Involvement of the cerebellum in EMDR efficiency: a metabolic connectivity PET study in PTSD

BACKGROUND

We recently reported an improvement of precuneus PET metabolism after EMDR therapy in military participants suffering from PTSD.

OBJECTIVE

The aim of the present study was to investigate the metabolic changes of precuneus connectivity in these participants after such treatment.

METHOD

Fifteen participants with PTSD performed a brain 18F-FDG-PET sensitized by virtual reality exposure to war scenes, before and after EMDR treatment. Inter-regional correlation analysis was performed to study metabolic changes of precuneus connectivity through SPMT maps at whole-brain level (p < 0.005 for the voxel, p < 0.05 for the cluster).

RESULTS

A decrease of connectivity was observed after EMDR between the precuneus and two significant bilateral clusters of the cerebellum (bilateral Crus I and VI cerebellar lobules, Tmax voxel of 5.8 and 5.3, and cluster size of 343 and 314 voxels, respectively). Moreover, higher cerebellar metabolism before treatment was associated with reduced clinical PTSD scores after EMDR (p = 0.03).

CONCLUSIONS

The posterior cerebellum and its metabolic connectivity with the precuneus are involved in the clinical efficiency of EMDR in PTSD.

Growth, morphology and electronic properties of epitaxial graphene on vicinal Ir(332) surface

Superlattice induced minigaps in graphene band structure due to underlying one-dimensional nanostructuration has been demonstrated. A superperiodic potential can be introduced in graphene if the substrate is periodically structured. The successful preparation of a periodically nanostructured substrate in large scale can be obtained by carefully studying the electronic structure with a spatial averaging technique such as high-energy resolution photoemission. In this work, we present two different growth methods such as temperature programmed growth (TPG) and chemical vapor deposition (CVD) studied by scanning tunnelling microscopy (STM) and low energy electron diffraction (LEED). In both methods, we show that the original steps of Ir(332) have modified with (111) terraces and step bunching after graphene growth. Graphene grows continuously over the terrace and the step bunching areas. We observe that while TPG growth does not give rise to a well-defined surface periodicity required for opening a bandgap, the CVD growth does. By combining with angle-resolved photoemission spectroscopy (ARPES) measurements, we correlate the obtained spatial periodicity to observed band gap opening in graphene.

Increase of precuneus metabolism correlates with reduction of PTSD symptoms after EMDR therapy in military veterans: an 18F-FDG PET study during virtual reality exposure to war

PURPOSE

The prevalence of posttraumatic stress disorder (PTSD) is higher among veterans, and can lead to disastrous consequences such as suicide. Eye movement desensitization and reprocessing (EMDR) is recommended in first-line psychotherapies for PTSD. Virtual reality exposure (VRE) coupled with 18F-FDG PET imaging can highlight the activated brain regions during stress exposure. The objective of this study is to identify, after EMDR therapy, the regions of brain metabolism that evolve during the stress exposure of a war scene with symptomatic remission in a group of military veterans suffering from PTSD, and to secondarily search for predictive metabolic features.

METHODS

We recruited 15 military veterans suffering from PTSD who performed an ¹⁸F-FDG PET sensitized by the exposure to a virtual war scene, before (T0) and after (T1) EMDR therapy. Statistical parametric mapping was used to compare brain metabolism before and after treatment and to study correlations between metabolism and evolution scores on PTSD clinical scales (PTSD Checklist Scale, PCLS; Clinician-Administered PTSD Scale, CAPS).

RESULTS

The metabolic activity of the precuneus was increased after EMDR therapy (p < 0.005 uncorrected, k > 180) and correlated with clinical improvement with the CAPS scale (r = -0.73 and p < 0.001). Moreover, the precuneus metabolic value before therapy predicted the clinical improvement on the PCLS scale (T1-T0) after EMDR (r = -0.667 and p < 0.006).

CONCLUSION

The clinical improvement in military patients with PTSD after EMDR is related to increased precuneus metabolism upon VR stress exposure.

Circulatory assistance by way of long-term cardiopulmonary bypass

From 1978 to 1986, 46 patients underwent prolonged circulatory support of 5-39 hours duration, at the Centre Chirurgical Marie Lannelongue. Indication for circulatory support was decided in the immediate postoperative stage, or later in patients with major, intractable heart failure, not responsive to standard resuscitative treatment. Patient details and equipment used are described, together with the details of monitoring. Outcome was favourable in 20 to 35% of cases, depending on the severity of the underlying cardiac pathology. Circulatory support by way of cardiopulmonary bypass (CPB) proved a readily feasible and reliable procedure. The method is an effective resuscitative technique, applicable in cases of reversible underlying pathology. In extreme cases, it may constitute an intermediate step before proceeding to cardiac transplantation or total circulatory support using a mechanical device such as an artificial heart.

