Influence of chemical and physical conditions in selection of Gluconacetobacter hansenii ATCC 23769 strains with high capacity to produce bacterial cellulose for application as sustained antimicrobial drug-release supports.

AIMS: Obtain varieties of Gluconacetobacter hansenii from original strain ATCC 23729 with greater efficiency to produce bacterial cellulose (BC) membrane with better dry mass yield for application as support of sustained antimicrobials' drug release. METHODS AND RESULTS: Application of different chemical and physical conditions (pH, temperature and UV light exposure) to obtain different G. hansenii varieties with high capacity to produce BC membranes. Characterization of the G. hansenii variants was performed by scanning electron microscopy (SEM) and optical microscopy of the colony-forming units. BC membrane produced was characterized by SEM, infrared spectroscopy and X-ray diffraction. The BC produced by variants isolated after incubation at 35°C showed elevated dry mass yield and high capacity of retention and sustained release of ceftriaxone antibiotic with the produced BC by original G. hansenii ATCC 23769 strain subjected to incubation at 28°C and with commercial BC. CONCLUSION: The application of different chemical and physical conditions constitutes an important method to obtain varieties of micro-organisms with dissimilar metabolism advantageous in relation to the original strain in the BC production. SIGNIFICANCE AND IMPACT OF THE STUDY: These results demonstrate the importance of in vivo studies for the application, in medicine, of BC membranes as support for antimicrobial-sustained release for the skin wound treatment.

Surgical management of an epithelioid hemangioendothelioma of the superior vena cava protruding into the right atrium.

Epithelioid hemangioendothelioma (EH) is a rare malignant tumor of vascular origin that often involves soft tissues and visceral organs, and less commonly, large veins. We report a case of EH of the superior vena cava protruding into the right atrium and its surgical management.

[Multiple myxomata: about one case]. / Myxomes multiples: à propos d'un cas.

Among the primitive cardiac tumours, myxoma is the most common. This benign tumour is sometimes described in the context of Carney's syndrome, in which cardiac myxoma, cutaneous myxoma, lentigo and pigmentary nevus cutaneous lesions, endocrine disorders, and testicular, thyroid and hypophyseal tumours are associated. The cardiac myxomata observed are multiple, recurrent, and involve the four cardiac chambers, with a peak incidence at 25 years of age. These observations may exist in a familial context, linked to an autosomal dominant genetic factor, localized on the 17q2 chromosome with polymorphism of the PRKAR1a gene. As in the case of sporadic myxoma, rapid surgical treatment with cardio-pulmonary bypass is indicated, bearing in mind the increased risk of thromboembolic phenomena and sudden death from valvular encroachment. We report a case of bi-atrial myxoma observed in the context of Carney's syndrome.

[Complications of pulmonary resection]. / Les complications des résections pulmonaires.

INTRODUCTION: Surgical pulmonary resection remains the most effective treatment of non-small cell lung cancer which is its principal indication. Peri-operative mortality remains fairly high and is associated with post operative complications. BACKGROUND: Complications can involve all the thoracic organs: lung, pleura, bronchi and chest wall and also the heart, blood vessels, nervous system and digestive tract. Individually, but often in combination, these complications can lead to post-operative respiratory failure which has a poor prognosis. Beside the pulmonary conditions that are familiar to the respiratory physician other factors add to the morbidity, notably: age, cardiovascular disease and neo-adjuvent therapies. Many of these complications can be explained by the operative procedure: extent of resection, lymph node dissection, adhesions, dissection of the mediastinum etc. These factors should be considered at an early stage in order to achieve prompt diagnosis and management. Broncho-pleural fistulae present major problems on account of both their prognosis and difficult management. CONCLUSION: Many complications, especially cardiovascular, should be anticipated by the pre-operative investigations. Pneumonectomy remains a procedure with high morbidity and mortality. The risk factors should be taken into account when making a decision on surgical treatment.

