["Heart, arteries and women" an innovative care pathway for women at high risk: First evaluation at one year]. / Le circuit « cœur, artères et femmes ¼ chez la femme à haut risque cardiovasculaire : première évaluation à un an.

INTRODUCTION: Cardiovascular diseases remain the first cause of death in women. To improve women's health cardiologists and gynaecologists should work together on women's specific cardiovascular risk factor. METHOD: Our study evaluated a care pathway named "heart, arteries and women". One hundred and ninety-one women were included for vascular (n=55) or hypertensive (n=136) explorations from January the first to December the 31st of 2013. We studied their clinical presentation and medical management. RESULTS: All women were at high cardiovascular risk (38% of them at very high risk). The average age was 52 years old. A woman on three had experienced high blood pressure or diabetes during pregnancy. One on two was postmenopausal woman. We stopped twelve estrogen-progesterone contraceptions; 60% didn't have gynaecological follow-up; 146 had high blood pressures (73% at night, 50% had no dipping blood pressure profile and 15 were newly diagnosed for hypertension). Sleep apnoea syndrome was suspected in half women. Medical therapies were optimized especially for women with atheroma in which 30 to 46% were properly treated (P=0.0005). Only 18% of the gynecologists received conclusive reports. CONCLUSION: At one year, our care pathway "heart, arteries and women" allowed to optimize medical therapy and clinical management. Everyone should be aware of this program.

Use of preoperative computed tomography for surgical treatment of recurrent draining tracts.

OBJECTIVES: To evaluate a rational decision-making approach based on preoperative computed tomography for surgical planning in dogs and cats with recurrent draining tracts. METHODS: Retrospective evaluation of case records of animals that underwent preoperative computed tomography for surgical treatment of thoracic/abdominal recurrent draining tracts. Cases were classified according to whether a source of inflammation and/or infection, in particular foreign bodies, was identified (group 1), suspected (group 2) or neither identified nor suspected (group 3) at computed tomography. Surgery consisted of removal of the source of inflammation and/or infection (group 1), debridement or abscess drainage (group 2) or en bloc resection of diseased tissues (group 3). Clinical outcome was evaluated at least 12 months after surgery. RESULTS: A source of inflammation and/or infection was found in 100% (8 of 8), 41% (7 of 17) and 25% (3 of 12) of cases in groups 1, 2 and 3, respectively. Recurrent draining tracts resolved in 100% (8 of 8), 94% (16 of 17) and 92% (11 of 12) of cases in groups 1, 2 and 3, respectively. CLINICAL SIGNIFICANCE: The proposed strategy provided a 95% (35 of 37) cure rate, after a single procedure in 81% (30 of 37) of cases. Recovery of a foreign body at surgery was not a prerequisite for the resolution of the recurrent draining tracts.

[Assessment of educational benefits in 73 hypertensive patients by telephone survey at distance of HTA Vasc educational program]. / Évaluation des acquis éducatifs de 73 patients hypertendus par enquête téléphonique à distance du programme HTA Vasc.

UNLABELLED: HTA Vasc offers an approved educational program for hypertensive patients at high cardiovascular risk (CVR). METHOD: A telephone survey (December 2011-July 2012) evaluated the benefits of different workshops "my treatment", "my blood pressure" and "my nutrition", more than 6 months after the end of the program. The follow-up data (TS) were compared to inclusion data (T0) and to final data (TF) in 73 hypertensive patients. RESULTS: The follow-up period was 6 to 31 months. The number of hypertensive controlled patients [blood pressure (BP)<140/90 mmHg] increased from 55.4% to 75.4% (P=0.0158) in TF, which remained over time. The practice of physical activity increased from 47.9% (T0) to 79.5% (TS) (P=0.001). The follow-up period of 18 months or more was associated with a tendency to weight gain (P=0.0059) and with a decline in physical activity [89.7% (<18 months) to 67.5% (≥ 18 months) (P=0.0198)]. The practice of self-measurement BP increased from 41.1% (T0) to 71.2% (TS) (P<0.0001); knowledge of the "rule of three" increased from 6.8% (T0) to 74% (TS) (P<0.0001). CONCLUSION: An educational support contributes to a better long-term BP control. The motivation for lifestyle rules decreases with time. The implementation of a structured motivational follow-up could maintain the lifestyle motivation at these CVR patients.

