Metabolic and Bariatric Surgery in Patients with Obesity Class V (BMI > 60 kg/m2): a Modified Delphi Study

BACKGROUND

Metabolic and bariatric surgery (MBS) is the preferred method to achieve significant weight loss in patients with Obesity Class V (BMI > 60 kg/m2). However, there is no consensus regarding the best procedure(s) for this population. Additionally, these patients will likely have a higher risk of complications and mortality. The aim of this study was to achieve a consensus among a global panel of expert bariatric surgeons using a modified Delphi methodology.

METHODS

A total of 36 recognized opinion-makers and highly experienced metabolic and bariatric surgeons participated in the present Delphi consensus. 81 statements on preoperative management, selection of the procedure, perioperative management, weight loss parameters, follow-up, and metabolic outcomes were voted on in two rounds. A consensus was considered reached when an agreement of ≥ 70% of experts' votes was achieved.

RESULTS

A total of 54 out of 81 statements reached consensus. Remarkably, more than 90% of the experts agreed that patients should be notified of the greater risk of complications, the possibility of modifications to the surgical procedure, and the early start of chemical thromboprophylaxis. Regarding the choice of the procedure, SADI-S, RYGB, and OAGB were the top 3 preferred operations. However, no consensus was reached on the limb length in these operations.

CONCLUSION

This study represents the first attempt to reach consensus on the choice of procedures as well as perioperative management in patients with obesity class V. Although overall consensus was reached in different areas, more research is needed to better serve this high-risk population.

RV function by cardiac magnetic resonance and its relationship with neutrophil/lymphocyte ratio in patients with acute inferior STEMI undergoing PPCI

Funding Acknowledgements

Type of funding sources: None.

Background

Although acute inferior myocardial infarction (MI) is usually regarded as being lower risk compared with acute anterior MI, right ventricular (RV) myocardial involvement (RVMI) carries an increased risk of cardiovascular (CV) morbidity and mortality in patients with inferior MI.Cardiac Magnetic resonance (CMR) is ideal for assessing the RV because it allows a comprehensive assessment of cardiovascular morphology and physiology without most of the limitations that hinder alternative imaging modalities.

Objectives

To evaluate the sensitivity of other parameters;the neutrophil/ lymphocyte ratio (NLR) and RV function using 2D speckle tracking echo compared to (CMR) among patients with inferior STEMI undergoing primary percutaneous coronary intervention (PPCI).

Methodology

 40 Patients with inferior MI who had PPCI were included in the study; two groups were highlighted according to the CMR derived RVEF RV dysfunction (RVD and non-RVD). NLR  and 2D speckle tracking echo were done in comparison to RVEF.

Results

out of the 40 patients, 18 (45%) patients had RVD. ST segment elevation in the right leads was significantly higher (P-value =0.03) in patients with RV dysfunction (55.6%) in comparison with patients (22.7%) who had no RV dysfunction.When comparing groups according to the complications, heart block was significantly higher in patients with RV dysfunction (P-value= 0.008) as it occurred in 5 (27.8%) patients.Echocardiography was done for all patients, and it was found that fractional area change (FAC) in the RV dysfunction group appeared to be significantly reduced compared to the group without RV dysfunction (P-value =0.03). RV longitudinal strain (LS) by speckle tracking echo was reduced with an average of -19.5 ±3.9 % in the RV dysfunction group P value 0.008.Both CMR- derived RV SV, and EF were lower among the RV dysfunction group, (26.8 ± 15.8) ml and (35.4 ± 6.9) % respectively, with large RV systolic volume, with the highly statistically significant difference in comparison to the other group (p value = 0.000). Mean N/L ratio was higher (7.3 ± 5.2 (10^3/uL)) in the group with RV dysfunction compared to (6.4 ± 4.1(10^3/uL)) in the group with non RV dysfunction group. N/L ratio for predicting RV dysfunction by CMR had a cutoff value of >7.7 with low sensitivity (38.89%) and high specificity (77.27 %), while LS for predicting RV dysfunction by CMR had both high sensitivity (83.33%) and high specificity (63.64%) with P-value =0.005.

Conclusion

Our results showed that RV dysfunction in inferior MI is better detected using cardiac magnetic resonance imaging. In inferior STEMI patients who underwent primary PCI, NLR has low sensitivity but high specificity for predicting  RVD when measured by cardiac MRI.

