[Physical and chemical stability of fortified ophtalmic ready-to-use solutions: review of literature]. / Stabilité physico-chimique de solutions ophtalmiques renforcées prêtes à l'emploi : une revue de la littérature.

INTRODUCTION: Ophtalmic infections and inflammations are often encountered during hospitalization. They require the preparation of "fortified" ophtalmic solutions, i.e. pharmaceutical ophtalmic solutions which are hyperconcentrated in active substance. The data of physicochemical stabilities are modified and it is therefore essential to gather the results of the various publications devoted to this subject. METHOD: In 2006, an initial literature review was undertaken to identify the molecules mostly used in the preparation of fortified ophtalmic solutions in hospital. A second review of the literature in 2010 has enriched the knowledge about it. RESULTS: Two new drugs have entered the summary table: amikacin and ticarcillin disodium. Date on 12 molecules already known in 2006 were updated to improve clinical practices. A review of the literature was undertaken in order to collect the results of the molecules mostly used for the preparation of the fortified ophtalmic solutions in hospitals. A summary table, indicating the active substance, its concentration, the assay method, the storage temperature and physicochemical modifications, presents all the results. CONCLUSION: This review of literature makes it possible to match stability and validity period to these preparations.

A Review of the EUSO-Balloon Pathfinder for the JEM-EUSO Program.

EUSO-Balloon is a pathfinder for JEM-EUSO, the mission concept of a spaceborne observatory which is designed to observe Ultra-High Energy Cosmic Ray (UHECR)-induced Extensive Air Showers (EAS) by detecting their UltraViolet (UV) light tracks "from above." On August 25, 2014, EUSO-Balloon was launched from Timmins Stratospheric Balloon Base (Ontario, Canada) by the balloon division of the French Space Agency CNES. After reaching a floating altitude of 38 km, EUSO-Balloon imaged the UV light in the wavelength range ∼290-500 nm for more than 5 hours using the key technologies of JEM-EUSO. The flight allowed a good understanding of the performance of the detector to be developed, giving insights into possible improvements to be applied to future missions. A detailed measurement of the photoelectron counts in different atmospheric and ground conditions was achieved. By means of the simulation of the instrument response and by assuming atmospheric models, the absolute intensity of diffuse light was estimated. The instrument detected hundreds of laser tracks with similar characteristics to EASs shot by a helicopter flying underneath. These are the first recorded laser tracks measured from a fluorescence detector looking down on the atmosphere. The reconstruction of the direction of the laser tracks was performed. In this work, a review of the main results obtained by EUSO-Balloon is presented as well as implications for future space-based observations of UHECRs.

The contribution of metronidazole and two metabolites to the mutagenic activity detected in urine of treated humans and mice.

The urine of two patients receiving therapeutic doses of the trichomonacide, metronidazole, was analyzed for mutagenic activity using the histidine auxotroph TA1535 of Salmonella typhimurium. The activity detected in the urine was significantly higher than could be accounted for by the presence of the administered drug. Chromatographic analysis of the urine indicated the presence of the metabolite 1-(2-hydroxyethyl)-2-hydroxymethyl-5-nitroimidazole, which when tested in vitro with TA1535 was found to be ten times more active than metronidazole. An additional urinary metabolite, 1-acetic acid-2-methyl-5-nitroimadazole, was found to be inactive when similarly tested. The in vitro mutagenic activity of metronidazole and the two metabolites was unchanged by the addition of phenobarbital- or Aroclor-induced rat liver homogenate to the test system. In addition, metronidazole and the hydroxymethyl metabolite reverted S. typhimurium TA100 but not TA1537, TA1538, or TA98, and the acetic acid metabolite failed to revert any of the tester strains. In studies with mice, metronidazole was required in excess of the human dose in order for significant amounts of the hydroxymethyl metabolite to be detected in the urine. Urine from mice pretreated with the hepatotoxin, carbon tetrachloride, prior to the administration of metronidazole demonstrated approximately a 50% reduction in mutagenic activity, and the formation of the urinary metabolites was inhibited. These findings indicate the production of metabolites from the parent compound by the liver of the intact animal which could not be determined by use of the standard in vitro liver homogenate system.

