[Impact of a trauma network on mortality in patients with severe pelvic trauma]. / Impact de la mise en place d'un réseau de soins en traumatologie sur la mortalité des patients traumatisés graves du bassin.

AIM: To evaluate the impact of a regional trauma network on intra-hospital mortality rates of patients admitted with severe pelvic trauma. STUDY: Retrospective observational study. PATIENTS: Sixty-five trauma patients with serious pelvic fracture (pelvic abbreviated injury scale [AIS] score of 3 or more). METHODS: Demographic, physiologic and biological parameters were recorded. Observed mortality rates were compared to predicted mortality according to the Trauma Revised Injury Severity Score methodology adjusted by a case mix variation model. RESULTS: Twenty-nine patients were admitted in a level I trauma centre (reference centre) and 36 in level II trauma centres (centres with interventional radiology facility and/or neurosurgery). Patients from the level I trauma centre were more severely injured than those who were admitted at the level II trauma centres (Injury Severity Score [ISS]: 30 [13-75] vs 22 [9-59]; P<0.01). Time from trauma to hospital admission was also longer in level I trauma centre (115 [50-290] min vs 90 [28-240] min, P <0.01). Observed mortality rates (14%; 95% confidence interval, 95% CI, [1-26%]) were lower than the predicted mortality (29%; 95% CI [13-44%]) in the level I trauma centre. No difference in mortality rates was found in the level II trauma centres. CONCLUSION: The regional trauma network could screen the most severely injured patients with pelvic trauma to admit them at a level I trauma centre. The observed mortality of these patients was lower than the predicted mortality despite increased time from trauma to admission.

[Exceptional medical circumstances: interest of an interhospital support strategy within the North Alps emergency trauma network]. / Situations médicales exceptionnelles : intérêt d'une procédure de renfort interhospitalier au sein du réseau Nord-Alpin des urgences.

The Northern French Alps Emergency Network (RENAU) has a main objective the improvement of the quality of the care in the field of the emergency medical treatment. With this French medical system, we developed a procedure allowing the detachment of a medical-surgical team of the university hospital to help general hospital team in the event of immediate vital emergency situation with untransportable patient. We reported the successful implementation of this support strategy for a 51-year-old patient arrived in a hospital of the network in extremely serious hemodynamic shock due to an important hemorrhagic pericardial effusion with tamponnade 1 day after percutaneous closure of the patent foramen ovale (PFO).

[Multidrug-resistant tuberculosis management in three French hospitals]. / Prise en charge de la tuberculose multirésistante dans trois hôpitaux français.

INTRODUCTION: Multidrug-resistant tuberculosis (MDR-TB) management is based on specific WHO guidelines. OBJECTIVES: The authors report MDR-TB management, in three French hospitals. METHOD: The authors retrospectively included patients with positive sample for multidrug-resistant Mycobacterium tuberculosis (isoniazid+rifampicin) from January 1, 2000 to December 31, 2005. The management was compared to the French and international prevalent guidelines. RESULTS: Sixteen patients were initially managed for MDR-TB by eight different medical teams over 6 successive years: 12 (75%) presented with primary MDR-TB. Management advice from the national referee center (NRC) for tuberculosis was reported in seven out of 14 treated cases. The median length of the intensive treatment was 2 months (IQR: 1-3). Eight patients (58%) had an overall treatment length of 18 months. The median number of effective drugs prescribed was 4 (IQR: 4-5). Nine patients (64%) were also managed in a sanatorium. Only eight patients (57%) completed the prescribed treatment. Nine patients were clinically cured and still followed-up, six of whom were bacteriologically cured. CONCLUSION: TB-MDR management was not conform to WHO guidelines in our study. Management in a sanatorium, NRC involvement, ambulatory DOT were highly beneficial.

Mechanisms of macrolide resistance in clinical group B streptococci isolated in France.

Macrolide susceptibility was investigated in clinical group B streptococci obtained from neonates or pregnant women in 2000 in France. Of 490 consecutive isolates, 18% were resistant to erythromycin. The erm(B), erm(A) subclass erm(TR), and mef(A) genes were harbored by 47, 45, and 6% of these strains, respectively. Two isolates did not harbor erm or mef genes.

A YAC contig map of the human genome.

A yeast artificial chromosome library containing 33,000 clones with an average insert size of one megabase of human genomic DNA was extensively analysed by several different procedures for detecting overlaps and positional information. We developed an analysis strategy that resulted, after confirmatory tests, in a YAC contig map reliably covering about 75% of the human genome in 225 contigs having an average size of about ten megabases.

