Seroprevalence of seven pathogens transmitted by the Ixodes ricinus tick in forestry workers in France.

In order to assess the level of occupational exposure to the main pathogens transmitted by the Ixodes ricinus tick, a seroprevalence study was performed on serum samples collected in 2003 from 2975 forestry workers of northeastern France. The global seroprevalence estimated for the seven pathogens studied was 14.1% (419/2975) for Borrelia burgdorferi sl, 5.7% (164/2908) for Francisella tularensis, 2.3% (68/2941) for tick-borne encephalitis virus, 1.7% (50/2908) for Anaplasma phagocytophilum and 1.7% (48/2908) for Bartonella henselae. The seroprevalences of Babesia divergens and Babesia microti studied in a subgroup of participants seropositive for at least one of these latter pathogens were 0.1% (1/810) and 2.5% (20/810), respectively. Borrelia burgdorferi sl seroprevalence was significantly higher in Alsace and Lorraine and F. tularensis seroprevalence was significantly higher in Champagne-Ardenne and Franche-Comté. The results of this survey also suggest low rates of transmission of Bartonella henselae and F. tularensis by ticks and a different west/east distribution of Babesia species in France. The frequency and potential severity of these diseases justify continued promotion of methods of prevention of I. ricinus bites.

Subclavian crush syndrome: a cause of pacemaker lead fracture.

A 48-year-old male with a symptomatic 2:1 atrio-ventricular block and a dual-chamber pacemaker, implanted one year previously, was admitted due to a syncopal episode. Pacemaker malfunction was identified as the cause of syncope. Subclavian crush syndrome was the cause of the pacemaker malfunction. Its incidence, consequences and management are discussed in this report.

Susceptibility of mice to invasive aspergillosis correlates with delayed cell influx into the lungs.

Ubiquitous fungus Aspergillus fumigatus (A. fumigatus) is involved in invasive pulmonary aspergillosis (IPA), a frequent infection in immunocompromized patients. Genetic differences are likely to play a role predisposing to IPA. This study was aimed to compare six genetically different mouse strains in their susceptibility to IPA and to determine possible mechanisms involved in the pathogenesis of this infection. Immunosuppressed BALB/c and C57BL/6 mice infected with A. fumigatus conidia were more resistant to IPA than DBA/1, DBA/2, CBA, and A/Sn strains. Phagocytosis of A. fumigatus conidia by blood polymorphonuclear neutrophils (PMN) or bone marrow derived dendritic cells showed no difference between strains. All IPA susceptible strains demonstrated decreased PMN influx into the lungs during infection compared with resistant strains. Flow cytometry analysis of the composition of lung infiltrating cells showed that IPA susceptible mice had a decreased number of phagocytes before the infection. After infection the numbers of Gr-1(+)CD11b(+) PMN cells in the lungs of immunosuppressed mice increased from 10-20% to 50-60% while the percentage of CD11(+)F4/80(+) resident macrophages was unchanged. Among susceptible strains DBA/2 and A/Sn have a defect in C5 component of complement. Injection of normal serum into complement deficient but not into complement sufficient CBA or DBA/1 mice significantly improved their survival. We showed that complement replacement significantly increased PMN homing to the lungs of complement deficient mice. Thus, defect in complement system can predispose to IPA. Our results demonstrated that early influx of PMN into the lungs of mice is important for the resistance to IPA.

[Acute myocardial infarction as an incidental finding: reflections on the preanesthesia evaluation]. / Infarto agudo de miocardio como hallazgo casual: consideraciones sobre la evaluación preanestésica.

A preoperative electrocardiogram in a 16-year-old boy scheduled for surgery for a fractured radius and mandibular condyle after a motorcycle accident showed signs of myocardial ischemia as an incidental finding. Coronary arteriography revealed complete occlusion of the anterior descending artery, confirming a diagnosis of acute coronary syndrome with ST elevation, with no myocardial viability. As the patient's general condition was acceptable, to prevent severe functional sequelae, surgery was rescheduled for 17 days later. An axillary block was well tolerated at that time. While indiscriminate ordering of preoperative tests is not recommended in the literature, such testing continues to be practiced in many hospitals, possibly for reasons of organization and legal cover. In our case, the electrocardiogram made it possible to diagnose a severe lesion and adjust the anesthetic technique to suit this situation, thereby possibly preventing devastating consequences. We recommend performing an electrocardiogram on all patients with suspected blunt chest trauma, regardless of the severity of the lesions, particularly in patients scheduled for surgery.

