Anthelmintic activity of Stevia multiaristata extract against Echinococcus granulosus sensu stricto.

Cystic echinococcosis is a zoonotic disease caused by the larval stage of the parasite Echinococcus granulosus sensu lato. The available anti-parasitic treatment is mostly limited to a continuous administration of albendazole. However, due to its numerous side-effects and efficacy of around 50%, there is a need to find new drugs to improve the treatment for this disease. In the current study, the in vitro and in vivo efficacy of a Stevia multiaristata extract against E. granulosus sensu stricto (s.s.) was demonstrated. Stevia multiaristata extract (100 and 50 µg mL−1) caused a quick viability decrease on protoscoleces which was consistent with the observed tegumental alterations. Loss of turgidity was detected in 95 ± 3.4% of cysts incubated with S. multiaristata extract during 2 days (100 µg mL−1) and the collapse of the germinal layer was observed in 60 ± 9.3% of cysts treated with 100 µg mL−1 of the S. multiaristata extract during 4 days. The half maximal effective concentration value was 69.6 µg mL−1 and the selectivity index for E. granulosus s.s. cysts was 1.9. In this clinical efficacy study, the treatment of infected mice with the S. multiaristata extract (50 mg kg−1) caused a significant decrease in the weight of the cysts compared with the control group. These results coincided with the tissue damage observed in the cysts at the ultrastructural level. In conclusion, we observed high protoscolicidal and cysticidal effects, and significant reduction in the weight of the cysts in experimentally infected mice following treatment with the S. multiaristata extract.

Antiparasitic Effects of Asteraceae Species Extracts on Echinococcus granulosus s.s.

Cystic echinococcosis is a zoonotic disease caused by the parasite Echinococcus granulosus sensu lato (s.l.), which is worldwide distributed and causes long-lasting infections in animals and humans. The existing treatment is limited to the use of benzimidazoles, mainly albendazole (ABZ). However, it has unwanted side effects and its efficacy is about 50%. The Asteraceae family includes plants that have therapeutic applications (medicinal species) and has an important role in new drug development. The species belonging to a different genus of this family show a wide range of anti-inflammatory, antimicrobial, antioxidant, hepatoprotective, and antiparasitic activities, among others. The aim of the present study was to evaluate the in vitro efficacy of extracts of four Asteraceae species against protoscoleces of E. granulosus sensu stricto (s.s.). On the other hand, the Stevia aristata extract was assessed on the murine cyst of E. granulosus (s.s.) and the efficacy of S. aristata extract was investigated in a murine model of CE. Stevia satureiifolia, S. aristata, Grindelia pulchella, and G. chiloensis extracts at 100 µg/mL caused a decrease in protoscoleces viability; however, S. aristata extract produced the greatest in vitro protoscolicidal effect. After 20 days of treatment with the highest concentration (100 µg/mL) of S. aristata extract, protoscoleces viability decreased to 0%. The tegumental changes observed by scanning electron microscopy were consistent with the reduction in vitality. The collapse of the germinal layer was registered in 60 ± 5.8% and 83.3 ± 12.0% of cysts treated during 4 days with 50 and 100 µg/ml, respectively. The half maximal effective concentration (EC50) value of the S. aristata extract against E. granulosus (s.s.) cysts was 47.86 µg/mL (96 h). The dosage of infected animals with the 50 mg kg-1 dose of S. aristata extract resulted in a significant reduction in cyst weight in comparison with the control group. In conclusion, S. aristata extract was demonstrated to exert a marked effect, both in vitro and in the murine model.

[Peripheral circulatory effects of sodium nitroprussate. Evaluation by plethysmography and capillaroscopy]. / Effets circulatoires périphériques du nitroprussiate de sodium. Appréciation par pléthysmographie et capillaroscopie.

Circulatory effects of intravenous injection of sodium nitroprusside are appreciated in 6 patients by monitoring systemic pressure, heart rate, digital systolic pressure, pulse plethysmography and nail-fold capillaroscopy. Low doses of nitroprusside (1.5 microg./kg/mn) enhance digital blood flow (+ 78.9%) and maximum height of the plethysmographic curve (+ 71.6%), without any significant modification of the systemic blood pressure (- 0.6%), heart rate (+ 6.3%) and digital pressure (- 1.15%). The peripheral resistances are strongly reduced. Nail fold capillaroscopy is unchanged. Higher doses, even with an adequate vascular filling, are potentially harmful for microcirculation.

