Production en ligne de liquide de substitution pour les techniques convectives

Les techniques convectives apparaissent être les modes d'épuration les plus efficaces. La stérilisation à froid du dialysat ultrapur est obtenue par ultrafiltration. Les ultrafiltres ont deux actions, Tune due à leur porosité, I'autre à leur capacity d'adsorption. Cinq moniteurs, marqués CE pouleur module de production en ligne, sont commercialisés à ce jour. La production en ligne de liquide de substitution fournit de grands volumes de liquide d'infusion a prix réduit, elle simplifie la technique d'hémodiafiltration. La stérilisation à froid a été acceptée dans plusieurs pays européens mais nest toujours pas approuvée par la Pharmacopée le liquide produit ne répondant pas aux critères de fabrication et de contrôle des liquides de perfusion. En juin 2000 les autorités sanitaires françaises ont publié une circulaire définissant les critères de sécurité indispensables à respecter pour le traitement des patients avec I'hémodiafiltration et I'hémofiltration en ligne.     

Immunogenicity and safety in newborns of a new recombinant hepatitis B vaccine containing the S and pre-S2 antigens.

A study to evaluate the safety and immunogenicity of a recombinant hepatitis B vaccine containing the S and pre-S2 antigens (GenHevac B Pasteur) was conducted in healthy newborn infants. All infants received 20 micrograms of vaccine within 24 h of birth and at 1 and 2 months with a booster injection at month 12. The vaccine was administered alone in 19 infants born to low risk mothers, i.e. surface antigen (HBsAg)-negative and antibody to the core antigen (Anti-HBc)-positive mothers. The vaccine was administered in combination with 100 IU hepatitis B immune globulin (HBIg) at birth and 1 month in 18 infants born to high risk mothers, i.e. HBsAg positive mothers. In the group not receiving HBIg, the anti-HBs seroconversion rate at the 10 mIU ml-1 threshold was 50% 1 month after the first injection. In both groups, the anti-HBs seroconversion rates were 100% 1 month after the third injection and greater than 85% 1 month after the second injection. After the booster injection greater than 90% of the infants had an anti-HBs titre greater than 1000 mIU ml-1 which will probably provide them with adequate protection for several years. The kinetics of the anti-pre-S2 response was similar to that of the anti-HBs response and 100% of infants in both groups had seroconverted 1 month after the second injection of the vaccine. The side effects were scarce, all mild and transient.(ABSTRACT TRUNCATED AT 250 WORDS)     

Use of brachial venous grafts in coronary bypass surgery

From May, 1975, to December, 1988, 30 patients (pts), 26 men and 4 women, aged 36 to 79 (average age: 58) underwent one or several aortocoronary bypass (ACB) operations requiring the use of veins from the upper limbs (VUL). Sixty operations (2.0 ACB/pt) were performed, involving the anterior interventricular artery in 27 cases, the right coronary artery in 14 and the other left vessels in 19. The grafts used were a VUL in 45 cases, an internal mammary artery in 13, a great saphenous vein in one case and a 4-mm polyurethan tube in one case. The indications for the use of a VUL included bilateral stripping in 23 patients, repeated phlebitis in one, bilateral varices in 2, and the previous use of the saphenous veins in 4 patients. The coronary lesions were a three-vessel involvement in 17 cases, a two-vessel involvement in 9 and a single-vessel involvement in 4. An additional procedure was required in two patients for the resection of a left ventricular aneurysm and for the plication of an akinetic area of the left ventricle. No intraoperative complication was observed. Perioperative mortality was of two cases (6.6%). The postoperative myocardial infarction rate was of one case (3.3%). A complication directly associated with the type of graft used (massive bleeding due to graft tearing) caused cardiac arrest in one case. Two patients presented with local disorders caused by the removal of veins from the upper limbs, including hypoesthesia of the forearm in one case and anesthesia associated with regressive muscle enfeeblement in the other.(ABSTRACT TRUNCATED AT 250 WORDS)     

Dopamine increases the expression of tyrosine hydroxylase and aromatic amino acid decarboxylase in primary cultures of fetal neurons.

