High performance of a novel antigen detection test on nasopharyngeal specimens for diagnosing SARS-CoV-2 infection.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has become a major public health issue worldwide. Developing and evaluating rapid and easy-to-perform diagnostic tests is a high priority. The current study was designed to assess the diagnostic performance of an antigen-based rapid detection test (COVID-VIRO®) in a real-life setting. Two nasopharyngeal specimens of symptomatic or asymptomatic adult patients hospitalized in the Infectious Diseases Department or voluntarily accessing the COVID-19 Screening Department of the Regional Hospital of Orléans, France, were concurrently collected. The diagnostic specificity and sensitivity of COVID VIRO® results were compared to those of real-time reverse-transcriptase quantitative polymerase chain reaction (RT-qPCR) results. A subset of patients underwent an additional oropharyngeal and/or saliva swab for rapid testing. A total of 121 patients confirmed to be infected and 127 patients having no evidence of recent or ongoing infection were enrolled for a total of 248 nasopharyngeal swab specimens. Overall, the COVID-VIRO® sensitivity was 96.7% (CI, 93.5%-99.9%). In asymptomatic patients, symptomatic patients having symptoms for more than 4 days and those with an RT-qPCR cycle threshold value ≥ 32, the sensitivities were 100%, 95.8%, and 91.9%, respectively. The concordance between RT-qPCR and COVID VIRO® rapid test results was 100% for the 127 patients with no SARS-CoV-2 infection. The COVID-VIRO® test had 100% specificity and sensitivity greater than 95%, which are better than the recommendations set forth by the WHO (specificity ≥ 97%-100%, sensitivity ≥ 80%). These rapid tests may be particularly useful for large-scale screening in emergency departments, low-resource settings, and airports.

Emerging resistance mutations in PI-naive patients failing an atazanavir-based regimen (ANRS multicentre observational study).

Background: Atazanavir is a PI widely used as a third agent in combination ART. We aimed to determine the prevalence and the patterns of resistance in PI-naive patients failing on an atazanavir-based regimen. Methods: We analysed patients failing on an atazanavir-containing regimen used as a first line of PI therapy. We compared the sequences of reverse transcriptase and protease before the introduction of atazanavir and at failure [two consecutive viral loads (VLs) >50 copies/mL]. Resistance was defined according to the 2014 Agence Nationale de Recherche sur le SIDA et les Hépatites Virales (ANRS) algorithm. Results: Among the 113 patients, atazanavir was used in the first regimen in 71 (62.8%) patients and in the first line of a PI-based regimen in 42 (37.2%). Atazanavir was boosted with ritonavir in 95 (84.1%) patients and combined with tenofovir/emtricitabine or lamivudine (n = 81) and abacavir/lamivudine or emtricitabine (n = 22). At failure, median VL was 3.05 log10 copies/mL and the median CD4+ T cell count was 436 cells/mm3. The median time on atazanavir was 21.2 months. At failure, viruses were considered resistant to atazanavir in four patients (3.5%) with the selection of the following major atazanavir-associated mutations: I50L (n = 1), I84V (n = 2) and N88S (n = 1). Other emergent PI mutations were L10V, G16E, K20I/R, L33F, M36I/L, M46I/L, G48V, F53L, I54L, D60E, I62V, A71T/V, V82I/T, L90M and I93L/M. Emergent NRTI substitutions were detected in 21 patients: M41L (n = 2), D67N (n = 3), K70R (n = 1), L74I/V (n = 3), M184V/I (n = 16), L210W (n = 1), T215Y/F (n = 3) and K219Q/E (n = 2). Conclusions: Resistance to atazanavir is rare in patients failing the first line of an atazanavir-based regimen according to the ANRS. Emergent NRTI resistance-associated mutations were reported in 18% of patients.

Prevalence of HIV-1 drug resistance in treated patients with viral load >50 copies/mL: a 2014 French nationwide study.

