Risk factors for surgical site infection associated with clean surgical procedures in dogs.

Surgical site infection (SSI) is associated with increased morbidity, cost and mortality in human medicine and with increased morbidity and cost in veterinary medicine. The aim of this study was to evaluate risk factors for SSI development after clean surgical procedures in dogs, treated at both first opinion clinics as well as referral hospitals. 1550 dogs scored 1 or 2 according to the American Society of Anesthesiologists (ASA), that underwent clean surgical procedures at 103 clinics located in Northern and Central Europe were included in the study. Data regarding the surgical procedure, surgery time use of perioperative antimicrobial prophylaxis (AMP), surgery type, intraoperative hypothermia, and the use of surgical implants were recorded according to predefined protocols. Active 30-day SSI surveillance was performed. A random effects logistic regression model was used to evaluate the association between the perioperative variables and SSI development. SSI was detected in 85/1550 dogs (5.5%); 25 occurred in the 500 orthopedic/neurosurgery procedures (5.0%), and 60 in the 1050 soft tissue procedures (5.7%). A total of 1524 dogs were included in the final multivariable model. Increased surgery time was the only variable associated with an increased risk of SSI. No association between the other risk factors evaluated in the study and SSI occurrence was detected. Efforts must therefore be made to keep the surgery time as short as possible. Orthopedic and neurosurgical procedures including those where an implant is placed should not automatically be regarded as high-risk procedures benefiting from perioperative AMP.

Validation of a fully automatic photoplethysmographic device for toe blood pressure measurement.

OBJECTIVES: This study was designed to assess the accuracy and reliability of a new, portable, fully automated photoplethysmography (PPG) device for toe blood pressure (TBP) measurement. DESIGN: Within-subject comparison with conventional laser Doppler (LD) measurement. MATERIALS AND METHODS: Four TBP measurements were performed on both lower limbs, alternatively with LD and PPG in 200 patients recruited at the Nîmes University Hospital. Reproducibility was assessed by the intraclass correlation coefficient (ICC). The concordance between the two methods was evaluated by Lin's concordance correlation coefficient (CCC), in the whole population as well as in comorbidity subgroups. A potential bias was investigated with the Bland and Altman method. RESULTS: The ICC was 0.887 (95% confidence interval (CI) 0.852-0.913) and 0.893 (0.860-0.918) on the right side (n = 193), 0.905 (0.875-0.928) and 0.898 (0.866-0.922) on the left side (n = 188) for PPG and LD measurements, respectively. The CCC was 0.913 (0.885-0.934) on the right side and 0.915 (0.888-0.937) on the left side, and remained >0.8 regardless of co-morbidities. CONCLUSIONS: This new, fully automatic, photoplethysmographic device yielded reliable TBP measurements and showed good agreement with the reference LD system over a wide range of values.

[Primary angiosarcoma of the aorta]. / Primäres Angiosarkom der Aorta.

Primary angiosarcoma of the aorta is a rare disease. The prognosis is poor, resulting of embolic complications and early metastatic disease, with a median survival of nine months. Diagnosis is difficult and often made post-mortem. We report the case of a 68-year-old woman referred for a thrombosis of the superior mesenteric artery, occurring a few weeks after resection of an angiosarcoma of the small intestine, disclosing a primary angiosarcoma of the aortic wall with metastatic disease.

[Segmental occlusion of the internal carotid artery with collateral reinjection downstream from the carotid sinus]. / Occlusion segmentaire de l'artère carotide interne avec une réinjection collatérale postbulbaire.

The preoperative evaluation before coronary bypass led to the discovery of complete atheromatous obstruction of the internal carotid artery sinus in a 79-year-old man free of any neurological symptom. Downstream from the carotid sinus, the patency of the internal carotid artery was ensured by a collateral branch fed by the ipsilateral external carotid artery. This exceptional anatomic variation can be explained by a persistent embryonic artery. The recognition of this atypical feature is clinically relevant because surgery may be possible in some cases, while it is not technically feasible in patients with total obstruction.

[Calf vein thrombosis: to treat or not to treat? Epidemiology, management and problematics]. / Thromboses veineuses profondes distales des membres inférieurs: to treat or not to treat? Epidémiologie, prise en charge et problématique.

