Scoring system to predict the risk of surgical-site infection after colorectal resection.

BACKGROUND: There is no dedicated scoring system for predicting the risk of surgical-site infection (SSI) after resection of the colon or rectum. Generic scores, such as the National Nosocomial Infections Surveillance index, are not used by colorectal surgeons. METHODS: Multivariable analysis of risk factors for SSI was performed in patients who underwent resection of the colon or rectum, and were followed during the first month after operation. A logistic regression model was used to identify determinant variables and construct a predictive score. RESULTS: There were 534 patients of whom 114 (21·3 per cent) developed SSI. In multivariable analysis, four parameters correlated with an increased risk of SSI: obesity (odds ratio (OR) 2·93, 95 per cent confidence interval 1·71 to 5·03), contamination class 3-4 (OR 3·33, 2·08 to 5·32), American Society of Anesthesiologists grade III-IV (OR 1·82, 1·14 to 2·90) and open surgery (OR 2·22, 1·01 to 4·88). Each of these contributed 1 point to the risk score. The observed risk of SSI was 5 per cent for a score of 0, 12·0 per cent for a score of 1 point, 18·7 per cent for 2 points, 44 per cent for 3 points and 68 per cent for 4 points. The area under the receiver operating characteristic curve for the score was 0·729. CONCLUSION: A simple clinical score based on four preoperative variables was clinically useful in predicting the risk of SSI in patients undergoing colorectal surgery.

Rifted margins classification and forcing parameters.

Rifted margins are the result of the successful process of thinning and breakup of the continental lithosphere leading to the formation of new oceanic lithosphere. Observations on rifted margins are now integrating an increasing amount of multi-channel seismic data and drilling of several Continent-Ocean Transitions. Based on large scale geometries and domains observed on high-quality multi-channel seismic data, this article proposes a classification reflecting the mechanical behavior of the crust from localized to diffuse deformation (strong/coupled to weak/decoupled mechanical behaviors) and magmatic intensity leading to breakup from magma-rich to magma-poor margins. We illustrate a simple classification based on mechanical behavior and magmatic production with examples of rifted margins. We propose a non-exhaustive list of forcing parameters that can control the initial rifting conditions but also their evolution through time. Therefore, rifted margins are not divided into opposing types, but described as a combination and continuum that can evolve through time and space.

[Limbic encephalitis with severe sleep disorder associated with voltage-gated potassium channels (VGKCs) antibodies]. / Encéphalite limbique avec anticorps anticanaux potassiques voltage dépendants et troubles sévères du sommeil.

INTRODUCTION: Voltage-gated potassium channels (VGKCs) antibodies are associated with neuromyotonia, limbic encephalitis and Morvan syndrome. CASE REPORT: We report the case of a patient who, after three weeks of fever, presented an anamnestic syndrome, associated with confusion and partial seizures. MRI showed left hyperintensity of mesial temporal structures on Flair images and right hippocampal atrophy on T1 weighted sequences. Laboratory tests only showed high level of anti-TPO antibodies. Thus, the patient was considered as having Hashimoto's encephalopathy. She was treated with intravenous methylprednisolone with no improvement of symptoms. On the contrary, the patient suffered from insomnia, deep diurnal drowsiness and complete disappearance of REM sleep. Episodes of hypothermia and severe hyponatremia were recorded. Serum VGKC antibodies were found at high level. After intravenous immunoglobulin treatment followed by methylprednisolone, we noted remarkable improvement of clinical status. Polysomnography showed reappearence of REM sleep. CONCLUSION: This case report broadens the spectrum of clinical manifestations associated with VGKC antibodies and suggests that VGKC are implicated in regulation of sleep. The potential pathophysiological mechanisms linking sleep disturbances and VGKC antibodies are discussed.

[Fatal giant cell arteritis with severe bilateral involvement of the vertebral arteries]. / Maladie de Horton d'évolution fatale avec atteinte sévère bilatérale des artères vertébrales.

With steroid therapy, it is commonly considered that prognosis is good in giant cell arteritis. However serious or even fatal complications may occur. Here we report the case of a patient who developed fatal giant cell arteritis with severe stenosis of both vertebral arteries and right carotid siphon. Several similar cases have been reported in the literature. Initially diagnosis may be difficult because neurological manifestations are intermittent and classical signs of giant cell arteritis may be lacking. In such condition the reason of poor outcome is unknown and therapy remains empiric.

Should a psychotic or manic episode be considered an early manifestation of Multiple Sclerosis? A multiple case study.