Mechanical ventilation with heated humidifiers or heat and moisture exchangers: effects on patient colonization and incidence of nosocomial pneumonia.

The contribution of ventilator circuit bacterial contamination to the occurrence of ventilator-associated pneumonia remains controversial. In a previous study, we found that the incidence of pneumonia was identical with ventilator circuit changes every 48 h and with no ventilator circuit changes. The present study prospectively assessed whether keeping ventilator circuits clean with a heat and moisture exchanger exhibiting antimicrobial barrier properties affects patient colonization and the incidence of nosocomial pneumonia in patients receiving mechanical ventilation for more than 48 h. Consecutive patients were randomly allocated to humidification with either a heat and moisture exchanger (Group 1, n = 61) or a heated humidifier (Group 2, n = 70). In both groups, no circuit changes were performed throughout ventilatory support. Duration of mechanical ventilation was identical in both groups (10 +/- 8.6 d (range: 2 to 47) in Group 1 and 12.5 +/- 14.2 d [range: 2 to 85] in Group 2). The incidence of pneumonia (positive quantitative culture of protected brush specimen) was similar in both groups (6/61 and 8/70 in Groups 1 and 2, respectively; p = 0.8), as was duration of ventilation prior to pneumonia (9 +/- 5.9 versus 8.2 +/- 5.7 d; p = 0.8). Ventilator tubing contamination was considerably reduced with the use of a heat and moisture exchanger. In contrast, bacterial colonization of the pharynx and trachea was identical in both groups. These results suggest that circuit colonization plays little or no role in the occurrence of ventilator-associated pneumonia, provided usual maintenance precautions are applied.(ABSTRACT TRUNCATED AT 250 WORDS)

Interaction between pepsin and acid secretion during fundic perfusion in cat and rabbit.

1. The effect of perfusion at pH 5.5 of a Heidenhain pouch on acid and pepsin secretion was studied in cats and rabbits. 2. In basal conditions, acid secretion was not modified by the perfusion while pepsin secretion was increased in both species. 3. After a meal, the perfusion did not modify the stimulation of acid secretion in cats nor the absence of secretions in rabbit. Stimulation of pepsin secretion was the same with or without perfusion in both species. 4. In rabbit, in contrast to cat, pepsin and acid secretions were independent during the meal-induced phase of gastric secretion.

Prospective evaluation of the incidence of bacteremia after protected specimen brushing in ICU patients with and without pneumonia.

To test the hypothesis that the use of protected specimen brushing (PSB) via flexible bronchoscopy does not predispose to bacteremia in ICU patients, we prospectively performed aerobic and anaerobic blood cultures immediately following bronchoscopy with PSB. A total of 123 episodes in 68 consecutive patients with suspected pneumonia were analyzed. Blood cultures were negative in 110 cases (89 percent) and positive in 13 cases (11 percent) (p < 0.001). Twelve of these 13 patients with positive blood cultures had quantitative PSB specimen cultures showing nonsignificant growth (< 10(3) CFU/ml). In nine patients, the bacteria recovered from blood cultures (coagulase-negative staphylococci or sarcina) were considered nonpathogenic according to conventional criteria. Blood cultures grew a Staphylococcus aureus in two patients with previously documented staphylococcal septicemia. In one patient with no identifiable site of infection, the blood culture yielded Enterococcus faecalis. The only patient with both a positive blood culture and PSB culture results indicating pneumonia had different organisms recovered from the two samples. Blood cultures taken after PSB in the 17 other episodes of pneumonia (PSB specimen cultures > or = 10(3) CFU/ml) were negative. At the time of brushing and blood sampling for culture, none of these patients was receiving antibiotics active on the organisms found. In conclusion, the incidence of bacteremia after PSB in ICU patients seems very low even in patients with documented pneumonia. Substantial savings would result from not performing routine blood cultures after PSB.

Variation of gastric lipase secretion in the Heidenhain pouch of the cat.

