Morphometric characteristics of feminine eyebrows: variations with ethnicities and age

OBJECTIVE

To explore some morphological features of the eyebrows of women of different ethnicities and ages.

MATERIALS AND METHODS

Standard digital photographs of 3600 women of six ethnicities, aged 18-84 years, previously used to describe the morphology of the human eyes, allowed us to focus on their eyebrows, as supplementary and opportunistic study. Photographs of both eyebrows were analysed partly by manual markings and automatically by dedicated algorithms. Six parameters of the eyebrows were recorded: length, waviness/curvature, oblique aspect, size (vertical height), total surface and hair coverage (density).

RESULTS

Most criteria present ethnic specificities. These are: length (longer eyebrows of Indian, shorter among African women); waviness where the straighter eyebrows were found among Chinese and Japanese women. In general, the longer the eyebrows, the higher their waviness and vice versa. Thickness (or height) of the eyebrows presents a wide ethnic variability as well as hair coverage, where African women present the lower hair density, inversely to Indian women. The same holds true with regard to the total surface of eyebrows, of a large variability (by about four times). Some criteria appear more individually dependent than ethnic-specific, such as the oblique positioning, at the exception of Indian women with less oblique eyebrows. In all subjects, the criteria of both eyebrows (Left vs. Right) were found to be highly correlated (r > 0.7, P < 0.001).

CONCLUSION

The present investigation brings new findings on a scarcely studied facial element, the morphologic features of which are, for most, ethnic-dependent. As applied consequences, the results of the present work pave the road to better adapt adorning procedures of the eyebrows vis-à-vis ethnic and age specificities.

Mapping, in vivo, the uniformity of two skin properties alongside the human face by a 3D virtual approach

OBJECTIVE

To determine the homogeneity in the distribution of two cutaneous functions (hydration and elasticity) along the entire human face.

MATERIAL AND METHODS

The half faces (right or left, randomly chosen) of two groups of Caucasian women were measured on 24 different small sites (elasticity) and 41 others (hydration), by instruments of small-sized probes (Cutometer^® and Corneometer^® , respectively). Hydration of the face was recorded at different times (up to 24 h), post application of a highly hydrating product. The recorded values (left and right half faces) were further gathered and digitally positioned on a virtual feminine face and their intensity was illustrated through a colored white (lower values)-blue (higher values) scale.

RESULTS

The reconstitution of the mapping of the two measured parameters (from the left and right sides of different subjects), shows a perfect symmetry vis à vis the nose axis. However, both parameters present slightly variable but significant values along the human face. Sites from the temple are less elastic than chin or forehead. The upper and lower parts of the forehead show slight disparities in their elasticity values. Cheeks are significantly less prone at retaining their imparted hydration status (lost 2 h after application of a hydrating product) as compared to sub-ocular regions or chin that retain their hydration up to 24 h. Attempts to establish a mutual relationship between the two skin properties unsurprisingly failed.

CONCLUSION

The two studied skin properties show a slight but highly symmetric disparity along the entire human face.

[Endobronchial ultrasound with transbronchial needle aspiration: Evaluation of clinical practice]

INTRODUCTION

Endobronchial ultrasound with transbronchial needle aspiration (EBUS-TBNA) has undergone a large increase in France since 2007. The aim is to study the evolution of the indications for EBUS-TBNA in our region during the period 2008-2013.

MATERIAL AND METHODS

We conducted a retrospective observational study including all the patients who underwent an EBUS-TBNA procedure in Picardie from 2008 to 2013. The respective proportion for each indication was noted.

RESULTS

During the study period, 1036 EBUS-TBNA procedures were performed with a continuous increase in number (86 in 2008 versus 275 in 2013). We observed an increase in the proportion of procedures performed for a suspected diagnosis of sarcoidosis (OR=1.31; IC 95% [1.09-1.58]; P=0.005) and for the simultaneous diagnosis and staging of lung cancer (OR=1.12; IC 95% [1.02-1.24]; P=0.022). For the diagnosis of sarcoidosis, we observed an improvement in the diagnostic yield between the periods [2008-2010] and [2011-2013] (42.9% versus 72.5%).

