Annales françaises d'anesthèsie et de rèanimation
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Ann Fr Anesth Reanim · Jan 1984
[Urinary excretion of creatinine and 3-methylhistidine in multiply injured patients].
The daily urinary excretion of 3,methylhistidine (3,MeHis) was measured in eight severely injured patients for periods of at least two weeks to at most one month after the trauma. The patients were fed with 0.20 +/- 0.05 g X kg-1 X 24 h-1 of nitrogen and 25 +/- 5 kcal X kg-1 X 24 h-1 given as glucose. The pattern of 3,MeHis and creatinine excretion as well as the weight loss suggested the following: 1) the muscle protein breakdown in these patients was approximately twice the normal value (the mean 3,MeHis excretions were respectively 7.98, 7.21, 6.26 and 5.14 mumol X kg-1 X 24 h-1 for the four week study period, compared with the normal value of 3.73); 2) the creatinine excretion decreased slowly. ⋯ Various factors could be responsible for increasing and extending the muscle protein catabolism: the importance of muscle damage, the metabolic response to neurotrauma, sepsis and prolonged immobilization. In these conditions, it would seem useless and even harmful to try, at all costs, to obtain a positive nitrogen balance. The authors suggest therefore an average intake of 0.2 g X kg-1 X 24 h-1 of nitrogen, which should be sufficient to meet the requirements for protein synthesis.
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Ann Fr Anesth Reanim · Jan 1984
Case Reports[Pneumomediastinum and subcutaneous emphysema after translaryngeal jet ventilation].
The use of emergency transtracheal jet ventilation in a 62 year-old female with laryngeal papillomatosis and respiratory distress is reported. Adequate ventilation of the lungs with an intermittent jet of oxygen under high pressure (5 bar) allowed anaesthesia and surgery to be carried out. Pathogenesis of the mediastinal and subcutaneous emphysema discovered at the end of the procedure is discussed.
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Ann Fr Anesth Reanim · Jan 1984
Case Reports[Pourfour Du Petit syndrome following brachial plexus block].
While Horner's syndrome resulted from a paralysis of the cervical sympathetic outflow, its opposite, Pourfour Du Petit's syndrome, was caused by the irritation of these nerves. The case described occurred after brachial plexus block.
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A severe case of boutonneuse fever was reported which was only diagnosed after death. The infectious syndrome and cutaneous eruption were associated with meningitis, encephalitis, hypoxaemia and thrombocytopaenia. ⋯ Serious cases of boutonneuse fever were usually rare; they were better known as Rocky Mountain spotted fever, a rickettsial infection of the same group, the clinical symptoms of which were very similar and which gave the same proteus agglutination reactions as with boutonneuse fever. An earlier diagnosis, now possible thanks to immunofluorescent techniques using skin biopsies, should enable earlier treatment.