The Trojan-horse mechanism: How networks reduce gender segregation.

The segregation of labor markets along ethnic and gender lines is socially highly consequential, and the social science literature has long viewed homophily and network-based job recruitments as some of its most crucial drivers. Here, we focus on a previously unidentified mechanism, the Trojan-horse mechanism, which, in contradiction to the main tenet of previous research, suggests that network-based recruitment reduce rather than increase segregation levels. We identify the conditions under which networks are desegregating, and using unique data on all individuals and all workplaces located in the Stockholm region during the years 2000-2017, we find strong empirical evidence for the Trojan-horse mechanism and its role in the gender segregation of labor markets.

Relationship between post-treatment platelet reactivity and ischemic and bleeding events at 1-year follow-up in patients receiving prasugrel.

BACKGROUND: Post-treatment platelet reactivity (PR) is associated with ischemic and bleeding events in patients receiving P2Y12 receptor antagonists. OBJECTIVES: We aimed to study the relationship between post-treatment PR after a 60-mg loading dose (LD) of prasugrel and 1-year thrombotic and bleeding events. METHOD: Patients were prospectively included in this multicenter study if they had a successful percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) and received prasugrel. The platelet reactivity index (PRI) was measured using the Vasodilator-Stimulated Phosphoprotein index (VASP) after a prasugrel LD. Endpoints included the rate of thrombotic events and bleeding events at 1 year. RESULTS: Among the 301 patients enrolled, 9 (3%) were lost to follow-up at 1 year. The rates of thrombotic and bleeding events at 1 year were of 7.5% and 6.8%, respectively. Receiver-operating curve (ROC) analysis demonstrated an optimal cut-off value of 53.5% of PRI to predict thrombotic events at 1 year. Using this cut-off value we observed that patients exhibiting high on-treatment platelet reactivity (HTPR) had a higher rate of thrombotic events (22.4% vs. 2.9%; P < 0.001). In parallel the optimal cut-off value of PRI to predict bleeding was 16%. Patients with a PRI ≤ 16% had a higher rate of bleeding events compared with those with a PRI > 16% (15.6% vs. 3.3%; P < 0.001). In multivariate analysis, the PRI predicted both thrombotic and bleeding events (OR: 1.44, 95% confidence interval [CI]: 1.2-1.72; P < 0.001 and OR: 0.75, 95% CI: 0.59-0.96; P = 0.024 [respectively, per 10% increase]). CONCLUSION: Platelet reactivity measurement after a prasugrel LD predicts both ischemic and bleeding events at 1 year follow-up for ACS patients undergoing PCI.

Identification of factors influencing the decision-to-delivery interval in emergency caesarean sections.

BACKGROUND: In a life-threatening context, the American College of Obstetrics and Gynecology and the Royal College of Obstetrics and Gynaecology recommend a maximum delay of 30 min between the decision to perform an emergency caesarean and the infant's birth. Our objectives were to estimate the rate of prolonged intervals and identify the factors influencing the decision-to-delivery interval. METHODS: All women who had given birth at Saint-Etienne University Hospital by a non-prophylactic caesarean section between September 1 and November 1, 2007 were included in a prospective cohort study. A linear regression analysis was performed to identify the factors influencing the decision-to-delivery interval. RESULTS: 68 women were included in the study. Regardless of the degree of emergency, the decision-to-delivery interval exceeded the recommended interval in 50% of the cases. In extremely urgent caesarean sections, the optimal interval of 15 min was exceeded in 85.7% of cases. We found that two factors contributed to delayed patient care: urgent and extremely urgent caesareans and hospitalization in a pathological pregnancy unit. This delay leads to more paediatric reanimations. CONCLUSION: This study highlights the difficulty to reach the recommended target interval. One solution is to improve the identification of the degree of urgency and the communication between the various members of the healthcare team.

[Shoulder dystocia: a ten-year descriptive study in a level-III maternity unit]. / La dystocie des épaules: analyse descriptive sur dix années dans une maternité de niveau III.