On the impact of ethanol on the rejection and transfer mechanism during ultrafiltration of a charged macromolecule in water/ethanol

Ultrafiltration (UF) is a sustainable membrane separation technique. It could be useful for the concentration/purification of bio-sourced molecules that are extracted either by pure ethanol or by water/ethanol mixtures. Nevertheless, the process optimization requires an in-depth understanding of the transfer mechanisms of solute through membranes, especially for charged solutes, that are nowadays not sufficiently documented. Previous studies achieved in aqueous media have shown that the rejection of charged solutes by an UF membrane involves at least three mechanisms: convection, diffusion and electrostatic interactions. The present study aims at a systematic analysis of the transfer mechanisms of a model protein (lysozyme) in water/ethanol mixtures (100/0-70/30 v/v) during UF by a zirconia inorganic membrane. The influence of the pH varying in the 4-9 range and of the ionic strength (I) is also discussed. The ionic strength I can be adjusted by addition of an indifferent electrolyte (NaCl) only aiming at the screening of the electrostatic interactions or by addition of a selectively adsorbed electrolyte(KH₂PO₄) that is able to change the isoelectric pH of the protein and thus to modulate the electrostatic interactions in a different way when compared to NaCl. Of course, both salts have an impact on the protein rejection in UF. The results are analysed using the CDE model previously developed in our group to explain the behaviour of a single protein during UF in water and accounting for convection, diffusion and electrophoretic migration. The applicability of the CDE model in water/ethanol mixtures up to 70/30 v/v is finally shown.

Effect of Nano-Silica on The Thermo-Physical Properties of the Thermal Eutectic (Na0.6K0.4)NO3 System

Here, we investigate the effect of adding nano-silica particles on the thermo-physical properties of the (Na0.6K0.4)NO3 based thermal energy storage systems. Five different systems tagged as M00, M01, M02, M03 and M04, with different nano-silica percentage of 0, 1, 2, 3, and 4 wt%, respectively, were prepared. Various experimental techniques were employed to study the thermo-physical properties of the systems during (solid-solid) phase P1, (solid-liquid) phase P2 and (liquid-solid) phase P3, and to clarify the effect of nano-silica on the thermal energy storage efficiency during both charging and discharging processes. According to the Differential Scanning Calorimeter (DSC) thermal analysis, it was found that the system M02 whose nano-silica addition rate of 2 wt%, has the most favorable thermal characteristics (i.e., highest specific heat and lowest enthalpy change). Moreover, the addition of 2 wt% represents the optimum distribution of nano-silica inside the principal base system M00. This leads to an improvement in the porosity of the system due to the degree of homogeneity caused by the thermophoresis effect distribution, the high surface area of the nano-silica with the activity of the M00 matrix alongside the degree of the alkalinity of nano-silica. Besides, the electric conductivity measurements showed that the 2wt% percentage is the optimum one for thermal energy storage systems.

Multilocus sequence typing of Carnobacterium maltaromaticum strains associated with fish disease and dairy products

AIMS

Carnobacterium maltaromaticum is a lactic acid bacterium of technological interest in the field of dairy ripening and food bioprotection and is generally recognized as safe in the United States. As it is associated with fish infections, the European Food Safety Agency did not include this species in the qualified presumption safety list of micro-organisms. This implies that the risk assessment for the species has to be performed at the strain level.

METHODS AND RESULTS

Multilocus sequence typing (MLST) is a tool that (i) potentially allows to discriminate strains isolated from diseased fish from apathogenic strains and (ii) to assess the genetic relatedness between both groups of strains. In this study, we characterized by MLST 21 C. maltaromaticum strains including 16 strains isolated from diseased fish and 5 apathogenic dairy strains isolated from cheese. The resulting population structure was investigated by integrating these new data to the previously published population structure (available at http://pubmlst.org), which represents an overall of 71 strains.

CONCLUSIONS

This analysis revealed that none of the strains isolated from diseased fish is assigned to a clonal complex containing cheese isolates, and that 11 strains exhibit singleton genotypes suggesting that the population of diseased fish isolates is not clonal.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study thus provides a population structure of C. maltaromaticum that could serve in the future as a reference that could contribute to the risk assessment of C. maltaromaticum strains intended to be used in the food chain.

Preparation of polyaniline/PbS core-shell nano/microcomposite and its application for photocatalytic H2 electrogeneration from H2O

Lead sulfide (PbS) and polyaniline (PANI) nano/microparticles were prepared. Then, PANI/PbS core-shell nano/microcomposites (I, II, and III) were prepared by oxidative polymerization of different aniline concentrations (0.01, 0.03, and 0.05 M), respectively, in the presence of 0.05 M PbS. FT-IR, XRD, SEM, HR-TEM, and UV-Vis analyses were carried out to characterize the samples. From the FT-IR data, there are redshifts in PbS and PANI nano/microparticles bands in comparison with PANI/PbS nano/microcomposites. The average crystallite sizes of PANI/PbS core-shell nano/microcomposites (I, II, and III) from XRD analyses were 46.5, 55, and 42.16 nm, respectively. From the optical analyses, nano/microcomposite (II) has the optimum optical properties with two band gaps values of 1.41 and 2.79 eV. Then, the nano/microcomposite (II) membrane electrode supported on ITO glass was prepared and applied on the photoelectrochemical (PEC) H₂ generation from H₂O. The characteristics current-voltage and current-time behaviors were measured at different wavelengths from 390 to 636 nm. Also, the incident photon-to-current conversion efficiency (IPCE) under monochromatic illumination condition was calculated. The optimum values for IPCE were 36.5 and 35.2% at 390 and 405 nm, respectively. Finally, a simple mechanism for PEC H₂ generation from H₂O using the nano/microcomposite (II) membrane electrode was mentioned.

