Effects of cigarette smoking on reproduction.

BACKGROUND Cigarette smoking is associated with lower fecundity rates, adverse reproductive outcomes and a higher risk of IVF failures. Over the last few decades, prevalence of smoking among women of reproductive age has increased. This review focuses on current knowledge of the potential effects of smoke toxicants on all reproductive stages and the consequences of smoke exposure on reproductive functions. METHODS We conducted a systematic review of the scientific literature on the impact of cigarette smoking and smoke constituents on the different stages of reproductive function, including epidemiological, clinical and experimental studies. We attempted to create hypotheses and find explanations for the deleterious effects of cigarette smoke observed in experimental studies. RESULTS Cigarette smoke contains several thousand components (e.g. nicotine, polycyclic aromatic hydrocarbons and cadmium) with diverse effects. Each stage of reproductive function, folliculogenesis, steroidogenesis, embryo transport, endometrial receptivity, endometrial angiogenesis, uterine blood flow and uterine myometrium is a target for cigarette smoke components. The effects of cigarette smoke are dose-dependent and are influenced by the presence of other toxic substances and hormonal status. Individual sensitivity, dose, time and type of exposure also play a role in the impact of smoke constituents on human fertility. CONCLUSIONS All stages of reproductive functions are targets of cigarette smoke toxicants. Further studies are necessary to better understand the deleterious effects of cigarette smoke compounds on the reproductive system in order to improve health care, help to reduce cigarette smoking and provide a better knowledge of the molecular mechanisms involved in reproductive toxicology.

Protracted deep coma after bromazepam poisoning.

BACKGROUND: Bromazepam intoxication is very common but surprisingly rarely reported. CASE DESCRIPTION: We describe the case of a 73-year-old woman who suffered from a prolonged coma after acute self poisoning with bromazepam (serum concentration of 2,000 ng/ml at admission, 2 - 10 hours after ingestion of up to 180 mg) and zolpidem (900 ng/ml at admission). Only the former lasted at toxic concentrations. Recovery of consciousness allowed extubation on Day 16. Repeat-dose activated charcoal (25 g every 6 h from Day 14 to 16) resulted in minimal effects on bromazepam grossly estimated kinetics. CONCLUSION: Despite its relatively low theoretic half-life, bromazepam may induce a prolonged life-threatening coma, even in the absence of renal or hepatic failure.

Lack of oxidative stress in a selenium deficient area in Ivory Coast--potential nutritional antioxidant role of crude palm oil.

BACKGROUND: Previous studies have described an important selenium deficiency in a mountain region (Glanle) in the west of Ivory Coast. AIM OF THE STUDY: To assess the antioxidant capacity of subjects from a selenium deficient area in Ivory Coast (Glanle region). METHODS: This study involved 57 subjects, 18 to 69 years old, living in the Glanle region and 56 healthy controls living in the southern coastal region (Bodou). In the Glanle region families consume basically a vegetarian and crude palm oil diet, whereas in the Bodou region, families eat a fish-based diet with principally refined palm oil. Fasting blood samples were collected to assess the following parameters: lipid status (plasma total lipids; total-, HDL and LDL-cholesterol; triglycerides; phospholipids; fatty acid composition), plasma protein status (total protein, albumin, transthyretin, orosomucoid, CRP, transferrin), antioxidant capacity (plasma selenium, uric acid, retinol, alpha-tocopherol and tocotrienols levels, plasma seleno-glutathione peroxidase (GSHPx) activity) and oxidative stress markers (malondialdehyde (MDA) and advanced oxidation protein products (AOPP)). RESULTS: The mountain region samples (Glanle) were characterized by significantly lower plasma albumin, total-, HDL- and LDL-cholesterol, retinol and selenium levels, plasma PUFA content and GSHPx activity, but significantly higher alpha-tocopherol index and total tocotrienol level, than controls from the coastal area (Bodou). These results suggest a higher exposure risk to oxidative stress for the mountain region subjects. However, the absence of oxidative damage in this group provides evidence of a selenium independent protection mechanism against oxidative stress. This protection is related to lower plasma LDL cholesterol and PUFA content, and to higher alpha-tocopherol index, delta and total tocotrienols. CONCLUSION: The long-term consumption of crude palm oil could be considered as an effective protective factor against oxidative stress.

