开放手术与经后腹腔镜肾蒂淋巴管结扎术治疗乳糜尿的疗效比较

目的评价开放式与经后腹腔镜肾蒂淋巴管结扎术的临床价值。方法2001年1月至2003年12月采用肾蒂淋巴管结扎术治疗乳糜尿患者19例。后腹腔镜组10例,男6例,女4例,平均年龄45岁;开放手术组9例,男5例,女4例,平均年龄42岁。对2种术式手术时间、术后住院天数、术中平均出血量、术后并发症发生率等项目进行统计分析。结果后腹腔镜与开放手术组手术时间分别为(68.4±39.2)min和(125.6±39.2)min,术后住院天数分别为(5.3±1.1)d和(9.8±2.3)d,术中出血量分别为(47.6±38.2)ml和(294.9±289.1)ml。组间比较差异均有统计学意义(P<0.001)。后腹腔镜组术后无并发症;开放手术组术后因感染或脂肪液化伤口愈合不良3例,并发重度肺部感染及重度代谢性酸中毒1例,术后出现低血压(<90/60mmHg)2例。2组患者术后随访6～12个月,乳糜尿无复发。结论后腹腔镜肾蒂淋巴管结扎术在手术时间、术中出血量和术后恢复等方面明显优于开放手术。     

后腹腔镜肾脂肪囊外途径肾蒂淋巴管结扎术治疗乳糜尿的临床疗效分析

目的:评价后腹腔镜肾脂肪囊外途径肾蒂淋巴管结扎术治疗乳糜尿的临床疗效。方法:回顾性分析2012年1月—2018年12月九江市第一人民医院行后腹腔镜肾蒂淋巴管结扎术治疗乳糜尿42例患者的临床资料,其中经后腹腔镜肾脂肪囊外途径18例(A组),经后腹腔镜肾脂肪囊内途径24例(B组)。结果:A组手术时间、术中出血量、术后放置引流管时间、术后卧床时间及术后住院时间均少于B组,术后镇痛药物使用率低于B组(P<0.05)。所有患者术后随访8～83个月,A组肾下垂及复发率低于B组,两组比较差异无统计学意义(P>0.05)。结论:后腹腔镜肾脂肪囊外途径肾蒂淋巴管结扎术不需要剥离肾脂肪囊,不用做肾固定,缩短了手术时间,创伤小,恢复快,术后并发症少。该术式是治疗乳糜尿的一种可行而有效的手术方法。     

后腹腔镜与开放手术行肾蒂淋巴管结扎术治疗乳糜尿的临床效果比较

目的:通过与开放性肾蒂淋巴管结扎术的临床效果比较,评价后腹腔镜肾蒂淋巴管结扎术的临床价值。方法:回顾性分析后腹腔镜肾蒂淋巴管结扎术54例(A组)及开放性肾蒂淋巴管结扎术29例(B组)的临床资料,就两组患者一般资料、手术时间、术中出血量、术后肠道功能恢复时间、术后止痛药用量、术后住院天数、术后感染和复发率等指标进行比较。根据数据类型选用χ~2检验、两样本t检验或Wilcoxon秩和检验,P0.05为差异有统计学意义。结果:两组患者的一般资料相似,差异无统计学意义,具有可比性。后腹腔镜手术组在手术时间、术中出血量、术后肠道功能恢复时间、术后止痛药用量、术后住院天数、术后感染和术后乳糜尿复发率等方面优于开放手术组,差异有统计学意义(P0.05)。结论:后腹腔镜肾蒂淋巴管结扎术治疗乳糜尿疗效肯定,与传统的开放性手术相比,创伤小、恢复快、疗效满意,是目前治疗乳糜尿较理想的手术方法,值得进一步推广。     