[Ultrasonographic evaluation of the uterine cervix length remaining after LOOP-excision]

OBJECTIVES

To assess whether there is a correlation between the length of a conization specimen and the length of the cervix measured by vaginal ultrasonography after the operation

PATIENTS AND METHODS

Prospective observational study including patients less than 45 years with measurement of cervical length before and the day of the conization, and measuring the histological length of the specimen.

RESULTS

Among the 40 patients enrolled, the average ultrasound measurements before conization was 26.9 mm (± 4.9 mm) against 18.1mm (± 4.4mm) after conization with a mean difference of 8.8mm (± 2.4mm) (difference statistically significant P<.0001). The extent of histological specimen was 9 mm (± 2.2mm) on average. A correlation between ultrasound and histological measurements with a correlation coefficient R=0.85 was found statistically significant (P<0.0001). Moreover, the rate of cervix length remove by loop-excision in our series is 33% (± 8.5%).

DISCUSSION

A good correlation between the measurements of the specimen and the cervical ultrasound length before and after conization was found, as a significant reduction in cervical length after conization. The precise length of the specimen should be known in case of pregnancy and the prevention of prematurity due to conization rests on selected indications and efficient surgical technique.

[Are vaginal pap smear necessary after total hysterectomy for CIN3?]

The practice of vaginal smears after total hysterectomy should be discussed according to the indication for hysterectomy. We have thus performed a literature review using PubMed medical database with selection of articles presenting a practical interest for clinicians. The practice of vaginal smears after endometrial cancer can be abandoned, but in case of cervical cancer it improves the performance of clinical examination in the early follow-up (in the first 5 years of follow-up) especially in early diagnosis of subclinical recurrence. After this period, the interest of vaginal smears drop drastically and the follow-up is mainly clinical. When hysterectomy is proposed as part of cervical intraepithelial neoplasia (particularly when associated uterine lesions and cervical conization not accessible), the risk of vaginal recurrence of HPV-induced pathology fully justifies an annual monitoring (recurrences or virus-induced lesions are seen up to 25 years after surgery). Finally, after hysterectomy for benign uterine non-HPV-induced, there is no need to propose a systematic follow-up cytology.

[Pleomorphic lobular intraepithelial neoplasia: clinical, histological and prognostic study of nine cases]

INTRODUCTION

Retrospective clinical, histological and prognostic study of nine cases of lobular intraepithelial neoplasia in its pleomorphic subtype (LIN-P).

PATIENTS AND METHODS

Analysis of our center database with selection of nine cases of LIN-P from 140 files of patients who underwent surgical excision with a final diagnosis of LIN (2000 to 2011). The medical files were reviewed with a re-analysis of the mammograms and the histological slides. The outcome of the patients was also analyzed according to their clinical and operative data.

RESULTS AND DISCUSSION

The average age at diagnosis was 63 years (later than common LIN [LIN-C]). All patients had mammograms classified ACR 4 and 5, mainly due to the presence of microcalcifications (seven cases) with a case of opacity associated with microcalcifications, and two other cases with only isolated opacities. The preoperative diagnosis of these lesions was difficult: five cases on nine core needle biopsies were reviewed and reclassified LIN-P after finding the presence of LIN-P on the surgical specimen. Associated invasive lesions were found in 55% of core needle biopsy and in 33% of cases of surgical resection specimen. The treatment included a wide surgical excision (five lumpectomies and four mastectomies with a patient who had two lumpectomies) with margins of more than 2mm: we noted a recurrence of LIN-P only in one case where margins were very close (1mm). The analysis of our cases confirms that LIN-P if they probably share the same origin as the LIN-C represent a particular form constituting a true precancerous condition warranting at least a wide surgical excision.

Review on Medusa®:a polymer-based sustained release technology for protein and peptide drugs

The polymer-based Medusa system (Flamel Technologies) has been designed for slow release of therapeutic proteins and peptides. The Medusa II consists of a poly L-glutamate backbone grafted with hydrophobic alpha-tocopherol molecules, creating a colloidal suspension of nanoparticles (10 - 50 nm) in water. The sustained drug release is based on reversible drug interactions with hydrophobic nanodomains within the nanoparticles. In vivo, it is suggested that the therapeutic protein is displaced by endogenous proteins present in physiological fluids, leading to a slow drug release. The peak concentration is dramatically decreased and the protein release substantially extended. The Medusa technology has been applied to subcutaneous injection for several therapeutic proteins, such as IL-2 and IFN-alpha(2b), in animal models (rats, dogs, monkeys) and clinical trials in renal cancer (IL-2) and hepatitis C (IFN-alpha(2b)) patients.

Suppression of the Moiré effect in sub-picosecond digital in-line holography

Digital in-line holography is widely used in flow studies where the 3D position, size and velocity of particles or fibers have to be known at a given time. When holograms are recorded by using a sub-picosecond laser the enlargement of the spectral distribution acts as a spatial low-pass filter over the intensity distribution of the diffraction pattern. This is not a disadvantage as regards to the spatial sampling. Indeed, the Moiré effect, due to the sub-sampling of the fringe pattern is naturally reduced. Experimental results are provided.

