Tissue near infra red spectroscopy change is not correlated with patients' outcome in elective cardiac surgery.

BACKGROUND: Microcirculatory disturbances following cardiac surgery with cardiopulmonary bypass (CPB) are thought to be at the origin of organ dysfunction, although few studies have correlated microvascular alterations with outcome. We aimed to assess the microcirculation with near infrared spectroscopy (NIRS) and correlate NIRS parameters with intensive care length of stay and organ dysfunction. METHODS: Forty patients at increased risk of postoperative systemic inflammatory response syndrome after an elective cardiac surgery with CPB were included in this prospective observational study. Microcirculation of the thenar eminence was analysed by NIRS technology, through the tissue oxygen saturation (StO2 ) and the recovery slope after an ischaemic challenge. Organ dysfunction was assessed with the Sequential Organ Failure Assessment (SOFA) score. Microcirculation parameters were recorded at baseline, at different time points during the surgery and the first 48 postoperative hours. RESULTS: StO2 at baseline was 82% and decreased significantly until 77% at 2 h after CPB. Recovery slope values were 4.3% per second at baseline and decreased to 2.5% per second during CPB (P < 0.05). From 12 h after CPB time point, both parameters were not statistically different from baseline anymore. We found no correlation between microcirculatory parameters and mean arterial pressure, cardiac index, intensive care unit (ICU) length of stay or SOFA score. CONCLUSION: This study confirms, through a non-invasive technology, a significant but transient alteration of the microcirculation during elective cardiac surgery. However, as these microvascular alterations were not correlated with patient's outcome, NIRS-derived parameters seem to be of limited interest in the cardiac surgery setting.

Beat-by-beat cardiovascular index to predict unexpected intraoperative movement in anesthetized unparalyzed patients: a retrospective analysis.

OBJECTIVE: Unexpected intraoperative movement may be detrimental during delicate surgery. This study tested retrospectively an algorithm based on beat-by-beat circulatory variables (incorporated into a Cardiovascular depth of anesthesia index: CARDEAN in relationship to unexpected movement, and compared its performance to that of the electroencephalogram (EEG)-derived index: BIS-XP 4.0. METHODS: 40 ASA I or II patients presenting for knee surgery had EEG (BIS XP 4.0), beat-by-beat (Finapres) finger non-invasive blood pressure (BP), conventional brachial BP and electrocardiogram (EKG) monitors attached. Anesthesia was induced and maintained with propofol and remifentanil. Before incision, the propofol concentration was set to maintain BIS < 60. From incision to emergence, the anesthesiologist was denied access to BIS or Finapres. Anesthesia adjustment was titrated at the discretion of the anesthesiologist according to conventional signs only: brachial BP, EKG, eyelash reflex, movement. Occurrences of movement and eye signs (divergence of eyeballs, tears, corneal reflex, eyelash reflex) were observed. The CARDEAN algorithm was written retrospectively and tested vs. BIS. RESULTS: 11 movements occurred in 8 patients. CARDEAN > 60 predicted movement in 30% of the cases, 15 to 274 s before movement (sensitivity: 100%, specificity: 95%; relative operating curve ROC = 0.98; prediction probability pk = 0.98). BIS > 60 predicted movement in 19% of cases (sensitivity: 64%; specificity: 94%, ROC: 0.85, pk: 0.85). CONCLUSION: Retrospectively, a cardiovascular index predicted unexpected intraoperative movements. Prospective validation is needed.

Predominance of serotype-specific mucosal antibody response in Shigella flexneri-infected humans living in an area of endemicity.

The mucosal humoral immune response elicited following Shigella flexneri infection in patients living in Antananarivo districts (Madagascar Island) was evaluated by measuring the gut-derived, circulating immunoglobulin A (IgA) antibody-secreting cells (ASC) specific for the major bacterial antigen lipopolysaccharide (LPS). Fifty, 34, 11, and 5% of the S. flexneri-positive patients were infected with serotypes 2a, 1a, 4a, and 3a, respectively. The total number of IgA ASC in infected patients increased significantly, compared to the number in healthy controls, early after the onset of disease. The number of anti-homologous LPS IgA ASC varied among individuals and peaked between days 5 and 10 after the onset of the disease. In the S. flexneri 1a- and 2a-infected patients, the level of IgA ASC cross-reactivity to heterologous S. flexneri serotypes was weak. These data indicate that S. flexneri 2a and 1a are the predominant strains responsible for shigellosis in this area of endemicity and that the anti-LPS antibody response following natural infection is mainly directed against serotype-specific determinants.