[Late complications of catheterization of the subclavian vein]. / Complications tardives du cathétérisme de la veine sous-clavière.

Percutaneous subclavian venous cannulation has now become a routine procedure in anaesthesia and intensive care. Its early complications are well-known, but its delayed complications, somewhat rarer, remain often undiagnosed. A case is reported of a 32 year old man who presented with a subclavian arterial pseudo-aneurysm associated with a recurrent nerve palsy some 18 months after undergoing major trauma in a car crash. The post-traumatic origin of this complication is discussed. It was probably due to percutaneous venous cannulation, which led to a subclavian arterial lesion.

[Risk factors in histamine liberation: a prospective study in an anesthetized population]. / Facteurs de risque d'histaminolibération: étude prospective dans une population anesthésiée.

23,444 anaesthetic files were collected over a 12-month period from all the anaesthetic departments of the Regional Hospital in Nancy and three private clinics in town. The data were set out on a computer data-sheet aimed at defining the risk factors for histamine release. As a result, two groups are defined: a group of patients who released histamine (HL+; n = 212) and a group of patients who did not release histamine (HL-; n = 23,232). In increasing order of severity, the incidence of reactions were 1 in 143 for chest erythema, 1 in 630 for generalized erythema and Quincke's oedema, 1 in 230 for generalized erythema and hypotension, and 1 in 23,444 for fatal shock. The two groups were compared one with the other for each factor, using the chi-squared test or Fisher's test of exact probabilities. The statistically significant risk factors were: female patients, patients aged between 15 and 25 years, patients with an allergic history, a history of multiple anaesthesias, close one after the other, and exaggerated preanaesthetic anxiety. The drugs most often incriminated were: Althesin, propanidid, suxamethonium, alcuronium, gallamine and Haemaccel. A multifactorial analysis is being carried out to determine the part played by each factor in the release of histamine.

[Evolution of plasma histamine after midazolam in patients at risk of histamine liberation]. / Evolution de l'histamine plasmatique après midazolam chez les sujets à risque d'histaminolibération.

Changes in plasma histamine levels 2 min (t1) and 10 min (t2) after the intravenous injection of 0.2 mg X kg-1 midazolam were measured in 10 subjects at risk of releasing histamine (group I) and compared with those of 15 other subjects free from any risk of releasing histamine (group II). There was mean increases in plasma histamine levels of 0.78 ng X ml-1 between t0 and t1 (p less than 0.01), and of 0.41 ng X ml-1 between t0 and t2 (p less than 0.01) in group I; they only rose by 0.18 ng X ml-1 between t0 and t2 (p less than 0.01) in group II. The only statistically significant variation between the two groups was that at t1 (p less than 0.03): plasma histamine levels rose higher at the second minute in those cases at risk. This was a rather small increase, within physiological limits, and without any clinical or haemodynamic manifestation.

[Effect of tritoqualine on the histamine levels of whole blood]. / Action de la tritoqualine sur le taux d'histamine du sang total.

For ten years now, tritoqualine, a histidine decarboxylase inhibitor, has been advocated in a prevention protocol for anaphylactoid reactions occurring during general anaesthesia. The present double-blind study aimed to quantify the effects of the drug on whole blood histamine levels. 44 patients were assigned at random to two different groups, one taking 300 mg t.i.d. tritoqualine for three days, and the other taking a placebo. The histamine levels were measured before the treatment and 12 h after the last dose of the drug after haemolysis of the sample, by the fluorometric technique preceded by column chromatography. In the group taking tritoqualine, the histamine level fell from a mean of 109 +/- 61 to 91 +/- 41 ng X ml-1, whereas it rose from a mean of 92 +/- 55 to 105 +/- 62 ng X ml-1 in the control group taking placebo. These variations were not statistically significant. In both groups were present four volunteers with a history of allergy; their histamine level fell from 107 +/- 35 to 71 +/- 36 ng X ml-1 after tritoqualine intake (p less than 0.05), whereas it rose from 76 +/- 19 to 162 +/- 36 ng X ml-1 after placebo (p less than 0.05). The small differences found in the whole blood histamine level 12 h after the last oral dose of the drug suggested that the present tritoqualine dose regimen was inadequate to achieve the aims of its prescription.

[Which assessment of coagulation, for which operation?]. / Quel bilan de la coagulation, pour quel opéré?