Background: Surveillance of HIV-1 resistance in treated patients with a detectable viral load (VL) is important to monitor, in order to assess the risk of spread of resistant viruses and to determine the proportion of patients who need new antiretroviral drugs with minimal cross-resistance. Methods: The HIV-1 protease and reverse transcriptase (RT) and integrase genes were sequenced in plasma samples from 782 consecutive patients on failing antiretroviral regimens, seen in 37 specialized centres in 2014. The genotyping results were interpreted using the ANRS v24 algorithm. Prevalence rates were compared with those obtained during a similar survey conducted in 2009. Results: The protease and RT sequences were obtained in 566 patients, and the integrase sequence in 382 patients. Sequencing was successful in 60%, 78%, 78% and 87% of patients with VLs of 51-200, 201-500, 501-1000 and >1000 copies/mL, respectively. Resistance to at least one antiretroviral drug was detected in 56.3% of samples. Respectively, 3.9%, 8.7%, 1.5% and 3.4% of patients harboured viruses that were resistant to any NRTI, NNRTI, PI and integrase inhibitor (INI). Resistance rates were lower in 2014 than in 2009. Resistance was detected in 48.5% of samples from patients with a VL between 51 and 200 copies/mL. Conclusion: In France in 2014, 90.0% of patients in AIDS care centres were receiving antiretroviral drugs and 12.0% of them had VLs >50 copies/mL. Therefore, this study suggests that 6.7% of treated patients in France might transmit resistant strains. Resistance testing may be warranted in all treated patients with VL > 50 copies/mL.

Accuracy of gradient diffusion method for susceptibility testing of dalbavancin and comparators.

OBJECTIVES: This multicenter study aimed to assess the performances of gradient diffusion (GD) method in comparison to broth microdilution (BMD) method for susceptibility testing of dalbavancin, daptomycin, vancomycin, and teicoplanin. METHODS: Minimum Inhibitory Concentrations (MICs) were retrospectively determined concomitantly by BMD and GD methods, for 93 staphylococci and enterococci isolated from clinical samples. BMD was considered as the gold standard. Essential (EA) and categorical agreements (CA) were calculated. Discordant categorical results were categorized as major (ME) and very major errors (VME). RESULTS: EA and CA were 95.7% and 96.8%, 82.8% and 100%, 97.8% and 96.8%, and 94.6% and 95.7% for dalbavancin, daptomycin, vancomycin, and teicoplanin respectively. Concerning dalbavancin, 3 ME without any VME were observed and discrepancies were low (≤ to 2 two-fold dilutions) between both methods. VME were noted in 1 and 3 cases for vancomycin and teicoplanin, respectively, and resulted from 1 two-fold dilution discrepancy in each case. EA was lower for daptomycin. When they were discrepant, BMD MICs were systematically higher than GD ones. Nevertheless, no categorical discrepancy was noted. CONCLUSIONS: GD appears as an acceptable and convenient alternative for dalbavancin, vancomycin, and teicoplanin MICs determination. Our study also emphasizes how achieving accurate daptomycin MICs remains challenging.

Zinc oxide nanorod based photonic devices: recent progress in growth, light emitting diodes and lasers.

Zinc oxide (ZnO), with its excellent luminescent properties and the ease of growth of its nanostructures, holds promise for the development of photonic devices. The recent advances in growth of ZnO nanorods are discussed. Results from both low temperature and high temperature growth approaches are presented. The techniques which are presented include metal-organic chemical vapour deposition (MOCVD), vapour phase epitaxy (VPE), pulse laser deposition (PLD), vapour-liquid-solid (VLS), aqueous chemical growth (ACG) and finally the electrodeposition technique as an example of a selective growth approach. Results from structural as well as optical properties of a variety of ZnO nanorods are shown and analysed using different techniques, including high resolution transmission electron microscopy (HR-TEM), scanning electron microscopy (SEM), photoluminescence (PL) and cathodoluminescence (CL), for both room temperature and for low temperature performance. These results indicate that the grown ZnO nanorods possess reproducible and interesting optical properties. Results on obtaining p-type doping in ZnO micro- and nanorods are also demonstrated using PLD. Three independent indications were found for p-type conducting, phosphorus-doped ZnO nanorods: first, acceptor-related CL peaks, second, opposite transfer characteristics of back-gate field effect transistors using undoped and phosphorus doped wire channels, and finally, rectifying I-V characteristics of ZnO:P nanowire/ZnO:Ga p-n junctions. Then light emitting diodes (LEDs) based on n-ZnO nanorods combined with different technologies (hybrid technologies) are suggested and the recent electrical, as well as electro-optical, characteristics of these LEDs are shown and discussed. The hybrid LEDs reviewed and discussed here are mainly presented for two groups: those based on n-ZnO nanorods and p-type crystalline substrates, and those based on n-ZnO nanorods and p-type amorphous substrates. Promising electroluminescence characteristics aimed at the development of white LEDs are demonstrated. Although some of the presented LEDs show visible emission for applied biases in excess of 10 V, optimized structures are expected to provide the same emission at much lower voltage. Finally, lasing from ZnO nanorods is briefly reviewed. An example of a recent whispering gallery mode (WGM) lasing from ZnO is demonstrated as a way to enhance the stimulated emission from small size structures.

