Volumes of the spinal canal and caudal space in children zero to three years of age assessed by magnetic resonance imaging: implications for volume dosage of caudal blockade.

BACKGROUND: The primary aim of this study was to objectively assess the different spinal and caudal volumes that are of interest for caudal block volume dosing. METHODS: Three directly assessed (volume of spinal canal/caudal space, volume of the dural sac and volume of spinal cord) and two derived volumes (volume of the epidural space and cerebrospinal fluid volume) were determined from magnetic resonance images (MRI) in 20 children (zero - three yr of age). The assessed volumes were correlated to age, height and weight. Furthermore, the volumes of the epidural space from caudal canal to three different clinically relevant target levels (L 1, Th 10 and Th 6) and the epidural volume of each individual spinal segment at the caudal, lumbar and thoracic levels were calculated. RESULTS: All volumes correlated in a linear manner to length and weight (R2 0.614 - 0.867) whereas a curvilinear correlation was associated with best curve fit for age (R2 0.696 - 0.883). The median volumes of the epidural space from caudal canal to L 1, Th 10 and Th 6 were 1.30 ml kg-1 (95%CI 1.08-1.51), 1.57 ml kg-1 (95%CI 1.29-1.81) and 1.78 ml kg-1 (95%CI 1.52-2.08), respectively. The median volumes of the epidural space per vertebral segment were Thoracic: 0.60 ml (95%CI 0.38-0.75); Lumbar: 1.18 ml (95%CI 0.94-1.43) and Caudal: 0.85 ml (95%CI 0.56-1.18). CONCLUSIONS: The spinal volumes of interest show a linear correlation to height and weight whereas a curvilinear correlation was found for age. The volume of the epidural space per segment was found to be significantly higher at the lumbar level compared with the caudal and thoracic levels.

O6-Methylguanine-DNA methyltransferase status in neuroendocrine tumours: prognostic relevance and association with response to alkylating agents.

BACKGROUND: O(6)-Methylguanine-DNA methyltransferase (MGMT) loss of expression has been suggested to be predictive of response to temozolomide in neuroendocrine tumours (NETs), but so far, only limited data are available. We evaluated the prognostic and predictive value of MGMT status, assessed by two molecular methods and immunohistochemistry, in a large series of NETs of different origins. METHODS: A total of 107 patients, including 53 treated by alkylants (temozolomide, dacarbazine or streptozotocin), were retrospectively studied. In each case, we used methyl-specific PCR (MS-PCR) and pyrosequencing for evaluation of promoter methylation and immunohistochemistry for evaluation of protein status. RESULTS: MGMT promoter methylation was detected in 12 out of 99 (12%) interpretable cases by MS-PCR and in 24 out of 99 (24%) by pyrosequencing. O(6)-Methylguanine-DNA methyltransferase loss of expression was observed in 29 out of 89 (33%) interpretable cases. Status of MGMT was not correlated with overall survival (OS) from diagnosis. Progression-free survival and OS from first alkylant use (temozolomide, dacarbazine and streptozotocin) were higher in patients with MGMT protein loss (respectively, 20.2 vs 7.6 months, P<0.001 and 105 vs 34 months, P=0.006) or MGMT promoter methylation assessed by pyrosequencing (respectively, 26.4 vs 10.8 months, P=0.002 and 77 vs 43 months, P=0.026). CONCLUSIONS: Our results suggest that MGMT status is associated with response to alkylant-based chemotherapy in NETs.

Reduction of cerebral mean blood flow velocity and oxygenation after high-volume (1.5 ml kg⁻¹) caudal block in infants.

