[Complement inhibitors: A global point of view]. / Les inhibiteurs du complément : une vue d'ensemble.

Innate immunity, and more specifically the complement system, has arised renewed interest in the medical field in recent years. Many innovative complement-inhibiting drugs have appeared, acting at various levels of the complement cascade. These drugs have made it possible to transform poor prognosis of certain diseases. Many of them are currently being tested in clinical trials for various indications. Many questions appear about their optimal use and their future indications. This article recalls the fundamental role of the complement system in the human organism. It then discusses the diseases in which the complement is involved on the pathophysiological level. The third part details the different classes of complement inhibitors and briefly recalls the indications for which these treatments seem the most promising. Finally, we end with a discussion that highlights the different aspects and questions induced by these new treatments.

[Infectious myositis]. / Myosites infectieuses.

Infectious myositis is a rare condition that can be caused by bacteria, viruses, parasites or fungi. Muscle pain or weakness are symptoms shared by all type of myositis. Diagnosis is made on clinical presentation: fever and poor general state is found in bacterial myositis, diffuse muscle pain with flu-like symptoms in viral causes, eosinophilia and a tropical travel history can be related to parasitic etiology, and immunocompromising condition suggests fungal infection. Rhabdomyolysis, leukocytosis and elevated C-reactive protein are common. Imaging (computed tomography or magnetic resonance imaging) can be useful to detect which muscle is affected. The causative organism can be identified on blood cultures, skeletal muscle biopsy, serology or any other pathogen specific test. Treatment depends on the causative organism. Open surgical or imaging-guided drainage is usually necessary in bacterial myositis.

Superficial contamination of bovine carcasses by Escherichia coli O157:H7 in a slaughterhouse in Normandy (France).

In 1997, analyses were carried out on 255 bovine carcasses to determine the extent of superficial contamination by E. coli O157. A 50-cm(2) meat sample taken from all carcasses was collected and tested using immunomagnetic separation method to detect E. coli O157. One strain of E. coli O157 bacterium was isolated and sent to the reference national center (Institut Pasteur, Paris). The strain was confirmed as E. coli O157:H7 and found to contain two out of the three pathogenicity genes (eae and EHEC-hlyA) necessary for enteropathogenicity. Shiga toxin genes were not detected. Superficial contamination of E. coli O157:H7 was established, but at low level (0.4%).

Influence of midazolam on the plasma concentrations of mepivacaine after lumbar epidural injection in children.

Twenty children undergoing surgery received a lumbar block using 0.4 ml/kg mepivacaine 2.0%. They were randomized into two groups, one of which received midazolam 0.4 mg/kg rectally as premedication. Midazolam administration did not significantly influence the plasma concentrations of mepivacaine.

The influence of midazolam on the plasma concentrations of bupivacaine and lidocaine after caudal injection of a mixture of the local anesthetics in children.

Twenty children undergoing surgery received a caudal block using 1 ml per kg of a mixture of 50% lidocaine (1%) and 50% bupivacaine (0.25%). They were randomly allocated to two groups, one of which received midazolam 0.4 mg/kg rectally as premedication. Midazolam administration resulted in a significantly lower AUC value for lidocaine but did not influence the plasma concentrations of bupivacaine.

Bupivacaine free plasma levels in children after caudal anaesthesia: influence of pretreatment with diazepam?

Diazepam-induced modifications in bupivacaine distribution have been noted in previously reported data investigating the influence of diazepam on bupivacaine plasma levels in children undergoing surgery under caudal block with a mixture of lignocaine and bupivacaine. Possible diazepam-induced changes in protein binding were therefore examined in this study. Our data did not demonstrate significant modifications in bupivacaine protein binding when diazepam is used concomitantly.

The influence of diazepam on the plasma concentrations of bupivacaine and lignocaine after caudal injection of a mixture of the local anaesthetics in children.

Twenty-one children undergoing surgery received a caudal block using 1 ml kg-1 of a mixture of 50% lignocaine (1%) and 50% bupivacaine (0.25%). They were randomized into two groups, one of which received diazepam 10 mg rectally as premedication. Diazepam administration resulted in significantly higher Cmax and AUC values for bupivacaine but did not influence the plasma concentrations of lignocaine.

[Caudal epidural anesthesia in children. Study of endocrine changes]. / Anesthésie péridurale par voie caudale chez l'enfant. Etude des variations endocriniennes.

Changes in serum levels of corticotrophin (ACTH), immunoreactive beta-endorphin, antidiuretic hormone and cortisol were compared in children undergoing minor surgery under either general anaesthesia with halothane or epidural anaesthesia by the caudal route. A rapid and major increase in hormone levels was observed under general anaesthesia but not under epidural anaesthesia.

[Caudal anesthesia in pediatric surgery]. / L'anesthésie caudale en chirurgie pédiatrique.

Caudal anaesthesia in pediatric surgery about 116 cases (children from three weeks to 18 years with 64 below 5 years) is reported. The caudal anaesthesia, at 6 mg/kg, is very usefull for surgery below T 10 because: --it can be used in day surgery, --it avoids intubation and its complications, --it allows feeding as soon as required, --it gives a post operative analgesia. In our practice, this technique is safe and is real progress compare to the general anaesthesia.