M. Cottrel’s scientific contributions

Background Postoperative pain after breast cancer surgery is usually short and moderate, but as a risk factor for chronic pain, it should be a critical target. Moreover, it is crucial for these patients during this early stage of their treatment not to step into a vicious circle of deconditioning, fatigue and chronic pain. Therefore, fast rehabilitation methods should be promoted. Partial mastectomy with sentinel lymph node dissection can be performed under general anesthesia or paravertebral block, either alone or associated with sedation or general anesthesia. Paravertebral blockade provides an efficient analgesia, allowing a reduction of morphine consumption and postoperative nausea and vomiting, has been showed to prevent chronic pain and may reduce the risk of recurrence or metastasis. It is a long-known regional anesthetic technique, but has been more commonly used recently for thoracic surgery, including breast surgery, since generalization of ultra-sound guidance brought security and reliability to the procedure. However, a sedation is often necessary to reduce anxiety, which can be high in this type of surgery. Hypnosis is an excellent alternative to sedation and general anesthesia. It improves patient comfort and reduces anxiety, without impending surgical quality. Therefore hypnosis and paravertebral block are an interesting association for the perioperative management of breast cancer patients. We propose to study the efficacy of associated paravertebral block and hypnosis, compared to general anesthesia, on acute pain. The results of this pilot study will ground a future randomized trial on the subject. Trial design This is a pilot, non-interventional, observational, prospective study. Patients will receive either remifentanil for general anesthesia, or a paravertebral block with hypnosis. A hypnotic trance will be maintained until the end of surgery, and a small dose of remifentanil (0,025 μg.Kg-1.min-1) and/or a supplementary local anesthesia can be administered in case of discomfort during surgery. Should this discomfort persist, general anesthesia can be induced. Postoperative analgesia includes level I and II analgesics, with morphine in case of severe pain. Eligibility criteria Patients with primitive breast cancer scheduled for elective partial mastectomy with sentinel lymph node dissection. Specific aims The objective is to demonstrate the superiority of paravertebral block with hypnosis, compared to general anesthesia with opioid analgesia, in the postoperative acute pain management. Primary endpoint will be pain intensity on a numeric rating scale 24 hours after surgery. Secondary endpoints include pain intensity 1, 6 hours and 3 months after surgery, morphine consumption, nausea and vomiting, patient comfort and satisfaction on a 0 to 10 scale. Additionnally, an analysis of surgical oncologic criteria is aimed to prove that there is no significant difference in the margin status between these two groups. Statistical methods For quantitative variables, T Student test or Mann Whitney test will be used as appropriate. Fisher's exact test will be used for categorical data. Accrual Accrual as for June 11, 2013 is 7 patients. Target accrual is 40 patients. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr OT2-2-02.

Des complications infectieuses graves peuvent survenir après une intervention chirurgicale malgré une antibioprophylaxie adaptée. Nous rapportons le cas d’une méningite à Escherichia Coli après ponction biopsie de prostate. La conjonction de plusieurs facteurs a pu conduire à la survenue de cette complication rare tels que la résistance du germe aux fluoroquinolones, et/ou la capacité de la bactérie à traverser la barrière hématoméningée. Une susceptibilité du patient aux infections graves n’a pas été mise en évidence.

Serious infectious complications may appear after a surgical procedure despite antimicrobial prophylaxis. We report a case of Escherichia Coli meningitis after a prostate puncture biopsy. Many factors may have contributed to this rare complication such as fluoroquinolone resistance, and/or the bacterium's ability to cross the brain blood barrier. The patient was not found susceptible to severe infections.

Intoxications with sodium channel-blocking agents are an important cause of morbidity and mortality due to refractory cardiotoxicity. While treatments are mainly supportive, successful use of intravenous fat emulsions has been reported in several cases. Ion channels including sodium and calcium channels play a major role in generating and conducting action potentials that initiate myocardial contraction. Sodium channel blockade therefore explains arrhythmias and myocardial depression in overdoses. In animal studies, Intralipid® was shown to be beneficial on hemodynamic recovery and survival after cardiovascular collapse caused by local anaesthetics as well as other membrane stabilising agents (clomipramine and propanolol). Although the exact mechanism of lipid rescue is still unknown, several hypotheses have been suggested: “lipid sink” removing the lipophilic drug from tissues into a lipid phase, metabolic benefit on myocardial ATP synthesis or direct effect of free fatty acids on ion channels, especially calcium channels. In clinical practice, based on human cases and experimental reports since no randomised study is available, lipid emulsions should be considered as a complement of conventional cardiovascular support, given its reported safety.