Effects of coordination mode of 2-mercaptothiazoline on reactivity of Au(I) compounds with thiols and sulfur-containing proteins.

Gold(I) based drugs are interesting for their potential medical use. The relatively facile ligand substitution in linear gold(I) compounds makes the identification of active species complicated. Ligands such as PR3 and CN- are likely to be carrier ligands due to their strong trans-directing properties and will dictate the nature of substitution reactions. The 2-mercaptothiazoline (mtz) ligand is an N,S-heterocyclic compound which presents an exocyclic thiol sulfur as well as a heterocyclic nitrogen. The coordination of mtz to transition metals can be modulated by the trans ligand and complexes with metal bound through the nitrogen and/or the exocyclic sulfur are known. Therefore, the complexes [NCAu(N-mtz)] (N-coordinated) and [(Ph3P)Au(S-mtz)] (S-coordinated) were investigated to compare the influence of CN- and PR3 as well as the coordination mode of the mtz ligand on reactivity with thiols and sulfur-containing proteins. As a further comparison the compound [(Ph3P)AuCN] was also studied. Human serum albumin, egg white lysozyme and, principally, the C-terminal zinc finger (ZF2) of the nucleocapsid NCp7protein of HIV-1 were studied. Results from zinc finger studies show that the coordination structure can determine the reactivity toward biomolecules. Due to ligand scrambling, the complex [NCAu(N-mtz)] forms very reactive species in solution generating [NCyAux-biomolecule] adducts, where x,y≤3. The observation by mass spectrometry of [(CN)Au]-ZF confirms the ability of Au(I) compounds to form [(Ligand)Au] adducts on zinc fingers, in contrast to Au(III), where all ligands are lost upon reaction with the zinc finger. On the other hand, [(Ph3P)Au(S-mtz)] also generates the [(Ph3P)2Au]+ species due to ligand scrambling, that showed lower reactivity, probably due to steric hindrance. For this complex [(Ph3P)Au-biomolecule] and [Au-biomolecule] adducts are dominant. The results corroborate the hypothesis of modulation through coordination as the reactivity clearly depends on not only the ligand, but also the coordination mode.

A novel binuclear copper complex incorporating a nalidixic acid derivative displaying a one-dimensional coordination polymeric structure.

The identification of the antibacterial action of nalidixic acid (nx) was central to the development of the quinolone antibacterial compounds. The ability of the nx naphthyridyl ring to interact with and inhibit some proteins has encouraged the investigation of similar structures in the search for more active compounds with less adverse effects. The possibility of structural modification by attachment of other biologically active moieties to the naphthyridyl ring of nx allowed the development of new active antimicrobial molecules. Hydrazone derivatives of nx can be synthesized easily based on the condensation of the hydrazide derivative of nx with the desired aldehyde or ketone. Only a few complexes with nx hydrazone derivatives have been described but for none were the crystal structures elucidated. The synthesis of a new one-dimensional Cu(II) coordination polymer, namely catena-poly[[copper(II)-di-µ-chlorido-copper(II)-{µ-1-ethyl-N'-[(1H-imidazol-4-yl)methylidene]-7-methyl-4-oxo-1,4-dihydro-1,8-naphthyridine-3-carbohydrazidato}-[dimethanolcopper(II)]-{µ-1-ethyl-N'-[(1H-imidazol-3-yl)methylidene]-7-methyl-4-oxo-1,4-dihydro-1,8-naphthyridine-3-carbohydrazidato}] dichloride methanol tetrasolvate], {[Cu3(C16H15N6O2)2Cl2(CH3OH)2]Cl2·4CH3OH}n, with the (1H-imidazol-4-yl)methylidene carbohydrazide derivative of nalidixic acid (denoted h4imi), is presented and its structure is compared to the density functional theory (DFT) optimized structure of free h4imi. The title structure presents an octahedral Cu(II) ion on an inversion centre alternating along a polymer chain with a square-pyramidal Cu(II) ion, with the two Cu(II) centres bridged by two chloride ligands. Hydrogen bonds involving chloride counter-ions and methanol solvent molecules mediate the three-dimensional packing of the polymer. Comparison of the geometrical results from the structure analysis with those derived from a DFT study of the free ligand reveal the differences that arise upon coordination.