On-line dialysis quantification in acutely ill patients: preliminary clinical experience with a multipurpose urea sensor monitoring device.

Direct dialysis quantification offers several advantages compared with conventional blood urea kinetic modeling, and monitoring urea concentration in the effluent dialysate with an on-line urea sensor is a practical approach. Such a monitoring device seems desirable in the short-term dialysis setting to optimize and personalize both renal replacement therapy and nutritional support of acutely ill patients. We designed a urea monitoring device consisting of a urea sensor, a multichannel hydraulic circuit, and a PC microcomputer. The sensor determines urea from catalysis of its hydrolysis by urease in liquid solution during neutral conditions. Hydrolysis of urea produces NH4+, and creates an electrical potential difference between two electrodes. Each concentration determination of urea is the average value of 10 measurements; samples are diverted and measured every 7 min. Laboratory calibration of the urea sensor has demonstrated linearity over the range 2-35 mmol/L. Urea monitoring was performed throughout the treatment course, either on the effluent dialysate or ultrafiltrate in seven acutely ill patients treated by either hemofiltration (n=5) or hemodiafiltration (n=2). The slope of the concentration of urea in the effluent over time was used to calculate an index of the dialysis dose delivered (Kt/V), urea mass removal, and protein catabolic rate. In addition, samples of the effluent were drawn every 21 min, and sent to the central laboratory for measurement of urea concentrations using an autoanalyzer. Kt/V values also were calculated with Garred's equation using pre and post session concentrations of urea in blood. Concentrations of urea in the effluent determined by the urea sensor were found to be very close to those obtained from the central laboratory over a wide range of values (3 to 42 mmol/L). In addition, Kt/V values for both hemofiltration and hemodiafiltration, when calculated with concentrations of urea in the effluent obtained by the urea sensor, did not significantly differ from Kt/V values obtained from the laboratory concentrations of urea in the effluent. On-line urea sensor monitoring of the effluent suppresses the cumbersome task of total effluent collection, and the complexity of urea kinetic analysis. The multipurpose prototype described here represents a new, simple, and direct assessment of dialysis dose and protein nutritional status of acutely ill patients, and is suitable for various modalities.

Multicentre evaluation of the DCA 2000 system for measuring glycated haemoglobin. DCA 2000 Study Group.

The recommended method for assessing long-term blood glucose control in diabetic patients is the measurement of glycated haemoglobin (Hb). The Ames DCA 2000 system for assaying glycated Hb uses an immunoassay with a monoclonal antibody specific for an aminoacid sequence within the HblAc molecule. This study compared the performance of the DCA 2000 system for HblAc measurement with that of high-performance liquid chromatography (HPLC). A total of 1.016 insulin-dependent and non-insulin-dependent diabetic patients from 5 outpatient clinics took part. The correlation coefficients between DCA 2000 and HPLC data ranged between 0.94 and 0.98, depending on site. The mean variations and 95% confidence intervals for the differences between the results for each sample were: site A 0.172 (-1.186 to 1.53), site B -0.275 (-1.317 to 0.767), site C -0.146 (-0.868 to 0.576), site D -0.088 (-0.864 to 0.688), and site E -0.251 (-1.099 to 0.597). The sensitivity of the DCA 2000 assay ranged between 80 and 94%, and the specificity between 88 and 100%, depending on site. For pooled results, the correlation coefficient assayed by the two methods was 0.95. The mean variation was -0.116 and the 95% confidence interval -1.23 to 0.998. The sensitivity of DCA 2000 was 91%, and the specificity 94%. DCA tended to underestimate HbAlc slightly as compared to HPLC. This study confirms the reliability of DCA 2000 for measuring glycated Hb. The system is easy to use and provides valuable information for the care of the diabetic patients.