Congenital jaundice in bovine aborted foetuses: an emerging syndrome in southern Belgium.

Southern Belgium faces an unusual recent increase of icteric bovine aborted foetuses. In the necropsy room, the majority of foetuses presented jaundice and splenomegaly. Despite a wide range of analyses, no definitive cause of abortion has yet been established but some analysis results support the leptospirosis hypothesis. This first description of cases will help veterinary practitioners to recognize more cases and to conduct those to the laboratory for future investigations.

A class-I intron in a cyanelle tRNA gene from Cyanophora paradoxa: phylogenetic relationship between cyanelles and plant chloroplasts.

Cyanelles are photosynthetic organelles which are considered as intermediates between cyanobacteria and chloroplasts, and which have been found in unicellular eukaryotes such as Cyanophora paradoxa. The nucleotide sequence of a 667-bp region of the cyanelle genome from Cyanophora paradoxa containing genes coding for tRNA(UUCGlu) and tRNA(UAALeu) has been determined. The gene coding for tRNA(UAALeu) is split by a 232-bp intron which has a secondary structure typical for class-I structured introns and which is closely related to the intron located in the corresponding gene from liverwort and higher plant chloroplasts. It appears therefore that these tRNA(UAALeu) genes are all derived from one common ancestral gene which already contained a class-I intron.

Controlled comparison of nefazodone and amitriptyline in major depressive inpatients.

Nefazodone, a phenylpiperazine antidepressant, exhibits novel dual activity on serotonin (5-HT) neurons; it binds to 5-HT2 receptors and inhibits 5-HT reuptake. Flexible doses of nefazodone (100-400 mg/day) and amitriptyline (50-200 mg/day) were compared in 106 major depressive inpatients in a 6-week double-blind study. Results showed significant superiority of amitriptyline over nefazodone on all rating instruments: Montgomery and Asberg depression rating scale (P < 0.0001), Hamilton depression scale (P < 0.0006), Clinical Global Impressions (P < 0.0001) and Patient Global Assessment (P < 0.01). A total of 65% of patients under amitriptyline and 56% of patients under nefazodone reported adverse events during the study, with significantly more dry mouth in the amitriptyline group (39% versus 11%, P = 0.001). Modal daily doses within the last treatment week reached 242 mg with nefazodone and 124 mg with amitriptyline. The lower efficacy of nefazodone, which contradicts comparative trials with imipramine in US patients, is discussed with regard to the dose of nefazodone, probably below the optimal therapeutic range for melancholic patients, and to the clinical differences between the patient samples.

Controlled comparison of two doses of milnacipran (F 2207) and amitriptyline in major depressive inpatients.

A multicenter study compared the antidepressant efficacy and the tolerance of two doses of milnacipran (50 mg and 100 mg/day) and amitriptyline (150 mg/day) in three parallel groups of 45 major depressive inpatients defined by Research Diagnostic Criteria. After a wash-out period of 4-7 days on placebo with lorazepam and/or nitrazepam if necessary, patients were randomly assigned to a daily dose of milnacipran 50 mg, milnacipran 100 mg or amitriptyline 150 mg reached on the 5th day and then stable over a 4-week period, with weekly assessments by means of the Montgomery and Asberg depression scale, the Hamilton depression scale, the Clinical Global Impressions (CGI) and the Target Emergent Signs and Symptoms. Results showed significant superiority of both milnacipran 100 mg/day and amitriptyline over milnacipran 50 mg/day at the end of the treatment period. However, amitriptyline induced a nonsignificant trend toward more rapid improvement after 2 weeks of treatment, mainly based on items related to insomnia, supporting more sedative properties of amitriptyline as compared to milnacipran. Anticholinergic side-effects were significantly lower with milnacipran than with amitriptyline, explaining why milnacipran 100 mg exhibited at the end of the treatment period, a nonsignificantly better efficacy index on the CGI. Moreover, in contrast to milnacipran, amitriptyline was responsible for a significant decrease in blood pressure and a significant weight gain.

