Superficial temporal artery injury and delayed post-cranioplasty infection.

OBJECTIVE: Complications after cranioplasty after decompressive craniectomy (DC) have been reported to be as high as 40%. The superficial temporal artery (STA) is at substantial risk for injury in standard reverse question-mark incisions that are typically used for unilateral DC. The authors hypothesize that STA injury during craniectomy predisposes patients to post-cranioplasty surgical site infection (SSI) and/or wound complication. METHODS: A retrospective study of all patients at a single institution who underwent cranioplasty after decompressive craniectomy and who underwent imaging of the head (computed tomography angiogram, magnetic resonance imaging with intravenous contrast, or diagnostic cerebral angiography) for any indication between the two procedures was undertaken. The degree of STA injury was classified and univariate statistics were used to compare groups. RESULTS: Fifty-four patients met inclusion criteria. Thirty-three patients (61%) had evidence of complete or partial STA injury on pre-cranioplasty imaging. Nine patients (16.7%) developed either an SSI or wound complication after cranioplasty and, among these, four (7.4%) experienced delayed (>2 weeks from cranioplasty) complications. Seven of 9 patients required surgical debridement and cranioplasty explant. There was a stepwise but non-significant increase in post-cranioplasty SSI (STA present: 10%, STA partial injury: 17%, STA complete injury: 24%, P=0.53) and delayed post-cranioplasty SSI (STA present: 0%, STA partial injury: 8%, STA complete injury: 14%, P=0.26). CONCLUSIONS: There is a notable but statistically non-significant trend toward increased rates of SSI in patients with complete or partial STA injury during craniectomy.

Is it justified to search for cancer in patients with peripheral arterial disease?

BACKGROUND: Cancer is the leading cause of death in European countries, ahead of cardiovascular diseases. Cancer is also the most common co-morbidity among patients hospitalized for the management of cardiovascular diseases. Through an overview, we searched for the frequency and types of cancer associated with peripheral arterial disease (PAD) in order to address the relevance of cancer screening in patients with PAD. METHODS: We searched in PubMed database from 1996 to 2020 for retrospective and prospective cohort or cross-sectional or randomized studies evaluating the frequency of all types of cancer in patients with PAD excluding patients with aneurysmal disease. The keywords used were: peripheral arterial disease, arterial thrombosis, acute leg ischemia, critical leg ischemia, chronic leg ischemia, intermittent claudication, malignant tumor, cancer. RESULTS: Based on published studies, the frequency of cancer in patients with PAD varied widely from 3.8 to 30.4% depending on study design, population, method used to screen for cancer and study period. In medical records database and registers,cancer prevalence varied from 3,8% to 22,4% in 4 retrospective studies of patients with acute limb ischemia and from 10.5 to 30.4% in 3 prospective studies of patients with acute limb ischemia, critical ischemia or intermittent claudication. In 3 retrospective analyses from 2 population-based cohorts and health insurance claims data, incidence of cancer in patients with intermittent claudication, acute limb ischemia or peripheral arterial disease varied from 8% to 11.7%. The frequency of cancer in PAD patients appeared higher than in the general population. Tobacco-dependent cancers seemed to be the most common cancers in PAD. Cancers were also more frequent in case of anemia, amputation and iterative bypass thrombosis in few studies. CONCLUSION: Although there is no recommendation for cancer screening in patients with PAD, the high prevalence of cancer raises the question of screening patients at high risk such as those with acute or critical limb ischemia and especially in case of severe tobacco use, anemia, amputation and iterative bypass thrombosis. These results call for further studies with larger sample size and long term follow-up.

[Detection of micro-embolic signals: a review of the literature]. / Détection de signaux micro-emboliques: revue de la littérature.

BACKGROUND: The detection of micro-embolic signals (MES), by transcranial Doppler sonography might be useful for risk stratification in patients with symptomatic and asymptomatic carotid or cerebral artery stenosis, dissections, aortic atheroma, interventional procedures, and right to left cardiac shunts. AIM: Review of the technique and clinical situations of MES detection. METHODS: PubMed search from 1990 to 2012. RESULTS: MES were found in 0,19, 48% versus 0,3, and 12% of patients with symptomatic and asymptomatic inferior than 30, 30 to 69, and 70 to 99% carotid stenosis, respectively. MES were related to the risk of recurrent stroke or transient ischemic attack (TIA). In the ACES study, the absolute annual risk of stroke or TIA after 2 years was 7% with vs 3% without MES. In patients with intracranial stenosis, the risk of stroke recurrence was 48% with vs 7% without MES at 13.6 months follow-up. MES were reported in 25% of the symptomatic versus none of the asymptomatic patients with intracranial stenosis. CONCLUSION: Detection of MES is feasible and reproducible for multicenter studies, using rigourous methodology and long lasting recordings. It may contribute to risk stratification, especially in patients with extra- or intracranial stenosis.

