Overcoming barriers to glycemic control in African Americans with type-2 diabetes: benefits of insulin therapy.

A disproportionate number of African-American men and women are affected by obesity and diabetes. The documented rate of poor glycemic control in the African-American population may contribute to the high rate of morbidity and mortality due to diabetes observed in these patients. Since the benefits of strict glycemic control have been demonstrated in multiple large trials, the aim of treatment should be to achieve the goals set forth by the American Diabetes Association. Insulin remains an essential therapeutic agent for helping patients achieve glycemic control and preventing long-term comorbidities. However, barriers to insulin therapy exist for both the physician and patient. Strategies to counter this resistance include identifying barriers to treatment, restoring the patient's sense of control, utilizing simple regimens, and reviewing the benefits of insulin and the risk of hypoglycemia. In treating African-American patients with diabetes, providers of various racial and ethnic backgrounds may maximize treatment efficacy by attempting to understand and practice culturally competent care.

[Stability and antimicrobial effectiveness of Javel water in a tropical hospital environment]. / Stabilité et efficacité antimicrobienne de l'eau de Javel en milieu hospitalier tropical.

A sodium hypochlorite solution (NaClO) containing 0.5% w/v of available chlorine (0.5% Cl2 or 5000 ppm) is a good and cheap solution for disinfecting material used to medical care. It is effective against bacteria, fungi and viruses. It is easy to prepare. It can be a good solution for antisepsis and disinfection in dispensaries in developing countries. However, it is not always easy to keep it in adequate conditions. That's the reason why we have evaluated the durability of such a solution of NaClO exposed to disadvantageous factors, specially daylight and air, and its antibacterial effectiveness. In this study, after exposure of NaClO containing 4350 ppm of available chlorine to these adverse conditions, the final concentration of NaClO was 2300 ppm of available chlorine and was found effective for decontamination of medical material. A protocol for conservation and use of a sodium hypochlorite solution (0.5% Cl2) in dispensaries of developing countries is proposed.

[Comparative trials of fluid gelatins on hemostasis in heart surgery in adults]. / Essais comparatifs des gélatines fluides sur l'hémostase dans la chirurgie cardiaque de l'adulte.

The purpose of this study was to compare, in adult cardiac surgery, the results of two gelatin substitutes (Plasmion and Haemaccel) especially for haemostasis and coagulation factors. Patients showing before operation any perturbation of blood parameters (anaemia, coagulation troubles) as well as patients suffering from serious complications or deceased in the postoperative period have been excluded. This study was realised with 54 patients randomised in two groups: group P (Plasmion); group H (Haemaccel). Anaesthesia was a diazanalgesia. Hemodilution was used in combination with autologous peroperative blood transfusion and reinfusion of residual blood from ECC after ultrafiltration. The two groups were statistically similar. In average, patients received the same gelatins quantity. The only remarkable findings were: a lesser decrease of platelets number per-ECC: a lesser fibrinogen level in postoperative period with Haemaccel.

[Effectiveness of the Cell Saver and salvage from ultrafiltered extracorporeal circulation in heart surgery]. / Efficacité respective du Cell Saver et de la récupération du circuit de CEC ultrafiltré en chirurgie cardiaque.

The efficiency of two intraoperative techniques of blood saving were compared prospectively. During a period of eight months, in 120 adults patients undergoing heart surgery with a cardiopulmonary bypass (CPB). They all had blood removed before the start of CPB for isovolaemic haemodilution. They were randomly assigned to two groups (n = 60 for each): for group A patients, blood was salvaged during surgery before the start of the CPB, during cardioplegia, and from the CPB circuit at the end of surgery, using a Cell Saver 1V (Haemonetics), and returned to the patient in theatre or in intensive care; in group B patients, blood in the CPB circuit at the end of surgery was ultrafiltered and returned to the patient at the same time as 0.8 mg.kg-1 protamine sulfate. The same anaesthetic protocol was used in all the patients (flunitrazepam, phenoperidine and pancuronium bromide). There was no significant difference between the two groups in the volume of blood removed at the start of surgery (9.12 +/- 2.01 ml.kg-1 (A) vs. 8.85.2.22 ml.kg-1 (B)), in the amounts of replacement fluid (Haemaccel, 4% albumin) given to maintain volaemia, and in postoperative blood loss Red cell count, haemoglobin level and haematocrit were higher in the Cell Saver group at the third postoperative hour and on the first postoperative day, whereas fibrinogen levels and platelet count were higher in the ultrafiltration group at the same times. A mean of 1.02 +/- 1.71 homologous blood units were given to group A and 1.45 +/- 1.71 in group B (not significant).(ABSTRACT TRUNCATED AT 250 WORDS)

[The use of the Haemolite Cell Saver in cardiovascular surgery]. / Utilisation du Cell Saver Haemolite en chirurgie cardio-vasculaire.

