Anatomic basis of the liver for the development of a perihepatic prosthesis

We studied specimens from 50 cadavers (27 men and 23 women) to obtain anatomical data concerning the liver and its attachments. The results allowed us to develop a polyglactin perihepatic prosthesis for compression of the injured liver. The falciform ligament and a narrowing of the hepatic parenchyma at this level allow attachment of the prosthesis. Separate prostheses were designed for each lobe. Clinical use has demonstrated that our prosthesis can be used to achieve effective control of haemorrhage and bile leakage.

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Etude anatomique du foie. Développement d'une prothèse péri-hépatique

Résumé Sur une série de 50 pièces anatomiques d'adultes (27 hommes, 23 femmes), l'étude morphométrique du foie, de ses attaches dorsales et leurs variations a permis la confection d'une prothèse périhépatique en polyglactine adaptable à chaque lobe et fixée grâce à des artifices anatomiques. Celle-ci assure une compression efficace du parenchyme lésé et donc une hémostase et une bilistase correctes. Le ligament falciforme et le rétrecissement du parenchyme hépatique à son niveau assurent le maintien de la prothèse. Un exemplaire a été réalisé pour chaque lobe.

     

Vertebral hydatidosis and paraplegia

We report the management of two children and 11 adults with paraplegia secondary to vertebral hydatidosis. Destruction of pedicles, posterior vertebral elements and discs as well as the vertebral bodies was common and all six patients with thoracic disease had involvement of adjacent ribs. The 13 patients had a total of 42 major surgical procedures; two patients died from postoperative complications and four from complications of the disease and paraplegia. All eight patients initially treated by laminectomy or anterior decompression alone relapsed within two years and seven required further surgery. Circumferential decompression and grafting gave the best results, six of nine patients being in remission an average of three years and six months later. The prognosis for such patients is poor; remission is the aim, rather than cure. Anthelminthic drugs may improve the prognosis, but radical surgery is likely to remain the keystone of treatment in the foreseeable future.     

Viscoelastic properties of human arteries methodology and preliminary results

In order to study the biomechanical properties of the arterial wall and to compare arteries with different histologic structures, we designed a device that allows testing of arterial segments under near-physiologic conditions. A hydrodynamic generator simulates systolo-diastolic pressures in an open loop. An intraarterial pressure sensor and a sonomicrometer connected to two piezoelectric crystals placed in diametric opposition on the arterial wall allow computer calculation of compliance, stiffness, midwall radial arterial stress, Young modulus, and incremental modulus for a given arterial segment at a given pressure setting. Seven healthy common carotid artery (CCA) segments and seven healthy (superficial) femoral artery (FA) segments were studied immediately after removal from brain-dead donors between the ages of 18 and 35 years. Histologic examination was performed to determine the density of elastic fibers in the arterial wall. Hysteresis was observed in all segments regardless of pressure settings. Compliance was greater and modulus values and stiffness were lower in CCA than in FA. No evidence of structural change was noted after testing in the circulation loop. These preliminary results open the way to a wide variety of applications for our hydrodynamic circulation loop. Experiments will be undertaken to compare the mechanical properties of arteries before and after cryopreservation.

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Propriétés visco-élastiques des artères humaines. Méthodologie et résultats préliminaires

Résumé Dans le but d'étudier les propriétés mécaniques de la paroi artérielle et de pouvoir établir des comparaisons entre des segments artériels de structure histologique différente, nous avons mis au point un banc d'essai hydrodynamique permettant de tester des segments artériels dans des conditions voisines de la réalité physiologique. Un générateur hydrodynamique permettait d'obtenir dans un circuit ouvert un régime de pressions de type systolo-diastolique. Un capteur de pression intra-artériel, ainsi qu'un sonomicromètre relié à des cristaux piézo-électriques placés de façon diamétralement opposée sur la paroi artérielle, permettaient de calculer, pour un régime de pressions donné et grâce à l'acquisition de données dans un système informatique, la compliance, la rigidité, la contrainte trans-pariétale, le module de Young, le module incrémentiel d'un segment artériel. Nous avons étudié sept artères carotides communes (CC), et sept artères fémorales (superficielles) (F) fraîchement prélevées chez des sujets sains âgés de 18 à 35 ans. Des corrélations avec la richesse en fibres élastiques de la paroi artérielle ont été établies. Nous avons mis en évidence un phénomène d'hystérésis pour chaque artère testée quel que soit le niveau de pression considéré. La compliance des artères CC a été plus importante, les modules et la rigidité ont été moins importants et ce de façon significative par rapport aux artères F. Aucune altération histologique n'a été mise en évidence après passage des segments artériels au banc d'essai. Ces résultas préliminaires nous permettent d'envisager de nombreuses applications à ce travail dont l'une d'entre elles sera la mesure comparative des propriétés mécaniques des artères avant et après cryopréservation.

