Comparison of mortality prediction models and validation of SAPS II in critically ill burns patients.

Specific burn outcome prediction scores such as the Abbreviated Burn Severity Index (ABSI), Ryan, Belgian Outcome of Burn Injury (BOBI) and revised Baux scores have been extensively studied. Validation studies of the critical care score SAPS II (Simplified Acute Physiology Score) have included burns patients but not addressed them as a cohort. The study aimed at comparing their performance in a Swiss burns intensive care unit (ICU) and to observe whether they were affected by a standardized definition of inhalation injury. We conducted a retrospective cohort study, including all consecutive ICU burn admissions (n=492) between 1996 and 2013: 5 epochs were defined by protocol changes. As required for SAPS II calculation, stays <24h were excluded. Data were collected on age, gender, total body surface area burned (TBSA) and inhalation injury (systematic standardized diagnosis since 2006). Study epochs were compared (χ2 test, ANOVA). Score performance was assessed by receiver operating characteristic curve analysis. SAPS II performed well (AUC 0.89), particularly in burns <40% TBSA (AUC 0.93). Revised Baux and ABSI scores were not affected by the standardized diagnosis of inhalation injury and showed the best performance (AUC 0.92 and 0.91 respectively). In contrast, the accuracy of the BOBI and Ryan scores was lower (AUC 0.84 and 0.81) and reduced after 2006. The excellent predictive performance of the classic scores (revised Baux score and ABSI) was confirmed. SAPS II was nearly as accurate, particularly in burns <40% TBSA. Ryan and BOBI scores were least accurate, as they heavily weight inhalation injury.

Les scores prédictifs de mortalité spécifiques aux brûlés comme l'ABSI, le Ryan, le BOBI, ainsi que le Baux révisé ont été très largement étudiés. Les études ayant validé le SAPS II ont certes inclus des brûlés, mais ils n'ont pas été étudiés en tant que sous-population. Cette étude rétrospective, réalisée dans une unité de réanimation de brûlés suisse, avait pour but de comparer les performances de ces scores et d'évaluer l'impact d'une définition standardisée des lésions d'inhalation. Elle a inclus 492 patients hospitalisés entre 1996 et 2013, répartis en 5 périodes définies par des modifications du protocole interne de prise en charge. L'âge, la surface brûlée et l'inhalation (définition standardisée depuis 2006) ont été recueillis. Les périodes ont été comparées par ANOVA et χ2. La performance des scores a été évaluée par analyse des courbes ROC. Le SAPS II a démontré une bonne performance (AUC 0,89), particulièrement en cas de brûlure <40% SCT (AUC 0,93). L'ABSI et le Baux révisé étaient les plus performants (AUC 0,92 et 0,91) et sont avérés peu affectés par le changement de définition de l'inhalation. Le BOBI et le Ryan se sont révélés moins précis (AUC 0,84 et 0,81) avec des performances encore davantage dégradées après le changement de définition de l'inhalation. L'excellente valeur prédictive du Baux révisé et de l'ABSI est ainsi confirmée. Le SAPS II s'est montré presque aussi précis, en particulier pour des surfaces <40%. Les scores Ryan et BOBI ont été les moins précis.

Differential expression of LMO4 protein in Alzheimer's disease.

The molecular bases of late-onset and sporadic Alzheimer's disease (AD) still have to be unraveled. Among putative candidates for molecular variations in AD, we propose LMO4 protein, a transcription regulator, involved in multiple protein complexes. We investigated changes in LMO4 immunoreactivity in vulnerable brain regions of AD cases and controls of comparable age. Immunocytochemical analysis revealed a high level of LMO4 expression in the entorhinal cortex (EC) and in the CA1 hippocampal region of the control brains and a consistent decrease in the AD brains, correlated with the amount of neurofibrillary tangles (NFT) degenerating neurones and the severity of senile plaques deposition. The decrease in LMO4 immunoreactivity resulted both from weaker immunoreactive signals and from a loss of immunoreactive neurones. LMO4 immunocytochemical staining appeared not to be colocalized with NFT in a majority of neurones. Its expression was weak in the dentate gyrus and stronger in CA3-4, two regions with no or low numbers of NFT, but there was no decrease in AD compared to control cases. In the frontal cortex, the ventro-infero-median region (area 12) showed a greater LMO4 expression than the polar one (area 9), but no decrease in AD was observed. As LMO4 has been proposed to inhibit cellular differentiation, it can be hypothesized that a reduced expression is associated in EC and CA1 with attempts of diseased neurones to differentiate (e.g. compensatory neuritogenesis). Taken together, these data indicate that LMO4 protein is involved in the complexity of the disease phenotype, at least as a secondary factor.