Risk of pulmonary embolism and/or deep venous thrombosis in Asian-Americans.

Several reports from Asian countries suggest a low prevalence of pulmonary embolism (PE) and deep venous thrombosis (DVT) in Asians, and sparse US data show that a slightly higher prevalence of PE/DVT in "nonwhites" than in whites is evident in all geographic regions except the Pacific region (California, Oregon, and Washington) where "nonwhites" include a larger proportion of Asians and Hispanics than in other US locations. We prospectively studied PE/DVT hospitalizations in 128,934 persons in relation to traits determined at health examinations in 1978 to 1985. Through 1994, 337 persons were subsequently hospitalized for PE and/or DVT (for PE first, n = 206). Cox proportional-hazards models with 9 covariates were used. In multivariate models, the following RRs (95% confidence intervals) were found for PE/DVT combined: black/white = 1.1 (0.4 to 1.4); Hispanic/white = 0.7 (0.3 to 1.5); and Asian/white = 0.2 (0.1 to 0. 5; p = 0.002). The lower risk of Asians was present in each sex and for persons first hospitalized for either PE or DVT. Covariates with significant positive relations to risk were age, male sex, body mass index, and a composite coronary disease risk/symptom variable; covariates not significantly related were education, marital status, smoking, and alcohol. These data suggest that Asians have very low risk of PE/DVT, which may account for US geographic variations in white/non-white risk differences. Possible explanations include the absence of hazardous mutations or unspecified PE/DVT protective traits in Asians.

Acute dislocation of the patella. A correlative pathoanatomic study.

The objective of our study was to elucidate the characteristic pathoanatomy associated with patellar dislocation and report the preliminary results of early surgical repair. Twenty-three patients with documented patellar dislocation had standard radiographs and a magnetic resonance imaging scan. Intraarticular lesions were evaluated and treated arthroscopically followed by an open exploration of the medial aspect of the knee in 16 patients. Twelve patients were observed for a minimum of 2 years after surgical repair (average, 34 months). Eleven patients returned for a follow-up examination. Magnetic resonance imaging revealed effusion (100%), tears of the femoral insertion of the medial patellofemoral ligament (87%), increased signal in the vastus medialis muscle (78%), and lateral femoral condyle (87%) and medial patellar (30%) bone bruises. Arthroscopic examination revealed osteochondral lesions involving the patella and the lateral femoral condyle in 68% of cases. Open surgical exploration revealed tears of the medial patellofemoral ligament off the femur in 15 of 16 patients (94%). After medial patellofemoral ligament repair, none of the patients experienced recurrent dislocation. Overall 58% of the results were considered to be good or excellent and 42% were fair. Fifty-eight percent of the group returned to their previous sport with no or minor limitations.

Changes on magnetic resonance images after traumatic hip dislocation.

Fourteen patients with traumatic hip dislocation had serial magnetic resonance imaging and routine radiographic studies from the time of injury through 24 months after injury. One experienced radiologist interpreted all images prospectively for abnormalities suggesting osteonecrosis of the femoral head and posttraumatic arthritis. Eight hips demonstrated abnormal marrow signals on T1 and T2 weighted images within 6 weeks of injury. These changes progressed in 3 hips, and osteonecrosis was confirmed subsequently by plain radiography. The abnormal marrow signals in the remaining 5 hips proved to be transient, resolving on magnetic resonance images within 3 months in 4 of the 5 patients. Magnetic resonance imaging can be used with confidence for the early detection of osteonecrosis of the femoral head after traumatic hip dislocation or fracture-dislocation. The presence of acetabular or femoral shaft hardware did not preclude magnetic resonance imaging assessment of these patients when coronal, sagittal, and axial images were obtained. Magnetic resonance imaging was not reliable for assessing marrow changes within the first week after injury, nor was it helpful in predicting which patients were at risk for posttraumatic arthritis to develop. An algorithm is proposed for using magnetic resonance imaging in the early diagnosis of osteonecrosis of the femoral head after traumatic hip dislocation.

Acute rupture of the extensor hallucis longus tendon.