Application of the fractional Fourier transformation to digital holography recorded by an elliptical, astigmatic Gaussian beam

The authors have studied the diffraction pattern produced by a particle field illuminated by an elliptic and astigmatic Gaussian beam. They demonstrate that the bidimensional fractional Fourier transformation is a mathematically suitable tool to analyse the diffraction pattern generated not only by a collimated plane wave [J. Opt. Soc. Am A 19, 1537 (2002)], but also by an elliptic and astigmatic Gaussian beam when two different fractional orders are considered. Simulations and experimental results are presented.

Influence of Angiotensin-Converting Enzyme Polymorphism Gene, IGF-1, and Other Factors in the Response Rate of Hematocrit to Enalapril Treatment in Patients With Posttransplant Erythrocytosis

A significant relationship between hematocrit values and serum parameters such as the insulin like growth factor (IGF-1) and calcium was observed in patients with posttransplant erythrocytosis (PTE). Since angiotensin-converting enzyme inhibitors (ACEI) decrease hematocrit (Ht) levels in these patients, ACE genotype should play an important role. We designed this study to investigate whether ACE genotype or baseline concentrations of IGF-1, IGF-blood binding protein 3 (BP3), growth hormone (GH), or Ca influenced the response of Ht to ACEI treatment. Twenty-one kidney graft recipients with PTE were treated with enalapril (2.5 to 5 mg/d) for 1 year. IGF-1, BP3, GH, Ca, and Ht were determined before as well as 15, 30, 90, 180, and 365 days after enalapril treatment. ACE polymorphism was also determined. Enalapril treatment significantly decreased Ht levels. Only IGF-1 baseline levels showed a positive correlation to the decreased Ht (P < .025). ACE genotype as determined in 18 patients, showed no correlation with the response to enalapril. Patients with ACE genotype II showed a tendency to an earlier display of PTE. We conclude that low doses of enalapril decrease Ht levels in PTE patients; that PTE begins earlier in patients with II ACE genotype; and that only IGF-1 baseline levels influence the Ht decrease after treatment. These observations suggest that ACEI decrease the Ht via an inhibitory effect on IGF-1, which has a stimulary effect on erythropoiesis.

A universal method for determining intensive care unit bed requirements

OBJECTIVE

Most methods used to estimate ICU bed needs rely either on simple formulas that do not consider the actual needs of the population or on simulations that are too specific to be applicable to all hospitals. We sought to develop a universally applicable nonparametric method.

DESIGN AND SETTING

For each day, the number of immediate patient transfers to other ICUs because of a full unit and the number of patients treated in the ICU were collected. The number of beds needed was selected according to the minimization of both the mean and the variance of three parameters (accessibility, safety, and efficiency). This method was applied to the ICU of a general hospital. Robustness of the model was assessed using outliers.

MAIN RESULTS

During the 5-month study period, 215 ICU stays were collected. The method selected a ten-bed model whereas length-of-stay ratio and case-mix methods selected a twelve- and height-bed models respectively. An unusual increase in admission requests had no consequence on the bed number selected, indicating that the method was robust. None of the parameters were dependent on specific ICU characteristics, establishing that this method is applicable to any type of hospital ward.

CONCLUSION

Our model is reliable for determining the number of beds needed in any type of ICU and can be used by all ICU managers. The software is available.

[Testicular microlithiasis and cryptorchism: ultrasound analysis after orchidopexy]

OBJECTIVE

To evaluate the testicular ultrasound features and frequency of testicular microlithiasis in a population of patients operated several years before for cryptorchidism, in order to define a group at possible increased risk of testicular cancer.

MATERIAL AND METHODS

This was a retrospective study of 202 patients, 63 of whom were reviewed by ultrasound with a mean follow-up of 9 years 3 months (7 years 5 months to 11 years 7 months).

RESULTS

32% of operated testes were hypotrophic compared to the correctly descended side; their mean volume was 9.42 ml versus 11 ml for the nonoperated side. 14.3% of surgically descended testes presented an ultrasonographically heterogeneous parenchyma and microlithiasis were present in 9.52% of cases.

CONCLUSION

The association between microlithiasis and cryptorchidism is not an incidental finding. Apart from the relative hypotrophy of the testis, ultrasound also revealed, in our study, that the presence of microlithiasis is not an extremely rare finding. Annual ultrasound surveillance is therefore required due to the risk of malignant transformation of these microlithiases.

