Acute necrotizing enterocolitis in adults. Analysis of a homogeneous series of 12 cases. Review of the literature]

A retrospective study of 12 cases of Acute Necrotic Enterocolitis in adults is realized. The role of disease association, the diversity of clinical aspects encountered and the diagnostic value of metabolic acidosis are emphasized. In spite of early and aggressive surgery combined with intensive assisted visceral reanimation, mortality is higher than 60 p. 100.     

Variations hémodynamiques induites par la laparotomie en chirurgie aorto-iliaque

A haemodynamic study was carried out on 53 patients undergoing elective surgery of the abdominal aorta in order to assess the haemodynamic changes consequent to abdominal manipulations prior to aortic clamping. Surgery was carried out under general anaesthesia and ventilation was controlled. The following parameters were monitored : mean arterial pressure (P̄a), cardiac index (CI), systolic index (SI), systemic vascular resistances (Rsa), pulmonary vascular resistances (Rpa), heart rate (f_C). Cutaneous circulation was monitored using a photoplethysmographic transducer. The following haemodynamic pattern was seen as the peritoneal cavity was opened and traction on the mesenter was applied : CI +40.7 %; f_C +28.61 %; SI +9.85 %; Rsa −39.16 %; Rpa −28.43 %; P̄a −15.7 %. The recording of the facial cutaneous photoplethysmographic wave showed an increase of 50 %. In some extreme cases, a state of cardiovascular collapse with marked cutaneous erythema strongly resembling anaphylactic shock ensued. The physiopathology of these cardiovascular reactions is unclear, but the haemodynamic pattern as well as the cutaneous vasodilation suggest a stimulation of both vagal and sympathetic nervous systems and the release of vasoactive substances into the general circulation.     

Digestive hemorrhage caused by seromuscular erosion of the wall of a section of the small intestine at the level of an aortic prosthesis implanted 5 years earlier

A new paraprosthetic enteric fistula case between the small bowel and the body of a Dacron aortobifemoral prosthesis is presented. That complication happened five years after the initial reconstruction and the fistula does not interest an anastomotic site. A process is rare (22 published cases); if symptomatology is often less important than complete fistulas, surgical therapy must be aggressive to be effective.     

Acute monoblastic leukaemia: Clinical,biological data and survival in 45 cases

Between 1978 and 1980, 45 cases of acute monoblastic leukaemia have been diagnosed, treated and followed in our institute. Morphological diagnosis was performed according to the French-American-British classification. Tumoral syndrome (particularly extra-medullary) and hyperleucocytosis were the most striking findings at the time of diagnosis. Cytogenetic analysis performed in 31 cases before treatment has showed that abnormality of the long arm of chromosome 11 seemed to be more frequently associated with the poorly differentiated cytological subtype M5 (a). Intensive chemotherapy with zorubicine and cytosine arabinoside led to complete remission in 75 % of the cases. Central nervous system prophylaxis appeared definitively useful in preventing meningeal relapse. Despite a prolongation of the median duration of complete remission which now reaches 12 months, the prognostic is still poor.     

Life and death decisions for incompetent patients: determining best interests--the Irish perspective

Aims: To determine whether healthcare providers apply the best interest principle equally to different resuscitation decisions. Methods: An anonymous questionnaire was distributed to consultants, trainees in neonatology, paediatrics, obstetrics and 4th medical students. It examined resuscitation scenarios of critically ill patients all needing immediate resuscitation. Outcomes were described including survival and potential long‐term sequelae. Respondents were asked whether they would intubate, whether resuscitation was in the patients best interest, would they accept surrogate refusal to initiate resuscitation and in what order they would resuscitate. Results: The response rate was 74%. The majority would wish resuscitation for all except the 80‐year‐old. It was in the best interest of the 2‐month‐old and the 7‐year‐old to be resuscitated compared to the remaining scenarios (p value <0.05 for each comparison). Approximately one quarter who believed it was in a patient best interests to be resuscitated would nonetheless accept the family refusing resuscitation. Medical students were statistically more likely to advocate resuscitation in each category. Conclusion: These results suggest resuscitation is not solely related to survival or long‐term outcome and the best interest principle is applied differently, more so at the beginning of life.