A 40-year-old man with a history of previous cheilectomy and two steroid injections for first metatarsophalangeal degenerative joint disease sustained an acute rupture of the extensor hallucis longus tendon. He was treated successfully with delayed primary repair of the tendon.

Impaired hexose uptake by diploid skin fibroblasts from galactosaemic patients. Connection with cell growth and amino acid metabolism, and possible bearing on late-onset clinical symptoms.

In skin fibroblasts of patients presenting with galactosaemia, either from galactose 1-phosphate uridyltransferase or galactokinase deficiency, a deficit in extracellular glucose utilization was observed. This deficit was constant over 3 weeks of continuous cell growth in a medium containing 5.5 mmol/L glucose as the only hexose, and homologous serum. Levels of glucose utilization by deficient skin fibroblasts were stable at about 65-70% of the glucose utilization of control normal skin fibroblasts. Cell morphology was normal, and cell growth was subnormal during this period. However, the energy provision appeared sufficient for cellular needs since cell growth in this glucose medium was observed not to depend on the presence of extracellular glutamine. In contrast, glutamine was required for growth of galactosaemic fibroblasts cultured in medium containing 5.5 mmol/L galactose. If expressed in many cell types, this impaired glucose uptake would be expected seriously to damage highly glucose-dependent tissues such as the central nervous system. This might be of relevance to the persistent neurological damage observed in many galactosaemic patients in spite of their compliance with an early strict galactose-free diet.

Cervical spondylolysis.

The term cervical spondylolysis describes a long-standing, perhaps congenital defect of the pars interarticularis of a cervical vertebra. We report 10 new cases of cervical spondylolysis and review the literature. All patients in this report were treated nonoperatively with subsequent symptomatic improvement. Cervical spondylolysis must be differentiated from its traumatic counterparts radiographically. Characteristic radiographic findings include well-corticated margins at the defect, a characteristic "bow tie" deformity, and ipsilateral dysplastic facets. Compensatory hypertrophic changes of the adjacent articular processes, spina bifida, and spondylolisthesis are frequently, but not always, seen in conjunction with cervical spondylolysis. The vast majority of patients with radiographically proven cervical spondylolysis can be treated confidently with conservative measures. Surgical intervention should be reserved for those who fail nonoperative management or who exhibit neurologic compromise referable to an unstable spondylolytic defect.

[Cardiac output studied by a non invasive method in hypertensive patients]. / Etude du débit cardiaque par une méthode non invasive chez des hypertendus.

We measured by thoracic bioimpedance (BoMed, NCCOM3-R7) non invasive cardiac index (CI), stroke index (SI) and systemic vascular resistance index (SVRI) in 48 hypertensive patients (OMS) compared to 30 normotensive. The mean arterial pressure (MAP) and the SVRI were significantly higher in the hypertensive group while the CI are significantly lower, as that was shown in previous invasive studies. We found an inverse correlation between age and CI (r = -.30, p < or = .05) in relation with a negative correlation between SI and age (r = -.35, p < or = .05) and no correlation between heart rate and age. Furthermore we divided normotensive and hypertensive patients in three groups of CI (low CI < 2.8 l/min/m2, 2.8 < or = normal CI < or = 4.2 l/min/m2, high CI > 4.2 l/min/m2) and in three groups of SVRI (low SVRI < 1660 Flohms/m2, 1660 < or = normal SVRI < or = 2580 Flohms/m2, high SVRI > 2580 Flohms/m2). Despite CI diminution in hypertension, high CI percentage's was the same in normotensive and hypertensive patients. In conclusion, these results confirm previous studies by using a simple, easy, non invasive and reproducible method.

[Adjustment of double-chamber pacemakers in VDD mode by measurement of thoracic electric bio-impedance]. / Réglage des stimulateurs double chambre en mode VDD par mesure de la bio-impédance electrique thoracique.

An optimal atrioventricular interval (AVI) was sought in 6 patients with a double chamber pacemaker by an non-invasive technique: measurement of stroke volume by thoracic bioimpedance. This method proved to be easy and reliable in practice when there was only one pacing spike (VDD mode). It confirmed the existence of a variable optimal AVI according to individual patients: 250 ms (3 patients), 200-250 ms (1 patient), 150 ms (1 patient), 75-100 ms (1 patient). The value of optimal AVI is unpredictable since it depends upon individual electrophysiological and hemodynamic parameters. In a patient with severe mitral incompetence, Echo-Doppler provided evidence of end-diastolic ventriculo-atrial regurgitation at middle and long AVI, while a short AVI enabled elimination of end-diastolic regurgitation and a 15.45 per cent improvement in stroke volume. In two patients with a long optimal AVI (250 ms), a programmed short AVI (75 ms) paradoxically appeared to be more favourable than a middle AVI (150 ms).

