Spinal anaesthesia with intravenous sedation for total hip arthroplasty in two patients with a history of orthotopic heart transplantation.

Many patients with orthotopic heart transplantation later undergo non-cardiac surgery. Historically, neuraxial anaesthesia has been avoided in these patients because the denervated heart is unable to compensate for hypotension via the baroreceptor reflex. Here, we present the cases of two patients with prior heart transplantation who underwent total hip arthroplasty under spinal anaesthesia with intravenous sedation. In both cases, this technique was well-tolerated haemodynamically. We propose that spinal anaesthesia with intravenous sedation can be a safe and efficacious anaesthetic technique for selected patients with a history of orthotopic heart transplantation, with careful intraoperative fluid and pharmacological management.

[Predictive factors and biomarkers of exudative lymphocytic tuberculous pleurisy]. / Facteurs prédictifs et biomarqueurs de la pleurésie exsudative lymphocytaire tuberculeuse.

INTRODUCTION: Tuberculosis is the leading cause of exudative lymphocytic pleural effusion. OBJECTIVE: To determine the predictive factors and assess the diagnostic performance of biomarkers for exudative lymphocytic tuberculous pleural effusion found in our practice. METHODS: Case-control study from 01 January 2015 to 30 August 2019, including patients admitted to the day-hospital facility for pleural biopsy. Histopathology of pleural biopsy fragments was the gold standard for assessing the diagnostic performance of the biomarkers studied (pleural adenosine deaminase, geneXpert and pleural fluid culture). RESULTS: One hundred and nine patients were included. The average age was 35.7±18.1 years. In all, 72.5% of them were diagnosed with tuberculosis. After multivariate analysis, only patients aged under 35 years old were found to be at risk for exudative lymphocytic tuberculous pleural effusion (adjusted odds ratio: 9.18 [1.99; 42.28], P=0.004). Histopathology was suggestive of tuberculosis in 84.8% of cases (P<0.0001). The sensitivity of geneXpert was 42.1% and the specificity was 100%, with a mean concordance rate with histopathology (k=0.46). One case of rifampicin-resistant tuberculosis was detected by geneXpert (2.2%). The diagnostic performance of pleural adenosine deaminase varies according to the defined positivity threshold. For values greater than 70UI/L, its sensitivity was 25% and its specificity was 86.7%. The area under the ROC curve of the pleural adenosine deaminase was 0.70. CONCLUSION: In patients with exudative lymphocytic pleural effusion, young age is a risk factor for pleural tuberculosis. The geneXpert, although not very sensitive, is a moderately efficient and specific test for tuberculosis. Pleural adenosine deaminase is a discriminating and useful biomarker for the diagnosis of tuberculosis.

Indirect electroreduction as pretreatment to enhance biodegradability of metronidazole.

The removal of metronidazole, a biorecalcitrant antibiotic, by coupling an electrochemical reduction with a biological treatment was examined. Electroreduction was performed in a home-made flow cell at -1.2V/SCE on graphite felt. After only one pass through the cell, analysis of the electrolyzed solution showed a total degradation of metronidazole. The biodegradability estimated from the BOD5/COD ratio increased from 0.07 to 0.2, namely below the value usually considered as the limit of biodegradability (0.4). In order to improve these results, indirect electrolysis of metronidazole was performed with a titanium complex known to reduce selectively nitro compounds into amine. The catalytic activity of the titanium complex towards electroreduction of metronidazole was shown by cyclic voltammetry analyses. Indirect electrolysis led to an improvement of the biodegradability from 0.07 to 0.42. To confirm the interest of indirect electroreduction to improve the electrochemical pretreatment, biological treatment was then carried out on activated sludge after direct and indirect electrolyses; different parameters were followed during the culture such as pH, TOC and metronidazole concentration. Both electrochemical processes led to a more efficient biodegradation of metronidazole compared with the single biological treatment, leading to an overall mineralization yield for the coupling process of 85%.

[Lactobacillus rhamnosus septicemia in a diabetic patient associated with probiotic use: a case report]. / Septicémie à Lactobacillus rhamnosus chez une patiente diabétique prenant un traitement probiotique.

BACKGROUND: probiotic agents are increasingly used as over the counter drugs for the treatment of a variety of inflammatory and infectious conditions. The rationale of their use seems to restore a friendly bacterial flora in the gut. Complications of probiotic use, although rarely reported, can occur. OBSERVATION: we describe the case of a 54-year-old diabetic woman, who developed Lactobacillus rhamnosus septicemia while she was using probiotic oral treatment. Lactobacillus is a major component of probiotic agents. Her infection resolved after amoxicilline administration. DISCUSSION: this case highlights the complication of probiotic use, and perhaps the patient's predispositions to develop such complications.

In vivo resistance to bacterial biofilm formation on tympanostomy tubes as a function of tube material.

Adherent bacterial biofilms have been implicated in the irreversible contamination of implanted medical devices. We evaluated the resistance of various tympanostomy (pressure equalization [PE]) tube materials to biofilm formation using an in vivo model. PE tubes of silicone, silver oxide-impregnated silicone, fluoroplastic, silver oxide-impregnated fluoroplastic, and ion-bombarded silicone were inserted into the tympanic membranes of 18 Hartley guinea pigs. Staphylococcus aureus was then inoculated into the middle ears. An additional 8 guinea pigs were used as controls; the PE tubes were inserted without middle ear inoculation. All PE tubes were removed on day 10 and analyzed for bacterial contamination using culture, immunofluorescence, and scanning electron microscopy (SEM). All infected ears developed otitis media with otorrhea, but none of the animal control ears drained. Fluorescence imaging of the animal control tubes showed large cellular components consistent with inflammation. The infected tubes showed heavy DNA fluorescence consistent with bacteria and inflammatory cells. All animal control tubes except the ion-bombarded silicone tubes showed adherent inflammatory film on SEM. Also, all tubes placed in infected ears except the ion-bombarded silicone tubes showed adherent bacterial and inflammatory films on SEM. Nonadherent surface properties such as the ion-bombarded silicone may be helpful in preventing chronic PE tube contamination.