OBJECTIVE: Shoulder dystocia is one of the most dreadful complications of vaginal deliveries. The aim of this observational study was to evaluate risk factors of dystocia, maternal and neonatal complications and recurrent risk factors. PATIENTS AND METHODS: Sixty-six cases of shoulder dystocia occurring between January 1998 and August 2008 in our university hospital were identified. Demographic data, labor management, management of the shoulder dystocia and neonatal outcome were recorded. RESULTS: The incidence of shoulder dystocia was 0.3%. Multiparity, weight gain greater than 12 kg, and post-term delivery were more present in our study group. McRoberts' manoeuver and symphyseal pressure were first realised. Brachial plexus injuries affected 9% of neonates with skeletal fractures in 7.5% of cases. Maternal morbidity was evaluated at about 8%. Twenty per cent had a recurrent shoulder dystocia. DISCUSSION AND CONCLUSION: Shoulder dystocia is an obstetric emergency which requires a prompt management of trained personnel. Despite the difficulty of being able to prevent shoulder dystocia, training the obstetric staff could probably improve management of shoulder dystocia.

Physiologic correlates of dyspnea in patients with morbid obesity.

OBJECTIVE: Mechanisms of dyspnea in obesity remain unclear. This study was undertaken to determine the relationships between dyspnea and pulmonary function including inspiratory muscle endurance (IME) in morbidly obese patients before bariatric surgery. RESEARCH METHODS AND PROCEDURES: Fifty-five patients with a mean+/-s.d. body mass index (BMI) of 49.4+/-7.0 kg/m(2) were included. Dyspnea was evaluated by the Baseline Dyspnea Index (BDI; 0-12, 0=maximal dyspnea). Pulmonary function tests included a plethysmography, maximal inspiratory pressure (PImax) and IME was assessed by the incremental threshold loading test, determining the maximal pressure sustained for 2 min (Plim(2)) and Plim(2)/PImax ratio. Patients were classified according to their BMI in two groups: BMI < or =49 (n=27) and >49 kg/m(2) (n=28). RESULTS: Breathlessness was higher in the BMI >49 kg/m(2) group compared to the BMI < or =49 kg/m(2) group (BDI score at 6.9+/-2.2 in the BMI >49 kg/m(2) group vs 8.9+/-2.5 in the BMI < or =49 kg/m(2) group, P<0.01). Patients with BMI >49 kg/m(2) had significantly higher PaCO(2) level and significantly lower vital capacity, inspiratory capacity and PImax values compared with the BMI < or =49 kg/m(2) group. Correlations between BDI and lung function were moderate: forced expiratory volume in 1 s (FEV(1))% pred: Rho=0.27; P=0.05; vital capacity % pred: Rho=0.40; P=0.004; and Plim(2)/PImax: Rho=0.40; P=0.003. Higher correlations with dyspnea were found in the BMI < or =49 kg/m(2) group: FEV(1)% pred: Rho=0.38; P=0.05; and Plim(2)/PImax: Rho=0.49; P=0.01. DISCUSSION: Inspiratory muscle performance is moderately reduced in morbid obesity. Dyspnea in these patients remains moderately related to lung function and inspiratory muscle performance. However, inspiratory muscles performance correlates more significantly with dyspnea in patients with a BMI < or =49 kg/m(2).

[Massive haemoptysis associated with pulmonary Strongyloides stercoralis hyperinfestation]. / Hémoptysie massive associée à une hyperinfestation pulmonaire à Strongyloides stercoralis.

INTRODUCTION: Pulmonary infestation with Strongyloides stercoralis is an exceptionally rare cause of haemoptysis, the diagnosis being difficult and often delayed. CASE REPORT: We report the case of a retired coal miner suffering from pneumoconiosis who presented with acute respiratory insufficiency and massive haemoptysis, with a fatal outcome, associated with pulmonary stongyloidosis. The only identified source of infestation with Strongyloides stercoralis was his period in the coal mine and the only risk factors for the hyperinfestation were a short course of systemic corticosteroid therapy and the presence of a peritoneal-auricular valve. CONCLUSION: This observation illustrates the importance of a systematic search for anguillosis in ex coal miners prior to any immunosuppressant treatment in order to avoid the serious and frequently fatal form of hyperinfestation with Strongyloides stercoralis.