BACKGROUND: We have recently described a bi-directional bulk flow of cerebrospinal fluid (CSF) (coined 'the CSF rebound mechanism') after the use of high-volume caudal block in infants, which may explain the secondary longitudinal spread of the block. If important the initial cephalad transfer of CSF should be of such a magnitude that it would cause a transient reduction in cerebral blood flow (CBF) and cerebral oxygenation. The primary aim of this observational study was to delineate the magnitude of the reduction of CBF velocity (CBFV) associated with high-volume caudal block in infants. METHODS: Ultrasound Doppler measurements of CBFV in the middle cerebral artery and also haemodynamic parameters and cerebral regional oxygenation (C(R)SO2) were followed during 5 min after the initial caudal injection (1.5 ml kg(-1), ropivacaine 0.2%) in 12 infants <3 months of age. RESULTS: The caudal injection was associated with immediate and major reductions in CBFV indicating a concomitant reduction in CBF. A significant reduction of cerebral regional oxygenation C(R)SO2 was also observed. Systemic haemodynamic parameters were unchanged during the observation period. CONCLUSION: High-volume caudal block causes a biphasic change in CBFV and was also found to affect cerebral oxygenation. Our findings lend further support to 'the CSF rebound mechanism' for secondary spread of high-volume caudal block.

Macroscopic and histologic regression of duodenal polyposis with FOLFOX4 chemotherapy for an ileal pouch adenocarcinoma in a patient with familial adenomatous polyposis.

Severe (stage IV) duodenal polyposis is difficult to manage in patients with familial adenomatous polyposis (FAP), with no effective medical treatment, complex endoscopic treatment modalities, and a high morbidity and mortality from pancreaticoduodenectomy. We present the case of a 44-year-old woman with FAP, stage IV duodenal polyposis, and with an ileal pouch adenocarcinoma that required surgery and adjuvant chemotherapy. Her duodenal polyposis regressed to stage II after four sessions of FOLFOX4 adjuvant chemotherapy, which avoided the need for aggressive endoscopic therapy or pancreatoduodenectomy in this patient.

Acute pancreatitis after transcatheter arterial chemoembolization for liver metastases of carcinoid tumors.

Acute pancreatitis is a rare side effect of non-selective transcatheter arterial chemoembolization (TACE) of hepatocellular carcinoma with an incidence ranging from 2% (clinical pancreatitis) to 40% (biological pancreatitis). This complication, due to embolization of extrahepatic arterial collaterals, has never been reported for treatment of well-differentiated endocrine carcinoma. We report here a case of acute clinical pancreatitis developing within 24 hours after a first selective TACE into the proper hepatic artery, with two peaks of hyperlypasemia, and intend to discuss its mechanism. Since it may clinically mimic a postembolization syndrome, dosage of serum pancreatic enzymes should be performed systematically in case of abdominal pain following TACE.

The endothelin receptor antagonist tezosentan improves renal microcirculation in a porcine model of endotoxemic shock.

BACKGROUND: Impaired renal microcirculation has been suggested as a factor contributing to the development of renal dysfunction in sepsis. This study was conducted to elucidate the role of endothelin-1 (ET-1)in mediating reductions in renal microcirculatory blood flow during endotoxemic shock. METHODS: A prospective, randomized, and experimental study was performed with 16 anesthetized and mechanically ventilated pigs. After 2 h of lipopolysaccaride-induced endotoxemia, eight animals received a bolus dose of the dual endothelin receptor antagonist tezosentan (1 mg/kg), followed by a continuous infusion of 1 mg/kg/h throughout the experiment. Eight animals served as the control group. Renal microcirculation, total renal blood flow, plasma creatinine levels, cardiac index, and mean arterial pressure were measured. Plasma samples were collected for the measurement of tumor necrosis factor alpha (TNF-alpha), interleukin-6 (IL-6), interleukin-10 (IL-10), ET-1, angiotensin II, and aldosterone. RESULTS: Endotoxin infusion resulted in a state of circulatory shock with impairment of renal microcirculation. An increase in the plasma levels of TNF-alpha, IL-6, IL-10, ET-1, angiotensin II, and aldosterone was also observed. Tezosentan attenuated the decrease in renal microcirculation and renal blood flow, and attenuated the increase in plasma creatinine. Treatment with tezosentan did not significantly affect the plasma cytokine, angiotensin II, or aldosterone response to endotoxemia. CONCLUSION: These results indicate that treatment with the dual endothelin receptor tezosentan in endotoxemic shock attenuates the reduction of renal microcirculation and total renal blood flow independently of plasma changes in the renin-angiotensin-aldosterone system or early plasma cytokine response.