Retrograde placement of a novel 3.5 mm titanium interlocking nail for supracondylar and diaphyseal femoral fractures in cats.

Twenty-four simple or comminuted supracondylar and diaphyseal femoral fractures in cats, which had been treated by retrograde insertion of a new 3.5 mm titanium interlocking nail (IN) from the intercondylar notch, were evaluated between June 2000 and October 2004 at the Ecole Nationale Vétérinaire d'Alfort. Patient data (species, breed, weight, and age), fracture characteristics, details of the surgery, post-operative complications and radiographic follow-up were recorded. The mean body weight was 3.75 kg and the cats ranged in age between four and 66 months (mean 29 months). The IN had a diameter of 3.5 mm and a length of 100, 109 or 119 mm, and were all fixed in a static position (two screws in seven cats, three screws in 10 cats and four screws in seven cats). Cerclage wires were used in seven cats and an autogenous bone graft was used in two cats. Screw or nail breakage were not recorded. Nineteen fractures healed without any complications, three cats died during the post-operative period from unknown causes, and two cats showed delayed bone healing. Twenty cats were considered to have an excellent limb function at one month. One cat with a sciatic injury was non-weight bearing for several months. Radiographic signs of degenerative joint disease of the stifle joint were not observed except in the cat with the sciatic nerve injury. The results of this study suggest that this new 3.5 mm titanium IN can be introduced from the intercondylar notch and be used in static fixation mode to stabilize supracondylar and diaphyseal femoral fractures in cats.

A new surgical method for the control of the epiphora in dogs: modified parotid duct transposition.

A five-year-old, female, spayed beagle with a history of unilateral epiphora of several months' duration as a result of inadequacy of the lacrimal drainage system was treated successfully with a new surgical method of parotid duct transposition. Data from complete preoperative ophthalmological examination, surgical technique, postoperative treatment, contrast radiography and histological examination were recorded. Absence of complications and complete patency of the stoma at 30 days after surgery confirmed the validity of this new technique. The use of an anatomic duct may be advantageous compared with the current techniques of conjunctivorhinostomy, conjuntivobuccostomy and conjunctival maxillary sinusostomy for the treatment of epiphora in the dogs caused by inadequacy of the lacrimal drainage system.

Rectovaginal fistula following colectomy with an end-to-end anastomosis stapler for a colorectal adenocarcinoma.

An 11-year-old, female neutered Labrador retriever was presented with a micro-invasive differentiated papillar adenocarcinoma at the colorectal junction. A colorectal end-to-end anastomosis stapler device was used to perform resection and anastomosis using a transanal technique. A rectovaginal fistula was diagnosed two days later. An exploratory laparotomy was conducted and the fistula was identified and closed. Early dehiscence of the colon was also suspected and another colorectal anastomosis was performed using a manual technique. Comparison to a conventional manual technique of intestinal surgery showed that the use of an automatic staple device was quicker and easier. To the authors' knowledge, this is the first report of a rectovaginal fistula occurring after end-to-end anastomosis stapler colorectal resection-anastomosis in the dog. To minimise the risk of this potential complication associated with the limited surgical visibility, adequate tissue retraction and inspection of the anastomosis site are essential.

Experimental bilateral lobar lung transplantation and its application in humans.