A multi-laboratory evaluation of cryopreserved monkey hepatocyte functions for use in pharmaco-toxicology

Ethical, economic and technical reasons hinder regular supply of freshly isolated hepatocytes from higher mammals such as monkey for preclinical evaluation of drugs. Hence, we aimed at developing optimal and reproducible protocols to cryopreserve and thaw parenchymal liver cells from this major toxicological species. Before the routine use of these protocols, we validated them through a multi-laboratory study. Dissociation of the whole animal liver resulted in obtaining 1-5 billion parenchymal cells with a viability of about 86%. An appropriate fraction (around 20%) of the freshly isolated cells was immediately set in primary culture and various hepato-specific tests were performed to examine their metabolic, biochemical and toxicological functions as well as their ultrastructural characteristics. The major part of the hepatocytes was frozen and their functionality checked using the same parameters after thawing. The characterization of fresh and thawed monkey hepatocytes demonstrated the maintenance of various hepato-specific functions. Indeed, cryopreserved hepatocytes were able to survive and to function in culture as well as their fresh counterparts. The ability for synthesis (proteins, ATP, GSH) and conjugation and secretion of biliary acids was preserved after deep freeze storage. A better stability of drug metabolizing activities than in rodent hepatocytes was observed in monkey. After thawing, Phase I and Phase II activities (cytochrome P450, ethoxycoumarin-O-deethylase, aldrin epoxidase, epoxide hydrolase, glutathione transferase, glutathione reductase and glutathione peroxidase) were well preserved. The metabolic patterns of several drugs were qualitatively and quantitatively similar before and after cryopreservation. Lastly, cytotoxicity tests suggested that the freezing/thawing steps did not change cell sensitivity to toxic compounds.

[Ethical aspects concerning nosocomial infections]

Ethical issues about nosocomial infections have to be considered in two fields: the daily practice and the doctors participation in the institutional or suprainstitutional committees, involved in various administrative, strategic or financial measures aiming at the control and the prevention of nosocomial infections. In daily practice the ethical rules are founded on the principles of individual good: regarding nosocomial infection the principle of non maleficence is the most relevant. Physicians, nurses or other health professional may have a part of responsibility in a nosocomial infection. However there are many impediments to their acknowledgement of their own moral responsibility. The most important impediments may be: a) the more and more collective approach of care in many hospitals wards; b) the fact that the consequences of a nosocomial infection in one patient can extend to patients in other structures and, thus, can remain ignored by those who are responsible for this infection; c) paradoxically enough, the high attention paid to the theoretical issues concerning nosocomial infection. It must be kept in mind, too, that the ethical issues concerning nosocomial infections include the necessity for providing the patients with adequate and truthful information about the risks of nosocomial infection, in every hospital or ward, and--if it happens--about the nosocomial nature of an infectious complication. There is also some concern about the fact that the various modalities of legal responsibility and indemnification for a nosocomial infection, that the law has already specified or could define in a near future, may have a negative influence on the capacity of many care providers to keep a feeling of their moral responsibility. In the official committees devoted to decide administrative, strategic or financial measures able to help scientific research and to induce better practice in the surveillance and the prevention of nosocomial infections, the ethical principles at use are not only those of good but also those of justice. The balance between these ethical principles is delicate, however, for doctors, the main concern should be to avoid any distortion of the debate which could result from their confusing use of the principles of good.

[Use of Glasgow coma scale by anesthesia and intensive care internists in brain injured patients]

OBJECTIVE

To evaluate the quality and reliability of the Glasgow coma scale (GCS) score when determined, in head trauma patients, by trainees in anaesthesiology.

STUDY DESIGN

Prospective survey. USERS: One hundred trainees in their first to fourth year of training in anaesthesiology.

METHODOLOGY

A questionnaire completed by the trainees concerning: demographic data; place, time and qualification of the physician determining the first GCS score; time and qualification of the physician determining the subsequent GCS score; assessment of the GCS score in case of asymmetrical motor response, tracheal intubation, bilateral eyelid oedema, or circulatory or ventilatory failure.

RESULTS

Sixty questionnaires were available for analysis. Lack of compliance with the rules for the GCS score evaluation resulted in many errors by most of the trainees. Only a few of them determined an accurate GCS score in cases of asymmetric motor response or impossibility to determine verbal or ocular response. Finally, GCS scores were determined later only very rarely.

CONCLUSION

In order to provide optimal care and allow an accurate assessment of therapeutic efficiency, special attention should be given to the teaching of the GCS scoring method in head trauma patients.

Nosocomial Acinetobacter baumannii infections: microbiological and clinical epidemiology

BACKGROUND

Acinetobacter baumannii is an important opportunistic pathogen that is rapidly evolving toward multidrug resistance and is involved in various nosocomial infections that are often severe. It is difficult to prevent A. baumannii infection because A. baumannii is ubiquitous and the epidemiology of the infections it causes is complex.

OBJECTIVE

To study the epidemiology of A. baumannii infections and assess the relation between fluoroquinolone use and the persistence of multidrug-resistant clones.

DESIGN

Three case-control studies and a retrospective cohort study.

SETTING

A 20-bed medical and surgical intensive care unit.