Biological changes after liver transplantation according to the presence or not of graft steatosis.

AIM: To assess the consequences of graft steatosis on postoperative liver function as compared with normal liver grafts. PATIENTS AND METHODS: From January 2005 to December 2007, liver transplant patients were prospectively included, excluding those who experienced arterial or biliary complications or presented acute rejection. All patients had a surgical biopsy after reperfusion. Patients were compared according to the rate of macrovacuolar steatosis: namely above or below 20%. RESULTS: Fifty-three patients were included: 10 in the steatosis group and 43 in the control group. No significant difference was observed in terms of morbidity, mortality, and primary non- or poor function. Nevertheless, biological changes after the procedure were significantly different during the first postoperative week. Prothrombin time, serum bilirubin, and transaminases were significantly increased among the steatosis group compared with the control group (P < .05). CONCLUSION: This case-controlled study including a small number of patients, described postoperative biological changes among liver transplantations with steatosis in the graft.

Cessation of screening for intestinal carriage of extended-spectrum ß-lactamase-producing Enterobacteriaceae in a low-endemicity intensive care unit with universal contact precautions.

OBJECTIVES: The usefulness of screening for carriage of extended-spectrum ß-lactamase-producing Enterobacteriaceae (ESBL-E) with active surveillance cultures (ASC) remains equivocal in low-endemicity intensive care units (ICUs). Our primary objective was to appraise the impact of ceasing ASC on the incidence of ICU-acquired ESBL-E infections in an ICU with universal contact precautions (CP). Patient outcomes and carbapenem consumption were also investigated. METHODS: A single-ICU, retrospective, uncontrolled before-and-after study including all patients admitted for ≥3 days during two consecutive 1-year periods with and without ASC. RESULTS: A total of 524 and 545 patients were included during the ASC and the no-ASC periods, respectively. Twenty-eight patients (5.3%) from the ASC period were ESBL-E carriers. An ICU-acquired ESBL-E infection (median duration of risk exposure, 4 (range 2-9) days for both periods) occurred in 1.1% and 1.5% of patients admitted during the ASC and the no-ASC periods (p = 0.64), with no inter-period variation in incidence after adjustment on competing risks of death and ICU discharge (standardized hazard ratio (SHR) 2.32, 95% CI 0.80-6.73, p = 0.12). An admission during the no-ASC period exerted no independent impact on the hazards of ESBL-E infections (adjusted OR 1.16, 95% CI 0.38-3.50, p = 0.79), in-ICU death (SHR 1.22, 95% CI 0.93-1.59, p = 0.15) and extended length of stay (SHR for discharge 0.89, 95% CI 0.79-1.01, p = 0.08). Carbapenem exposure in patients without ESBL-E infection decreased between the ASC and no-ASC periods (75 versus 61 carbapenem-days per 1000 patient-days, p = 0.01). CONCLUSIONS: In a low-endemicity ICU with universal CP, the withdrawal of routine screening for ESBL-E carriage had no significant effect on the incidence of ICU-acquired ESBL-E infections and patient outcomes. Carbapenem consumption decreased in patients without ESBL-E infection.