BACKGROUND: The critical lack of donor organs from people of small size or children has created great difficulties in transplantation for recipients who are of smaller size. Surgical techniques of organ reduction and partial transplantation may to some extent solve the problem of disparity in organ size, be it liver or lung, and lessen the problem of scarcity of paediatric organs. METHODS: In a series of experiments on dogs the surgical technique of pulmonary partition of a large organ from a grown dog followed by transplantation of lobes, either unilaterally or bilaterally, into a young dog was studied. Two series of experiments were performed in two groups of animals; in group 1 transplantation of a single right lobe (n = 6) or single left lobe (n = 6) from a split adult lung was carried out and in group 2 (n = 10) animals received bilateral lobar transplants from a single split adult lung. The animals were sacrificed at fixed intervals (days 8-120 in group 1, days 7-10 in group 2) and the results of the surgical technique were assessed. RESULTS: Healing of lobar bronchial anastomoses was found to be excellent with no histological evidence of dehiscence or ulceration. There was one bronchial anastomotic stenosis and one arterial thrombosis. Morphological and functional adaptation of the lobes in the thorax was found to be excellent in both groups of animals. The technique has been applied in a clinical setting and the first patient with bilateral lobar lung transplantation followed for 30 months is reported. CONCLUSION: Lung partition and subsequent lobar transplantation, either unilaterally or bilaterally, is associated with satisfactory early results in an animal experimental model. Initial clinical experience in one patient has been successful.

[Experimental model of pulmonary bipartition with bilateral lobe transplantation in dogs and application to clinical medicine]. / Mise au point expérimentale de la bipartition pulmonaire avec transplantation lobaire bilatérale chez le chien et application en clinique humaine.

The crucial need for donors of paediatric or small sized organs has been a great obstacle to overcome in organ transplantation in children or small adults. Some progress in adapting size of the donor organs has been achieved with surgical procedures for reducing the size of donor organs, partial transplantation (single lobe of the liver or the lung) and liver partition, offering a partial solution to the insufficient supply of paediatric organs. We propose an experimental model in the dog of lung partition associated with monolateral (series I) or bilateral (series II) lobe transplantation. The results have been encouraging both in terms of quality of healing and in morphological and functional adaptation of the transplanted lobes, allowing us to apply this technique of lung partition and bilateral lobe transplantation in human patients. The outcome has been excellent in the first case after 18 months follow-up.

Distribution of material injected intramuscularly in dogs.

A radiopaque marker was injected, using needles of various lengths, into the cervical musculature, the lumbar epaxial musculature, and the cranial and caudal muscular masses of the thighs of anesthetized dogs. After this procedure, the dogs were euthanatized and deep-frozen. The bodies were then sectioned, and the slices were radiographed to determine the fate of the injected material. Material that was injected into the neck or caudal region of the thigh was determined to be located in the muscle bellies or dispensed throughout the intermuscular fascial sheaths. In contrast, material injected into the lumbar area and cranial region of the thigh was located entirely in the muscle bellies. It was concluded that the best sites for injection in dogs are the lumbar epaxial musculature or the quadriceps femoris muscle when IM administration is imperative.

Exaggerated femoral anteversion and acetabular development: experimental study in growing dogs.

Femoral excessive anteversion caused by femoral osteotomy in growing dogs is an accurate dynamic model of experimental acetabular dysplasia. Radiographic and CT scan examinations were performed throughout the growing period. Evolution showed an incomplete femoral detorsion. It induced acetabular developmental modification leading to an anterior and superior acetabular dysplasia. At the end of the growing period, hips were not dislocated, but signs of femoral and acetabular osteoarthritis were obvious, which shows the importance of mechanical force modification in the creation of experimental osteoarthritis. The links between hip osteoarthritis and exaggerated femoral anteversion are discussed. Might acetabular dysplasia be secondary to femoral anteversion, which could justify a corrective osteotomy during childhood? Our experiment leads to a better comprehension of this phenomenon.

Routine hematology and clinical chemistry in female dogs with benign and malignant mammary tumors.