[Sedation with propofol and fentanyl in patients under intensive care]. / Sédation avec propofol et fentanyl en soins intensifs.

This study investigated the efficacy of a constant rate infusion of propofol and fentanyl in thirty patients requiring artificial ventilation for more than 24 h. A loading dose, which differed according to the patient's age, was administered over a 30 min period: 2.5 mg.kg-1 for patients less than 50 (G1) (n = 9), 2 mg.kg-1 for patients between 50 and 60 years old (G2) (n = 9), and 1.5 mg.kg-1 for patients over 60 (G3) (n = 12). This was followed by an infusion of 3 mg.kg-1.h-1 in G1 and G2, and 2 mg.kg-1.h-1 in G3. A 1 microgram.kg-1.h-1 infusion of fentanyl was also given. The degree of sedation was assessed with the Ramsay scale before starting, after induction, and every four hours thereafter. When this proved to be insufficient, the dose of propofol was increased by 0.5 mg.kg-1.h-1 as well as that of fentanyl by 0.5 microgram.kg-1.h-1. Heart rate, mean arterial blood pressure, blood propofol, creatinine, transaminase and lipid levels, and urine output were measured before, during, and after the infusion. The blood propofol level increased during the infusion, being correlated to the doses given (r = 0.64, p less than 0.001). Sedation lasted 91.7 +/- 57.7 h. After stopping the infusion of propofol, mean recovery times were 7.5 +/- 5.9 min (G1), 11.4 +/- 11.4 min, and 14.4 +/- 13.5 min (G3) (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Jejunal permeability to water and electrolytes in patients with chronic intrahepatic hypertension: evidence for a role of aldosterone.

Acute prehepatic portal hypertension induces intestinal secretion in animal models. In the course of chronic liver disease, however, these changes are not observed, despite higher portal pressures than those found in experimental studies. Eight patients without diarrhoea and with chronic alcoholic liver disease were examined for evidence of increased jejunal secretion; their suprahepatic wedge pressure was raised from 21 to 45 mmHg (mean 34.6 mmHg). Jejunal perfusion with a triple lumen catheter and a proximal occluding balloon was used to study net flows of water and chloride as well as net and unidirectional flows of sodium and potassium. No statistical difference in intestinal flows of water and electrolytes was noted between cirrhotic patients and control subjects after infusion with a 30 mmol/l glucose solution. Infusion with a 30 mmol/l mannitol solution resulted in a lower absorption of water, Na, K, and Cl than with the glucose solution. A higher rate of Na secretion was observed in cirrhotic patients than control subjects after infusion with 30 mmol/l mannitol (p less than 0.01). In addition, the rate of Na secretion was higher in cirrhotic patients than in control subjects (p less than 0.05). There was no correlation between the net flow of Na and the suprahepatic wedge pressure. A second perfusion with a 30 mmol/l glucose solution was given 75 minutes after a bolus injection of spironolactone (400 mg). Net flows of Na and Cl were lower in cirrhotic patients than in control subjects (p less than 0.05) because of a lower absorption of Na. Patients with gradually developing portal hypertension have moderate jejunal secretions of H2O and electrolytes which we assume are partly masked by increased absorption resulting from hyperaldosteronism. In contrast to animal models, this mechanism may be part of the jejunal adaptation to permeability in acute portal hypertension.

[Pharmacokinetics and changes in the physical properties of blood and urine after administration of dextran 60000]. / Pharmacocinétique et modifications des propriétés physiques du sang et des urines apès administration d'un dextran 60,000.