BACKGROUND: Early manifestations of Multiple Sclerosis (MS) can be atypical and misleading, and several case report studies have highlighted that MS onset sometimes takes the form of a psychotic or manic episode. METHODS: All neurologists belonging to the French Multiple Sclerosis Observatory network were contacted by email and were asked to find patients with MS who presented with a history of psychiatric episode(s) near MS onset. RESULTS: Seventeen patients were selected that met the criteria of presenting with psychotic or manic symptoms either before the diagnosis of MS (N=8), or at the time of the first neurological episode or shortly after (N=9). Patients with a history of a psychiatric episode occurring before the first neurological episode were diagnosed on average 7 years later than patients with either a first neurological or a mixed (both neurological and psychiatric) episode. However, psychiatric symptoms in the first group and the first neurological symptoms of MS in the second group occurred at a similar age. CONCLUSION: Based on this multiple case study, we question whether past psychotic or manic episode should be considered equivalent to a first manifestation of MS.

Hashimoto's encephalopathy: exacerbations associated with menstrual cycle.

The authors report a patient who had five relapses of encephalopathy with seizures and aseptic meningitis that coincided with the end of the menstrual cycle. High titers of antithyroid antibodies and the patient's response to corticosteroids suggested Hashimoto's encephalopathy. Pharmacologic suppression of the menstrual cycle made it possible to withdraw corticosteroids.

Long-term culture of human pancreatic islets in an extracellular matrix: morphological and metabolic effects.

In this experiment, various conditions for embedding cultures of human pancreatic islets in type I collagen gel were studied in an attempt to maintain the highly differentiated functions of islet cells and particularly insulin secretion over a long period of time. The islets isolated by a collagenase digestion technique were plated either on or within the collagen gel and refed with either Eagle's minimum essential medium (5.5 mM D-glucose) or RPMI 1640 medium (11 mM D-glucose) supplemented with 10% FCS and antibiotics. The comparison between the two culture media showed that embedded islets cultured in RPMI had a higher basal insulin secretion rate, survived longer than their MEM counterparts, but exhibited impaired response to an acute glucose test contrasting thus with islets cultured in MEM. The secretory behaviour of islets was also related to the different morphological modifications occurring during culture. Islets directly embedded within the collagen gel more or less maintained their spherical structure and highest secretory capacities. When overlaid with a second layer of collagen, well established monolayers of human islet cells grown on collagen underwent a gradual and complete reorganization into a three-dimensional islet-like structure with a striking reinforcement of their secretory activity. Both cultures were able to survive more than 8 weeks, thus proving the usefulness of such a new model for long-term culture. In contrast, standard cultures on culture treated plastic dishes on which islets cells rapidly established wide monolayers, exhibited a rapid and definitive decline in insulin secretion with a survival not exceeding 14 days. In the light of these different culture conditions, possible mechanisms responsible for disturbance of hormonal release and their implications for in-vitro study of isolated islets functions are discussed. In conclusion, this work is a new example of the permissive effects of collagen matrices on the establishment or maintenance of tissue-like structures in vitro, suggesting the definition of a new model for the study of human pancreatic islets in long-term culture.

Level of plasma fibronectin in patients with breast cancer.

Plasma fibronectin was determined by laser nephelometric immunoassay in two populations: healthy individuals and patients with metastatic or non-metastatic breast cancer. The results showed that the fibronectin concentration was higher in the patient group than in the healthy controls of similar age, with a significant difference (p less than 0.05). The patients who had metastatic breast cancer tended to show higher levels than those with no detectable metastasis, but such a difference was not statistically significant. Since fibronectin is sensitive to clinical events unrelated to the malignancy status, it does not seem suitable as a tumor marker.

Cutaneous interstitial fluid protein concentrations in the inflammatory syndrome: pharmacological consequences.

Concentrations of alpha 1 acid glycoprotein, albumin, transferrin, haptoglobin, immunoglobulins G, A, M and apolipoprotein B were measured in serum and suction blister fluid from a group of individuals presenting a biologically proven inflammatory syndrome, and from a control group. Protein values in suction blister fluid did not change from the 2nd to the 3rd h after the beginning of blister formation. The ratio of the concentration of proteins in blister fluid and serum did not differ significantly between the groups. However, a 25% decrease in blister fluid albumin and a 100% increase in blister fluid alpha 1 acid glycoprotein, recorded in the inflammatory group, were worth noting, since they possibly influence the tissular distribution of some protein-binding drugs. Finally, an inverse relationship was established between the blister fluid/serum concentration ratio and the respective molar mass of each protein.

In patients with cirrhosis, serum albumin determination should be carried out by immunonephelometry rather than by protein electrophoresis.