[Usefulness of a collecting bag for the diagnosis of post-partum hemorrhage]. / Intérêt de l'utilisation d'un sac de recueil dans le diagnostic des hémorragies de la délivrance.

OBJECTIVE: Depending on the country and the publications, post-partum hemorrhage (PPH) is either the first or second cause of maternal death in the world, including in developed countries. It remains a significant source of morbidity, severe anemia, blood transfusion, transfusion complications, acquired coagulation disorders and hemostasis hysterectomy. Visual assessment underestimates the amount of blood loss in around 45% of cases. Emergency treatment is therefore sometimes undertaken with some delay, giving time for Disseminated Intravascular Coagulation (DIC) to occur, which worsens the prognosis. A collecting plastic bag put under the pelvis of the mother just after delivery is a quantitative and objective method of measuring blood loss. The objective was to assess sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), studying correlation between bag's volume and hemoglobin and hematocrit variation. MATERIALS AND METHODS: Included outpatients were women with unique pregnancy at term. Breech presentations were excluded. We measured serum hemoglobin and hematocrit just after admission for labor. A collecting bag, placed under the pelvis of each woman just after birth, was weighted after delivery. Serum hemoglobin and hematocrit were again assessed at three days. Post-partum hemorrhage was defined by a fall of hematocrit more than 10 points (delta Ht), or by a fall of hemoglobin more than 3g/dL (delta Hb). RESULTS: From January 2003 to May 2003, 272 patients were included. 8.9% of the results were unuseful (n=24). The mean volume of blood loss was 190 ml (5th p=29 ml, 10th p=48 ml, 90th p=610 ml, 95th p=824 ml). The mean delta Ht was 2.7 +/- 4 pts (16.5 / -4.8). The mean delta Hb was 1.2 +/- 1.4 g/dL (5.9 / -1.5). For a delta Ht=10 the calculated bag volume was 564 ml. With this cut off we noted 5.5% PPH (n=15) prevalence=0.06. Sensitivity=34.21%. Specificity=99%. PPV=86%. NPV=90.38%. For a delta Hb=3 the calculated bag volume was 486 ml. With this cut off we noted 10.7% PPH (n=24) prevalence of PPH=0.1. Sensitivity=38.77%. Specificity=95.96%, PPV=67. 85%. NPV=87.7%. CONCLUSION: The collecting pelvis bag is a rapid and precise procedure to diagnose PPH in the delivery room. It also enables a visual and quantitative non-subjective estimation of blood loss. Because of its simplicity and very low cost, the collecting pelvis bag should be used widely as a routine preventive measure.

[Prenatal Bartter's syndrome. Report of two cases]. / Le syndrome de Bartter anténatal. A propos de deux cas.

Antenatal Bartter Syndrome (ABS) is a rare autosomic recessive tubulopathy characterized by idiopathic hydramnios, fetal polyuria and elevated levels of amniotic chloride. It is related to mutations affecting several transporters in the loop of Henle e.g. the Na-K-2Cl cotransporter, the chloride channel CLC-NKB and the potassium channel ROMK. We report two cases of ABS in siblings born to consanguineous parents (first cousins). The first pregnancy showed hydramnios of unknown etiology at week 23. Two amnio drains were performed at weeks 26 and 27. The baby was born in week 29 and developed polyuria with hyponatremia, hypokalemia and hyperaldosteronism. After eliminating diabetes insipidus and adrenal insufficiency, ABS was diagnosed. The baby was treated with 0.5 mg/kg/d indomethacine, which controlled the polyuria and the hydroelectrolytic disorder. The second pregnancy showed idiopathic hydramnios at week 24. The elevated amniotic chloride level (above 112 mmole/l) led to the antenatal diagnosis of ABS. The mother was treated with 1 mg/kg/d indomethacine until week 31 in order to stabilize the hydramnios. Two amnio drains at weeks 31 and 33 allowed the pregnancy to be prolonged until week 34. A genetic study of the family showed homozygosity of the NKCC2 gene marker suggesting its implication in the disease.