A safer methylation procedure with boron trifluoride-methanol reagent for gas chromatographic analysis of ritalinic acid in urine.

Ritalinic acid (RITA), the major metabolite of methylphenidate (Ritaline) is extracted with a solid-phase C8 column. Following elution, methylation of the carboxylic group is performed with boron trifluoride-methanol as a reagent. The methyl ester of RITA which structurally corresponds to the parent compound methylphenidate is reextracted at pH 9-11. Each step of the analytical method has been systematically studied, particularly the parameters governing the esterification reaction with BF3-methanol. The recovery from the overall method is 96%. The limit of detection is 0.05 micrograms ml-1 with GC-NPD for a 10-ml urine sample. The method has been successfully applied to the detection and quantitation of RITA in urine specimens. The specificity of the methylated RITA peak has been verified by GC-MS in scan mode. Use of diazomethane or sulphuric acid is thus replaced by the use of a less hazardous reagent.

[Closed trauma of the tendon of the brachial triceps. Review of the literature. Apropos of 2 cases]. / Les traumatismes fermés du tendon du triceps brachial. Revue de la littérature. A propos de 2 cas.

Triceps tendon closed trauma remains a rare injury. A palpable gap with impossible elbow extension against gravity is an important physical finding, and a positive "flake sign" or small avulsion fracture from the olecranon is found in the majority of patients. Trans-osseous suture gives excellent results. Partial lesions must be treated conservatively.

[Detection of lysergic acid diethylamide in human urine: elimination, screening and analytical confirmation]. / Détection de l'acide lysergique diéthylamide (LSD) dans l'urine humaine: élimination, dépistage et confirmation analytique.

The Coat-A-Count DPC and Roche Abuscreen RIA for LSD were used to search for LSD in urines containing various drugs commonly found in specimens from addicted groups. Elimination of LSD in urine of a volunteer after ingestion of 50 micrograms confirmed that LSD can be detected after 3 days at 0.1 ng/ml cut-off level. Chromatographic conditions were restudied and the full spectrum of trimethylsilyl LSD at 0.125 ng with ion trap GC-MS (ITS40) was shown.

Simultaneous detection and quantitation of O6-monoacetylmorphine, morphine and codeine in urine by gas chromatography with nitrogen specific and/or flame ionization detection.

It is of importance to differentiate heroin intake from the absorption of opiate-containing pharmaceuticals or opiates from other sources. A method for the routine determination of O6-monoacetylmorphine (6-MAM), the specific metabolite of heroin in human urine, by gas chromatography and classical detectors without having recourse to gas chromatography/mass spectrometry-selected ion mode (GC/MS-SIM) is described. With dual detection by nitrogen selective and flame ionization detectors, the limits of detection for 6-MAM were determined to be 2 ng/mL and 4 ng/mL urine for a 10 mL sample. When applied to urines preliminarily screened for opiates, the results appeared consistent in comparison with those obtained by GC/MS-SIM. The method was also developed for the simultaneous quantitative analysis of morphine and codeine. The linearity was tested up to 600 ng/mL for the three compounds of interest 6-MAM, morphine and codeine and their absolute recoveries were 76%, 78%, 75% respectively.

[Preverbal communication and deafness]. / Communication préverbale et surdité.

Preverbal communication set up spontaneously and progressively between a mother and her child is especially important for a deaf child because of his polysensorial canals. Premature diagnosis of deafness endangers this communication. Different professionals from one CAMSP team along with a mother of deaf children are going to share their questions and thoughts concerning early treatments in the area of child deafness.