OBJECTIVE: Serum albumin is a key parameter for prognosis in cirrhosis. We compared levels of serum albumin determined by both protein electrophoresis and immunonephelometry, with special reference to the Child-Pugh classification. DESIGN AND METHODS: One hundred and thirty-one patients, including 39 with cirrhosis, were included prospectively during 2 months. The aetiology of cirrhosis was mainly alcoholism (67%) and hepatitis C virus (HCV) (18%). Serum albumin was determined simultaneously by electrophoresis (Hydrasys SEBIA following protein determination by the biuret reaction) and by immunonephelometry (BECKMAN Nephelometer). Values were compared by non-parametric tests. RESULTS: For the whole population, electrophoretic and immunonephelometric values correlated (p = 0.85; P < 0.0001), but electrophoresis significantly overestimated serum albumin by a median 1.6 g/l (P < 0.0001) with a large spread in values (range, -3.9 to 12.7). Median overestimation in cirrhosis was 2.6 g/l (P < 0.0001; range, -2.0 to 10.2) and 1.0 g/l (P < 0.0001; range, -3.9 to 12.7) in patients without cirrhosis (difference, P < 0.02). For 6/39 (15.4%) patients with cirrhosis, this overestimation led to an underestimation in the Child-Pugh classification. CONCLUSION: In our experience, electrophoresis can lead to serum albumin values which are significantly different compared to those obtained by immunonephelometry. This discrepancy may lead to an incorrect Child-Pugh classification. Therefore, in the follow-up of cirrhotic patients, serum albumin should be determined by immunonephelometry.

Use of cryopreserved animal and human hepatocytes for cytotoxicity studies.

To evaluate the potential use of cryopreserved hepatocytes for toxicological studies, rat, dog and human hepatocytes were frozen in Leibovitz medium containing 20% foetal calf serum and various concentrations of dimethylsulphoxide and stored in liquid nitrogen. 50% or more of the hepatocytes that attached and survived immediately after isolation still possessed these properties after freezing/thawing. Thawed hepatocytes from the three species showed only a slight reduction in their ability to metabolize phenacetin or to conjugate paracetamol with glucuronic acid. Sensitivity to the toxic effects of erythromycin was not affected by the MTT and neutral red assays. Similar observations were made with rat hepatocytes for five other toxic agents-chloramphenicol, chlorpromazine, acrylamide, chloroquine sulphate and p-chloromercuribenzoic acid. These results suggest that, after cryopreservation, isolated hepatocytes represent a suitable model for drug metabolism and toxicity screening studies.

[Asperger syndrome in childhood: review of four cases]. / Syndrome d'Asperger chez l'enfant: à propos de quatre observations.

INTRODUCTION: Asperger syndrome is a pervasive developmental disorder included lately in the international classifications. OBSERVATIONS: We report the observations of four children presenting this syndrome. For every patient, we collected antecedents and psychomotor development; we made neuropsychological assessment and video recording. Three patients underwent an EEG and one a cerebral MRI. RESULTS: These patients were between ten- and sixteen-year old. The neuropsychological assessment showed a heterogeneous intellectual functioning with three times out of four a dissociation between high verbal level and low non-verbal level. Their language appeared sophisticated, apragmatic, their comprehension was inflexible. The mean age at diagnosis was ten years. They showed a sociability and autonomy improvement but they were conscious of their difference and suffered from it. CONCLUSION: Our four cases allow to present Asperger syndrome, slightly known in France. Collaborative studies and genetic studies are necessary to improve the knowledge of this syndrome.

[Amniotic fibronectin in normal pregnancy and pregnancy with fetal anencephaly]. / Fibronectine amniotique au cours de grossesses normales et de grossesses avec anencéphalie foetale.

Fibronectin, which is an important protein in plasma and in surface cells was calculated in amniotic fluid using a laser ray nephelemetric technique. In normal pregnancies (in 72 samples studied) this protein which rises towards the 18th week of amenorrhoea (mean +/- S.D.: 60.8 +/- 16.0 mg/l), decreases steadily to term (mean 14.8 +/- 8.9 mg/l). In fetal anencephaly (10 samples tested) high levels were also found but the difference as compared with normal levels was not significant. This measurement does not therefore constitute an extra way of screening for closure of the neural tube.

[Value of the demonstration of amniotic phosphatidylglycerol in pregnancy in diabetic women]. / Intérêt de la mise en évidence du phosphatidyglycérol amniotique au cours de la grossesse chez la femme diabétique.

Correlation was made between phosphatidylglycerol (PG), L/S ratio results and respiratory distress syndrome (RDS). PG determination is an accurate predictor of fetal lung maturity in diabetic pregnancies: when it is present in amniotic fluid there is never risk of RDS for the infant.