Feasibility and limits of inguinal hernia repair under local anaesthesia in a limited resource environment: a prospective controlled study.

PURPOSE: Local anaesthesia (LA) has proven effective for inguinal hernia repair in developed countries. Hernias in low to middle income countries represent a different issue. The aim of this study was to analyse the feasibility of LA for African hernia repairs in a limited resource environment. METHODS: Data from patients who underwent herniorrhaphy under LA or spinal anaesthesia (SA) by the 6th and 7th Forward Surgical Team were prospectively collected. All of the patients benefited from a transversus abdominis plane (TAP) block for postoperative analgesia. Primary endpoints concerned the pain response and conversion to general anaesthesia. Secondary endpoints concerned the complication and recurrence rates. Predictors of LA failure were then identified. RESULTS: In all, 189 inguinal hernias were operated during the study period, and 119 patients fulfilled the inclusion criteria: 57 LA and 62 SA. Forty-eight percent of patients presented with inguinoscrotal hernias. Local anaesthesia led to more pain during surgery and necessitated more administration of analgesics but resulted in fewer micturition difficulties and better postoperative pain control. Conversion rates were not different. Inguinoscrotal hernia and a time interval <50 min between the TAP block and skin incision were predictors of LA failure. Forty-four patients were followed-up at one month. No recurrence was noted. CONCLUSIONS: Local anaesthesia is a safe alternative to SA. Small or medium hernias can easily be performed under LA in rural centres, but inguinoscrotal hernias required an ultrasound-guided TAP block performed 50 min before surgery to achieve optimal analgesia, and should be managed only in centres equipped with ultrasonography.

Realizing field-dependent conduction in ZnO nanowires without annealing.

We report on the low-temperature fabrication of field-effect transistors by bridging pre-patterned electrodes using ZnO nanowires grown in situ, which operate without requiring post-growth processing or annealing. The devices show good performance using as-grown nanowires, with on-off ratios of 105 and threshold voltages of 2 V. Electron microscopy shows the field-dependent nanowires hierarchically nucleate from larger ZnO nanorods, and both are oriented along a common c-axis. A high nanowire surface-to-volume ratio allows depleting electron traps on the nanowire surface to compensate intrinsic electron donors present throughout the nanowire bulk. This eliminates the need to reduce the electron concentration through high-temperature annealing, making the nanowires naturally field-dependent in their as-grown state.

Side of pupillary mydriasis predicts the cognitive prognosis in patients with severe traumatic brain injury.

BACKGROUND: Pupils' abnormalities are associated to bad prognosis in traumatic brain injury. We investigated the association between the side of pupil mydriasis and the long-term cognitive performance of patients with severe traumatic brain injury (TBI). METHODS: We analyzed the cognitive performance of patients admitted at the intensive care unit with isochoric pupils (IP, n = 28), left mydriasis (LM, n = 10), right mydriasis (RM, n = 9) evaluated in mean 2.5 years after the severe TBI and controls (n = 26) matched for age, sex and education level. RESULTS: Patients and controls had similar scores in the four WAIS-III investigated subtests. In comparison with controls, LM patients had lower scores in Letters and Category Fluency and IP patients in Category Fluency. Among the 10 evaluated memory tests, LM patients had lower scores than controls in eight, RM patients in two and IP in three memory tests. IP and RM were 3.5 to nine times more associated to significant impairment (cognitive scores under the percentile 10 of controls) in six of 16 investigated cognitive tests. LM was six to 15 times more associated to significant impairment in 10 of 16 cognitive tests. The association among the pupil abnormalities and cognitive performances remained significant after the multiple linear regression analysis controlling for age, gender, admission coma Glasgow scale and serum glucose, presence of associated trauma, and cranial computed tomography abnormalities. CONCLUSION: Side of admission pupil abnormalities may be a useful variable to improve prognostic models for long-term cognitive performance in severe TBI patients.

Is critical illness polyneuropathy associated with decreased heart rate variability?

INTRODUCTION: This pilot study assessed the association between critical illness polyneuropathy (CIP) and decreased heart rate variability (HRV) in intensive care patients. METHODS: All patients admitted to the intensive care unit and expected to be ventilated for at least 72 hours were included and underwent weekly electromyograms and HRV analyses for three weeks. HRV was assessed by time domain analysis of 24h recording electrocardiograms, and alterations in HRV were assessed as the square root of the mean squared differences of successive RR intervals (RMSSD) ≤ 15. RESULTS: We evaluated 26 patients, 12 men and 14 women, median age 64 years. During follow-up, 12 patients died and 9 developed CIP. CIP was not associated with age, sex, simplified acute physiology score II and treatment agents. Altered RMSSD tended to be associated with onset of CIP (P=0.06). Altered RMSSD occurred earlier or at the same time as electromyogram abnormalities in all CIP patients, but the difference was not significant. CONCLUSION: Altered HRV, may be associated with the onset of CIP in ICU patients. Although not statistically significant (P=0.06), altered RMSSD may be a surrogate marker of CIP in ICU patients undergoing mechanical ventilation. The physiological pathway linking HRV and CIP remains uncertain.

