[Beta-thalassemia and pregnancy. Apropos of 2 cases]. / Bêta-thalassémie majeure et grossesse. A propos de deux cas.

Homozygous beta-thalassemia is a severe, transfusion dependent anaemia that also causes infertility. Preimplantation genetic diagnosis is possible. Very few pregnancies are reported among such patients. They have a very high obstetrical risk and a pluridisciplinary follow is necessary.

Rate of intravenous thrombolysis for acute ischaemic stroke in the North-of-France region and evolution over time.

The proportion of patients with ischaemic stroke treated by intravenous (i.v.) recombinant tissue plasminogen activator (rt-PA) is an indicator of quality of stroke care. The objective of the study is to evaluate the rate of i.v. thrombolysis in the North-of-France region and its evolution over time. We determined the proportion of inhabitants treated by i.v. rt-PA in 2009-2010 (period A; 8 stroke units, no telemedicine) and 2012 (period B; population campaigns, 12 stroke units with telemedicine in 5). We used hospital registries from the 12 stroke units, and population-based data were collected in a subpopulation of 226,827 inhabitants (5.6% of the whole population). 1,563 inhabitants received i.v. rt-PA for stroke (period A: 835 in 24 months; period B: 728 in 12 months). Hospital and population data were similar. Annual rates of thrombolysis increased from 103 per million inhabitants [95% confidence interval (CI) 85-125] to 181 (95% CI 157-209; relative increase 76%, 95% CI 67-83%). This rate increased in 12 districts (significantly in 6), but the increase was greater in districts where new stroke units, telemedicine, or both were implemented. In conclusion, although the proportion of patients treated was already high in period A, there was still place for improvement. Implementation of new stroke units, extension of the telemedicine network and new population campaigns are necessary to improve the rate of thrombolysis in several areas, to ensure an equal access to treatment over the whole territory. The next step is now to determine whether this high rate of i.v. rt-PA delivery at the population level translates into clinical results.

[Obstetrical outcome and risk of uterine rupture following a caesarean section before 32 weeks]. / Modalités d'accouchement et risque de rupture utérine après césarienne réalisée avant 32 semaines d'aménorrhée.

OBJECTIVE: Our aim was to evaluate the subsequent obstetrical outcome and rate of uterine rupture following a caesarean section before 32 weeks of gestation. PATIENTS AND METHODS: A retrospective cohort study of 200 consecutive women with a prior caesarean section performed between 25 and 32 weeks were contacted by questionnaire or followed through medical charts to determine the subsequent mode of delivery. RESULTS: Two hundred caesarean section were performed between 25 and 32 weeks from January 1997 to March 2000. Thirty-nine patients (19.2%) were lost to follow-up. Seventy-one patients had a subsequent delivery. Thirty-two attempted vaginal birth and the success rate was 87.5%. Thirty-nine patients had a subsequent caesarean. One case of uterine rupture occurred before labour at 31 weeks (1.4%, % IC 95% [0.25; 7.56]). CONCLUSION: After a previous caesarean delivery before 32 weeks, a trial of labour may be proposed when obstetrical conditions are optimal. However, uterine rupture may occur prior to labor.

Specific and sensitive quantitation of 2,2'-dichlorodiethyl sulphide (sulphur mustard) in water, plasma and blood: application to toxicokinetic study in the rat after intravenous intoxication.

A sensitive and specific capillary gas chromatographic method has been developed to measure trace amounts of 2,2'-dichlorodiethyl sulphide (sulphur mustard) in environmental or biological samples. Sulphur mustard was isolated from water or plasma by a solid-phase extraction procedure and from blood by liquid-liquid extraction. The accuracy and precision of the methods were demonstrated using replicate analyses of spiked water, plasma or blood: within-run and between-run variabilities were less than 20%. These analytical methods were used to evaluate the rate of sulphur mustard degradation in water or plasma. Good linear calibration curves, with a detection limit of 45 ng/ml, were obtained for quantitation and determination of sulphur mustard in blood following its intravenous administration to rats. Initial toxicokinetic data were obtained.

Distribution of [14C]sulfur mustard in rats after intravenous exposure.

The distribution of sulfur mustard, bis(2-chloroethyl)sulfide, was investigated in rats. After i.v. injection of [14C]sulfur mustard (10 mg/kg), distribution of 14C was rapid (within minutes) to all tissues that were sampled. Significant amounts of 14C were detected in the kidney, liver, lung, intestine, and stomach, organs all associated with elimination and transformation processes. No more than 3 +/- 2% of the 14C was recovered in fat tissues, indicating that fat was not a major storage site for sulfur mustard. In addition to wide distribution, a significant uptake of 14C was observed in an aponeurosis in the leg receiving the dose of [14C]sulfur mustard (10 mg/kg or 500 micrograms/kg) via the superficial femoral vein. After injection of [14C]sulfur mustard via the jugular vein, no preferential retention site for 14C was detected in the lung.

Biological fate of sulphur mustard in rat: toxicokinetics and disposition.

1. The toxicokinetics of sulphur mustard were studied after i.v. administration (10 mg/kg) to rat. 2. After i.v. administration, blood concentrations of sulphur mustard were best described by a two-compartment model with distribution and elimination half-lives of 5.6 min and 3.59 h, respectively. The apparent volume of distribution at steady state (Vdss) was 74.4 l/kg and total body clearance (Cl) was 21 l/h kg-1. 3. Unchanged sulphur mustard was still detectable in the systemic circulation 8 h after administration. Appreciable and long (96 h) accumulation of 14C was found in the systemic circulation, and significant high affinity of 14C-sulphur mustard for red blood cells. 4. The disposition of 14C was also investigated after i.v. injection of 14C-sulphur mustard to rat. Urine was the major route of excretion of sulphur mustard and/or its metabolites. Of the administered radioactivity 80% was excreted in urine over 96 h, the greater part in the first 24 h after administration. Residual 14C continued to be excreted until 4 days later. In urine, no sulpho- or glucuronyl-conjugates were detected. Of dose < 3% was recovered in faeces.