后腹腔镜与开放肾蒂淋巴管结扎术治疗乳糜尿疗效分析

目的：评价后腹腔镜肾蒂淋巴管结扎术治疗乳糜尿的临床价值。方法：回顾分析后腹腔镜肾蒂淋巴管结扎术治疗乳糜尿18例（A组）及开放组20例（B组）的临床资料。结果：手术操作时间分别为A组（76±31）min、B组（113±26）min;手术中出血量A组（25±29）ml、B组（190±76）ml;术后肠功能恢复时间A组（33±9）h、B组（69±14）h;术后下床活动时间A组（39±8）h、B组（74±12）h;术后住院天数A组（6．7±2．5）天、B组（12．4±4．1）天;住院总天数A组（14．8±4．7）天、B组（23．9±6．4）天;A组并发症方面明显少于B组,差异有统计学意义（P〈0．05或P〈0．01）;手术治疗费用A组（7582±1952）元、B组（3044±1015）元;B组在手术治疗费用方面少于A组,差异有统计学意义（P〈0．05或P〈0．01）。结论：后腹腔镜肾蒂淋巴管结扎术治疗乳糜尿借助腹腔镜的放大作用,可清楚辨认肾门处的淋巴管,使淋巴管结扎更完全,具有仓0伤小、出血量少,术后卧床和住院时间短、无明显的并发症、恢复快、术后无复发等优点。但应严格掌握手术适应证,积极做好围手术期处理。     

后腹腔镜结核肾切除术22例报告

目的　比较后腹腔镜结核肾切除术 (包括后腹腔镜单纯性肾切除术和后腹腔镜包膜下肾切除术)与开放手术方法的应用价值。　方法　①行腹腔镜结核肾切除术 22例 (A组 )。男7例,女15例。年龄 23~53岁,平均年龄 43岁。左肾 14例,右肾 8例。②同期行结核肾开放性肾切除 22例(B组)。男 9例,女 13例。年龄 27~51岁,平均年龄 39岁。左肾 15例,右肾 7例。两组手术均由同一组医师完成。比较两种方法的手术时间、术中失血量、术后平均住院时间、卧床时间。　结果　A组行单纯肾切除者 17例,另 5例因肾周严重粘连改行包膜下肾切除。B组改行包膜下肾切除者7例。A组手术时间为 ( 93. 0±12. 6 )min,术中失血量 ( 78. 3±60. 6 )ml、术后平均住院时间为(3. 3±0. 9)d、卧床时间为(1. 0±0. 2)d,B组上述指标分别为 (92. 6±35. 5)min、(160. 0±120. 0)ml、(9. 1±0. 8)d和(3. 9±0. 4)d;两组手术时间比较差异无统计学意义;但A组术中失血量、术后平均住院时间及卧床时间明显优于B组。　结论　与开放手术相比,后腹腔镜结核肾切除术具有创伤小、出血少、恢复快的优点,后腹腔镜包膜下肾切除术能有效处理粘连极重的无功能结核肾。     

后腹腔镜肾蒂淋巴管结扎术治疗乳糜尿的疗效观察(附12例报告)

目的:探讨后腹腔镜肾蒂淋巴管结扎术治疗乳糜尿的疗效。方法:回顾性分析后腹腔镜肾蒂淋巴管结扎术治疗的12例乳糜尿患者的临床资料,其中男7例,女5例,年龄50~68岁,平均61岁,病史2~8年,左侧7例,右侧4例,双侧1例。均采用后腹腔镜肾蒂淋巴管结扎术治疗。结果:手术均成功,手术时间90~140min,术中出血量50~200ml。术后8d出院,术后随访无复发。结论:后腹腔镜肾蒂淋巴管结扎术治疗乳糜尿创伤小、恢复快、复发率低,是一种安全有效的治疗方法。     

