[The first our quintet or the channel of care for the most usual urgent pathologies]. / Le quintette de la première heure ou les filières de soins des pathologies urgentes les plus fréquentes.

The European Community has named five emergencies as being priorities. These five emergencies are: the cardiorespiratory arrest, the myocardial infarction, the severe polytrauma, the cerebral vascular accident and the severe acute dyspnoea. In this article three of them are discussed. Seen with the eyes of a generalist the severe polytrauma requires simple gestures, such as an early call for help by the SMUR, axialisation of head, trunk and members, compression of overtly sources of bleeding and opening the airway to facilitate breathing. The acute myocardial infarction continues to pose problems of diagnosis. The pathognomonic presentations are the STEMI and the N-STEMI infarction. In these cases it is a priority to call for the help of a SMUR unit. In the case of a STEMI infarction it is an absolute priority to admit the patient quickly to hospital and to directly move on to the coronarography ward for a primary angioplasty procedure. Within the first three hours of the infarction, if primary angioplasty is not a possibility within the first 90 minutes, thrombolysis is absolutely indicated. In the case of N-STEMI infarction a quick admission to a coronary care unit is urgent but the treatment is mainly medical. The cerebral vascular incident occurs more frequently than the myocardial infarction, but, culturally, not enough importance is attached to this pathology. Within the first three hours the aim is to get the patient to an emergency department (by means of the SMUR), to evaluate the coagulation values of the patient and to perform a head scan (without the injection of contrast) of good quality. If the patient is not too severely incapacitated (NIH score between 4 and 25), if the head scan does not show a hemorrhagic lesion and if there is no contraindication for thrombolysis, Actilyse should be administered. The time it takes to do all of these acts can not exceed the above mentioned three hours.

Rational design of an influenza subunit vaccine powder with sugar glass technology: preventing conformational changes of haemagglutinin during freezing and freeze-drying.

The development of a stable influenza subunit vaccine in the dry state was investigated. The influence of various carbohydrates, buffer types and freezing rates on the integrity of haemagglutinin after freeze-thawing or freeze-drying was investigated with a range of analytical and immunological methods. The use of fast freezing, Hepes buffer and carbohydrates (trehalose, inulin or dextran) as cryo- and lyoprotectants resulted in a significant reduction or even absence of conformational changes of HA as revealed by the used methods. The subunit vaccine in the powder was shown to remain immunogenic in an in vivo study in mice, using reconstituted powder. Moreover, the HA potency of the influenza subunit vaccine powder was stable for at least 26 weeks at room temperature.

Stability of influenza sub-unit vaccine. Does a couple of days outside the refrigerator matter?

In this study 27 full scale production batches of influenza sub-unit vaccine were evaluated on their stability. The batches varied with respect to the strains they contained and regarding the presence of the preservative thiomersal in the solution. The stability study showed that haemagglutinin content was the most sensitive parameter. An increase in the storage temperature strongly increased the degradation rate of haemagglutinin. The degradation rate of the haemagglutinin differed for the different strains tested. However, statistical evaluation of the data obtained for the most sensitive strain tested showed that even exposure during a 2 week period of the vaccine to room temperature would not adversely affect the shelf life claim of the influenza subunit vaccine of 1 year in the refrigerator. Moreover, this study showed that the presence of thiomersal in the solution has no effect on the stability of the vaccine.

[Carotid surgery with cervical plexus block: personal experience]. / Chirurgie carotidienne sous plexus cervical: expérience personnelle.

Although this is an unfrequently used technique, the authors report their early experience concerning twenty-seven cases of carotid artery revascularization under cervical plexus anesthesia. They express their surgical judgement about the advantages and the limits of the simplest and most reliable way of cerebral monitoring during the surgical procedure, but it might have only a limited indication.