Calf vein thrombosis corresponds to infrapopliteal deep vein thrombosis which accounts for roughly 50% of all cases of deep vein thrombosis and shares the same risk factors as proximal deep vein thrombosis. The complication rate and proper management remain debated. Recent studies suggest that the risk of proximal extension of calf vein thrombosis is 1 to 5% and that the risk of postthrombotic syndrome is 3%. In France, calf vein thrombosis is usually treated with compression stockings associated with a six week to three month regimen of anticoagulation therapy in patients presenting a transient triggering factor or longer otherwise. However, the benefit of such treatment, in terms of the hemorragic risk incurred, remains uncertain. The randomized double blind trial CACTUS (compression stocking + placebo versus compression stocking + heparin, for six weeks) that will start in September 2007, should provide answers the following question: should calf vein thrombosis be treated with anticoagulants?

[Treatment of post-catheterization pseudoaneurysms by ultrasound-guided thrombin injection: A single-center experience and practical guideline]. / Le traitement des faux anévrismes postcathétérisme par injection échoguidée de thrombine : expérience monocentrique et guide pratique.

Ultrasound-guided thrombin injection has been shown to be a safe and effective treatment for iatrogenic post-catheterization pseudoaneurysms, but still is underused in France. We report our single-center experience and propose a technical guideline for ultrasound-guided thrombin injection. Ultrasound-guided thrombin injection should be considered to be the first-line treatment of iatrogenic pseudoaneurysms.

A chloride requirement for Na+-dependent amino-acid transport by brush border membrane vesicles isolated from the intestine of a Mediterranean teleost (Boops salpa).

The uptake of D-glucose, 2-aminoisobutyric acid and glycine was studied with intestinal brush border membrane vesicles of a marine herbivorous fish: Boops salpa. The uptake of these three substances is stimulated by an Na+ electrochemical gradient (Cout greater than Cin). For glucose, an increase of the electrical membrane potential generated by a concentration gradient of the liposoluble anion, SCN-, increases the Na+-dependent transport. This responsiveness to the membrane potential was confirmed by valinomycin. Differently from glucose, uptake of glycine and 2-aminoisobutyric acid requires, besides the Na+ gradient, the presence of Cl- on the external side of the vesicles. In the absence of Cl-, amino acid uptake is not stimulated by the Na+ gradient and is not influenced by an electrical membrane potential generated by SCN- gradient (Cout greater than Cin) or by a K+ diffusion potential (Cin greater than Cout). This Cl- requirement differs from the Na+ requirement, since a Cl- gradient (Cout greater than Cin) does not result in an accumulation of glycine or 2-aminoisobutyric acid similar to that produced by an Na+ gradient.

Analysis of two chloride requirements for sodium-dependent amino acid and glucose transport by intestinal brush-border membrane vesicles of fish.

Intestinal brush border vesicles of a Mediterranean sea fish (Dicentrarchus labrax) were prepared using the Ca2+-sedimentation method. The transport of glucose, glycine and 2-aminoisobutyric acid is energized by an Na+ gradient (out greater than in). In addition, amino acid uptake requires Cl- in the extravesicular medium (2-aminoisobutyric acid more than glycine). This Na+- and Cl--dependent uptake is electrogenic, since it can be stimulated by negative charges inside the vesicles. The specific Cl- requirement of glycine and 2-aminoisobutyric acid transport is markedly influenced by pH, a change from 6.5 to 8.4 reducing the role played by Cl-. In the presence of Cl-, the Km of 2-aminoisobutyric acid uptake is reduced and its Vmax is enhanced. Cl- affects also a non-saturable Na+-dependent component of this amino acid uptake. Amino acid transport is also increased by intravesicular Cl- (2-aminoisobutyric acid less than glycine). This effect is more concerned with glucose uptake, which can be then multiplied by 2.3. A concentration gradient (in greater than out) as well as the presence of Na+ in the incubation medium seems to enter into this requirement. This intravesicular Cl- effect is not influenced by pH between 6.5 and 8.4.

Isolation of brush border membranes in vesicular form from the intestinal spiral valve of the small dogfish (Scyliorhinus canicula).

A simple, rapid method for the preparation of purified brush border membranes in vesicular form from rabbit kidney proximal tubules has been applied with closely similar results to the intestinal spiral valve of the small dogfish (Scyliorhinus conicula). Since the dogfish belongs to one of the most ancient species of fish, it may be suggested that the method is generally applicable to all species later evolved which possess a brush border membrane at the mucosal surface of the cells of the intestine or kidney.

