Effet apaisant du sucre chez le nouveau-né: revue de la littérature

Résumé  Le saccharose, administré à une concentration d’au moins 12% chez le nouveau-né à terme (24% chez le prématuré), en petite quantité (0,05 à 2 ml), dans une seringue ou mieux dans une tétine, 2 minutes avant la réalisation d’un soin douloureux avec effraction cutanée (microprélèvement, ponction veineuse), permet de réduire, plus rarement d’abolir, les comportements de détresse et/ou de douleur (pleurs et manifestations faciales). Il s’agit d’un moyen simple, non médicamenteux, et utilisable partout, qui doit pouvoir représenter une aide non négligeable chez les nouveau-nés, pour la prise en charge de la douleur provoquée par des soins modérément douloreux. Il peut être utilisé seul, mais son action limitée rend préférable de l’envisager comme technique adjuvante. Son mode d’action reste encore peu clair, ainsi que sa tolérance en cas d’administrations pluri-quotidiennes.

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Summary  Sucrose of at least 12% concentration delivered to full-term infants (24% concentration for preterm infants), in a small volume of 0.05 to 2 ml, through a syringue or better through a pacifier, 2 minutes before blood sample such as heel-stick or venipuncture, can attenuate or hardly abolish stress and/ or pain (crying and facial expressions). It is a simple non pharmacological treatment, helpful in the management of pain related to moderate painful procedures. As it exerts moderate effects, it is better used as an adjuvant treatment than used alone. Mechanisms of effects are not clear yet, as well as the occurrence of adverse effects when repeated daily administrations.

     

Assessment of the invasive potential of human gynecological tumor cell lines with the in vitro Boyden chamber assay: influences of the ability of cells to migrate through the filter membrane

The Boyden chamber assay is widely used for in vitro measurement of the invasive capacity of cells. However, results can be affected significantly if certain precautions are not taken. Using the Boyden chamber assay we investigated in vitro the invasive potential of a variety of human gynecological tumor cell lines to degrade and migrate through the artificial basement membrane matrix Matrigel. However, in the absence of this Matrigel layer large differences were observed in the ability of cells to adhere to, migrate through and attach to the lower side of the filter membranes. These differences were influenced by cell density, degree of directional locomotion, and the size of the filter pores. To adjust for these influences (which are not directly correlated to the capacity of cells to traverse the Matrigel layer), invasion results were corrected for the ability of cells to migrate through the filter membrane. In addition, the invasion of MDA-MB-231 cells was used as an internal standard to compensate for variations in the Matrigel layer between different experiments. Overall, in our experimental set up, the five human breast cancer cell lines were the most invasive (mean invasion ± SEM relative to MDA-MB-231 invasion: 104.7 ± 6.1%), the five human ovarian cancer cell lines the least invasive (60.2 ± 2.2%) and the six human endometrial cancer cell lines showed an intermediate capacity (79.1 ± 3.5%). In conclusion, the Boyden chamber assay can be used reliably for studying the invasive potential of cells in vitro, if the ability of the cells to migrate through the filter is taken into account, and a reference cell line is included to enable comparison of the data obtained from independently performed experiments on different cell lines.     

模拟医学生物化学实验血清标本的探讨

用蛋白胨、三油酸甘油酯、鼠肝、葡萄糖等材料模拟血清标本,通过测定该血清中蛋白、血脂、谷丙转氨酶、血糖以及部分物理参数,探讨了模拟血清从外观和实验项目上满足实验教学的可行性。结果表明,模拟血清实用、简便易得,既能解决医学生物化学实验教学标本来源困难问题,又能防止实验室污染和节省大量实验经费。     

Rh phenotype prediction by DNA typing and its application to practice

The complexity of the RHD and RHCE genes, which is the greatest of all blood group systems, confounds analysis at the molecular level. RH DNA typing was introduced in 1993 and has been applied to prenatal testing. PCR-SSP analysis covering multiple polymorphisms was recently introduced for the screening and initial characterization of partial D. Our objective is to summarize the accrued knowledge relevant to the approaches to Rh phenotype prediction by DNA typing, their possible applications beyond research laboratories and their limitations. The procedures, results and problems encountered are highly detailed. It is recommended that DNA typing comprises an analysis of more than one polymorphism. We discuss future directions and propose a piecemeal approach to improve reliability and cost-efficiency of blood group genotyping that may eventually replace the prevalent serology-based techniques even for many routine tasks. Transfusion medicine is in the unique position of being able to utilize the most extensive phenotype databases available to check and develop genotyping strategies.     

Combination of ABO blood group incompatibility and glucose-6-phosphate dehydrogenase deficiency: effect on hemolysis and neonatal hyperbilirubinemia

The incidence (%) of hyperbilirubinemia (serum bilirubin ≥257 μmol/l) was similar in neonates with a combination of ABO incompatibility and glucose-6-phosphate dehydrogenase (G-6-PD) deficiency (45%), with ABO incompatibility (54%) or G-6-PD deficiency (37%), alone (ns). Carboxyhemoglobin values, corrected for inspired CO, were similarly elevated in all three groups (0.87 ± 0.32%, 0.82 ± 0.29%, 0.76 ± 0.18%, respectively, ns), but correlated with bilirubin only in those with ABO incompatibility alone. ABO-incompatible/G-6-PD-deficient neonates, compared with those with either condition alone, are not at increased risk for hemolysis or hyperbilirubinemia.     

