Attempted suicide with a crossbow.

INTRODUCTION: Airway management and control of bleeding are essential aspects of the management of attempted suicide involving the head and neck. Attempted suicide using a crossbow is exceptional. The patient's respiratory status, the position of the crossbow bolt in the head and neck, the type of bolt and its exit wound required airway management that has not been previously reported in the literature. CASE REPORT: This conscious patient had attempted suicide by shooting a crossbow bolt to the head. The radiological assessment (contrast-enhanced CT scan) did not reveal any vascular, ophthalmological or neurological lesions. The submental entry wound of the bolt avoided any damage to the lingual and ethmoidal arteries, lamina papyracea, or frontal lobe. The bolt induced mechanical trismus and its position limited access to the base of the neck, preventing orotracheal intubation. Nasotracheal intubation and primary tracheotomy were also difficult in this situation. It was therefore decided to remove the bolt while the patient was still conscious, rapidly followed by intubation, with no complications. CONCLUSION: In attempted suicide by crossbow involving the head and neck, airway management depends on the possibility of exposure of the glottis, the bolt exit wound and safe access to the anterior neck.

[Fortified antibiotic (vancomycin, amikacin and ceftazidime) eye drop stability assessment at -20 degrees C]. / Stabilité à -20 degrés C des collyres antibiotiques renforcés (amikacine, ceftazidime, vancomycine).

INTRODUCTION: Fortified antibiotic ophthalmic solutions are regularly administered as an immediate treatment for bacterial keratitis. Fortified antibiotics used to be self-prepared by nurses. To solve this problem, pharmacy staff studied the stability of three 5% solutions of vancomycin, amikacin, and ceftazidime prepared in aseptic conditions from parenteral antibiotic solutions. MATERIAL AND METHODS: Solutions were frozen at -20 degrees C. Each solution were examined before storage and over a 75-day period. Ceftazidime and amikacin were diluted in 0.9% sodium chloride and vancomycin in 5% dextrose. Over a 75-day period, physical and pharmacological (absorbance spectra) properties and the sterility of each stock solution were studied. RESULTS: The pH of amikacin (6.51), ceftazidime (6.47), and vancomycin (3.77) remained stable during the 75-day period. Osmolarities also remained stable (367, 488, and 351 mOsm/L, respectively). There were no significant differences in the concentration, osmolarity, and pH of the three antibiotic solutions before storage and after 75 days of freezing. Over a 75-day period, the stability of amikacin, ceftazidime, and vancomycin remained constant; no contamination was detected before storage and after 75 days. CONCLUSION: Topical fortified antibiotic solutions can be stored for 75 days at -20 degrees C (15 days quarantine). After this time, these eye-drops should be stored at 4 degrees C and should be discarded after 3 days.

[Acute mesenteric ischemia and rhinopharyngeal carcinoma]. / Ischémie aiguë mésentérique et cancer du cavum.

UNLABELLED: This work is a part of a pharmacovigilancy survey. OBJECTIVES: To determine the links between radiation therapy, chemotherapy, nasopharyngeal carcinoma and mesenteric ischemia. MATERIAL AND METHODS: A case of 69 year old man with a nasopharyngeal carcinoma, treated by radiation therapy and chemotherapy, who developed a lethal mesenteric ischemia is described. Etiology of mesenteric ischemia was unknown. A review of literature had been made on Pubmed with terms: "Mesenteric ischemia" and cisplatin, 5-FU or fluorouracil, radiation therapy, cancer or neoplasm, "head and neck cancer" or "carcinoma of the nasopharynx. RESULTS: In our case, the origin of the mesenteric ischemia is not atheromatous. Chimiotherapy with 5-fluorouracile and cisplatine, radiation therapy and morphine were suspected. According to literature, responsibility of morphine and radiation therapy is uncertain. In opposition, the 5-FU and the cisplatine can be incriminated. CONCLUSION: Mesenteric ischemia is an uncommon adverse effect of a treatment with cisplatin and 5-FU. It's the second case of mesenteric ischemia associated with a treatment with 5-FU and cisplatin in a patient with a nasopharyngeal carcinoma. ENT physicians must be aware of this complication.

[Evaluation of patient information sheets in clinical trials]. / Evaluation de la notice d'information au patient dans les essais cliniques.

When an investigator invites a patient to take part in a clinical trial, he explains the purposes and details of the trial and gives him an information sheet. We decided to assess this information comparing it with the Huriet-Serusclat law and ICH norms. Seventy four information sheets from phase II and III trials were analysed. The research setting is always specified whereas the aim of the trial is presented in 96% of cases. The sequence of events is detailed in 76% of cases, and the benefits two times out of three. The text is often presented in only one paragraph and the average number of pages is about 2.6. For 25 percent of cases, information is lacking with regard to the progression of the trial; in other cases, the sheets are too long and patients are lost in an excess of information. Information sheets in clinical trials must be practical and short and rely on ICH recommendations.

Characterization of an anti-Borrelia burgdorferi OspA conformational epitope by limited proteolysis of monoclonal antibody-bound antigen and mass spectrometric peptide mapping.

Lyme borreliosis is a multisystem disorder caused by the spirochete Borrelia burgdorferi that is transmitted to humans by the tick Ixodes dammini. The immune response against the 31 kDa OspA, which is one of the most abundant B. burgdorferi proteins, appears to be critical in preventing infection and tissue inflammation. Detailed knowledge of the immunological and molecular characteristics of the OspA protein is important for the development of reliable diagnostic assays. In this study, we characterized a new conformational epitope present within the middle part of B. burgdorferi OspA. Our approach used enzymatic proteolyses of the immune complex followed by mass spectrometric identification of the peptides bound to the antibody. It appears to be one of the first reports on the characterization of a discontinuous epitope using mass spectrometry.

The hydroxylase component of soluble methane monooxygenase from Methylococcus capsulatus (Bath) exists in several forms as shown by electrospray-ionisation mass spectrometry.

The hydroxylase of the soluble methane monooxygenase from the bacterium Methylococcus capsulatus (Bath) has been investigated by means of electrospray-ionisation mass spectrometry (ESI-MS) and liquid chromatography ESI-MS (LC/ESI-MS). The hydroxylase is a non-heme diiron protein consisting of three pairs of non-identical subunits (alpha approximately 60 kDa, beta approximately 45 kDa and gamma approximately 20 kDa). Liquid chromatographic separation of the hydroxylase subunits was required before MS analysis in order to detect the alpha-subunit. The masses measured for the three subunits were found to disagree with those calculated from their gene sequences. Experiments involving the use of CNBr and trypsin cleavage followed by LC/ESI-MS and MS/MS analyses permitted the location and correction of errors in the sequences deduced from the use of cDNA. The ESI-MS results also showed that the alpha-subunit of the hydroxylase exists in multiple forms which result from cleavage of the protein. This observation explains a number of enigmatic features of the protein previously reported in the literature and illustrates the pivotal role of ESI-MS in complementing data obtained from molecular biology for the characterisation of the primary sequence of proteins.