Amplification by hyperoxia of coronary vasodilation induced by propofol

We tested the hypothesis that in vitro coronary and myocardial effects of propofol (10-300 microM) should be significantly modified in an isolated and erythrocyte-perfused rabbit heart model in the absence (PaO(2) = 137 +/- 16 mm Hg, n = 12) or in the presence (PaO(2) = 541 +/- 138 mm Hg, n = 12) of hyperoxia. The induction of hyperoxia provoked a significant coronary vasoconstriction (-13% +/- 7%). Propofol induced increased coronary vasodilation in the presence of hyperoxia. Because high oxygen tension has been reported to induce a coronary vasoconstriction mediated by the closure of adenosine triphosphate-sensitive potassium channels, we studied the effects of propofol in 2 additional groups of hearts (n = 6 in each group) pretreated by glibenclamide (0.6 microM) and cromakalim (0.5 microM) in the absence and presence of hyperoxia, respectively. The pretreatment by glibenclamide induced a coronary vasoconstriction (-16% +/- 7%) which did not affect propofol coronary vasodilation. The pretreatment by cromakalim abolished the amplification of propofol coronary vasodilation in the presence of hyperoxia. Propofol induced a significant decrease in myocardial performance for a concentration >100 micro M both in the absence and presence of hyperoxia. We conclude that propofol coronary vasodilation is amplified in the presence of hyperoxia. This phenomenon is not explained by the previous coronary vasoconstriction induced by glibenclamide. However, the pretreatment of hearts by cromakalim abolished the amplification of propofol coronary vasodilation in the presence of hyperoxia. The myocardial effects of propofol were not affected by the presence of hyperoxia. IMPLICATIONS: Propofol induced a coronary vasodilation that was amplified in the presence of hyperoxia. This phenomenon does not seem to be related to previous coronary vasoconstriction. The myocardial effects of propofol were not significantly modified in the presence of hyperoxia.     

Facial localizations of Buruli ulcers: two cases

We report the first two published cases of a facial localization of Mycobacterium ulcerans ulcer (Buruli ulcer). M. ulcerans is the third most common mycobacteriosis, after leprosy and tuberculosis. Clinical manifestations involve large necrotic ulcerations with protruding edges, mainly localized on the limbs. Both of our patients, 9 and 45-year-old females, resided in endemic areas of Buruli ulcer in the Ivory Coast. The ulcers were located on the left zygomatic malar region in one patient and the submental region in the other. Treatment involved resection of the ulcer followed by total skin graft. Ulcer healing was observed after two months hospitalization in one patient. The other patient died.     

Open-heart surgery in sickle-cell haemoglobinopathies: report of 15 cases

Fifteen cases of open-heart surgery in patients with sickle-cell haemoglobinopathies are reported; 13 had sickle-cell trait, one had SC haemoglobinopathy, and one had β-thalassaemia sickle-cell disease. All patients except one were operated on with moderate hypothermia, aortic cross-clamping, topical hypothermia, and cold cardioplegia. A bloodless priming solution was used in nine patients and five did not receive any blood throughout their hospital stay. Arterial and venous blood gas analysis and a search for sickle cells and haemolysis were carried out during and after cardiopulmonary bypass. The data were compared with the findings in a group of 29 patients without haemoglobinopathy operated on without blood transfusion. Two patients died from low cardiac output, unrelated to the haemoglobinopathy. All other patients recovered uneventfully. Sickling occurred during and after bypass in only one case, and the percentage of sickle cells was considerably lower during and after surgery than before. Haemolysis occurred only once during cardiopulmonary bypass and twice after surgery (the two deaths from low cardiac output). There was no acidosis or hypoxia. There was no difference in the loss of haemoglobin between the 13 survivors and the control group. Our data suggest that adequate oxygenation and avoidance of acidosis and dehydration during surgery are important. On the other hand, we do not believe that preoperative transfusion or exchange transfusion, a blood prime, normothermia, and the avoidance of aortic cross-clamping or topical hypothermia are essential precautions. We believe that transfusion should be used during cardiopulmonary bypass only for severely anaemic patients. The technique used in our cases adds to the safety of the procedure and improves the protection of the myocardium.     

Ten years experience in Mali community health centers

At the end of 10 years' existence, the community health centres of Mali show a way of organisation which meets the public health requirements and demands of financial viability of any health establishment. Their originality lays in several factors: their legal personality, their private status, their financial support of the medical staff, their management by a users association and the public utilities agreement they have signed with the department. In spite of their success which makes their numbers reach 350, they suffer from great deficiencies, which are resulted by the lack of democratic traditions within the associations, a inappropriate transparency of their accounts and an inefficient supervision from the part of the department. The main questions posed by this new experience concern the limits of the concept of community, the importance of citizenship in the development dynamics, the participation of private institutions in the accomplishment of public utilities, the jacobin and authoritarian attitude of the department representatives, the contradictions between multiplication of centres to improve geographic access and the requirements of financial viability.     

Experimental in vitro efficacy study on the interaction of epiroprim plus isoniazid against Mycobacterium tuberculosis

Thirty Mycobacterium tuberculosis strains (8: INH(R)/INH(R), 12: INH(R)/RIF(S), 10: INH(S)/RIF(S)) were examined against MICs of epiroprim (EPM) and isoniazid (INH) separately or in association. EPM alone proved to be insufficiently active against the various mycobacterial isolates (MIC > or =256 microg/ml). The observed average sensitivity to the association of EPM plus INH was, in contrast, considerably increased, as reflected by reduced MICs and lower percentages of resistant strains. MICs ranged between 16 and 32 microg/ml EPM and 2 and 4 microg/ml INH for INH(R) strains. All INH(S) isolates were inhibited by a concentration of 0.125 microg/ml EPM and 0.06 microg/ml INH. The fractional inhibitory concentration indices indicated an additive activity on INH(R)/RIF(R) strains and a synergistic activity on INH(R)/RIF(S) and INH(S)/RIF(S) strains. The synergistic activity of this drug association needs to be confirmed in an animal model.     

Daily titration of neurally adjusted ventilatory assist using the diaphragm electrical activity

Purpose  

To determine the feasibility of daily titration of the neurally adjusted ventilatory assist (NAVA) level in relation to the maximal diaphragmatic electrical activity (EAdi_maxSBT) measured during a spontaneous breathing trial (SBT) during pressure support ventilation (PSV).     

Direct Current Cardioversion in Abidjan: Report of a Ten-year Practice in Institute of Cardiology of Abidjan, Ivory Coast

Direct current cardioversion is effective in arrhythmias' termination. Few is known about its use in our practice. This work aims to report its outcomes over a ten-year period in Abidjan. Method. One thousand, three hundred and ninety one charts of arrhythmic patients were reviewed. Results. Cardioversion was attempted in 102 patients. One hundred and eighty one shocks were delivered with a mean energy of 262, 1 joules. Success occurred in 84 patients (82,3%). Cardioversion failed in 18 patients mostly in atrial fibrillation. Eight serious complications (7,8%) occurred including 1 sinus node dysfunction, 1 pulmonary oedema, 1 metrorrhagia, 2 stroke, 1 pulmonary embolism. Two patients with ventricular tachycardia died of end-stage heart failure and aftermath of a mitral valve surgery. Conclusion. Direct current cardioversion is effective and safe in our practice. Complications are predominantly due to the medical environment such as antiarrhythmic drugs use or clinical conditions.