Non-invasive continuous haemodynamic and PETCO2 monitoring during peroperative cardiac arrest

We describe a cardiac arrest which occurred during general anaesthesia in the prone position for surgical correction of lumbar kyphosis in a patient with Marfan's syndrome. Peroperative monitoring was routine with ECG, non-invasive arterial pressure, oximetry, PETCO2 and central venous pressure, plus aortic blood flow and and systolic time intervals via an oesophageal echo-Doppler device. Forty-five minutes after the start of surgery, a sudden decrease in aortic blood flow followed by a decrease in PETCO2 suggested acute cardiac failure despite continuation of the ECG signal. Initial CPR in the prone position produced a slight increase in PETCO2. When the patient was turned to the supine position and the legs elevated, chest compression was more efficient and spontaneous circulation was rapidly restored. Circulatory arrest could be explained by incompletely treated hypovolaemia, or by myocardial depression (decrease in aortic blood flow and lengthened pre-ejection period) combined with excessive hypotension in a patient with Marfan's syndrome, thus compromising coronary blood flow producing ST segment depression. Continuous non-invasive aortic blood flow and PETCO2 monitoring proved valuable in the early detection and treatment of circulatory arrest and in the evaluation of the efficiency of peroperative CPR.     

Rénal oxalic and gallbladder lithiasis after ileal resection for Crohn's disease: a report on one case (author's transl)

The authors report the association, in a 64-year old man with previous large ileal resection (110 cm) for Crohn's disease, of gallstone and oxalate renal stones. The oxaluria was 60 mg per day (normal, less than 25 mg) and the fecal fat excretion was 50 g per day (normal, less than 6 g). A low--oxalate and--fat diet for 3 months reduced dramatically the steatorrhea, but was totally ineffective for the reduction of hyperoxaluria. The physiopathological mechanisms and the therapeutic consequences of these metabolic complications of ileal resections are discussed.     

Corrosion intercristalline du nickel

The aim of our study is to investigate the influence of the grain size and of the surface state on the passivation-depassivation phenomenon, for nickel in normal sulphuric acid. Up to a value of 750 mV vs S.S.E., an instantaneous depassivation leads to an I(t) response which tends towards a stable value of the current, whatever the electrode structure and surface state might be. Corrosion is essentially of an intergranular type. For higher values of potential, electrode response during depassivation is quite different. Current intensity never tends towards a stable value whatever the grain size and the kind of polishing of the sample, this leads to different corrosion facets.     

Brugia pahangi: effects of protective resistance on lymphatic lesions and granulomatous inflammation in infected jirds (Meriones unguiculatus)

Effects of protective resistance on lymphatic lesions and granulomatous inflammation in infected jirds (Meriones unguiculatus). Experimental Parasitology 77, 395-404. The hypothesis that protective immune responses play a role in the induction of filarial-associated lymphatic lesions was tested in jirds immunized twice with 75 Brugia pahangi radiation-attenuated third-stage larvae. Lymphatic lesions and granulomatous reactivity were compared in immunized, infected, and naive jirds at both acute and chronic periods following challenge with 100 third-stage larvae. Challenge worm burdens were reduced in immunized jirds at both infection periods. The ratio of lymph thrombi to lymphatic worms, an indicator of lymphatic lesion severity, was significantly greater in immunized jirds than in nonimmunized-challenged jirds during acute but not chronic infections. Parasite-specific-granulomatous hypersensitivity was assessed by measurements of granuloma areas around B. pahangi-soluble adult worm antigen-coated sepharose beads embolized in the lungs prior to necropsy. Marked granulomatous inflammatory responses seen during the acute period in both immunized-challenged and nonimmunized-challenged jirds were significantly reduced in similar jirds during chronic periods. Jirds with existing B. pahangi infections were not resistant to homologous challenge infection and had fewer lymphatic lesions and reduced granulomatous inflammatory responses to soluble adult worm antigen compared to previously naive jirds at acute periods postchallenge. These data suggest that protective immune responses increase the severity of filariae-induced lymphatic inflammation. The subsequent modulation of these lesions is probably associated with parasites that survived the protective immune response.     

Cytofluorometric analysis of chondrotoxicity of fluoroquinolone antimicrobial agents

Betulinic acid [1] and platanic acid [2], isolated from the leaves of Syzigium claviforum, were found to be inhibitors of HIV replication in H9 lymphocyte cells. Evaluation of anti-HIV activity with eight derivatives of 1 revealed that dihydrobetulinic acid [3] was also a potent inhibitor of HIV replication. The C-3 hydroxy group and C-17 carboxylic acid group, as well as the C-19 substituents, contribute to enhanced anti-HIV activity. The inhibitory activity of these compounds against protein kinase C (PKC) was also examined, since a correlation between anti-HIV and anti-PKC activities has been suggested. However, there was no apparent correlation between anti-HIV activity and the inhibition of PKC among these compounds.     

