[Maternal deaths due to infections in France 2013-2015]. / Mortalité maternelle par infection en France 2013­2015.

Over the 2013-2015 period, maternal mortality due to infections accounted for 10 % of direct maternal deaths and 13 % of indirect maternal deaths. Among the 21 deaths from infection, and compared to the last triennium, maternal deaths from genital infection doubled with 11 deaths during the 2013-2015 period. This included 6 cases of puerperal toxic shock syndrome, 4 of which due to Streptococcus A, and 5 cases of sepsis caused by intrauterine infection due to Gram-Negative Bacillus. Indirect maternal deaths due to infections from extragenital sources represented 10 deaths in this triennium, including four influenza infections and three infectious complications of an immunosuppressive state (uncontrolled HIV infection for two patients and CMV encephalitis during an immunosuppressive treatment for one patient). Of these 21 deaths by infectious causes, 6 direct maternal deaths and 9 indirect maternal deaths were considered preventable. The most common preventable factors were those related to medical management (13 times): diagnostic failure or delayed diagnosis leading to a delayed medical treatment, absence of influenza vaccination. The other contributory factors were related to the organization of healthcare (delayed transfer, lack of communication between clincians) as well as factors related to patient social vulnerability.

Prévention et prise en charge de l'infection herpétique au cours de la grossesse et de l'accouchement : recommandations pour la pratique clinique ­ texte des recommandations (texte court).

OBJECTIVE: Identify measures to diagnose, prevent and treat genital herpes infection during pregnancy and childbirth and neonatal infection. METHODS: Bibliographic search from Medline, Cochrane Library databases and research of international clinical practice guidelines. RESULTS: Genital herpes lesion is most often due to HSV2 (LE2). The risk of HSV seroconversion during pregnancy is 1 to 5% (LE2). Genital herpes ulceration during pregnancy in a woman with history of genital herpes corresponds with a recurrence. In this situation, there is no need for virologic confirmation (grade B). In case of genital lesions in a pregnant woman that do not report any genital herpes before, it is recommended to perform a virological confirmation by PCR and HSV type specific IgG (Professional consensus). In case of first episode genital herpes during pregnancy, antiviral treatment with acyclovir (200mg 5 times daily) or valacyclovir (1000mg twice daily) for 5 to 10 days is recommended (grade C). In case of recurrent herpes during pregnancy, antiviral therapy with acyclovir (200mg 5 times daily) or valacyclovir (500mg twice daily) can be administered (grade C). The risk of neonatal herpes is estimated between 25% and 44% in case of initial episode (LE2) and 1% in case of recurrence (LE3) at the time of delivery. Antiviral prophylaxis should be offered for women with first episode genital herpes or recurrent genital herpes during pregnancy from 36 weeks of gestation and until delivery (grade B). In case of a history of genital herpes without episode of recurrence during pregnancy, it is not recommended routinely offer a prophylactic treatment (professional consensus). A cesarean section should be performed if there is a suspicion of first episode genital herpes at the onset of labor (grade B), in the event of premature rupture of the membranes at term (professional consensus), or in case of first episode genital herpes less than 6 weeks before delivery (professional consensus). In case of recurrent genital herpes at the onset of labor, cesarean delivery will be all the more considered if the membranes are intact and vaginal delivery will be all the more considered in case of prolonged rupture of membranes (professional consensus). Neonatal herpes is rare and mainly due to HSV-1 (LE3). In most of the case of neonatal herpes, the mothers have no history of genital herpes (LE 3). In case of suspicion of neonatal herpes, different samples (blood and cerebrospinal fluid) for HSV PCR must be carried out to confirm the diagnosis (professional consensus). Any newborn suspected of neonatal herpes should be treated with intravenous acyclovir (60mg/kgs/day 3 times daily) (grade A) prior to the results of HSV PCR (professional consensus). The duration of the treatment depends on the clinical form (professional consensus) CONCLUSION: There is no formal evidence that it is possible to reduce the risk of neonatal herpes in genital herpes during pregnancy. However, appropriate care can reduce the symptoms associated with herpes, the risk of recurrence term and the cesarean rate performed to decrease the risk of neonatal herpes.

Galanin in porcine vagal sensory nerves: immunohistochemical and immunochemical study.

In this work, the presence of galanin was examined by immunohistochemistry, radioimmunoassay and high performance liquid chromatography (HPLC) in porcine nodose ganglia, mainly constituted of cell bodies from the vagal sensory neurons. Galanin-like immunoreactivity (Gal-LI) was revealed in 10 to 15% of the total cell bodies by the indirect immunofluorescent technique of Coons. For comparison, a positive staining was revealed in a few cell bodies of the submucous plexus and in fibers located in the different layers of the ileum. The extractable Gal-LI content in nodose ganglia was 7.2 +/- 0.8 pmol/g wet tissue, which represents a concentration about nine times lower than that found in the ileum. HPLC of extractable material revealed a predominant peak which coeluted with the synthetic peptide. We propose that, in pigs, galanin may play a role in the transmission of visceral information through the vagal afferences.

