[Severe lactic acidosis revealing hematologic malignancy]. / Une acidose lactique sévère révélatrice d'une hémopathie maligne.

A 75-year-old woman is hospitalised for sepsis. The diagnosis of cholecystitis is made and an antibiotic therapy is debuted. The clinical worsening leads to realise an urgent cholecystectomy. A sepsis like shock persisted. The antibiotherapy was changed and a second abdominal look made. A severe lactic acidosis persisted since the cholecystectomy despite a continuous hemofiltration. The diagnosis of type B lactic acidosis secondary to malignancy was suspected. An osteomedullar biopsy revelled B-cell lymphoma EBV induced.

STING: a soft-tissue intervention and neurosurgical guide to access deep brain lesions through curved trajectories.

Current trends in surgical intervention favour a minimally invasive approach, in which complex procedures are performed through very small incisions. Specifically, in neurosurgery there is a need for minimally invasive keyhole access, which conflicts with the lack of manoeuvrability of conventional rigid instruments. In an attempt to address this shortcoming, the current state of progress is reported on a soft-tissue intervention and neurosurgical guide (STING) to access deep brain lesions through curved trajectories. The underlying mechanism of motion, based on the reciprocal movement of interlocked probe segments, is biologically inspired and was designed around the unique features of the ovipositor of certain parasitic wasps. Work to date has focused on probe development, low- and high-level control, and trajectory planning. These aspects are described, together with results on each aspect of the work, including biomimetic microtexturing of the probe surface. Progress is very encouraging and demonstrates that forward motion into soft tissue through a reciprocating mechanism is indeed viable and can be achieved through a suitable combination of microtexturing and microfabrication techniques.

Biomimetics--a review.

Biology can inform technology at all levels (materials, structures, mechanisms, machines, and control) but there is still a gap between biology and technology. This review itemizes examples of biomimetic products and concludes that the Russian system for inventive problem solving (teoriya resheniya izobreatatelskikh zadatch (TRIZ)) is the best system to underpin the technology transfer. Biomimetics also challenges the current paradigm of technology and suggests more sustainable ways to manipulate the world.

[Atrio-oesophageal fistula after radiofrequency ablation: predominant neurological symptoms]. / Fistule atrio-oesophagienne après radiofréquence: des signes neurologiques au premier plan.

A 58-year-old man was admitted to our hospital for septic shock and meningitis. He had undergone, three weeks earlier, a radiofrequency ablation for drug-refractory atrial fibrillation. A polymicrobian septicemy suggested a digestive etiology. A CT scan suggested an atrio-oesophageal fistula with cerebral and renal emboli. The patient deceased from brain death. The diagnosis of atrio-oesophageal fistula was confirmed by autopsy.

The "click" mechanism in dipteran flight: if it exists, then what effect does it have?

This paper is concerned with the flight mechanism of diptera. For many years it was thought that the flight mechanism incorporated a "click". In recent years, however, doubt has been cast as to whether this exists, or whether it is an artifact of experimental procedure. The aim of this paper is to contribute to this debate by presenting an investigation into the advantages or disadvantages of such a mechanism by conducting a dynamic analysis of a simplified model of such a mechanism. It is shown that, provided the mechanism is driven well below its resonance frequency and it is well-damped, i.e., it does a lot of work, then the flight mechanism with a "click" has distinct advantages over a system that does not have a "click" but is driven at its resonant frequency.

A novel strain sensor based on the campaniform sensillum of insects.

