Uncomplicated neurosurgical resection of a malignant glioneuronal tumour under haemostatic cover of rFVIIa in a severe haemophilia patient with a high-titre inhibitor: a case report and literature review of rFVIIa use in major surgeries.

The development of inhibitors following factor VIII replacement therapy is a serious complication in severe inherited haemophilia. Whereas significant experience, notably in orthopaedic surgery, is now obtained with the use of bypassing agents in haemophilia with high-titre inhibitor, new surgical challenges might occur due to patients' increasing life expectancy. A 56-year-old severe haemophilia A patient with a high-titre inhibitor was diagnosed for probable right temporoparietal malignant glioneuronal tumour on cerebral magnetic resonance imaging (MRI) (4 cm x 3 cm cerebromeningeal tumour with perilesional oedema and transfalcial herniation) requiring total resection. Then recombinant activated FVII (rFVIIa) was chosen as the haemostatic agent: bolus of 270 microg kg(-1) every 2 h during the first 24 h, 180 microg kg(-1) every 3, 4 and 6 h, respectively, at days 2-3, from days 4-10 and finally from days 11-15. Tranexamic acid was associated. Pre- and postoperative courses were uneventful, the surgical procedure being assessed at optimal haemostatic condition without any unusual haemorrhage on MRI controls, diffuse intravascular coagulation criteria or thromboembolic event. Intensive rFVIIa therapy has shown to be safe and effective in this first reported neurosurgery about a malignant tumour exhibiting to a high-bleeding risk notably in haemophilia with high-titre inhibitor. The use of lower doses of rFVIIa might have been possible; however, in the absence of accurate test for monitoring rFVIIa therapy, the potentially life-threatening complications of this procedure required maximum haemostasis with high rFVIIa doses.

Role of ghrelin in the regulation of gastric acid secretion involving nitrergic mechanisms in rats.

Ghrelin, an endogenous ligand for growth hormone secretagogue receptor (GHS-R), has been identified in the rat and human gastrointestinal tract. Ghrelin has been proposed to play a role in gastric acid secretion. Nitric oxide (NO) was shown as a mediator in the mechanism of ghrelin action on gastric acid secretory function. However, there is a little knowledge about this topic. We have investigated the role of ghrelin in gastric acid secretion and the role of NO as a mediator. Wistar albino rats were used in this study. The pyloric sphincter was ligated through a small midline incision. By the time, saline (0.5 ml, iv) was injected to the control group, ghrelin (20 microg/kg, iv) was injected to the first experimental group, ghrelin (20 microg/kg, iv) + L-NAME (70 mg/kg, sc) was injected to the second group and L-NAME (70 mg/kg, sc) was administered to the third group. The rats were killed 3 h after pylorus ligation; gastric acid secretion, mucus content and plasma nitrite levels were measured. Exogenous ghrelin administration increased gastric acid output, mucus content and total plasma nitrite levels, while these effects of ghrelin were inhibited by applying L-NAME. We can conclude that ghrelin participates in the regulation of gastric acid secretion through NO as a mediator.

[Massive haemorrhage after dorsal decompressive laminectomy]. / Hémorragie massive après laminectomie dorsale décompressive.

We describe a case of a massive haemorrhage after dorsal decompressive laminectomy. The biological syndrome was at first a disseminated intravascular coagulation (DIC), rapidly complicated by a secondary fibrinolysis. The usual treatment of DIC with plasma and platelet transfusion failed to control bleeding and the patient underwent four repeat operations for relapsing rapidly evolving paraplegia. Aprotinine treatment stopped the haemorrhage. The vertebral metastasis causing spinal compression proved to be of prostatic origin.

Time-dependent changes in superoxide dismutase, catalase, xanthine dehydrogenase and oxidase activities in focal cerebral ischaemia.