CONCLUSION

A continuous increase in the number of EBUS-TBNA procedures was observed during the period 2008-2013. It was associated with a modification in practice with an increased proportion of procedures performed for the diagnosis of sarcoidosis.

Evaluation of the hypothalamic-pituitary-adrenal axis and its relationship with central respiratory dysfunction in children with Prader-Willi syndrome

BACKGROUND

Children with Prader-Willi Syndrome (PWS) have been considered at risk for central adrenal insufficiency (CAI). Hypothalamic dysregulation has been proposed as a common mechanism underlying both stress-induced CAI and central respiratory dysfunction during sleep.

OBJECTIVE

To evaluate CAI and sleep-related breathing disorders in PWS children.

PATIENTS AND METHODS

Retrospective study of cortisol response following either insulin tolerance test (ITT) or glucagon test (GT) in 20 PWS children, and comparison with 33 non- Growth Hormone deficient (GHD) controls. Correlation between sleep related breathing disorders and cortisol response in 11 PWS children who received both investigations.

RESULTS

In PWS children, the cortisol peak value showed a significant, inverse correlation with age (Kendall's τ = -0.411; p = 0.012). A similar though non-significant correlation was present between cortisol increase and age (τ = -0.232; p = 0.16). Similar correlations were found in controls. In only 1 of 20 PWS children (5 %), ITT was suggestive of CAI. Four patients had an elevated central apnea index but they all exhibited a normal cortisol response. No relationship was found between peak cortisol or cortisol increase and central apnea index (respectively p = 0.94 and p = 0.14) or the other studied polysomnography (PSG) parameters.

CONCLUSIONS

CAI assessed by ITT/GT is rare in PWS children. Our data do not support a link between CAI and central respiratory dysregulation.

[Intrascrotal herniation of the ureter]

We describe one case of intra-scrotal hernia of the right ureter. The anomaly was recognized on a pre-operatory urogram. It was an extra-peritoneal ureteral hernia. There are two types of ureteral hernia: the para-peritoneal hernia with a peritoneal sac; the extra-peritoneal type with only a fatty hernia. The mecanism of the latter illustrated by our case is a prolapse of the retro-peritoneal fat. It is not possible to practice an urogram before the cure of every inguinal hernia, so the prevention in this rare situation of the damage of ureter is to be cautious in the resection of huge lipomas and sliding fat when operating on inguinal hernias.

Lymphatic malformations of the head and neck: a retrospective review and a support for staging

BACKGROUND

Lymphatic malformations (LM) are rare benign congenital tumors appearing mainly in the head and neck with a considerably variable outcome. A need exists to validate a staging system, taking into account the prognosis of the malformation, including preoperative and postoperative complications, long-term sequelae, and persistence of the disease to improve parental counseling and evaluate the outcome of a surgical treatment of such tumors.

METHODS

Twenty-two patients treated for LM were selected from a series of 129 patients operated on for congenital malformations of the head and neck between 1986 and 1997 at St-Luc University Hospital, Brussels, Belgium. Their charts were reviewed retrospectively, with a special focus on the anatomic location of the lesions and all the complications reported. According to de Serres et al, LM up to now have been divided into six possible categories according to their unilateral or bilateral infrahyoid and/or suprahyoid locations.

RESULTS

Stage I (unilateral infrahyoid): nine patients, 11% of complications (without mediastinal extension: 0%, with mediastinal extension: 50%); stage II (unilateral suprahyoid): three patients, 33% of complications; stage III (unilateral suprahyoid and infrahyoid): eight patients, 75% of complications; stage V (bilateral suprahyoid and infrahyoid): two patients, 100% of complications. None of the children was initially seen with stage IV (bilateral suprahyoid) or stage VI (bilateral infrahyoid) LM. Overall complications, preoperative complications, postoperative com- plications, and long-term morbidity showed a significant in- crease from stage I to V (p <.01, p =.002, p =.02, and p =.03, respectively).