[Antibiotic prevention and appendectomy. Practical consequences for health economics. Apropos of a series of 642 cases]. / Antibioprophylaxie et appendicectomie. Conséquences pratiques pour une économie de santé. A propos d'une série de 642 cas.

A total of 642 patients undergoing appendicectomy were divided into two groups of 321 patients prior to surgery. One group (A) received prophylactic antibiotic therapy, the other (B) no previous treatment. Patients were from the same region and groups were comparable for age, sex and indications for operation. Antibiotic treatment was administered according to a personal protocol based on gross appearance of appendix, and involved two molecules: Baypen in 69 cases and cephamycin (Mefoxin) in the other 252. Although not a randomized trial, the protocol was considered effective for prevention of postoperative infectious complications. In the group A, 21 patients (6.54%) developed these complications as against only 3 (0.93%) in group B, a significant difference if the total group B is considered or the two antibiotic subgroups. However, no valid conclusion can be drawn in favor of one or other of the two molecules. This effective procedure reduces by a half the duration of postoperative hospital stay for patients with a simple acute or a chronic appendicitis accepting the follow up surveillance required by the protocol. This attitude should be extended to a larger number of patients with resulting non-negligible health costs economy.

[Is it necessary to confirm the results of drug screening with a 2d analytical method?]. / Faut-il confirmer les résultats du dépistage des drogues par une deuxième méthode d'analyse?

Systematic analyses of positives from urine drug screening with immunochemical techniques have shown the importance of the confirmation of results by a chromatographic procedure. 15 to 30% of false positives can be encountered for opiates. The confirmation technique should have better sensitivity (and specificity) in order to discard divergence from differences between detection limits. Potential false negatives or falsification of positives are discussed. Propositions for a coherent behavior in the Swiss situation are given.

[Validation of a method for detecting benzodiazepines in the urine by acid extraction of their benzophenones and thin layer chromatography]. / Validation d'un procédé de détection des benzodiazépines dans l'urine par extraction acide de leurs benzophénones et chromatographie sur couche mince.

The authors confirm the validity of a method of detection for 18 benzodiazepines. Its original feature consists of the extraction in an acid medium. Between 70 and 100 per cent of the drug is recovered, except for the benzophenones which are strongly basic. The yield of hydrolysis is between 70 and 95 per cent, except for diazepam and lormetazepam, for which the yield is about 50 per cent. Depending on the nature of the benzodiazepines, the limit of detection of the process described is between 5 and 20 micrograms/l of urine. Following a single therapeutic dose in non-dependent volunteers, the benzodiazepines were detectable for at least 36 to 48 hours.

[Excretion of 11-nor-delta 9-tetrahydrocannabinol-9-carboxylic acid in experimental smokers. Duration of detection in urine]. / Excrétion de l'acide 11-nor-delta 9-tétrahydrocannabinol-9-carboxylique chez les fumeurs expérimentaux. Durée de détection dans l'urine.

Cannabis cigarettes of comparable potency were smoked by experimental smokers. Peak excretion occurs between 2 to 7 hours and falls rapidly in the first 30 hours period. Elimination then goes on slowly over 5 days. Individual and interindividual variations are observed. The test can detect occasional use of cannabis no longer than 36 h to 48 h with good probability. Negative detected user can suddenly excrete metabolites to positive levels. This has a consequence on the use of the test to screen exposed group for epidemiologic studies.

[Non-drug cure of heroin addicts in association with chemical analysis as a factor of evaluation]. / Cure non médicalisée des héroïnomanes en association avec l'analyse chimique comme facteur d'appréciation.

Group psychotherapy programme is applied in a heroin addiction treatment center in conjunction with a systematic planning of chemical analyses along the course of the cure. The addicts live under inspected regime. At best 25 out of 70 cases (36%) conclude the programme with occasional and non repetitive failures. The question of their follow-up beyond their treatment period arises in order to better evaluate their retrieval.

[Results of analytical controls of the urine of drug addicts]. / Résultats de contrôles analytiques des urines de toxicomanes.

Chemical analyses provide a useful and necessary mean of information on progress of drug addicts in desintoxication program. Meanwhile, a systematic planning of analytical controls should be settled. Results observed on two groups of addicts in Switzerland are presented.