PATIENTS

Acinetobacter baumannii was isolated from 45 patients in urine (31%), the lower respiratory tract (26.7%), wounds (17.8%), blood (11.1%), skin (6.7%), cerebrospinal fluid (4.4%), and sinus specimens (2.2%). One death was due to A. baumannii infection.

MEASUREMENTS

Antimicrobial resistance pattern and molecular typing were used to characterize isolates. The incidence of A. baumannii infection and the use of fluoroquinolones were calculated annually.

RESULTS

Initially, 28 patients developed A. baumannii infection. Eleven isolates had the same antimicrobial susceptibility profile, genotypic profile, or both (epidemic cases), and 17 were heterogeneous (endemic cases). A surgical procedure done in an emergency operating room was the main risk factor for epidemic cases, whereas previous receipt of a fluoroquinolone was the only risk factor for endemic cases. The opening of a new operating room combined with the restriction of fluoroquinolone use contributed to a transitory reduction in the incidence of infection. When a third epidemiologic study was done, previous receipt of a fluoroquinolone was again an independent risk factor and a parallel was seen between the amount of intravenous fluoroquinolones prescribed and the incidence of endemic infection.

CONCLUSION

Epidemic infections coexisted with endemic infections favored by the selection pressure of intravenous fluoroquinolones.

[Hemodynamic changes induced by apnea test in patients with brain death]

OBJECTIVE

In France, an apnoea test is compulsory to confirm brain death. This test results in a major hypercarbia and respiratory acidosis. This study aimed to assess haemodynamic changes elicited by the apnoea test.

STUDY DESIGN

Prospective clinical study.

PATIENTS

Fifteen patients with brain death

METHODS

Before the apnoea test, the lungs were ventilated with pure oxygen for 20 minutes. Thereafter, the test was conducted with continuous oxygen flow through the endotracheal tube, and SpO2 monitoring. Blood gases and haemodynamic parameters, including systemic arterial pressure, pulmonary artery pressure, pulmonary artery occlusion pressure, cardiac index and right ventricular function parameters were assessed before, during and 20 minutes after the apnoea test. Mean values at the various times were compared.

RESULTS

Hypercarbia and acidosis induced a major pulmonary hypertension and an increase in cardiac output, associated with a decrease in systemic vascular resistances. Despite pulmonary hypertension and acidosis, right ventricular function was maintained. All haemodynamic modifications were reversed by reventilation.

CONCLUSION

Apnoea test induces a reversible pulmonary hypertension that is seemingly not deleterious for right ventricular function. Apnoea test probably does not alter viability of the donor's organs.

[Laparoscopic surgical treatment of simple cysts of the kidney]

OBJECTIVE

To demonstrate the efficacy of laparoscopic treatment of symptomatic renal cysts or cysts suspicious of malignancy.

MATERIAL AND METHODS

10 patients (mean age: 58 years) were operated by laparoscopy either for compressive or symptomatic cysts (7 cases), or for cysts suspicious of malignancy (3 cases). The mean cyst diameter was 7.8 cm. All patients were evaluated by preoperative CT scan. There were 8 Bosniak type I and 3 Bosniak type II cysts.

RESULTS

The procedure was performed via an intraperitoneal approach (8 cases) or via a retroperitoneal approach (2 cases). The mean operating time was 92 min and the mean hospital stay was 5.4 days. One patient was operated (conversion to lumbotomy) for uncontrolled haemorrhage of the base of the cyst. The 10 cysts were found to be benign histologically. All 10 patients are asymptomatic (mean follow-up: 8.3 months) with disappearance of the cyst on the follow-up CT scan.

CONCLUSION

Laparoscopic treatment of renal cysts is feasible and effective. However, this treatment must be reserved for Bosniak type I and II cysts, associated with a low risk of malignancy.

Non-selective effects of adenosine A1 receptor ligands on energy metabolism and macromolecular biosynthesis in cultured central neurons

To investigate the effects of adenosine A1 receptor activation on energy metabolism and RNA and protein biosynthesis in central neurons, cultured neurons from the rat forebrain were exposed for 1 hr to 72 hr to various concentrations (10 nM-100 microM) of the selective A1 receptor agonist 2-chloro-N6-cyclopentyladenosine (CCPA) or the A1 receptor antagonist 8-cyclopentyltheophylline (CPT). At all concentrations tested, the adenosinergic compounds did not affect cell viability within 72 hr of treatment, except for CPT, which reduced viability by 19.7% when used at the concentration of 100 microM. Energy metabolism was analysed by studying the specific uptake of 2-D-[3H]deoxyglucose ([3H]2DG). Rates of RNA and protein biosynthesis were assessed by the measurement of [3H]uridine and [3H]leucine incorporation, respectively. Neuronal [3H]2DG uptake was increased by 16% (P < 0.01) after 8 hr in the presence of 100 microM CCPA, whereas 100 microM CPT for 24 hr also increased [3H]2DG uptake (8%, P < 0.01). At these concentrations, both ligands inhibited [3H]uridine incorporation after a 3-hr treatment by 92% and 30%, respectively. CCPA never altered [3H]leucine incorporation when compared to controls, and CPT significantly inhibited protein synthesis only at 10-100 microM. Additional experiments to analyse the influence of A1 ligands on the transport of [3H]2DG, [3H]leucine and [3H]uridine suggested that CCPA and CPT, which interact functionally with adenosine receptors by regulating cyclic AMP production in this model, are able to alter energy metabolism and RNA synthesis in central neurons in a nonspecific manner by interacting with glucose and uridine transporters.

