Atypical pleural effusion by transdiaphragmatic communication. Apropos of two cases: chylothorax and hydrothorax]

We report two cases of pleural effusion in which a subdiaphragmatic cause was noted. In both cases it was necessary to obliterate a defect in the diaphragm via a thoracic incision. In one case, a left chylothorax occurred in a patient with hepatic cirrhosis. In this case, it was postulated that the normal lymphatic pathway through the right hemidiaphragm could have been stopped by pleural sequelae from right lobectomy. In the other case, a right pleural effusion occurred after peritoneal dialysis. It is a well known pathological entity: the structural defect can be observed by separation of collagen bundles in the tendinous diaphragm. This type of pleuro-peritoneal communication is well known in women suffering from menstrual pneumothorax or in patients treated by peritoneal dialysis.     

Effects of natural oestrogen/progestogen substitution therapy on carbohydrate and lipid metabolism in post-menopausal women

Oral glucose tolerance tests were performed in 30 post-menopausal women before and after 1 mth and 6 mth of cyclic 17 beta-oestradiol/norethisterone acetate substitution therapy. Before undergoing treatment the patients were divided into three groups comprising subjects with normal glucose tolerance, subjects with impaired glucose tolerance and diabetic subjects receiving oral diabetic treatment respectively. Carbohydrate metabolism was evaluated during a 2-h oral glucose tolerance test following a 100 g glucose load. Both blood glucose and plasma insulin values were measured. The fasting serum cholesterol and triglyceride levels were also determined. Hormone substitution therapy had no effect on fasting blood glucose values in any of the three groups. At the end of the 6 mth substitution therapy, however, it was found that the blood glucose values in the subjects with impaired glucose tolerance were significantly lowered by the end of the 2-h test period. The glucose areas under the curve during oral glucose tolerance tests following the hormone treatment were also reduced in this same group. In the case of insulin, the areas under the curve remained unchanged in all three groups. Fasting serum cholesterol levels tended to fall, while the triglyceride levels remained unaltered, during the hormone treatment periods. However, a slight increase in triglyceride levels was observed in the subjects with impaired glucose tolerance.     

High plasmatic angiotensin-converting enzyme (ACE) activity is not correlated with training-induced left ventricular growth in ACE congenic rats

Aim: The aim of this study was to determine the influence of angiotensin‐converting enzyme (ACE) genotype on left ventricular growth after endurance training, in ACE congenic rats with plasma ACE activity twice as high as the donor strain (LOU), thus mimicking the ACE I/D polymorphism observed in humans. Methods: LOU and congenic rats (n = 12) were submitted to an endurance training on a treadmill for 7 weeks, while similar LOU and congenic rats (n = 10) constituted the control groups. Blood pressure, skeletal muscle citrate synthase activity, plasma and left ventricular ACE activity were assessed, and echocardiography was performed before and after the training. Results: Angiotensin‐converting enzyme plasmatic activity of congenic rats (188.2 ± 26.6 in controls and 187.1 ± 22.6 IU in trained rats respectively) was twofold that of the LOU strain (91.9 ± 23.3 in controls, and 88.3 ± 18.1 IU in trained rats respectively). After training, congenic and LOU rats showed a similar significant increase in citrate synthase activity (P < 0.05), and in the left ventricular mass/body mass ratio × 10³: 3.7 ± 0.3 and 3.6 ± 0.6 in the trained congenic and LOU groups, respectively, vs. 3.0 ± 0.1 and 2.9 ± 0.2 in the control congenic and LOU groups respectively (P < 0.05). There was no significant correlation between ACE plasma activity and left ventricular mass in trained or untrained congenic rats. Conclusion: We conclude that training‐induced left ventricular growth is not associated with plasma ACE activity in congenic rats.     

Unacknowledged adverse transfusion reactions: Are they a mine to dig?

Objectives

Haemovigilance has long tried to characterize and understand transfusion reactions in order to prevent them. Unacknowledged ones are now a minority but they question us. Are they the result of incomplete clinical setting and/or insufficient medical reasoning, or can they contain real new entities we have not yet understood?