A study was carried out to assess the changes induced by an infusion of dextran, molecular weight 60,000 daltons, in blood and urine. Plasma and urine dextran and serum protein concentrations, haematocrit, blood and urine viscosities, and blood oncotic pressure were measured in 10 consecutive male patients. Fifteen min after administration of 20 ml dextran 1000 (Promit), they were each given 500 ml (30 g) dextran 60 (Hemodex) over 30 min for plasma volume expansion. The measurements were carried out at the end of the infusion, and then at regular intervals over a 48 h period. The highest dextran blood concentrations were found at the end of the infusion, decreasing thereafter with a distribution half-life of 1.83 +/- 0.64 h, and an elimination half-life of 25.5 +/- 7.6 h. Haematocrit values decreased by 12%, and serum protein concentrations by 9.5%, after the end of the infusion. These changes remained significant for 9 h; they were probably due to the dilution effect of 500 ml of dextran. Colloid osmotic pressure was not significantly altered (20.7 +/- 4.7 mmHg vs. 23.1 +/- 5.1 mmHg 48 h after the end of the infusion). The colloid osmotic pressure due to dextran 60 compensated for the fall in protein concentration. A decrease in blood viscosity was found at different shear rates, despite dextran 60 being highly viscous. This could also be explained by a dilution effect. The highest degree of urinary excretion occurred 30 min after the end of the infusion, and lasted for 3 h. Forty-five percent of the total dextran dose had been excreted by the 48th hour.(ABSTRACT TRUNCATED AT 250 WORDS)

[The course of blood concentrations of propofol administered at a constant rate, combined with fentanyl]. / Evolution des concentrations sanguines du propofol administré à débit constant en association avec le fentanyl.

The blood concentration of propofol was studied in 14 ASA 1 informed patients, who were to undergo orthopaedic or plastic surgery lasting at least 90 min. Anaesthesia was induced with a 2 mg.kg-1 bolus of propofol together with 0.86 microgram.kg-1 fentanyl. This was followed by a constant rate infusion of propofol and fentanyl, 5 mg.kg-1.h-1 and 3 micrograms.kg-1.h-1 respectively. The mean duration of propofol infusion was 153 +/- 63 min, with extremes of 90 and 315 min. Propofol concentration was measured using gas phase chromatography on total arterial blood; the lower limit of detection was 0.05 mg.l-1. During the infusion, blood concentrations were found between 2 and 4 mg.l-1. It was 2.25 mg.l-1 at the fifth min; this was 80% of the concentration found at the 120th min. There was in fact no statistically significant difference between the values found at the 90th, 120th and 150th min. On stopping the infusion, the concentrations fell rapidly during the first 5 min, and then more slowly. By the 30th min, it had reached a value 4.5 times less than that at the end of the infusion. However, individual variations were found, which could explain delayed recovery. The calculated pharmacokinetic parameters were: elimination half-life = 41.7 +/- 20 min, clearance = 2.14 +/- 0.55 l.min-1 and equilibrium distribution volume = 43.4 +/- 15.2 l. These results are discussed. It is therefore possible to give propofol continuously at a constant rate without having any accumulative effect.

[Value of hemodilution in maxillofacial surgery for postoperative traumatic edema and graft viability]. / Intérêt de l'hémodilution en chirurgie maxillo-faciale sur l'oedème traumatique postopératoire et sur la vitalité des lambeaux.

