cerebral ischemia causes a rapid shift of Ca++ from the extracellular spaces into cells and it is assumed that this excessive entry of Ca++ is the final pathway of cell death. In addition, Ca++ is involved in the diffuse vasospasm which occurs after global cerebral ischemia. Therefore, calcium entry blockers such as dihydropyridines derivatives have sparked considerable interest especially because of their preferential cerebrovasodilating effects. In vivo studies have demonstrated protection from brain ischemia with calcium entry blockers. However no direct protective effect of these drugs has been shown on neurons. More recent results have underscored the importance of excitatory amino acid neurotransmitters and receptors (particularly N-Methyl-D-Aspartate receptors) in causing intracellular calcium overload and neuronal death after ischemia. Blockade of these receptors or their associated channels may be an interesting way to protect the brain against ischemic damage.

From pathogenic datas about sickle cell disease, the authors enumerate precautions that should be taken during pre, per- and post-operative periods. These conclusions have been established according to previous publications and according to a personnel serie of 31 general anaesthesias, 11 of which on patients with sickle cell disease.

The authors have followed up 26 children suffering from severe scoliosis associated with congenital heart disease up to the end of puberty. The curve was usually a very severe idiopathic scoliosis developing early and requring surgical treatment. Two types may be distinguished: I. Scoliosis without excessive surgical risk, in patients in whom the heart disease is not associated with cyanosis or where the heart condition has already been treated surgically and in which there are no clinical, radiological or electrical signs of cardiac failure. 2. Scoliosis with considerable surgical risk because of heart disease with cyanosis not treated surgically, or with signs of heart failure or pulmonary hypertension. In such cases, the surgical treatment of the scoliosis is likely to endanger life.

Orthopaedic operations such as procedures for spinal deformity or operation for septic or loose total hip prosthesis are often associated with massive haemorrhage. Electrolyte analysis in 44 cases showed a low level of potassium. Rapid transfusion with stored blood appeared to have little effect on cardiac efficiency unless dilute calcium chloride was added. Alkaline preparations were used in patients with circulatory deficiency. Abnormalities of blood clotting were prevented by the use of fresh blood. Hypothermia and pulmonary complications also occurred and were eventually prevented by the use of assisted ventilation during the post-operative period.

In emergency traumatology, the iodine 125 labelled fibrinogen test is useful in the early detection of phlebitis in patients in whom the routine use of heparin is not possible--fractures of the cervical spine, severe cranial trauma, elderly subjects. It makes possible the institution of appropriate heparin therapy, without waiting for clinical signs to become evident. We noted that isotopic venous thromboses occured very frequently and very early, and that clinical signs, when present (50 p. cent of cases) occurrer 24 to 48 hours after the appearance of isotopic signs.

In a retrospective study the authors had compared the results obtained in two series of identical scoliosis. All were examined after a two year minimal follow-up. Group A. There were 31 children operated on between 1966 and 1972. The average initial curve measured 111 degrees, and the average follow-up was eight years. In this group there was no preoperative preparation, and a Harrington rod was accompanied by cancellous grafting. The average correction was 34 degrees. Four paraplegias were seen, three of which recovered. Group B. There were 45 children operated on between 1973 and 1980. The average initial curve was 170 degrees and the average follow-up was 4.5 years. In this group, there was pre-operative use of a Halo cast routinely. In 14 children, Harrington rodding was supplemented by anterior fusion to correct associated kyphosis. The posterior Harrington rodding was completed by tibial grafting. The average correction was 47 degrees, without any neurological complications. It was noted that after one year, pulmonary function was not impaired to a greater extent after an anterior fusion than after a purely posterior fusion. Two-thirds of the cases gained considerable cosmetic benefit.

In a prospective randomised trial, two groups of 20 patients each were compared. The first group received low dose heparin (t.i.d.) and the second group received low dose heparin (t.i.d.) combined with aspirin. The incidence of deep vein thrombosis (DVT) were determined using both radioactive fibrinogen uptake test and venography. The correlation between the two methods of diagnosis was better than 90%. There was no significant difference in the incidence of DVT between the two prophylactic regimen. A significant tendancy towards increased bleeding in observed with the combination of low dose heparin and aspirin.

Our experience of the prevention of thrombosis and embolism by the use of low doses of calcium heparinate in total hip replacement, with individual variations, shows that this method is efficacious, convenient and has a low complication rate both locally and generally.

Out of a total of 30 cases of traumatic tetraplegia with the lesion situated from C1 to C8 seen during the acute phase in the department of Professor JUDET, 8 posed no respiratory problems, whilst the others suffered lobar or pulmonary atelectasis in 13 cases, retention of bronchial secretions with secondary infection in 6 cases and progressive hypoxaemia in 3 cases. The first two types of complication are mechanical in origin and are directly related to the neurological problem. The third type is of more complex pathogenesis, combining water retention, hypoproetinaemia and secondary infection.