The functional design of the campaniform sensillum was modelled as a hole in a plate using two- and three-dimensional finite-element modelling. Different shapes of opening in a fibrous composite plate amplify differently the global strains imposed on the plate, and different configurations of reinforcement also have an effect. In this paper, the main objective is to study the strain and displacement fields associated with circular or elliptical openings in laminated plates in order to investigate their potential for integrated strain sensors. Since we are therefore primarily interested with the detection of displacement, the detailed stress concentration levels associated with these openings are not of primary concern. However, strain energy density levels associated with different hole and fibre configurations have been used to assess the relative likely strength reduction effect of the openings. To compare the relative strain amplification effect of drilled and formed holes of the same size in loaded plates, we have used the relative change in length of diameters (circular) or semi-axes (elliptical) in directions parallel and normal to the load. Various techniques which could sense this deformation were investigated, in particular, the coupling mechanism of a campaniform sensillum of Calliphora vicina. This mechanism was resolved into discrete components: a cap surrounded by a collar, a joint membrane and an annulus-shaped socket septum with a spongy compliant zone. The coupling mechanism is a mechanical linkage which transforms the stimulus into two deformations in different directions: monoaxial transverse compression of the dendritic tip and vertical displacement of the cap. The mechanism is insensitive to change of the material properties of the socket septum, the cuticular cap and the spongy cuticle. The joint membrane may serve as a gap filler. The material properties of the collar have a substantial influence on the coupling mechanism's output. A 30% change of stiffness of the collar causes 45% change in the output of the coupling mechanism. The collar may be able to tune the sensitivity of the sensillum by changing its elastic properties.

Variations in the morphology of wood structure can explain why hardwood species of similar density have very different resistances to impact and compressive loading.

A clear relationship has been established between the impact resistance and density of softwoods. However, there are hardwood species that have the same density but very different impact resistance. Softwoods are largely composed of tracheid cells (30-50 microm across); hardwoods have smaller fibre cells and also contain vessels (50-500 microm across). We examined white oak, beech, hickory and spruce. Compressive deformation was identified as the main mechanism for energy absorption in the type of impact test used. The disparate size of different wood cells in the hardwoods results in heterogeneous compressive deformation. During compression, large vessels cause smaller surrounding cells to be deformed more than in regions without vessels, increasing the energy absorbed. However, vessels that are too close together initiate kink banding at low loads and less energy is absorbed. The different morphologies of hardwoods are probably responsible for the variation in impact resistance between species of similar density. Drilling small holes along the grain of spruce, which naturally lacks vessels, mimicked the effect of vessels and did not reduce the energy-absorbing capabilities of the wood, despite the density being reduced. These findings could be used to increase the energy-absorbing capacity of synthetic foam materials.

Preparation of insect-cuticle-like biomimetic materials.

A model system of tanning of a protein matrix within a fibrous structure, such as most commonly found in insect cuticle, was developed, using the cellulose of paper in place of chitin. The paper was impregnated with a tripeptide, DOPA-Gly-Gly, or a protein (BSA) plus catechol and treated with tyrosinase to oxidize the catechol. The resulting material was waterproof and had very high wet strength. If the material was wetted and dried repeatedly its water retention decreased by a factor of at least 2.

Affine versus non-affine deformation in soft biological tissues, measured by the reorientation and stretching of collagen fibres through the thickness of compressed porcine skin.

Skin is a complex three-dimensional structure of cells, collagen fibres and other proteins. However most mechanical analyses treat skin as a two-dimensional membrane, neglecting the through thickness structure. In this paper we investigate through thickness reorientation of collagen fibres. The mode of deformation of skin is also considered. For modelling purposes deformation is usually assumed to be affine. This assumption was tested by constructing a simple geometrical, affine deformation model to predict the through thickness reorientation of collagen fibres, from their initial through thickness angle and the measured deformations of skin samples during compression. The measured reorientation of collagen fibres was found to be very variable, however the average reorientations were consistent with the predictions of the model, with the inclusion of a systematic error. The variation in the reorientation of individual fibres can be explained by the variations in the structure at a micrometre scale. The systematic deviation of reorientations from the model predictions can be explained by a non-affine relationship between the collagen fibres and ground substance at a micrometre scale. However, non-affine deformations at a micrometre scale caused by irregularities of structure are likely to average out at a millimetre scale, because at this level material is evenly distributed.

Maximizing therapeutic effects in treating sexual offenders in an Australian correctional system.