[Anxiety in palliative care]. / Anxiété dans le cadre de soins palliatifs.

In palliative care, the intensity and duration of anxiety as well as its consequences on the patient's daily activities can significantly decrease his quality of life. Anxiety that does not incapacitate the patient to the point of his being unable to communicate or perform his usual activities does not necessarily require drug treatment. The non pharmacological treatments of anxiety are presented in some detail. Prescription of anxiolytic drugs in renal or hepatic failure, as well as when oral intake or venous access are difficult, is briefly discussed.

[Not Available]. / Peau sèche-rêche et "Hydratation". Concept de la capture de l'eau organisée comme de la glace.

About sixty years ago Frank and Evans showed, by entropy measurements, that when a "non-polar molecule dissolves in water it modifies the water structure in the direction of greater 'cristallinity', the water builds a microscopic iceberg around it" Now, we propose the "concept of ice-like-water capture": a lowering of organized ice-like water promotes aggregation (loss of solubility) of the filaggrin/keratin1/keratin10 associations through their hydrophobic patches. The capture of ice-like water may be performed by the glucoceramides-rich bilayers in stratum granulosum. Probably, the same process aggregates the proteins of corneocytes envelope as well as corneodesmosomes proteins. According to the "concept of ice-like-water capture", to regulate the keratinization, it is not total water that must be added to the stratum corneum, but ice-like water that must be removed from stratum granulosum. Both petrolatum (lipophilic ingredient) and glycerol (hydrophilic ingredient) would capture the ice-like water, most probably after combination with the lipid bilayers of stratum corneum. Moisturizing cream, when organized in secondary droplets is likely to perform the same action. Measurements by near-infrared reflectance spectroscopy of the skin show that petrolatum; glycerol and/or moisturizing cream enhance the quantity of bulk water (1890-1897 nm band). As the ice-like water is the complement of bulk water, the enhanced bulk water let presume an ice-like water lessening. Some desynchronization (late or forward) of the keratinization/differentiation which confer the somatosensory problems associated with "dry and flaky skin" may be linked to an excess or lack of ice-like. For instance, the winter xerosis, very common by chilling weather, could be explained by an increase of ice-like water driven by the fall of the temperature.

[Is length of stay in the recovery room a risk factor for cross infections?]. / Le séjour en salle de surveillance postinterventionnelle peut-il être à l'origine de transmissions croisées?

OBJECTIVE: To assess cross contamination for patients at the time of their stay in the recovery room (RR). STUDY DESIGN: Prospective study. PATIENTS AND METHODS: A prospective survey over 3 weeks with 75 adult patients admitted to RR after thoracic or neck surgery. Samples for bacterial analysis were systematically taken from all patients before they left the operating theatre and just before discharge of RR (nose-throat and skin adjacent to the surgical wound). During this period, hand's health care workers (HCW) and environmental surfaces were sampled. RESULTS: There were 3 groups of patients: endoscopy (41%), thoracic surgery (39%). And thyroidectomy (20%), 392 samples were analysed. Potentially pathogenic floras were found on the admission for 25 patients and at discharge for 31 patients. A pathogenic flora was detected at discharge in 13 patients, whereas none was found at admission in RR. These patients were principally in the thyroidectomy group and their stay in RR was longer than 20 minutes. There is no significant difference concerning the nosocomial risk between 3 groups. Pathogenic flora was found in 19% of HCW (8 of 42). CONCLUSION: Cross contamination can exist in recovery room and educative measures are to be taken regarding handwhashing, isolation precautions and environmental cleaning.

[Acquired peeling skin syndrome in an adult]. / Syndrome de desquamation continue ("peeling skin syndrome") acquis à l'âge adulte.