Isolated congenital diverticulum of the left ventricle disclosed by ventricular tachycardia in a 72-year-old woman

A 72-year-old woman presented with poorly tolerated ventricular tachycardia reduced by intravenous amiodarone. The possibility of an ischaemic aetiology led us to perform coronary angiography. The coronary arteries were pathological. Left ventricular angiography revealed limited anterior hypokinesia and a large contractile apical pouch appended to the left ventricle by a long narrow neck. Despite the appearance suggestive of congenital left ventricular diverticulum (contractility, narrow neck) and because of the coexistence of ischaemic heart disease, we preferred to confirm the muscular nature of the diverticulum by myocardial thallium scintigraphy, which showed reversible decreased uptake in the anterior zone related to coronary artery disease, and confirmed the muscular nature of the diverticulum which showed normal thallium uptake. MRI clearly visualized the ventricular ectasia attached by a narrow neck to the rest the left ventricle. This long narrow neck indicated that this muscular diverticulum constituted a congenital diverticulum. The contribution of ultrasonography was limited by a poorly defined point during the examination. This congenital diverticulum, discover during adulthood, and previously asymptomatic, is a rare lesion, in the light of a review of the literature.     

Albumin-impregnated polyester vascular prosthesis for abdominal aortic surgery: an improvement?

AIM: To compare the peroperative blood loss and the postoperative systemic inflammatory reaction in patients receiving either a Vasculour II Albumin pre-impregnated prosthesis (VA group, n = 32) or a preclotted Vasculour II prosthesis (V group, n = 33) for elective surgery of the abdominal aorta. SETTING: University Hospital. DESIGN: Prospective, randomised study. METHODS: Peroperative blood loss was measured over two different periods: Phase I from the beginning of the operation to the completion of the proximal anastomosis, when blood loss cannot be related to the model of prosthesis implanted and phase II after the completion of the proximal anastomosis to the end of the operation. Postoperative blood loss was evaluated by the determination of the retroperitoneal drainage volume over a period of 2 days immediately following the operation. The presence of periprosthetic fluid was measured with echography at days 4, 9, 30 and 60. The postoperative systemic inflammatory reaction was evaluated by measuring the sedimentation rate and the C reactive protein levels daily from day 1 to day 9, and at days 14, 21, 28, 45, and 60, and by measuring the body temperature daily from day 1 to day 9. RESULTS: No significant differences of peroperative blood loss were observed. The same proportion of patients (35%) in both groups received homologous transfusion. The mean number of units of homologous blood transfused per patient was respectively 0.77 and 0.91 for the VA and the V group. The retroperitoneal drainage volume and the percentage of patients with periprosthetic fluid did not differ significantly. No significant differences in systemic postoperative inflammatory reaction were observed. CONCLUSION: There were no benefits in using albumin-impregnated prosthesis as opposed to preclotted prosthesis in terms of peroperative and postoperative blood loss, or by looking at the incidence of homologous blood transfusion. However, the glutaraldehyde cross-linked albumin did not induce any systemic inflammatory reaction.     

Feedback control and optimization for the production of commercial fuels by blending

This paper presents a control algorithm for blending systems. Such systems are used in refining to produce mixtures having specified properties from several components. The underlying control problem is multi-variable, with constraints on the inputs and outputs, and involves large uncertainties. To address this complexity, a constrained optimization problem is formulated, while the uncertainties are treated in closed-loop by an estimator of the components properties. Besides a theoretical study of the main algorithm and a study of convergence, the paper presents numerous technical details that are needed to solve blending problems as they appear in refining operations. Among them are a general lack of measurements, variable delays, measurement synchronization, infeasibilities management, hydraulic constraints, and pre-blends. Industrial case-studies are provided and stress the relevance of the approach.     

Design and Characterization of an Inhalation System of Iron and Manganese Oxide Nanoparticles for Rodent Exposure

Because of the rise of anthropogenic sources of NP human exposure to NP has dramatically increased in the recent years, in the general population as well as in workers (e.g., welders). This raises the question of the potential adverse effects of NP on human health, particularly at the respiratory level, since it represents the main route of exposure for air pollutants. Since inhalation exposure is the most relevant but yet under evaluated route of exposure for the evaluation of NP toxicity our study was aimed to design, build, and characterize a safe inhalation system dedicated to evaluate the respiratory effects of NP in mice. We chose to focus on the generation of iron (Fe) and manganese (Mn) oxide NP distributions centered on 20–25 nm diameters at concentrations of 10⁷–10⁸ NP/cm³ as it is representative of the occupational exposure of welders. Fe and Mn NP aerosols were generated with the spark discharge generator technique with air as a carrier gas conditio sine qua non for the mice. Indeed, the spark generator has been widely studied and used but in noble gases (N2, Ar,?.?.?.) suggests the absence of oxidation. Aerosol particles are characterized in terms of size distribution, concentration, morphology, and chemical composition. Exposure of mice for 1 to 4 days (3 h a day) to these occupationally relevant aerosol concentrations induces inflammatory effects (increased lung total protein content). Moreover, clusters of particles were observed throughout the lungs.

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