In Australia, the community response to sexual offenders is marked by uncertainty as to whether offenders should be incarcerated as punishment or provided treatment in order to reduce the likelihood of re-offense. The incarceration of sexual offenders results in particular management, ethical, and political issues. Nevertheless incarceration can provide leverage to encourage the offender to participate in treatment while delivering punishment for wrongdoing and acting to protect the community. In the state of Victoria the CORE Sex Offender Programs have developed a statewide strategy in the public correctional system in order to assess, manage, and treat male sexual offenders. However, such offenders are notoriously reluctant to engage in treatment to address offending behaviors. A critical element of the strategy has been the Victorian Adult Parole Board, an entity that can determine that an offender needs to engage in treatment before he is considered for parole. Using the therapeutic jurisprudence framework as outlined by Wexler (1990), strategies to minimize the anti-therapeutic effects of the Victorian Adult Parole Board and maximize the therapeutic effects of the CORE Sex Offender Programs are highlighted.

From cellulose to cell.

The cell wall is often pictured as a more-or-less random feltwork of cellulose microfibrils in association with other polysaccharide and protein complexes. There is evidence from morphology, morphogenesis and mechanics that the structures in the cell wall are far more regular and that their interactions are driven by their chemical and morphological properties. In particular, a model based on liquid crystal structures has more than morphological implications.

Pulmonary toxoplasmosis after allogeneic bone marrow transplantation: case report and review.

We report an isolated case of toxoplasma pneumonitis in a 27-year-old man. This acute infection occurred after induction chemotherapy for AMLo relapsing 3 years post-allogeneic BMT. The detection of Toxoplasma gondii in the bronchoalvolar lavage (BAL), by culture in fibroblast cell line MRC5 enabled us to make the diagnosis. Pyrimethamine and sulfadiazine were effective.

Young's moduli and shear moduli in cortical bone.

Young's modulus and shear modulus are determined for cortical bone from mammals and birds and for antler bone, using three-point bending at a range of span-to-depth ratios between 25 and 10. Young's modulus is obtained by extrapolating the values for the flexural modulus Eapp to infinite span-to-depth ratios. The shear modulus is obtained from the dependance of Eapp on this ratio. The main determinant for the mechanical properties is the mineral content. For mammalian bone the frequency of Haversian systems correlates negatively with stiffness and resistance to shear. However, because Haversian systems have a lower mineral content than laminar bone (the main component), material and structural determinants can not be separated at present. The ratio of Young's modulus to shear modulus is of the order of 20:1. This high value is discussed in terms of the Cook-Gordon theory of controlled crack propagation as well as in its significance for protecting hollow bones from failing upon local impact.

Adrenocortical function during septic shock.

OBJECTIVE: To investigate, in patients with severe septic shock, the adrenocortical function assessed by daily plasma cortisol determinations during the first 72 h and by the short synthetic ACTH stimulation test performed within 24 h of the onset of shock. DESIGN: Prospective clinical investigation. SETTING: Medical intensive care unit in a university teaching hospital. PATIENTS: 40 consecutive patients with documented septic shock requiring at least hemodynamic resuscitation and respiratory support. INTERVENTIONS: There were no interventions. MEASUREMENTS AND RESULTS: Basal cortisol concentrations were increased with a mean value of 36.8 micrograms/dl (range 7.9-113). Of the overall cortisol determinations 92% were above 15 micrograms/dl. No statistically significant differences in basal cortisol concentrations were found when survival, type of infection, and positive blood cultures were considered. Patients with hepatic disease had significantly higher cortisol (50.1 (+/- 6.2) micrograms/dl versus 35.9(+/- 3.3) micrograms/dl, p = 0.035) levels compared to other patients. No correlations were found between basal plasma cortisol concentrations and factors such as SAPS, OSF, hemodynamic measurements, duration of shock, and amount of vasopressor and/or inotropic agents. Cortisol concentrations had significant but weak correlation with ACTH levels in survivors (r = 0.4; p = 0.03; n = 28) but not in non-survivors (r = 0.03; p = 0.85; n = 52). Cortisol levels in non-survivors increased significantly from enrollment time to the 72nd hour of the survey (day 1: 38.9(+/- 3.8) micrograms/dl versus day 3: 66.7(+/- 17.1) micrograms/dl; p = 0.046) and were significantly higher than those recorded in survivors. Responses to the short ACTH stimulation test were not significantly different between survivors and non-survivors. According to the different criteria used to interpret the response to the ACTH stimulation test, incidence of adrenocortical insufficiency was highly variable ranging from 6.25-75% in patients with septic shock. Only one patient had absolute adrenocortical insufficiency (basal cortisol level below 10 micrograms/dl; response to the ACTH stimulation test below 18 micrograms/dl). CONCLUSION: Our data suggest that in a selected population of patients with severe septic shock single plasma cortisol determination has no predictive value. The short ACTH stimulation test performed within the first 24 h of onset shock can neither predict outcome nor estimate impairment in adrenocortical function in patients with high basal cortisol level. Adrenal insufficiency is rare in septic shock and should be suspected when cortisol level is below 15 micrograms/dl and then confirmed by a peak cortisol level lower than 18 micrograms/dl during the short ACTH stimulation test.