Predominance of G9P[8] rotavirus strains throughout France, 2014-2017.

OBJECTIVES: Group A rotavirus is a major cause of acute gastroenteritis in young children worldwide. A prospective surveillance network has been set up in France to investigate rotavirus infections and to detect the emergence of potentially epidemic strains. METHODS: From 2014 to 2017, rotavirus-positive stool samples were collected from 2394 children under 5 years old attending the paediatric emergency units of 13 large hospitals. Rotaviruses were genotyped by RT-PCR with regard to their outer capsid proteins VP4 and VP7. RESULTS: Genotyping of 2421 rotaviruses showed that after a marked increase in G9P[8] (32.1%) during the 2014-2015 season, G9P[8] became the predominant genotype during the 2015-2016 and 2016-2017 seasons with detection rates of 64.1% and 77.3%, respectively, whereas G1P[8] were detected at low rates of 16.8% and 6.6%, respectively. Phylogenetic analysis of the partial rotavirus VP7 and VP4 coding genes revealed that all of these G9P [8] strains belonged to the lineage III and the P [8]-3 lineage, respectively, and shared the same genetic background (G9-P[8]-I1-R1-C1-M1-A1-N1-T1-E1-H1) as did most of previously detected G9P[8] strains and particularly the emerging G9P[8] strains from the 2004-2005 season in France. CONCLUSIONS: G9P[8] rotaviruses have become the predominant circulating genotype for the first time since their emergence a decade ago. In the absence of rotavirus immunization programmes in France, our data give an insight into the natural fluctuation of rotavirus genotypes in a non-vaccinated population and provide a base line for a better interpretation of data in European countries with routine rotavirus vaccination.

[How to operate kidney puncture in percutaneous nephrolithotomy?]. / Comment ponctionner un rein pour réaliser une néphrolithotomie percutanée?

Obtaining a precise percutaneous calyceal puncture gave way to the development of percutaneous nephrolithotomy, one of the first micro-invasive techniques described in urology. Both radiologist and urologist can perform puncture, sometimes in a collaborative effort. However, being followed by a true surgical procedure, it should be done in the O.R; perfect knowledge of the procedure is mandatory for every urologist. Standard guidance uses a fluoroscopic C-arm device, only able to guide the needle precisely towards the apex of the chosen calyx. Moving the C-arm with cephalad tilting will provide 3-D imaging. Ultrasound guidance is an alternative, but might be difficult with non dilated upper tract. CT guidance and retrograde puncture are rarely used. The access is to be adapted according to the patient (adult or child), type of stone (single or multiple access), or kidney position (eutopic or ectopic). Direct ad stable puncture entering the apex of the chosen calyx is a pre-requisite for easy and efficient subsequent nephrolithotomy.

Clinical severity and molecular characteristics of circulating and emerging rotaviruses in young children attending hospital emergency departments in France.

Group A rotavirus (RVA) is the leading cause of acute gastroenteritis in young children worldwide. A prospective surveillance network has been set up to investigate the virological and clinical features of RVA infections and to detect the emergence of potentially epidemic strains in France. From 2009 to 2014, RVA-positive stool samples were collected from 4800 children <5 years old attending the paediatric emergency units of 16 large hospitals. Rotaviruses were then genotyped by RT-PCR with regard to their outer capsid proteins VP4 and VP7. Genotyping of 4708 RVA showed that G1P[8] strains (62.2%) were predominant. The incidence of G9P[8] (11.5%), G3P[8] (10.4%) and G2P[4] (6.6%) strains varied considerably, whereas G4P[8] (2.7%) strains were circulating mostly locally. Of note, G12P[8] (1.6%) strains emerged during the seasons 2011-12 and 2012-13 with 4.1% and 3.0% prevalence, respectively. Overall, 40 possible zoonotic reassortants, such as G6 (33.3%) and G8 (15.4%) strains, were detected, and were mostly associated with P[6] (67.5%). Analysis of clinical records of 624 hospitalized children and severity scores from 282 of them showed no difference in clinical manifestations or severity in relation to the genotype. The relative stability of RVA genotypes currently co-circulating and the large predominance of P[8] type strains may ensure vaccine effectiveness in France. The surveillance will continue to monitor the emergence of new reassortants that might not respond to current vaccines, all the more so as all genotypes can cause severe infections in infants.