Replacement fluids in plasmapheresis: cross-over comparative study

OBJECTIVE

To compare the tolerance and the cost of three replacement fluids in plasmapheresis: albumin 4% alone, albumin 4% + dextran 40, or albumin 4% + hydroxyethylstarch 6%.

DESIGN

A one center randomized, cross-over, comparative study designed to explore the tolerance and the colloid oncotic pressure in patients undergoing plasmapheresis.

PATIENTS

225 plasmapheresis procedures were performed in 27 patients.

MEASUREMENTS AND RESULTS

Hemodynamic tolerance was good in the three treatment groups. Serum protein concentration after plasmapheresis was significantly lower in the albumin + hydroxyethylstarch group, followed by albumin + dextran 40, versus albumin alone. Colloid oncotic pressure before and after exchange was similar in the three groups.

CONCLUSIONS

The clinical use of 25-30% of hydroxyethylstarch 6% or dextran 40 with albumin 4% was clinically well tolerated and associated with a 12% decrease of the cost of substitution solutions.

Quality of life 6 months after intensive care: results of a prospective multicenter study using a generic health status scale and a satisfaction scale

OBJECTIVE

To assess the quality of life of intensive care survivors 6 months after discharge.

DESIGN

Multicenter prospective study.

SETTING

Medical-surgical intensive care units (ICUs) of four French university hospitals.

PATIENTS

Among the 589 patients admitted to the four ICUs between 1 January and 31 March 1989, 329 were investigated.

MEASUREMENTS AND RESULTS

A generic scale assessing health-related quality of life, the Nottingham Health Profile (NHP), a satisfaction scale, the Perceived Quality of Life scale (PQOL) and a questionnaire on professional status were sent by mail 6 months after discharge. Data concerning age, severity of acute illness (assessed by the Simplified Acute Physiology Score) and main diagnosis were recorded. A total of 223 questionnaires (67.8 %) were analysable. The professional status remained unchanged in 79.7% of the patients, despite a significant (p < 0.01) increase (15.3 vs 22.1%) in sick leave. Quality of life, assessed with NHP, was fair (50th percentile = 0.73 on a 0 to 1 scale), whereas satisfaction measured by PQOL was lower (50th percentile = 0.61). Both scales correlated well (z = 9.853; p = 0.0001) but with a large dispersion. The NHP scale showed a severe reduction in energy, sleep and emotional reactions, whereas social isolation, pain and physical handicap were infrequent. Family support was rated with the PQOL score as very good, whereas dissatisfaction concerning recreational and professional activities was expressed. Subsequent sick leave was associated with a poor quality of life (p < 0.05). Quality of life was mainly a function of the diagnosis, not of age and severity of illness: patients admitted for suicide attempt or chronic obstructive pulmonary disease fared poorly.

CONCLUSIONS

Quality of life measured with a health-related quality of life scale and a satisfaction scale 6 months after an ICU stay depended on the admission diagnosis. Different dimensions of quality of life were variably affected.

[Malaria in expatriates in Africa. 154 cases. Clinical problems and therapeutic difficulties]

OBJECTIVES

Malaria is a major health priority. The aim of this study was to describe clinical expression, laboratory findings and therapeutic aspects of Plasmodium falciparum malaria observed in a French military population stationed in Gabon.

PATIENTS AND METHODS

One hundred fifty-four cases of P. falciparum malaria were observed between July 1, 1994 and February 29, 1996. In 145 cases malarial fever predominated and in 9 others further complications occurred. Mean age of the patients was 23.7 years and mean delay to consultation was 30 hours. Seventy-two percent of the patients stated they took prophylaxis (chloroquine-proguanil) regularly.

RESULTS

Pain generally accompanied the episodes of fever. There were 21 atypical cases. Parasitemia was < 25000 HPM in 70% of the cases. Blood counts showed leukopenia, lymphopenia, and thombopenia. Plasma cholesterol was low and lactic acid dehydrogenase levels were elevated. Halofantrine was used for curative treatment (2 doses with a 7 day interval) in 145 cases. Intravenous quinine was used in 9 cases.

DISCUSSION

This series demonstrates the importance of malarial morbidity in French military men stationed in Africa and confirmed the performance of the acridine orange test. It also emphasized the importance of indirect laboratory findings for early diagnosis of malaria in foreigners living in Africa. A new dosage of halofantrine is proposed for the second injection due to cardiac toxicity.