Time-dependent changes in the activities of antioxidant enzymes and an oxidant enzyme, xanthine oxidase (XO), were detected in primary and peri-ischaemic brain regions during permanent occlusion of the middle cerebral artery (MCAO) in rats. There were no changes in superoxide dismutase (SOD) and catalase (CAT) activities after 3 h of MCAO, whereas antioxidant enzyme activities decreased significantly in ischaemic brain areas following 24 h of ischaemia. After 48 h, the enzyme activities returned to the baseline but then a further increase was observed in ischaemic brain areas by 72 h post-ischaemia. Normally, XO exists as a dehydrogenase (XD), but it is converted to XO which contributes to injury in some ischaemic tissues. The XO activity increased slightly at 3 h after ischaemia, but after 24 h of ischaemia it returned to the baseline and then remained relatively unchanged in ischaemic areas. Pretreatment with allopurinol before ischaemia prevented changes in SOD and CAT activities and attenuated brain oedema during 24 h of ischaemia. Neither XO nor XD activity changed in allopurinol-treated rats at the times of ischaemia. These results indicated that ischaemic brain tissue remained vulnerable to free radical damage for as long as 48 h after ischaemia, and XO was probably not an important source of free radicals in cerebral ischaemia.

Effect of Ramadan fasting on platelet aggregation in healthy male subjects.

The purpose of this study was to examine platelet aggregation during Ramadan fasting. A group of 20 healthy non-smoking male volunteers were studied, whose mean age was [21 (SD 2.4) years range 19-24]. The average fast was about 15 h. Venous blood samples were taken on 4 different days; 1 day before Ramadan (day 0), then on the 1st, 14th and 28th day of Ramadan. On each of these 4 days, blood samples were taken at 4 p.m. (1 h before the evening meal). Body mass index and platelet count did not change during fasting. Bleeding and coagulation time had increased significantly by the end of Ramadan fasting (P < 0.05, P < 0.005 respectively), but these changes remained within physiological limits. Ramadan fasting induced a reduction in platelet sensitivity to adenosine 5'-diphosphate (ADP) and collagen on days 14 (P < 0.05) and 28 (P < 0.05, P < 0.005 respectively). However, adrenaline-induced platelet aggregation decreased only on day 28 (P < 0.05). This study indicated that Ramadan fasting led to a decrease in the platelet responses of different aggregating agents (ADP, adrenaline and collagen) in vitro. It also led to an increase in bleeding and coagulation time.

Effect of oral pyridoxine hydrochloride supplementation on arterial blood pressure in patients with essential hypertension.

The purpose of this study was to test the effect of vitamin B6 (pyridoxine-HCl, CAS 58-56-0) supplementation on arterial blood pressure in essential hypertension. The trial comprised 9 normotensive subjects (7 men and 2 women, aged between 32-58 years; mean +/- SD, 48 +/- 11) and 20 patients with essential hypertension (16 men and 4 women, aged between 32-69 years; mean +/- SD, 56 +/- 12). The patients were treated during 4 weeks with a single oral dose of pyridoxine (5 mg/kg body weight/day). After a 5-min rest, measurements were made in the supine position. When compared with the normotensive subjects, the hypertensive subject group had a significantly higher systolic and diastolic blood pressure (p < 0.001) and higher level of plasma norepinephrine (NE) (p < 0.01) before pyridoxine treatment. On the other hand, there were no significant differences in plasma epinephrine (E) and heart rates. Treatment of hypertensive patients with pyridoxine significantly reduced systolic (p < 0.01) and diastolic blood pressure (p < 0.005), plasma NE (p < 0.005) and E (p < 0.05) within 4 weeks. However, there was no significant difference in heart rate at the end of pyridoxine treatment. These results indicate a relationship between pyridoxine status and arterial blood pressure in the essential hypertensive patients.

Effect of fish oil on indometacin-induced gastric lesions in rats.

The effect of fish oil in promoting the healing of indomethacin-induced gastric lesions was investigated in Wistar albino rats. After indomethacin treatment (30 mg/kg, s.c.), animals were given fish oil, olive oil, or normal diet for 48 h. The ulcer index was found to be decreased to 2.1 +/- 1.8 mm with fish oil, 13.7 +/1 5.4 mm with olive oil, and 14.6 +/- 2.4 mm with normal diet. Fish oil showed a potent healing-promoting effect on acute gastric erosions and ulcers induced by indomethacin and significantly enhanced the mucus content of the mucosa (p < 0.05).

Protective effect of fish oil against stress-induced gastric injury in rats.