Screening of freshwater and seawater microalgae strains in fully controlled photobioreactors for biodiesel production

Strain selection is one of the primary hurdles facing cost-effective microalgal biodiesel production. Indeed, the strain used affects both upstream and downstream biodiesel production processes. This study presents a screening procedure that considers the most significant criteria in microalgal biodiesel production including TAG production and wet extraction and recovery of TAGs. Fourteen freshwater and seawater strains were investigated. Large variation was observed between the strains in all the screening criteria. The overall screening procedure ultimately led to the identification of Parachlorella kessleri UTEX2229 and Nannochloropsis gaditana CCMP527 as the best freshwater and seawater strains, respectively. They featured the largest areal TAG productivity equal to 2.7×10(-3) and 2.3×10(-3)kgm(-2)d(-1), respectively. These two strains also displayed encouraging cell fragility in a high pressure bead milling process with 69% and 98% cell disruption at 1750bar making them remarkable strains for TAG extraction in wet environment.

Association Between Metacognition and Mood Symptoms Poststroke

INTRODUCTION

The link between metacognition and mood has been well established, particularly in other conditions with psychological comorbidity, however, there is no evidence regarding this association in the area of stroke.

AIM

The aim of this study was to examine the association between metacognition, based on the Self-Regulatory Executive Function model, and mood symptoms in the acute phase after stroke.

METHODS

One hundred thirty patients were recruited to a prospective stroke study in Bahrain, and n = 64 were assessed for mood and cognition. A neuropsychological battery of cognitive assessments included the following measures: the Mini-Mental State Examination, the Trail Making Test (A+B), and the Metacognition Questionnaire 30 (MCQ-30) for metacognition. The Hospital Anxiety and Depression Scale assessed mood symptoms, and stroke severity was measured using the National Institute of Health Stroke Severity Scale.

RESULTS

Total MCQ-30 scores were significantly associated with both anxiety (r = .47, P = .001) and depression (r = .54, P <. 0001). The MCQ-30 subscales' cognitive confidence, cognitive self-consciousness, and uncontrollability/danger were the specific factors to be associated with mood symptoms (P < .01). Global cognition (r =.32, P < .01), but not executive function, was significantly associated with depression only. Metacognition remained a statistically significant correlate with depression (β = .42, P < .0001) and anxiety (β = .51, P < .0001) after adjusting for education and global cognition.

DISCUSSION

Metacognition is a better determinant of mood symptoms after stroke, especially in regions where illiteracy levels are high in older populations, in comparison to executive function and global cognition.

Development and validation of a screening procedure of microalgae for biodiesel production: application to the genus of marine microalgae Nannochloropsis

Nannochloropsis has emerged as a promising alga for biodiesel production. However, the genus consists of 6 species and hundreds of strains making strain selection a challenge. Furthermore, oil productivity is instrumental to economic viability of any algal strain for industrial production, which is dependent on growth rate and oil content. In most cases, these two parameters have been studied independently. Thus, the goal of this study is to provide a combined method for evaluating strain performance in specially designed photobioreactors together with an in-depth lipidomic analyses. The nine strains of Nannochloropsis tested showed considerable variations in productivity and lipidomics highlighting the importance of strain selection. Finally, Nannochloropsis gaditana CCMP527 and Nannochloropsis salina CCMP537 emerged as the two most promising strains, with an oil content of 37 and 27 dry wt% after 11-day nitrogen starvation, respectively, resulting in TAG productivity of 13×10(-3) and 18×10(-3) kg m(-3) d(-1), respectively.

A study of the phase transition of reheated diphenyl carbazide (DPC) by using UV spectroscopy

Phase transition phenomenon in reheated diphenyl carbazide (DPC) is studied here using UV spectroscopy. The optical band gap for reheated DPC is obtained by measuring the optical diffused reflectance (DR) and equals to 3.55 eV. Also, the optical band gap is calculated using UV technique and equals to 3.548 eV. The absorbance of reheated DPC is studied at some selected temperatures in order to check the presence of phase transitions at 90°C and 125°C. According to the present work, the band gaps are calculated at 80°C, 110°C and 130°C and equal to 3.548 eV. But at 100°C, the optical band gap has changed to 4.139 eV. It was found that each phase of reheated DPC belongs to a certain definite crystal structure. The presence of the phase transitions are checked and confirmed by scanning electron microscopy (SEM). The structural properties and morphology of reheated diphenyl carbazide are investigated by SEM. The SEM images are taken at some selected temperatures to confirm the presence of phase transitions.

Transient tachypnea of the newborn: Is empiric antimicrobial therapy needed?

BACKGROUND

Transient tachypnea of the newborn (TTN) is a self- limited increase in the work of breathing in near- and full-term infants; it is attributed to a delay in the clearance of alveolar fluids. Prophylactic antibiotics are usually administered until blood cultures are reported negative for 48 hours.