Infarto agudo de miocardio como hallazgo casual: consideraciones sobre la evaluación preanestésica / Acute myocardial infarction as answer finding: reflections on the preanesthesia evaluation

Un varón de 16 años, propuesto para cirugía por fracturade radio y cóndilo mandibular tras caída de motopresentó, en el electrocardiograma preoperatorio, signosde isquemia miocárdica como hallazgo casual. La coronariografíadetectó una obstrucción completa de la ramadescendente anterior y se confirmó el diagnóstico de síndromecoronario agudo con elevación de ST, sin viabilidadmiocárdica. Dado que el paciente mantenía un aceptableestado general, y con el fin de evitar secuelasfuncionales graves, se intervino en el 17º día de evolución,bajo bloqueo axilar, con buena tolerancia.Aunque la solicitud indiscriminada de pruebas preoperatoriasno está recomendada por la literatura médica,se sigue realizando en muchos centros, posiblementepor motivos organizativos y de cobertura legal. En elcaso presentado, el electrocardiograma permitió el diagnósticode una lesión grave y el ajuste de la técnica anestésicaa esta condición, lo que posiblemente evitó consecuenciasdevastadoras.Como conclusión, se sugiere la conveniencia de realizarun control electrocardiográfico a cualquier pacientecon sospecha de haber sufrido un traumatismo torácicocerrado, independientemente de la gravedad de las lesiones,especialmente si va a ser sometido a intervenciónquirúrgica(AU)

A preoperative electrocardiogram in a 16-year-oldboy scheduled for surgery for a fractured radius andmandibular condyle after a motorcycle accident showedsigns of myocardial ischemia as an incidental finding.Coronary arteriography revealed complete occlusion ofthe anterior descending artery, confirming a diagnosis ofacute coronary syndrome with ST elevation, with nomyocardial viability. As the patient’s general conditionwas acceptable, to prevent severe functional sequelae,surgery was rescheduled for 17 days later. An axillaryblock was well tolerated at that time. Whileindiscriminate ordering of preoperative tests is notrecommended in the literature, such testing continues tobe practiced in many hospitals, possibly for reasons oforganization and legal cover. In our case, theelectrocardiogram made it possible to diagnose a severelesion and adjust the anesthetic technique to suit thissituation, thereby possibly preventing devastatingconsequences. We recommend performing anelectrocardiogram on all patients with suspected bluntchest trauma, regardless of the severity of the lesions,particularly in patients scheduled for surgery(AU)

Effects of conidia of various Aspergillus species on apoptosis of human pneumocytes and bronchial epithelial cells.

Aspergillus species can cause mycoses in human and animals. Previously, we demonstrated that A. fumigatus conidia from a human isolate inhibited apoptosis in human pneumocytes and bronchial epithelial cells. In the current study, we studied the effects of A. fumigatus conidia non-human origin and A. flavus, A. nidulans, A. niger and A. oryzae conidia on human cells apoptosis. Human pneumocytes or bronchial epithelial cells were simultaneously exposed to apoptotic inductors and aspergilli conidia. The cell cultures were analyzed by flow cytometry, immunoblotting, and examination of nuclear morphology. Similar to A. fumigatus conidia, A. flavus conidia inhibited cellular apoptosis while A. nidulans, A. niger and A. oryzae conidia did not affect apoptosis. We further studied the species specificity of conidia: there were no differences in the inhibition of apoptosis by A. fumigatus conidia from either human or bird isolates. In order to determine whether the inhibition of apoptosis by conidia is limited to certain strains, the effect on human cell apoptosis of different A. fumigatus human clinical isolates and A. fumigatus of environmental origin was evaluated. All A. fumigatus isolates inhibited apoptosis; an anti-apoptotic factor was released by conidia. For TNF-induced apoptosis, the anti-apoptotic effect of conidia of all isolates was found to be associated with a reduction of caspase-3 in human cells. The results suggest that suppression of apoptosis may play a role in reducing the efficacy of host defense mechanisms during infection with Aspergillus species.

[Total intravenous anesthesia for repositioning an implantable defibrillator in a patient with long QT syndrome]. / Anestesia total intravenosa para recolocación de un desfibrilador automático implantable en paciente con síndrome de QT-largo.

