Gallbladder pathology in the Ivory Coast. Contribution of ultrasonics

Ultrasound imaging was first used in the two hospital and university centers of Abidjan in 1983, and findings since then have demonstrated the previously unrecognized frequency and variability of gallbladder affections. Particular conditions of functioning of an ultrasonography department in tropical surroundings are analyzed and ultrasound features of bile stones, cholecystitis and gallbladder cancer described.     

In vitro kinetics of the activity of fusidic acid and fluoroquinolones combinations against staphylococci according to methicillin-resistance phenotype. Implications for the treatment of osteoarticular infections]

The kinetics of the effect of fusidic acid and of two fluoropiperazinyl quinolones (ofloxacin and pefloxacin), used alone or in combination, on ten methicillin-susceptible or methicillin-resistant strains of staphylococci were studied. Little or no bactericidal effects were seen with fusidic acid. With ofloxacin and pefloxacin, the bactericidal effect was delayed and occurred only with high concentrations. Used in combination, fusidic acid and the fluoroquinolones exhibited no synergistic effects and occasionally antagonized each other in vitro. The methicillin-resistance phenotype of organisms had no influence on results.     

Heat-moulded plastic splint for the nose]

The authors present a very simple and very comfortable splinting device for use after rhinoplasty. It consists of a splint made from malleable plastic which can be moulded by soaking in water at 60 degrees C, allowing perfect modelling to the shape of the nose. This splint is held in place by means of Velcro bands which offer remarkable flexibility of use.     

A new series of antiarrhythmic procainamide derivatives: toxicity and activity-simulated passive absorption relation

Several compounds derived from benzamidines and nicotinic pyridinic amidines with a structure similar to that of procainamide, exhibit notable antiarrhythmic properties after injection into animals. The diffusion rate of these different compounds through a solid lipidic artificial membrane was studied with Dibbern's apparatus. A statistical relation was established between the diffusion rate and the principal pharmacological parameters obtained after intraperitoneal injection (toxicity and anthiarrhythmic activity). Essential structural elements seem to determine a better bioavailability than procainamide: character of the substitution (in para) of the benzenic cycle; length of the lateral chain.     

From substance dependence to addiction: impact of a conceptual shift on therapeutic approaches?

Switching from the concept of substance or alcohol dependence to that of addiction has profoundly modified our ways of approaching, treating and organizing the care of this disease. This more complex and subtle approach gives less importance to the substance and its effects and focuses more on the initiation of pathological behavior. It is important to keep in mind that the addictive process associates a substance (more or less addictive), an individual (more or less vulnerable) and an environment (more or less condoning). Today, it is no longer possible to consider that a drug acts on only one receptor or one system. Current understanding of inner regulation mechanisms integrates the interactions between the various stimulated brain pathways. Addiction treatments which should benefit from advances in genetics, neuropsychology and neuroimaging could be increasingly individualized in the years to come. The "addictology" approach has triggered thinking about other therapeutic approaches such as modification of therapeutic objectives toward "risk reductions" or applying this model to behavioral addictions (food, sex, sport, gaming...). This conceptual shift seems to enrich clinical analysis, the therapeutic possibilities and the avenues for research.     

Drug addiction, love, and the higher power

This discussion piece suggests that reliance on a Higher Power in drug abuse recovery programs is entertained among some addicts for its psychobiological effects. Prayer, meditation, early romantic love, and drug abuse may have in common activation of mesolimbic dopaminergic pathways of the brain and the generation of intense emotional states. In this sense, reliance on a Higher Power may operate as a substitute addiction, which replaces the psychobiological functions formerly served by drug use. Implications of this perspective are discussed.     

A severe form of Chryseobacterium indologenes pneumonia in an immunocompetent patient

We report a case of severe pneumonia due to Chryseobacterium indologenes in an immunocompetent patient. Chryseobacterium indologenes (formerly Flavobacterium indologenes) are saprophytic Gram-negative rods widely distributed in damp environment. Many sites of infection were described in the literature. These infections are always severe sometimes associated to multiple organ failure. The evolution is usually favorable with antibiotic treatment. Bacteria characteristically grow as yellow-pigmented colonies. They are naturally resistant to many antimicrobial agents. They are usually susceptible to piperacillin(DCI) alone or combined with tazobactam(DCI), ceftazidime(DCI), cefepime(DCI), fluoroquinolones(DCI), rifampin(DCI) and cotrimoxazole(DCI), but the in vitro susceptibility to these antibiotics should be systematically tested. Nevertheless, the optimum antibiotic treatment for Chryseobacterium-related infections remains to be established. In the case we report, the diagnosis was made according to the results of bronchial sample bacterial culture. This case report underlines the need for specific management of patients infected with this species.     

The VenaTech LP permanent caval filter: effectiveness and safety in the prevention of pulmonary embolism--a European multicenter study

PURPOSE: To evaluate (i) the appropriateness, safety, and patient outcomes after placement of the VenaTech LP caval filter and (ii) the success of filter insertion through various venous access routes. MATERIALS AND METHODS: An open multicenter prospective observational study was conducted in 12 European centers, including an initial part limited to four centers. Patients with common indications were eligible for inclusion after approval by an independent ethics committee. Over a 42-month period, 106 patients (46 men [43.4%], 60 women [56.6%]), 72.2 years +/- 13.3 of age (range, 37-97 y), with poor prognoses were included. Patients were examined 2-5 days after the procedure, then at 30 days +/- 5 and 90 days +/- 15 for clinical follow-up and filter assessment. Evaluation criteria were based on occurrence of pulmonary embolism (PE), adverse events, death, filter position, and caval patency. Data were available in 101 case report forms at days 2-5, in 75 at day 30 +/- 5, and in 60 at day 90 +/- 15. Two patients (1.9%) were lost to follow-up. RESULTS: The overall mortality rate was 20.8%. PE was present in 71 patients (67.0%). History of venous thromboembolic disease (VTED) was noted in 32 patients (30.2%), and recently diagnosed VTED was present in 101 patients (95.3%). Partial caval thrombosis was present before the procedure. Filter tilting of 10-45 degrees was seen in 3.9% of cases at days 2-5, 4.3% of cases at day 30 +/- 5, and 1.9% of cases at day 90 +/- 15. Follow-up evidenced neither clinical signs of PE nor significant device-related events. CONCLUSIONS: In a prospective patient cohort with a projected 3-month mortality rate of nearly 21.0% as a result of severe prognoses, the success of insertion via various venous access routes and the appropriateness and safety of the VenaTech LP caval filter were assessed. Findings at 90-day follow-up were free of symptomatic PE and device-related adverse effects.