Contribution à l'étude des effets de l'anesthésie générale sur la circulation pulmonaire

Doctorat en sciences médicalesinfo:eu-repo/semantics/nonPublishe

Intracranial pressure monitoring

The management of neurosurgical patients has changed since a few years with the development of intracranial pressure (ICP) monitoring, the value of which having now become widely recognized. An understanding of pathophysiological mechanisms of increased ICP is mandatory for its management. In the normal state, a variation of volume of any of the intacranial constituants [brain substance, cerebrospinal fluid (CSF), arterial and venous blood] is accompanied by an inverse change of the others, so that the total volume and the pressure remain constant. As soon as the compensation mechanisms are outrun, the ICP measured as the ventricular fluid pressure will increase. The relationship between volume and pressure increases is represented by the compliance curve of the intracranial contents. Continuous measurement of ICP is mainly done by two methods :catheterization of a ventricle which allows CSF removal for drainage or analysis and testing of the cerebral compliance (by addition or subtraction of one ml of fluid and noting the change in pressure); recording the extradural pressure, which entails less risk of infection, but does not allow CSF removal and may over-read the intraventricular pressure. The nomrla ICP lies between 10-15 mm Hg (15-20 cm H2O). The recognition of abnormal ICP waves is important :Lundberg first described the large A or plateau waves (50-100 mm Hg), accompanied by clinical signs of cerebral hypertension; there are also B waves (up to 50 mm Hg), less significant, usually accompanying a decrease of wakefulness, and C waves seemingly correlated with Traube-Hering-Mayer waves of the blood pressure. ICP may be increased due to disease (tumor, hematoma, edema, CSF blockage or benign cerebral hypertension) or iatrogenic (increased cerebral blood flow with vasodilatation during hypoxia, hypercarbia and anesthesia with most halogenated anesthetics; impaired venous drainage :coughing, straining, positive pressure ventilation with PEEP, etc.). In conclusion, ICP monitoring is a useful tool in neuroanesthesia and in neurological intensive care and in association with other methods of investigation like cerebral blood flow and metabolic rate measurement, CAT scanning, will be contributive in evaluating new treatments.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

De la préparation de l'anesthésie au réveil: rôle important de l'infirmier(e) de bloc opératoire

info:eu-repo/semantics/publishe

Contribution à l'étude des effets de l'anesthésie générale sur la circulation pulmonaire

Doctorat en sciences médicalesinfo:eu-repo/semantics/nonPublishe

Anaesthesiological manpower in europe

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Immunological mechanisms of reactions to macromolecular solutions

SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Composition of fresh frozen plasma

We analyzed 35 samples of fresh frozen plasma (FFP), finding mean concentrations of 535 mg/dl glucose, 172 mEq/L sodium, 73 mEq/L chloride, 3.5 mEq/L potassium, 15 mEq/L bicarbonate, and 5.5 g/dl protein with 60% albumin. Thus, FFP is a hyperosmolal, hyperglycemic, hypernatremic, and hypochloremic solution which may be a less effective volume expander than other albumin-containing solutions, due to its lower albumin content.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Is lumbar epidural analgesia an alternative in patients who have incomplete colonoscopy with standard premedication?

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Hyperthermic isolation perfusion of the limbs with cytostatics after surgical excision of sarcomas

In order to prevent recurrence, isolation perfusion was applied in 15 patients after resection of sarcomas of the limbs. There were 6 liposarcomas, 4 synoviosarcomas, 2 malignant fibrohistiocytomas, 1 malignant mesenchynoma, 1 Kaposi, and 1 osteosarcoma (the only bone sarcoma). Eight sarcomas were recurrent after narrow surgery and/or radiotherapy. The treatment schedule was conducted in 2 steps: (a) removal of the tumor with safety margins at least outside the tumor capsule, followed 3-8 weeks later by (b) isolation perfusion with melphalan with or without actinomycin D under moderate hyperthermia at 39-41°C for 1 hour. Median follow-up time has been 30 months. Four of the 8 recurrent sarcomas recurred again and developed distal metastases. In contrast, none of the previously untreated patients recurred and 1 disseminated in the form of multicentric liposarcoma. Eleven are still alive with survival ranging from 8 to 103 months. It is concluded that isolation perfusion with melphalan with or without actinomycin D may be considered as an adjunct to surgery.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

High serum levels of TNF-α after its administration for isolation perfusion of the limb

In a phase II study, 18 patients with locally spreading melanoma or sarcoma of lower limb were treated by isolation perfusion (ILP) with hyperthermia and local infusion of high dose of recombinant human tumor necrosis factor α (rHuTNF-α) (4 mg). Bioactive TNF-α and interleukin 6 (IL-6) serum levels were measured serially, In the limb, TNF-α rapidly reached a plateau at 2 μ/ml, while IL-6 appeared later and progressively increased until the end of ILP. In the systemic circulation TNF-α rose up to a median concentration of 31 ng/ml after 1 hour, then decreased and became negligible after 6 hours. IL-6 peaked only after 5 hours after start of ILP (median: 36.7 ng/ml). In patients with substantial leakage towards systemic circulation, both cytokines peaked higher and earlier as compared with patients with minimal leakage. No correlation was found between cytokine levels and severity of side effects which in all cases were reversible. We conclude that high dose TNF-α infusion in ILP results in extremely high levels of bioactive TNF-α in the systemic circulation without irreversible side effect, and provokes a delayed blood release of large amounts of IL-6; there was a correlation between leakage from the limb during procedure and the magnitude of systemic cytokines levels. © 1992.SCOPUS: ar.jinfo:eu-repo/semantics/publishe