Effects of Cu, Zn and Cr salts on antioxidant enzyme activities In vitro of red blood cells of a marine fish Dicentrarchus labrax.

Effects of xenobiotics (potassium dichromate, copper sulphate and zinc chloride) in vitro on antioxidant enzyme activities and lipid peroxidation in sea bass erythrocytes were investigated. Total cell haemolysis was observed after 24 hr of exposure to 2 mm dichromate at 20 degrees C, 0.1 mm CuSO(4) and 1 mm ZnCl(2). 24 hr exposure to non-haemolytic concentrations of CuSO(4) and ZnCl(2) led to a concentration-related decrease in glutathione peroxidase activity. With dichromate, this activity was increased at the lowest concentrations (1-100 mum) and was decreased for the highest (0.5 and 1 mm). Dual effects were also found on dichromate-treated cells for manganese-dependent superoxide dismutase activity, whereas Zn(2+) had only inhibitory effects. Total superoxide dismutase activity was depressed by CuSO(4) and ZnCl(2); this effect was concentration dependent. With regard to catalase activity, ZnCl(2) and K(2)Cr(2)O(7) were found to be activators, whereas CuSO(4) was an inhibitor. Study of the effects of metals on lipid peroxidation was based on the release of TBA-reactive substances in the surrounding medium; 24 hr exposure to 1 mm dichromate, 10 mum CuSO(4) and, in particular, 100 mum ZnCl(2), increased the amount of this lipid peroxidation indicator. This work suggests that the defence system of sea bass red blood cells against active oxygen species can be compromised by metal ions, this imbalance being able to cause increased membrane lipid peroxidation. This study has demonstrated that seawater fish erythrocytes are a valid cell model for study of the effects in vitro of xenobiotics on antioxidant mechanisms.

Mondor's disease: what's new since 1939?

Mondor's disease (MD) is a rare and self-limited benign disease first described in 1939. Originally its clinical presentation was a superficial vein thrombosis (SVT) without contiguous skin inflammation of the chest wall veins. Over time its definition has evolved and now also includes subcutaneous thrombosis of the dorsal vein of the penis but also retractile scarring of the fascia after breast surgery without concomitant SVT. In all cases clinical examination constitutes the first step of diagnostic management. It is followed by an ultrasound exploration (US) to search for a thrombus. In about half of all cases the disease is considered as idiopathic and cancer is rare. Whatever the location considered, the follow-up is usually uneventful with low rates of recurrence and of subsequent cancer. Treatment is debated and ranges from therapeutic abstention to anticoagulants or even surgery. It is likely that the new locations and mechanisms (without thrombosis) of the MD have lead to the constitution of a heterogeneous entity precluding from a consensual mode of care.

[Role of duplex ultrasound for lower limb artery, abdominal aorta, and carotid artery surgery follow-up]. / Le rôle de l'échographie-Doppler dans la surveillance après chirurgie artérielle des artères des membres inférieurs, de l'aorte et des artères carotides.

Long-term post-surgery follow-up is an essential part of the surgical and medical care for vascular surgery patients with peripheral arterial disease. Close collaboration with the patient's primary care physician is essential. In addition to close surveillance of the outcome after vascular surgery, follow-up includes an assessment and appropriate treatment of cardiovascular risk factors. Duplex ultrasound is a safe and noninvasive surveillance method, which should be performed by an experimented physician. We summarize the specific features of duplex ultrasound examinations after arterial surgery of the carotid arteries, the abdominal aorta and the lower limbs, and propose a surveillance schedule.

In vitro effects of wastewater treatment plant effluent on sea bass red blood cells.

Red blood cells of marine fish have been used in suitable biological assays to study the (eco)toxicity of wastewater treatment plant effluents. The aim of the present work was to draw upon their more relevant effects on cell hemolysis, ATP content, osmotic resistance and cell volume regulation. Following physico-chemical treatment, treatment plant effluents showed a residual toxicity resulting from multiple impairment of cell metabolism and structures. The earliest and most sensitive effects were related to the regulation of intracellular osmotic pressure leading to decreased cell water volume. Such effects were also observed following short-term incubation in 10-fold diluted effluent. Other damages were found following incubation in non-diluted effluent. Membrane structure was affected leading to increased osmotic resistance. Later, a decrease of the intracellular ATP level was found, followed by hemolysis. The presence of glucose in the incubation medium lessened the fall in ATP content and hemolysis in the treated cells but also in control cells.

