[Anaesthesia for bronchial echoendoscopy: experience with the laryngeal mask]. / Anesthésie en échoendoscopie bronchique : expérience du masque laryngé

INTRODUCTION: Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) has recently been shown to be an accurate modality in the diagnosis and staging of mediastinal lymph node metastases. This procedure takes significantly longer than a conventional bronchoscopy and may therefore cause more discomfort. Since its introduction into respiratory practice in France, several airway management strategies have been used. PATIENTS AND METHODS: Both anaesthesia care and procedural sedation services share the goals of providing the patient with comfort during a potentially distressing procedure while also ensuring that the operating physician has an acceptable working environment. Historically, anaesthesiologists have applied the expertise gained in managing anaesthesia for major surgery to sedation care for minor procedures. While the supply of anaesthesiologists and anaesthetists has shown only a modest increase, the growth in minimally invasive procedures has been exponential in recent years. To investigate this further, we performed a retrospective study of the use of general anaesthetic with ventilation by a laryngeal mask during EBUS, which we have adopted in our unit. RESULTS: Sixty-three patients were included in the study. In 41 a laryngeal mask was used and in 22 the examination was performed under local anaesthetic alone. Eighty-seven percent of procedures were informative with cells from lymph nodes obtained (89% from examinations using laryngeal mask with a mean of 3.8 passes and 86% with sedation alone with a mean of 2.9 passes). In 45 cases (78%) it was possible to avoid mediastinoscopy. CONCLUSION: It was possible to establish a secure airway and maintain oxygenation with the laryngeal mask during bronchoscopy without any reduction in the success of the procedure.

Utilization of parenteral nutrition in patients receiving peripheral blood stem cell transplantation.

A paucity of information is available on the use of parenteral nutrition (PN) in patients undergoing peripheral blood stem cell transplantation (PBSCT). To characterize the utilization of PN in patients undergoing PBSCT, we conducted a retrospective chart review study on adult patients receiving autologous and allogeneic PBSCT. Data collection included nutritional parameters such as indications for PN, days of PN administration, and PN-associated complications (i.e., metabolic, infectious, and mechanical). Outcome parameters assessed included length of hospitalization, days to engraftment, graft versus host disease (GVHD), and veno-occlusive disease (VOD). A total of twenty-one consecutive patients were evaluated with 12 receiving allogeneic PBSCT and 9 receiving autologous PBSCT. The allogeneic group received PN for a mean of 25 days compared to 21 days for the autologous group. The rate of metabolic abnormalities was significantly higher in the allogeneic group compared to the autologous group (1.02 abnormalities/PN days vs 0.61 abnormalities/PN day, p < 0.05), but mechanical and infectious complications were similar between the two groups. Length of hospitalization, days to engraftment, incidence of GVHD and VOD did not differ significantly between the two groups. However, mortality prior to discharge was significantly higher in the allogeneic vs autologous group (58% vs 0%, p < 0.05). We conclude that allogeneic PBSCT patients appear to be at a greater risk for metabolic complications while receiving PN as compared to autologous PBSCT patients. As nausea and vomiting are two primary reasons for initiation of PN in this patient population, further studies of aggressive antiemetic therapy may prove to decrease the need for PN in PBSCT patients.

Visual field loss caused by retinal vascular occlusion after vitrectomy surgery.

PURPOSE: To report complete superonasal retinal arterial occlusion with resulting temporal visual field loss after uneventful pars plana vitrectomy with gas-fluid exchange. METHOD: Case report. RESULTS: Superonasal retinal arterial occlusion was observed 12 days after vitrectomy surgery. Within 10 weeks, the artery reperfused, leaving minimal vascular attenuation and mild optic atrophy. CONCLUSIONS: Uneventful vitrectomy surgery can be associated with notable peripheral visual field loss caused by arterial occlusion in the immediate postoperative period. Rapid resorption of the intraocular gas and timely postoperative examination may disclose retinal arteriolar occlusion; otherwise, subsequent reperfusion may leave little evidence of the vascular event.

Combined pars plana vitrectomy-lensectomy and open-loop anterior chamber lens implantation.

PURPOSE: To investigate the effectiveness of open-loop, one-piece, flexible, Kelman-style, all-polymethylmethacrylate (PMMA) anterior chamber intraocular lenses (AC IOLs) in patients undergoing pars plana vitrectomy surgery for a variety of vitreoretinal disorders. METHODS: Fifteen patients (6 women and 9 men) underwent combined pars plana vitrectomy with insertion of an open-loop AC IOL. Postoperative results were evaluated. RESULTS: The average preoperative visual acuity of 20/360 (logMAR scale, 1.25 +/- 0.80) improved to 20/52 (logMAR scale, 0.42 +/- 0.35) after an average follow-up of 10.2 months (range, 1-41 months). Of 15 eyes, 7 (47%) achieved a visual acuity of better than 20/40. There was no evidence of glaucoma exacerbation or corneal decompensation. Visual acuity was limited primarily by chronic cystoid macular edema in 4 (27%) of 15 eyes. CONCLUSION: In this preliminary series of patients, open-loop, flexible, all-PMMA, Kelman-style AC IOLs appear to be well tolerated and represent a viable, simple alternative to transscleral fixation of a posterior chamber IOL or surgical aphakia in patients undergoing vitrectomy surgery.

The influence of the disappearance of plasmodesmal connections between antheridia and thallus on 3H-GA3 transport.