Long-term follow-up after prosthetic replacement of the superior vena cava combined with resection of mediastinal-pulmonary malignant tumors.

The contraindication to curative excision of mediastinal and pulmonary cancers because of invasion of the superior vena cava is now challenged by the existence of vascular prostheses that are suitable for venous replacement. Between 1979 and 1990 22 patients underwent resection of lung cancer (n = 6) or malignant mediastinal tumors (n = 16) involving the superior vena cava. Resection was done with concomitant venous reconstruction, and polytetrafluorethylene grafts were used. All bronchogenic carcinomas necessitated right pneumonectomy, whereas the excision of mediastinal tumors had to include pulmonary resections in nine patients (five lobectomies and four sublobar resections) and the right phrenic nerve in 12 patients. Venous reconstruction was performed by interposition of a large polytetrafluoroethylene graft between the proximal and cardiac ends of the superior vena cava (n = 8), or between one (n = 10) or both brachiocephalic veins (n = 4) and the right atrium. One patient died postoperatively (4.5%), and another had mediastinitis that was successfully treated by omentopexy. Chemotherapy was administered preoperatively to five patients and postoperatively to seven patients; radiotherapy was administered to two and 10 patients, respectively. The overall actuarial survival rate is 48% at 5 years, with 11 patients presently alive. The survival rate of patients with mediastinal tumors is 60% at 5 years. Among the patients with lung cancer, two with N1 disease are alive at 16 and 51 months, and one died at 38 months; the two patients with N2 disease died at 6 and 8 months. Only one graft occlusion occurred in the postoperative period; another occurred 14 months after operation and was precipitated by insertion of a central venous catheter. The patency of all remaining grafts was demonstrated after an average time of 23 (1 to 98) months. On the basis of these results, polytetrafluoroethylene graft replacement of the superior vena cava should be part of the planning and execution of radical excision with curative intent of mediastinal and right pulmonary malignant tumors that are not present with other contraindications, such as pleural or distant metastasis and severe systemic disease.

Thrombus in a normal sinus of Valsalva: angiographic, multiplane transoesophageal echocardiographic, and surgical findings.

A large intraluminal thrombus within an otherwise normal sinus of Valsalva was diagnosed in a 41 year old man who was investigated for myocardial infarction. The thrombus was suspected by aortic root injection, confirmed by transoesophageal echocardiography, and treated surgically.

Interleukine-6 (IL-6) synthesis and gp130 expression by human pericardium.

Growing evidence shows that cytokines of the IL-6 family play an important regulatory role in heart physiology such as inducing cardiomyocyte hypertrophy. The purpose of this study was to see if IL-6 and its soluble receptors (sIL-6R and sgp130) could be detected in pericardial fluids, and to see if they are produced by the pericardium. We report that human pericardial fluid from patients with coronary pathologies contained IL-6, sIL-6R, and sgp130. However, the levels present in sera and pericardial fluid did not correlate, which suggests local production. This observation was confirmed by in vitro studies demonstrating massive IL-6 production by cultured pericardial samples, which could be strongly inhibited by methylprednisolone. RT-PCR studies revealed that IL-6 was weakly expressed in fresh tissues and strongly induced after culture. In situ hybridisation and immunohistochemical analysis showed that IL-6 and gp130 were mainly present in mesothelial cells. sIL-6R and sgp130 were also produced by pericardium in vitro, and their synthesis was upregulated by methylprednisolone. Taken together, these results demonstrate that IL-6 is present in pericardial fluid and that its presence could be due to synthesis by pericardial tissue. In vitro studies suggest that IL-6 production by this tissue could be strongly induced and regulated. A potential paracrine role of these factors in cardiomyocyte functions in normal or pathological conditions is discussed.

