Tumescent local anaesthesia in dermatologic surgery performed under anticoagulant or antiagregant therapy

Autogenous bone remains the gold standard for preimplant bone-grafting procedure.When important volumes must be grafted with cancellous bone, the calvarial-harvesting site must still be considered, due to the quality of this membranous bone and the safety of the procedure if the surgeon is experimented.To simplify the procedure, the author proposes calvarial-bone harvesting under local anesthesia with a mini-bone plane. This technique remains very comfortable for the patient and also safe because of the almost complete preservation of the outer calvarial table.

Haemodynamic profile in paraphenylene-diamine poisoning

The accurate assessment and monitoring of arterial pressure is a key issue in the ICU. Arterial tonometry (applanation tonometry) is increasingly used in the cardiovascular field to noninvasively estimate pressure at the radial artery and carotid artery level and to reconstruct central aortic pressure. This allows the quantification of left ventricular afterload and may improve the evaluation of arterial stiffness and cardiovascular risk. The present article briefly summarizes the technical and methodological aspects of the technique and the potential interest in the rationale, pathophysiological management of ICU patients, with special focus on the links between pulse pressure and stroke volume.

Évolution chirurgicale de la myélopathie thoracique secondaire à l'ossification des ligaments jaunes

Calcification of the cervical ligamentum flavum is a rare entity observed exclusively in Japanese people. We report a new case in a 65-year-old man from Tunisia who presented with symptoms of cervical myelopathy with mild tetra paresis, sensory abnormalities and dysuria. Magnetic resonance imaging (MRI) showed a posterior compression of the spinal cord at C3-C4. CT-scan showed a calcification of the ligamentum flavum at level C3-C4, compressing the left postero-lateral aspect of the spinal cord. C3-C4 laminectomy was performed with removal of abnormal ligamentum flavum tissue. The postoperative course was uneventful and all symptoms resolved.Calcification of the cervical ligamentum flavum is a rare entity; the diagnosis is easy but the pathogenesis remains unclear. Literature regarding this pathology is reviewed.

Démarche d’assurance qualité en chirurgie ambulatoire de la main

Postoperative rehabilitation is a multidisciplinary program that requires participation of anesthetists and surgeons. The development of laparoscopic surgery is one of the components of this program. Rehabilitation requires effective analgesia avoiding the administration of too much opiate because of their side effect on the digestive tract. Postoperative-epidural analgesia with local anesthetics significantly shortens postoperative ileus, but intravenous infusion of lidocaine should have the same effect. The main objectives are reduction in postoperative morbidity and shortening of hospital stay.

Traumatisme de l’aorte thoracique par broche

penetrating ulcer of the aorta is a rare ulcerating atherosclerotic lesion of the aortic wall. two new cases are reported.

Surveillance during the postoperative period

The accurate assessment and monitoring of arterial pressure is a key issue in the ICU. Arterial tonometry (applanation tonometry) is increasingly used in the cardiovascular field to noninvasively estimate pressure at the radial artery and carotid artery level and to reconstruct central aortic pressure. This allows the quantification of left ventricular afterload and may improve the evaluation of arterial stiffness and cardiovascular risk. The present article briefly summarizes the technical and methodological aspects of the technique and the potential interest in the rationale, pathophysiological management of ICU patients, with special focus on the links between pulse pressure and stroke volume.

Relation entre le taux de 1,25-dihydroxycholécalciférol et le pronostic fonctionnel après une fracture de hanche chez les personnes âgées

The present treatment of a fracture must allow an anatomical consolidation and an ad integrum functional recuperation. An osteosynthesis giving immediate stability allows for an early rehabilitation, articular and muscular. However, it modifies the biological and mechanical conditions of the spontaneous bony consolidation and determines limits to the physiotherapy according to the type of the fracture, the type of the osteosynthesis and the degree of evolution. A poor osteosynthesis and/or a maladjusted rehabilitation exposes a pathological consolidation.

Cervical esophagostomy

• TOTAL HIP ARTHROPLASTY PROCEDURES relieve patients' arthritic hip pain. Since the first procedure was performed in the 1960s, surgeons and implant companies have worked to improve prosthesis design, composition of implants, and the mechanisms for holding the implants in place.• RECENTLY, SURGEONS HAVE FOCUSED on minimizing the surgical incision. Smaller incisions have resulted in smaller scars and faster recoveries.• THIS ARTICLE PRESENTS a brief historical overview of, as well as current trends in, minimally invasive total hip arthroplasty. All aspects of care for a patient undergoing total hip arthroplasty are discussed. AORNJ 79 (June 2004) 1244–1258.

Faut-il modifier ou optimiser le traitement préopératoire ?

Mild therapeutic hypothermia (32–34 °C) has been recently introduced into the international guidelines of cardiac arrest management, considering that the patient survival without neurological sequellae for out-of-hospital cardiac arrests following ventricular fibrillation has been improved with induced and controlled hypothermia. The benefit of therapeutic hypothermia is largely related to its neuroprotective effects. However, several issues remain unsolved to date. Consistently, the therapeutic window for applying hypothermia and the exact mechanism of the hypothermia effects on the ischemia-reperfusion syndrome and the cerebral anoxia are only partially understood. Furthermore, this efficient treatment is associated with some side effects that could counterbalance its benefits. Although recommended by all international committees, the exact implementation modalities of hypothermia still remain to be clarified, including the patient-to-treat selection criteria, the most efficient cooling and rewarming devices, the cooling duration and depth, the optimal temperature monitoring, and the usefulness of the associated treatments. Beneficial or deleterious extraneurological hypothermia effects, mainly regarding the cardiovascular and the respiratory systems, have also not been yet completely elucidated. Taking into accounts its risk-benefit balance and treating its potential complications should enhance hypothermia benefits. Only a better understanding of its precise effects and its optimal implementation modalities would be helpful in order to improve the final cardiac arrest prognosis.

More CME — is this for me?

Continuing medical education (CME) increasingly focuses on measurable patient outcomes. Nevertheless, international data on this issue are insufficient, and in Germany the measurable effects of CME in terms of its efficacy and utility for patient care have hardly been subjected to scientific examination. Advanced medical education as a continuation of university education is always based on scientific standards and research-oriented learning. Advanced medical training in Germany therefore requires the implementation of a kind of learning and teaching research that should be geared toward individual training needs, personal motivation and the outcomes of medical care. In addition, the definition of educational goals and the advancement of CME in terms of continuing professional development (CPD) should be considered an important component for a re-evaluation of CME.