[The prospective multicenter study on standard photopatch tests by the French Society of Photodermatology from 1991-2001]. / Etude prospective multicentrique 1991-2001 de la batterie standard des photopatch-tests de la Société Française de Photodermatologie.

INTRODUCTION: To develop a standard panel of photopatch tests, the French Society of Photodermatology conducted a prospective study from 1991 to 2001 on the frequency of photoallergens encountered in France and on the relevance of the choice of the various photoallergens. PATIENTS AND METHODS: Thirteen photobiology centers participated in the study from 1991 to 1995, and ten centers from 1995 to 2001. A set of 3 samples of photopatch tests was applied on any patient suspected of photoallergy. On Day 2, two sets were irradiated with ultraviolet A (UVA) and total spectrum (DEM 0.75); with the third set being used as control. Readings were made on D3 and D4. RESULTS: Two thousand sixty-seven patients were tested. Eight hundred fifty-six, i.e., 41% exhibited one or several positive tests. In the majority of cases it was a photoallergy (39.7 to 60% of cases) and eczema (29.5 to 45.6%). Photoaggravation was infrequent (7.9 to 10.3%). Cases of phototoxicity were rare. Sesquiterpenic lactones constantly provoked photoallergy, with 12 cases in 10 years. Although phenothiazines were the most photosensitizing allergens up until 1995, they were then overridden by ketoprofen in 1996 with 107 cases of UVA photosensitive reactions (75 cases) and total spectrum (32 cases). These were followed closely by sun screens, benzophenone (notably Eusolex 4360 with 54 pertinent cases of photoallergy) and dibenzoylmethane (with 31 cases due to Eusolex 8020). UVB filters were all potentially photosensitizing but to a lesser degree from 1 to 5 cases). DISCUSSION: Our results differ from those of Anglo-Saxon teams in the appearance of a new photoallergen, ketoprofen, which provoked numerous photosensitivities in both UVA and UVB. This justifies the systematic addition of this substance in our prospective set. Photoallergy was relatively rare, with around 100 cases reported within 10 years. Total spectrum irradiation of the photopatch tests revealed photoallergies that would not have been found with UVA alone. CONCLUSION: Study of photopatch tests has permitted the uniformization of the methodology in France, an overview of the frequency of the photoallergens tested and the development of a new standard set.

Study of cortical spindles during sleep in the rat.

A systematic analysis of the dorsally accessible cortical areas has been undertaken so as to study the space-time distribution, the intrinsic characteristics and the physiological appearance modalities of cortical spindles in the rat. After falling asleep, the animal presents anterior spindles of which the number, duration and amplitude increase as sleep with slow waves deepens. These spindles are fully developed during intermediate state which precedes and follows paradoxical sleep, where they are associated with a theta rhythm in the hippocampus and the visual cortex. These spindles, at their maximum in anterior regions, lose intensity as one approaches the cerebellum. Uniquely during slow wave phase of sleep, the rat presents posterior spindles which are predominant in the occipital region, are less marked in parietal and cerebellar regions and disappear in the frontal cortex. Less frequent than anterior spindles, they are significantly distinguished by their lower amplitude, higher frequency and shorter duration.

Monitoring of the motor pathway during spinal surgery.

Paraplegia caused by irreversible lesions of the spinal cord is one of the major possible complications after scoliosis surgery. Several monitoring methods have been proposed but none are completely satisfactory. Since 1986 the authors assessed motor pathways during scoliosis surgery, using electrical stimulation of the motor cortex and lower limb muscle recordings (tibialis anterior muscle). Twenty-seven patients were included in this study: 25 with idiopathic scoliosis and 2 with dorsal kyphosis. Recordings in anesthetized patients with hypothermia were performed before and after spinal derotation during the surgical procedure. Magnetic cortical stimulation was carried out in ten awake patients before and after surgery. Reproducible responses were obtained in 22 patients under anesthesia. In eight patients no difference of the latency of the muscle response was detected before and after the correction of the spinal angulation. In 14 patients the increase of latency ranged from 0.4 ms to 5.2 ms. No correlation was found between the slowing of motor conduction and the magnitude of spine correction. No central neurologic complications were seen after surgery. The authors concluded that their study demonstrated that motor pathway assessment in anesthetized patients can be performed at different times during the surgical procedure. This technique should help in the future monitoring spinal function during scoliosis surgery.