BACKGROUND: Peeling skin syndrome is a rare form of congenital ichthyosis. The term was coined in 1982 by Levy and Goldsmith and the syndrome is clinically characterized by generalized scaling. Histologically, there is an epidermal separation in the stratum corneum. CASE REPORT: We report the case of a 73-year-old woman who had ichthyosis without cicatricial progressive alopecia since her first pregnancy. An ultrastructural study was performed confirming the clinical diagnosis of peeling skin syndrome. DISCUSSION: The peeling skin syndrome designates several different clinical entities classed by Traupe in type A and type B. Mevorah and al. expanded this classification with a type C. This classification has remained valid after additional information provided by ultrastructural studies and may suggest different pathogenic mechanisms underlying the dermatosis. A critical review of the literature shows that the case reported here is exceptional and had a late clinical onset.

[Epidermolysis bullosa acquisita and hepatitis C]. / Epidermolyse bulleuse acquise et hépatite virale C.

INTRODUCTION: Epidermolysis bullosa acquisita is a bullous dermatosis. Its etiology remains unknown and the efficacy of its treatment is low. OBSERVATION: We report the first association between epidermolysis bullosa acquisita, chronic hepatitis C and cryoglobulinemia, healing with interferon alpha and ribavirine. DISCUSSION: We suggest a role for hepatitis C virus in the pathogenesis of epidermolysis bullosa acquisita. We suppose a synthesis of autoimmune antibodies in a dysimmune environment. Interferon alpha and ribavirine might be a new therapeutic avenue but further studies are necessary to confirm it.

T-lymphocyte populations in the blood of caprine arthritis encephalitis virus-infected goats.

The effect of natural infection by Caprine Arthritis Encephalitis Virus on the phenotypic pattern of T lymphocytes in peripheral blood was studied in a herd of 127 milking goats by flow cytometry. Total leukocyte and T-lymphocyte numbers tend to decrease with age, with only small changes in the CD4/CD8 ratio. The lymphocyte phenotypes show no strong correlation with seropositivity to CAEV or the presence of clinical symptoms, suggesting that this macrophagetropic lentivirus does not greatly effect the lymphocyte population.

[Breeding, advice and ecopathology. A didactic approach to situations involving breeding diagnosis in swine production]. / L'élevage, le conseil, et l'écopathologie. Résultats d'une approche didactique de situations de diagnostic d'élevage en production porcine.

Innovation, quality, variety and flexibility of production require simultaneously an improvement of professional skills and an increase in cooperation. However, this cooperation should not be reduced to a mere data exchange, but must extend to a co-construction of new representations and new action schemes. In this way, health advising integrates production and knowledge apprenticeship, which we studied using a didactic approach (from the knowledge point of view). In this article, we will establish that animal ecopathology, by the standardization of the breeding description through diagnostic activity, has contributed to the strengthening of the cooperation between the breeder and the practicien.

Les enzymes de l'espace extra-cellulaire du stratum corneum.

Synopsis Bien que le stratum corneum soit composé de cellules 'mortes', il est le siège d'une activité métabolique très importante. Mais, contrairement à la plupart d'autres tissus, cette activité a la particularité d'étre extra-cellulaire. Elle est due à des enzymes excrétées par les Corps d'Odland avec les bicouches céramidiques. Ces enzymes sont des hydrolases, elles sont identiques ou très proches de celles des lysosomes. Les principales activités observées correspondent à une (ou des) glycosidase(s), une phospholipase, une sphingomyélinase, une phosphatase, une (ou des) estérase(s), des sulfatases, des protéases. Comme les hydrolases des lysosomes, elles semblent peu spécifiques. Ce pool enzymatique pourrait jouer plusieurs rôles fondamentaux, notamment: 1. La transformation des bicouches gluco-céramidiques en bicouches ceramidiques plus lipophiles; 2. L'élimination de la membrane plasmique, dont certains produits du catabolisme, comme les acides gras et les céramides, peuvent être intégrés aux bicouches céramidiques; 3. La diminution de la cohésion entre les cornéocytes; 4. La protection contre l'intrusion de corps étrangers. Comme tout système enzymatique, les hydrolases extra-cellulaires, sont certainement soumises à des régulations. Plusieurs de ces régulations sont envisagées. A partir de considérations d'enzymologie, le pH de la base du stratum corneum peut être estiméà environ 5. En cosmétologie, les enzymes du stratum corneum sont mises à contribution pour rendre actifs des précurseurs. L'étude des conséquences des modifications de l'activité enzymatique sur l'état de la peau pourrait constituer une future voie de recherche extrêmement prometteuse.