CONCLUSIONS

A staging system of cervicofacial LM based on the anatomic location can be reliably used for prognostic purposes, allowing a more accurate assessment of the global risk of complications and determination of surgical outcome. Mediastinal extension in stage I patients seems to be associated with a higher rate of complications. Such information can be used to inform parents more appropriately regarding the management and long-term prognosis of their children's malformation.

Congenital nasal pyriform aperture stenosis in newborn: report on three cases

Congenital nasal pyriform aperture stenosis (CNPAS) is recognized as a cause of nasal airway obstruction in the newborn. The nasal pyriform aperture is narrowed by a bony overgrowth of the nasal process of the maxilla. The CNPAS may occur as an isolated congenital defect or in combination with other abnormalities. Three cases of CNPAS are reported with special attention to the clinical presentation and to the management recommendation prior to surgery. Surgical repair was performed for all these three highly symptomatic patients using a sublabial approach for drilling the nasal process in order to obtain a wider nasal vestibular patency. All of them were equipped with bilateral nasal stenting.

Pancreatic pseudocyst located in the liver: a case report and literature review

Pancreatic pseudocyst in the liver is a rare complication of acute or chronic pancreatitis. However, its frequency seems to be increasing with modem imaging procedures. The authors report a case of pancreatic pseudocyst involving the left lobe of the liver that occurred in a patient who never showed clinical evidence of pancreatitis or pancreatic injury. Complete screening led to the discovery of alcoholic chronic pancreatitis. The pseudocyst was treated successfully by radiologic drainage. The pancreatic pseudocyst location and therapeutic approaches are discussed. A literature review uncovered 26 cases of hepatic pancreatic pseudocysts. Clinical presentation, imaging characteristics, and treatment of these cases are analyzed.

Metabolic and hemodynamic changes during recovery and tracheal extubation in neurosurgical patients: immediate versus delayed recovery

Delayed recovery has been advocated to limit the postoperative stress linked to awakening from anesthesia, but data on this subject are lacking. In this study, we measured oxygen consumption (V(O2)) and plasma catecholamine concentrations as markers of postoperative stress. We tested the hypothesis that delayed recovery and extubation would attenuate metabolic changes after intracranial surgery. Thirty patients were included in a prospective, open study and were randomized into two groups. In Group I, the patients were tracheally extubated as soon as possible after surgery. In Group II, the patients were sedated with propofol for 2 h after surgery. V(O2), catecholamine concentration, mean arterial pressure (MAP), and heart rate (HR) were measured during anesthesia, at extubation, and 30 min after extubation. V(O2) and noradrenaline on extubation and mean V(O2) during recovery were significantly higher in Group II than in Group I (V(O2) for Group I: preextubation 215 +/- 46 mL/min, recovery 198 +/- 38 mL/min; for Group II: preextubation 320 +/- 75 mL/min, recovery 268 +/- 49 mL/min; noradrenaline on extubation for Group I: 207 +/- 76 pg/mL, for Group II: 374 +/- 236 pg/ mL). Extubation induced a significant increase in MAP. MAP, HR, and adrenaline values were not statistically different between groups. In conclusion, delayed recovery after neurosurgery cannot be recommended as a mechanism of limiting the metabolic and hemodynamic consequences from emergence from general anesthesia.

IMPLICATIONS

In this study, we tested the hypothesis that delayed recovery after neurosurgery would attenuate the consequences of recovery from general anesthesia. As markers of stress, oxygen consumption and noradrenaline blood levels were higher after delayed versus early recovery. Thus, delayed recovery cannot be recommended as a mechanism of limiting the metabolic and hemodynamic consequences from emergence after neurosurgery.