Patient's bleeding history is an important part of preoperative evaluation but must be associated with hemostatic tests. The choice in between these different hemostatic tests will be made according to the knowledge of the bleeding history and; the type of surgery planned. In case of hemostatic abnormality, additional tests can be performed in order to determine a more precise state of the patient's hemostatic dysfunction. However, complete preoperative hemostatic evaluation (including patient's bleeding history and blood tests) may not entirely avoid per and post-operative hemostatic complications. Indeed, there is no absolute correlation between hemostatic screening and bleeding or thrombosis risks. Some other factors, completely independent from hemostatic function, such as shock, surgical bleeding, anoxia... may intervene.

[Risks acceptability related to obstetrical epidural analgesia]. / Acceptabilité des risques associés à la mise en place d'une analgésie péridurale obstétricale.

OBJECTIVES: Evaluation of the acceptability of complications related to obstetrical epidural analgesia in two populations, parturients and anesthesiologists. STUDY DESIGN: Prospective, transversal, single center study. MATERIALS AND METHODS: Evaluation of the acceptability of complications associated with obstetric epidural analgesia performed using a questionnaire of six clinical scenarii in two populations: parturients cared at the University maternity of Nancy and anesthesiologists of Lorraine. Patients were interviewed by an anesthesiologist, physicians via Internet. Acceptability was assessed using two tools, the absolute acceptability with a visual analog scale and the relative acceptability obtained by classifying clinical scenario against each other, in ascending order of acceptability. RESULTS: One hundred and forty-six parturients and 87 anesthetists assessed the acceptability of the different scenarios. The three less serious scenarios (hypotension, failure, dural tap) were acceptable for both populations. One case (spinal hematoma) was unacceptable for parturients. Three cases of varying severity (failure, dural tap, plexus injury with sequelae) were judged significantly less acceptable by patients than physicians (5.9 vs. 7.9 [P<0.001], 5.75 vs. 8.1 [P<0.01], 4.1 vs. 5.1 [P=0.035]). Multivariate analysis did not show any predictive factor of acceptability in both populations. CONCLUSION: In this study, the overall acceptability of the inherent complications of epidural analgesia was good in the two populations. It was essentially based on the notion of severity and preventability. A large interindividual variability was observed and a better acceptance by the anesthesiologists.

[Morbidity and mortality conferences in anaesthesia and intensive care: experience feedback from Nancy university hospital]. / Revues de morbi-mortalité (RMM) en anesthésie-réanimation : retour d'expérience au CHU de Nancy.

OBJECTIVES: Assessment of the morbidity mortality conferences (MMC) durableness in the Anaesthesiology and Surgical Intensive Care Department of the Urban Hospitals of Nancy University Hospital; evaluation of the proportion of medical education in the corrective actions implemented, and research for improvement ways. PATIENTS: All the cases of death and near-death in the operating room and all the cases deemed to be instructive or useful for security improvement. METHOD: Retrospective analysis of MMC activity since its initiation in 2005. RESULTS: Durability of MMC and good attendance rate have been sustained over time. As in the USA, MMCs result firstly in resident's education and continued medical education actions. Medical education actions represent 75% of all corrective measures, followed by changes in practices (62%), in procedures (48%) and in organisation (5%). DISCUSSION: The development process of a culture of the safety has been initiated and perpetuated. Some ways of improvement have been proposed: MMC must certainly be widened as well regarding to the categories of addressees, as the topics (any event deemed to be noteworthy for the safety of care) or the time scale of the analysis. Others propositions: preparation of the presentations with a colleague experienced in MMC; participation of external MMC experts; monitoring of local markers of security of care and of corrective measures efficiency; inclusion of MMC cases presentation in the trainees pedagogic objectives.

[The Bain anesthetic system in facial surgery]. / Le circuit bain en chirurgie faciale.

The BAIN circuit was studied in 11 patients undergoing maxillofacial surgery, with no respiratory deficit, and under spontaneous and assisted ventilation, with a rate of flow of gas of 80, 100, 120, 140 ml/kg/min. From the results it could be concluded that this circuit should be used with a flow of at least 140 ml/kg/min, in assisted ventilation, in order to avoid any retention of CO2. Capnographic follow-up enabled better regulation of the flow rate necessary.

[Fat overload during intake of lipids]. / Surcharge graisseuse au cours de l'apport des lipides.

