Small volumes of hypertonic saline solution (HS 7.5% NaCl) produce systemic and microcirculatory benefits in hemorrhaged animals. Pentoxifylline (PTX) has beneficial effects when administrated after ...hemorrhagic shock. We tested the hypothesis that the combination of HS and PTX in the initial treatment of hemorrhagic shock provides synergistic hemodynamic benefits. Twenty-four dogs were bled to a target arterial blood pressure of 40 mm Hg and randomized into 3 groups: lactated Ringer's solution (33 mL/kg; n = 6); HS (7.5% NaCl 4 mL/kg; n = 9); and HS+PTX (7.5% NaCl 4 mL/kg + PTX 15 mg/kg; n = 9). Systemic hemodynamics were measured by Swan-Ganz and arterial catheters. Gastric mucosal-arterial Pco2 gradient (D(g-a)Pco2; gas tonometry), portal vein blood flow (ultrasonic flowprobe), and systemic and regional O2-derived variables were also evaluated. HS induced a partial increase in mean arterial blood pressure, cardiac output, and portal vein blood flow. In the HS+PTX group, we observed a significant, but transitory, increase in systemic oxygen delivery (180 +/- 17 versus 141 +/- 13 mL/min) in comparison to HS alone. PTX infusion during hypertonic resuscitation promoted a significant reduction in D(g-a)Pco2 (41.8 +/- 4.8 to 25.7 +/- 3.9 mm Hg) when compared with isolated HS infusion (48.2 +/- 6.4 to 39.4 +/- 5.5 mm Hg). We conclude that PTX as an adjunct drug during hypertonic resuscitation improves cardiovascular performance and gastric mucosal oxygenation.
Introduction La maladie coronarienne représente la première cause de morbimortalité chez le diabétique. Son incidence chez les sujets âgés augmente avec l’allongement de l’espérance de vie. ...L’objectif de notre travail est d’évaluer l’utilité et les risques de la stratégie coronaire invasive chez les diabétiques et d’en préciser les résultats, les complications et la mortalité hospitalière. Patients et méthodes Il s’agit d’une étude rétrospective, comparative menée sur 63 patients âgés (> 75 ans) et diabétiques, admis pour SCA au CH Haguenau entre août 2012 et août 2013. Résultats Sur un total de 6 patients âgés de plus de 75 ans diabétiques. L’âge médian était de 80 ± 4,3 ans, 54 % étaient des hommes. L’indication principale était un syndrome coronaire aigu, l’atteinte coronaire souvent tritronculaire. Un premier groupe ( n = 21) a eu une coronarographie seule conduisant au renforcement du traitement médical (30,2 %) et au pontage dans 3,2 % cas. Le second groupe ( n = 42) a eu une coronarographie suivie d’angioplastie percutanée (42), soit 66,7 % des cas. Le taux de succès primaire de l’ICP a été de 97 % (un seul cas d’echec). La voie radiale a été utilisée dans 57,1 % des procédures. Les échecs d’abord vasculaire et/ou les difficultés de cathétérisme (4,8 %) ont été assez rares. Les complications locales (1 cas d’hématome) et générales (1 cas d’AVC, 9 insuffisances rénales, 7 insuffisances cardiaques congestives, 7 troubles de rythme/conduction, 2 récidives de nécrose en intrahospitalier). Aucune mortalité hospitalière n’a été notée. Conclusion La coronarographie est réalisable chez les diabétiques préférentiellement par voie radiale avec un taux réduit de complications. Elle permet de proposer une angioplastie coronaire dans les deux tiers des cas. L’angioplastie percutanée coronaire est réalisable avec un taux élevé de succès, un risque acceptable de complications locales et générales. Déclaration d’intérêt Les auteurs déclarent ne pas avoir d’intérêt direct ou indirect (financier ou en nature) avec un organisme privé, industriel ou commercial en relation avec le sujet présenté.
To compare variations of plethysmographic wave amplitude (ΔPpleth) and to determine the percent difference between inspiratory and expiratory pulse pressure (ΔPp) cutoff values for volume ...responsiveness in a homogenous population of postoperative cardiac surgery patients.
Intra-thoracic pressure variations interfere with stroke volume variation. Pulse pressure variations through arterial lines during mechanical ventilation have been recommended for the estimation of fluid responsiveness. Pulse oximetry may offer a non-invasive plethysmographic method to evaluate pulse pressure; this may be useful for guiding fluid replacement.