Increase of cytochrome P-450 1A and glutathione transferase transcripts in cultured hepatocytes from dogs, monkeys, and humans after cryopreservation

The study was designed to investigate the effects of phenobarbital (PB), 3-methylcholanthrene (3-MC), and oltipraz (OPZ), a synthetic derivative of 1,2-dithiole-3-thione, on the levels of cytochrome P450 1A1/2 and gluthathione transferase (GST) mRNAs in both fresh and cryopreserved human, monkey, and dog hepatocytes in primary culture. GST alpha mRNAs were demonstrated in liver parenchymal cells from the three species: after 4 days of culture, their basal levels were decreased, but were strongly higher in PB- and OPZ-treated cells from the three species. In contrast 3-MC was mostly effective on human hepatocytes. The increased levels of GST alpha mRNAs in the presence of PB or OPZ were not observed in all cell populations. GST mu mRNAs, which were detected in both dog and monkey hepatocytes, were induced only in the presence of OPZ. GST pi mRNAs were expressed in dog hepatocytes but did not respond to any of the inducers. In all cases, similar effects were observed in fresh and thawed hepatocytes. Similarly, CYP1A1/2 transcripts were induced by 3-MC in both fresh and cryopreserved cells from the three species but also after OPZ treatment for monkey hepatocytes. These findings demonstrate that enzymes which play a major role in bioactivation/detoxication of xenobiotics remain expressed and inducible in hepatocytes from various species after cryopreservation and thawing.

Short-term impact of the European Consensus Conference on the use of selective decontamination of the digestive tract with antibiotics in ICU patients

Because it remained controversial, the use of selective digestive decontamination (SDD) in patients in the intensive care unit (ICU) was chosen as the topic of the first European Consensus Conference in Intensive Care Medicine (ECCICM) in December, 1991. The Consensus Bureau decided to assess the impact of this conference 2 years afterwards. For this purpose, a questionnaire was sent to the members of the European Society of Intensive Care Medicine, the Societé de Réanimation de Langue Française and the Societé Française d'Anesthesie et Réanimation before the conference. The recommendations following the conference discouraged the systematic use of SDD in ventilated patients and urged the monitoring of bacterial resistance and adapting antibiotics to epidemiology of the units. Two years after the conference, the same questionnaire was sent to those physicians who had responded to the first one. Eighteen percent used SDD for all ventilated patients and 17% remain users after 2 years. Among the occasional (32%) or continual (17%) users of SDD, the regimens used were mostly intravenous cefotaxime (60% of systemic antibiotics) and a topical combination of polymixin E, tobramycin, and amphotericin B (62% of overall topical combinations). The antibiotics used were unchanged after 2 years in almost all cases. In conclusion, the short-term impact of the Consensus Conference on SDD in ICU patients has been poor. This may be related to the continuing insufficiency of strong, definite data regarding the impact of this technique upon mortality and the theoretical risk of resistance to antibiotics, thus allowing physicians to stick to their policies until there is new evidence.

Hemodiafiltration in pentobarbital poisoning

We report the use of continuous venovenous hemodiafiltration (CVVHD) in a case of massive intentional ingestion of pentobarbital associated with severe coma and hypotension. Despite a poor hemodynamic state, toxic epuration (15% of drug ingested) was obtained. However, death occurred 7 hr after the end of treatment. This report suggests that CVVHD can be effective in the treatment of massive pentobarbital intoxication.

Adenosine physiology and pharmacology: how about A2 receptors?

Adenosine participates in the physiology of central and peripheral tissues through several subtypes of G-protein-coupled receptors. Positively linked to adenylate cyclase, A2 receptors have been subdivided into A2a and A2b sites on the basis of their molecular, biochemical and pharmacological properties. They exhibit selective distribution, and are implicated in the modulation of psychomotor activity, circulation, respiration, and metabolism. Recent data support the evidence that adenosine A2 receptor properties may prove useful in future drug development, and selective manipulation of receptor-associated biologic effects might be relevant in the treatment of various disorders, including psychiatric diseases, hypoxia/ischemia, inflammation or erythrocytosis.