Autoradiograms of antheridial filaments labelled after tritiated gibberellic acid (3H-GA3) administration at various developmental stages of Chara contraria (in control and after plasmolysis) show that intensity of gibberellin binding depends mainly on symplasmic connection of antheridia with thallus. Young antheridia before spontaneous symplasmic isolation which precedes spermiogenesis, contain antheridial filaments labelled more intensively than the older ones. This difference disappears if antheridia were plasmolyzed and symplasmic isolation was induced before incubation. These findings are in agreement with the previous results obtained in Chara vulgaris after 14C-GA3 treatment.

DNA endoreduplication, RNA and protein synthesis during growth and development of the antheridial basal cell in Chara vulgaris L.

Cytophotometric measurements of nuclear DNA contents and morphometric analyses indicate that the level of endopolyploidy plays an important role in determining the maximum size, transcriptional and translational activity that the antheridial basal cell attains during successive stages of spermatogenesis in Chara vulgaris. During the proliferative period of antheridial development, the metabolic activity of basal cell, expressed as the total incorporation of radioactive uridine and leucine was found to increase gradually with the increasing DNA C-values, yet both the synthesis of RNA and then the synthesis of proteins become reduced at the stage preceding spermiogenesis. In accordance with some earlier data [2], the obtained results seem to support the hypothesis that regulatory mechanisms of symplasmic connections between the antheridium and a thallus participate in the regulation of morphogenesis of the male sex organs in Chara.

The association of HLA-B8, B51, DR2, and multiple sclerosis in pars planitis.

PURPOSE: To establish a human leukocyte antigen (HLA) association in a homogeneous population of patients with pars planitis. METHODS: A strict set of inclusion parameters was established for the diagnosis of pars planitis. Forty patients with pars planitis who met these criteria underwent HLA analysis of class I and II phenotypes. RESULTS: HLA-B8 was present in 15 (37.5%) of 40 patients versus 85 (19.7%) of 431 controls (relative risk, 2.44; P = 0.011). HLA-B51 was present in 9 (22.5%) of 40 patients versus 51 (11.8%) of 431 controls (relative risk, 2.16; P = 0.049). HLA-DR2 was present in 27 (67.5%) of 40 patients versus 121 (28.0%) of 431 controls (relative risk, 5.32; P < 0.0001). HLA-DR2 has been associated with multiple sclerosis (MS). Exclusion of five patients with pars planitis in whom MS subsequently developed did not change the significance of these findings. CONCLUSIONS: The strongest association of pars planitis with HLA-DR2 and the temporal development of MS in some patients with pars planitis further supports an association between pars planitis and MS.

Long-term visual outcome and complications associated with pars planitis.

PURPOSE: To identify the ocular complications and to statistically evaluate the possible association of pars planitis with multiple sclerosis (MS) in a homogeneous population of pars planitis patients. METHODS: The authors reexamined 36 patients and reviewed the records of an additional 18 patients (total: 54 patients, 108 eyes) with idiopathic pars planitis. RESULTS: The initial mean visual acuity of 20/46 (logMAR: 0.36 +/- 0.50) was not statistically different from the final mean visual acuity of 20/44 (logMAR: 0.34 +/- 0.45; P = 0.73), after a mean follow-up of 89.2 months. Complications included neovascularization with or without associated vitreous hemorrhage (7 eyes, 6.5%), moderate to severe cellophane retinopathy (7 eyes, 6.5%), chronic cystoid macular edema (CME) (9 eyes, 8.3%), visually significant cataracts (16 eyes, 14.8%), and retinal detachment (9 eyes, 8.3%). Significant lens opacification was associated with a greater risk of retinal detachment (P = 0.004). In four patients (7.4%), optic neuritis developed, and in an additional eight patients (14.8%) MS developed. Kaplan-Meier analysis of these data showed a 16.2% +/- 6.2% risk of MS solely developing in patients, and a 20.4% +/- 6.7% risk of either MS or optic neuritis developing, after 5 years of disease. The presence of periphlebitis at the time of pars planitis diagnosis increased the rate of development of these conditions (P = 0.002). Six patients (11.1%) had a family history positive for MS in a first-degree relative. CONCLUSIONS: This study demonstrates the overall favorable visual prognosis in patients with pars planitis. Patients with significant cataract formation appear to be at greater risk for retinal detachment. Periphlebitis at the time of diagnosis of pars planitis increases the risk of development of optic neuritis or MS. The strong association demonstrated between pars planitis and MS in this study further supports a link between the two disease states.

Differentiated reaction of different types of antheridial cells in Chara vulgaris to the changes in light conditions during 24 hours.

Circadian rhythm of activity of 3H-leucine incorporation into antheridial cells of Chara vulgaris, in natural photoperiod was compared with changes in mitotic activity of antheridial filament cells which form spermatozoids. Three types of cells functionally connected with each other i.e. manubria, capitular cells and antheridial filaments indicate high amplitude (80-90%) changes in circadian translational activity and some similarities in their course. The shield cells are characterized by small circadian changes in translational activity in the range of 15-30% and their different rhythm. Manubria, which are the secretive cells indicated the highest dependence of the dynamic of translational activity on the time of day. Their high activity overlaps light phase, low activity--dark phase. The reaction of capitular cells to day/night change is delayed in comparison with the reaction of manubria, and that of antheridial filaments is delayed in comparison with the capitular cells reaction. The assumption was set forth that manubria play the role of oscillators (starttercells) which induce the wave of changes translocating to the other cells functionally and spatialy connected with them. The course of the wave of antheridial filaments mitotic activity suggests that a distinct drop in MI in the morning may be the result of the lack of the factors necessary for initiation of the mitosis, dependent on light-induced high translational activity of antheridial cells.