Porphyria cutanea tarda associated with human immunodeficiency virus infection. A study of four cases and review of the literature.

We report the cases of 4 male subjects, 29, 32, 41 and 44 years old, presenting isolated seropositivities for the human immunodeficiency virus (HIV), or full-blown acquired immunodeficiency syndrome, associated with a typical porphyria cutanea tarda (PCT). The 4 patients are in the usual risk groups for HIV infection. Viral hepatitis was observed in 3 of the 4 cases. Over the past 3 years, 15 cases associating HIV infection and PCT have been reported; almost all had the usual risk factors for HIV infection and hepatopathy. We speculate that HIV infection may have favored the occurrence of early PCT in these cases by altering the metabolism of the porphyrins, either directly or by means of the associated hepatopathy.

Approche osmotique de l'hydratation du stratum corneum.

Summary An osmotic approach to a study of hydration of the stratum corneum At first Middleton, in his classic studies, explains the water sorption of stratum corneum by osmotic processes. To follow Middleton, and in order to study water osmosis diffusion, we made an osmotic model of stratum corneum (OMSC). The OMSC was constituted by 0.8 g of sheep wool, which was closed in a dialysis bag. When the OMSC was placed in the water, its weight increased, due to water diffusing through the membrane to bind with the protein. The rate of sorption was slow, but the value was about the same as that which Scheuplein has observed for the stratum corneum. At saturation, the weight of 'bound water'was 13 times greater than the weight of keratine. The components of Natural Moisturizing Factor and glycerol enhance the sorption rate and the weight fraction 'bound water'at saturation. The best component is urea. This observation suggests that humectants increase the number of water-binding sites of keratin. The OMSC could allow preliminary tests of water-soluble skin moisturizers.

[Mycobacterium chelonei cutaneous infections. General review apropos of a case]. / Infections cutanées à Mycobacterium chelonei. Revue générale à propos d'un cas.

Mycobacterium chelonei is a facultative pathogen which exists as a saprophyte in the environment and rarely produces clinical manifestations in humans. We describe a 62-year-old woman, long-term treated with low-dose steroids for severe asthma, who presented sporotrichoid-like lesions on one leg. These lesions appeared two months after a cat-scratch and were present for six months. Histological examination showed acute inflammation with polymorphonuclear infiltration without tuberculoid granuloma nor caseation necrosis. Ziehl-Neelsen stains were negative. Mycobacteria were found by direct examination and Mycobacterium chelonei chelonei was identified by culture. Treatment with isoniazid, rifampicin and ethambutol was given for one month and followed by complete resolution of the lesions, though each of these antibiotics was not effective in vitro. The literature about Mycobacterium chelonei infections is reviewed and the role of the antibiotherapy in clinical recovery is discussed.

Study of a ternary diagram gel according to a methodology of experimental research.

Synopsis The purpose of this work was to compare two methods to determine the formulation of a gel: a 'classical'method previously used and a rational method using matrixes based on the Scheffe algorithm which is particularly useful in the study of these type of mixtures. This gel was composed of three products: C12-C15 Alcohols Benzoate, Cyclomethicone and Ethylene Vinyl Acetate Copolymer in water. The ratios of these compounds were studied according to five criteria: compatibility between phases, consistency, whiteness, cost and 'skin spreading'. To determine the incompatibility zone inside the ternary diagram, we carried out our study by a systematic sequential walk strategy (seven experiments). Three parameters (consistency, whiteness, cost) were optimized using the Scheffe algorithm. This method only needs a limited number of experiments on which to base an empirical mathematical model of the studied phenomena as a function of the different experimental factors. The formulation is therefore discussed as a function of the first degree linear, the second degree and a third degree 'reduced cubical'model. The validity of the possible models are also discussed and the 'reduced cubical'best fits our phenomena.