Monitoring of pefloxacin serum concentrations in intensive care unit patients: comparison of a new immunoassay with high-performance liquid chromatography

Serum quinolone concentrations are not routinely measured in clinical practice. However, in order to optimize quinolone treatment, monitoring of serum concentrations could sometimes be useful particularly in critically ill patients. A new enzyme-linked immunosorbent assay (ELISA) that permits direct determination of pefloxacin in serum is described. To validate this new assay, pefloxacin concentrations were measured in 314 serum samples from 74 intensive care unit patients treated with pefloxacin (400 mg i.v. twice daily). Reference concentrations were obtained by reverse phase high-performance liquid chromatography (HPLC) with spectrofluorometric detection. Results showed that concentrations measured by ELISA correlated very well with those by HPLC (r = 0.957; y = 1.03 and x -0.15). In this population, the concentrations found by ELISA varied between individuals (Cmin = 0.70-39 micrograms/ml; Cmax = 5.2-40 micrograms/ml). However, 86% of the measured Cmax and Cmin levels were adequate for optimal pefloxacin therapy. Only 11% of Cmin and 14% of Cmax were below the optimal values (i.e., 2 and 8 micrograms/ml, respectively). These results suggest that despite the large therapeutic index of pefloxacin, monitoring of its serum concentrations using a rapid ELISA technique may be useful for optimal antimicrobial treatment of certain intensive care unit patients.

Effects of a comprehensive rehabilitation programme in patients with three-vessel coronary disease

The aim of the study was to assess the effects of rehabilitation in 46 consecutive three-vessel coronary disease patients who were considered to have no possibility of revascularization; there were 45 males and one female (mean age 58) sent in the third week after acute myocardial infarction (N = 31) or after unstable angina (N = 15). Left ventricular ejection fraction (EF) was normal in 50% of the patients, but 15% had an EF less than or equal to 0.30. Three patients could not begin their rehabilitation because of unstable angina (N = 2) or severe pulmonary oedema (N = 1). After a 4-week rehabilitation programme, the comparison of stress tests revealed an increase in functional capacities (maximal work-load = 103.6 +/- 27 W before rehabilitation, 126.4 +/- 31 W after rehabilitation, P less than 0.001), and an improvement of the ischaemic threshold [82 +/- 32 W before rehabilitation, 91 +/- 31 W after rehabilitation, P less than 0.05]. During long-term follow up [20.8 months], four patients died of cardiac events [8.7%]; all of them had an EF less than 0.45. Among the 42 living patients 61.9% were asymptomatic, 28.7% had exertional angina, and 9.4% had cardiac complications, and coronary surgery was performed in two cases with good results. The level of return to work was 85% with the mean delay of 1.7 months after rehabilitation. So, rehabilitation in three-vessel coronary disease patients is safe under medical control; improvements in exertional capacities are obvious and give the patients a better self confidence as assessed by the good score of return to work after rehabilitation.

Return to work after rehabilitation in coronary bypass patients. Role of the occupational medicine specialist during rehabilitation

The aim of the study was to assess the role of the occupational medicine specialist in improving return to work (RTW) after coronary bypass graft (CABG) surgery, with an early intervention in the rehabilitation programme of the patients. There were 57 patients (56 male, 1 female, mean age was 50.7 years), sent for rehabilitation 22 days after surgery (49% of them had a prior myocardial infarction, and the ejection fraction (EF) was greater than or equal to 0.55 in 67%, 0.30 less than EF less than 0.55 in 25%, or less than or equal to 0.30 in 8%; myocardial revascularization was complete in 47% of the patients). Jobs required a high level of physical activity in 52.5% of the patients, a medium or low level in 44% and 3.5% of the patients were unemployed. At 7 months follow-up, 73.2% out of the 56 alive patients had returned to work with a mean delay of 109.9 +/- 84 days after surgery. The causes of non-return to work were social and economical factors (46.6%), psychological factors (40%) and medical reasons (13.4%). No clinical data were correlated with return to work (age, EF, extent of revascularization, or results of the stress tests), but return to work varied with the energy requirement in jobs with 97.3% return to work in case of low physical level, and 46.7% in case of high physical level (P less than 0.001). The comparison with a previous study performed in 1984 in 45 rehabilitation patients (with non-systematic vocational counselling), showed an increase in return to work in cardiac patients from 51% to 78% (P less than 0.05) after intervention of the occupational physician. So, the different ways of improving return to work in post-CABG patients are complementary: exercise training and secondary prevention are important, but must be completed with individual vocational counselling that should be included in every rehabilitation programme.