[Prevalence of Helicobacter pylori infection in Tananarive, Madagascar]. / Prévalence de l'infection à Helicobacter pylori à Tananarive, Madagascar.

During a 8-month period, Helicobacter pylori infection has been studied in 140 patients who presented upper gastrointestinal symptoms. Helicobacter pylori was searched in antral biopsy specimens using standard bacteriological methods (Gram-staining, urea-test, culture) and histological staining techniques (hematoxylin-eosin-saffron, undifferentiated Giemsa). The global prevalence of H. pylori infection was 59%. The prevalence rates did not seem to differ with age and sex but H. pylori infection was significantly more frequent in patients with an active duodenal ulceration (30 of 41) compared with those with a normal endoscopy (21 of 47) (p < 0.02).

[Thrombopenia induced by heparin: treatment with Org 10172. Tolerability and efficacy]. / Thrombopénie induite par l'héparine: traitement par l'ORG 10172. Tolérance et efficacité.

OBJECTIVES: Heparin-induced thrombocytopenia is a relatively common and potentially serious adverse complication of heparin treatment. After heparin withdrawal initiation of an alternative anticoagulant is often indicated. Org 10172 or Orgaran is a mixture of several non-heparin low molecular weight glycosaminoglycans with proven antithrombotic efficacy. Unlike low molecular weight heparins, Org 10172 has a low cross reaction rate (about 10%) with the heparin-dependent antibody. METHODS: We present nine patients with heparin induced thrombocytopenia. Org 10172 was prescribed to treat or to prevent a thromboembolic event. RESULTS: Seven patients required further parenteral anticoagulant at diagnosis of heparin-induced thrombocytopenia. Org 10172 was given at prophylactic doses for three patients with a high thrombosis risk and at therapeutic doses for four patients who presented either a venous or an arterial thrombosis related to thrombocytopenia. Two patients presented heparin-induced thrombocytopenia four to six years earlier and needed a parenteral anticoagulation treatment in a post-operative period. CONCLUSION: For the nine patients, Org 10172 was a safe and effective antithrombotic treatment. However, strict monotoring of the platelet count is absolutely mandatory during Org 10172 therapy.

Epidemiological study of infantile rotavirus diarrhoea in Tananarive (Madagascar).

An epidemiological study of rotavirus infections was conducted in Tananrive, Madagascar, from November 1988 to October 1990. Rotavirus antigen was detected by ELISA in faecal specimens of 183 of 1,659 children with acute diarrhoea (11%) and in 11 of 631 specimens from children without diarrhoea (1.7%). Rotaviral diarrhoeas were most frequently found in infants aged 6 to 18 months and occurred throughout the year with a definite peak during the first winter months. Analysis of the viral RNA by polyacrylamide gel electrophoresis permitted the characterisation of 170 and 194 strains identified. Nine different electropherotypes (A-I) and one mixed infection were observed. The "short" electropherotypes (A-E) were predominant and represented 140 strains (82.4%), and the "long" electropherotypes (F-I and M) represented 30 strains (17.6%). The "short" electropherotype A (cafb) was the most frequent in our environment (45.3% of cases) and was predominant during the first 14 months of the study. The "long" electropherotype F (bbea) appeared in July 1990 and was predominant during the last three months. Among these children with diarrhoea, the presence of rotavirus was significantly associated with vomiting, fever, and moderate to severe dehydration. However, no significant differences in the occurrence of these symptoms were found between the "short" and "long" electropherotypes.

[Preliminary study of the prevalence of Helicobacter pylori in Tananarive, Madagascar and the antibacterial activity in vitro of 13 Malagasy medicinal plants on this germ]. / Etude préliminaire de la prévalence d'Helicobacter pylori à Tananarive, Madagascar et de l'activité anti-bactérienne in vitro sur ce germe de 13 plantes médicinales malgaches.