后腹腔镜肾蒂淋巴管结扎治疗乳糜血尿的临床研究

目的通过与传统开放手术比较，探讨后腹腔镜肾蒂淋巴管结扎术在治疗乳糜尿的临床应用价值。方法确诊乳糜尿的患者39例，分别采用后腹腔镜（A组，21例，24侧）和传统开放手术（B组，18例，19侧）行肾蒂淋巴管结扎术，比较两种手术的疗效、手术时间、术中术后并发症、术中出血量、术后肠道功能恢复时间以及术后住院时间等指标。结果39例患者手术成功，术后均恢复顺利，乳糜尿消失。A组：1例发生切口周围皮下气肿，术后第3天完全吸收。术后4例出现肉眼血尿，持续1～3天自行消失。B组：1例分离左肾蒂时损伤肾动脉外膜，形成动脉瘤，行外膜修补术后动脉瘤消失。1例损伤右肾静脉，术中成功修补。术后8例出现肉眼血尿，持续持续2-3天自行消失。1例伤口感染。术后3月仍有5例患者诉患侧腰部疼痛或不适。全部患者随访18个月以上。A组1例、B组2例复发。A、B两组单侧手术时间分别为（72．3±21．6）分钟和（156．7±30．9）分钟，术中出血量分别为（43．7±19．3）m1和（132．6±61．4）m1；术后肾周引流管留置时间分别为（1．5±0．5）天和（3．5±1．5）天，引流量分别为（22．4±14．1）m1和（42．3±25．6）m1：术后卧床时问分别为（2．1±1．1）天和（4．6±1．6）天：术后胃肠道功能恢复时间分别为（24．6±14．4）小时和（48．0±25．1）小时；术后住院时间分别为（5．2±1．2）天和（8．5±2．5）天。A、B两组上述指标比较P均〈0．05，有统计学意义。结论腹膜后腹腔镜技术行肾蒂淋巴管结扎术具有创伤小、出血少、并发症少、恢复快的优点，疗效满意，将取代开放性手术。     

改良后腹腔镜下肾蒂淋巴管结扎术治疗乳糜尿的疗效分析

目的 探讨改良后腹腔镜下肾蒂淋巴管结扎术治疗乳糜尿的疗效.方法 回顾性分析2002年1月至2012年6月58例乳糜尿患者的临床资料,男34例,女24例.年龄23～ 78岁,平均58岁.临床表现为“牛奶样”乳糜尿,病程1～9年.术前美国麻醉师协会(ASA)评分均为Ⅱ级,平均体质指数(BMI)为17.3 kg/m2.采用改良后腹腔镜下肾蒂淋巴管结扎术36例,传统腹腔镜下肾蒂淋巴管结扎术22例,比较两组平均手术时间、术后卧床时间、术后住院时间、术后疼痛指数.结果 本组58例手术均顺利完成.改良组手术时间50 ～ 132 min,平均(86.8±21.8) min,术后卧床时间(1.7±0.5)d,术后疼痛指数(1.4±0.8)分,术后住院时间(6.8±1.7)d;传统组手术时间60～195 min,平均(132.9±35.7) min,术后卧床时间(3.4±0.5)d,术后疼痛指数(3.9±0.8)分,术后住院时间(8.8±1.6)d,两组比较差异均有统计学意义(P＜0.05).随访3～ 103个月,两组均未见复发,无并发症及肾下垂发生.两组的治愈率均为100％.结论 改良后腹腔镜下肾蒂淋巴管结扎术可避免完全游离肾周脂肪,缩短手术时间、术后卧床时间、术后住院时间,减轻患者术后腰背部的疼痛.     

后腹腔镜肾蒂淋巴管结扎术治疗乳糜尿

目的:探讨后腹腔镜肾蒂淋巴管结扎术在乳糜尿治疗中的临床价值。方法:回顾分析14例后腹腔镜肾蒂淋巴管结扎患者的临床资料,观察手术时间,术中出血量,术后肠功能恢复时间、住院天数、尿液变化,比较手术前后血红蛋白及血白蛋白变化。结果:14例手术全部取得成功,无中转开放,平均手术时间(156.4±68.7)min;术中平均出血量(25.7±14.7)ml;术后平均住院(9.3±2.4)天,术后肠功能恢复时间1～3天。所有患者术后乳糜尿立即消失。术后随访0.5～2.0年,患者尿液清亮,营养状况明显改善;术后半年复查血红蛋白及血白蛋白,均较术前有显著增加。结论:后腹腔镜肾蒂淋巴管结扎术手术疗效肯定,术中出血少,术后恢复快,对患者损伤小,并发症少,是一种安全,有效的治疗方法,有推广运用价值。     