Surgical management of parapharyngeal cystic hygroma causing sudden airway obstruction

Parapharyngeal cystic hygroma is a rare tumor of the neck. This report describes two cases in which surgical resection was necessary to overcome sudden airway obstruction and details the surgical technique. These cases were considered "near misses" for sudden infant death syndrome (SIDS) and were revealed by computed tomography (CT) and echography to be parapharyngeal cystic hygroma. The location of this malformation could have produced sudden airway collapse and be erroneously diagnosed as SIDS. The postoperative follow-up was satisfactory and no recurrence was detected. We believe CT and echography should be included in the evaluation of such cases.

Clostridium difficile in neonates: serogrouping and epidemiology

A typing scheme for Clostridium difficile based on serogrouping, toxigenicity and sorbitol fermentation was applied to 270 strains isolated in one neonatal ward during a 6-month prospective study. Two hundred and twenty-three strains were isolated from 377 faecal samples of 114 neonates and 47 from 92 environmental specimens. The isolates were distributed among five different types; 87% of the faecal and 85% of the environmental isolates belonged to two of these types (toxigenic, sorbitol negative, serogroup F and nontoxigenic, sorbitol positive, serogroup A). Nosocomial spread was clearly demonstrated and the environment appeared to be the main source of contamination: most of the neonates were colonized after admission by strains found in their environment; clusters of colonization with unusual isolates were observed following referral of patients from the intensive care unit or from other hospitals. No relation was found between the acquisition or the carriage of C. difficile and any intestinal symptoms. All the strains belonged to types different from those usually found in cases of antibiotic associated colitis (AAC) suggesting differences of pathogenicity among the different types.

Validation of a radioreceptor assay technique for monitoring pharmacological active material during intensive diazepam tetanus therapy

The present study's aim was to monitor the daily plasma levels of diazepam and its metabolites in two tetanic patients who were receiving very strong doses of diazepam in continuous infusion. The kinetics of high doses of diazepam were estimated. These plasma levels were determined selectively using gas-liquid chromatography (GLC), then correlated with a global estimation by radioreceptor-assay (RRA). At the end of the infusion, the kinetics of diazepam and of RRA active material were calculated using a linear, open, two compartment model. Muscle-relaxant and residual sedative effects were clinically monitored. The mean concentrations of diazepam (2.33, 0.60 micrograms/ml), desmethyldiazepam (3.27, 1.00 micrograms/ml) and oxazepam (0.73, 0.47 micrograms/ml) estimated by GLC and of RRA active material (5.62, 1.08 micrograms/ml) correlated better when active metabolites were considered (r = 0.898) than when diazepam alone was taken into account (r = 0.730), indicating that these metabolites influence the overall activity of the parent compound. Half-lives of RRA results (52.6 h for patient 1 and 82.5 h for patient 2) were higher than those of diazepam estimated using GLC results (21.2 h for patient 1 and 42.3 h for patient 2). This could be related to the contribution of the active metabolites and might explain the residual sedative effect observed for at least seven days following cessation of the diazepam (DZP) infusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation of a Bayesian method of amikacin dosing in intensive care unit patients with normal or impaired renal function

