Rachianesthésie à la bupivacaïne à 0,5 % sans glucose. Effets de l''âge

The effects of age on the characteristics of spinal anaesthesia with plain bupivacaine were investigated in 29 adult patients (less than 50 yr : group I), and 37 older patients (greater than or equal to 80 yr : group II). Three millilitres of 0.5% solution (15 mg) were injected at the L3-L4 interspace in the lateral position; the patients were turned supine immediately afterwards. The onset, extent and duration of sensory and motor blockade, the cardiovascular effects and the quality of anaesthesia were evaluated. Anaesthesia was unsatisfactory in one patient in group I and two patients in group II; they required a supplement with intravenous inhalation anaesthesia. These patients were not included in the analysis of the variables studied. The time to maximum spread was significantly shorter in the group I : 7.3 min versus 9.9 min in group II. A higher sensory spinal blockade was obtained in the older age group (T 10.4 versus T 11.2). There were no significant difference between the two groups in the mean time from the injection to recovery from analgesia in the two uppermost segments (121 min versus 107 min). The mean duration of analgesia at the L2 level did not differ significantly (149 min versus 164 min). All the patients had complete motor blockade of lower limbs. Only the Bromage's degrees 2 and 1 were greater in the elderly's group. In the older group, there was a tendency to a greater decrease in systolic arterial pressure from the preanaesthetic values (-20.9% versus -13%). But moderate falls in mean and diastolic arterial pressures were observed.(ABSTRACT TRUNCATED AT 250 WORDS)     

A novel fluorometric assay for aldo-keto reductase 1C3 predicts metabolic activation of the nitrogen mustard prodrug PR-104A in human leukaemia cells

Aldo-keto reductase 1C3 (AKR1C3, EC 1.1.1.188) metabolises steroid hormones, prostaglandins and xenobiotics, and activates the dinitrobenzamide mustard prodrug PR-104A by reducing it to hydroxylamine PR-104H. Here, we describe a functional assay for AKR1C3 in cells using the fluorogenic probe coumberone (a substrate for all AKR1C isoforms) in conjunction with a specific inhibitor of AKR1C3, the morpholylurea SN34037. We use this assay to evaluate AKR1C3 activity and PR-104A sensitivity in human leukaemia cells. SN34037-sensitive reduction of coumberone to fluorescent coumberol correlated with AKR1C3 protein expression by immunoblotting in a panel of seven diverse human leukaemia cell lines, and with SN34037-sensitive reduction of PR-104A to PR-104H. SN34037 inhibited aerobic cytotoxicity of PR-104A in high-AKR1C3 TF1 erythroleukaemia cells, but not in low-AKR1C3 Nalm6 pre-B cell acute lymphocytic leukaemia (B-ALL) cells, although variation in PR-104H sensitivity confounded the relationship between AKR1C3 activity and PR-104A sensitivity across the cell line panel. AKR1C3 mRNA expression showed wide variation between leukaemia patients, with consistently higher levels in T-ALL than B-ALL. In short term cultures from patient-derived paediatric ALL xenografts, PR-104A was more potent in T-ALL than B-ALL lines, and PR-104A cytotoxicity was significantly inhibited by SN34037 in T-ALL but not B-ALL. Overall, the results demonstrate that SN34037-sensitive coumberone reduction provides a rapid and specific assay for AKR1C3 activity in cells, with potential utility for identifying PR-104A-responsive leukaemias. However, variations in PR-104H sensitivity indicate the need for additional biomarkers for patient stratification.     

Right ventricular strain in patients with pulmonary embolism and syncope

Journal of Thrombosis and Thrombolysis - Patients with acute pulmonary embolism (PE) can present with various clinical manifestations including syncope. The mechanism of syncope in PE is not fully...     

Electrocortical measures of performance monitoring from go/no-go and flanker tasks: Differential relations with trait dimensions of the triarchic model of psychopathy

This study examined associations of performance-monitoring event-related potentials (ERPs) from go/no-go and flanker tasks with one another, and with psychopathy-related traits of disinhibition, meanness, and boldness. A task-dependent relationship was evident between the error-related negativity (ERN) and trait disinhibition, with high-disinhibited participants showing reduced no-go ERN but not flanker ERN. Disinhibition was also inversely related to variants of the P3 and the error positivity (Pe) from these two tasks. A factor analysis of the ERPs revealed two distinct factors, one reflecting shared variance among the P3 and Pe measures from the two tasks, and the other covariance among the N2 and ERN measures. Scores on the P3/Pe factor, but not the N2/ERN factor, were inversely related to disinhibition, and accounted for associations of this trait with variants of the P3 and Pe across tasks. The implication is that high trait disinhibition relates mainly to reductions in brain responses associated with later elaborative stages in the processing of motivationally significant events across different tasks. Importantly, no-go ERN predicted disinhibition scores beyond N2/ERN factor scores, indicating that high disinhibition is not generally related to diminished early preresponse conflict and error processing, but rather to processing impairments in conditions calling for inhibition of prepotent response tendencies.     