[Cardiac mass, ventricular relaxation parameters and their correlation with blood pressure during rest and ambulatory monitoring]. / Paramètres de masse cardiaque, de relaxation ventriculaire et leurs corrélations avec la pression artérielle enregistrée au repos et en ambulatoire.

UNLABELLED: A resting blood pressure (Dynamap, 8AM-8PM, one recording every 15 minutes) has been recorded among 60 patients; mean age: 51 +/- 14 years (24 females, 36 males; 3 normotensive and 57 hypertensive WHO) and a echocardiogram TM and two-dimensional with doppler in order to measure the interventricular septum thickness, Left Ventricular Posterior Wall Thickness and the left Ventricular Internal diameter with which we can calculate the myocardial mass (MM, Devereux formula) and the myocardial mass index using the body surface. Furthermore ventricular relaxation has been studied (A/E, PHT) by using doppler echocardiogram. During the same week an ambulatory blood pressure (Nippon Colin 8AM-8PM one reading every 15 minutes) has been recorded. The blood variables are the mean of the recording, systolic, diastolic, mean. We have confirmed the conclusion between blood pressure and left ventricular mass by using resting and ambulatory blood pressure recordings. But it does not exist any significant difference within we compare the correlations coefficients (Hotteling's Test with Williams modification) obtained with two devices. In revenge this difference exists with ventricular relaxation index A/E to MBP: mMBPr = 0.51, mMBPa = 0.34 (p less than 0.05), and PHT to MBP: mMBPr = 0.49, mMBPa = 0.31, (p less than 0.05) and to the SBP: mSBPr = 0.54, mSBPa = 0.35, (p less than 0.05). CONCLUSION: the relationship between blood pressure and myocardial mass and by, the heart effect from hypertension can be studied by using in any case resting and ambulatory blood pressure recordings. This will confirm the hypothesis in which the blood pressure recordings multiplication is more important than the way of recording it.(ABSTRACT TRUNCATED AT 250 WORDS)

Respective effects of glucose and glutamine on the glutamine synthetase activity of human skin fibroblasts.

The activity of Glutamine Synthetase (GS) was measured during the growth of human diploid skin fibroblasts cultured for three weeks in the presence or absence of either glucose or glutamine or both. In medium free of both glucose and glutamine, a single late peak in GS activity was observed concomitantly with delayed small cell protein increment. In all media containing either glucose or glutamine or both. GS activity rose sharply during rapid cell growth, displayed a plateau, and then decreased once the cells had reached confluency. The variations in extracellular amino acid levels were also determined and were found to depend on the composition of the medium but not on the cell culture duration. These results demonstrate, for the first time as far as we know, that strong GS activity is present in rapidly growing skin fibroblasts. In contrast to many other mammalian cell types, GS activity in human skin fibroblasts appears not to be subject to regulation by extracellular glutamine. This difference may well be connected with cell differentiation.

[Blood pressure variability and morbidity]. / Variabilité tensionnelle et morbidité.

In a previous study (resting blood pressure profile, Dinamap) we have confirmed the correlations between blood pressure and left ventricular mass (myocardial hypertrophy being one of the morbidity criteria in Hypertension) and we have demonstrated the absence of significant difference (Fisher's z Test) with the results of ambulatory recordings found in literature. Furthermore, we have showed a weaker correlation between absolute variability (AV) and left ventricular mass (LVM). If indeed there exists a cause-effect relationship between the AV increase and the LVM increase, a relative independence between VA and blood pressures mean (mBP) should still be demonstrated. In order to do that we have used the factorial analysis (main components analysis) with which a small number of independent factors can be isolated from a large number of correlated variables. A resting blood pressure (Dinamap, 8AM-8PM, one reading every 15 minutes) has been recorded among 551 patients (259 females, 292 males; 109 normotensive WHO, 442 hypertensive WHO) and an echocardiogram TM and two-dimensional in order to measure the interventricular septum thickness (IVST), the posterior wall thickness (PWT) and the left ventricular internal diameter (LVID) with which we can calculate the myocardial mass (MM, Devereux formula) and the myocardial mass index (MMI) using the body surface (BS). The blood pressure variables are the means of the recordings (mBP): systolic (mSBP), diastolic (mDBP), mean (mMBP) and their standard deviations (SSD, DSD, MSD) corresponding to the AV. We have studied the heart rate (HR) with its standard deviation (HRSD) and age.(ABSTRACT TRUNCATED AT 250 WORDS)

Glutamine dependency of human skin fibroblasts: modulation by hexoses.