Pre- and postoperative imaging analysis for frontal sinus disease following conservative partial middle turbinate resection.

The prudence of partial or complete middle turbinate resection during endoscopic sinus surgery (ESS) is controversial. The greatest concern regarding partial resection relates to the effect on the frontal recess and the development of frontal sinus disease. The purpose of this study was to radiographically evaluate the frontal sinus in patients who had undergone ESS with partial conservative middle turbinate resection. We reviewed the charts and operative records from 195 consecutive cases of ESS performed by a single surgeon (JFB) over a two-year period. Thirty-three of 117 patients who had undergone ESS with conservative partial middle turbinate resection without frontal recess exploration agreed to return for magnetic resonance imaging (MRI) of their sinuses. The preoperative computed tomography (CT) scans and postoperative MR images were reviewed and graded (1-3) by a single neuroradiologist. Significant frontal sinus disease (grades 2 and 3) was seen in 15 of 52 sides preoperatively (29%), and in 14 sides postoperatively (27%). During the postoperative MRI studies, only six frontal sinus sides demonstrated minimal mucosal thickening (grade 1) which had not been apparent on preoperative CT. This radiographic analysis suggests that conservative partial middle turbinate resection during ESS does not adversely affect the frontal sinus. We believe that the surgical technique employed when resecting the middle turbinate, and the avoidance of unnecessary dissection in the recess are both important factors in preventing the development of frontal sinus disease following ESS.

Mie and Rayleigh modeling of visible-light scattering in neonatal skin.

Reduced-scattering coefficients of neonatal skin were deduced in the 450-750-nm range from integrating-sphere measurements of the total reflection and total transmission of 22 skin samples. The reduced-scattering coefficients increased linearly at each wavelength with gestational maturity. The distribution of diameters d and concentration ρ(A) of the skin-sample collagen fibers were measured in histological sections of nine neonatal skin samples of varying gestational ages. An algorithm that calculates Mie scattering by cylinders was used to model the scattering by the collagen fibers in the skin. The fraction of the reduced-scattering coefficient µ(s)' that was attributable to Mie scattering by collagen fibers, as deduced from wavelength-dependent analysis, increased with gestational age and approached that found for adult skin. An assignment of 1.017 for n(rel), the refractive index of the collagen fibers relative to that of the surrounding medium, allowed the values for Mie scattering by collagen fibers, as predicted by the model for each of the nine neonatal skin samples to match the values for Mie scattering by collagen fibers as expected from the measurements of µ(s)'. The Mie-scattering model predicted an increase in scattering with gestational age on the basis of changes in the collagen-fiber diameters, and this increase was proportional to that measured with the integrating-sphere method.

Gestational age correlates with skin reflectance in newborn infants of 24-42 weeks gestation.

Accurate gestational age determination is limited in very low birthweight infants using neurological and physical assessments. As one of the markers of intrauterine development, skin maturation is assessed qualitatively by pediatricians. Based on this observation, we hypothesize that skin reflectance relates directly to gestational age. Light was delivered and collected from the skin through a topically placed optical patch. Reflected light was detected by the spectrophotometer and corrected by an adjacent laptop computer to yield the true total diffuse reflectance as a function of wavelength between 380-820 nm. The calculated reflectance at 837 nm (R837) where it is independent of melanin, was determined by extrapolation from the reflectance at 650 and 750 nm. Sixty-four neonates of different races with gestational ages of 24-42 weeks were studied at 2-151 h of age. R837 was related exponentially to gestational age (GA) by the equation R837 = Rmax(1-exp[-(GA-G0)/tau]), where Rmax is the maximal value of R837, G0 is an apparent delay time before dermal scattering increases rapidly, and tau is a time constant, r = 0.88, p < 0.001. In summary, the extrapolated skin reflectance offers a quantitative and objective assessment of gestational age which is independent of melanin and sex.

XeCl laser ablation of atherosclerotic aorta: optical properties and energy pathways.

The energetics of 308-nm excimer laser irradiation of human aorta were studied. The heat generation that occurred during laser irradiation of atherosclerotic aorta equaled the absorbed laser energy minus the fraction of energy for escaping fluorescence (0.8-1.6%) and photochemical decomposition (2%). The absorbed laser energy is equal to the total delivered light energy minus the energy lost as specular reflectance (2.4%, air/tissue) and diffuse reflectance (11.5-15.5%). Overall, about 79-83.5% of the delivered light energy was converted to heat. We conclude that the mechanism of XeCl laser ablation of soft tissue involves thermal overheating of the irradiated volume with subsequent explosive vaporization. The optical properties of normal wall of human aorta and fibrous plaque, both native and denatured were determined. The light scattering was significant and sufficient to cause a subsurface fluence (J/cm2) in native aorta that equaled 1.8 times the broad-beam radiant exposure, phi o (2.7 phi o for denatured aorta). An optical fiber must have a diameter of at least 800 microns to achieve a maximum light penetration (approximately 200 microns for phi o/e) in the aorta along the central axis of the beam.