Previous studies, aimed at identifying which diffusible signals may influence the differentiation of embryonic neurons towards the monoaminergic phenotypes during brain development, have shown that serotonin itself could promote the 'serotoninergic-like properties' of hypothalamic cells from mouse embryos. We presently reinvestigated such 'autocrine/paracrine' regulatory mechanisms by exposing dissociated cell cultures from embryonic rat hypothalamus and brain stem to dopamine--or related agonists--in an attempt to influence their differentiation towards the catecholaminergic phenotype. Chronic treatment of cells by dopamine or apomorphine (a mixed D1/D2 agonist), but not selective D1 and D2 agonists, significantly increased the number of cells that expressed tyrosine hydroxylase (TH: as assessed with a specific anti-TH antiserum) and the activity of aromatic L-amino acid decarboxylase (AADC) in the cultures. Furthermore, apomorphine treatment also decreased the levels of cholecystokinin-like material in primary cultures from the brainstem (but not the hypothalamus) where both dopamine and cholecystokinin are--partly--colocalized in mesencephalic dopaminergic neurons. The maximal effects of both dopamine and apomorphine on TH expression and AADC activity occurred earlier in the brainstem (on cells from 14- to 15-day-old embryos) than in the hypothalamus (on cells from 15- to 16-day-old embryos), in line with the well established caudo-rostral maturation of the rat brain. Furthermore both the expression and the dopamine-induced modulation of AADC activity and TH immunoreactivity appeared to occur independently of each other. Present and previous data are in agreement with a possible autocrine/paracrine action of dopamine and serotonin during brain development.(ABSTRACT TRUNCATED AT 250 WORDS)     

Artificial hearts. The experience of Henri Mondor University Hospital]

Results obtained with 52 patients referred for urgent heart transplantation or when transplantation was impossible because no graft, mechanical assistance or circulatory support were available, are reported. These suggest that the protocol used to select the indications of assistance and transplantation, based on the response to the introduction of enoximone into the medical treatment, allows reconciling the patients' interest-their survival-with the community's interest-i.e. the control of the costs of implemented treatments.     

Emergency aorto-coronary bypass after myocardial infarction]

During a recent three-year period, 37 patients had an emergent aortocoronary bypass (ACB) after evolutive acute myocardial infarction. The patients are divided up into two groups: group I includes 12 patients who were operated after the failure of early thrombolysis; group II includes 25 patients operated after the failure of revascularization through percutaneous angioplasty. In group I, all patients survived and 9 had no postoperative complications. In group II, the outcome was favorable for 16 patients. Long-lasting postoperative inotropic support was required for nine patients. Two patients died early. In all patients of the study, surgery failed to prevent myocardial necrosis but there was no recurrence of angina nor major left ventricular malfunction in the long term. This work suggests that early surgery after acute myocardial infarction may be a rescue procedure, with low risks and good long-term results.     

Ofatumumab capacity to deplete B cells from chronic lymphocytic leukaemia is affected by C4 complement exhaustion

The management of patients with chronic lymphocytic leukaemia (CLL) has improved with the utilisation of ofatumumab as a novel anti‐CD20 monoclonal antibody. However, as half of the patients fail to respond to the treatment, the aim of this study was to evaluate circulating CLL cell depletion and clinical response according to the context of complement activation and FcγRIIIA polymorphism in ten CLL patients with relapsed/refractory disease. At the end of the treatment, results indicated that circulating CD5⁺ CD19⁺ CLL cell depletion was major (<0.01 × 10⁹/L) in 4 of 10 patients, partial (>50% decrease) in 4 of 10 patients and ineffective for the two other patients. No clinical modifications were observed following ofatumumab introduction. Ofatumumab administration leads to a rapid and important exhaustion of complement C4 levels in patients with initial lymphocytosis. C4 exhaustion was accelerated in a non‐responder patient, and incomplete in two patients with partial circulating depletion. Moreover, delaying weekly to monthly ofatumumab injections improved CLL cell depletion in two patients. FcγRIIIA 158 polymorphism (FF n = 6 and VF n = 4) was not associated with major and/or partial circulating CLL cell depletion. In conclusion, ofatumumab induces an important C4 exhaustion that needs to be taken into account when treating CLL patients with ofatumumab.     

Ileal Varices Revealed by Recurrent Hematuria in a Patient with Portal Hypertension and Mekong Schistosomiasis

This present report describes a unique case of a patient with ileal varices revealed by recurrent bleeding from vesical varicosities. Ileal varices were associated with portal hypertension secondary to portal thrombosis. An unusual ileovesical shunt was demonstrated by the venous phase of the superior mesenteric arteriogram. This shunt was favored by adhesions between an abnormal ileal loop, which was infiltrated with ova of schistosome mekongi, and the superior vesical wall. The patient was treated successively by lysis of adhesions and ileal resection. No portacaval shunt was performed.