Acute supra-therapeutic oral terbutaline administration has no ergogenic effect in non-asthmatic athletes

This study aimed to investigate the effects on a possible improvement in aerobic and anaerobic performance of oral terbutaline (TER) at a supra-therapeutic dose in 7 healthy competitive male athletes. On day 1, ventilatory threshold, maximum oxygen uptake $ (\dot{V}O_{2\max }) $ and corresponding power output were measured and used to determine the exercise load on days 2 and 3. On days 2 and 3, 8 mg of TER or placebo were orally administered in a double-blind process to athletes who rested for 3 h, and then performed a battery of tests including a force–velocity exercise test, running sprint and a maximal endurance cycling test at Δ50 % (50 % between VT and $ \dot{V}{\text{O}}_{2\max } $ ). Lactatemia, anaerobic parameters and endurance performance ( $ \dot{V}{\text{O}}_{ 2} ,\dot{V}E $ and time until exhaustion) were raised during the corresponding tests. We found that TER administration did not improve any of the parameters of aerobic performance (p > 0.05). In addition, no change in $ \dot{V}{\text{O}}_{2} $ kinetic parameters was found with TER compared to placebo (p > 0.05). Moreover, no enhancement of the force–velocity relationship was observed during sprint exercises after TER intake (p > 0.05) and, on the contrary, maximal strength decreased significantly after TER intake (p < 0.05) but maximal power remained unchanged (p > 0.05). In conclusion, oral acute administration of TER at a supra-therapeutic dose seems to be without any relevant ergogenic effect on anaerobic and aerobic performances in healthy athletes. However, all participants experienced adverse side effects such as tremors.     

Survival of patients with resected N2 non-small-cell lung cancer: evidence for a subclassification and implications.

PURPOSE: Patients who suffer from non-small-cell lung cancer (NSCLC) with ipsilateral mediastinal lymph node involvement (N2) belong to a heterogeneous subgroup of patients. We analyzed the prognosis of patients with resected N2 NSCLC to propose homogeneous patient subgroups. PATIENTS AND METHODS: The present study comprised 702 consecutive patients from six French centers who underwent surgical resection of N2 NSCLC. Initially, two groups of patients were defined: patients with clinical N2 (cN2) and those with minimal N2 (mN2) disease were patients in whom N2 disease was and was not detected preoperatively at computed tomographic scan, respectively. RESULTS: The median duration of follow-up was 52 months (range, 18 to 120 months). A multivariate analysis using Cox regression identified four negative prognostic factors, namely, cN2 status (P <. 0001), involvement of multiple lymph node levels (L2+; P <.0001), pT3 to T4 stage (P <.0001), and no preoperative chemotherapy (P <. 01). For patients treated with primary surgery, 5-year survival rates were as follows: mN2, one level involved (mN2L1, n = 244): 34%; mN2, multiple level involvement (mN2L2+, n = 78): 11%; cN2L1 (n = 118): 8%; and cN2L2+ (n = 122): 3%. When only patients with mN2L1 disease were considered, the site of lymph node involvement according to the American Thoracic Society numbering system had no prognostic significance (P =.14). Preoperative chemotherapy was associated with a better prognosis for those with cN2 (P <.0001). Five-year survival rates were 18% and 5% for cN2 patients treated with and without preoperative chemotherapy, respectively. CONCLUSION: This study has identified homogeneous N2 NSCLC prognostic subgroups and suggests different therapeutic approaches according to the subgroup profile.     

Carp erythrocyte lipids as a potential target for the toxic action of zinc ions

The effects of zinc on the lipid components of carp erythrocytes (Cyprinus carpio L.) were studied on red blood cells exposed to ZnSO4 (0.01-1 mM) for 20 h. The temperatures of the incubation medium were 5 and 20 degrees C for carp collected in winter and summer, respectively. It was observed that increase in the concentration of metal ions in the medium led to significant changes in the content of the main phospholipid classes. Zinc induced the reduction of phosphatidylcholine as well as the increase in the content of phosphatidylserine and phosphatidylinositol. A marked increase in the levels of malondialdehyde and conjugated dienes was also found both in the cells and the incubation medium. Moreover, elevated Zn concentrations caused alterations in the erythrocyte plasma membrane fluidity, estimated by measuring the fluorescence of 1-[4-trimethylaminophenyl]-6-phenyl-1,3,5-hexatriene and 12-[9-anthroyloxy]stearic acid, located on the surface and in the hydrophobic regions of the lipid bilayer. This study in vitro confirmed that higher concentrations of zinc ions induce marked changes in the composition and structure of membrane lipids in carp erythrocytes.