Retransplantation of the liver after side-to-side caval anastomosis

Caval reconstruction in orthotopic liver transplantation is generally performed by two end-to-end anastomoses, using a portal and caval-axillary bypass to sustain hemodynamic stability. In the piggyback modification, the donor's suprahepatic inferior vena cava (IVC) is anastomosed end-to-side to the recipient's preserved IVC. We have used a recently described variant of the piggyback in 18 patients in whom both IVCs are anastomosed side-to-side. We report two patients who needed three retransplants after this reconstruction and conclude that regrafting can be performed in a quick and safe manner.     

Interleukin-1Β, interleukin-6, and growth hormone levels in human follicular fluid

Purpose To investigate possible relationships of interleukin-1 (IL-1, interleukin-6 (IL-6), and growth hormone (GH) with biochemical variables in human follicular fluid (FF) and selected in vitro fertilization (IVF) parameters.Methods A total of 67 FF samples (n=67 patients undergoing oocyte retrieval for IVF) was evaluated. IL-1, IL-6, GH, hLH, FSH, PRL, hCG, testosterone, total protein, fibrinogen, sialic acid, ₁-antitrypsin, plasminogen levels, and spectrophotometric absorbance at 458 nm were analyzed for selected FF. IL-6 and GH levels of serum and FF samples were also compared (n=23).Results Immunoreactive levels of IL-1, IL-6, and GH were detected in all FF samples. A positive correlation existed for IL-6 (r=0.5069, P=0.0161 when serum-to-FF levels were compared (concentration ratio, 11.857). Smaller-volume follicles (<4 ml) were associated with high IL-1 levels (P=0.0229, and an additional tendency of IL-1 to decrease with increasing embryo cleavage and scoring was observed. With the exception of a weak positive correlation between follicular IL-1 and testosterone levels (r=0.3128, P=0.025, no other relationship with biochemical variables or IVF parameters (etiology, e.g., endometriosis) could be implicated.Conclusions Substantially higher IL-6 levels occurred in FF compared to serum, thus supporting intrafollicular production. Interleukin- 1,IL-6, and GH levels in FF are, however, unsuitable markers for in vitro fertilization outcome.     

Hemodynamic effects of medical antishock trousers during mechanical ventilation

Purpose

To compare the hemodynamic effects of medical antishock trousers (MAST) inflation in mechanically ventilated patients with normal and poor left ventricular function.

Methods

Twelve patients requiring respiratory support were divided into two groups according to baseline transesophageal echocardiography (TEE) measurements: normal left ventricular dimensions and fractional area of contraction (FAC=61 ± 5%) (n=7) and dilated cardiomyopathy with reduced FAC (21 ± 1%) (n=5). All patients were studied when two successive levels of load (mild load by inflation of the leg compartment of MAST at 50 cmH₂O and high load by adding the abdominal compartment of MAST inflated at 30 cmH₂O) were applied. Global left ventricular systolic function was assessed on the TEE transgastric short-axis view. End-systolic wall stress (ESWS) was used as an indicator of left ventricular afterload.

Results

Total respiratory, lung and chest wall compliances were reduced by 48%, 51% and 27% respectively at the high load level (P < 0.05). Whereas no hemodynamic changes occurred at mild load, the high load level produced an increase in left ventricular afterload as evidenced by concomitant increases in diastolic arterial blood pressure (66 ± 6 to 79 ± 6 mmHg,P < 0.05) and ESWS (69 ± 12 to 74 ± 12 Kdyn·cm^?2·m^?2,P < 0.05). In patients with dilated cardiomyopathy, this increase in afterload impaired the left ventricular systolic function and end-systolic area increased (19.0 ± 2.5 to 21.4 ± 2.9 cm²·m^?2,P < 0.05) while FAC decreased (22 ± 2 to 16 ± 2%,P < 0.05). Left ventricular end-diastolic area remained unchanged during the study in both groups.

Conclusion

MAST inflation impairs respiratory mechanics and global left ventricular systolic function in cardiac patients without changes in left ventricular preload.     

