[Role of emergency subtotal colectomy in neoplastic obstructions of the left colon]. / Place de la colectomie subtotale en urgence dans les occlusions néoplasiques du côlon gauche.

From 1984 to 1990, 60 patients underwent emergent surgery for a neoplastic obstruction of the left colon. We performed 19 colostomies without initial exeresis and 41 immediate tumoral resections. In the latter group, five subtotal colectomies (S.T.C.) were performed, including four with immediate mechanical anastomosis. Two patients had synchronous cancers and three had pre-perforating cecal lesions. Three patients had an associated general peritonitis. Three of the patients treated with STC died. These were these patients with general peritonitis, two of whom also had hepatic metastases. The data found in the literature on neoplastic obstructions of the left colon treated with STC with immediate anastomosis (227 cases are published) show an overall mortality rate of 8.4% with 24% morbidity, a complication of the anastomosis occurring in 4.5% of all cases.

Pharmacokinetics and pharmacodynamics of vecuronium in patients with cholestasis.

The pharmacokinetics and pharmacodynamics of vecuronium were studied in nine surgical patients with cholestasis, and in 14 patients without hepatic or renal disease. After the administration of vecuronium 0.2 mg kg-1 the plasma concentration of vecuronium and the degree of neuromuscular blockade were measured. The plasma clearance of vecuronium was decreased significantly (P less than 0.01) from 4.30 +/- 1.56 ml min-1 kg-1 (mean +/- SD) in normal patients to 2.36 +/- 0.80 ml min-1 kg-1 in patients with cholestasis. The elimination half-life was of 58 +/- 22 min in normal patients and was prolonged to 98 +/- 57 min (P less than 0.05) in patients with cholestasis. The total apparent volume of distribution was unchanged in patients with cholestasis. A prolonged neuromuscular blockade induced by vecuronium was observed in patients with cholestasis: the duration of effect from injection to 75% recovery of the twitch height was prolonged from 74 +/- 19 min in normal patients to 111 +/- 13 min in patients with cholestasis. The plasma concentration corresponding to 50% recovery from paralysis did not differ significantly between the two groups. Vecuronium has a prolonged effect in patients with cholestasis which is caused by a delay in its elimination.

[Intramuscular premedication with diazepam in a fat emulsion]. / Prémédication intra-musculaire par le diazépam en émulsion lipidique.

10 mg of diazepam in fat emulsion was given for premedication intramuscularly to 106 patients. In 53% of the cases patients were well sedated, 33% were apprehensive, 14% anxious. Pain related to the injection was complained of by 4 patients. Plasma concentration of diazepam at induction (60 minutes after the injection) was 130 ng/ml. Compared to diazepam in propylene glycol, pain at the injection side was less frequent while the level of sedation and the plasma concentration of diazepam were similar.

Temperature independence of the alkaline Bohr effect in pig red cells and pig haemoglobin solutions.

The influence of temperature on the oxygen affinity and the alkaline Bohr effect of pig red cells and pig hemoglobin solutions has been compared to that of human adult red cells and human adult hemoglobin. Pig red cells and pig Hb evidence a lower affinity for oxygen in various conditions of pH, temperature and salt concentration, in the presence as well as in the absence of organic phosphates. It has been observed that the alkaline Bohr effect of pig Hb was reduced by 20-25% compared to Hb A0 and independent of changes in temperature, contrary to human Hb A0. Titrations of pig Hb with C1- indicate a lower heterotropic effect of this anion at low concentration of the salt. It is concluded that this may be the origin of the temperature independence of the alkaline Bohr effect in pig Hb. Conversely, the temperature dependence of the alkaline Bohr effect of Hb A0 should be related to the oxygen-linked binding of C1- at the alpha 1-alpha 2 interface.

The measurement of the intrinsic alkaline Bohr effect of various human haemoglobins by isoelectric focusing.

