Annales de l'anesthésiologie française
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Starting from a collection of 67 cases of hanging taken over by the Anesthesia Resuscitation Department belonging to Reims Hospital University Centre, the authors report their clinical observations and make an analytical confrontation of this type of accident according to various criteria such as: - the initial physical condition of the victims; - the evolution of the symptoms; - the various medical treatments used. The immediate consequences of miscarried hangings lead to a physio-pathological argument dealing mainly with the neurological and breathing manifestations. The elements of this argument enable the writers to back up certain therapeutic orientations among which hyperbaric oxygen therapy and early prescription of which seems to be wished for in the most severe forms of hanging.
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The authors present 29 cases of post-operative respiratory complications in abdominal surgery in subjects without any past history of respiratory disorders. They stress the diagnostic value of these cases of acute respiratory failure shown in a third of the cases of surgical complications.
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Intra-thoracic gaseous collections, pneumodiastinum and pneumothorax, have become more common since the use of positive expiratory pressure, either with spontaneous ventilation or in association with artificial ventilation. In our experience, the occurence rate of such collections has increased from 7 p. 100 in 1970 to 19 p. 100 in 1974, related to the use of continuous positive pressure of long duration in the treatment of idiopathic respiratory distress or hyaline membrane disease. These gaseous collections were initially associated with a high mortality (50 p. 100) which is now practically nil. Improved knowledge of the clinical and radiological signs and the insertion of thoracic drains in the presence of the slightest doubt represent the explanation of this reduced mortality.
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Six cases of grave hypothermias are reported, having arisen during surgical interventions which necessitated a rapid and abundant transfusion of badly warmed blood. The role of favouring factors, surrounding cold due to the air-conditioning, anaesthesia, extent of the area of operation, seems important. ⋯ Accidents during the warming process associate collapse and disturbances in coagulation. It is therefore necessary to consider certain signs of alarm as important and generalize the conditions for prevention of thermolysis in the operating theatre.