Physical fitness and sport activity of children and adolescents: Methodological aspects of a regional survey

Summary Measurement of physical fitness and physical activity in children and adolescents raise a lot of methodological issues, explaining the scarcity of surveys in European countries and in Switzerland. This article exposes the design and the methods used in a survey on physical fitness, physical activity and health conducted in a region of Switzerland, and discuss the choice of the instruments and the quality control procedure selected to measure physical activity and physical fitness. The survey was conducted in a sample of 3540 students 9–19 years-old and included a battery of physical fitness tests, anthropometrics measurements and a self-report questionnaire on physical activity, sports activity and life styles. An ancillary study in a sub sample assessed daily physical activity with a pedometer, dietary intake with a 3-day dietary record, serum lipids and nutritional status. Some results are displayed as example. Quality control techniques are exposed and the choice of the instrument to assess physical fitness, physical activity, sports, and dietary intake are discussed. Local reference tables are now available for fitness tests and the practicability of fitness testing has been demonstrated in physical education. The research process has induced the sensitisation of schools toward health promotion through physical activity.

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Zusammenfassung Das Messen der physischen Kondition und der physischen Aktivität von Kindern und Adoleszenten wirft eine Vielzahl methodologischer Fragen auf, weshalb wohl in europäischen Ländern und in der Schweiz bisher nur wenige solche Untersuchungen durchgeführt wurden. Es sollen in dieser Studie, welche in einer Region der Schweiz zum Thema physische Kondition, körperliche Betätigung und Gesundheit durchgeführt wurde, die zur Anwendung gekommenen Untersuchungsmethoden dargestellt und das eigentliche Vorgehen beschrieben werden. Ebenfalls werden die instrumentenwahl sowie die für diese Studie ausgearbeiteten Verfahren zur Qualitätssicherung der Messungen der physischen Kondition und der physischen Aktivität diskutiert. Die Untersuchung wurde mit einer Auswahl von 3540 neun-bis neunzehnjährigen Schülern durchgeführt und beinhaltet die Messung der physischen Kondition mit Hilfe einer Testserie, anthropometrische Messungen und einen Fragebogen zur physischen Aktivität, sportlichen Betätigung und zum Lebensstil. Eine Zusatzstudie wurde in einem Teilkollektiv durchgeführt. Dabei wurden die tägliche physische Aktivität mit Hilfe eines Pedometers gemessen, während drei Tagen ein Tagebuch über die Nahrungsaufnahme geführt und die Lipidwerte im Blut sowie der Ernährungszustand analysiert. Einige Ergebnisse werden als Beispiel aufgeführt. Die zur Qualitätsgarantie der erfassten Daten eingesetzten Massnahmen, sowie die Wahl der für die Messungen der physischen Kondition, der körperlichen Aktivität, der sportlichen Betätigung und der Ernährung verwandten Instrumente werden diskutiert. Das Erstellen von lokalen Referenztabellen zur physischen Kondition von Jugendlichen erlaubte es, die Konditionstests in den Sportunterricht einzuführen und schulnahe Kreise dafür zu sensibilisieren, dass die körperliche Betätigung für eine Strategie der Gesundheitsförderung eine wichtige Rolle spielt.

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Résumé La mesure de la condition physique et de l'activité physique des enfants et des adolescents pose des problèmes méthodologiques particuliers, qui expliquent sans doute le petit nombre d'études de ce type dans les pays européens et en Suisse. Cet article présente la procédure et les méthodes utilisées dans une enquête sur la condition physique, l'activité physique et la santé, réalisée dans un canton de Suisse et discute le choix des instruments et des procédures mises en uvre pour assurer la qualité des mesures de la condition physique et d'activité physique. L'enquête a été conduite dans un échantillon de 3'540 élèves de 9 à 19 ans et comprenait des mesures de la condition physique grâce à une batterie de tests, des mesures anthropométriques et un questionnaire sur l'activité physique, la pratique sportive et les habitudes de vie. Dans un souséchantillon, on a utilisé un pédomètre mesurant l'activité physique quotidienne, un journal alimentaire de trois jours et un dosage sanguin des lipides et du status nutritionnel. Quelques résultats sont donnés à titre d'exemple. Les mesures mises en place pour assurer la qualité des données recueillies sont discutées, ainsi que le choix des instruments de mesure de la condition physique, de l'activité physique, de la pratique sportive et de l'alimentation. La réalisation de tables de référence locales pour les tests de condition physique a permis d'introduire l'utilisation des tests de condition physique dans l'enseignement de l'éducation physique, et de sensibiliser le milieu scolaire à l'importance de l'activité physique dans une stratégie de promotion de la santé.