In vitro evaluation of donor liver preservation fluids on human hepatocyte function

Successful liver transplantation depends on adequate preservation of cellular function. We therefore tested the effects of two currently used liver preservation fluids, Euro-Collins (EC) solution and University of Wisconsin (UW) solution, on the viability and some functional activities of hepatocytes isolated from human livers. Cells in primary culture were maintained under hypoxic (95% N2/5% CO2) and hypothermic (4 degrees C) conditions for 24 h, either in EC or UW solution. This treatment did not result in significant hepatocyte damage, as judged by phase contrast microscopy, intracellular LDH release, and the MTT mitochondrial test. However, neutral red uptake indicated that lysosomal functions were slightly affected (35% decrease) when compared to control conditions. At the end of the hypoxia/hypothermia period, hepatocyte monolayers were incubated at 37 degrees C under normoxic conditions for 24 h, in order to simulate the reperfusion of a transplanted liver. Three drugs--midazolam, diazepam, zidovudine--were used as diagnostic substrates to check the metabolic abilities of human hepatocytes replaced in normal conditions. Both phase I (hydroxylation, demethylation) and phase II (glucuronidation) metabolic reactions were affected by the hypoxia/hypothermia shock. Indeed, a 30%-50% decrease in these activities was observed as compared to values obtained in control hepatocytes. No difference could, however, be found at the cellular level regarding the solution used for cold storage. These results suggest that the superiority of UW over EC solution, already reported in clinical practice after transplantation of preserved human livers, was not due to a better preservation of the hepatocytes.

Analysis of glutamate receptors in primary cultured neurons from fetal rat forebrain

In order to further analyze the development of glutamatergic pathways in neuronal cells, the expression of excitatory amino acid receptors was studied in a model of neurons in primary culture by measuring the specific binding of L-[3H]glutamate under various incubation conditions in 8-day-old intact living neurons isolated from the embryonic rat forebrain, as well as in membrane preparations from these cultures and from newborn rat forebrain. In addition, the receptor responsiveness to glutamate was assessed by studying the uptake of tetraphenylphosphonium (TPP+) which reflects membrane polarization. In the presence of a potent inhibitor of glutamate uptake, the radioligand bound to a total number of sites of 36.7 pmol/mg protein in intact cells incubated in a Tris buffer containing Na+, Ca2+, and Cl-, with a Kd around 2 microM. In the absence of the above ions, [3H]glutamate specific binding diminished to 14.2 pmol/mg protein with a Kd-value of 550 nM. Under both of the above conditions, similar Kd were obtained in membranes isolated from cultures and from the newborn brain. However, Bmax-values were significantly lower in culture membranes than in intact cells or newborn membranes. Displacement studies showed that NMDA was the most potent compound to inhibit [3H]glutamate binding in membranes obtained from cultured neurons as well as from the newborn brain, whereas quisqualate, AMPA, kainate and trans-ACPD were equally effective.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparative metabolism of 3'-azido-3'-deoxythymidine in cultured hepatocytes from rats, dogs, monkeys, and humans

3'-Azido-3'-deoxythymidine (AZT), the main antiretroviral drug used against Human Immunodeficiency Virus, was approved by the Food and Drug Administration in 1987 with only little knowledge concerning its metabolism. The aim of our study was to evaluate the interspecies variability of AZT metabolism in primary cultures of hepatocytes, freshly isolated from rats, dogs, monkeys, and humans. Cultures were exposed to 10 or 100 microM [3H]AZT. Extracellular and intracellular compartments were analyzed using a HPLC method. Intracellular and extracellular metabolic patterns were qualitatively similar, but very low amounts of AZT and metabolites were detected within hepatocytes. In all species, the 3'-azido-3'-deoxy-5'-O-beta-D-glucopyranuronosylthymidine (GAZT) was identified as the major metabolite of AZT. In addition to this glucuronide, two minor peaks were detected: one coeluting with 3'-amino-3'-deoxythymidine(AMT); and the other with a retention time corresponding, on the basis of the publications in this field, to 3'-amino-3'-deoxythymidine glucuronide. However, further investigation allowed this compound to be characterized as tritiated water, possibly representing a catabolic endproduct of AZT. Although glucuronidation was the main metabolic pathway in the four species studied, AZT biotransformation rate was much lower in rat and dog hepatocytes than in monkey and human ones. Finally, an excellent correlation was obtained between in vivo and in vitro metabolic data.

Increased plasma levels of human interleukin for DA1.a cells/leukemia inhibitory factor in sepsis correlate with shock and poor prognosis

Animal study results have suggested a role in sepsis for human interleukin for DA1.a cells/leukemia inhibitory factor (HILDA/LIF). HILDA/LIF and interleukin-6 (IL-6) levels were prospectively studied by serial ELISAs in 34 septic patients. HILDA/LIF was detected in 11 of 34 patients at plasma levels of 100-37,000 pg/mL. Peak HILDA/LIF levels correlated with increased temperature and creatinine and IL-6 and with decreased arterial CO2 (P < .05). Multivariate analysis showed that shock and decreased arterial CO2 accounted for 75% of peak HILDA/LIF plasma variations (R2 = .753). Fatal outcome was most often associated with detectable HILDA/LIF (> 56 pg/mL) and peak IL-6 plasma levels > 850 pg/mL (sensitivity, 83%; specificity, 87%), but both (at respective levels of > 480 and > 850 pg/mL) were associated with fatal outcome. HILDA/LIF was detected in septic patients exhibiting shock, and its levels correlated with higher mortality and shorter survival.