Helicobacter pylori infection has been studied in 60 patients who were suffering from either a peptic ulcer disease or a gastritis complaint. Helicobacter pylori was searched in antral biopsy specimens using standard bacteriological methods (Gram-staining urea-test, culture) and histological staining techniques (hematoxylin-eosin-saffron, undifferentiated Giemsa). The culture was successful in 40 cases. The antibacterial activity of 13 malagasy medicinal plants has been tested versus Helicobacter pylori using disc method on agar culture. For five extracts, we observed an anti-Helicobacter pylori activity which would deserve further investigations.

[Antibiotic resistance of strains of Shigella dysenteriae and flexneri isolated in Tananarive and on the east coast of Madagascar]. / Résistance aux antibiotiques de souches de Shigella dysenteriae et flexneri isolées à Tananarive et sur la côte-est de Madagascar.

From November 1988 to March 1989, stools from 804 Malagasy children were examined, thirty-seven strains of Shigella were isolated, from which 5 S. dysenteriae serotype 1 (= Shiga bacillus) strains were found to be resistant to ampicillin, carbenicillin, streptomycin, chloramphenicol, tetracycline, sulphonamide and even to trimethoprim. Resistance to trimethoprim has appeared only recently in Madagascar.

A cohort study of enteric campylobacter infection in children from birth to two years in Bangui (Central African Republic).

A cohort of 111 children from Bangui, Central African Republic, was followed for enteric campylobacter infection from birth until the age of 2 years. Stools were examined at each episode of diarrhoea, and bi-weekly up to the age of 6 months irrespective of the presence of diarrhoea. 349 episodes of diarrhoeal illness were recorded (1.6 per child-year). Campylobacters were isolated from 41 (11.7%) of the 349 episodes, but in half of them another enteric pathogen was also isolated. Campylobacters were statistically associated with diarrhoea only before the age of 6 months. Bi-weekly sampling up to this age detected 75 infections (1.3 per child-year), yet only 12 (16%) were associated with diarrhoea. Campylobacter coli was isolated slightly more often (51%) than C jejuni (49%); biotyping and serogrouping showed that no strain was especially associated with disease. Fewer children who had campylobacter infection before the age of 6 months suffered campylobacter diarrhoea between 6 and 24 months of age than those who did not, but the difference did not reach statistical significance. A significantly higher rate of isolation was found in the homes of infected children (human and animal contacts) than of non-infected children. Campylobacter infections were statistically associated with the presence of live poultry and the lack of piped water in homes.

The embolic type of popliteal entrapment syndrome.

The authors describe their experience with two patients who presented with clinical extremes of popliteal entrapment syndrome. One patient presented with acute ischemia and the second patient presented with a chronic Buergerian-like syndrome. The common denominator for both of them was embolic phenomena originating at the site of entrapment. Discussion is centered on pathogenesis of the embolic phenomenon, prevalence of distal arterial degradation and its clinical manifestation. The clue for differentiation from true Buerger disease is the angiographic pattern demonstrating apparently healthy distal arterial segments, confirmed by mandatory arterial biopsy. It is emphasized that in cases having acute embolic presentation the primary pathology should be treated concomitantly to revascularization.

[Evaluation of the prevalence of the main enteropathogenic agents in the West Imerina region: Manarintsoa]. / Evaluation de la prévalence des principaux agents enteropathogènes dans la région de l'Imerina ouest: Manarintsoa.

For a 288 children's population aged from 5 to 14 years old and being school attendents in the village of MANARINTSOA, we have systematically investigated 60% of them in May 1988 and January 1989. Bacterial, parasitical and viral study of these stools showed off an important number of A. dispar and E. coli strains which have special phenotypes characters. The prevalence of Campylobacter and Ascaris lumbricoïdes is higher in this rural zone than in TANANARIVE. Two poliovirus of type 2 have been isolated in January 1989.

[Infantile diarrheal diseases in Madagascar: bacterial, parasitologic and viral study]. / Les maladies diarrhéiques infantiles à Madagascar: etude bactérienne, parasitaire et virale.

From November 1988 to October 1989, an etiological study showed off the prevalence and the part of several enteropathogen agents which are not yet studied in MADAGASCAR. 1,523 stool's samples from 884 children with diarrhea and 639 children without diarrhea from 0 to 14 years old have been investigated. A bacterial, parasitical or viral etiology was found from 36.3% of diarrheic children and 11.2% of healthy children. The three agents the most frequently identified from children with diarrhea are EPEC (10.5%), Campylobacter jejuni (10.3%) and rotavirus (10%) and associations of two or three pathogen agents are frequent (6.2%).

