[French national survey of the use of monitoring devices during cardiopulmonary bypass in 2001]. / Enquête française sur les dispositifs de surveillance de la CEC en 2001.

OBJECTIVES: To study the different monitoring devices used during cardiopulmonary bypass (CPB) and to determine the factors, which may influence the choice of these equipments. STUDY DESIGN: Survey. METHODS: A postal questionnaire was send to the 66 French cardiac surgery centres. Results have been analysed about the economic status (public health service or private institution) and the business of the centre (less than 500, between 500 to 800 and more than 800 cardiopulmonary bypass/year). RESULTS: The rate of answer reached 73%. In 40% of centres, the cardiovascular perfusionist was not alone during the procedure. The percentage of centres using a checklist was 80%, a neurologic monitoring 42%, anaesthesia depth monitoring 40%, venous reservoir level detector 52%, arterial line bubble detector 38%, cardioplegia circuit bubble detector 6%, transoesophageal echocardiography 48%, pipe's temperature monitoring 90%; oxymetry 44%, capnography 25%, SvO2 98%, blood gas analysis outside the OR 46% and computer records 35%. No difference was observed between public and private institution for these latter devices. However, a significant difference was noticed among the low, intermediate and highly busy centres for the use of checklist, the EEG monitoring, the pipe and water circuit temperature monitoring, capnography and location of the biologic analysers. CONCLUSION: Equipments were not similar among the different French cardiac surgery centres. Furthermore, the French practice seems different from American, UK and Australian's one. These results highlight the need of establishing French guidelines, which are absent.

Relation between HFE mutations and mild iron-overload expression.

The identification of the HFE gene involved in hemochromatosis allows genetic tests based on mutation analysis to be performed. However, discrepancies in the correlation between HFE genotypes and iron-loading status have arisen. We investigated 708 patients with various signs or symptoms suggesting a putative iron overload that, nevertheless, did not reach the current criteria for hemochromatosis diagnosis. Most of the patients (91.4%) included in our study displayed one of three classical iron marker values above the threshold defined for iron overloading. HFE mutation analysis allowed us to identify 45.7% of carrier chromosomes in the studied group of patients that showed higher frequencies of HFE mutations compared with controls. In addition, the frequencies of compound C282Y/H63D heterozygous, H63D/H63D homozygous, and C282Y heterozygous genotypes were higher than those in HH probands and controls; they accounted for 16, 5.6, and 22.5% of the patients, respectively. All genotypic groups had a significantly higher value of serum ferritin concentration compared to the normal value; only the C282Y homozygotes and compound heterozygotes with H63D had a transferrin saturation significantly higher than the normal value. On the whole the H63D homozygous and compound heterozygous patients constitute an intermediate phenotypic group between HH and controls. Some of them may reach the critical overloading defined for HH diagnosis along with a potential risk of developing complications, whereas others only show a partial phenotypic expression.

Afterdrop after hypothermic cardiopulmonary bypass: the value of tympanic membrane temperature monitoring.

OBJECTIVES: After weaning from cardiopulmonary bypass (CPB), a decrease in nasopharyngeal temperature (NPT) occurs (afterdrop). The pathophysiology of the afterdrop remains unclear: It might be caused by either inadequate total body rewarming on CPB or to heterogenous distribution of heat during CPB, with subsequent redistribution of heat from the warmer core to the cooler shell tissues. The study objectives were (1) to determine whether post-CPB afterdrop is the result of a negative CPB thermal balance, and (2) to investigate which sites (if any) could best predict the afterdrop. DESIGN: Prospective evaluation using within-patient comparisons during CPB cooling, CPB rewarming, and 45 minutes post-CPB. SETTING: Adult patients gave informed consent before a cardiac surgical procedure in a university hospital. PARTICIPANTS: Eight patients undergoing CABG or valvular replacement with hypothermic CPB (NPT near 29 degrees C) and standardized general anesthesia. INTERVENTIONS: Each patient was studied with temperature monitors (Mon-a-therm 7000; Mallinckrodt-Medexel, Gemenos, France) attached to disposable thermocouple probes placed as follows: urinary bladder, rectum, deltoid, esophagus, nasopharynx, tympanic membrane, and four skin sites. In addition, the temperatures from the thermistors of the pulmonary artery catheter, and the arterial and venous lines of the CPB circuit were considered. Thirteen sites for monitoring temperature were studied. MEASUREMENTS AND MAIN RESULTS: Temperatures were recorded every 5 minutes, from the beginning of CPB to the 45th minute after CPB, and thermal exchanges were calculated: change in body heat (QBH), thermal exchanges between the patient and the pump (QCPB), metabolic heat production (Qm) (equal to calculated VO2 at the pump level), and heat loss to the environment (QS) (equal to QBH-QCPB-Qm). Thermal exchanges were obtained in six patients during the plateaus of cooling and rewarming, during the whole CPB phase, and after CPB. It was found that despite a change in QBH during rewarming (1,017 +/- 88 kJ) that was slightly greater than during cooling (-1,008 +/- 104 kJ) (mean +/- SEM), a significant decrease in post-CPB "core" temperature occurred (afterdrop: -1.4 degrees C). Magnitude of the afterdrop was directly related to the magnitude of tympanic membrane cooling and was negatively correlated to the temperature difference between the warmest site (tympanic membrane) and the coolest site (cutaneous thigh temperature) observed at the end of rewarming (r = -0.667; p < 0.05). CONCLUSIONS: It is suggested that besides post-CPB heat loss, redistribution of heat may be involved in the mechanism of the afterdrop and that measurements of tympanic membrane and cutaneous thigh temperatures are the best monitors of adequacy of rewarming during CPB.

Changes in brain monoamine content and metabolism induced by paraoxon and soman intoxication. Effect of atropine.

1. Soman induced a decrease in hypothalamic, hippocampal and cortical noradrenaline, an increase in hippocampal and cortical dopamine and an increase in hypothalamic serotonin while paraoxon did not modify these neurotransmitter concentrations. The increases in 3,4-dihydroxyphenylacetic acid, homovanillic acid and 5-hydroxyindole acetic acid produced by the two drugs witness an accelerated turnover of dopamine and serotonin. 2. Atropine pretreatment completely antagonized the paraoxon-induced changes but only partially suppressed the soman-induced modifications. 3. These data suggest that soman produces a direct effect on monoamine metabolism which is not related to acetylcholine accumulation.

[Use of the urocytogram in sexual ambiguities before puberty]. / Applications de l'urocytogramme dans les ambiguités sexuelles avant la puberté.

The cellular material studied in the urinary sediment mainly obtained from exfoliated cells of the bladder trigone was submitted to hormonal stimulation. The urocytogram has proved a useful and even necessary examination to establish the hormonal check-up of a child suffering from early puberty. This simple, painless method, without any psychological consequences is also indicated in pediatric gynecology, and in certain sexual ambiguity cases. This examination, undergone by a child premature or not, contributes to the early diagnosis of congenital adrenal hyperplasia. In the course of childhood, it helps to investigate pseudohermaphroditisms and various malformations. This examination has proved an important help in the diagnosis of all the cases of sexual ambiguity.