In the cat, gastric lipase secretion was equally but weakly stimulated by pentagastrin, a major stimulant of acid secretion, and by carbamylcholine, a major stimulant of pepsin secretion. Lipase was also stimulated by fresh liver, which induces a large blood gastrin release and not by canned food, which is a poor gastrin releaser. Lipase output always preceded that of acid an pepsin. Lipase was not correlated with acid and pepsin secretion while acid and pepsin were well correlated during all stimulations but not in basal state. Lipase is co-localized with pepsin in the chief cells but is also present in pepsin-free cells, the mucus surface cells of the fundus and the antrum. The distribution of lipase explains the lack of correlation between pepsin and lipase as already mentioned. However, our data show that lipase secretion is under the control of gastric stimulants and might play a role in the gastric initiation of pancreatic meal lipolysis.

Cholinergic and pentagastrin stimulation of the gastric secretions of acid, pepsin and lipase in the awake rabbit.

Acid, pepsin and lipase secretions were simultaneously studied in awake rabbits with a Heidenhain pouch during cholinergic (carbamylcholine 20 micrograms.kg-1 x h-1) or maximal pentagastrin stimulation (64 mu.kg-1 x h-1). To avoid lipase inactivation by low pH, the pouch was perfused at a constant pH, with a solution irrigating the pouch without inducing any pressure. Acid and pepsin outputs were equally activated by both stimulants. Lipase output was stimulated much more by pentagastrin (x26) than by carbamylcholine (x6). The maximal lipase output preceded that of acid output. Lipase concentration increased in the gastric juice whereas pepsin concentration remained constant. A negative correlation was calculated between acid and lipase or pepsin and lipase output. A positive correlation was obtained between acid and pepsin. Our data show that pepsin and lipase secretions which come from distinct chief cells, in the rabbit, responded to the same stimulants but with quantitative and timing differences.

Post-prandial lipase, pepsin and acid secretion of a Heidenhain pouch in the rabbit.

The kinetics of the gastric secretion of lipase, pepsin and acid were studied after a meal in Heidenhain-pouch rabbits. After a 24-h fast, feeding immediately stimulated (< 15 min) lipase (x 4.1) and later on pepsin (x 1.8) output which reached respectively 16 and 47% of the output observed after pentagastrin stimulation (64 micrograms.kg-1.h-1 for 1 h), and which were significantly correlated. Lipase concentration was enhanced earlier and to a greater degree (x 7.3) than pepsin concentration (x 2.5). No stimulation of high basal acid secretion occurred. It was concluded that: 1) gastric lipase secretion is stimulated by feeding in the rabbit; 2) pepsin secretion is stimulated by feeding. The modalities of the secretion of lipase and pepsin are compatible with the existence of distinct secretory cells; 3) acid secretion is not stimulated by feeding. The decrease in acid secretion during the post-prandial phase favors a physiological role for lipase which is altered by low pH. The absence of acid stimulation by feeding in the rabbit, in contrast to other species, requires additional studies on the release of gastrointestinal hormones, namely gastrin, cholecystokinin and somatostatin.

Mapping the whole human genome by fingerprinting yeast artificial chromosomes.

Physical mapping of the human genome has until now been envisioned through single chromosome strategies. We demonstrate that by using large insert yeast artificial chromosomes (YACs) a whole genome approach becomes feasible. YACs (22,000) of 810 kb mean size (5 genome equivalents) have been fingerprinted to obtain individual patterns of restriction fragments detected by a LINE-1 (L1) probe. More than 1000 contigs were assembled. Ten randomly chosen contigs were validated by metaphase chromosome fluorescence in situ hybridization, as well as by analyzing the inter-Alu PCR patterns of their constituent YACs. We estimate that 15% to 20% of the human genome, mainly the L1-rich regions, is already covered with contigs larger than 3 Mb.

Pharmacokinetics of lomefloxacin in healthy volunteers: comparison of 400 milligrams once daily and 200 milligrams twice daily given orally for 5 days.

We evaluated the effect of repeated oral doses (5 days of treatment) on the kinetics of lomefloxacin in volunteers and compared the kinetics after two different regimens, i.e., 400 mg once daily and 200 mg twice daily. After 400 mg of lomefloxacin was given once daily, no significant modification in the pharmacokinetic parameters was noted between the first and the fifth dose (maximum concentration of drug in serum, about 4 mg/liter; elimination half-life, about 6.3 h). After a dose of 200 mg every 12 h, a significant increase in the minimum concentration of drug in serum (0.49 +/- 0.1 and 0.72 +/- 0.2 mg/litter at days 1 and 5, respectively) and the area under the concentration-time curve (about 20%) was noted. The 400-mg regimen is probably adequate for therapeutic use.