Extracorporeal repair of renal artery branch lesions.

Complex renal artery lesions which formerly would have been treated by nephrectomy may now be reconstructed by extracorporeal surgery and autotransplantation. Our experience in 15 patients (17 operations) with renal artery lesions extending into its branches or confined to them is described. Two patients underwent separate operations on both sides. The indications for surgery were severe renovascular hypertension (10 cases), renal artery aneurysm, (5 cases) and deteriorating renal function (2 cases). Overall clinical results after a mean follow up of 3 years were considered excellent in 13 procedures (11 patients). Improvement in 2 patients and failure in the other 2, who ultimately underwent nephrectomy. Discussion is focussed on results, vascular indications, (namely aneurysm, stenosis, dissecting aneurysm and trauma) and surgical techniques. Preservation of functioning renal tissue should be the ultimate goal of renovascular surgery where the ex vivo technique, when indicated, will achieve favorable results in most patients.

[Bacterial, viral and parasitological study of a population of Chaerophon pumila bats in Anjiro, Madagascar]. / Etude bactérienne, virale et parasitaire d'une population de chauves-souris Chaerophon pumila à Anjiro, Madagascar.

This bacterial, viral and parasitical study of the insect eater bats Chaerophon pumila allowed to isolate, from stools of 88 of them, 115 bacterial strains to Enterobacteriaceae family: some of them were identified as very atypical, rare or potentially pathogenic for man. From salivary glands, brain and blood, 13 viral strains were also isolated: 8 of them were less identified as Dakar-bat virus. Any parasite was observed.

[Evaluation of 30-year-activity of the Virology Laboratory of the Pasteur Institute in Madagascar (1958-1987)]. / Bilan de trente ans d'activité du laboratoire de Virologie de l'Institut Pasteur de Madagascar (1958-1987).

The authors studied the different activities of Pasteur Institute virology laboratory since it was created. In general virology laboratory, 1.685 viral strains were isolated from 9.533 studied samples (17.6% of positivity). Enterovirus represented 90% of the viral strains. From 2.417 taking of rhino-pharynx, 133 myxovirus were isolated: A/H3N2 represented 76% of them. 10.776 patients, from 36.169 antirabic department consultants, were vaccinated and 600 had an antirabic serotherapy. 2.828 suspect samples were analysed for the rabies diagnostic: 1.438 were positive (51%). The Institute produced 3.410 liters of Fermi human vaccine type.

[Development of antibiotic resistance of type 1 Shigella dysenteriae strains (Shiga bacillus) isolated in Tananarive on the East coast of Madagascar]. / Evolution des résistances aux antibiotiques des souches de Shigella dysenteriae type 1 (bacilles de Shiga) isolées à Tananarive et sur lacôte Est de Madagascar.

From November 1988 to March 1989, 804 Malagasy children stools were studied and 37 Shigella strains isolated. 5 Shigella dysenteriae type 1 from Malagasy East coast (Mananjary), presented a multiply resistance to ampicillin, carbenicillin, streptomycin, chloramphenicol, tetracycline, sulphonamides and trimethoprim. This last resistance has recently appeared in this area.

Subgroups, serotypes, and electrophoretypes of rotavirus isolated from children in Bangui, Central African Republic.

The subgroups and serotypes of 178 strains of rotavirus isolated from diarrheic and healthy children in Bangui, Central African Republic, during a 27-month period were determined by enzyme-linked immunosorbent assay. The subgroup was determined for 152 of the viral strains, 18.4% being subgroup I and 81.6% being subgroup II. Of the 143 strains which could be serotyped, 71.3% were serotype 1, 15.4% were serotype 2, and 13.3% were serotype 3. Serotypes 1 and 3 were detected throughout the study, while serotype 2 was detected only during 8 months. No serotype exhibited any special epidemiological properties. The serotypes were found to consist of three different electrophoretypes, two long ones (A and B) and a short one (C). All subgroup I, serotype 2 strains presented short electrophoretypes. Strains with identical long electrophoretypes A were either serotype 1 or serotype 3.