In vivo effects of phenolic compounds on blood parameters of a marine fish (Dicentrarchus labrax).

Sea bass (Dicentrarchus labrax) were injected intraperitoneally once (single dose) or three times (fractionated dose) with phenol or OH-phenols (hydroquinone, resorcinol, and pyrocatechol). On the basis of the lethal doses, OH-phenols were more toxic than phenol, and pyrocatechol was the most powerful compound. Hematological, metabolic and antioxidant blood parameters were measured 3 days after the end of the treatment. Metabolic variations as specific effects on erythrocytes were revealed and differences between single and fractionated doses were observed. OH-phenols-treated fish showed disorders in the metabolic toxicity indicators as hypoglycemia, low blood urea nitrogen level (BUN) and decrease of alkaline phosphatase activity (ALP). In addition, quantitative structure-activity relationships were developed using the n-octanol:water partition coefficient (log K(ow)). Positive correlations were found with ALP, plasma glucose and hemoglobin.

Further studies on intestinal accumulation of glycine during fasting in rainbow trout (Salmo gairdneri Richardson).

Using the sliced intestine method, we studied in vitro the effects of long-term fasting (4 and 8 weeks) on the accumulation of 0.5 and 10 mM glycine in the mid- and hindgut of the trout. Increased glycine accumulation during fasting was noted when accumulation was calculated per gram of intestinal dry weight, per milliliter of cellular water, but especially per gram of mucosal tissue. The glycine tissue to medium ratios are also higher in fasted intestines, revealing an enhancement of the active pathways of the amino acid transport. After 4 weeks of fasting, the increased glycine accumulation is greater in hindgut, especially for the lowest glycine concentration (0.5 mM). With the highest concentration (10 mM), the effects of fasting similarly decrease in intensity and affect in the midgut and hindgut. After 8 weeks of fasting, the differences between fed and fasted intestines tend to be fewer, probably because of a progressive attenuation of the effect of fasting on the active pathways of glycine accumulation.

[In vivo determination of alkaline phosphatase activity of the intestine of the rainbow trout (Salmo gairdneri R.)]. / Mesure in vivo de l'activité de la phosphatase alcaline dans l'intestin de la truite arc-en-ciel (Salmo gairdneri R.).

This work has concerned the description of a method suitable for the measurement, on living trout, of the intestinal alkaline phosphatase activity. The experiments consist in the perfusion, in the lumen, of an appropriate substrate and in the prevention of its absorption or that of the products of its hydrolysis. This condition has not been satisfied by using paranitrophenyl phosphate which has been replaced by glucose-1-phosphate. The absorption of glucose produced has been inhibited by phloridzin (10(-4) M) in a KCl (150 mM) solution. Under these conditions an hydrolysis of glucose phosphate has been shown at alkaline pH, which remains linear with time up to 60 min. A research of the Km of the enzyme activity has been carried out.

Glycine transport by intestinal brush border vesicles of the amphibian Discoglossus pictus.

1. In order to determine the different components of glycine uptake by the intestine of the frog, Discoglossus pictus, we have used brush border membrane vesicles isolated by a classical precipitation technique. 2. Enzymatic tests showed that a good purification was obtained. The concentration ratio of alkaline phosphatase was 14.8. 3. Glycine entry in vesicles as a function of time, in presence or absence of sodium, indicated an overshoot which decreased when incubation time was prolonged. The overshoot was dependent on the presence of sodium. 4. The nature of the anion associated to sodium had little effect on glycine uptake. Nevertheless, chloride and thiocyanate appeared more efficient than glutarate. 5. The effect of transmembrane potential was studied by using valinomycin associated with a potassium gradient. The addition of this substance stimulated glycine transport by 43%. 6. The transport at different glycine concentrations showed two components: one non-saturable with weak affinity and the other saturable with strong affinity (Kt = 0.338 mM). 7. In conclusion, glycine transport by the brush border of D. pictus intestine presents a saturable component depending on sodium and on transmembrane electrical potential.