Detoxification of mercury in the environment.

In this study, a "green chemistry" approach was developed as an option for remediation of toxic mercury in the environment. Twenty mercury compounds were treated with an environmentally friendly agent cyclodextrin to produce stable non-toxic mercury in soil and water. The binding efficiency was determined using high performance liquid chromatography with diode-array detection. The stability of the cyclodextrin mercury complexes toward environmental microorganisms in water was estimated under OECD guidelines using gas chromatography-mass spectrometry. The toxicity of the cyclodextrin mercury compounds to terrestrial organisms was investigated by use of internationally recognized toxicity methods using mercuric acetate as a model contaminant. Key process conditions, for example pH, temperature, and amount of detoxifying agent were investigated and found to have significant effects on the toxicity of mercury. It was found that organic and inorganic mercury pollutants could be mineralized in the environment with cyclodextrins. The bound mercury compounds resisted biodegradation and were found to be non-toxic to environmental microorganisms under laboratory conditions.

[Esophago-bronchial fistula in adults]. / Les fistules oeso-bronchiques de l'adulte.

The authors report five cases of benign oesophago-bronchial fistula in adults. These chronic bronchitic patients presented with recurrent episodes of secondary lung infections (or even haemoptysis). Questioning of the patients revealed a history of coughing when swallowing liquids in three cases. Two women concealed this symptom, which was only revealed retrospectively. The fistula was detected by upper GI series in three cases and by oesophageal fibroscopy in one case. In the remaining case, it was discovered at operating for severe haemoptysis. In four of the five cases, the fistula was situated on the right and was of post-tuberculous origin. In one case of post-traumatic fistula, it involved the left main bronchus. All of the patients were operated: a resection-suture of the fistula was performed via the oesophageal approach and, via the bronchial approach, simple suture of the fistula was possible in two cases, while resection of the destroyed pulmonary parenchyma was necessary in three cases (one right lower lobectomy, two bilobectomies). Demonstration of the oesophago-bronchial fistula, definition of its site and assessment of the condition of the pulmonary parenchyma are essential steps to be performed prior to surgery.

[Cardiac rhythm disorders after pneumonectomy]. / Troubles du rythme cardiaque après pneumonectomie.

The authors studied 13 cases of arrhythmia following pneumonectomy in a series of 94 pneumonectomies performed in the Thoracic Surgery Unit. The arrhythmias essentially consisted of atrial fibrillation which was well tolerated haemodynamically. It generally occurred in ambulant patients on about the 5th postoperative day. These arrhythmias responded well to treatment with continuous infusion of amiodarone. By comparing the files of the standard series of 94 pneumonectomies to the series of 13 cases of arrhythmia, the authors tried to determine the predisposing causes. The most obvious cause was the opening of the pericardium, but a number of other predisposing factors were detected: not so much hypoxia or hypovolaemia, but, more importantly, an increase in the effusion in the pneumonectomy cavity with displacement of the mediastinum.

[Reversible pulmonary hypoperfusion following proximal bronchial obstruction caused by a benign process]. / Hypoperfusion pulmonaire réversible secondaire à l'obstruction d'une bronche proximale par un processus bénin.

Obstruction of a major bronchus by a benign lesion can be accompanied by a functional reduction of the perfusion of the distal lung. This disorder is reversible after removal of the obstruction. We present 5 cases of obstruction of a main bronchus with functional exclusion of the affected lung on scintigraphy. The obstructing lesion was carcinoid tumour in 4 cases and a plasmocytic granuloma in another case. The perfusion was found to be restored following the operation (one bronchotomy, three isolated resection-anastomoses and one resection-anastomosis with lobectomy). These disorders are due to reflex phenomena and anatomical modifications related to the trapping effect. These phenomena are revealed by plain chest x-rays and by perfusion and ventilation pulmonary scintigraphy.

[For a clinical approach to impulsion phobias]. / Pour une approche clinique des phobies d'impulsions.

Having first recalled the problems involved in classifying impulsion phobias, (problems which have been experienced in the course of all the work done on this subject), the authors report, from a strictly clinical viewpoint, on a series of studies of patients whose problems are very different but who all show the symptoms of impulsion phobia. They next setout a phenomenological approach to the problem, with emphasis on the products of the patient's imagination, his passive fascination with the image of a terrifying act constituting the object of the phobia, the external world in relation to the subject, and the ambiguity of dependance on others which is mirrored by aggressiveness. Lastly, the subject's entire existence is put symbolically at stake, and the phobia is seen to spring from his narcissistic relationship with the external world at a deeper level than that of any oedipian relationships. The first stage in the treatment is, indeed, to build up this narcissistic relationship, and later treatment will be varied according to the patient's fundamental needs.

[Anesthesia for resections-anastomoses of the trachea and the tracheal bifurcation]. / Anesthésie pour les résections-anastomoses de la trachée et de la bifurcation trachéale

Resection and anastomosis of the trachea or the tracheal bifurcation, raises numerous problems, which will be discussed in a series of 81 patients: -there is more or less marked ventilatory insufficiency related to the degree of the stenosis, and difficulties of expectoration responsible for retention of sputum; -per-operative ventilation. One must choose between an intubation catheter of small caliber in order to overcome the stenosis, or a large catheter to remain above it. The problem is all the more delicate to solve when the stenosis is tighter and higher; -during the period when the trachea is open, the surgeon must intubate the central part of the trachea with a sterile catheter. If the division is low, it is necessary to intubate the main bronchi or one only, and then create a marked shunt effect which would be ill-supported by the patient; -It is advisable to remove the catheter at the end of the operation. Awakening should be perfect in order to cough to be immediately efficacious in a patient who often has to remain with his head flexed forwards.

[Re-establishment of tracheal continuity by lowering the larynx after tracheal resection]. / Le rétablissement de la continuité trachéale par abaissement du larynx apreès résection trachéale

The authors describe a technique for re-establishing tracheal continuity after anastomotic resection of the cervical and cervico-thoracic trachea. Simply lowering the larynx cervically without an associated thoracic phase enables termino-terminal anastomosis of the trachea to be carried out after resection of more than 5 cm. In this article, the technique and the results obtained in 8 cases of pure tracheal stenosis are described in detail.