The effect of an isoprenaline infusion on the splenic blood flow and intrasplenic platelet kinetics

The effect of a constant isoprenaline infusion on the venous platelet count, splenic blood flow and intrasplenic platelet kinetics was investigated in 6 healthy male volunteers. The study was carried out using autologous 111In-labelled platelets and dynamic gamma camera imaging of the initial distribution of radiolabelled platelets between blood and splenic platelet pool. The isoprenaline infusions were administered i.v. over 30 min in a dose of 0.03 micrograms/kg/min. These infusions significantly increased the splenic blood flow and the size of the exchangeable splenic platelet pool. Concomitantly, there was a decrease of labelled as well as unlabelled platelets in the peripheral blood. The intrasplenic platelet transit time was not affected. Before start of infusion, the splenic blood flow was 6.1 +/- 2.9 (SD) % of total blood volume/min and the splenic platelet pool size 34 +/- 9 (SD) %. During infusion the corresponding values were 8.7 +/- 3.9 (SD) and 41 +/- 11 (SD), respectively. It is concluded that an i.v. infusion of isoprenaline enhances splenic pooling of platelets as a result of an increase in splenic blood flow.     

Twenty-four-hour ambulatory blood pressure profiles in pediatric patients after renal transplantation

Ambulatory blood pressure monitoring was applied in 27 pediatric patients aged 6.3 – 24.3 (median 15.0) years who had been transplanted 1.5 – 8.4 years previously. Daytime values were compared with the mean of 10 concomitant casual blood pressure recordings. At the time of the study, antihypertensive drugs were given to 17 patients. Inulin clearance ranged from 18 to 116 (median 66) ml/min per 1.73 m². Ambulatory blood pressure monitoring confirmed hypertension or normotension determined by casual blood pressure measurements in 63% of patients. The physiological nocturnal dip in blood pressure was attenuated or reversed in 8 of 27 patients. It was reduced in all 3 patients with renal artery stenosis of the graft, in 3 of 4 patients with chronic rejection, in the only patient with recurrent focal segmental glomerulosclerosis, and in 1 of 6 patients with past acute rejection. The dipping was not related to inulin clearance. In conclusion, casual blood pressure measurements do not accurately reflect blood pressure in pediatric patients transplanted more than 1.5 years previously. A reduced nocturnal dip in blood pressure may indicate an underlying renovascular or renoparenchymal pathology. Ambulatory blood pressure monitoring should regularly be applied in patients with renal transplants. Received May 23, 1995; received in revised form June 18, 1996; accepted June 20, 1996     

大白鼠肾上腺的血管构筑

本实验采用血管铸型扫描电镜,注射明胶卡红组织切片显微镜下观察和注射铅丹乳胶追踪血管来源三种方法对14只健康大白鼠肾上腺血管构筑进行了研究。大白鼠肾上腺动脉发自腹主动脉和肾动脉。它们在行程中发出分支至腺体表面,再次分支穿入囊内,逐级分支至毛细血管。皮质动脉发自囊内血管,它们在皮质中分支分布。球状带的毛细血管与囊的毛细血管相连,毛细血管在球状带围绕细胞团形成网眼状;在束状带呈放射状排列;在网状带吻合增多形成网状。髓质动脉亦发自囊的血管,它们在皮质中不发分支直抵髓质,在髓质分成毛细血管。网状带的毛细血管越向髓质口径越粗,它们在皮髓交界处互相吻合形成更粗的静脉,这些静脉逐级吻合,最后形成一主干——中央静脉,它穿出皮质出现于肾上腺门处。左侧的中央静脉注入在肾静脉,右侧的注入下腔静脉。     

Local and central sympathetic reflex control of blood flow in skeletal muscle and subcutaneous tissue in normal man

Summary. The effect of age and sex on relative changes in blood flow and vascular resistance in skeletal muscle and subcutaneous tissue during postural changes and during local increase in transmural pressure was studied in 33 healthy subjects. The intra-individual variation was studied in five subjects. Blood flow was measured by the local ¹³³Xenon wash-out method. No relation to age or sex was seen in the centrally elicited sympathetic vasoconstrictor responses in subcutaneous tissue and skeletal muscle and in the locally elicited vasoconstriction in subcutaneous tissue. A small, but statistically significant, correlation to sex and age was found in the local sympathetic vasoconstrictor response in skeletal muscle. The age correlation was caused only by an attenuated response in the young subjects below 40 years of age and may be fortuitous. The intra-individual variation was acceptably small. Based on the present results, a reduction in blood flow in skeletal muscle and subcutaneous tissue during centrally or locally elicited sympathetic vasoconstriction of 10% or less should be considered abnormal. The local ¹³³Xenon wash-out method is of value in examining patients suspected of dysfunction in the sympathetic part of the autonomic nervous system.