[Chronic cough after laparoscopic adjustable gastric banding]. / Toux chronique après gastroplastie par anneau modulable.

INTRODUCTION: Patients are frequently referred for chronic cough. The causes are various. CASE REPORT: We report two cases of chronic cough that occurred after laparoscopic adjustable gastric banding for treatment of morbid obesity. In both cases, the computed tomography scan showed an important oesophageal dilatation. The cough disappeared after the band deflation. CONCLUSION: Oesophageal dilatation after laparoscopic adjustable gastric banding is a new cause to be included in the aetiology of chronic cough.

The giant protein AHNAK is a specific target for the calcium- and zinc-binding S100B protein: potential implications for Ca2+ homeostasis regulation by S100B.

Transformation of rat embryo fibroblast clone 6 cells by ras and temperature-sensitive p53val(135) is reverted by ectopic expression of the calcium- and zinc-binding protein S100B. In an attempt to define the molecular basis of the S100B action, we have identified the giant phosphoprotein AHNAK as the major and most specific Ca(2+)-dependent S100B target protein in rat embryo fibroblast cells. We next characterized AHNAK as a major Ca(2+)-dependent S100B target protein in the rat glial C6 and human U-87MG astrocytoma cell lines. AHNAK binds to S100B-Sepharose beads and is also recovered in anti-S100B immunoprecipitates in a strict Ca(2+)- and Zn(2+)-dependent manner. Using truncated AHNAK fragments, we demonstrated that the domains of AHNAK responsible for interaction with S100B correspond to repeated motifs that characterize the AHNAK molecule. These motifs show no binding to calmodulin or to S100A6 and S100A11. We also provide evidence that the binding of 2 Zn(2+) equivalents/mol S100B enhances Ca(2+)-dependent S100B-AHNAK interaction and that the effect of Zn(2+) relies on Zn(2+)-dependent regulation of S100B affinity for Ca(2+). Taking into consideration that AHNAK is a protein implicated in calcium flux regulation, we propose that the S100B-AHNAK interaction may participate in the S100B-mediated regulation of cellular Ca(2+) homeostasis.

[Intensive care after digestive surgery: the outcome in elderly patients]. / Réanimation en chirurgie digestive: devenir des patients âgés.

STUDY AIM: In surgical intensive care, the results must be analyzed both in terms of mortality and quality of life; this is particularly important in elderly patients for whom recovery remains uncertain. The aim of this prospective study was to assess the early and late prognosis in elderly patients (aged over 75 years) admitted to a digestive surgical intensive care unit (DSICU) for mortality, quality of life, patient autonomy, and also the predictive factors involved. PATIENTS AND METHODS: Over a one-year period, 182 patients were admitted to a tertiary referral DSICU; 30 of these subjects were over 75 years old, and formed the basis of this study. The following data were analyzed: hospital mortality rate; mortality rate at six months, and quality of life at six months (Kamofsky scale). These factors were correlated with the severity of the patient's state at admission and also with the causal disease, circumstances connected with admission, and duration of stay in the DSICU. RESULTS: The hospital mortality rate of patients was 23% (7/30 patients), and the overall mortality rate at six months was 40% (12/30 patients). Of the 12 patients who stayed in the DSICU for more than ten days with a simplified acute physiology score (APS) = 10, not one was alive at six months post-DSICU admission. The 18 remaining patients were still alive at six months, and 72% of them (13/18 patients) had regained their previous post-operative autonomy. CONCLUSION: These results provide reference data for this patient category. The results concerning long-term survival and the good functional outcome are encouraging. If the prognostic criteria defined in this investigation are confirmed by further studies, they may help in making the sometimes difficult decisions regarding elderly patients hospitalized in a DSICU.

[Hypoxemia secondary to inferior vena cava return into left atrium]. / Hypoxémie secondaire à un abouchement de la veine cave inférieure dans l'oreillette gauche.

The case of a right-to-left shunt-induced hypoxemia with an abnormal return of the inferior vena cava (AIVCR) into the left atrium (LA) is reported in a 30-year-old male with cyanosis and polycythemia. The chest X ray and the lung CT scan was normal. Spirometry was normal but the transfert-CO coefficient (KCO) was lowered. Hypoxemia was observed at rest and worsening during exercise. The alveolo-arterial oxygen tension difference under hyperoxia was increased (56 kPa). Contrast echocardiography (CEch) suggested the presence of an AIVCR with a right-to-left shunt only observed by the inferior route. The inferior vena cava (IVC) angiography and the magnetic resonance imaging demonstrated an AIVCR characterized by a direct drainage of IVC in the left atrium. The good tolerance can be explained by the association of AIVCR with an inter-auricular septal defect resulting in a left-to-right shunt which partially corrected the right-to-left shunt. After surgical treatment, arterial blood gases normalized, KCO remained low and CEch became negative.

Enhancement of postoperative desaturation in heavy snorers.

The risk of postoperative decreases of arterial saturation in oxygen (SpO2) could be enhanced in patients with previous history of sleep-induced respiratory impairment. To test this hypothesis, patients scheduled for orthopedic surgery were classified preoperatively as heavy snorers, light snorers, and nonsnorers, according to their answers to a questionnaire. During the first postoperative night, the patients were breathing room air and both the arterial saturation and the tracheal sounds were monitored. Although the cumulated duration of snore was similar in the three groups, the number of desaturations (decrease in SpO2 > or = 4%) was more in the heavy snorers (14.9 +/- 27.9) than in the light snorers (0.1 +/- 0.3) and the nonsnorers (0.2 +/- 0.3) (P < 0.05). The percent duration of recording at SpO2 < 90% was longer in the heavy snorers (52.0% +/- 41.9% of the recording time) than in the two other groups: 9.3% +/- 12.4% (light snorers) and 17.5% +/- 21.8% (nonsnorers) (P < 0.05). Patients with a previous history of sleep-disordered breathing risked postoperative desaturation and could be detected preoperatively by the answers to certain questions.