We have used isoelectric focusing to measure the differences between the pI values of various normal and mutant human haemoglobins when completely deoxygenated and when fully liganded with CO. It was assumed that the DeltapI(deox.-ox.) values might correspond quantitatively to the intrinsic alkaline Bohr effect, as most of the anionic cofactors of the haemoglobin molecule are ;stripped' off during the electrophoretic process. In haemoglobins known to exhibit a normal Bohr coefficient (DeltalogP(50)/DeltapH) in solutions, the DeltapI(deox.-ox.) values are lower the higher their respective pI(ox.) values. This indicates that for any particular haemoglobin the DeltapI(deox.-ox.) value accounts for the difference in surface charges at the pH of its pI value. This was confirmed by measuring, by the direct-titration technique, the difference in pH of deoxy and fully liganded haemoglobin A(0) (alpha(2)beta(2)) solutions in conditions approximating those of the isoelectric focusing, i.e. at 5 degrees C and very low concentration of KCl. The variation of the DeltapH(deox.-ox.) curve as a function of pH (ox.) was similar to the isoelectric-focusing curve relating the variation of DeltapI(deox.-ox.) versus pI(ox.) in various haemoglobins with Bohr factor identical with that of haemoglobin A(0). In haemoglobin A(0) the DeltapI(deox.-ox.) value is 0.17 pH unit, which corresponds to a difference of 1.20 positive charges between the oxy and deoxy states of the tetrameric haemoglobin. This value compares favourably with the values of the intrinsic Bohr effect estimated in back-titration experiments. The DeltapI(deox.-ox.) values of mutant or chemically modified haemoglobins carrying an abnormality at the N- or C-terminus of the alpha-chains are decreased by 30% compared with the DeltapI value measured in haemoglobin A(0). When the C-terminus of the beta-chains is altered, as in Hb Nancy (alpha(2)beta(Tyr-145-->Asp) (2)), we observed a 70% decrease in the DeltapI value compared with that measured in haemoglobin A(0). These values are in close agreement with the estimated respective roles of the two major Bohr groups, Val-1alpha and His-146beta, at the origin of the intrinsic alkaline Bohr effect [Kilmartin, Fogg, Luzzana & Rossi-Bernardi (1973) J. Biol. Chem.248, 7039-7043; Perutz, Kilmartin, Nishikura, Fogg, Butler & Rollema (1980) J. Mol. Biol.138, 649-670]. In other mutant haemoglobins it is demonstrated also that the DeltapI(deox.-ox.) value may be decreased or even suppressed when the substitution affects residues involved in the stability of the tetramer. These results support the interpretation proposed by Perutz, Kilmartin, Nishikura, Fogg, Butler & Rollema [(1980), J. Mol. Biol.138, 649-670] for the mechanism of the alkaline Bohr effect, and also indicate that the transition between the two quaternary configurations is a prerequisite for the full expression of the alkaline Bohr effect.

The involvement of tertiary conformational changes and the role of the alpha-chain-binding sites on oxygen-linked chloride release from human hemoglobin.

Chloride anions, when bound to human hemoglobin, lower the affinity for oxygen and increase the alkaline Bohr effect. These oxygen-linked characteristics are attributed to the preferential binding of Cl- to both alpha- and beta-chains in their deoxy configuration. It is demonstrated that the release of Cl- upon oxygenation is mainly due to tertiary changes, as shown by the effect of the anion on K1, the affinity constant of hemoglobin for oxygen at a very low saturation level (y less than or equal to 1.5%) where the cooperativity is unity. Investigation of the chloride effect on adult hemoglobin specifically carbamylated at the N-terminal valine of the alpha-chains, indicated a large inhibition of the effect of Cl-. The alpha-chain-binding sites appear to be the sites of the greatest affinity for the anion.

Oxygen-linked binding of halothane to human adult haemoglobin.

The affinity for oxygen of normal human haemoglobin (Hb) solutions was measured in the presence of increasing concentrations of halothane. We observed a maximum increase in P50 of 25% with halothane 40 kPa compared with control (oxygen-argon gas mixtures) indicating the oxygen-linked character of the binding of halothane to the Hb molecule. The effect of halothane on P50 was independent of pH between 7.0 and 8.0 and of chloride concentration between 10 and 100 mmol litre-1. This suggests that halothane-Hb interactions may occur through hydrophobic linkage as occurs with short chain aliphatic hydrocarbons. The oxygen-linked binding of halothane appears of minor importance in altering oxygen binding to Hb in vivo compared with other factors such as chloride ion or 2, 3-DPG.