The high burden of hospitalizations for primary EBV infection: a 6-year prospective survey in a French hospital.

Primary Epstein-Barr virus infection (PEI) is acquired increasingly later in life in developed countries, involving a growing number of adults. No studies have examined the effect of age on PEI. We conducted a prospective, single-centre, noninterventional survey to assess the clinical and economic effects of PEI care according to age. We included all serology-confirmed cases observed in all departments of a large regional hospital. Clinical and biologic data, therapeutics and costs of care were examined. Over a 6-year period, we included 292 subjects (148 children and 144 adults) with a median age of 15.4 years (range 9 months to 79 years). Adults were hospitalized more often (83% vs. 60%) and for longer periods of time (median 4 days vs. 2 days) than children (p ≤ 0.0001 for both). Two adults required a secondary transfer into the intensive care unit, although no children did. Typically, adults showed higher levels of activated lymphocytes and liver abnormalities. They also required the use of systemic corticosteroids more often (45% vs. 23%, p < 0.0001) and for longer periods of time (median 7 days vs. 3 days, p 0.02) than children. Overall, the costs were significantly higher for adults than for children (median, €1940 vs. €1130, p < 0.0001), mainly because of the frequency and duration of hospitalizations. Age increases the immune response and clinical severity of PEI, resulting in substantial additional costs for the community. Better recognition of the disease in adults could shorten the average length of hospital stay.

Relation between PROP taster status and fat perception, touch, and olfaction.

We tested the hypothesis that fat perception (sensitivity to and preferences for fat) may be linked to 6-n-propylthiouracil (PROP) taster status as a result of differences in trigeminal innervation of the oral cavity. In addition, we examined the relationship between taster status and sensitivity to other taste attributes, as well as tactile and olfactory sensitivities. Subjects (40 nontasters, 67 medium tasters, and 40 supertasters of PROP) rated samples (potato chips, chocolate drink, mashed potatoes, and vanilla pudding) varying in fat and flavor concentrations for the intensity of fattiness, saltiness, and sweetness, first without and then with nose clips, and for liking. Tactile sensitivity of the tongue was assessed according to responses to stimulation with Von Frey filaments (2.36, 2.44). Olfactory thresholds were determined for two odors (diacetyl and phenylethyl methyl ethyl carbinol). In general, taster status was not related to the perceptions of fat, saltiness, and sweetness. Subjects were able to accurately assess the fat content of the samples. Increasing the flavor levels in the potato chips and mashed potatoes enhanced the perception of fattiness for these systems. Supertasters were more sensitive to stimulation on the median of the tongue with the no. 2.36 Von Frey filament, and the olfactory thresholds for diacetyl were lower for PROP tasters and supertasters than for nontasters.

Relation between parotid saliva flow and composition and the perception of gustatory and trigeminal stimuli in foods.

The objective of this study was to investigate whether and how parotid saliva flow and composition correlated with the perception of gustatory and/or trigeminal stimuli in foods. Thirty (15 male and 15 female) subjects tasted seven foods or beverages (lemonade, beer, wine, soup, methyl cellulose, peanut butter, and crackers) with three levels each of a gustatory or trigeminal stimulus and rated the perceived intensity of the corresponding sensation over time using the time-intensity (TI) method while their parotid saliva was being collected. Salivary flow rates of males were significantly higher than those of females for all stimuli (p < 0.001). That did not translate, however, into consistent differences in perception of sensory attributes between males and females. Significant positive correlations were found between saliva flow and (1) TI parameters for adhesiveness of peanut butter and cohesiveness of mass of crackers (p < 0.05 or lower) and (2) time from intake to swallowing of crackers and peanut butter (p < 0.05). No correlations were found between saliva composition (e.g., sodium and total protein) and TI parameters. These results indicate that parotid saliva flow may correlate with the perception of some texture and mouthfeel attributes (presumably through oral work and bolus formation) but not with that of the taste attributes examined in this study (at the concentrations studied).