OBJECTIVES

To prospectively compare outcomes of infants presented with classic TTN who were treated with or denied from intravenous antibiotics.

METHODS

A prospective cohort study was conducted on all infants admitted with classic TTN. Pre-set diagnostic criteria for classic TTN were applied in order to exclude other cases presenting with respiratory distress. Infants with classic TTN were stratified into two groups based on whether they received or did not receive antibiotics. The decision to administer antibiotics solely depended upon the style of the covering physician at the time of admission to the NICU. The following investigations were obtained from infants of both groups: blood culture, C-reactive protein, complete blood count, blood gas profile and chest X-ray.

RESULTS

A total of 15146 full-term infants were delivered during the study period; of them 923 were admitted to the NICU. Classic TTN was diagnosed in 168 infants; of them 106 (63%) received and 62 (37%) did not receive antibiotics. Two infants in the treated group and an infant in the non-treated group had microbiologically confirmed bacteremia. Infants in the treatment group stayed longer in the hospital (72 ± 6 vs. 48 ± 3 hrs). No recorded cases required readmission in either group.

CONCLUSIONS

With the application of strict criteria for classic TTN and the close observation in the NICU, the empiric use of antibiotics may be avoidable. Randomized controlled trials are needed to confirm the feasibility and safety of such approach.

Diffused reflectance and structure analysis for the nano-matrix (ZnO(1-x)SiO2(x)) system

Optical and structural properties of the investigated matrix ZnO(1-x)SiO2(x) system were characterized by various techniques such as X-ray analysis and UV-VIS-NIR absorption. The structural changes of the studied nano-matrix ZnO(1-x)SiO2(x) with the concentration of nanosilica are checked by X-ray analysis measurement. The crystal structures for ZnO, (ZnO)0.75(SiO2)0.25, (ZnO)0.50(SiO2)0.50 and (ZnO)0.25(SiO2)0.75 and pure SiO2 are hexagonal, monoclinic, tetragonal, orthorhombic and amorphous respectively and detailed crystal parameters are obtained. The electronic properties of ZnO(1-x)SiO2(x) are investigated, where the optical band gaps for the five studied systems are 3.22eV, 3.24eV, 3.27eV, 3.30eV and 4.5eV respectively. It is clear that the band gap increases with increasing SiO2 content. Mixing the ZnO with SiO2 enhance the UV response of these materials which is confirmed by diffused reflectance spectrum used to analyze the UV response of the studied systems.

IR spectroscopic analysis of the new organic silver complex C13H13N4OAg

IR analysis in the frequency range 400-4000 cm(-1) is used here to investigate the changes in different modes of thermally treated new metal complex (diphenyl carbazide silver complex DPCAg, C13H13N4OAg) during the glass transition at 91 °C and the high temperature phase transition at 167 °C. These two phase transitions in this new metal compound are studied here by detecting the changes in some IR spectroscopic parameters (e.g., mode shift, band contour, peak height and peak intensity) during the elevation of temperature. All of the vibrations of DPCAg were found to be due to ionic fundamentals 3311 cm(-1), 3097 cm(-1), 3052 cm(-1), 1677 cm(-1), 1602 cm(-1), 1492 cm(-1), 1306 cm(-1), 1252 cm(-1), 887 cm(-1) and 755 cm(-1). The results obtained can be considered as the first spectroscopic analysis of this new metal complex. These results strongly confirmed that the thermally treated DPCAg transverse a glass transition at 91 °C and a high temperature phase transition at 167 °C. Anomalous spectroscopic changes near the glass transition temperature Tg could be recorded. A temperature dependence of peak intensity of the two modes 810 cm(-1) and 3440 cm(-1) could be observed beyond Tg. Also, the high temperature phase modification at 167 °C showed anomalous change in the spectroscopic parameters before and after the phase transition process. A proposed silver position in the new silver complex DPCAg has been presented.

IR spectroscopic analysis of polymorphism in C13H14N4O

IR analysis is used here to investigate the changes in N-N, N-H, CO modes of thermally treated diphenyl carbazide (DPC) during the variation of temperature from room temperature up to ≈160°C. Polymorphism in DPC compound has been studied here by detecting the changes in some IR spectroscopic parameters (e.g., mode shift, band contour) during the elevation of temperature. Also, DSC, X-ray, NMR and atomic mass spectra are used as confirming tools for what is obtained by IR. All of the vibrations of DPC were found to be due to ionic fundamentals 3311 cm(-1), 3097 cm(-1), 3052 cm(-1), 1677 cm(-1), 1602 cm(-1), 1492 cm(-1), 1306 cm(-1), 1252 cm(-1), 887 cm(-1) and 755 cm(-1). The results revealed for the first time that the thermally treated DPC traverse four different phase transformations at 50°C, 90°C, 125°C and 140°C. The crystal structure was found to be amorphous, monoclinic, tetragonal, orthorhombic and amorphous within a temperature range (30°C-160°C). X-ray diffraction patterns support the results obtained by IR and DSC.