The effects were studied of normovolaemic haemodilution on postoperative traumatic oedema after surgical repair of craniofacial disjunction (CFD) and on pedicle graft viability after excision of squamous carcinomas of the floor of the mouth (CFM). Fourty patients were studied: twenty operated on for CFD and twenty for CFM. These patients were randomly assigned to the treated or the control groups. The treated ones were operated on under moderate normovolaemic haemodilution induced with a colloid solution (Plasmion). The subsequent haematocrits were 0.29 +/- 0.01 for the CFD group and 0.30 +/- 0.02 for the CFM group. The biometric parameters and the length of the surgical procedures were comparable for the two series. Operative blood loss was less in the treated series (p less than 0.001 for the CFD group and p less than 0.01 for the CFM group), thus needing less blood transfusion (p less than 0.001). The postoperative oedema in the treated CFD series was less (p less than 0.001), although the oncotic pressure and the plasma osmolality were decreased in this series (p less than 0.05). On the other hand, viscosity in the hemodiluted series was significantly decreased in comparison with the control series (p less than 0.001). Graft viability was significantly improved in the treated series (p less than 0.05). Thus, normovolaemic haemodilution was a very useful adjunct in plastic and reconstructive surgery of the face and the mouth. This technique had three advantages: reduction of postoperative traumatic oedema after CFM repair, graft viability improvement after mouth carcinoma excision and blood saving in both procedures.

[Value of intraventricular morphine analgesia in intractable neoplasm pain. Apropos of 8 cases with self-administration in 4]. / Intérêt de l'analgésie morphinique par voie ventriculaire dans les algies rebelles néoplasiques. A propos de 8 cas dont 4 avec auto-administration.

Intractable pain in 4 patients having disseminated cancer was treated by intraventricular morphine. For all these patients, previous efficiency of opiates therapy was assessed by a positive trial of epidural injections of morphine. The latter method had to be stopped and a switch to intraventricular morphine was motivated, in 3 cases, by a local non-tolérance to the subarachnoid catheter. In one case, an intraventricular system was inserted at the first onset. In all cases, the intraventricular system consisted of a "Holter" type device, using a reservoir implanted subcutaneously in the frontal scalp and connected at right-angle with a catheter inserted in the lateral ventricle. Trial times were respectively of 8 days, one month, two months and six months (this latter case still under trial). In comparison with the epidural and lumbar intrathecal administration of morphine, the authors insisted upon the quality of analgesia obtained, the absence of respiratory depression, the comfort and minimal daily quantities of morphine injected (inferior to one mg daily in three cases). Enlightened by these 4 cases, the authors also discussed the relative importance of the spinal and brain mechanisms involved in morphinic analgesia.

[Pharmacokinetic basis of constant-flow administration of drugs during long-lasting anesthesia]. / Bases pharmacocinétiques des drogues administrées à débit constant au cours d'anesthésies die longue durée.

The criteria for intravenous administration of anesthetics or their adjunctives in continuous and constant flow remain imprecise and incompletely understood. Drugs with a very short half-life are usually preferred, without this being a restrictive notion. The theoretical bases for the kinetics of constant flow intravenous infusion are well known but not the practical carrying out, and the practitioner remains confronted with various fundamental questions. Indeed, the quantity administered must take in account it's elimination, but what happens in cases of destructive metabolism, above all when the metabolites are toxic? On the other hand, can the kinetics observed for a given dose be extrapolated to any dose that is administered? Using real examples during constant-flow anestesia, we reconsider a simple calculation method based on the total clearance for a given substance and providing the theoretical constant-concentration level. This study shows how complex the kinetics of constant-flow administration area. All these techniques should be preceded before human application, by serious research on adequate experimental models.

[Plasma concentration of fentanyl administered at a constant flow rate during prolonged anesthesia]. / Etude de la concentration plasmatique du fentanyl administré à débit constant au cours d'anesthésie de longue durée.

By radio-immunological estimation using fentanyl H-3, a study was undertaken in ten adults under anaesthesia of long duration obtained by infusion at a constant rate of alfadione and fentanyl of the plasma concentration of fentanyl during and after anaesthesia. Anaesthesia was induced by the administration of 4.3 ml of alfadione and 0.084 mg of fentanyl. The maintenance dose was on average 0.15 ml/kg-/h-1 +/- 0.03 of alfadione and 2.96 micrograms/kg-1/h-1 +/- 0.58 of fentanyl. The mean duration of anaesthesics was 388 minutes +/- 104. The results of this study showed that from the third hour onwards a plateau of serum concentration was established around a mean value of the order of 4.8 micrograms/l-1. The study of excretion curves demonstrated the existence of a three compartment system with respective half lives of 12.75 and 510 minutes. Maintenance of a stable plasma concentration may be explained by an increase in tissue diffusion (increase in mid and long term half life in comparison with single injections) and by increased metabolism. This study provided pharmacokinetic evidence to justify the administration of fentanyl at a constant flow rate preceded by a loading dose.