后腹腔镜肾蒂淋巴管结扎术治疗乳糜尿

目的:探讨后腹腔镜肾蒂淋巴管结扎术治疗乳糜尿的临床疗效。方法:2007年10月～2008年10月收治13例乳糜尿患者,其中男5例,女8例,年龄28～54岁(平均38岁),病史1～15年。乳糜尿来自左侧6例,右侧7例。13例均行后腹腔镜肾蒂淋巴管结扎术。结果:13例手术均取得成功,无一例转开放手术,手术时间60～115 min(平均90 min),术中出血量10～80 ml(平均40 m1),均未输血。13例患者术后当天乳糜尿均消失,未出现并发症。术后平均住院5.5天。随访0.5～1年,仅1例出现对侧复发再次行患侧后腹腔镜肾蒂淋巴管结扎术,其他患者均无乳糜尿症状复发。结论:后腹腔镜肾蒂淋巴管结扎术是一种治疗乳糜尿安全、有效的方法,具有创伤小、并发症少、术后恢复快、复发率低等优点,值得临床推广应用。     

Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity?

Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg^?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg^?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg^?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.     

Membranes in Artificial Organs

Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.     

Dilemma of Membrane Biocompatibility and Reuse

Abstract: Numerous articles have been published on the multiple use of dialyzers and on the effect of different reprocessing chemicals and techniques on the dialyzer biocompatibility and performance. The results often appear contradictory, especially those comparing standard biocompatibility parameters. Despite this confusion, a discerning review of the published works allows certain limited conclusions to be drawn. Reprocessing of used hemodialyzers changes the biocompatibility profile of a dialyzer as defined by the parameters complement activation. leukopenia, and cytokine release. The effect of reprocessing depends on the chemicals and reprocessing technique applied and also on the type of membrane polymer being subjected to the reprocessing procedure. Reports of pyrogenic reactions indicate that the flux of the membrane also influences how suitable it is for safe reuse. An increased risk of allergic and pyrogenic reactions appears to be associated with dialyzer reuse. Furthermore, there has been a lack of investigations into the immunologic effect of the layer of adsorbed and chemically altered proteins that remains on the inner surface of reprocessed dialyzers. We conclude that the clinical benefit of dialyzer reuse cannot be generally accepted from a biocompatibility point of view.     

The analgesic effect of racemic ketamine in patients with chronic ischemic pain due to lower extremity arteriosclerosis obliterans

Background : Ketamine in sub-dissociative doses has been shown to have analgesic and phantom-Limb pain, where conventional treatment has often failed. Chronic ischemic pain due to lower extremity arteriosclerosis obliterans often responds poorly to analgesics, and the pain-generating mechanisms are not well understood.
Methods : Eight patients with rest pain in the lower extremity due to arteriosclerosis obliterans were given sub-dissociative doses of 0.15, 0.30, or 0.45 mg/kg racemic ketamine and morphine 10 mg as a 5-min infusion on four separate days in a cross-over, double-blind, randomised protocol. Plasma levels of (S)- and (R)-ketamine and their nor-metabolites were analysed with an enantioselective high-performance liquid chromatography (HPLC) method. Pain levels were evaluated with a visual analogue scale (VAS).
Results : Individual pain levels were highly variable during and after all the infusions but the pooled pain levels showed a dose-dependent analgesic effect of ketamine with a transient but complete pain relief in all patients at the highest dose (0.45 mg/ kg). Side-effects, mainly disturbed cognition and perception, were pronounced and dose-dependent. Morphine 10 mg had an analgesic peak at 20 min and 5/8 patients had complete pain relief. The remaining 3 patients also had high baseline pain scores, indicating a higher analgesic potency for the 0.30 and 0.45 mg/ kg ketamine doses than for morphine 10 mg.
Conclusion : We have demonstrated a potent dose-dependent analgesic effect of racemic ketamine in clinical ischemic pain. Due to a narrow therapeutic window, this analgesic effect is probably best utilised in combination with other analgesics.     