Relation between saliva flow and flavor release from chewing gum.

The objective of this study was to investigate whether or not parotid saliva flow is a significant determinant of flavor release from chewing gum. Cherry-flavored gum with 3 concentrations of citric acid (0.5, 1, and 2%) acting as a sialagogue was evaluated for sweetness and cherry flavor in duplicate by 13 subjects, using a computerized system for simultaneous time-intensity (TI) measurements and unilateral collection of parotid saliva. With increased acidity in the gum, maximum intensity of, and area under, the cherry flavor curve increased (p < 0.001), whereas total duration of sweetness decreased (p < 0.05). Large interindividual differences were found for parotid saliva flow in response to chewing gum. Mean unilateral parotid saliva flows in response to stimulation with water and gum with 0.5, 1, and 2% citric acid were 0.07, 0.30, 0.36, and 0.44 g/min, respectively. There was a significant positive correlation between saliva flow and time to reach maximum intensity of sweetness (p < 0.05) and of cherry flavor (p < 0.01), with "high-flow" subjects taking longer to reach maximum intensity than "low-flow" subjects for both attributes. We conclude that parotid saliva flow may affect the rate of flavor release, but not how much nor for how long flavor is released.

Chemoreception and perception of the bitterness of isohumulones.

Psychophysical experiments were conducted to determine whether isohumulones share a common receptor mechanism with other bitter compounds, and whether parotid saliva flow affects perception of their bitterness. Findings from a study of inter-individual differences in sensitivity to 23 sweet and/or bitter compounds among 25 subjects using the time-intensity (TI) method suggest that isohumulone and tetrahydroisohumulone may share a common receptor mechanism with other bitter compounds except those with the thiourea moiety. Isohumulone and tetrahydroisohumulone displayed a unique dome-shaped TI profile. The bitterness of the two compounds took longer to develop, but it lasted as long as for other bitter stimuli. In a study of the relation between perception of bitterness in beer and parotid saliva flow in 20 young adults, no significant difference was found among the mean saliva flows triggered by 0, 15 and 30 mg/L of isohumulones added to beer, and no significant correlation was found between saliva flow and maximum intensity or total duration of bitterness.

Does consumption of beer, alcohol, and bitter substances affect bitterness perception?

The relation between consumption of beer, alcohol, and bitter substances was investigated by comparing 20 each of male adults, low users ( < 720 ml/week) and high users ( > 3.61/week) of beer for sensitivity to and like/dislike for the bitterness of isohumulones. Intake of beer, alcohol, and bitter substances was measured with a food frequency questionnaire and a 14-day recall journal. Intake of alcohol (including alcohol from sources other than beer) and bitter substances was higher for high users of beer than for low users. The average bitterness units (BUs) in the beers consumed by the two groups did not differ, indicating that high users do not consume more bitter beers than low users. Detection thresholds for isohumulones in water did not differ between the two groups, but high users had higher difference thresholds for isohumulones in beer (p < 0.10). In time-intensity measurements of bitterness in beer, low users of beer recorded significantly higher maximum intensities (p < 0.001) and shorter total durations (p < 0.001) than high users, with no difference between the two groups for time to maximum intensity and area under the TI curve. There was no significant difference between the two groups for BUs of beers produced by ad lib mixing of low- and high-bitterness beers, or for mean hedonic ratings of various concentrations of isohumulones in beer. These results suggest that intakes of beer, alcohol, and bitter substances are not major determinants of taste responses to the bitterness of isohumulones.

Sensory responses to fat are not affected by varying dietary energy intake from fat and saturated fat over ranges common in the American diet.