Circulating soluble gp130, soluble IL-6R, and IL-6 in patients undergoing cardiac surgery, with or without extracorporeal circulation.

OBJECTIVE: Soluble forms of interleukin-6 (IL-6) receptors are known to modulate biological activities of IL-6. The purpose of the study was to measure circulating levels of IL-6, sIL-6R and sgp130 in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass (CPB group) or without CPB (non-CPB group). METHODS: The CPB group included 19 patients and the non-CPB group 12 patients. Sera levels of IL-6, sIL-6R and sgp130 were measured by specific ELISA at the beginning of the operation (T0, 15 min before skin incision) and 6 h later (T1). RESULTS: IL-6 sera levels were respectively 9+/-20 pg/ml (mean+/-SD) and 13+/-19 pg/ml at T0 and reached 340+/-250 pg/ml and 965+/-1060 pg/ml at T1 in CPB and non-CPB groups, indicating a significant increase from T0 to T1, but no differences between the two groups. When compared to T0 values, sgp130 levels decreased in both groups (respectively 105+/-37 and 115+/-35 ng/ml at T0 for CPB and non-CPB groups, and 72+/-25 and 84+/-29 ng/ml at T1) while we are not able to detect differences between the groups. Whatever the group or the time, sIL-6R concentrations remained unchanged. CONCLUSIONS: We showed that the increase of IL-6 after artery bypass grafting was similar between patients operated with CPB or without CPB. We conclude that the main inductor of IL-6 release is linked to surgical trauma rather than a reaction to CPB. Since it is known that gp130 inhibits IL-6-biological activities, we suggest that the decrease of sgp130 sera levels could further enhance the inflammatory effects of IL-6 in cardiac surgery.

[Videosurgical pleuro-pericardial windows in oncology]. / Fenêtres pleuro-péricardiques vidéo-chirurgicales en contexte néoplasique.

Fifteen consecutive patients with recurrent pericardial effusion associated with confirmed neoplastic disease (N = 11) or with a triad of symptoms: weight loss, anorexia, tiredness (N = 4), underwent videosurgery through a pleuro-pericardial window. The mean age was 58 years (37-77 years). The average procedure and assisted ventilation times were 56.5 min (40-110 min) and 86 min (70-140 min) respectively. Three patients experienced cardiac arrhythmias which regressed. The patients were discharged home on the 5th day (3-11 days). In contrast to needle biopsy which only provided a diagnosis in 3 cases, the histopathological findings were diagnostic in all cases: 12 malignant and 3 benign pericardial effusions with correction of the presumed clinical diagnosis in the latter 3 cases. The average follow-up was 10 months (7 days-3.5 years). There was no operative mortality. Global survival at 1 year was 66%, death being generally caused by a complication of the malignant disease. There were no deaths in the 3 patients with benign pericardial effusions, underlying the necessity of an accurate etiologic diagnosis before assuming malignant pericardial invasion. There were no recurrences of the pericardial effusion and the ventilatory status of these patients was adapted for everyday activities. In patients with malignant disease, the construction of a pleuro-pericardial window by videosurgery is a satisfactory approach. It provides etiologic diagnosis and is well tolerated by patients in poor general condition with no operative deaths, low morbidity and definite improvement in the patients' comfort.

[Intracardiac metastasis of malignant melanoma. Literature review and case report]. / Métastases intracardiaques de mélanome malin. Revue de la littérature à propos d'un cas.

The authors report the case of a 70 year old man with a past history of nucleation of the left eye thirty years previously, in whom two masses, one in the right atrium and the other in the left ventricle, were chance findings on transthoracic echocardiography. After surgery, during which the right atrial tumour was removed and the left ventricular tumour biopsied, histology confirmed the malignant melanomatous nature of the tumours. Further investigations did not detect a primary tumour or other secondary ones. The choroidal origin of these metastases cannot be excluded. After 5 years follow-up, the patient remains in good general condition and the tumours have not recurred or progressed. The literature is reviewed with reference to this case report.