     

Midterm Outcomes of Embolisation of Internal Iliac Artery Aneurysms

ObjectivesThere is no standardised technique for internal iliac artery aneurysm (IIAA) embolisation and results of long-term prevention of rupture are unknown.DesignWe retrospectively evaluated technical aspects and results of IIAA embolisation in a multicentre study.MethodsAneurysm morphology and embolisation techniques were reviewed. Aneurysm-related death, rupture, diameter increase, endoleak, secondary procedure and complication related to the IIA occlusion were recorded.ResultsBetween 2001 and 2011, 53 patients with 57 IIAA were treated. Mean diameter of IIAA was 41 mm (range: 25–88 mm). Embolisation techniques were distal and proximal occlusion (n = 24), proximal occlusion (n = 18) and sac packing (n = 15). Cumulative overall survival rate was 92% at 1 year, 83% at 3 years and 59% at 5 years. No cause of deaths was related to aneurysm. Aneurysm diameter increased in five patients and endoleak was observed in 11 patients. One secondary open conversion and five secondary endovascular procedures were performed for increase of diameter or proximal endoleak. Two patients experienced a disabling buttock claudication.ConclusionsEmbolisation of IIAA is safe in the short- and midterm. However, endoleak and aneurysm diameter increases are not rare. Yearly post-procedure computed tomography angiography seems appropriate.     

Multidisciplinary team meeting for complex bone and joint infections diagnosis: The PHICTOS study

Background

In France, the most severe bone and joint infections (BJI), called “complex” (CBJI), are assessed in a multidisciplinary team meeting (MTM) in a reference center. However, the definition of CBJI, drawn up by the Health Ministry, is not consensual between physicians. The objective was to estimate the agreement for CBJI classification.

Decreased Mechanical Strength and Collagen Content in SPARC‐Null Periodontal Ligament Is Reversed by Inhibition of Transglutaminase Activity

The periodontal ligament (PDL) is a critical tissue that provides a physical link between the mineralized outer layer of the tooth and the alveolar bone. The PDL is composed primarily of nonmineralized fibrillar collagens. Expression of secreted protein acidic and rich in cysteine (SPARC/osteonectin), a collagen‐binding matricellular protein, has been shown to be essential for collagen homeostasis in PDL. In the absence of SPARC, PDL collagen fibers are smaller and less dense than fibers that constitute WT PDL. The aim of this study was to identify cellular mechanisms by which SPARC affected collagen fiber assembly and morphology in PDL. Cross‐linking of fibrillar collagens is one parameter that is known to affect insoluble collagen incorporation and fiber morphology. Herein, the reduction in collagen fiber size and quantity in the absence of SPARC expression was shown to result in a PDL with reduced molar extraction force in comparison to that of WT mice (C57Bl/6J). Furthermore, an increase in transglutaminase activity was found in SPARC‐null PDL by biochemical analyses that was supported by immunohistochemical results. Specifically, collagen I was identified as a substrate for transglutaminase in PDL and transglutaminase activity on collagen I was found to be greater in SPARC‐null tissues in comparison to WT. Strikingly, inhibition of transglutaminase activity in SPARC‐null PDL resulted in increases in both collagen fiber thickness and in collagen content, whereas transglutaminase inhibitors injected into WT mice resulted in increases in collagen fiber thickness only. Furthermore, PDL treated with transglutaminase inhibitors exhibited increases in molar extraction force in WT and in SPARC‐null mice. Thus, SPARC is proposed to act as a critical regulator of transglutaminase activity on collagen I with implications for mechanical strength of tissues. © 2015 American Society for Bone and Mineral Research     

Efficacy and safety of low dose aztreonam in the treatment of moderate to severe gram-negative bacterial infections

One hundred and fifty-three patients with moderate to severe infections due to Gram-negative bacteria, including septicaemia (60 cases), lower respiratory tract infection (32 cases), intra-abdominal infection (40 cases) and urinary tract infection (21 cases), were treated with aztreonam 1 g every 12 h. This dosage is lower than usual. Criteria for inclusion included documented Gram-negative bacterial infections, and assessment of the severity of the disease by a scoring system for both community and hospital acquired infections. No other antibiotic active against Gram-negative bacteria was allowed. In 71 patients, in whom Gram-positive or anaerobic organisms were detected or suspected, additional agents effective against these organisms were administered. One hundred and forty-one patients (92.2%) were cured with a mean duration of treatment of 10.9 +/- 4.0 days. None of the Gram-negative bacteria initially isolated became resistant to aztreonam. Colonization, generally by a Gram-positive organism, was observed in 27 patients and superinfection in five. Aztreonam was well tolerated. This study suggests that a daily dosage of 2 g of aztreonam should be sufficient in the treatment of moderate to severe Gram-negative bacillary infections due to sensitive organisms.     

A study on the venom of Bothrops alternatus Duméril, Bibron and Duméril, from different regions of Argentina

We report a comparison of toxic and enzymatic activities of Bothrops alternatus venoms collected from specimens of different regions of Argentina with a pool of these same venoms. We determined lethal, hemorrhagic and pro-coagulant (plasma and fibrinogen) doses, as well as indirect hemolysis, hydrolysis of gelatin and fibrinogen. The electrophoretic pattern of the venoms and that of fibrinogen incubated with each of the venoms was studied by SDS-PAGE. The toxic activities were consistent with those reported for these venoms but with noticeable differences between samples which do not seem related to geographical or climatic characteristics. In some cases the pooled venom showed values close to the individual samples, but it was not representative since at least the half of the venoms (4/9) exhibited very different patterns of toxicity. The potency of some activities in the individual venoms ranged from much higher to much lower than those determined in the pooled venom (0.1 to 3 fold). Not all venoms exhibited thrombin-like activity but all hydrolyzed α and β chains of fibrinogen; however, degradation patterns were not always similar. Variation in activities and toxicities do not seem to be related to geographical or climatic characteristics.