[Intraorbital dermoid cyst: case report]

Dermoid cysts account for 3-4 % of primary orbital tumors. The intraorbital location is relatively rare. The authors report a case of a 12-year-old male with an intraorbital dermoid cyst revealed by progressive right proptosis. The imaging aspects (CT scan and MRI) were consistent with intraconic dermoid cyst. The tumor was extirpated via a subfrontal approach. Histopathologic examination confirmed the diagnosis of dermoid cyst. The authors discuss the clinical symptoms, radiological aspects, and management.

[Neurosurgical management of paraplegia complicating Pott's disease: a six-case study]

Tuberculosis is a rare disease in economically developed countries. Paraplegia is one of its severe complications, occurring in cases of spondylodiscitis with compressive epiduritis and/or pathological fracture of vertebral bodies with subacute kyphosis. Six patients aged 15-75 years were treated in our department from May 2005 to April 2006 by the same operator (L.N.) for paraplegia complicating Pott's disease. Patients' neurologic function at admission and their outcomes three and 12 months after surgery were graded using the Frankel classification. MRI showed a single lesion in five cases and skip lesions in one case. Standard antituberculosis chemotherapy was started immediately within the first week of admission in five patients following a 12-month regimen. Principles of surgical treatment were ventral spinal cord decompression (with or without dorsal stage procedure), immediate grafting, correction of subacute spinal deformity and instrumentation in all cases. The diagnosis of Mycobacterium tuberculosis was confirmed by laboratory investigations in four cases and by histopathological examination in all cases. One patient who had undergone prior isolated laminectomy performed by an on call team presented neurological deterioration and progressive kyphosis. Neurological outcome improved in five patients. Four of them were able to walk unaided within the first three months after surgery. No perioperative complication occurred. In paraplegia complicating vertebral tuberculosis, overall neurological outcome appeared to be good in case of delayed emergency surgical management combined with antituberculosis chemotherapy.

Effect of alpha-stat vs. pH-stat strategies on cerebral oximetry during moderate hypothermic cardiopulmonary bypass

BACKGROUND AND OBJECTIVES

This study was undertaken to compare the effect of alpha-stat vs. pH-stat strategies for acid-base management on regional cerebral oxygen saturation (RsO2) in patients undergoing moderate hypothermic haemodilution cardiopulmonary bypass (CPB).

METHODS

In 14 adult patients undergoing elective coronary artery bypass grafting, an awake RsO2 baseline value was monitored using a cerebral oximeter (INVOS 5100). Cerebral oximetry was then monitored continuously following anaesthesia and during the whole period of CPB. Mean +/- SD of RsO2, CO2, mean arterial pressure and haematocrit were determined before bypass and during the moderate hypothermic phase of the CPB using the alpha-stat followed by pH-stat strategies of acid-base management. Alpha-stat was then maintained throughout the whole period of CPB.

RESULTS

The mean baseline RsO2 in the awake patient breathing room air was 59.6 +/- 5.3%. Following anaesthesia and ventilation with 100% oxygen, RsO2 increased up to 75.9 +/- 6.7%. Going on bypass, RsO2 significantly decreased from a pre-bypass value of 75.9 +/- 6.7% to 62.9 +/- 6.3% during the initial phase of alpha-stat strategy. Shifting to pH-stat strategy resulted in a significant increase of RsO2 from 62.9 +/- 6.3% to 72.1 +/- 6.6%. Resuming the alpha-stat strategy resulted in a significant decrease of RsO2 to 62.9 +/- 7.8% which was similar to the RsO2 value during the initial phase of alpha-stat.

CONCLUSION

During moderate hypothermic haemodilutional CPB, the RsO2 was significantly higher during the pH-stat than during the alpha-stat strategy. However, the RsO2 during pH-stat management was significantly higher than the baseline RsO2 value in the awake patient breathing room air, denoting luxury cerebral perfusion. In contrast, the RsO2 during alpha-stat was only slightly higher than the baseline RsO2, suggesting that the alpha-stat strategy avoids luxury perfusion, but can maintain adequate cerebral oxygen supply-demand balance during moderate hypothermic haemodilutional CPB.

Comparison of RANTES expression in Crohn's disease and ulcerative colitis: an aid in the differential diagnosis?

BACKGROUND

RANTES (regulated on activation, normal T cell expressed and secreted) expression is increased in inflammatory bowel disease (IBD). RANTES is produced at higher levels in granulomatous conditions, so increased RANTES expression can be expected in Crohn's disease compared with ulcerative colitis.

AIM

To compare RANTES expression between intestinal biopsy specimens of patients with Crohn's disease and those with ulcerative colitis.

MATERIALS AND METHODS

A prospective study of patients presenting with lower gastrointestinal symptoms at the Bahrain Specialist Hospital from July 2004 to April 2005 was carried out. Endoscopic colonic biopsy specimens were taken from every patient and subjected to (a) routine haematoxylin and eosin staining examination by light microscopy, (b) immunohistochemistry for examination of RANTES protein expression by light microscopy and (c) in situ hybridisation for examination of RANTES mRNA expression by light microscopy. RANTES expression was assessed and quantified.