[Valvular tumor: diagnostic trap. Report of a case of marastic endocarditis]. / Tumeur valvulaire: piège diagnostique. A propos d'un cas d'endocardite marastique.

Marastic endocarditis is a rare clinical condition described in cases of cancer or other severe inflammatory diseases. The authors report the case of a young patient in good general condition, admitted after a cerebro-vascular accident. Investigations showed an isolated mitral valvular mass on transoesophageal echocardiography which, after unsuccessful medical therapy, was operated. It was, in fact, a case of marastic endocarditis, and a pulmonary tumour was discovered one month after surgery. The bronchopulmonary adenocarcinoma had remained infraclinical beforehand. The advances in echocardiographic imaging will probably lead to an increase in such cases of early diagnosed thrombotic non-bacterial endocarditis (ETNB. This case suggests that it is justified to carry out an aetiological investigation of thrombotic non-bacterial endocarditis in all cases of isolated mitral valve masses.

[Mycotic aneurysm of the splenic artery. A rare complication of surgically treated infectious endocarditis and its causative cardiac lesion]. / Anévrisme mycotique de l'artère splénique. Une localisation rare des endocardites infectieuses traitée chirurgicalement en même temps que la cardiopathie causale.

The authors report the case of a 59 year old woman with mitral valve streptococcal endocarditis complicating rheumatic valvular disease with several metastatic septic complications. In addition to ocular and cerebral localisations, the patient developed a very rare mycotic aneurysm of the splenic artery. Mitral valve replacement was necessary because of severe mitral regurgitation with major dilatation of the left heart chambers. This surgery was performed under high dose heparin therapy. Large aneurysms of the splenic artery carry a high risk of rupture. This splenic artery aneurysm was treated in the same operative session as the valvular disease by a sternolaparotomy: the aneurysm was operated first of all, and then valvular replacement was performed. Three years later, the patient is well and cured of the endocarditis. To the authors' knowledge, this is the third report of mycotic aneurysm of the splenic artery and the first case combined with surgery of the infectious valvular disease and the gastro-intestinal artery aneurysm.

[Rupture of ascending aortic aneurysm revealing Takayasu's arteritis]. / Rupture d'un anévrisme de l'aorte ascendante révélant une artérite de Takayasu.

Takayasu's disease is rare in Western countries. It is most often revealed by stenosing lesions, aneurysmal attacks being less frequent, generally multifocal, and associated with stenoses. An isolated aneurysmal attack of the ascending aorta is exceptional. It is a deleterious factor in the disease process, and one of the causes of death in this disease. We report a case of isolated aneurysm of the ascending aorta extending to the aortic arch, undergoing emergency surgery at the rupture phase, revealing Takayasu's arteritis. Classically, isolated, asymptomatic, small aneurysms without lesions of other branches are slow to evolve with prolonged corticosteroid therapy. Our observation was contrary to these data, with rapid growth in a major inflammatory context, and rupture. It would seem important to rapidly diagnose and treat Takayasu's disease aneurysms of the ascending aorta, given their progressive potential. In a young female the signs of parietal thickening of the aneurysm must provoke diagnosis and treatment rapidly.

[Cardiogenic shock due to myocardial infarction: surgical revascularization with centrifugal left ventricular assistance. Report of 2 cases treated successfully]. / Choc cardiogénique de l'infarctus du myocarde: revascularisation chirurgicale sous couvert d'assistance centrifuge ventriculaire gauche. A propos de deux cas traités avec succès.