The effect of fish oil and olive oil on the gastric mucosal damage induced by cold-restraint stress was investigated in rats. The oils were dietary supplemented for 3 weeks. The results demonstrate that a diet containing fish oil, when ingested for 3 weeks before exposure to stress, protected from gastric ulceration significantly (p < 0.01) and led to a statistically significant increase both in mucus and phospholipid content of the gastric mucosal barrier (p < 0.02 and p <0.001, resp.) in cold-restraint stress-induced gastric injury in rats. However, further studies are required to determine the role of dietary fish oils in the prophylaxis and treatment of peptic ulcer.

Effect of oral pyridoxine hydrochloride supplementation on in vitro platelet sensitivity to different agonists.

Effect of vitamin B6 (pyridoxine-HCl, CAS 58-56-0) on platelet aggregation, plasma lipids and serum zinc level was investigated. The trial comprised 24 healthy male volunteers, aged between 19-24 years. The subjects were randomized in two groups of 12 and treated for 4 weeks by a single daily oral dose of 5 mg/kg vitamin B6 or placebo. Pyridoxine inhibited ADP- or epinephrine-induced aggregation by 48% and 41% (p < 0.001), respectively, whereas there was no change in control group. No significant effect on either, bleeding time, coagulation time or on platelet count was demonstrated in subjects given placebo. Pyridoxine prolonged both bleeding and coagulation time but not over the physiological limits. It had no effect on platelet count. These observations strongly suggest that vitamin B6, with no effect on platelet count, not only inhibits platelet aggregation but also prolongs clotting time. Pyridoxine significantly reduced total plasma lipid and cholesterol levels, whereas it enhanced HDL-cholesterol level. Serum zinc level was also significantly increased by pyridoxine (p < 0.001). These findings suggest that oral vitamin B6 inhibits platelet aggregation in normal subjects.

[Real-time ultrasonography in neurosurgery. Puncture of an intracranial hypoechogenic cavity]. / Ultra-sonographie en temps réel en neurochirurgie. Ponction d'une cavité hypo-échogène intracrânienne.

The authors have been using real time echography in neurosurgical procedures since 1981: either for detection of a small sub-cortical tumor during a surgical operation, either for biopsy-guidance, or for puncturing a cavity (abscess, cyst or hematoma). The imaging is performed with a CGR SONEL 100 apparatus and two different frequency transducer elements: 3.5 MHz and 5 MHz. 56 patients underwent this technique; 22 times the lesion was hypoechoic: abscess give homogeneous, round hypoechoic image, often surrounded by a fine hyperechoic line; intracerebral hematoma produces an hypoechoic image after a 10 to 15 days evolution: compared to an abscess it then has a more hyperechoic irregular wave-like limit; tumoral-cyst echogenicity is very low; it can even be anechoic. If a stereotaxic structure exists, indication of real time echography must be limited to such stereotaxy contraindications: threatening intracranial hypertension, suppurated lesion, fragile patient. The technique has its limit: that is the small volume of the target-lesion (inferior to 10 mm); advantages must be emphasized: light procedure, satisfying confidence when considering the probe progression, sometimes better information than that of a CT-Scan examination especially for tumoral and cystic lesions.

[Elements predicting respiratory complications after total excision of neurinomas of the 8th nerve. Consequences on the postoperative treatment (study of 12 cases)]. / Les éléments de la prédiction des complications respiratoires après exérèse totale des neurinomes du VIII. Conséquences sur le traitement postopératoire (étude de 12 cas).

Pulmonary complications are observed after radical surgery of acoustic neurinomas. This study, performed on 12 patients was undertaken to appreciate central respiratory activity by measuring the respiratory response to CO2 before and after the operation and to find out whether they could be used to predict post-operative respiratory complications. The patients who developped pulmonary or bronchial infections had increased PaCO2 (45.1 +/- 3.0 mmHg--mean +/- S.D.) and decreased ventilatory response to CO2 (VE/PACO2: 0.65 +/- 0.37 1/min/mmHg) before the operation. After the operation, all these patients developped swallowing difficulties and a decreased vigilance; therefore we assumed that swallowing troubles and decrease of vigilance could be responsible for bronchopulmonary infection. Patients with a low respiratory response to CO2 have higher risk of developping pulmonary complications and can be detected before surgery by this non-invasive test and by the measure of PaCO2.