RESULTS

58 patients were enrolled to the study. Of them, 40 had IBD (21 had Crohn's disease and 19 had ulcerative colitis), 15 were controls with normal colonic biopsy results or non-inflammatory lesions and 3 had colonic inflammatory lesions other than IBD. RANTES expression in lymphocytes or histiocytes was significantly higher (p = 0.04) in new patients with ulcerative colitis than in those with Crohn's disease analysed by immunohistochemistry (IHC).

CONCLUSION

RANTES expression in lymphocytes or histiocytes is significantly higher in patients with ulcerative colitis than in those with Crohn's disease. Hence, RANTES IHC can be an effective method for distinguishing between biopsy specimens of patients with ulcerative colitis from those of patients with Crohn's disease, where routine histological features are indeterminate. RANTES IHC may prove to be a useful technique for identifying early or equivocal granulomas.

Élimination des cations métalliques divalents : complexation par l'alginate de sodium et ultrafiltration

Depuis quelques années la pollution par les métaux lourds et devenue un problème important pour la protection de l'environnement et de nombreuses méthodes ont été développées pour éliminer les métaux toxiques présents dans l'eau.

Parmi les différents procédés utilisés, la complexation-ultrafiltration est bien connue et de nombreuses études sur ce sujet sont décrites dans la littérature. Cependant, le choix de nouveaux macroligands hydrosolubles demeure important pour développer cette technologie.

L'un des objectifs de ce travail était de montrer que dans ce procédé un biopolymère peut remplacer un macroligand de synthèse. Les expériences ont été menées avec de l'alginate de sodium, polysaccharide extrait des algues brunes, et porteur de groupements carboxyliques et hydroxydes capables de complexer les cations.

Notre étude se divise en trois parties. Après avoir décrit, dans la première, le matériau et les méthodes utilisées, nous étudions dans la seconde les conditions de l'ultrafiltration (seuil de coupure, pression appliquée, pH, concentration ), avant de discuter dans la troisième les résultats obtenus dans le traitement de solutions contenant Cd2+, Cu2+, Mn2+ and Pb2+.

[The Dijon Physical Activity Score: reproducibility and correlation with exercise testing in healthy elderly subjects]

PURPOSE

To validate a French physical activity score for current use in healthy elderly people.

PATIENTS AND METHODS

A brief questionnaire was developed for healthy elderly subjects older than 72 years. Questions asked about self-assessed physical fitness (1), daily activity (2), leisure and sport activity (5) and rest time (1). Correlations were searched between the score and several parameters of physical fitness: maximal exercise stress test (peak VO(2)), six-minute walk test, 200-meter long walk test, timed up an go test.

RESULTS

A total of 57 subjects were studied (mean age, 77.6 +/-3.6 years; 28 females and 29 males). The mean time to complete the questionnaire was 3.96 minutes. Reproducibility was 0.606, as determined by Spearman's coefficient. Correlations were found between the physical activity score and peak VO(2) (0.302, P <0.05) and peak power (0.257, P <0.10).

CONCLUSIONS

This easily obtained physical activity score provides a new way to assess physical activity in active elderly subjects. The physical score correlated in part with maximal ability but must be validated in several diseases.

[Tophaceous gout of the cervical spine, causing cord compression. Case report and review of the literature]

We present the case of a 74-year-old patient with long-standing gout who developed C4-C5 tophaceous gout causing cord compression. The patient had undergone 4 years earlier for a disco-osteophytic cord compression (anterior C4-C5 and C5-C6 discectomy). When admitted, the patient presented quadriparesia which had developed during the previous week in association with acute tophaceous gout on the knees, and the metarsophalangeal articulations, in the context of a bronchial infection. The diagnosis of spondylodiscitis was initially retained because of the clinical features of severe infection and the radiological data (C4-C5 cord compression, with anterior epidural lesions in MRI). The intervention allowed decompression and pathological diagnosis of tophaceous gout. Spinal gout is well-known, and very rarely responsible for cord compression: only 15 cases of cervical gout have been described in the literature. Radiological findings are not specific, and treatment is surgical in the event of medullar compression despite medical treatment.

[Cervical medullary metastasis in a patient with Von Hippel-Lindau disease]

Von Hippel-Lindau disease is an autosomal dominant disorder mainly characterized by hemangioblastoma(s) associated with kidney clear-cell carcinoma. Hemangioblastoma represents 2 to 3% of all central nervous system tumors whereas extramedullary metastasis accounts for 30 to 50% of all intravertebral column tumors. The most common sites of metastatic dissemination in order of frequency are the lung, breast, prostate and kidney. We report a case of an unusual cervical intradural extramedullary metastasis of clear-cell kidney carcinoma associated with a cervical spinal cord hemangioblastoma in a 45-year-old patient with Von Hippel-Lindau disease who had developed retinal hemangioblastomas 20 years earlier. A review of the relevant literature is proposed.

