A role for B1 and B2 kinin receptors in the modulation of T-kininogen during the acute phase response of inflammation.

Kinin antagonists at B1 and B2 receptors were examined on liver and serum concentrations of immunoreactive T-kininogen and its gene expression in a rat model of carrageenan-induced hindpaw edema. Whereas the B2 antagonist, HOE140, dose-dependently inhibited the paw edema induced by intraplantar injection of carrageenan, the B1 receptor agonist [Sar(D-Phe8)des-Arg9]BK and antagonist [Lys(Leu8)des-Arg9]BK were ineffective. On its own, HOE140 (3.25 x 10(-7) mol/ paw, intraplantar) had no effect on liver and serum T-kininogen levels but it significantly enhanced liver T-kininogen concentrations in rats pretreated with carrageenan at 8 and 24 h postinjection. In the liver, the most pronounced effect was seen at 24 h (treated 248 +/- 7 micrograms/g vs. untreated 113 +/- 9 micrograms/g). The same dose of HOE140 increased serum T-kininogen from 1255 +/- 57 to 1696 +/- 83 micrograms/ml at 24 h. HOE140 did not affect tissue albumin content during the same period. Transcript measurements revealed that the steady-state level of liver T2-kininogen mRNA was specifically increased by HOE140 during inflammation. In carrageenan-treated rats, the B1 antagonist [Lys(Leu8)des-Arg9]BK also significantly increased liver T-kininogen at 24 h. The present results support a role for B2 kinin receptors in the early phase of acute phase protein synthesis and of both B2 and B1 receptors in the late phase (24 h). Hence, systemic effects of kinins should be taken into account in the pharmacology and physiopathology of B1 and B2 kinin receptors in inflammation.

[Conservative surgery of the pulmonary parenchyma and bronchial cancer (author's transl)]. / Chirurgie d'épargne du parenchyme pulmonaire et cancer bronchique. Résultats de 22 bronchoanastomoses.

In a series of 236 patients operated upon for bronchogenic carcinoma, a limited pulmonary resection with bronchial resection and anastomosis has been performed in 22 cases. There has been no postoperative mortality; the complications have been remarkably rare: anastomotic stenosis (1 case), temporary bronchial leak (2 cases), local recurrence (2 cases) by patients with hilar or mediastinal involvement, chylothorax (1 case). The pulmonary function also has not been much reduced by the operation, leaving the patients a good quality of life. Survival after bronchoplastic procedures as compared with pneumonectomy or lobectomy shows a mean survival of 30% to 12.5% and 21% respectively for the latter procedures.

[The EEA stapler in low rectal anastomoses: preliminary results (author's transl)]. / Les anastomoses rectales basses à la pince mécanique EEA. Premiers résultats de 24 résections antérieures du rectum.

In the past two years, we have been using the EEA stapler for anastomoses of the extra-peritoneal rectum. With this technique, we have been able to preserve the anal sphincter in all cases of tumor at or above 6 cm from the anal verge. The results of 24 consecutive cases demonstrate the safety of the mechanical anastomoses of the mid-rectum with no death, nor anastomotic dehiscence in 15 cases. Complications occurred in the lowest locations which would have been otherwise treated by an abdomino-perineal excision or pull through procedure: 1 death from peritonitis and stress ulcer 3 temporary leaks and 3 stenoses, easily treated by digital dilatation. The potential danger of anastomotic leaks justifies in the very low anastomoses a temporary colostomy : healing then occurs after a few weeks. The final result is an intact anatomy and sphincteric function.

[False aneurysm of the external iliac artery. A late complication of hip surgery (author's transl)]. / Faux anévrisme de l'artère iliaque externe. Une complication tardive de la chirurgie de la hanche.

The authors report one case of false aneurysm of the right external iliac artery following perforation of the acetabulum by a Böhler nail, which was placed twenty-two years before. Clinical signs were a no-pulsating tumor of the right fossa iliaca, deep venous thrombosis of the right leg and severe anemia. Treatment included resection of the false aneurysm, suture of the arterial wound and removal of the Böhler nail. The authors report the place held by vascular lesions in bone surgery, and diagnostic difficulties due to the delayed clinical manifestations.

[Treatment of resectable cancer of the stomach]. / Traitement du cancer gastrique réséquable.

The results of 631 cancers of the stomach treated by gastrectomy between 1970 and 1983 were closely reviewed in six departments of surgery. This review showed that the prognostic factors determined by resectability, extension of the tumor and lymph node involvement are considered to be reliable following the various pre- and postoperative examinations. In addition, it was shown that most of the gastrectomies were performed following conventional procedures and that the widespread lymph node dissections are not applied in a systematic manner. The postoperative mortality is very low (4.4%) for all the gastrectomies and even lower for the radical gastrectomies (3%). The 5 year survival rate for all the gastrectomies is 15%; this rate amounts to 36% for the gastrectomies performed with a curative aim. In the discussion, the adjuvant radiotherapy and chemotherapy are discussed and their timeliness is shown.

