RESUMEN
Objectif: Depuis l'avenement de la chirurgie minimale invasive; la voie laparoscopique devient la reference pour le traitement chirurgical des pathologies renales. L'objectif de ce travail est d'analyser les complications de la nephrectomie laparoscopique. Patients et methodes: Les nephrectomies laparoscopiques realisees en 10 ans (1996 - 2005) ont ete revues. Les caracteres demographiques; les incidents per-operatoires et les complications post-operatoires ont ete etudies. Resultats: Il y avait 181 patients operes dont 83 nephrectomies radicales; 80 nephrectomies simples et 18 nephro-ureterectomies. L'age moyen est de 59 ans. Des antecedents de chirurgie et/ou de radiotherapie etaient observes chez 103 patients (56;91). Chez 25 patients (13;81); on notait au moins une complication. Une conversion etait necessaire chez 6 patients (3;31) avec 4 plaies vasculaires et 2 difficultes de dissection. Dans 10 cas (5;52); les complications etaient majeures (8 cas de saignements; 1 cas d'odeme aigu des poumons; 1 cas de fistule digestive) avec 2 deces. Chez 15 patients (8;29); elles etaient mineures avec 9 cas d'hematome; 3 cas d'infection parietale; 2 cas d'emphyseme sous cutanee et 1 cas d'eventration lombaire. Conclusion: Le taux global de complications est de 13;81. Il semblerait que l'existence de facteurs de risque associes (age avance; tares; antecedents chirurgicaux ou irradiation) augmente le taux de complication. Le profil de ces patients est un des elements a prendre en compte pour prevoir et prevenir ces complications
Asunto(s)
Neoplasias Renales , Nefrectomía/complicaciones , Complicaciones PosoperatoriasRESUMEN
INTRODUCTION: Psychiatric adverse effects of fluoroquinolones are known for long, but can sometimes be missed. We analyse cases spontaneously reported to the French pharmacovigilance. METHODS: Cases of psychiatric adverse effects with fluoroquinolones reported to the French pharmacovigilance system were analysed. The studied period was from January 1985 and June 2002. Data analysed included age, sex, adverse effect, fluoroquinolone, seriousness and evolution. RESULTS: Five hundred ninety cases have been reported concerning 273 males and 316 females (sex unknown in 1 case). Mean age was 66 years (median: 70, range: 12-102). The most frequently reported psychiatric adverse effects were confusion (51%), hallucinations (27%), agitation (13%), delusion (12%), insomnia (8%), somnolence (4%) (several adverse effects could be associated in a single patient). Serious cases represented 21.7% (resulting in hospitalisation in most cases). Evolution was favourable in most cases (88.5%), and was unknown in 9.5% of cases. CONCLUSION: The number of cases reported during this period is moderate, but under-reporting probably interferes. The eventuality of this kind of adverse effect with fluoroquinolones should be kept in mind. Dose should be adjusted to renal function, especially in older patients.