Variations of plasma immunoreactive motilin, pancreatic polypeptide, gastrin and somatostatin along the duodenal motility cycle in the pig.

The peripheral plasma concentrations of immunoreactive motilin, pancreatic polypeptide (PP), somatostatin and gastrin were measured in 7 pigs fasted to 24 h and subsequently fed a standard meal. Plasma motilin peaked during the last part of phase II activity of the migrating myoelectric complex (MMC) sequence (25.2 +/- 2.3 pM), the lowest value being recorded during phase I (10.6 +/- 1.5 pM) after a 24 h fast. Plasma motilin remained at a low level during the digestive pattern of duodenal activity, no fluctuation occurring when the first postprandial MMC recurred. At variance analysis, gastrin and PP were not released phasically with MMC in the fasting state, while at autocovariance both peptides tended to fluctuate during the MMC sequence with positive and negative peaks at regular intervals along MMC cycles. No variation of plasma somatostatin was observed in the fasting animals. These findings argue against a major role of circulating PP, gastrin and somatostatin-like components in the control of fasted and post absorptive duodenal motility in pigs while the role of motilin remains equivocal.

Measurement of gastric emptying by intragastric gamma scintigraphy.

Gastric emptying is usually measured in animals and humans by dilution/sampling or external scintigraphy. These methods are either time consuming or require expensive equipment. The capacity of a miniature gamma counter positioned in the stomach to measure emptying of liquid and solid meals was evaluated. In eight conscious pigs fitted with gastric and duodenal cannulae, gastric emptying of saline (500 mL), dextrose (20%, 500 mL), porridge (300 g) and scrambled eggs (300 g), all labelled with 3.5 MBq 99mTC, was evaluated. When positioned in the antrum the probe was unable to quantify gastric emptying. In contrast, measurements of the fractional emptying of saline over 4-min periods by the probe positioned in the corpus and quantification of radioactivity in the duodenal effluent correlated closely (r = 0.88, P < 0.05). Gastric emptying (50% emptying time) of saline and both solid meals measured by the probe was not significantly different from quantification of the duodenal effluent volume. No difference was observed also for the dextrose meal but only while gastric acid secretion was suppressed by omeprazole. We conclude that an intragastric gamma counter permits measurement of gastric emptying of homogeneous meals provided meal stimulation of gastric secretion was not extensive. This was possible probably by monitoring emptying from the proximal stomach.

Muscular hyperalgesia and hypoalgesia after stimulation of the ureter in rats.

Vocalization electric thresholds were measured bilaterally in muscles of the lower back and in the tail after electrical stimulation of the left ureter in rats implanted with electrodes. 'Painful' stimulation immediately produced a hyperalgesia lasting about half an hour in the left lower back muscles and tail, followed by a 10 min hypoalgesia limited to the back muscles. No modification or only a delayed hypoalgesia appeared in the right muscle. Strong but 'non-painful' stimulation produced no effect or gave rise to an immediate hypoalgesia in the left muscle. Weak non-painful stimulation produced a delayed hypoalgesia in the tail.

Preliminary results of a magnetic resonance imaging (MRI) study of the pig brain placed in stereotaxic conditions.

Magnetic resonance imaging (MRI) of two pig brains was realized. The animals were placed in the stereotaxic conditions currently used in experiments. To allow the positioning of the animal in the MRI instrument, landmarks were previously traced on the snout of the pig. To avoid movements, animals were deeply anesthetized. MRI were taken in frontal, horizontal and sagittal directions. Afterwards, the brains of the pigs were frozen and cut into sections, frontal for one animal and sagittal for the other. Histologic and MR images were compared. The usefulness of this technique is discussed.

A stereotaxic apparatus for the study of the central nervous structures in the pig.

An apparatus has been developed derived from the Horsley-Clarke principle. Specific requirement was to use large breeds of pigs from weaning to adult age (5 to 120 kg). The pig auditory canals are oblique; the measurement of the corresponding angles was achieved by means of two interconnected barrels, used afterwards to fix the ear-bars. The wide variability of the skull morphology led to the systematic use of ventriculography with a liquid of contrast. Consequently the pieces allowing the head fixation in the stereotaxic apparatus were designed to avoid any shadow on the brain area. As it was not always possible to localize the commissura anterior, the anterior border of the recessus preopticus was chosen to determine, together with the commissura posterior, the reference horizontal plane. The antero-posterior coordinates were counted from the anterior border of the commissura posterior. The methodology, which has been tested in a wide range of pigs, is discussed in relation with the methods used for other animal species.

Stereotaxic atlas of the pig brain.