[Surgery of acute cholecystitis in patients 80 years of age or older]. / Chirurgie de la cholécystite aiguë au-delà de 80 ans.

In 17 Belgian surgical centers, 324 operations have been performed for acute cholecystitis in patients 80 years of age or older. In this group of patients: 1. The incidence of acute cholecystitis is hardly higher in women than in men. 2. The patients were operated within 24 hours of admission in 38% of cases. The main bile duct was surgically explored in 1/3 of patients. Cholecystostomy or simple drainage were used in 1/10 of cases only. 3. Operative mortality was 19%. It was higher for patients operated as emergencies than for delayed operations and higher also when the cholecystectomy was associated with an exploration of the bile duct. The ideal treatment for such patients should thus be a cholecystectomy with an endoscopic sphincterotomy.

[Surgery in the octogenarian (introduction). Results of a national survey]. / Chirurgie de l'octogénaire (introduction). Résultats d'une enquête nationale.

Presentation of the results of a national, multicentric and retrospective study regarding the surgery of the octogenarian. The series counts 7,407 patients accepted for surgery, and which can be divided into 4,581 women (61.8%) and 2,826 men (38.2%) of an average age of 84.4 years old (extremities 80-101 years old). The global mortality of this population of elderly (whether operated on or not) amounts to 16.7%. The postoperative mortality of the 4,177 operated patients is 18.2% with different rates according to the surgical disciplines: 34.7% for surgery of the colon, 23.2% for bone surgery, 22.4% for vascular surgery, 15.3% for biliary surgery, 8.7% for urologic surgery and 5.6% for cardiac surgery.

[Implantation of a cardiac pacemaker in the octogenarian]. / Implantation de stimulateur cardiaque chez l'octogénaire.

Thirteen centres, specialized in pacemakers and studying the implantation, brought together their material. Consequently, 785 patients living with a pacemaker (PM) were grouped. The average age at the time of the first implantation is 83,5 years old. The mortality of 7.5% as well as the morbidity of 16% lie very low. Nevertheless, their causes are discussed and compared to those resulting from other types of surgical pathologies on the octogenarian. It seems that the implantation of a PM, even on a person of 80 or older, is an efficient therapeutic gesture, benign and capable of normalizing the chances and quality of life on a long term basis.

[Arterial thrombosis of the lower limb in patients over 80 years of age. Belgian multicentric experience concerning 802 patients]. / Arteriële thrombose van het onderste lidmaat boven de 80 jaar. Belgische multicentrische ervaring betreffende 802 patiënten.

This report concerns a joint study of fourteen centres about the treatment of arterial occlusion of the low extremity. Eight hundred and two patients older than 80 years have been studied during a period from 1 to 27 years. The operative mortality was 25.2%. There was no significant difference in mortality between emergency cases and those patients who were operated under elective conditions. Leg amputations are followed by a significant higher mortality than more conservative surgery such as arterial by-pass, sympathectomy or embolectomy. The most frequent cause of death was from cardiopulmonar origin (57%). The postoperative morbidity of cardiac, pulmonary, urinary or infectious origin was frequent (50%). Surgical complications in the true sence of the word are quite rare and their frequency is limited to 7%. The conclusion of this study is that conservative surgery such as reascularisation or sympathectomy is, whenever possible, to be preferred over amputation not only because of their lower mortality (13 to 19%) but also since they permit better revalidation of these elderly patients.

Surgical treatment of bronchiectasis in Kartagener's syndrome.

A case of Kartagener's syndrome in which bilateral partial pulmonary resection was performed is reported. The literature concerning the surgical treatment of severe bronchiectasis is reviewed.

A competitive enzyme immunoassay for albuterol: its application for the drug screening in urine.

A competitive enzyme immunoassay using purified monoclonal IgG1 and an alkaline phosphatase-albuterol derivative has been developed for the quantification of albuterol in urine. The calibration curve obtained in optimal incubation conditions is characterized by a minimum detectable level of 26 fmol/well and a working range from 52 fmol to 4,2 pmol/well. This method allows the precise and accurate quantification of albuterol in horse urine without any clean up or extraction step. Moreover the definition of its specificity shows a cross-reactivity of the antibody with the glucurono-/sulfo-conjugates of albuterol. This property is particularly interesting for the screening of urinary albuterol residues in meat producing animals.