A review of the recent literature indicates that fat overload during the infusion of lipid emulsions remains rare, at least clinically. Nevertheless, two pictures may be seen, the physiopathology of which is discussed:--overload syndrome, with an association essentially of general and digestive signs, related to the accumulation of lipids in a certain number of parenchymatous tissues;--fat embolism. Problem may be seen at any time after administration of the solution is begun. Youth seems to predominate amongst the favourising factors. Prevention is possible if rules of caution concerning dose and the rate of administration are respected, combined with biological surveillance involving at laboratory studies at least once a week.

[Epidemiology of infections on a thoracic surgery service]. / Epidémiologie des infections dans un service de chirurgie thoracique.

The aim of the present work is to discover the origin of the post-operative infections presented by certain patients following surgery for pulmonary exeresis in a surgical unit that deals both with thoracic and general surgical patients (most commonly cancer surgery). A prospective epidaemiological investigation of 54 pulmonary cases was thus undertaken, lasting for a period of 6 months. This consisted in obtaining multiple microbiological specimens from the patient himself, but also from the patient's environment and from the hospital staff (more than 1000 specimens were examined). The study begins at the stage of entry of the patient to the hospital department and follows him through the operation theatre stage and the post-operative period in the intensive care unit. In the intensive care unit the patients will come into contact with other patients who have been admitted urgently. These cases may or may not be of a pulmonary nature. Among the 54 subjects studied, 19 presented with infectious post-operative complications that led to 2 deaths. In 9 cases the infection was due to auto-contamination. It would appear that the environment plays a very small rôle as a factor leading to the development of post-operative infection since very few of the specimens taken were postive and usually the staphylococci were of various different lysotypes and never corresponding to the lysotype of the infective organism. Some predisposing factors to infection were demonstrated: an association with alcoholism and chronic bronchitis, pre-operatory bronchial suppuration, and widespread pulmonary exeresis was found.

[Hemodynamic effects of normovolemic hemodilution]. / Les effets hémodynamiques de l'hémodilution normovolémique.

After reviewing data from the literature concerning the effects of normovolaemic haemodilution on cardiac output and regional flow rates, the authors illustrate these concepts by a personal study involving the haemodynamics of 10 subjects undergoing operation in normovolaemic haemodilution. Removal of blood was compensated simultaneously by modified liquid gelatin in electrolytic solution (Plasmion) until the haematocrit was 0.30. Measurements were performed before haemodilution in patients in a steady state (anaesthetised, intubated, normoventilated), at the end of haemodilution, at the end of the operation, then 4 hours after recovery. There was no variation in blood pressure and heart rate, showing that normovolaemia was maintained. At the end of haemodilution, cardiac index increased from 3.10 to 3.84 l.min-1.m-2 (0.0517 to 0.0638 l.s-1 . m-2) (p < 0.005); stroke volume increased from 70 to 83 ml (p < 0.005); systemic resistance fell from 1585 to 1262 dynes. s.cm-5 (158.5 to 130.4 kPa.s.l-1) (p < 0.005); arterial oxygen content decreased from 191.1 to 152.1 ml.100 ml-1 (8.535 to 6.793 mmol.l-1) (p < 0.005), whilst oxygen transport was unchanged. These various haemodynamic measurements showed no significant changes at the subsequent times when they were measured, values remaining close to those obtained at the end of haemodilution. The results confirm the fact that norvolaemic haemodilution is accompanied by a fall in systemic vascular resistance with an increase in cardiac output. Regional circulations are thus improved. Since oxygen transport is unaffected, the oxygenation of peripheral tissues is ensured normally.

[Prevention of complications of histamine liberation occurring after administration of anesthetic agents and adjuvants]. / Prévention des accidents d'histaminolibération survenant après administration d'agents anesthésiques et adjuvants.

To protect the organism against histamine liberated during anesthesia specific premedication is used including:--hydroxyzine (Atarax) which blocks the H1 histamine receptors, and is an anxiolytic,--tritoqualine (Hypostamine) which inhibits histamine synthesis,--epsilon aminocaproic acid (Hemocaprol) which prevents the antigen-antibody reaction and blocks the alternate route of complement. Twenty five patients were thus premedicated, 25 others received no premedication. All were put to sleep with Alfatesine. The results were judged on the clinical symptoms and the variations of histamine in whole blood. This premedication seems very efficacious, in particular in subjects with a high risk of histamine liberation.