Intravenous endotoxin does not increase tissue extravasation of albumin in rats

Background : It is unclear whether activation of the inducible nitric oxide synthase (iNOS) increases or decreases the extravasation of plasma.
Methods : Chloralose anaesthetised male Wistar rats received E. coli lipopolysacharide (LPS), 3 mg kg^-1 i.v., or the corresponding volume of saline, 3 or 5 h before the end of the experiment. Mean arterial pressure (MAP) and heart rate (HR) were recorded. Tissue clearance of radio-labelled albumin, during the last 2 h of each experiment, was determined by a double-isotope method. In separate animals, the serum concentration of nitrite and nitrate was determined, 5 h after LPS or the solvent.
Main Results : LPS initially decreased MAP and lastingly increased HR. In the 3-h LPS animals (n=8), tissue plasma clearance was lower in the heart and calf muscle and increased only in diaphragm, compared to corresponding control animals (n=8). In the 5-h LPS rats, clearance was lowered (n=8) in the entire gastrointestinal tract and in testes, compared to controls (n=8). The serum nitrite/nitrate concentration was higher in animals given LPS (n=6) than in controls (n=6).
Conclusion : After LPS, tissue clearance of albumin was not increased in any major tissue, in spite of increased serum levels of NO end products. Apparently, after activation of iNOS, the augmented release of NO is not necessarily associated with increased albumin extravasation.     

Adrenaline markedly improves thoracic epidural analgesia produced by a low-dose infusion of bupivacaine, fentanyl and adrenaline after major surgery: A randomised, double-blind, cross-over study with and without adrenaline

Background: Basic pharmacological research indicates that there are synergistic antinociceptive effects at the spinal cord level between adrenaline, fentanyl and bupivacaine. Our clinical experience with such a mixture in a thoracic epidural infusion after major surgery confirms this. The objectives of the present study were to evaluate the effects on postoperative pain intensity, pain relief and side effects when removing adrenaline from this triple epidural mixture. Methods: A prospective, randomised, double-blind, cross-over study was carried out in 24 patients after major thoracic or abdominal surgery. Patients with only mild pain when coughing during a titrated thoracic epidural infusion of about 10 ml · h^?1 of bupivacaine 1 mg · ml^?1, fentanyl 2 μg · ml^?1, and adrenaline 2 μg · ml^?1 were included. On the 1^st and 2^nd postoperative days each patient was given a double-blind epidural infusion, at the same rate, with or without adrenaline. The effect was observed for 4 h or until pain when coughing became unacceptable in spite of a rescue analgesic procedure. Rescue analgesia consisted of up to two epidural bolus injections per hour and i.v. morphine if necessary. All patients received rectal paracetamol 1 g, every 8 h. Fentanyl serum concentrations were measured with a radioimmunoassay technique at the start and end of each study period. Main outcome measures were extent of sensory blockade and pain intensity at rest and when coughing, evaluated by a visual analogue scale, a verbal categorical rating scale, the Prince Henry Hospital pain score, and an overall quality of pain relief score. Results: The number of hypaesthetic dermatomal segments decreased (P <0.001) and pain intensity at rest and when coughing increased (P <0.001) when adrenaline was omitted from the triple epidural mixture. This change started within the first hour after removing adrenaline. After 3 h pain intensity when coughing had increased to unacceptable levels in spite of rescue analgesia (epidural bolus injections and i.v. morphine). Within 15–20 min after restarting the triple epidural mixture with adrenaline, pain intensity was again reduced to mild pain when coughing. Serum concentration of fentanyl doubled from 0.22 to 0.45 ng · ml^?1 (P <0.01), and there was more sedation during the period without adrenaline. Conclusions: Adrenaline increases sensory block and improves the pain-relieving effect of a mixture of bupivacaine and fentanyl infused epidurally at a thoracic level after major thoracic or abdominal surgery. Serum fentanyl concentrations doubled and sedation increased when adrenaline was removed from the epidural infusion, indicating more rapid vascular absorption and systemic effects of fentanyl.     

Utilisation des médicaments prokinétiques en réanimation : indications et limites ?

Enteral feeding is often limited by gastric and intestinal motility disturbances in critically ill patients, particularly in patients with shock. So, promotility agents are frequently used to improve tolerance to enteral nutrition. This review summaries the pathophysiology, presents the available pharmacological strategies, the clinical data, the counter-indications and the principal limits. The clinical data are poor. No study demonstrates a positive effect on clinical outcomes. Metoclopramide and erythromycin seems to be the more effective. Considering the risk of antibiotic resistance, the first line use of erythromycin should be avoided in favor of metoclopramide.     