Rubella, the Trojan horse of obstetrics.

Documentation has been provided that health care personnel working in prenatal clinics have exposed their patients to the rubella virus. Various states have instituted rules and regulations toward the prevention of spread of rubella to pregnant women. These regulations have been ineffectual as rubella antibody testing and immunization programs do not include all health care providers. Cogent reasons for rubella antibody testing and immunization of all susceptible health care providers, whether they are physicians, nurses, or students, are presented.

Cesarean section and maternal mortality in Rhode Island. Incidence and risk factors, 1965-1975.

An 11-year study from January 1, 1965, through December 31, 1975, was undertaken to study maternal death associated with cesarean section in Rhode Island. The risk of maternal death associated with cesarean section and that for vaginal delivery was calculated, and it was found that the risk of death from cesarean section was 26 times greater than with vaginal delivery. The expanding indications for cesarean section, factors associated with excess risk of death from cesarean section, and suggestions to prevent such catastrophe are discussed.

Puerperal uterine inversion.

A 10-year retrospective study of acute puerperal inversion of the uterus was undertaken at Women and Infants Hospital of Rhode Island. There were 11 inversions in 70,481 deliveries for an incidence of one in 6407. The age ranged from 19-31 years. Seventy-three percent occurred in nulliparous women. All cases were recognized immediately, and vaginal replacement was successful in nine patients. One patient had a placenta accreta necessitating a supracervical hysterectomy, and one patient required a laparotomy and Huntington procedure for replacement. Six patients had blood loss greater than 1000 mL and three required transfusion. There were no maternal deaths.

Cesarean section for delivery of the second twin.

Four cases of combined vaginal-abdominal delivery of twins are presented, and an additional 5 cases from the recent literature are discussed. Malposition, malpresentation, and contracted cervix were the main indications for cesarean section for the birth of twin B. In the 9 cases presented, there were 2 perinatal deaths.

Epidemiology and management of sexual assault victims.

One hundred and twenty-six sexual assault victims were examined and treated at the Women and Infants Hospital of Rhode Island from July 1 1976, through June 30, 1977. Sixty-six were less than 18 years of age, and of this group, 54 were less than 16 years of age, and 26 of these were prepubertal. Evidentiary examination was performed on 100 victims. No pregnancies resulted, and no victim acquired syphilis from the assault. Five patients had positive cultures for gonorrhea at the time of initial examination and all were cured by therapy. Epidemiologic correlates of sexual assault are discussed.

Interest of a loading dose of milnacipran in endogenous depressive inpatients. Comparison with the standard regimen and with fluvoxamine.

A multicenter controlled study was designed to test the hypothesis that a loading dose of an antidepressant could shorten the latency of its clinical efficacy. Three parallel groups of about 40 endogenous depressive inpatients received either a loading dose of milnacipran (300 mg daily for 2 weeks and 150 mg daily during the 2 following weeks), the standard regimen of milnacipran in severe depression (200 mg daily for 4 weeks), or fluvoxamine (200 mg daily for 4 weeks). The duration of the study was 4 weeks, with assessments at baseline and after 4, 9, 14, 21, and 28 days of therapy by means of Montgomery and Asberg depression scale (MADS), the Hamilton depression scale, the Clinical Global Impressions (CGI), and a checklist of symptoms and side-effects. Results showed very similar evolution in the 3 treatment groups. In addition, the level of side-effects did not exhibit significant differences among the treatment groups, except for excitement-nervousness and akathisia which were more frequently reported with fluvoxamine. These results do not support the usefulness of a loading dose of an antidepressant such as milnacipran. They demonstrate however that milnacipran can be given at a 300 mg daily dose from the very first day of treatment with an excellent tolerance.

Mirtazapine is more effective than trazodone: a double-blind controlled study in hospitalized patients with major depression.