[Colchicine poisoning: a case report]. / A propos d'une intoxication létale à la colchicine.

Colchicine is a drug commonly used for treatment of acute and chronic gout. Poisoning is a rare but always serious event. The purpose of this report is to describe the case of a 16-year-old girl who ingested an unknown amount of colchicine in a suicide attempt. At the time of admission she presented with gastrointestinal manifestations and reduced consciousness. After ten days in the intensive care unit she died due to multiple organ failure. This case provides the opportunity not only to review the clinical course and prognostic factors associated with colchicine poisoning but also to underline the difficulty of its management due to the absence of a specific antidote and of emergency pharmacologic doses.

[Impetigo herpetiformis and Ondine curse]. / Impétigo herpétiforme et syndrome d'Ondine.

INTRODUCTION: Impetigo herpetiformis is a rare dermatitis that occurs during pregnancy and may be life threatening for both mother and child. In this case report, we present an Ondine curse involving the baby, and the good response to isotretinoine. CASE REPORT: A first pregnancy, 26 year-old woman developed at 8 months a widespread skin lesion involving the medial side of the thighs, abdomen and intertriginous areas, with a severe systemic toxic condition and fever. Diagnosis of impetigo herpetiformis was made and corticosteroids, methotrexate and cyclosporine were unsuccessful. Isotretinoine rapidly improved the patient with good control of the disease. The full term baby had an Ondine curse. DISCUSSION: Our case is typical of impetigo herpetiformis. Maternal and infant complication may be life threatening and we report a real Ondine curse the etiology of which remains unknown. Moreover, this observation is unusual because the lesions did not clear despite delivery and good treatment. In our opinion, the great improvement with isotretinoine would suggest it could be used as first line treatment.

[Contribution of the French Armed Forces Health Services to relief in Indonesia following the tsunami on December 26, 2004]. / Principales actions menées par le Service de santé des armées en Indonésie au décours du tsunami du 26 décembre 2004.

As of early January 2005, the French Armed Forces Health Services were on the ground in Indonesia to contribute to relief operations following the tsunami in Indonesia on December 26, 2004. Findings of preliminary investigation performed upon deployment of the first French elements demonstrated that a major priority was to speed up vaccination against measles in children between the ages of 6 months and 15 years. A vaccination campaign was planned in cooperation with Indonesian authorities and UNICEF. Implementation involved training of personnel and setting up vaccination clinics in refugee camps, schools, and neighborhoods in the city of Meulaboh. The vaccination campaign was hampered by a number of problems in particular involving logistics and required constant supervision. A survey to evaluate the results of the campaign in terms of vaccination coverage showed that the objective of vaccinating 70% of children in refugee camps was achieved. The survey provided other child health indicators that will be helpful to local authorities taking over after the departure of the French Armed Forces Health Services.

Isoelectric focusing (IEF) and immunofixation for determination of disialotransferrin.

OBJECTIVES: A new simplified method for detection and quantitation of disialontransferrin in serum is described. DESIGN AND METHODS: The method is based on polyacrylamide gel isoelectric focusing, direct immunofixation with a specific antibody, and measurement by computerized scanning densitometry. Disialotransferrin levels were determined in 24 teetotallers and 34 alcoholics at 3 moments during detoxification. Three groups of drinkers were arranged: group 1 (without), group 2 (with light), and group 3 (with severe hepatitis). RESULTS: The metho showed very good reproducibility and accuracy with a coefficient of variation between 5 to 8%. Alcoholic patients could be clearly separated from teetotallers, with a specificity of 100% and a sensitivity of 94%. After 12 days of alcohol withdrawal, disialotransferrin values declined in alcoholics but remained slightly high. They were not influenced by the severity of liver disease. No significant difference was found between the 3 groups. CONCLUSIONS: An easy-to-perform, sensitive, and inexpensive method has been developed to quantify disialotransferrin that can be used by laboratories almost everywhere.

Quantitation of platelet antigens after chloroquine treatment.

The effect of chloroquine treatment on the expression of various platelet antigens was studied. For this purpose, the binding of several human platelet-reactive antibodies (polyspecific HLA antibodies; platelet-specific PlA1, PlA2, Baka antibodies; platelet autoantibodies) and of murine monoclonal antibodies specific for epitopes on the glycoprotein (Gp) complexes IIb/IIIa or Ib/IX were quantitated by means of a competitive enzyme-linked immunoassay (CELIA) using fresh and stored chloroquine-treated platelets. We found that HLA antigens were substantially removed from platelets following chloroquine treatment (confirming earlier results) while platelet-specific antigens on the Gp complex IIb/IIIa were but little affected. Epitopes on the Gp complex Ib/IX did not show any alteration. Storage of chloroquine-treated panel platelets known to interfere with immunofluorescence had no effect on quantitative IgG determinations by CELIA. We conclude that chloroquine treatment of platelets is practicable for platelet antibody analysis, but exerts its effect unspecifically and requires cautious interpretation.