OBJECTIVE: To examine the effects of manipulating dietary fat in foods on sensitivity and hedonic response to fat in selected foods. DESIGN: Twenty subjects were randomly assigned to a sequence of three 8-week experimental diets (average American diet, step 1 diet, low-saturated-fat diet) that varied in energy from fat (37%, 30%, and 26%, respectively) and saturated fat (17%, 10%, and 6%, respectively). Subjects participated in sensory tests designed to assess their sensitivity to and liking for fat in several foods, before the study (baseline), after consumption of each diet, and after the study (washout). SUBJECTS/SETTING: Subjects were participants in the Dietary Effects on Lipoprotein and Thrombogenic Activity (DELTA) study. RESULTS: No significant differences were found among diets for difference thresholds (i.e., just noticeable differences) for fat in milk and pudding, ad libitum mixing of low- and high-fat samples of milk and soup, and hedonic scaling of fat concentrations in milk and muffins and of cheese, mayonnaise, hot dog, and pastry samples. APPLICATIONS/CONCLUSIONS: Within the dietary fat ranges and for the fat stimuli tested in this study, dietary fat as percentage of energy from fat and saturated fat was not a significant determinant of sensitivity to and/or liking for fat. Sensory factors should not be a barrier to the implementation of low-fat diets such as the step 1 and low-saturated-fat diets.

Celiac artery aneurysm.

Aneurysms of the celiac axis are rare, since only 50 cases were reported in 1976, 14 of which were operated on successfully. We report here the 15th case. This celiac aneurysm involved the origin of the splenic left gastric and common hepatic arteries. After controlling the aorta by a thoraco-phrenolaparotomy, the celiac artery was ligated at its origin, the anterior wall of the aneurysm was incised and the splenic and the left gastric arteries ligated by an obliterative endoaneurysmorrhaphy. The hepatic vascularization was restored from the gastroduodenal artery with a restorative endoaneurysmorrhaphy. The control arteriogram showed a good arterial revascularization.

Laryngospasm-induced pulmonary edema.

We report the case of a 6-month-old child who developed acute pulmonary edema because of laryngeal spasm during orthopedic manipulations for congenital hip dysplasia. Laryngospasm was probably secondary to an unsuspected light level of anesthesia, maintained via face mask. No other predisposing factors, such as enlarged adenoid tonsils, laryngitis, epiglottitis, mechanical stimulation of the larynx or aspiration of foreign material were identified. Serious oxygen desaturation and bradycardia ensued, during inefficient attempts at positive pressure ventilation. After emergency intubation without muscle relaxant, copious pink secretions emerged from the airway. Negative pressure pulmonary edema was confirmed by chest X-ray, and short-lasting arterial desaturation despite positive pressure ventilation with high oxygen concentration. This type of pulmonary edema is caused by marked elevated negative intra-airway pressure, massive sympathetic discharge causing a blood shift from the systemic to the pulmonary circulation, and accentuation of physiological ventricular interdependence during forceful inspiratory effort against a closed glottis. As usual in such cases, pulmonary edema and laryngospasm resolved spontaneously without specific treatment, and extubation was carried out uneventfully two hours later. The child suffered no sequelae.

Double-blind comparison between inverse sequence induction with atracurium and rapid sequence induction with succinylcholine.

In this double-blind randomized study of 60 patients, a new rapid sequence induction technique (RSI), the so-called inverse sequence induction technique (ISI), is compared to the standard RSI using succinylcholine (SUX). All patients were premedicated with midazolam 0.07 mg.kg-1 and morphine 5 mg im. The patients in the ISI group received atracurium 0.6 mg.kg-1 followed after 1 min by thiopental 5 mg.kg-1. The patients in the SUX group were precurarized with atracurium 0.06 mg.kg-1 followed after 3 min by thiopental 5 mg.kg-1 and succinylcholine 1.5 mg.kg-1. In both groups patients were intubated 1 min after thiopental injection by a trained blinded anesthetist who graded intubation conditions from 1 (excellent) to 4 (impossible). Intubation scores (ISI: 1 and SUX: 1 (range 1-3)) and intubation times (from laryngoscopy to cuff inflation: ISI 18 +/- 10 s, SUX 19 +/- 8 s) as well as mean arterial pressure, heart rate, SpO2 and EtCO2 values were not significantly different between groups. Three patients in the ISI group failed to maintain a handgrip. In both groups all patients were able to cough forcefully at the time of thiopental injection. These data emphasize the reliability and safety of ISI as an alternative for RSI when succinylcholine is contraindicated. However, the unpleasantness of awake partial curarization may limit its acceptance.