Controlled, prospective study in cardiac surgery patients under controlled ventilation. Simultaneous digital recordings of arterial pressure and plethysmographic waves were performed. ΔPp, systolic pressure (ΔPs), ΔPpleth, and systolic component (ΔSpleth) were calculated. A ΔPp ≥ 13% identified fluid-responsive patients. Volume expansion was performed in responsive subjects. Systolic and amplitude components of pressure and plethysmographic waves were compared.
In 50 measurements from 43 patients, ΔPp was correlated with (Ppleth (r=0.90, p<0.001), (Ps (r=0.90, p<0.001), and (Spleth (r=0.73, p<0.001). An aArea under ROC curve (AUC) identified the fluid responsiveness thresholds: (Ppleth of 11% (AUC = 0.95±0.04), (Ps of 8% (AUC=0.93±0.05), and (Spleth of 32% (AUC=0.82±0.07). A (Ppleth value ≥ 11% predicted (Pp ≥ 13% with 100% specificity and 91% sensitivity. Volume expansion, performed in 20 patients, changed (Pp, (Ppleth, (Ps and (Spleth significantly (p<0.008).
ΔPpleth is well correlated with ΔPp and constitutes a simple and non-invasive method for assessing fluid responsiveness in patients following cardiac surgery.
Summary
Here, we present two new HLA allelic variants at C locus: HLA‐C*08:63 and HLA‐C*14:44 detected by sequence‐based typing. In both cases, a single‐nucleotide mutation in exon 3 is responsible ...for a change in aminoacid translation. The extremely high polymorphism of human leucocyte antigen (HLA) system in human genome is responsible for the capability to recognize different antigens, including non‐self‐MHC (Major Histocompatibility Complex) molecules. This very high polymorphism and the improving accuracy of genomic HLA typing methods lead to an exponential increasing of known HLA alleles. Here, we describe the characterization of two new HLA‐C alleles identified by sequence‐based typing (SBT): HLA‐C*08:63 and HLA‐C*14:44.
Summary
Two novel human leucocyte antigen (HLA) class I alleles have been identified in two Italian individuals. HLA‐B*27:07:02 is identical to HLA‐B*27:07:01 except for a nucleotide substitution at ...position 846 (A‐>G) resulting in a silent mutation. HLA‐B*35:206 differs from the most similar allele, HLA‐B*35:08:01, because of a single base mutation at position 149 (G‐>C) causing an aminoacidic change at codon 26 from Gly to Ala.
Although administration of 17beta-estradiol (estrogen) following trauma-hemorrhage attenuates the elevation of cytokine production and mitogen-activated protein kinase (MAPK) activation in epidermal ...keratinocytes, whether the salutary effects of estrogen are mediated by estrogen receptor (ER)-alpha or ER-beta is not known. To determine which estrogen receptor is the mediator, we subjected C3H/HeN male mice to trauma-hemorrhage (2-cm midline laparotomy and bleeding of the animals to a mean blood pressure of 35 mmHg and maintaining that pressure for 90 min) followed by resuscitation with Ringer's lactate (four times the shed blood volume). At the middle of resuscitation we subcutaneously injected ER-alpha agonist propyl pyrazole triol (PPT; 5 microg/kg), ER-beta agonist diarylpropionitrile (DPN; 5 microg/kg), estrogen (50 microg/kg), or ER antagonist ICI 182,780 (150 microg/kg). Two hours after resuscitation, we isolated keratinocytes, stimulated them with lipopolysaccharide for 24 h (5 microg/mL for maximum cytokine production), and measured the production of interleukin (IL)-6, IL-10, IL-12, and TNF-alpha and the activation of MAPK. Keratinocyte cytokine production markedly increased and MAPK activation occurred following trauma-hemorrhage but were normalized by administration of estrogen, PPT, and DPN. PPT and DPN administration were equally effective in normalizing the inflammatory response of keratinocytes, indicating that both ER-alpha and ER-beta mediate the salutary effects of estrogen on keratinocytes after trauma-hemorrhage.