Extramucosal pylorotomy by laparoscopy.

Extramucosal pylorotomies were performed by laparoscopy in infants with congenital hypertrophic pyloric stenosis. The surgical technique and precautionary measures taken for the pneumoperitoneum are described in these initial 10 cases. The advantages of this original technique are discussed.

Clustered cases of leptospirosis in Rochefort, France, June 2001.

Five clustered cases of leptospirosis were diagnosed in the area of Rochefort, France, in June 2001, among teenagers who had swum in the Genouillé canal. The symptoms included fever, headache, abdominal pain and vomiting, chills and myalgia. Three cases were confirmed by PCR and serology. The mean cumulative duration of bathing was significantly higher in cases (23.8 hours) compared to controls (14.4 hours). No other particular risk factor was observed. The environmental investigation revealed the presence of rodents excreting of leptospires near the bathing area. For all antigens considered, the occurence of seropositive rodents was 30.8%, L. icterohaemorrhagiae being the predominant serogroup (23,1%).

Extramucosal pyloromyotomy by laparoscopy.

Since 1990, we have performed extramucosal pyloromyotomies by laparoscopy in 70 infants presenting with congenital hypertrophic pyloric stenosis. Ever since the first cases, the technique and the instruments have been adapted. The surgical technique and the precautionary measures are here explained again. This technique is beneficial for infants with a better postoperative course and avoidance of any skin scar.

Abnormalities of cilia and chronic sinusitis.

An ultrastructural study was performed on 34 biopsy samples of the sinusal mucosa in 28 patients who were investigated for chronic sinusitis. Twelve specimens with normoplastic sinusitis and eighteen with hyperplastic sinusitis were studied. Four normal specimens served as controls. The incidence of ultrastructural ciliary abnormalities was 2%. Morphological changes of dynein arms have not been observed in the present study. Compound cilia were found in approximately 2/3 of the studied cases. Microtubular abnormalities occurred in roughly 50%. The observed abnormalities, also seen in the control group, were independent on the sinusitis type and could not been correlated with mucociliary transport. Their significance is discussed.

Endoscopic and histopathological observations of chronic maxillary sinusitis.

111 patients are studied in order to find possible relations between the endoscopic images and histopathological findings in the chronic maxillary sinusitis. The clasification of the different types of sinusitis is based on the aspect of the mucosa (normoplastic, hypoplastic, polypous, polypoido-polypous) and on the histological features (lymphoplasmocytic, eosinophilic, eosino-lymphoplasmocytic infiltration, low cellularity). The confrontation of the sinusoscopic and histopathological observations give interesting information, such as differenciation between stabilized and evolutive sinusitis, simple and complicated inflammation. This information facilitates our therapeutic choice.

[Antibiotic prevention with a single dose of metronidazole in appendectomy in children]. / Antibioprophylaxie par dose unique de métronidazole pour appendicectomie chez l'enfant.

One hundred children were prophylactically treated with 15 mg/kg-1 of metronidazole immediately before appendicectomy and retrospectively compared with 100 other patients without any antibioprophylaxis. No statistically significant difference was found between the two groups as regards age, weight, sex and macroscopic appearance of the appendix. The overall incidence of complications was 1% in the antibioprophylactic group and 9% in the control group. Furthermore, a single pre-operative intravenous dose of metronidazole was as effective as conventional antibioprophylaxis.

[Topographic anatomy of the ethmoid labyrinth in x-ray computed tomography]. / Anatomie topographique du labyrinthe ethmoïdal en tomodensitométrie.

These last years the surgical treatment of inflammatory ethmoid disease has been completely modified, with new endoscopic conservative procedures. In a preoperative phase it is mandatory to provide optimal CT imaging of the ethmoid labyrinth, and for this purpose sections perpendicular and parallel to the nasofrontal duct axis are better than axial and coronal slices. The anatomy of the ethmoid is fairly complex; however certain constant anatomic landmarks allow a systematic analysis of the ethmoid labyrinth: the unciform process, the bulla, the middle turbinate, the superior turbinate and their respective basal lamellae.

[Effects of isoflurane and halothane on motor evoked potentials in the rabbit]. / Effets de l'isoflurane et de l'halothane sur les potentiels évoqués moteurs chez le lapin.