[Acute puerperal uterine inversion: two cases]. / Inversion utérine puerpérale aiguë: à propos de deux cas.

Acute puerperal inversion is both rare and serious (1/20000 deliveries in France) and may lead to significant morbidity and mortality. Outcome depends on the degree of uterine bleeding and the presence or not of a state of shock. Acute puerperal inversion occurs at the time of placental delivery. Four stages are usually described by degree of exteriorization of the uterus. The diagnosis is essentially clinical. The predisposing factors are hypotonic uterus, fundal implantation of the placenta and placental acretas. 60% of all cases are caused by precipitous manoeuvres including traction on the cord or improper fundal pressure. Once a diagnosis is made immediate measures must be undertaken to assure clinical stability of the mother. Manuel reinversion of the uterus must be done quickly to avoid a cervical stricture that may form within thirty minutes of the inversion making successful manipulation very difficult. Failure or reoccurrence requires surgical treatment either by abdominal or vaginal approach. We report on two cases: one of complete inversion leading to a hysterectomy in order to control bleeding and a second case of incomplete inversion where repositioning was successful.

[Premature rupture of the membranes between 28 and 34 weeks of amenorrhea. Retrospective study apropos of 71 cases]. / Rupture prématurée des membranes entre 28 et 34 semaines d'aménorrhée. Etude rétrospective à propos de 71 cas.

OBJECTIVE: The aim of our study is to compare the outcome of infants born after preterm premature rupture of the membranes (PPROM) between 28 and 34 weeks gestation. We compare two groups of infants: group A, infants born in hospitals without neonatal intensive care unit, after PPROM with long tocolysis, no maternal prophylactic antibiotic therapy and no systematic maternal steroid therapy. Group B with systematic maternal steroid therapy, maternal prophylactic antibiotic therapy, short tocolysis and born in an hospital with neonatal intensive care unit. The latency period (time from rupture of membranes to the onset of labor) authorized was 15 days in the group B and not limited in the group A. RESULTS: Death (13.8% vs 0%; p=0.022), neonatal infection (66.6% vs 28.6%; p=0.0013), and respiratory distress (63.8% vs 34.3%; p=0.0144) were less frequent in the group B. The group A infants passed more than ten days in intensive care unit (61.1% vs 37.1%; p=0.043). Neonatal infection was not higher in the corticosteroïd therapy group (41.2% vs 70.3%; p=0.0135). There is more neonatal infection in the group A with long latency period (61.7% vs 24.3%; p=0.0014) and more chorioamnionitis (70.6% vs 24.3%; p<0.0001). CONCLUSION: The association maternal steroid and antibiotic therapy, short latency period, and hospitalization of the pregnant woman close to a neonatal intensive care unit reduce significantly the neonatal morbidity after preterm premature rupture of the membranes.

[Skin gangrene of the external genitalia. Report of 44 cases]. / Gangrène cutanée des organes génitaux externes. A propos de 44 cas.

STUDY AIM: The aim of this study is to report 44 cases of male external genitalia cutaneous gangrene which have been observed at the Principal Hospital of Dakar (Senegal) during a 4-year period. PATIENTS AND METHODS: The patients all belonged to a black and poor population (mean age: 60 years). Diabetes was present in 11% of the patients. In ten patients, no aetiology was found. The other 34 cases were secondary mainly to urogenital pathology (50%). In 50% of the cases, the lesions were localised on the external genitalia, in the other 50%, the lesions had spread to the hypogastrium and/or the perineum. Medical treatment included intensive care and triple antibiotic therapy, penicillin, gentamycin and metronidazole. A hyperbaric oxygen therapy was associated in 25% of the cases. The surgical treatment in the acute period included incising, debridement, paring, draining, urinary derivation (n = 36), and colostomy (n = 5). Thirteen patients had the benefit of sequential and prospective bacteriological tests. RESULTS: Spontaneous healing was obtained in 48% of the patients within 2 to 3 months. Secondary reconstructive surgery consisted mainly in cutaneous grafts. Global mortality rate was 34%, mortality rate was 30% in the secondary gangrenes, 40% in the primitive gangrenes. Mean hospitalisation duration was 6 weeks. Main sequelae were cheiloïd scars. CONCLUSIONS: The authors try to clarify the nosological imprecisions of this pathology by distinguishing between the secondary types and the primitive types corresponding to Fournier's gangrene, which still inspires many questions concerning its etio-pathogenesis. The surgical treatment must eradicate all necrosis by suited iterative procedures, associated with local care. Hyperbaric oxygen therapy was not efficient in this series. This pathology, although rare, needs to be better known, because only an early and efficient surgical and medical treatment will be able to decrease the exceptional gravity of the prognosis.