The combined effects of carbohydrates and glutamine were investigated in diploid strains of normal human skin fibroblasts cultured for 21 days under eight different culture conditions: hexose-free medium or medium containing D-glucose, D-galactose, or D-fructose, with or without added glutamine. Cell growth, hexose consumption, lactate production, intracellular glycogen content and extracellular amino acid levels were measured every third to fourth day. In the presence of glutamine, cells reached a higher saturation density in fructose medium than in glucose or galactose medium but per cell consumption of fructose and galactose was much less than that of glucose. Consumption of all three carbohydrates per unit cell growth exhibited three distinct phases: Days 1-3, 3-10, and 10-20, respectively. In the absence of glutamine the rate of cell growth was not altered in glucose or galactose medium, but slowed down considerably in fructose medium. Glutamine deprivation also led to changes in hexose consumption. In hexose-free media the cell growth rate at first was very slow, but rose after 2 or 3 weeks of culture. The levels of extracellular nonessential amino acids varied according to medium and growth phase. One of the most exciting findings was that human fibroblasts are able to maintain a slight excess of glutamine in all media not supplemented with glutamine and, more surprisingly, to synthesize it in a medium containing galactose and glutamine.

[Relationship between heart mass and semi-ambulatory pressure profiles]. / Relation masse cardiaque et profils tensionnels semi-ambulatoires.

This work was undertaken with 420 patients (90 normotensives: casual blood pressure less than or equal to 140/90 mmHg and 330 hypertensives) in which was recorded a semi ambulatory blood pressure profile (Dinamap 8AM-8PM, a reading every fifteen minutes). On the same day an echocardiogram was performed. We have correlated the left ventricular mass, the left ventricular mass index, the interventricular septum, the left ventricular cavity volume and the left ventricular posterior wall with casual blood pressure, average daily blood pressure standard deviation and variation coefficient for mean blood pressure, systolic blood pressure and diastolic blood pressure. Analysis by sex, left ventricular mass index and blood pressure level (normotensive, hypertensive): we observe a left ventricular hypertrophy in normotensive males (18 p. 100) and hypertensive ones (39.8 p. 100), in normotensive females (15 p. 100) and hypertensive ones (33.3 p. 100). Overall in 420 patients: excellent correlation (p less than 0.001) between average daily blood pressure, casual blood pressure and the four echocardiographic parameters except for left ventricular cavity volume. But correlation is better (z test of Fisher) with average daily blood pressure than with casual blood pressure. No difference exists between results obtained in women (194) and men (226). Concerning variability, four observations: there exists a correlation between standard deviation, left ventricular mass index, interventricular septum, left ventricular posterior wall (only for standard deviation of MBP). No correlation with coefficient correlation except for the MBP with septum in women. The correlation for the standard deviation are weaker than with average daily blood pressure. They are better with the septum than with other echocardiographic parameters.(ABSTRACT TRUNCATED AT 250 WORDS)

Antidiuretic hormone response to osmotic stimulus under fentanyl anaesthesia.

The effect of fentanyl anaesthesia on the plasma antidiuretic hormone (ADH) response to osmotic stimulus was studied in eight patients. Eight g (137 mmol) NaCl were rapidly injected intravenously the day before anaesthesia and blood samples were collected 5, 10, 20 and 30 min after the injection. This protocol was repeated in the same subjects, under anaesthesia with thiopental, nitrous oxide and fentanyl before surgical incision. Plasma ADH markedly increased after NaCl administration and was significantly correlated with plasma sodium (r = 0.67, P less than 0.005) when the patients were awake, whereas it did not change over 30 min and was not correlated with plasma sodium (r = 0.18, P greater than 0.05) under fentanyl anaesthesia. This inhibitory effect of anaesthesia occurred in spite of a significant fall in the mean arterial pressure during the study. In order to eliminate the role of overnight fasting, premedication and fluid load, the same protocol was performed in six control patients who were fasted overnight, premedicated and fluid loaded. These results demonstrate that fentanyl anaesthesia abolishes the plasma ADH response to both osmotic and low arterial pressure stimuli.