We report the case of a 27-year-old woman with congenital long QT syndrome (LQTS) who was scheduled for surgery to reposition an implantable defibrillator. Given the risk of sudden death due to fatal ventricular arrhythmia, the woman required implantation of a defibrillator with pacemaker capability. Combined anesthesia-analgesia was used in order to minimize the risk of ventricular arrhythmia caused by increased serum concentrations of catecholamines. When cardioversion, defibrillation and anti-tachycardia functions had been deactivated, anesthesia was induced with propofol, fentanyl and rocuronium. Anesthesia was maintained with an infusion of propofol and remifentanil. We describe the pathophysiology and treatment of LQTS and discuss anesthetic management for repositioning a defibrillator in a patient with congenital LQTS.

Anestesia total intravenosa para recolocación de un desfibriladorautomático implantable en paciente con síndrome de QT-largo / Total intravenous anesthesia for repositioning an implantable defibrillator in a patient with long QT syndrome

Presentamos el caso de una mujer de 27 años, con síndromede QT-largo (SQTL) de origen congénito, programadapara recolocación de un desfibrilador automáticoimplantable (DAI). Debido al riesgo de muerte súbitasecundario a arritmias ventriculares letales, precisó laimplantación de un DAI con capacidad de marcapasos.Para minimizar el riesgo de arritmias ventricularessecundarias al incremento de las concentraciones séricasde catecolaminas, la técnica anestésica elegida se basó enla analgesia. Desactivadas las funciones de cardioversión,desfibrilación y antitaquiarritmias, se procedió a lainducción anestésica con propofol, fentanilo y rocuronio.El mantenimiento anestésico se realizó con perfusión depropofol y remifentanilo. Describimos la fisiopatología yel tratamiento del SQTL, y se discute el manejo anestésicopara la recolocación de un DAI en una pacienteafecta de SQTL de origen congénito (AU)

We report the case of a 27-year-old woman withcongenital long QT syndrome (LQTS) who was scheduledfor surgery to reposition an implantable defibrillator.Given the risk of sudden death due to fatal ventriculararrhythmia, the woman required implantation of adefibrillator with pacemaker capability. Combinedanesthesia-analgesia was used in order to minimize therisk of ventricular arrhythmia caused by increased serumconcentrations of catecholamines. When cardioversion,defibrillation and anti-tachycardia functions had beendeactivated, anesthesia was induced with propofol,fentanyl and rocuronium. Anesthesia was maintainedwith an infusion of propofol and remifentanil. Wedescribe the pathophysiology and treatment of LQTS anddiscuss anesthetic management for repositioning adefibrillator in a patient with congenital LQTS (AU)

Exéresis de un liposarcoma bajo en anestesia combinada intradural - epidural y sedación con propofol y renifentanilo en paciente embarazada / No disponible

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[Spinal anesthesia in a patient with congenital complete atrioventricular block]. / Anestesia subaracnoidea en paciente portador de bloqueo auriculoventricular completo congénito.

Congenital complete atrioventricular block is a rare cardiac conduction abnormality that predisposes to arrhythmias and cardiac arrest. Recommendations for the anesthetic management of patients with this condition are based on the few case reports that have been published. We describe the successful use of spinal anesthesia for ankle osteosynthesis in a patient with asymptomatic congenital complete atrioventricular block detected during preoperative assessment.

Anestesia subaracnoidea en paciente portador de bloqueo auriculoventricular completo congénito / Spinal anesthesia in a patient with congenital complete atrioventricular block

El bloqueo auriculoventricular completo congénito esuna rara anomalía de la conducción cardiaca que predisponea la aparición de arritmias y paro cardiaco. Lasrecomendaciones para su manejo anestésico se basan enlos pocos casos clínicos publicados. Se describe la utilización,con éxito, de la anestesia subaracnoidea paraosteosíntesis de tobillo en una paciente portadora debloqueo auriculoventricular completo congénito asintomático,detectado en el estudio preoperatorio (AU)

Congenital complete atrioventricular block is a rare ;;cardiac conduction abnormality that predisposes to ;;arrhythmias and cardiac arrest. Recommendations for ;;the anesthetic management of patients with this ;;condition are based on the few case reports that have ;;been published. We describe the successful use of spinal ;;anesthesia for ankle osteosynthesis in a patient with ;;asymptomatic congenital complete atrioventricular ;;block detected during preoperative assessment (AU)

Insuficiencia respiratoria asociada a hipofosfatemia / Respiratory failure related to hypophosphatemia

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Infecciones en el paciente “gran quemado” en una Unidad de Cuidados Críticos / Infections in patients with extensive burns in the critical care unit

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[Aortopulmonary fistula complicating aortic arch aneurysm]. / Fistula aorto-pulmonar como complicación de aneurisma de cayado aórtico.