Pharmacological and molecular characterisation of beta-adrenoceptors in adult rat diaphragm muscle.

Using pharmacological and molecular approaches to investigate beta-adrenoceptor (beta-AR) subtype expression in adult rat diaphragm, we found that adenylyl cyclase (AC) was potently stimulated by the beta2-AR-selective agonist fenoterol, weakly stimulated by the beta1-AR-selective agonist prenalterol and unaffected by the beta3-AR agonist CGP12177. AC activity in response to a submaximal isoproterenol concentration was potently inhibited by the beta2-AR-selective antagonist ICI118551, whereas the beta1-AR-selective antagonist CGP20712A was effective only in very high concentrations. (-)-[125I]-cyanopindolol ([125I]-CYP) saturation binding experiments indicated a single affinity component (dissociation constant (Kd) = 22 +/- 2 pM) for beta-AR sites (maximal beta -AR density (Bmax) = 14 +/- 2 fmol/ mg). Eadie-Hofstee analysis of [125I]-CYP displacement curves by beta1-, beta2- or beta3-AR-selective ligands allowed to characterise a homogeneous population of beta2-AR sites. Finally, reverse transcriptase-polymerase chain reaction analysis of beta-AR subtype mRNAs identified beta2-AR transcripts but no beta1- and beta3-AR mRNAs. Our results demonstrate that beta2-AR is the only beta-AR subtype expressed in the diaphragm.

[Endoscopic treatment of vesicorenal reflux in children. Five-year assessment of the use of Macroplastique]. / Traitement endoscopique du reflux vésico-rénal chez l'enfant. Bilan de cinq ans d'utilisation de Macroplastique.

OBJECTIVE: To compare the results of endoscopic treatment of vesicorenal reflux by Macroplastique implantation versus Teflon implantation. MATERIAL AND METHODS: 297 children with 454 refluxing vesicorenal units were treated by endoscopic implantation of Macroplastique (Rplasty)-A.B.S.: 385 cases of primary reflux and 69 cases of secondary or associated reflux. All children were reviewed by ultrasound and cystography 6 weeks and 1 year after implantation. RESULTS: Regardless of the aetiology and the grade, reflux resolved in 91.2% of children (93.3% of ureters). Complications such as ureteric stasis were rare (3 cases). 161 children (253 ureters) were reviewed 1 year after treatment: reflux had recurred in 8.7% of patients. CONCLUSION: Although the mean quantity implanted was lower with Macroplastique, the results appeared to be better than those obtained with Teflon (bases on a previous series of 402 children: cure for 87.1% of ureters and 85.7% of children). The advantages of Macroplastique compared to Teflon include the less liquid consistency, the absence of retraction of the product and the presence of larger microparticles without any local or distant inflammatory reaction.

[Excimer laser assisted angioplasty. Immediate results in the treatment of complex coronary lesions]. / Angioplastie assistée par laser Excimer. Résultats immédiats dans le traitement des lésions coronaires complexes.