In eighteen adult patients scheduled for cardiac and vascular surgery, shed blood was treated with the Haemonetics Cell Saver Haemolite. On average by patient, the autologous blood volume restored was 471.94 +/- 235.7 ml. The haemoglobin level was 16.88 g.dl-1 and haematocrit level was 49.31 +/- 7.2%. Thirteen by eighteen patients did not require any homologous blood transfusion. The Cell Saver Haemolite technique is restricted to moderate and gradual peroperative bleeding. This technique is particularly designed for vascular and pediatric surgery. Postoperative shed blood salvage is a marginal indication.

[Role of the hospital pharmacy in the preparation of an emergency plan. Experience of the central pharmacy of Angers Regional University Hospital Center]. / Rôle d'une pharmacie hospitalière dans l'élaboration d'un plan d'urgence. Expérience de la pharmacie centrale du CHRU d'Angers.

In case of disasters, an emergency plan has been set up in Angers hospital, to conform to the law. This plan concerns many partners including the hospital Pharmacist. The two principal roles of the Pharmacist are the elaboration of a checklist of drugs, medical and hospital supplies necessary for the care of the victims and the sep up of emergency containers. The computerization of this plan will facilitate its management. Thus the Hospital Pharmacist contributes to the rationalization of a health care necessity in a constrained economic context.

[Topical ophthalmic drugs]. / Actualités sur les formes médicamenteuses ophtalmiques locales.

Although satisfactory therapeutic results are obtained with usual topical opthalmic drugs, they present some inconveniences. Particularly, their biodisponibility is often poor, requiring the use of relatively important doses, and repeated applications. In order to avoid these difficulties, different systems more or less sophisticated, such as soluble inserts, impregnated lenses, liposomes or implantable pumps, have been conceived for topical application. However, although these systems seem to present certain advantages, none of them, commercialized or not, have been quite satisfactory.

[Comparative economic evaluation of nonwoven and traditional woven textiles in operating rooms]. / Evaluation économique comparative du linge non tissé et du linge traditionnel en bloc opératoire.

The nonwoven textiles do not let oneself unconcerned, but are often considered with reserve in the operating theatre, at least for the "noble" textiles, such as the surgical drapes or the surgeon's gowns. Their part is to set barriers to prevent against microbial contamination. Now, it is proved that these nonwoven textiles qualities rise above that of the woven materials. What are the reasons for this reserve? A survey carried out in 1986 at the Angers hospital, compared with other similar studies, have shown a cost decreased by 20 per cent on an average, when the nonwoven textiles are used for a surgical operation, except the gowns. On the other hand, the cost increases by 20 per cent when nonwoven textiles gowns are also used. The features of the traditional textiles versus nonwoven ones in an operating theatre are described and show the interest of the nonwoven textiles.

[Heart surgery in 2 previously pneumonectomized patients]. / Chirurgie cardiaque chez deux patients antérieurement pneumonectomisés.

Two cases of cardiac surgery under cardiopulmonary bypass in previously pneumonectomized patients are reported. In one case a postoperative tension pneumothorax required an emergency drainage. No other complications occurred. The authors describe their technique and underline the value of an adequate pre-operative respiratory preparation and a systematic drainage of the pleural cavity.

[Vascular subendothehlium: structure and functions (author's transl)]. / Le sous-endothélium vasculaire: structure et fonctions

Two subendothelial structures, glomerular basement membrane and arterial subendothelium, were compared regarding their biochemistry and ultrastructure and their role in physiology and pathology. Filtration function of the glomerular basement membrane can be related to the presence of three layers which are superimposed on each other and which differ regarding the orientation and density of the microfibrils. The arterial subendothelium which is a mixture of amorphous material, microfibrilis, elastin and collagen, with a still unknown orientation of these components, limits the transport of many blood molecules and reinforces the endothelial barrier. A striking difference is observed in the thrombogenicity of these two structures, especially in their reactivity towards platelets. This can be related to the presence of collagen IV in the glomerular basement membrane and of collagen III in the arterial subendothelium: in both cases adhesion of platelets can be observed. The presence of platelet aggregates on the subendothelial surface may also be seen. This is probably due to the presence of collagen III which is known to be able to induce the platelet release reaction and thereby promotes aggregation.