Routine hematological and serum biochemical screening was done in 61 female dogs with benign mammary tumors and 51 female dogs with malignant mammary tumors. Most parameters were not significantly different from age-matched female controls; moreover, no significant difference could be observed between animals with benign and malignant tumors. It is concluded that routine hematology and biochemistry offer little diagnostic or prognostic benefit in female dogs with mammary tumors.

Pharmacokinetics of methylprednisolone, methylprednisolone sodium succinate, and methylprednisolone acetate in dogs.

The absolute bioavailability and pharmacokinetic parameters of two methylprednisolone formulations (methylprednisolone sodium succinate and methylprednisolone acetate) were determined in five dogs. Plasma concentrations of methylprednisolone, methylprednisolone sodium succinate, and methylprednisolone acetate were measured by sensitive and specific high-performance liquid chromatographic methods. After intravenous methylprednisolone sodium succinate administration, methylprednisolone was released rapidly but the extent of availability was rather low (43.6%). This has been tentatively explained in terms of its subsequent single-pass metabolism in the liver, i.e., hepatic hydrolysis of methylprednisolone sodium succinate followed by immediate hepatic elimination of the released methylprednisolone. After intramuscular administration of methylprednisolone acetate, its absorption was slow (half-time of absorption, 69.04 h) and the availability of the released methylprednisolone was low (42.7%). Therapeutic implications of these results are discussed, especially those which are relevant to shock therapy.

Bovine plasma and synovial fluid kinetics of methylprednisolone and methylprednisolone acetate after intra-articular administration of methylprednisolone acetate.

After an intra-articular administration of methylprednisolone acetate (MPA) in the cow, methylprednisolone (MP) was detected in the synovial fluid, at pharmacologically significant concentrations, during more than 3 months. From in vitro assay, it was shown that hydrolysis of MPA to MP was rapid both in blood (half-times from 11.8 to 21.7 min) and in synovial fluid (half-times from 45.6 to 130.3 min). After intra-articular administration of MPA as a suspension (200 mg in toto), both MP and MPA decline very rapidly and, 24 hr after injection, less than 1% of the dose was present in the synovial fluid, but systemic availability of MP during the first 24 hr was only 30% of the dose. Twenty-four hours postadministration, post-mortem examinations showed a significant quantity of MPA precipitated at the bottom of the synovial cavity. It was assumed that the relatively slow decline of MP synovial fluid concentration from 24 hr to 5 days postadministration was due mainly to a process of MP absorption. After this delay, the synovial fluid concentration decreased very slowly with an apparent half-time of 18 days. This has been tentatively explained in terms of a slow release of MP from MPA embedded in a fibrin-like deposit. Despite the fact that the quantity of MP absorbed each day was small, long-term systemic effects were observed. During 6 weeks, plasma hydrocortisone levels remained low or undetectable and the return to normal adrenal responsiveness to an adrenocorticotropic hormone test took 12 weeks.

[Red cell indices in the aged. 1 726 patients over the age of 70 (author's transl)]. / L'hémogramme du sujet âgé. 1 726 personnes de 70 ans ou plus.

Statistical analysis of red cell constants in 1 726 patients over the age of 70 shows that red cell counts, hemoglobin and hematocrits are slightly lower than those in young adults. However, the quality of the red cells is normal, because the MCV (mean cell volume) and MCHC (mean cell hemoglobin concentration) are normal.

[Frequency and etiology of anemia in patients over the age of 70 (author's transl)]. / Fréquence et étiologie des anémies chez les personnes âgées de plus de 70 ans. Etude de 1 726 sujets.

The study of 1 726 patients living in homes for the aged, or hospitalized shows that 20% of them have anemia. There is no increase in prevalence of the disease in females. A wide variety of mechanisms may cause anemia. However, chronic bleeding of essentially digestive origin is the most common. Several anemia-causing factors are particularly frequent in the aged: bleeding, inflammation, nutritional deficiencies, bone marrow failure. Diagnosis is complicated and may require examinations which are not always easily accepted by the aged.