[Which graft for which patient? and when? III. Organization schema of organ procurement and graft coordination]

Organ and tissue procurement strongly increased during the past decades to become a common activity among accredited hospitals. Structuring efficient regional organ procurement organisations appear as an important goal in order to offer the relevant number and quality of transplants to the patients on the national waiting list maintained by the Etablissement français des Greffes. Two structures acting together coordinate organ and tissue procurement: (i)accredited hospitals allocate some medical and non medical personal interfacing; (ii) the Etablissement français des Greffes through one of its seven regional units or its national unit. These units are in charge with the operational responsibility of multiorgan and tissue retrieval co-ordination in their geographical area, with organ allocation and with an institutional role of local and regional organ procurement development and promotion.

[Intravascular volume expansion and intravenous nimodipine in the treatment of cerebral vasospasm after surgical treatment of intracranial aneurysm]

The advantage of calcium antagonist on cerebral arterial spasm during the peri-operative period has been recently demonstrated. However, the role of volemia and cardiac output in the pathogenesis of arterial spasm seems predominant. The basal hemodynamic profile of 17 patients operated for an intracranial aneurysm was investigated. The hemodynamic and neurological modifications induced by treatment with nimodipine, modification of blood volume and the use of inotropic drug was subsequently analysed. In 8 patients there was a clearcut hypovolemia with diminished cardiac index whereas in 9 other patients there were low filling pressures with an unmodified cardiac index. As early as the 48th hour of treatment, there was an improvement of Hunt and Hess score in 12 patients whereas in 5 others the score remained unchanged. Two death occurred due to the extension of secondary ischemic lesions. This study seems to confirm the aggravating role of hypovolemia in the occurrence of vasospasm and the neurological improvement due to the association of a calcium antagonist, restoration of blood volume with or without a vasoconstrictor.

[Management of meningeal hemorrhage for angiographic evaluation]

Perfect immobilization of the patient is mandatory when performing cerebral angiography. It allows good analysis and diagnosis of arterial or arterio-venous malformations. Neuroleptanalgesia or general anesthesia are currently used. Most common complications are due, either to induced arterial hypertension or to arterial catheterism (vasospasm or embolism). Early diagnosis and adequate treatment are necessary.

[Natural history and current surgical prognosis of intracranial arterial aneurysms]

The abrupt flow of blood in the meninges or in the brain after fissure or rupture of an arterial aneurysm still remains a medico-surgical emergency which includes the mobilisation of important technical and financial means which justifies itself by the reduction of the occurrence of a more severe accident and to give the patient its best chances. The cure of a cerebral aneurysm and its intracranial consequences must not be dissociated from its clinical context. Surgical indication must take into account the cause of the vascular lesion, the background on which it has evoked, its natural outcome which is characterised by rebleeding and vasospasm. Surgical cure of intracranial aneurysm is one of the great achievement of modern surgery. A better understanding of the malformation, the improvement of neuro-anesthesia and intensive care, and the use of pre-operatoire adjuvants have considerably improved the surgical results over the years. At the moment, alternative treatment start to emerge such as selective vascular catheterism with ejectable balloon which become more feasible and seductive.

[Interaction of nimodipine and isoflurane in surgery of intracranial aneurysm]

A moderate controlled hypotension has been performed with isoflurane in the presence of nimodipine (4 mg.h-1) on ten patients anesthetized for cerebral aneurysm clipping. The administration of both drugs induced a dose-dependent hypotension secondary to the reduction of the systemic vascular resistance without impairment of cardiac index. Nimodipine did not modify the cardiovascular effects of isoflurane. It is concluded that intravenous administration of nimodipine should be continued during the operative period.

[Bronchial diffusion of ceftriaxone]

The value of a single daily injection of 2 g ceftriaxone in lower respiratory tract superinfections was demonstrated in 22 patients in a neurosurgical intensive care unit. Catheter bronchial samples were submitted to bacteriological investigation and ceftriaxone concentrations were determined in serum and bronchial secretions. Results show that sustained efficient levels of ceftriaxone were achieved and enabled the successful treatment of lower respiratory tract infections due to susceptible pathogens.

[Results of microneurosurgical treatment of 300 intracranial arterial aneurysms]

The authors present the results obtained with the current neurosurgical treatment in an homogeneous of 292 patients totalling 300 intracranial arterial aneurysms. The cure rate was 74% and the death rate 14%; poor results were obtained in 12% of the cases. Analyzed globally, the main prognostic factors were the patient's age and general condition, the site and mode of rupture of the aneurysm and the timing of surgery.