A comparative study between classical stirred and ultrasonically-assisted dead-end ultrafiltration

The aim of this work was to determine mass transfer coefficients in the cases of ultrasonically-assisted and classical stirred dead-end ultrafiltration. A comparative study was then performed, and mass transfer coefficients obtained under ultrasonic conditions are described by an empirical model. This correlation results from an analogy with what is observed using a stirred cell and involves the ultrasonic power as the main parameter. The hydrodynamics are assumed to depend on the intensity of the ultrasound effects illustrated by the agitation arising within the cell. This agitation is due to convective currents as well as physical effects due to cavitation. The concentration polarization phenomenon is therefore affected by this action of ultrasonic waves.

Sevoflurane anesthesia in a myasthenic patient undergoing transsternal thymectomy

Myasthenia gravis (MG) is an autoimmune disease resulting from the production of antibodies against the acetylcholine receptors of the neuromuscular synapse. The thymus gland is involved in the autosensitization process, and there is a consensus that all adults with generalized MG should have a thymectomy. Removal of a much thymic tissue as possible via the transsternal approach in the logic goal of thymectomy in the treatment of MG. Because of the unpredictable response to succinylcholine and the marked sensitivity to nondepolarizing muscle relaxants in the MG patients, some anesthesiologists avoid the use of muscle relaxants in the myasthenic patients, and depend on deep inhalation anesthesia, such as halothane, isoflurane or sevoflurane. In the present report, we used sevoflurane 4%, without supplementation by muscle relaxants, for the induction and maintenance of anesthesia in a MG patient undergoing transsternal thymectomy. The report reviews the anesthetic technique, and describes the electromyographic (EMG) changes following sevoflurane.

[Aneurysm of the postero-inferior cerebellar artery associated with arteriovenous malformation]

A saccular aneurysm of the posterior inferior cerebellar artery lying in the fourth ventricle and an arteriovenous malformation in the cerebellum fed by the same artery are reported. Clipping of the neck of the aneurysm and total removal of the arteriovenous malformation were performed successfully during one stage. Review of the pertinent literature indicates that the aneurysm of the posterior inferior cerebellar artery originates from the peripheral portion of the artery when associated with arteriovenous malformation. The treatment is often surgical with good results in more than 80% of cases. A one-stage operation is the method of choice. Embolization is not without risk and can be attempted when the PICA's course allows easy catheterization.

[Dermoid cyst of the lateral ventricle associated with ethmoidal dermal sinus. Report of a case]

We report a case of a ventricular dermoid cyst associated with a dermal sinus connected with the ethmoidal cells in a patient who developed rapid symptoms of raised intracranial pressure. Computed tomography showed a cystic mass in the right lateral ventricle with a hydrolipidic image in the left frontal horn of the ventricle and associated hydrocephalus. Magnetic resonance imaging showed a heterogeneous T1 hyperintense mass with a fistulous tract communicating with the ethmoid cells. A cerebrospinal fluid ventriculo-peritoneal shunt was initially established, which required further revision. A right sided transventricular approach was undertaken in a second stage, allowing resection of a dermoid cyst. Obliteration of the dermal sinus tract was obtained using pericranial duraplasty. Clinical and imaging features are discussed. The need for total resection including the tumor capsule and occlusion of the fistula are emphasized if recurrence and infection are to be prevented.

Apnea-induced hemoglobin desaturation during one-lung vs two-lung ventilation

PURPOSE

To compare the rate of apnea-induced hemoglobin desaturation during one-lung ventilation (OLV) vs. two-lung ventilation (TLV) in patients undergoing thoracic surgery.

METHODS

Six patients undergoing thoracotomy or thoracoscopy were included. Each patient served as his/her own control. The lungs were ventilated with oxygen 100% using TLV, followed after 20-30 min by OLV and the resultant PaO2 was measured. Apnea was then induced following the two techniques of ventilation, and the times for every 1% decrease in hemoglobin saturation from 100% to 95%, as monitored by pulse oximetry, were recorded. The times for every 1% decrease in the saturation were compared in the two groups.

RESULTS

The mean PaO2 value following TLV (445+/-99 mm Hg) was higher than the mean PaO2 following OLV (156+/-18 mm Hg). Also, the mean time for subsequent apnea induced hemoglobin desaturation from SpO2 100% to 95% following TLV was twice the time of desaturation following OLV (6.3+/-1.2 min vs. 3.2+/-0.5 min, P<0.05).

CONCLUSION

Hemoglobin desaturation occurs more rapidly during apnea following OLV than TLV. The rapid desaturation may be attributed to the decrease of FRC, associated with an increased transpulmonary shunting. The results suggest that two-lung ventilation with oxygen 100% provides a greater safety margin than one-lung ventilation with oxygen 100% whenever ventilation is interrupted.

[Krouamania causing an acute subdural hematoma of arterial origin]

We report a case of arteriolar subdural hematoma caused by Jedba assimilated to Krouamania. We discuss the pathophysiological mechanism of subdural bleeding, the clinical symptoms, the characteristics of such hematomas and the therapeutical management.

