Elective laparoscopic colectomy for sigmoid diverticulitis. Prospective study of 56 cases

OBJECTIVE: The aim of this prospective study was to assess the feasibility and postoperative advantages of the laparoscopic-assisted elective colectomy for diverticular disease. PATIENTS AND METHODS: From january 1989 to december 1997, among the 114 patients electively operated on for diverticulitis, 56 patients were treated by laparoscopic approach. Evaluated parameters included: gender, age, weight, size, ASA score, operating time, duration of hospital stay, of analgesic treatment, and of postoperative ileus, morbidity and mortality rate. RESULTS: The study group consisted of 35 women and 21 men. Mean age was 59 years (34-81 years); 29 patients were ASA 1 and 27 ASA 2. Overall postoperative mortality rate was 0% and morbidity rate 16% (n = 9). There were no complications directly related to laparoscopic technique. The conversion rate was 14% (n = 8). Mean operating time was 300 min (200-600 min). Mean duration of postoperative ileus was 2.4 days. Mean duration of hospital stay was 9.4 days. CONCLUSION: This study demonstrates the feasibility of elective laparoscopic-assisted colonic resection for diverticular disease in more than 80% of cases with a postoperative morbidity and mortality rate comparable to those of conventional surgery.     

Results of randomized controlled trials of low-versus high-osmolality contrast media

The authors reviewed 100 randomized controlled trials (RCTs) conducted in humans to compare safety or efficacy of new low-osmolality contrast media (LOM) with that of high-osmolality contrast media (HOM). Findings of the 43 RCTs judged to be of the highest quality suggest that the efficacy of LOM in imaging is equal or superior to that of HOM for all routes of administration. Heat sensation occurred less often with LOM for all routes and pain occurred less often with LOM for intraarterial routes. No differences were seen in nephrotoxicity or in frequency of nausea, vomiting, urticaria, bronchospasm, laboratory test abnormalities, or neurologic events. Greater cardiovascular changes were seen with HOM, including increased or decreased heart rate, increased left ventricular end-diastolic pressure, decreased systolic pressure, and QT prolongation, depending on route of administration. To demonstrate whether a reduction in clinically significant adverse outcomes truly occurs with LOM, trials will need to enlist larger numbers of patients and employ appropriate outcome measures. Future trials should stratify patients according to their risk of adverse reactions to provide better information about benefits of LOM in low- versus high-risk patients.     

Direct and reversible inhibitory effect of the tetrapeptide acetyl-N- Ser-Asp-Lys-Pro (Seraspenide) on the growth of human CD34+ subpopulations in response to growth factors

The tetrapeptide Acetyl-N-Ser-Asp-Lys-Pro (AcSDKP, Seraspenide; Ipsen- Biotech, Paris, France), an inhibitor of murine spleen colony-forming units reduces the number and the percentage in DNA synthesis of progenitors from human unfractionated bone marrow. To determine whether AcSDKP may directly affect the growth potential of purified progenitors even at the most primitive level, CD34+HLA-DRhigh and CD34++HLA-DRlow cells were highly purified by cell sorting. Then, CD34+ subsets were stimulated in liquid culture with combinations of growth factors (GFs) and AcSDKP was added for 20 hours or 6 days and cells plated in methylcellulose. After a 20-hour incubation, we show that AcSDKP (at 10(-10) mol/L) significantly inhibits the colony formation of both CD34+ subsets. Moreover, when added daily for 6 days, AcSDKP: (1) reduces the proliferation of both CD34+ cell fractions stimulated by 3 or 7 GFs, and (2) decreases the number of progenitors generated from the CD34+HLA-DRhigh and CD34++HLA-DRlow cell fractions. Furthermore, we show for the first time, using both high proliferative potential cell and long-term culture initiating cell assays, that AcSDKP inhibits the most primitive cells contained in the CD34++HLA-DRlow subpopulation. Finally, by using limiting dilution assays we demonstrated that AcSDKP acts directly at a single cell level and that its inhibitory effect is reversible and dose dependent.     

Rhodium effects on Pt anode materials in a direct alkaline ethanol fuel cell

The development of efficient catalysts for ethanol oxidation in alkaline medium requires a synthetic approach that may prevent the surfactant molecules from being adsorbed at the catalytic sites and decreasing the electrochemical performance of the final direct ethanol fuel cell. Toward this goal, the recently reported surfactant-less Bromide Anion Exchange (BAE) method, appears as a promising route to conveniently aim at preparing PtRh alloys dispersed on carbon substrates. The catalysts prepared herein by the BAE method were characterized physicochemically to obtain structural information on the PtRh/C nanomaterials, their morphology (size and shape), and their chemical and surface composition. Electrochemical behavior and properties of these electrodes were then investigated in a half-cell before the implementation of a direct ethanol fuel cell (DEFC) in a home-made anion exchange membrane Teflon cell. The analysis of the electrolytic solution in the anodic compartment by chromatography revealed that acetate was the major reaction product and the carbonate amount increased with the Rh content in the bimetallic composition. With 2.8–3.6 nm particle sizes, the Pt₅₀Rh₅₀/C catalyst exhibited the highest activity towards the ethanol electrooxidation.

The development of efficient catalysts for ethanol oxidation in alkaline medium requires an approach that avoids surfactant molecules from being adsorbed at active sites and decreasing the electrochemical performance of the direct ethanol fuel cell.     

Immune Reconstitution Inflammatory Syndrome Secondary to Mycobacterium kansasii Infection in a Kidney Transplant Recipient

Nontuberculous mycobacteria (NTM) infection is a challenging diagnosis for clinicians in solid organ transplantation. Immune reconstitution inflammatory syndrome (IRIS) is so far unreported in this context. We report here the case of a renal transplant recipient who developed Mycobacterium kansasii–associated lymphadenitis complicated by IRIS while undergoing reduction of his immunosuppressive therapy. For IRIS, the patient required low‐dose steroids and an increase in global immunosuppression, in association with NTM antibiotherapy.     

Time division multiplexing based method for compressing ECG signals: application for normal and abnormal cases

The proposed ECG compression method combines three major approaches based on time division multiplexing (TDM) and multilevel wavelet decomposition followed by parametrical modelling. Before applying these techniques, a pre-processing step is required, which consists of detecting and aligning different beats. Even though this compression method is regarded as a lossy method, we will show how a high compression ratio (CR) can be achieved by preserving the major medical information within the ECG. Several normal and abnormal signals from various databases are used to evaluate the performance of the proposed technique.