Organ donors with a serologic profile of recovered (HBsAg negative and/or anti-HBc IgG positive) hepatitis B virus infection (HBV) have been reported to transmit HBV to recipients. In Italy, up until ...2002, anti-HBc determination was not mandatory. We retrospectively evaluated the incidence of HBV transmission among recipients transplanted with organs from anti-HBc positive donors from 1997 to 1999. Anti-HBc was screened in 886 available sera among 964 HBsAg and anti-HCV negative donors. HBV transmission was evaluated in 325 kidney, liver, and heart recipients according to their pretransplant HBV serum profile. Of 210 anti-HBc positive donors, 185 were anti-HBc positive/anti-HBs positive and 25 anti-HBc positive/anti-HBs negative with a prevalence of 20.8% and 2.8%, respectively. One hundred seven sera (51%) were collected from donors after transfusion of blood components, the remainder were either before transfusion or from nontransfused donors. The 210 anti-HBc positive subjects donated 356 kidneys, 117 livers and 117 hearts, among whom follow-up is presently available for 251 kidney, 61 liver, and 25 heart recipients. No HBV transmission was observed independent of the recipient immunological profile among the kidney or heart recipients. In liver recipients, no transmission was reported in recovered or vaccinated patients, while a high incidence (43%) of de novo hepatitis was observed among naive patients. In conclusion, there does not seem to be a risk of transmitting HBV through anti-HBc positive transplants in heart and kidney recipients; only naïve liver recipients are at high risk of HBV infection.
La maladie coronarienne représente la première cause de morbi-mortalité chez le diabétique. Son incidence chez les sujets âgés augmente avec l’allongement de l’espérance de vie. L’objectif de notre ...travail est d’évaluer la prise en charge des patients âgés diabétiques. Il s’agit d’une étude rétrospective, comparative menée sur 204 patients âgés (> 75 ans), admis pour SCA au CH Haguenau entre août 2012 et août 2013. On a comparé 63 patients âgés diabétiques (GI), et 141 patients âgés non diabétiques (GII). Mode d’âge (GI) : 80 ans ; 82 ans (GII). Discrète prédominance masculine est notée chez les 2 groupes. Les diabétiques présentent plus de facteurs de risque : fréquence plus élevée d’HTA ( p = 0,002), dyslipidémie ( p = 0,034), alors que (GI) est plus plutôt tabagique. Plus de comorbidités chez (GI), notamment insuffisance rénale ( p < 0,001). SCA sans sus-décalage du segment ST est prédominante dans les 2 groupes. À la coronarographie, l’atteinte tritronculaire était plus fréquente chez (GI). L’angioplastie est moins utilisée dans le (GI) 62,7 % que le (GII) 69,5 %. Les complications hospitalières étaient plus élevées chez les diabétiques notamment, l’insuffisance rénale ( p = 0,055). L’évolution à 6 et à 12 mois révèle une légère prédominance des complications chez (GI). La qualité de vie des diabétiques après une angioplastie était meilleure en comparaison au traitement conventionnel. D’autre part, la qualité de vie des non-diabétiques s’améliore mieux que chez les diabétiques, Le sujet âgé diabétique est à très haut risque cardiovasculaire, caractérisé par la sévérité de l’atteinte coronarienne. Les diabétiques sont traités moins agressivement que les non-diabétiques, pourtant que leur qualité de vie s’améliore mieux en comparaison avec le traitement conventionnel.
Intraventricular thrombosis is a serious event, generally complicating a wide myocardial infarction. It requires an adapted therapy, based on the oral anticoagulants. The diagnosis is generally ...carried out by trans-thoracic echocardiography but with an insufficient sensitivity and a specificity. In this context, the place of cardiac MRI remains to be explored.
We carried out a retrospective registry of all cardiac MRI done in our hospital since 2003, for assessment of an intracardiac mass or an cerebral stroke. The aim was to compare the results of cardiac MRI with those of echocardiography and contrast ventriculography.
Our registry includes 26 cases of intraventricular thrombi, confirmed by cardiac MRI. Our results confirm the lack of sensitivity of echocardiography and the ventriculography. The Kappa correlation coefficient of echocardiography and ventriculography, with respect to the MRI, are very weak, respectively of -0.08 and 0.16.
The values of echocardiography and contrast ventriculography seem limited. The realization of a complementary cardiac MRI must be recommended as often as possible in case of doubt or high risk disease.
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