Our study was designed to determine the population pharmacokinetic parameters of amikacin in intensive care unit patients and to develop a Bayesian method allowing individual estimation of pharmacokinetic parameters. A two-stage method was used for estimating the population characteristics of the pharmacokinetic parameters. Calculations of optimum doses and dosing intervals were based on individual parameters. Our results indicate that the Bayesian method is capable of estimating the individual pharmacokinetic parameters with no significant bias and good precision. Individualization of amikacin dosage was assessed 70 times in 52 patients. To determine the predictive performance of the method, observed peak and trough levels were compared with predicted values by computing precision, bias, and correlation. The amikacin dosing method was unbiased and showed a high correlation coefficient (r = 0.962) between measured and predicted drug serum concentrations. No significant differences were found between the predicted and observed peak (17.3 +/- 3.5 and 17.3 +/- 3.8 micrograms/ml, respectively) and trough (2.86 +/- 0.93 and 3.08 +/- 1.41 micrograms/ml, respectively) amikacin serum concentrations. Among the 52 patients, wide variations were observed in the pharmacokinetic parameters (Vd = 0.21-0.50 L/kg; t 1/2 = 1.1-22 h) and the daily doses (2.8-42 mg/kg/day).

The challenge of upper airway obstruction in pediatric intensive care

Over a 5-year period, 75 patients were admitted to a pediatric intensive care unit because of acute upper airway obstruction (AUAO). Congenital abnormalities were demonstrated in 25 children; 9 of them died secondary to severe combined malformations or major central nervous system dysfunction. Acquired AUAOs were seen in 50 patients; 1 died in brain death secondary to anoxia. Obstructions were observed at all levels of the airways from the nose to the carina. In 28% of the patients, AUAO had remained undiagnosed until admission for complications such as acute respiratory failure, cardiac arrest, coma, seizures. With early diagnosis and prompt release of the obstruction the prognosis is good unless severe congenital abnormalities or major central nervous system damage are associated.

Plasma concentrations and pharmacokinetics of midazolam during anaesthesia

Midazolam and 1-hydroxymidazolam plasma concentrations have been monitored and pharmacokinetic parameters of midazolam estimated during anaesthesia induced and maintained by its repeated injection according to two protocols (3 X 0.3 mg kg-1 at 45 min intervals or an induction dose of 0.3 mg kg-1 with maintenance doses of 0.15 mg kg-1 at 30 min intervals). Minimum plasma concentrations of midazolam measured just before each injection were 258.8 +/- 108.4 ng ml-1 for the first protocol and 353.1 +/- 55.2 ng ml-1 for the second protocol; maximum midazolam concentrations, measured 5 min after the last administration, were 1103.1 +/- 237.9 ng ml-1 and 743.0 +/- 103.2 ng ml-1, respectively, suggesting that a continuous infusion of midazolam after a loading dose should be better than repeated injections at keeping the concentration close to the sedative level of 400 ng ml-1. The estimated pharmacokinetic parameters were similar to those already published, except for the beta elimination half-life of midazolam (3.24 +/- 0.90 h for protocol 1 and 3.34 +/- 1.47 h for protocol 2) which was slightly longer than that reported for single dose studies. The comparison of plasma determinations, obtained either by gas-liquid chromatography or by a radioreceptor assay technique, clearly showed that 1-hydroxymidazolam, even after repeated midazolam administration, was not present at a concentration sufficient to affect the overall pharmacological activity of the parent drug.

Intensive care course after orthotopic liver transplantation in children

Eight children 1 to 13 years old, were submitted to OLT. Six patients had normal liver function and complete rehabilitation 4 to 17 months after OLT. Two patients died during their ICU course respectively on day 15 and 34 after operation. The ICU management of the surviving patients is compared to the two fatal cases. At the time of admission in the ICU, there was no difference between the two groups, except for age. All patients were physiologically stable and needed essentially continuous monitoring and nursing care. All were rapidly weaned off artificial ventilation. During the first week after operation, surviving patients demonstrate improvement of liver function test, absence of infection, normal renal function and short ICU stay. They all suffered from systemic hypertension easily controlled by drugs. The two fatal cases were less than 15 months old and did not show improvement of their liver function. They suffered from severe infection, renal failure and protracted systemic hypertension and needed prolonged invasive monitoring and therapy.