Transluminal coronary angioplasty (TCA) with pulsed excimer laser (CVX 300 Spectranetics) was performed in 89 patients (age 63.7 years); CCS I: 6; CCS II: 12; CCS III: 40; CCS IV: 31; instable: 58%. There was a previous history of myocardial infarction (MI) in 27 cases, TCA (9 restenoses) in 24 cases, 19 bypass graft procedures, 13 failures of TCA. The lesions (n = 90) affected the left main coronary artery: 1 case; the left anterior descending artery: 37 cases; the left circumflex: 8 cases; the right coronary: 28 cases and there were saphenous vein grafts in 16 cases. The lesions were classified B2 (ACC/AHA) in 56 cases and type C in 34 cases. There were 24 lesions > 10 mm, 15 > 20 mm; calcification in 49 cases; excentric in 65 cases; ostial in 9 cases; affecting bifurcations in 13 cases; affecting collateral vessels in 16 cases; chronic occlusions in 12 cases and restenoses of stents in 4 cases. Multifiber catheters: 1.4 mm (50), 1.7 mm (41) and 2 mm (3), were used to deliver energies of 43.3 mj/m2 (+/- 8.1 mj) with an average of 5.2 +/- 1.2 applications persite, and 2.7 +/- 1.1 passages. A balloon dilatation was performed after laser angioplasty in 96% of cases. The following results were observed: success of laser angioplasty (20% reduction of stenosis) in 95.5%, a successful procedure (residual stenosis less than 50% without major complications) in 95.5%, and a clinical success (no pathological Q wave or non-Q wave infarction, bypass graft, or repeat TCA): 92.1%. The following complications were observed: death = 0, non-Q wave infarction 2.2%, emergency bypass surgery in 1 case with Q wave infarction: 1.1%. The use of laser angioplasty may be proposed in the following indications: long, moderately calcified lesion, ostial lesions, complete occlusions, bypass graft disease, failure of angioplasty. In addition to these indications, we propose the treatment of restenosis on stents. The main disadvantage of the Excimer Laser is the poor cost/benefit ratio, given the relatively small number of indications.

[Comparative effects of anti-arrhythmia agents on ventricular refractory period and prevention of ventricular tachycardia induced by stimulation]. / Effets comparés des antiarythmiques sur la période réfractaire ventriculaire et sur la prévention des tachycardies ventriculaires induites par stimulation.

The efficacy of antiarrhythmic drugs is attributed to their actions on the refractory periods or conduction velocity in the reentry circuit. The aim of this study was to determine the relationship between these factors and the prevention of electrically inducible ventricular tachycardia (VT). Twenty-seven patients with sustained monomorphic postinfarction VT underwent programmed stimulation under basal conditions and after administration of oral Class I antiarrhythmic drugs. The protocol of stimulation consisted of delivering one to three extrastimuli to the right ventricular apex on two basic cycle lengths. Sustained VT was induced in all patients. After the same protocol under antiarrhythmic therapy (1 to 5 tests, average 2.9 +/- 1) sustained VT could not be induced in 12 patients (44%). The effective right ventricular refractory period was significantly increased in patients without inducible VT under treatment (247 +/- 18 versus 302 +/- 26 ms). The increase in the right ventricular effective refractory period in patients with persistence of inducible VT was much less (from 270 +/- 28 to 287 +/- 30 ms). In all patients in whom several antiarrhythmic drugs were tested the right ventricular effective refractory period was higher when the treatment was judged to be effective (299 +/- 27 ms) than ineffective (272 +/- 27, p < 0.02). The prevention of inducible VT by class I antiarrhythmic agents seems therefore to be related to their effect on the ventricular refractory period.

Dietary vitamin C intake and concentrations in the body fluids and cells of male smokers and nonsmokers.

Inhaled cigarette smoke releases a variety of oxidizing agents. Ascorbic acid is recognized as an important biological antioxidant. To better characterize the antioxidant protective role of ascorbic acid, a comparison of ascorbic acid concentrations in plasma, leukocytes, bronchoalveolar lavage fluid and alveolar macrophages from a homogeneous group of healthy male smokers (n = 10) and nonsmokers (n = 14) was investigated. The resulting ascorbic acid contents were (means +/- SD) 91 +/- 25 (n = 10) and 87 +/- 25 (n = 14) mumol/L in plasma, 2.09 +/- 0.62 (n = 7) and 2.12 +/- 0.77 (n = 11) mumol/10(9) cells in mononuclear leukocytes, 3.2 +/- 2.2 (n = 10) and 1.7 +/- 1.5 (n = 13) mumol/L in bronchoalveolar lavage fluid and 3.4 +/- 2.3 (n = 8) and 1.6 +/- 1.3 (n = 6) mumol/10(9) cells in alveolar macrophages from smokers and nonsmokers, respectively. Mean daily dietary vitamin C intake was 116 +/- 68 and 107 +/- 59 mg/d for smokers and nonsmokers, respectively. The ascorbic acid contents of bronchoalveolar lavage [3.9 +/- 1.9 mumol/L (n = 8)] and alveolar macrophages [4.1 +/- 2.1 mumol/10(9) cells (n = 6)] of smokers consuming 15 to 20 cigarettes/d were significantly higher (P less than 0.05) than those of nonsmokers. The increased content of ascorbic acid in bronchoalveolar lavage and in alveolar macrophages of smokers compared with nonsmokers may reflect a defensive mechanism against free radical species derived from cigarette smoke.