The effects of isoflurane or halothane on motor evoked potentials (MEPs) were assessed and compared in the rabbit, in order to contribute to devise a rigorous human anaesthetic protocol to be used for monitoring of MEPs in corrective spinal surgery. Ten black adult New Zealand rabbits were anaesthetised twice at a month interval, once with isoflurane and once with halothane. Once a control cortical stimulation had been carried out after the animal had breathed pure oxygen for three minutes, the following concentrations of anaesthetic agent were given for 3 min each: respectively 0.3 vol %, 0.5 vol % and 1 vol % of isoflurane, and 0.5 vol % and 1 vol % of halothane. Cortical stimulation was carried out every minute. The signs of anaesthesia (diameter decrease of the pupil, eye covered by the nictating membrane), muscle relaxation (ears drop) and breathing rate were recorded. MEPs were recorded 1, 2, 3 and 5 minutes after the end of anaesthesia. Isoflurane had a stronger effect on MEPs than halothane. The effect was more pronounced on amplitude than on latency. MEPs remained present whatever the concentration of halothane. In 70% of cases, MEPs, discontinued with isoflurane, more rapidly, more deeply, and for a longer time. Mean latency was more constantly increased in the isoflurane than in the halothane group. The effect of volatile halogenated anaesthetics on mean latency of MEPs seemed to be more delayed than that on amplitude. One should also take into account an individual sensitivity, it is concluded that the interpretation of MEPs during anaesthesia with volatile halogenated agents should be carried out with caution.

[The thesis of Reininger (1722) in the history of pituitary sinuses]. / La thèse de Reininger (1722) dans l'histoire des sinus pituitaires.

The thesis written by Sebastian Reininger in 1722 was conserved by Albert de Haller, the renowned scholar who collected interesting medical publications in the 18th century. He included Reininger's work on the pituitary sinuses in his Disputationes anatomicae. This thesis is probably the first published work dealing exclusively with the sinuses and their anatomy, function and pathology. There are also some comments on therapy. It was thus written before thesis by Ludolph Heinrich Runge (1750) often cited as the earliest work in this field. The Reininger dissertation is based on a personal series of cranial dissections and is completed with references to other authors of the same period. It is an interesting synopsis of the knowledge of pituitary sinuses at the beginning of the 18th century.

[Anatomic and endoscopic studies of the anterior ethmoid]. / Etude anatomique et endoscopique de l'ethmoïde antérieur.

Introduction of present-day sinonasal endoscopy and progress in endonasal surgery under endoscopic guidance of endoscopy provide for anatomical exploration of the anterior part of the ethmoid bone, which is the crosspoint of the facial sinus draining paths. We propose to present here a simple and logical scheme of the topographical anatomy of the ethmoid bone. Classification of the ethmoidal cells allows to define the structures, whereby appropriate nomenclature may be adopted and certain confusions avoided. Thus, each cell within particular cell groups acquires a specific designation based on its draining paths and location in relation to basal lamellae. Endoscopic analysis also deserves being described in some length, since the panoramic view afforded by currently used optics modifies the image ans requires that the observer develop an "endoscopic eye". We draw attention to the endoscopic anatomical fine points in the crucial area of the bullar "circus". These landmarks come in as necessary guides in surgical practice.

[Spinal anesthesia in ambulatory anesthesia of the infant]. / La rachianesthésie dans la chirurgie ambulatoire du nourrisson.

Two hundred spinal anesthesias have been performed in infants for abdominal surgery, thirty of which for day surgery. Intrathecal injection of 0.5% bupivacaine solution is realised in good conditions, sometimes with narcosis complementation (ketamine or halothane). Motor block takes place without delay and lasts for an average of 95 +/- 25 minutes. There is no hemodynamic disturbance. This technic could be used in day surgery by reason of quick recovery.

[Caudal and spinal anesthesia in sub-umbilical surgery in children. Apropos of 1875 cases]. / Anesthésie caudale et rachianesthésie dans la chirurgie sous-ombilicale chez l'enfant. A propos de 1875 cas.