Cardiogenic shock in the acute phase of myocardial infarction still carries a high mortality. In young patients who cannot be revascularised by angioplasty, when medical therapy is failing, some workers recommend an energetic approach, even cardiac transplantation, often with the bridge of mechanical cardiac assistance. This is not possible everywhere, thus preventing possible myocardial salvage and resulting in fairly high mortality. The authors report two cases in which endoluminal revascularisation was not possible and so complete surgical revascularisation with left ventricular assistance was chosen. The two patients survived and one was successfully transplanted electively. This management may be proposed in young patients with multiple occlusions of large coronary arteries in post-infarction cardiogenic shock when medical management is failing despite intra-aortic balloon pumping.

[Heart rupture by closed chest trauma]. / Rupture des cavités cardiaques lors des traumatismes fermés du thorax.

Cardiac rupture is certainly unrecognised in the context of closed chest trauma. There have been few reports in the literature despite the fact that autopsy series show that it is the second cause of death after serious thoracic injury. The authors report three cases of traumatic rupture of the heart. The clinical presentation, apart from cardiogenic shock, differs according to whether there is an associated rupture of the pericardium. When the pericardium is intact, the diagnosis is suggested by the signs of tamponade: With earlier treatment of trauma by medical teams, this lesion should be diagnosed as soon as possible. Echocardiography has many indications in closed chest trauma. Early surgical intervention is the only treatment of these lesions.

[Effect of age on the prognosis of infectious endocarditis]. / Influence de l'âge sur le pronostic de l'endocardite infectieuse.

The aim of this study was to evaluate the influence of age on the prognosis of infectious endocarditis. A retrospective study from 1987 to 1997 of 136 patients with infectious endocarditis on native, prosthetic valves or cardiac pacing catheter was performed. The outcome was analysed with the help of general practitioners. Two groups of patients were compared: 87 patients of 65 years of age or more (Group 1) and 49 patients under 65 years of age (Group 2). With a follow-up period of 5 years, the global mortality was 35%, but greater in Group 1 (p = 0.06). Cardiac failure was the main cause of death. The mortality was significantly higher in patients who were not operated (p < 0.002). The authors conclude that age of over 65 does not significantly worsen the prognosis of infectious endocarditis. The absence of surgery seems to be an indirect factor of a poor prognosis. Long-term follow-up of patients is necessary to diagnose and treat cardiac failure at an early stage and to consider referral for surgery.

[Papillary fibroelastoma. A rare etiology of strokes in young patients]. / Fibroélastome papillaire. Une étiologie rare des accidents vasculaires cérébraux du sujet jeune.

BACKGROUND: The papillary fibroelastomas are cardiac lesions, which typically occur on the cardiac valves, but rarely on the endocardium. The incidence of these benign primitive tumors varies from 0.002 to 0.33% and increases with advancing age. METHODS: We report two cases of stroke, one in a 31-year-old man and the other in a 48-year-old woman, both admitted to the same stroke center. RESULTS: The diagnostic studies were normal in these two patients, except for the echocardiography. The first showed an echogenic mass on the mitral valve on transthoracic echocardiography (TTE), confirmed by the transesophageal echocardiography (TEE). The second demonstrated a mass on the sigmoid aortic valve on TEE, but the TTE was normal. For these two patients, a surgical excision was carried out and pathologic examination concluded to a papillary fibroelastoma. After surgery, no recurrence was observed. CONCLUSIONS: The papillary fibroelastomas are usually asymptomatic and easily detected by TEE. However, it can be revealed by stroke, myocardial infarction and lower limbs ischemia. These cardiac tumors should be surgically removed, since their complete excision remains the only means of avoiding a recurrence of embolism.

[Alveolar adenoma: a rare peripheral pulmonary tumor]. / L'adénome alvéolaire: une tumeur pulmonaire périphérique rare.

Alveolar adenoma was first described in 1986. It is a benign peripheral lung neoplasm present more frequently in middle-aged woman. We report a new case occurring in 52 year-old woman. We describe histopathological and immunohistochemical characteristics. Then, this observation is compared with the 11 cases previously published. Finally, we try to understand its origin.