Fluosol 43 intravascular persistence in mice measured by 19F nmr

Quantitative determination of the intravascular persistence of F-tri-n-butylamine (FC 43 as Fluosol 43) in mice was carried out using 19F nmr spectroscopy. The method allows the direct study of whole blood, neither separation nor extraction of the sample being required. Accuracy (reproducibility) is better than +/- 3%, and is comparable to that of the gas chromatographic (gc) method. The sensitivity of detection is less than that of the gc method but is sufficient for this biological study. It was observed that the intravascular elimination of F-tri-n-butylamine follows a non-linear kinetic and becomes faster about 40 h after the injection. This phenomenon may be explained by the size-increase of the FC 43 droplets in the emulsion. Indeed, at about 40 h after injection, the level of Pluronic F-68 in the bloodstream was no longer sufficient to maintain the stability of the FC-43 droplets. They therefore tended to coalesce forming larger droplets that were phagocytosed more rapidly by the histiocytes of the reticuloendothelial system.

Effect of leucine or ketoleucine on nitrogen metabolism in postoperative patients receiving energy substrate

It has been shown that ketoisocaproate (KIC) spares nitrogen (N) in fasting postoperative patients while leucine does not. The aim of the present study was to determine if KIC when compared with leucine, decreases nitrogen excretion in postoperative patients receiving energy substrate. Thirty patients undergoing gynecological surgery (hysterectomy with or without lymphadenectomy) were randomized to receive for the first 3 postoperative days one of the following I.V. solutions per kilo and per day: 3 g glucose (group A) 3 g glucose + 90 mg Leucine (group B), 3 g glucose + 100 mg ketoleucine (group C). The output of 3 methylhistidine (3 MEH), total nitrogen and creatinine were measured daily. Although muscle protein breakdown measured as 3 MEH/creatinine molar ratio was significantly reduced in group C as compared with A and B, total nitrogen and creatinine did not differ significantly in A, B and C. Thus, the metabolic effects of KIC in postoperative patients are appreciably influenced by glucose infusions and the usefulness of KIC infusions in such patients needs further study.

The early period of experimental Mendelson's syndrome in dogs with PaCO2 and pH in a normal range

In 9 dogs the first 240 min of experimental Mendelson's syndrome were studied. To minimise hemodynamic alterations, the PaCO2 and pH were kept within the normal range. An increase in pulmonary artery pressure, Qs/Qt and a decrease in PaO2 were demonstrated. Diminution of heart rate and cardiac index were associated with the decrease of systemic oxygen transport. The first 30 min appeared as a para-sympathetic syndrome, the remainder of the experiment as a hypovolemic syndrome. Severe hypoxia was observed during the two periods.

[Criteria for reoperation in abdominal surgery (exclusive of surgical and nephrological criteria)]

In summary, 40 p. 100 of 104 reinterventions carried out in 71 patients from the Resuscitation sector were decided upon in the absence of surgical and nephrological criteria. The authors emphasize the value of the infectious syndrome (74 p. 100 of the cases), of water and electrolyte disorders (60 p. 100 of the cases), and of hypercatabolism (83 p. 100 of the cases).

[Nutrition in the surgical patient with complications]

Parenteral feeding in complicated abdominal surgery has been a definite therapeutic progress. However the authors emphasize the divergent attitudes concerning the amounts of nitrogen which should be supplied as well as the variations in the calories-nitrogen ratio. They propose a practical attitude which must be reevaluated individually.

Ventilation and blood-gas studies during experimentally produced Mendelson's syndrome in the dog

Hydrochloric acid was instilled into the bronchial tree in anaesthetized dogs. A severe respiratory acidosis resulted. The metabolic component of acid-base balance was little affected.