[Respiratory effects of midazolam in patients with obstructive sleep apnea syndromes]. / Effets respiratoires du midazolam chez les patients atteints du syndrome d'apnées obstructives du sommeil.

The administration of benzodiazepines at sleeping doses can be followed by an increased rate of upper airways obstruction episodes, especially in patients with an obstructive sleep apnea syndrome (OSAS). However, the effects of benzodiazepines at premedication doses have not yet been assessed. Therefore, fourteen patients were studied after administration of midazolam 0.08 mg.kg-1 i.m.: seven with an OSAS diagnosed previously (baseline recording) (= OSAS group) and seven without risk factors for OSAS (= Control group). The recordings were undertaken in the sleep laboratory. The airflows were assessed by nasal and oral thermistors and chest and abdominal movements by strain gauges. The electromyogram of the chin muscles was recorded, the electroencephalogram and the electro-oculogram electrodes were placed as described by RECHTSCHAFFEN and KALES. The arterial saturation in oxygen (Spo2) was monitored by pulse oximetry. All the signals were digitized and fed into a computer. The apnea was defined as a cessation of airflows for a least 10 s. The hypopnea was defined as a 10 s decrease in airflow with a drop in Spo2 of 4% or more. The respiratory event (apnea or hypopnea) was qualified as obstructive if the thoraco-abdominal movements persisted. The rate and the duration of respiratory events per sleep hour (mean +/- SEM) in OSAS group after midazolam (respectively 29.6 +/- 10 and 11.2 +/- 3.5 min) were not different from those of the baseline recording (respectively 38.4 +/- 11.6 and 12 +/- 3.5 min) and were significantly higher than in the control group (respectively 38.2 +/- 2 and 1.8 +/- 1.3 12 +/- 3.5 min) and were significantly higher than in the control group (respectively 3.8 +/- 2 and 1.8 +/- 1.3 min; p < 0.05). In the OSAS group, the percentage of sleeping time spent with a Spo2 < 90% was 1.5 +/- 1.4% during the baseline recording and 4.7 +/- 1.9% after midazolam (difference n.s.). However, a dramatic increase was observed in two patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Methylmethacrylate plasma levels during total hip arthroplasty.

Methylmethacrylate (MMA) plasma concentrations were measured in 11 patients scheduled for total hip arthroplasty. After acetabular and after femoral cement implantation, sequential blood samples were withdrawn from pulmonary and radial artery catheters. The peak concentration of MMA (mean +/- standard error of the mean) in pulmonary artery blood occurred two minutes after cement implantation and was significantly higher after acetabulum (5.0 +/- 1.3 micrograms/ml) than after femoral cement insertion (1.9 +/- 0.6 micrograms/ml). The MMA peak in plasma was above 1 micrograms/ml in 13 cases, and the decrease fit a biexponential decay (r = 0.91). The initial half-life was 0.3 +/- 0.1 minutes, and the terminal half-life was 3 +/- 0.7 minutes. The areas under the curve (AUC) were determined for pulmonary (AUCpa) and radial (AUCra) plasma samples, and the ratio (AUCpa - AUCra)/AUCpa was computed: 55.1 +/- 7.8% of MMA was cleared during the transpulmonary passage. These results demonstrate that: (1) MMA could be determined after each cement implantation, (2) MMA plasma concentrations were higher after acetabulum than after femoral cement implantation, and (3) the half-life is short and the total pulmonary clearance is high.

Droperidol prevents serotonin-induced bronchospasm in the guinea pig.

The effects of droperidol on bronchoconstriction induced by serotonin (5-HT) were studied in mechanically ventilated, paralyzed guinea pigs that had been anesthetized with pentobarbital. Droperidol did not modify the resting bronchial tone but prevented the bronchoconstrictor effects of 5-HT in a dose-related manner. Pretreatment with propranolol, hexamethonium, or prazosin did not alter the protective effects of droperidol on 5-HT-induced bronchoconstriction. The bronchoconstrictor responses to histamine or acetylcholine were not affected by droperidol. These results suggest that the protective effects of droperidol on 5-HT-induced bronchoconstriction are mediated through 5-HT receptor blockade on bronchial smooth muscle.

Fentanyl-induced airway hyperreactivity in the guinea pig.

The bronchopulmonary effects of fentanyl were studied in mechanically ventilated, paralyzed guinea pigs that had been anaesthetized with pentobarbitone sodium. Fentanyl did not alter the resting bronchial tone but enhanced the bronchoconstrictor effects of 5-hydroxytryptamine in a dose-related manner. The enhancement induced by 20 micrograms kg-1 fentanyl was suppressed by pretreatments with 0.5 mg kg-1 naloxone or 5 mg kg-1 propranolol, but did not change after 3 mg kg-1 atropine. The bronchoconstrictor responses to histamine were also enhanced by 20 micrograms kg-1 fentanyl. These results suggest that fentanyl-induced airway hyperreactivity is not mediated by an increase in vagal tone but is due to a reduction in the central sympathetic drive and/or in the levels of circulating catecholamines, which occurs through stimulation of opiate receptors.