[Detection of left cardiopathy using echocardiography during acute respiratory failure in chronic respiratory insufficiency]. / Dépistage des cardiopathies gauches par échocardiographie au cours de l'insuffisance respiratoire aiguë des insuffisances respiratoires chroniques.

Echocardiography was performed in a systematic fashion in 58 patients suffering from on-chronic respiratory failure (IRC) who were admitted to the intensive care unit. The prevalence of left ventricular disease in patients with IRC who were admitted to the intensive care unit was 31%, there were 18 cases of cardiac disease: nine had hypertrophic cardiac disease (two with intraventricular gradients), three had dilated cardiomyopathies, and there were six cases of ischaemic cardiac disease. Among these cases, six had not previously been diagnosed as having cardiac disease (10%). In cases with poor echogenicity by the transthoracic root, oesophageal echocardiography was performed and this improved the feasibility of a good examination with only a five per cent failure rate. Left ventricular disease was implicated in the clinical assessment eleven times (19%), either on admission (nine times) or during the course of the in-patient treatment (twice). In directing the initial assessment and the aetiological treatment, echocardiography directly contributed to better management in six cases (10%). As regards the number of cases of cardiac disease which were detected, the study confirms the value of this technique at the bedside of the patient. The use of the transoesophageal route improves the diagnostic value including those patients who were intubated and ventilated.

[Value of approach monitoring of infusion pressure in neonatology]. / Intérêt de la surveillance des voies d'abord par monitorage des pressions de perfusion en néonatalogie.

The consequences of catheter occlusions are particularly dangerous in neonates. For early detection and to efficiently prevent such occlusions, the monitoring of infusion pressure by a variable pressure pump is reported. Two ways of monitoring can be recommended: easy viewing of infusion pressure and programming a pressure limit. Infusion pressure is recorded at around +/- 30 cm water pressure of the mean day pressure. Consequently, a rise above this gap must be considered as suspect. The regular viewing of this measurement is a way of predicting such problems as occlusions. The optimum pressure limit is programmed at 30 cm water pressure above the infusion pressure. This alarm may identify the beginning of occlusions or reduce the extent of tissue damage in early detecting of an infiltration.

Poisson's ratio in skin.

Poisson's ratio of cow teat skin was measured uni- and biaxially and shown to be anisotropic and dependent on aspect ratio. At strains below 0.1 (where Cauchy and Hencky strain are indistinguishable) the Poisson's ratio of cow teat skin measured biaxially is very much greater than 1.0, whereas the Poisson's ratio of distending artery is between 0.5 and 0.3. Knitted fabric behaves similarly to cow teat skin in that it can give a negative Poisson's ratio at low strains. Skin is therefore probably to be considered mechanically as an open feltwork of fibres rather than some sort of continuum.

Measuring the forces acting during microtomy by the use of load cells.

The forces acting upon the cutting blade during microtomy can be accurately measured by using a load cell. From the information obtained, the optimal knife angles (rake, clearance and slant) can be determined. In addition, the speed of cutting and thickness of sections can also be optimized. The information obtained from the load cell additionally reveals variations in tissue composition which affect the cutting forces. This paper is a preliminary communication to illustrate the possible roles for a modified microtome in (a) the study of microtomy and (b) comparative studies of tissue density.