Aortopulmonary fistulas secondary to thoracic aneurysms are difficult to diagnose and few cases are reported in the literature. We describe the case of a patient first admitted to another hospital with a diagnosis of right upper lobe pneumonia. After the patient had been a week in hospital without improving, a computed tomography scan of the chest revealed a saccular aneurysm of the aortic arch measuring 9 cm at its widest diameter. Hemodynamics and respiratory signs deteriorated a few hours after transfer to our hospital. Physical examination revealed a systolic murmur and poor peripheral perfusion. The patient was intubated and inotropic support was provided. Upon insertion of a Swan-Ganz catheter, given suspicion of septic shock, progressive elevation of mixed venous oxygen saturation was observed. Measurement of venous oxygen saturation was 74% in the right atrium and 93% in the pulmonary artery. Left-right shunt was diagnosed and an emergency aortography revealed the aortopulmonary fistula. Emergency surgery was performed with the patient in deep hypothermia and cardiocirculatory arrest. There were no adverse events, and postoperative recovery and clinical course were good.

B-1-like cells exist in sheep. Characterization of their phenotype and behaviour.

Two populations of B lymphocytes, B-1 (CD5+ and/or CD11b+) and B-2 (CD5- and CD11b-) cells have been described. In mice, which is the species of reference for B-1 and B-2 cell studies, these two subsets present different developmental schemes, phenotypes, antibody repertoires, localization and behaviours. Interestingly, in sheep, B cells rearrange their immunoglobulin (Ig) loci around the neonatal period, similarly to murine B-1 cells. However, the phenotype of the sheep B cells has not been characterized with regards to their developmental pathway. In this report, we show that two sheep B-cell subsets can be distinguished on the basis of CD11b expression. Relative to CD11b- B cells, the CD11b+ B cells frequently co-express CD5, CD11c, higher levels of surface IgM (sIgM), show larger cell size and higher cell-cycling activity, and thus present a B-1-like phenotype. However, unlike murine B-1 cells, sheep B-1 like cells mainly localize in blood, display a higher propensity to spontaneous apoptosis relative to B-2-like cells, and proliferate after sIgM stimulation. Our data show that despite neonatal immunoglobulin loci rearrangements, sheep B cells do not all express a B-1-like phenotype. However, B-1-and B-2-like cells co-exist and present phenotypic and behavioural specificities. Nevertheless, sheep B-1-and B-2-like cells differ from the murine B-1 and B-2 cells in their cell behaviour. These subsets can thus not be considered as true homologues among species.

Two- and three-dimensional cell structures govern epidermal growth factor survival function in human bladder carcinoma cell lines.

Human bladder carcinomas often express high levels of the epidermal growth factor (EGF) receptor. In three human bladder carcinoma cell lines (OBR, T24, and 647V), we show that two EGF receptor ligands, namely EGF and transforming growth factor alpha, enhanced the apoptosis due to serum starvation on cells cultured as monolayers. Conversely, EGF and transforming growth factor alpha prevented apoptosis when the same serum-starved cells were cultured as three-dimensional spheroids. Both stimulation and inhibition of apoptosis by EGF were associated with p21 WAF1/CIP1 overexpression. In 647V spheroids, EGF protection against radiation-induced apoptosis was negated by genistein and tyrphostin AG1478, suggesting that blockade of the EGF signal transduction in patients with bladder cancer may improve the radiotherapy efficacy.

Feeding heated soyabean flour increases the density of B and T lymphocytes in the small intestine of calves.

The effect of dietary antigens on the gut morphology and density of immune cells was studied in preruminant calves fed milk substitutes containing skim milk powder (SMP), non-antigenic hydrolysed soya protein isolate (HSPI) or antigenic heated soyabean flour (HSF) as their main protein source for 3 months. The height and perimeter of proximal jejunum villi were highest in the calves fed SMP and lowest in those fed HSF (P < 0.05). In contrast, the crypt depth and perimeter were apparently not influenced by the dietary treatments studied. This morphological alteration was associated with a dramatic infiltration of the lamina propria by B and T lymphocytes in the calves fed HSF (P < 0.01). Increased B cell density was essentially accounted for by IgA-, IgG1- and IgG2-bearing cells. The density of CD2-positive T lymphocytes increased (P < 0.01) in the jejunal lamina propria of HSF calves, involving helper (CD4+) and suppressor-cytotoxic (CD8+) T cell subsets. The density of gamma-delta (WC1+) T cells also increased (P < 0.01). The major change concomitantly observed in the villus epithelium was an increased density of CD8+ cells (P < 0.05) and WC1 + cells (P < 0.01).