Comparison of Short-Term Effectiveness and Postoperative Complications: Laparoscopic Gastric Plication vs Laparoscopic Sleeve Gastrectomy

Introduction

Bariatric surgeries are the only effective long-term treatment in obese patients. The innovation of laparoscopic gastric plication (LGP) raised some questions about its effectiveness compared to traditionally used techniques such as laparoscopic sleeve gastrectomy (LSG). We tried to answer some of these questions.

Materials and Methods

We investigated 70 patients in a randomized clinical trial (IRCT2013123012294N5) from 2012 to 2015. Thirty-five patients were randomly assigned to each LSG or LGP group, using sealed envelope method. The body mass index (BMI) reduction and the percentage of excess weight loss (%EWL) along with %total body weight loss (%TWL) were primary endpoint and were assessed at follow-up periods. We recorded postoperative complications, as well.

Results

Two-year follow-up rate was 100%. There were no statistically significant differences between the two groups in means of preoperative BMI. Also, postoperative follow-ups were not suggestive for a significant difference in BMI (all p values > 0.05). The mean %EWL at follow-ups showed no significant difference at any point, except for 3 and 6 months after surgery (p value = 0.002 and 0.017, respectively). This finding was confirmed by %TWL trend in 12 months after surgery. LSG patients were readmitted more than LGP patients (seven cases vs one case, p value = 0.024). Postoperative complications such as nausea and vomiting, hair loss, iron deficiency, vitamin D deficiency, and cholelithiasis were not different between the two groups. There was one death in the LGP group due to pulmonary thromboembolism.

Conclusions

LGP showed to be efficient regarding %EWL and %TWL reduction in short-term follow-ups with comparable postoperative complications to LSG.

     

Minimizing diaphragmatic injury during radiofrequency ablation: efficacy of intraabdominal carbon dioxide insufflation

OBJECTIVE: The purpose of our study was to determine whether intraperitoneal insufflation of carbon dioxide (CO(2)) reduces adjacent diaphragmatic injury. MATERIALS AND METHODS: In seven pigs under anesthesia, a 17-gauge percutaneous insufflation needle was inserted in the infraumbilical midline using a standard insufflator. Three to six liters of CO(2) was infused into the peritoneal space to achieve at least a 1-cm separation between the liver and the diaphragm and maintained by a pressure of 8-10 mm Hg. Seven control lesions in six historical controls were used. In addition, five lesions were created in one animal from this cohort who served as a control. Superficial areas of liver separated from diaphragm were fluoroscopically targeted for radiofrequency ablation, and several 2-cm-diameter radiofrequency lesions were generated. The pigs were sacrificed at 48 hr, and at laparotomy, the liver surface was inspected and sectioned to select lesions with centers within 1 cm of the surface. The thermal injury to the corresponding adjacent diaphragm was examined to determine the depth of injury. Diaphragmatic injury was graded on a scale from 0 to III (0, no injury; I, mild injury to one-third thickness; II, moderate injury to two-thirds thickness; III, severe injury to full thickness.) RESULTS: Of 72 total lesions created, 60 had centers less than 1 cm from the liver surface (i.e., superficial) at laparotomy. Of these 60 lesions, 55 caused no significant diaphragmatic injury, two caused grade I injury and three caused grade III injury. In comparison, seven of seven historic superficial control lesions and five of five superficial radiofrequency control lesions from the current cohort caused grade III injury. Superficial radiofrequency lesions created after intraperitoneal CO(2) insufflation caused significantly less (p < 0.01) diaphragmatic injury. CONCLUSION: We have shown that in pigs, intraperitoneal CO(2) insufflation helped significantly reduce severe diaphragmatic injury when superficial hepatic radiofrequency ablation was performed.     

Cycle-to-cycle variation in utero-ovarian hemodynamic indices in ovarian stimulation and natural cycles of the same women and its effect on the outcome of assisted reproduction treatment

OBJECTIVE: To investigate the blood flow parameters between cycles of the same women to assess whether parameters predicting a successful pregnancy in a stimulation cycle could be used to determine the outcome of subsequent natural cycles. DESIGN: A prospective study. SETTING: Assisted reproduction unit, the University of Hong Kong. PATIENT(S): Fifty-eight IVF cycles and 40 natural cycles were evaluated. INTERVENTION(S): Assessments of the utero-ovarian pulsatility indices (PIs), resistance indices (RIs), and endometrial color signals. RESULT(S): In IVF cycles, the pregnancy rate (27%) was similar to that in frozen-thawed embryo transfer (FET) (28%) cycles. The utero-ovarian PIs and RIs in IVF cycles were significantly lower than those in the natural cycles. There was a significant correlation between the uterine PI in stimulation cycles and that in natural cycles. In IVF cycles, the pregnancy rate declined significantly when the uterine PI was >2.70 and the RI was >0.9. In FET cycles, no decline in pregnancy rate was seen. Conceptional FET cycles showed significantly higher uterine PI, uterine RI, and endometrial color signals compared with conceptional IVF cycles. CONCLUSION(S): Hemodynamic parameters in stimulation cycles are different from those in natural cycles, and the values of various parameters in predicting pregnancy are also different.