Homocysteine induces DNA synthesis and proliferation of vascular smooth muscle cells by a hydrogen peroxide-independent mechanism

Elevated plasma levels of homocysteine have been identified as an important and independent risk factor for cerebral, coronary, and peripheral atherosclerosis, although the mechanisms are unclear. Homocysteine has been shown to promote cell proliferation and induction of the gene transcription factor c-fos in vascular smooth muscle cells. Earlier reports have suggested that homocysteine exert its effect via hydrogen peroxide (H2O2) produced during its metabolism. To evaluate the contribution of homocysteine to the pathogenesis of vascular diseases, we examined whether the effect of homocysteine on vascular smooth muscle cell growth is mediated by H2O2. We observed that 1.0 mM homocysteine induces DNA synthesis by 1.5-fold and proliferation of vascular smooth muscle cells two-fold in the presence of peroxide scavenging enzyme, catalase (2,600 U/ml). Our results suggest that homocysteine induces smooth muscle cell growth by an H2O2-independent pathway and that the effects of homocysteine may sum together with the known initiating events produced by oxidative stress and accelerate the progression of atherosclerosis.

[Intra-orbital dacryops. Report of a case]

We report a case of intra-orbital Dacryops in a 7-year-old child. The presenting sign was progressive exophtalmus. The patient was operated via a lateral approach allowing total removal of the cyst without recurrence after one year. The clinical, radiological (CT Scan and MRI) and therapeutical aspects are discussed.

[Chronic subdural hematoma in utero. Case report with literature review]

We present a case of chronic subdural hematoma diagnosed in utero by ultrasonography, and MRI at 31 weeks gestation. No cause of usual intracranial hemorrhage was found. There was no trauma. The child was operated after induced vaginal delivery at 37 weeks gestation, with good results and normal neuropsychological development after one year. We discuss the symptomatology and the therapeutic attitude in such cases.

[Trauma-induced arterial aneurysm in childhood. Report of a case and review of the literature]

We report a case of calloso-marginal artery aneurysm in a 3 year old child, revealed 3 weeks after a craniocerebral trauma with frontal embarrure, by a sudden subarachnoidal hemorrhage syndrome with loss of consciousness and coma. The CT scan confirmed the subarachnoid hemorrhage in all the basal cisterns, with an interhemispheric subdural hematoma. The carotid angiography showed a right calloso-marginal aneurysm. The child has been operated (coagulation of the artery and excision of the false aneurysm. We studied the mechanism of pediatric post-traumatic aneurysm, the histological and clinical presentation emphasizing the necessity of a complete neuroradiological exploration when new neurological symptoms develop after head trauma. Neurosurgical and/or endovascular neuroradiological treatment is mandatory.

Effect of vitamin E and probucol on dietary cholesterol-induced atherosclerosis in rabbits

The preventive effect of vitamin E and Probucol against atherosclerosis in rabbits were compared. Atherosclerosis was induced by a 2% cholesterol-containing vitamin E-poor diet (5-10 ppm). Six groups of five rabbits each were studied. Group I (control) was fed on a vitamin E-poor diet. The other groups had the following supplements: group II, 50 mg/kg vitamin E i.m.; group III, 2% cholesterol; group IV, 2% cholesterol plus 50 mg/kg vitamin E i.m., group V, 2% cholesterol plus 1% Probucol; group VI, 2% cholesterol + 1% Probucol plus 50 mg/kg vitamin E i.m. After 4 weeks, aortas were removed and analyzed by light and scanning electron microscopy for atherosclerotic lesions. Samples of the media were analyzed for protein kinase C activity. The aortas of cholesterol-fed rabbits showed typical atherosclerotic lesions, detected by microscopic examination, their media smooth muscle cells exhibited an increase in protein kinase C activity. Vitamin E fully prevented cholesterol-induced atherosclerotic lesions and the induction of protein kinase C activity. Probucol was not effective in preventing either cholesterol-induced atherosclerotic lesions or the induction of protein kinase C activity. These results show that the protective effect of vitamin E against hypercholesterolemic atherosclerosis is not produced by an other antioxidant such as Probucol, and therefore, may not be linked to the antioxidant properties of this vitamin. The effects observed at the level of smooth muscle cells ex vivo suggest an involvement of signal transduction events in the protective effect of vitamin E against atherosclerosis.

The hemodynamic effects of isoflurane before and after sternotomy in patients undergoing coronary artery bypass grafting

The hemodynamic effects of isoflurane were studied in 30 patients undergoing coronary artery bypass grafting, and receiving high dose of fentanyl (40 micrograms/kg). In 15 patients, isoflurane 2% was administered for ten minutes before sternotomy, while the same concentration of isoflurane was administered in the other 15 patients after sternotomy for the same interval of time. Isoflurane administration before sternotomy produced a significant decrease in cardiac index and mean arterial pressure, without a significant change in systemic vascular resistance or other hemodynamic variables. On the other hand, when isoflurane was used to counteract sternotomy-induced hypertension, it produced a significant decrease of systemic vascular resistance, associated with a significant increase in cardiac index.