Anesthésie générale chez l’enfant : quid des pratiques en 2010 ?

Introduction

The practice of pediatric anesthesia requires a regular update of scientific knowledge and technical skills. To provide the most adequate Continuing Medical Education programs, it is necessary to assess the practices of pediatric anesthesiologists. Thus, the objective of this survey was to draw a picture of the current clinical practices of general anesthesia in children, in France.

Material and methods

One thousand one hundred and fifty questionnaires were given to anesthesiologists involved in pediatric cases. These questionnaires collected information on various aspects of clinical practice relative to induction, maintenance, recovery from general anaesthesia and also classical debated points such as children with Upper Respiratory Infection (URI), emergence agitation, epileptoid signs or anaesthetic management of adenoidectomy. Differences in practices between CHG (general hospital), CHU (teaching hospital), LIBERAL (private) and PSPH (semi-private) hospitals were investigated.

Results

There were 1025 questionnaires completed. Fifty-five percent of responders worked in public hospitals (CHG and CHU); 77% had a practice that was 25% or less of pediatric cases. In children from 3 to 10 years: 72% of respondents used always premedication and two thirds performed inhalation induction in more than 50% of cases. For induction, 53% used sevoflurane (SEVO) at 7 or 8%. Respondents from LIBERAL used higher SEVO concentrations. Tracheal intubation was performed with SEVO alone (37%), SEVO and propofol (55%) and SEVO with myorelaxant (8%), 93% of respondents used a bolus of opioid. For maintenance, the majority of respondents used SEVO associated with sufentanil; desflurane and remifentanil were more frequently used in CHU. Two thirds of respondents used N₂O. Depth of anesthesia was commonly assessed by hemodynamic changes (52%), end tidal concentration of halogenated (38%) or automated devices based on EEG (7%). In children with URI, 98% of respondents used SEVO for anesthesia. To control the airway 42% used a tracheal tube, 30% a laryngeal mask and 20% a facial mask. Emergence agitation was an important concern for two thirds of respondents, while epileptoid signs were considered as important by only 20%. Eighty-nine percent of respondents practiced anesthesia for adenoidectomy. Anesthesia was induced by inhalation of SEVO 7–8% (41%), 6% (39%) or 4% (12%), 66% put an intravenous line (less frequently in LIBERAL). 67% of the responders managed adenoidectomy without any device to control the airway (more frequently in LIBERAL), 32% administrated a bolus of opioid (less frequently in LIBERAL).

Discussion

This survey demonstrated that the practices regarding general anesthesia in children are relatively homogenous. Most of the differences appeared between LIBERAL and the others structures; the anaesthetic management for adenoidectomy illustrates these findings.     

Intérêt d’une rééducation précoce pour les patients neurologiques

Rehabilitation improves the functional prognosis of patients after a neurologic lesion, and tendency is to begin rehabilitation as soon as possible. This review focuses on the interest and the feasibility of very early rehabilitation, initiated from critical care units. It is necessary to precisely assess patients’ impairments and disabilities in order to define rehabilitation objectives. Valid and simple tools must support this evaluation. Rehabilitation will be directed to preventing decubitus complications and active rehabilitation. The sooner rehabilitation is started; the better functional prognosis seems to be.     

Risiko Schlaganfall — Öffentlichkeitsarbeit und Aufklärung dringend erforderlich

Zusammenfassung Das wesentliche — und zugleich noch wenig ausgeschöpfte — Potenzial der Schlaganfallmedizin liegt in der langfristigen Prophylaxe. Durch Beeinflussung von Lifestylefaktoren wie Ernährungsgewohnheiten, Zigarettenkonsum und körperlichem Training durch entsprechende Aufklärung ließe sich ein erheblicher Teil an zerebralen Ereignissen vermeiden. Ein weiterer in Deutschland noch zu wenig beachteter Faktor ist die konsequente Blutdruckeinstellung. Breitgestreute Aufklärung könnte außerdem potenziellen Patienten helfen, bereits auftretende Warnsymptome wie die transiente ischämische Attacke richtig einzuschätzen, um eine rechtzeitige Behandlung zu ermöglichen.