The Use of a Fabricated Endotracheal Tube During an Acute Massive Pulmonary Hemorrhage: A Case Report

A massive pulmonary hemorrhage is an emergency that can lead to airway compromise and cardiovascular collapse. The goals of airway management are to isolate and protect the nonbleeding lung while providing a route for interventions to diagnose and control the bleeding site. We present a case of an adult male with a lung mass who underwent a bronchoscopy and cryobiopsy that was complicated by a massive pulmonary hemorrhage. We report the successful use of an elongated fabricated end-to-end endotracheal tube to manage his airway during this time-critical situation.

The Rare Codon AGA Is Involved in Regulation of Pyoluteorin Biosynthesis in Pseudomonas protegens Pf-5

The soil bacterium Pseudomonas protegens Pf-5 can colonize root and seed surfaces of many plants, protecting them from infection by plant pathogenic fungi and oomycetes. The capacity to suppress disease is attributed to Pf-5's production of a large spectrum of antibiotics, which is controlled by complex regulatory circuits operating at the transcriptional and post-transcriptional levels. In this study, we analyzed the genomic sequence of Pf-5 for codon usage patterns and observed that the six rarest codons in the genome are present in all seven known antibiotic biosynthesis gene clusters. In particular, there is an abundance of rare codons in pltR, which encodes a member of the LysR transcriptional regulator family that controls the expression of pyoluteorin biosynthetic genes. To test the hypothesis that rare codons in pltR influence pyoluteorin production, we generated a derivative of Pf-5 in which 23 types of rare codons in pltR were substituted with synonymous preferred codons. The resultant mutant produced pyoluteorin at levels 15 times higher than that of the wild-type Pf-5. Accordingly, the promoter activity of the pyoluteorin biosynthetic gene pltL was 20 times higher in the codon-modified stain than in the wild-type. pltR has six AGA codons, which is the rarest codon in the Pf-5 genome. Substitution of all six AGA codons with preferred Arg codons resulted in a variant of pltR that conferred increased pyoluteorin production and pltL promoter activity. Furthermore, overexpression of tRNAUCUArg, the cognate tRNA for the AGA codon, significantly increased pyoluteorin production by Pf-5. A bias in codon usage has been linked to the regulation of many phenotypes in eukaryotes and prokaryotes but, to our knowledge, this is the first example of the role of a rare codon in the regulation of antibiotic production by a Gram-negative bacterium.

[Stomach duplications apropos of a case revealed by digestive hemorrhage. Value of ultrasonic endoscopy. Review of the literature]

Double stomach is a relatively rare inborn malformation. Manifestations are usually observed during the neonatal period or in early childhood. In adults, complications usually lead to diagnosis. Echographically and endoscopically, the malformation takes on the aspect of a tumour of the gastric mesenchyme. Echo-endoscopy is required for diagnosis. Surgery is the only treatment with or without exeresis of the gastric collar surrounding peripheral often pediculated lesions. Laparoscopic control may be helpful. Other procedures may be adapted on a case by case basis. Prognosis depends on associated malformations.

[Technique of isoperistaltic esophageal gastroplasty. Comparative study of in vitro arterial vascularization]

Operative survival is impaired by anastomotic fistula after esophageal resection and reconstruction. Hypovascularisation of esophageal substitute is essential. Stomach is a useful esophageal substitute however proximal resection of lesser curvature compromises vascularisation of the highest point of fundus which is usually sutured to esophagus. To improve this a new S shape esophagoplasty with isoperistaltique stomach was achieved. Fifteen cadaveric stomachs were assigned to three equal groups prepared as follow: narrow J shape stomachs, large J shape stomachs, large S shape stomachs. The arterial tree was studied following injection of contrast media barium from the right gastroepiploic artery. Proximal arteries of the S shape stomachs were well filled comparing to the others. This was allowed by keeping intact the tronc of the left gastric artery branches, severing the left gastroepiploic artery close to the spleen, and dividing the proximal fundal region as a curve.

Lupus psychosis: differentiation from the steroid-induced state

Steroid induced psychosis in SLE is rare but clinically important, and often difficult to distinguish from lupus cerebritis. We report a patient with SLE who became depressed following an increase in her steroid dosage. Based on her clinical presentation and high levels of antibodies to P ribosomal proteins (both in CSF and serum) a diagnosis of lupus cerebritis was made. Steroid dosage, time intervals, and the duration of mental changes may help in differentiating steroid psychosis from lupus cerebritis. No single laboratory test sufficient to establish a definitive diagnosis of lupus cerebritis is available at the present time. However, elevated levels of antibodies to P ribosomal proteins may assist in confirming the diagnosis of this condition.

[Should routine exploratory laparotomy be performed in the presence of an abdominal wound? Discussion apropos of 176 cases]

Management of abdominal wounds is presently the subject of discussion between the partisans of routine laparotomy and those preferring "armed" surveillance. Results of study of a series of 176 abdominal wounds subjected to surgical dogma showed: that the diagnosis of non penetrating wounds (17.6%) was not always evident, due either to their anatomical localization (frontier region wounds) or to insufficient local exploration in urgent cases (6.6% of false-negatives), that the existence of serious clinical signs (50 cases) was always associated with one or more visceral lesions, requiring urgent laparotomy with a morbidity of 20% and a mortality of 8% (4 cases), that in the case of asymptomatic penetrating wounds (96 cases), routine laparotomy did nevertheless allow the diagnosis of visceral lesions in 50 cases (including 23 major lesions) but was of no utility in 46 cases (31.5% of blind laparotomies for the total series). The elevated proportion of useless laparotomies (30% in the literature), the result of a dogmatic attitude, or the risk of a delayed intervention (5 to 8%) in the series practising the selective method, led to a modification in the authors' attitude. The existence of serious signs should obviously result in a laparotomy. In their absence, and when confronted with a penetrating or doubtful (frontier region) wound, an exploratory celioscopy is proposed to ensure complete abdominal exploration, to confirm the presence or absence of penetration, to treat minimal lesions and to perform a classical laparotomy in case of evident necessity.

[Utility of serotyping in the study of Serratia marcescens infections in Strasbourg Hospitals (author's transl)]

A total of 1,499 Serratia marcescens strains were isolated in Strasbourg University Hospital within a period of three years. Serotyping could split this collection into 37 different serotypes. Two serotypes (014:H12 and 013:H17) were responsible for a persistent S. marcescens endemic. Serotype 014:H12 was mostly recovered from sputa, whereas serotype 013:H17 was mostly recovered from urine. These two serotypes had different antibiotic resistance patterns.