[Comparison of two E.E.C. baths by study of the oncotic pressure-pulmonary artery pressure gradient]. / Comparaison de deux bains de C.E. C. par l'étude du gradient pression oncotique-pression artérielle pulmonaire.

Variations in oncotic pressure-pulmonary artery diastolic pressure gradient and in intrapulmonary shunt were studied in two groups of patients undergoing surgery with extracorporeal circulation for aortocoronary bypass of excision of an aneurysm. The two groups, differed only in terms of the E.C.C. bath (Group A: Ringer Lactate; Group B: DDextran 60,000). The effects of E.C.C. on these parameters were as follows: - decrease in both groups in the gradient (OP-PAP) (respectively P < 0.001 and P < 0.01) but with a more marked decrease in group A than in group B (P < 0.05) with non-negativisation of the gradient in that group; - non-significant variations in Qs/Qt in both groups without any correlation with gradient (OP-PAP). The onset of pulmonary oedema associated with a decrease in gradient (OP-PAP) leads to the suggestion of the use of Dextrans in pathological situations where OP is low or PAP high and all the more so when both of these factors are present.

[Blood and urinary cyanide concentrations during long-term sodium nitroprusside perfusion]. / Etude des concentrations sanguine et urinaire en cyanure au cours de perfusion de nitroprussiate de sodium de longue durée.

Five deeply comatose neurological patients were administered a continuous perfusion of sodium nitroprusside (SNP) at the rate of 3 microgram.kg-1.min-1. The levels of blood cyanide (CN-) were measured two hours after the start, then every 12 hours during, and 12 and 24 hours after the end of perfusion. The urinary output of CN- was also studied. The results show that total blood CN- stabilized after 36 hours to a mean value of 0.11 mg/l. When perfusion was stopped, CN- blood levels dropped but did not reach pre-perfusion values at the 24th hour. Urinary excretion of CN- which reached a maximum value of 0.050 mg/24 h represents a negligible amount and does not explain the fall of blood CN- and the occurrence of a concentration plateau. The results showing lower values obtained on non-anesthetized patients during the first hours of perfusion compared to those of a previous study done under neuroleptanaesthesia are discussed. These results suggest that prolonged perfusions at SNP at the rate of 0.177 mg.kg-1.h-1 do not produce toxic blood level of CN-.

[Changes in physicochemical parameters and coagulation factors in hemodilution with dextran of molecular weight 60,000]. / Modifications des paramètres physico-chimiques et des facteurs de la coagulation sous l'effet de l'hémodilution avec un dextran de poids moléculaire 60 000.

In 18 subjects undergoing aorto-bifemoral by-pass, pre-operative isovalaemic hemodilution was carried out (using a dextran of molecular weight 60,000) at the same time as venous section of a mean value of 1087 ml reducing the hematocrit to 0.30. The following were studied before, immediately after and 24 hours after hemodilution: blood viscosity (at variable shearing rates), oncotic pressure, sedimentation rate, clotting factors, plasma electrolytes. These results showed that at the end of hemodilution, oncotic pressure was maintained and even increased despite the fall in blood protein levels, with also a decrease in blood viscosity, a tendency to dynamic hypocoagulability (thrombocytopenia, fall in fibrinogen and increase in cephalin kaolin time and Quinck time) without any increase in lytic activity. 24 hours later, these parameters tended to return to normal. Discussion on the basis of a study carried out in vitro, seeks to demonstrate which of these changes were related to the dextran molecule and which were related to the hemodilution.