A stereotaxic atlas of the pig brain has been established. It consists of 60 frontal and 18 sagittal drawings illustrating Nissl stained sections. A stereotaxic apparatus adapted for the Pig was used to determine the brain coordinates. Radiographic techniques were applied to verify the correct position of the central nervous structures in the apparatus. The zero horizontal plane contains the line joining the recessus preopticus and the posterior commissure (PC) images. These two landmarks were identified by ventriculography. The anterior limit of the PC is used as zero on the stereotaxic atlas. Vertical electrode trajectories implanted at a fixed depth in the brain and at different anterior and lateral levels were used to determine the lateral, vertical and height coordinates in the different planes. Then the brains were perfused and embedded to avoid major displacement of the cerebral structures. Frontal and sagittal serial sections of 100 microns were performed in two different animals. Magnified diagrams of brain sections representing the cellular architecture of the brain structures were produced, some of which are illustrated with photomicrographs. For certain areas, the limits of the nuclei were difficult to determine even when complementary electrophysiological studies were carried out. Each plate is accompanied by a list of abbreviations used to label structures on the plate, together with the terms which they represent. This work should provide a useful anatomical guide for research on the pig brain.

Morphometry of the small intestine in pigs with ileo-rectal anastomosis.

Ileo-rectal anastomosis (IRA), which is frequently used to measure prececal digestibility in pigs, could induce some disturbances of the normal absorptive function. Our aim was to investigate the effects of different IRA surgical procedures on the main histologic characteristics of the small intestine in pigs. The 4 different IRA procedures compared to intact pigs (INT) were the following: either end to end (EE) or end to side (ES) with or without preservation of the ileocecal valve (EEV, EE, ESV, ES respectively). At 147 d after surgery, samples of the wall of the duodenum, jejunum and ileum were taken under anesthesia and histometric examinations were performed on HE- and PAS-colored sections to estimate changes mainly of mucosa and muscle layers. The values recorded for villus length, crypt depth, and whole thickness of the mucosa suggested that the EE procedures disturb the small intestine less than the ES models. A new parameter, called epithelial quotient and calculated as [(villus length/crypt depth)/mitotic index], was proposed to improve the comparisons. According to this quotient, EE procedures did not significantly affect the mucosa of the whole small intestine. An increased density of goblet cells was recorded in all operated pigs along the small intestine, but mainly in the ileum after EE-IRA. The lymphatic follicle area was reduced. These findings, which were in agreement with a reduced mitotic index in the ileum of EE-pigs, indicated a decreased effect of noxious factors on the small intestinal mucosa in IRA-pigs, especially after the EE-IRA procedure. Some atrophic or hypertrophic effects on the muscle layers were related to the absence or preservation of the ileo-cecal valve. Finally it was concluded that i) there was no major disturbance after IRA, and ii) the end to end procedure was most beneficial for the structural integrity of the small intestine.

[Uterine rupture after tubal reimplantation]. / Rupture utérine après réimplantation tubaire.

The authors report a case of rupture of the right cornu of the uterus in the ninth month of pregnancy in a woman who had had her right tube implanted into her uterus. This complication is considered, in the discussion, to be rare. It is very difficult to prevent it happening during pregnancy. It would seem that a prophylactic caesarean operation should be carried out if the insertion of the placenta is in the area of the implantation.

Somatic and visceral growth, and adiposity in the pig after partial small bowel resection. I. - Variations according to the kinds of operations, to the specific location along the intestinal tract and to the sex of the animals.

The effects of small bowel resection were studied in 123 pure-bred Large White pigs, during 2 separate experiments. The first one aimed at studying the somatic growth in 60 castrated male pigs during a 16 weeks-period, following either a (I) laparotomy, (2) proximal or distal double transsection, or (3) proximal or distal resection of 25 p. 100 of the total small intestine length. Operations were performed at the age of 91 days and 26 kg live weight. Secondly, both grwoth of 63 pigs operated at the age of 97 days and at 28 kg live weight, was studied during a 16 weeks-period, in order to assess the effects of resection of 4m of distal jejunum (i.e. 25 p. 100 of the small intestine), according to the sex of the animals. After slaughtering visceral measurements and indirect measurement of carcass adiposity were made. It appeared that laparotomy was detrimental to continuation of normal growth, whereas resections or sham operations allowed better performances although less than that of control pigs. In short-term studies, proximal resections allowed better results than distal ones; the reverse conclusion could be drawn from long term studies. Small intestine tissue weight was not changed after laparotomy, and was slightly increased after transsection. Sixteen weeks after resection, tissue weight of residual small intestine was not very lower than that of entire small intestine in control pigs. This compensation was better after proximal resection, the apparent local hypertrophy being greater after distal resection. Concerning the sex-dependent effects after partial resection of distal jejunum, there was an improvement of performances (growth/food intake), and a true body growth acceleration in female and castrated male pigs. The morphological compensation of tissue loss was very good in residual small intestine of female pigs, partially assumed by large intestine in normal male pigs, and poor in castrated male pigs. The greatest hypertrophy was always noted in the ileal segment below the resected area. Carcass adiposity (specific gravity) was not significantly modified by the various operations in castrated male pigs, whereas it was significantly decreased after resection in entire male or female pigs.