[Gastric acidity induced by cimetidine. Evaluation during general anaesthesia (author's transl)]. / Contrôle de l'acidité gastrique par la cimétidine au cours de l'anesthésie générale.

400 mg of cimetidine were administered intramuscularly 60 minutes before the beginning of general anesthesia. The double blind experiment was conducted on 84 patients divided in two groups: cimetidine and control. As far as the gastric fluid volumes are concerned there was no difference between the two groups during general anesthesia, but acid secretion decreased significantly in the cimetidine group, pH values lower than 2.5 were observed in 33.3 p. cent at induction time and 34 p. cent at recovery time in the control group against 14.6 p. cent and 0 p. cent in the cimetidine group.

The binding of lactate and chloride ions to human adult hemoglobin.

The effects of sodium lactate (Lact) on the oxygen affinity and the Bohr effect of purified human adult hemoglobin solutions have been compared to the effects of sodium chloride (Cl). Changes in the affinity for oxygen have been estimated from the variations of log(O2)50 with pH and at various salt concentration from 0.005 up to 2.0 mol.l-1. (O2)50 was calculated as alpha.P0.5 where alpha is the solubility coefficient of oxygen in the solutions at various salt concentrations. Variations of log(O2)50 with pH at constant salt concentration and variations of log(O2)50 with anion concentration at constant pH have been studied according to the linked-functions theory (Wyman, 1968). Bohr curves and salt binding curves were calculated from standard iterative curve fitting procedures and various parameters relevant to the effects of salts on hemoglobin function were estimated. It is shown that Lact and Cl increase (O2)50 and the alkaline Bohr effect in a comparable way at low salt concentration. At high concentration the effect of Lact predominated over that of Cl. The amount of oxygen linked Lact was larger than that of Cl. Binding constants for both anions to deoxy and oxy Hb were estimated. Lact and Cl have comparable binding constants to deoxy hemoglobin. By contrast Lact binds to oxy hemoglobin to a lesser extent than Cl. This may account for the differences observed in the effects of Lact and Cl on the function of hemoglobin. The reason for the low affinity of oxy hemoglobin for Lact may be related to steric differences between the two anions.

Interaction of butene with human hemoglobin A.

The binding of various alkanes by proteins was recognized years ago. We have studied the effect of butene (C4H8), a short-chain aliphatic hydrocarbon, on the functional properties of human adult hemoglobin. Under 1 atm pressure (100 kPa) butene decreased the affinity of hemoglobin (Hb) for oxygen (p50) by 45% without altering the cooperativity of ligand binding. This effect was independent of pH (from 7.0 to 8.0) and of ionic strength. The changes in the affinity of hemoglobin for oxygen were dependent upon the partial pressure of butene and evoked a saturating mechanism of the binding site(s). Mathematical simulation of the curve relating p50 to the concentration of dissolved butene allowed us to calculate the apparent association constants for one single binding site KHb = 10.4 mmol-1 and KHbO2 = 1.53 mmol-1 to Hb and HbO2 respectively. The larger binding of butene by Hb was confirmed by a 25% decrease in K1, the first association constant of oxygen to the tetrameric hemoglobin. It is concluded that butene is an allosteric effector of human Hb which acts most likely through hydrophobic interactions. It is postulated that the oxygen-linked binding site may be located at the alpha 1 beta 2 interface.

Comparative effects of CO2 on the affinity for O2 of fetal and adult erythrocytes.