[Value of systematic preventive antibiotherapy in cardiac pacemaker implantation]. / Intérêt de l'antibiothérapie prophylactique systématique lors de l'implantation d'un stimulateur cardiaque.

The aim of this study was to assess the usefulness of prophylactic antibiotics during insertion of a cardiac pacemaker, in order to avoid infection of exteriorisation of infectious origin. The study involved two groups. One hundred and eight patients made up group I, a control group without the use of prophylactic antibiotics. Group II consisted of 101 patients who were given an intravenous injection of 1 or 2 g of oxacillin before surgery, followed up by four days of oral oxacillin (3 g per day). Serum oxacillin levels at the end of the procedure were 0.37 +/- 0.09 mcg/ml, falling within the range of minimum inhibitory concentrations of methicillin-sensitive staphylococci. In the patients of the control group, followed up for 1 to 36 months (mean 12 +/- 11 months), during the first 2 months there were 2 infections, 4 exteriorisations and one cutaneous erosion over the pacemaker. In addition, one exteriorisation and one infection occurred at 17 and 29 months respectively. In patients with exteriorisation of their pacemaker device, there was nothing to suggest an infection and bacteriological specimens were sterile. No obvious infections nor any cutaneous complications occurred in the patients of group II, with prophylactic antibiotics, followed up for 1 to 21 months (mean 6 +/- 5 months). In conclusion, anti-staphylococcal antibiotic treatment appears not only to be capable of avoiding cardiac pacemaker infections but also of preventing exteriorisation of the pacemaker device, which may be linked to hidden infections. A randomised study is nevertheless necessary to confirm this hypothesis.

[Coronary angioplasty in patients aged 70 and over. Immediate results and later outcome]. / L'angioplastie coronaire chez le sujet âgé de 70 ans et plus. Résultats immédiats et devenir à moyen terme.

One hundred and ninety one consecutive patients over 70 years of age (127 men and 64 women, average age 75.6 years) underwent percutaneous transluminal coronary angioplasty (PTCA) between January 1986 and February 1989. One hundred and sixty patients had severe angina (20 Class III and 140 Class IV), 72 patients had previous myocardial infarction, 36 of which were recent (less than 1 month), and 6 patients had previously undergone coronary bypass surgery. The coronary lesions affected one vessel in 67 patients and more than one vessel in 124 patients. The left ventricular ejection fraction was less than 50% in 15 patients. Angioplasty was attempted on 245 lesions (228 stenoses and 17 occlusions): 1 lesion in 141 patients, 2 lesions in 46 patients, 3 lesions in 4 patients, with a primary success rate of 81% in stenotic and 41% in occluded arteries. There were 9 deaths (4.7%) 6 of which occurred in patients with multivessel disease and unstable angina; there were 6 Q-wave infarctions (3.1%), 8 non Q-wave infarctions (4.2%) and 3 emergency coronary bypass operations (1.6%). The first 123 patients of this series were followed up for an average of 18.8 months (7 to 37 months). Follow-up of the 100 patients successfully dilated (4 lost to follow-up) showed that 55 remained improved (53 asymptomatic), 25 had recurrent angina after the initial improvement due to restenosis in 19, progression of coronary athero-sclerosis in 3, restenosis and an evolution of coronary atherosclerosis in 1 and a lesion which had been neglected in 2 cases.(ABSTRACT TRUNCATED AT 250 WORDS)