     

Epidemiology of lyme disease in France: Lyme borreliosis in the region of Berry sud: A six year retrospective

The purpose of this epidemiologic retrospective is to recognize the endemic nature of Lyme borreliosis in Berry, region of France. Fifty-nine cases have been reported here during the past six years (1988–1994). An erythema migrans (EM), or a late manifestation concurrent with positive ELISA-test represents the main inclusion criterion (case definition used by the CDC). The results reveal a high incidence considering the limited information available in France. The farmer has been found to be mainly at risk, with EM being observed in 49% of cases. In general, late manifestations are rarely described. Peripheral neurological manifestations occur more frequently than those reported in the USA. The steps taken as a result of our study of Lyme disease are in accordance with the recommendations of the World Health Organization.Participants in this survey: GEEP, Groupe d'Etudes Epidémiologiques et Prophylactiques, Centre Hospitalier Intercommunal de Villeneuve Saint Georges, France; and ORMAT, Observatoire Rural des Maladies Transmissibles, Antenne du GEEP, Centre Hospitalier de La Châtre, France}     

Properties of fibres,endplates and acetylcholine receptors in the diaphragm,masseter, laryngeal,abdominal and limb muscles in the goat

Purpose

Although differences in fibre composition, fibre size or acetylcholine receptor (AChR) density between muscles have often been proposed to explain the unequal sensitivities of muscles to muscle relaxant drugs, it is not clear whether or how these parameters differ among muscles or are related to one another. In this study, several muscles were examined to determine the composition and cross-sectional area (CSA) of types I and II fibres, the surface area of their motor endplates (ESA), and their AChR density.

Methods

Biopsies from the thyroarytenoideus, cricoarytenoideus dorsalis, masseter, diaphragm, transversus abdominis, rectus abdominis, gastrocnemius and soleus muscles of goats were processed by muscle histochemistry and morphometry and the ESA:CSA ratio was computed. The number and density of AChRs per endplate were estimated by¹²⁵I-α-bungarotoxin binding studies.

Results

The mean type 1 fibre composition (range: 0–100%), fibre diameter (28–50 μm) and the ESA:CSA ratio (0.27–1.01) differed among muscles (P = 0.0001), but there were no significant differences (P > 0.05) in the mean endplate size (577–725 μm²), AChR number (6.6?14.5 × 10⁶) or AChR density (8,900–22,300 μm^?2) probably because of marked individual variations. Fibre size increased and the ESA:CSA ratio decreased in the order laryngeal, diaphragm, jaw, limb and abdominal muscles.

Conclusion

It is concluded that between muscles fibre size varies more than endplate size or AChR number.     

Diffusion of information about genetic risk within families

Recent developments in genetics are likely to exacerbate the ethical issues in clinical practice, especially with regard to privacy and disclosure of genetic information. To evaluate the behaviour of patients with respect to transmitting carrier information, we undertook a survey of 283 families with a balanced chromosomal rearrangement as a model. In these families, 1816 relatives were considered at risk and 806 of them were karyotyped (44.4%). The percentage of karyotypes performed is significantly related to the number of living children of the index couple, the reason for referral, the nature of the anomaly, the training of the counsellor and the age of the index case. This study shows the limits of the screening of at risk individuals within families, based on the willingness of the patients, and addresses practical and ethical issues around family disclosure in medical genetics.