1. Oxygen-linked carbamino formation in fetal erythrocytes was compared to that measured in adult erythrocytes. 2. Whole oxygen binding curves were recorded on washed intact erythrocytes either fresh or D-glycerate-2,3-P depleted with a continuous recording technique. Erythrocytes were resuspended in buffer media of different pH and PCO2 varying from 0-10.7 kPa (80 torr) at physiological ionic strength. Oxygen linked carbamates were estimated as deltalog PO2/delta log PCO2 at constant pH and constant saturation levels from 10-90% oxygen saturation. 3. The overall CO2 effect (deltalog P50/deltalog PCO2) was consistently lower in fetal erythrocytes than in the adult. The deltalog PO2/deltalog PCO2 ratio was markedly dependent on oxygen saturation in both types of erythrocytes and highest at the early part of the oxygen binding curve. This was more so in fetal erythrocytes. 4. Carbamino formation was lower in fetal erythrocytes than in adult erythrocytes at any pH value, indicating a higher apparent pK of the alpha amino groups involved in CO2 binding in fetal erythrocytes. This may be related to the different primary structures of the non alpha chains of HbFII and HbAI. 5. The large effect of low PCO2 on both fetal and adult erythrocytes was related to the higher affinity for CO2 of deoxyhemoglobin compared to oxyhemoglobin and a model for CO2 binding analogous to that described by de Bruin et al. [6] for anion binding is proposed. 6. It is concluded that the lower CO2 binding to fetal erythrocytes is in keeping with the lower allosteric effect of other major effectors of hemoglobin within the cells. This leads to a higher affinity for O2 of fetal erythrocytes well suited for O2 transport in utero.

Chloride binding and the Bohr effect of human fetal erythrocytes and HbFII solutions.

1. We have observed that the alkaline Bohr effect of washed human fetal erythrocytes was larger than in human adult intact red cells, in physiological conditions of pH, PCO2 and temperature. This was also observed independently of the presence of CO2 and of 2,3 diphosphoglycerate (fresh or stored erythrocytes). 2. Experiments performed in purified HbFII and HbA1 solutions and direct titration of protons released upon oxygenation confirmed the larger alkaline Bohr effect of fetal hemoglobin, at physiological ionic strength. 3. At low chloride concentration HbFII solutions had an alkaline Bohr effect identical to that measured in HbA1 solutions. 4. Titration of purified Hb solutions with increasing concentrations of NaCl evidenced a lower O2 linked chloride binding by HbFII and predominantly at acid pH. 5. It is concluded that the larger alkaline Bohr effect of fetal erythrocytes of HbFII solutions is related to a diminished acid Bohr effect, due to the lower affinity of HbFII for chloride anions. 6. The physiological interest of these results for placental O2 transfer (double Bohr effect) and O2 delivery to the foetus is discussed.

[Increase of anaerobic infections. Prevalence of Bacteroides. Apropos of 17 cases in abdominal surgery]. / Recrudescence des infections à germes anaérobies. Prédominance des bactéroïdes. A propos de 17 cas en chirurgie abdominale.

Seventeen cases of anaerobic infections in abdominal surgery are reported. Predominance of bacteroides is evident (9/17), especially bacteroides fragilis. The clinical manifestations of bacteroides infections are severe: 7 septicemias and 2 parietal infections, being the cause of the death in four patients. Bacteroides infection develops preferently in an old patient, with severe disease, in colic surgery especially in emergency. Bacteroides are characterized by their polyresistance to antibiotics: beta-lactamins, except carbenicillin, and aminosids. Metronidazole is a powerful bactericidal agent with a very low toxicity, particularly active in the treatment of these affections, as well as clindamycin. If oral route is impossible, chloramphenicol, I.V. tetracyclin, and above all carbenicillin are able to be used with success.

[Value of moderate fentanyl dosage during anesthesis in abdominal surgery. Apropos of 100 cases]. / Intérêt du fentanyl a posologie modérée au cours de l'anesthésie en chirurgie abdominale. A propos de 100 observations

Fentanyl was used in 100 abdominal surgical interventions, combined with droperidol or with diazepan, always with good results as far as analgesia was concerned. Tensional variations that occurred during the induction were quite small and disappeared during the filling up. In the course of the intervention, tensional variations were only met with subjects suffering from high blood pressure. The respiratory depression that went with analgesia did not constitute an obstacle but made it necessary to use artificial ventilation for the intervetion. The awakening was always quick, smooth, without any vomiting and was influenced neither by the time taken up by the intervention nor by the condition of the patient. No residual respiratory depression requiring the use of an anti-morphinic was noted. At the end of the study, fentanyl appears as a powerful analgesic, easy to use and successful in all the cases of abdominal surgery. Its effect does not last, a drawback that can be avoided by the use of an intravenous drip.