Alterations of cerebromicrovascular Na+,K(+)-ATPase activity due to fatty acids and acute hypertension.

Acute hypertension, induced in rats by intravenous injection of angiotensin II, previously has been shown to increase cerebrovascular permeability to macromolecules. The purpose of this study was to examine the effect of acute hypertension on Na+,K(+)-ATPase, the enzyme responsible for controlling ionic permeability of the cerebromicrovascular endothelium. The K(+)-dependent p-nitrophenylphosphatase activity of the cerebromicrovascular Na+,K(+)-ATPase was determined using microvessels prepared from hypertensive and normotensive rats. When compared to controls, a 70% decrease (P < 0.02) in the maximum rate (Vmax) of the Na+,K(+)-ATPase from hypertensive rats was evident with no change in the Michaelis constant (KM). In contrast, gamma-glutamyltranspeptidase, a marker enzyme for cerebral endothelial cells, was not significantly affected. Sodium arachidonate (1-100 microM) inhibited the phosphatase activity of the Na+,K(+)-ATPase in microvessels isolated from both normotensive and hypertensive rats in a dose-dependent manner. Furthermore, poly-unsaturated fatty acids (sodium linoleate and arachidonate) evoked the greatest inhibition of the enzyme, while sodium oleate and sodium palmitate inhibited the Na+,K(+)-ATPase to lesser extents. This regulation of enzyme activity by fatty acids was comparable in control and hypertensive groups. In summary, the data indicate that the cerebromicrovascular Na+,K(+)-ATPase was altered as a consequence of acute hypertension and that poly-unsaturated fatty acids can modulate this enzyme in microvessels derived from hypertensive or control rats.

[Percutaneous endoscopic gastrostomy: its value in assisted alimentation in malnutrition in elderly patients. Apropos of 101 consecutive cases in patients over 70 years of age]. / La gastrostomie percutanée endoscopique: intérêt dans l'alimentation assistée du sujet âgé dénutri. A propos de 101 cas consécutifs chez des patients âgés de 70 ans et plus.

This is a prospective study concerning 101 percutaneous endoscopic gastrostomies (PEG) performed in patients aged from 70 to 98 (83.6). We obtained a success in 99%. Indications were stroke and its consequences in 36%, dementia in 22%, depressive syndrome in 38% (7% in the postoperative period) laryngeal or oesophageal tumors in 4%. This technique was carried out in outpatients without anesthesia but PEG must be considered to be a surgical method. Only 5% patients presented major immediate complications with three deaths (3%) due to the technique. Follow-up (30 days) demonstrated 11 other deaths. Would earlier PEG have given better results? Oral feedings (alone or both oral and PEG) were possible in 51% patients. PEG is a valuable technique of feeding assistance in the aged, offering an alternative to nasogastric tube and could be used more extensively in old patients.

[Aorto-arteriography of the legs in the elderly. Tolerability and value. Report of 100 tests carried out consecutively in patients over 70 years of age]. / Aorto-artériographie des membres inférieurs chez le vieillard. Tolérance et intérêt. A propos de 100 examens réalisés consécutivement chez des patients de plus de 70 ans.

Over a period of 4 years, we have studied 100 consecutive cases of arteriographies, realized out of emergency, and concerning patients age 70 and above (average age 77). In 2/3 of cases, the arteriography was requested for a stage IV arteriopathy of the inferior limbs, the other 1/3 being equally distributed between stage II and III. On the technical plan, the femoral pathway with retrograde catheterization was mostly performed because femoral pulses were correct in most cases. Only one major complication occurred. The presurgery balance, patience and gentleness have permitted to reduce risks. We haven't observed any type of complications during the procedure in these elderly patients with polysystem disease (HT, diabetes, CVA, cardiopathology) latent renal insufficiency at this age did not create a problem because normal precautions were taken during procedure and new contrast products with low osmolarity used. The study of arteriographies by a personal scoring that we elaborated has clearly confirmed the distal and often bilateral nature of arterial lesions. The indications of this examination are of course already assessed by medico-surgical teams who select patients susceptible of enduring a by pass. The imagery obtained has allowed in almost 40% of cases either a revascularization act or a per cutaneous angioplasty, thus proving the advantages of this examination, finally little aggressive, in evaluation of these predominantly distal lesions in the elderly people.

[Percutaneous endoscopic gastrostomy. 174 cases]. / Gastrostomie percutanée endoscopique. Cent soixante quatorze observations.

Nutritional assistance was given by percutaneous endoscopic gastrostomy to 174 patients with neurological diseases (80 cases), tumours of the ear, nose and throat (ENT) region (70 cases) or malnutrition (24 elderly people). These patients had either deglutition disorders with inhalation or severe malnutrition, or could not tolerate a nasogastric tube. The endoscopic catheter (Bioser) was installed by the pull technique under general anaesthesia (26 percent), neuroleptanalgesia (16 percent), premedication (14 percent) or without sedation (44 percent). Installation was possible in 98 percent of the cases. Twenty-nine percent of the patients were treated in an outpatient clinic. The problems encountered (21 percent) were mainly due to blockade of the flange and rupture of the thread. Transoperative accidents, such as dyspnoea, bleeding or cardiac arrest, all without sequelae, were noted in 5 percent of the cases. The catheter remained in situ for a mean period of 3.9 +/- 0.3 months (range: 0.1 to 20 months). The following complications were observed: short-term (15 percent), hyperthermia (5), local infection (6), abscess of the abdominal wall (3), meteorism (9), pneumoperitoneum (1), subocclusion (2); long-term (25 percent), inflammatory reactions (13), leakage (19), catheter displacement (8) and catheter rupture (3). Local infections were more frequent in patients with ENT tumours than in the others. Percutaneous endoscopic gastrostomy is a fast and reliable technique preferable to surgical gastrostomy. Complications are frequent (46 percent) but usually minor (42 percent). Contra-indications must be respected, and the catheter must be introduced with the utmost care.

[Post-gastrectomy arterio-venous fistula. About one new case (author's transl)]. / Les fistules artério-veineuses post-gastrectomie. A propos d'une nouvelle observation.

Post-gastrectomy arterio-venous fistula is rare: the the authors report one case. They discuss the hepatic consequences of arterio-portal fistula and the possible role of this in the cause of some cases of portal hypertension.