Two hundred hospitalized patients with DSM-III diagnosis of moderate to severe major depressive episode were randomized to receive mirtazapine or trazodone for 6 weeks in a double-blind trial. The dosages were 24-72 mg/day for mirtazapine and 150-450 mg/day for trazodone. The improvement on all depression rating scales used was generally greater for mirtazapine, with statistically significant differences over trazodone in the Hamilton Psychiatric Rating Scale for Depression total score and two subscores (the Bech melancholia factor and retardation factor), the Brief Psychiatric Rating Scale total score, the General Psychiatric Impression Global Assessment Scale, the Beck score and responder rates. Mirtazapine was well tolerated, while the trazodone-treated patients experienced somnolence more frequently, particularly during the first 2 weeks of treatment. Furthermore, postural symptoms were a clinical problem in 6% of the trazodone-treated patients. In this trial, mirtazapine showed significant clinical advantages over trazodone in terms of overall efficacy and tolerability.

Pyogenic infection of the sacro-iliac joint. Report of thirteen cases.

Thirteen cases of infectious sacro-iliitis caused by pyogenic organisms are reported and compared with thirty-four cases in the literature. Staphylococcus was the commonest infecting organism (six cases). Two clinical patterns were noted, acute (nine cases) and subacute (four cases). Treatment was by antibiotics and bed rest in all patients. Surgery was indicated for diagnosis in three patients and for abscess in three patients. All of our patients had very good functional recovery.

Lithopedion. A case report.

In a case of lithopedion the fetus survived to 15 weeks' gestation. The mother had an infertility problem, and following tuboplasty she became pregnant and had an incomplete abortion, although no fetal parts or chorionic villi were found at dilatation and curettage. Five and one-half years later a second laparotomy was performed, and the lithopedion was discovered.

Cesarean section: a contemporary assessment.

A one-year retrospective study of cesarean section (CS) at Women and Infants Hospital of Rhode Island is reported. There were 5,467 women delivered, including 1,011 who delivered by CS, yielding a total CS rate of 18.5% and a primary rate of 13.4%. The four leading indications for primary CS were: dystocia (38.8%), breech presentation (14.9%), malposition (11.9%) and fetal distress (11.3%). Sepsis was responsible for 75% of the complications. The incidence of low-birth-weight infants was 14.2% for primary CS and 6.7% for repeat CS. The perinatal death rate was 21.2% per 1,000. The relationship of these findings to changing obstetric practice is discussed.

[Role of tibial-fibular grafting in the treatment of infected pseudarthrosis of the tibia]. / Place de la greffe inter-tibio-péronière dans le traitement des fractures et pseudarthroses infectées de jambe.

The author presents a series of 112 patients, suffering an infected fracture or nonunion of the tibia, and operated on by intertibio-fibular grafting (ITFG), between 1960 to 1990. 110 of them were followed up during average 5 years. Some points of the technic are detailed. The whole treatment associates immobilization, antibiotherapy, cleaning procedures and eventually complementary grafting. All patients were consolidated, 73 after ITFG alone, 13 by association, in the same stage, of an open cancellous filling, following Papineau technique. 24 needed a complementary grafting, among them 7 because a technical flaw. 5 iterative fractures were observed, only one of them has not united. 96 patients were cured of any sepsis, most often by associated cleaning procedures, achieved either before or after ITFG. It existed 14 persistent draining sinus, but only 4 may be considered as real failures. The involvement of the ankle joint was unfortunately quite frequent, but it did not seem to be the consequence of the synostosis, but rather of the duration of immobilization. After review of the literature, the other methods of treatment were discussed, particularly these of Papineau and of Ilizarov. The conclusion was that each method has indications, but the ITFG must keep the largest place, being indicated in about two cases out of three.

[Hematogenous osteomyelitis in the adult]. / Ostéomyélite hématogène de l'adulte.

Between 1960 and 1985, 39 cases of haematogenous osteomyelitis in adults have been treated. The clinical signs were somewhat different from those seen in children or adolescents. The difference was due to different patterns in the blood supply of adult bones. Three types are described: acute, sub-acute and suppurating. Some patients purely suffered pain. After the age of 50 the prognosis was much worse. All the cases were treated surgically by evacuation of pus, excision of sequestra and necrosed bone, muscle flaps or bone grafting by the Papineau technique. The results were satisfactory except in the elderly.