Caudal and spinal anaesthesia are two techniques widely used in European children. The aim of this retrospective study was to evaluate the applicability of this practice in developing countries. The study concerned 1875 children, 1 day to 17 years old. isobaric 0.5% bupivacaine was used for spinal anaesthesia (n = 730) and mixture a of 1% lidocaine-0.25% bupivacaine with epinephrine 1/200,000 for caudal anaesthesia (n = 1,145). Spinal anaesthesia was performed in neonates and infants (< 3 years) and caudal anaesthesia in children (aged 14 days to 17 years) undergoing urological and lower extremity surgery. No variation of heart rate, blood pressure or blood oxygen saturation (SpO2) were observed during surgery. Failure of the technique was less than 1%. These two regional anaesthesia techniques are easy to perform and are inexpensive. This is advantageous for developing countries.

[Supportive, palliative care in lung cancer]. / Les soins de support dans les cancers bronchopulmonaires (CBP).

BACKGROUND: Despite recent advances, the prognosis of lung cancer (LC) remains poor and justifies the early introduction of palliative care (PC) and supportive care (SC). The objective of this paper is to describe the published data in this field. METHODS: After definitions of PC and SC, the different types of study are depicted: randomized clinical trials (RCT) and observational studies. RESULTS: All the RCT (most often performed in the USA) have emphasised the importance of the early introduction of PC and SC (less aggressive treatments at the end of life, better quality of life). Observational studies are scarce. The one performed in France (ETOBSUP study) showed that PC and SC, in real life, have not reached the objectives of the National Cancer Institute. CONCLUSION: All the studies agreed that PC and SC should be introduced as early as possible in patients with LC.

[Locoregional analgesia in palliative care: a 4-year survey]. / Analgésie locorégionale en soins palliatifs : bilan de quatre années d'utilisation.

UNLABELLED: It could append that patient pain relief in palliative care is not achieved despite the use of opioids and the multimodal approach. Therefore, regional techniques are used in the palliative care unit of the Limoges University Hospital since four years. PATIENTS AND METHODS: From October 2006 to September 2010, every patient under regional technique was followed with a specific form. The items collected were demographic characteristics, underlying disease, and associated treatments. The efficacy of regional techniques on pain was scored. RESULTS: Sixty-three patients, 39 males and 24 females, mean age 59 years, were treated by 104 regional procedures. There were 49 neuroaxial analgesia (40 spinal and nine epidural), 39 peripheral nerve blocks including 25 iliofascial blocks and 16 blocks for nerves of the scalp, face and neck. In 67.5% of the cases, the regional techniques provided adequate pain relief. For 24% of the cases, the results were uncompleted. Regional techniques were unsuccessful in 8.5%. CONCLUSION: Despite this underperformance in terms of pain control, a multicenter study is ongoing to evaluate the improvement of quality of life induced by the regional techniques.

[About safety parameters for patient-controlled analgesia (PCA) devices]. / À propos des paramètres de sécurité des pompes d'analgésie contrôlée par le patient (PCA).

During the course of preparation of an opioid prescription, the nurse in charge became aware that the patient-controlled analgesia (PCA) syringe driver did not permit programming for the delivery as required: a maximum bolus number (Bmax) was indicated but only a maximum cumulative dose (Dcmax) could be programmed. The prescription dose criteria were consistent with the guidelines of the French societies of palliative care, anesthesiology, and reanimation (Société française d'accompagnement et de soins palliatifs [Sfap] and Société française d'anesthésie réanimation [Sfar]). A Dcmax dose simulation was programmed and used in order to test this problem. This highlighted the following four defects: bolus delivery is not controlled, leading to potential overdose. When Dcmax is reached, the continuous flow stops, triggering an end dose failure and a new programming step is needed to restart infusion, increasing the risk of programming errors. Human intervention is required to stop the alarm, identify and solve the problem. Finally, Dcmax leads to random dose delivery in place of the predictability of dose delivery expected for opioid administration. On the other hand, Bmax is a limited dose, administered only as a bolus and regulated by the lockout interval. When the Bmax dose is reached, no alarm is triggered, the basal flow continues, but no additional doses can be delivered. Bmax and Dcmax systems are not interchangeable. No comparative study between Bmax and Dcmax could be found, and Sfap and Sfar guidelines are not precise and did not take into consideration the safety aspects of dose delivery however some facts tend to prefer that Bmax. Most of the syringe driver devices are configured for the Dcmax, but not all of them, and the physician is often forced to use the parameter of the available device restricting the choice between Bmax and Dcmax. This is not justified, whether by scientific evidence, industrial, manufacturing or commercial standards. It becomes only a technical option that does not promote standardization of dose delivery and compromises the main safety feature of PCA.