Characterization and in vitro evaluation of a vaginal gel containing Lactobacillus crispatus for the prevention of gonorrhea.

The increasing resistance of Neisseria gonorrhoeae to any current antibiotic treatment and the difficulties associated with the use of prevention means such as condom urge the need for alternative methods to prevent this sexually transmitted infection. In this work, a prevention strategy based on the use of a vaginal gel containing Lactobacilli was assessed in vitro. A Lactobacillus crispatus strain (ATCC 33197) was selected based on the published data on its ability to inhibit Neisseria gonorrhoeae. Its probiotic properties were first characterized. Then, a thermo-sensitive hydrogel containing 21.5% of poloxamer 407, 1% of sodium alginate and 9log10 CFU of Lactobacillus crispatus per gel sample (5 g) was developed. The gelation temperature and the rheological characteristics of this formulation appeared suitable for a vaginal administration. Lactobacillus crispatus was viable in the gel for six months although a large amount of the bacteria was not culturable. The ability of Lactobacillus crispatus to inhibit Neisseria gonorrhoeae was still observed with the gel. Such system, thus, appeared promising for the prevention of gonorrhea.

Evaluation of trace elements released by edible clays in physicochemically simulated physiological media.

Physicochemical simulation (pH, electrolytes and temperature) of three physiological media was carried out in order to follow the release of trace elements contained in seven edible clays (mainly kaolinite, illite, muscovite and quartz) collected from the West African countries of Côte d'Ivoire, Guinée and Sénégal. These clays are ingested by pregnant women for diverse reasons that are related to their condition. Simulated oral (6.5

Release of antiseptics from the aqueous compartments of a w/o/w multiple emulsion.

A w/o/w multiple emulsion drug carrier system has been developed for local vaginal therapy. To improve its efficacy and to extend the antimicrobial spectrum activity of benzalkonium chloride (CBZ), which is introduced in the external aqueous phase, chlorhexidine digluconate (CHD) was added to the internal aqueous phase of the multiple emulsions. The minimal bactericidal concentrations (MBC) for the association of CHD and CBZ in emulsion were determined towards Escherichia coli and Staphylococcus aureus. The main release mechanism considered for the CHD encapsulated in the inner phase was a swelling-breakdown phenomenon which followed dilution of the emulsion under hypo-osmotic conditions. In order to demonstrate this release, the bactericidal effect of multiple emulsions undiluted and diluted 1-5 and 1-10 in hypo-osmotic conditions at two CHD concentrations was evaluated. To validate and quantify this release, rheological and release kinetics studies were used. The bactericidal activity of combination CBZ-CHD in the emulsion was synergistic on the two bacterial strains and the release of encapsulated CHD in the internal phase was obtained following its dilution in hypo-osmotic conditions. Vaginal administration could be carried out following dilution at 1-5 in sterile water for multiple emulsions containing the lower concentration of CHD.

Screening of some New Caledonian and Vanuatu medicinal plants for antimycobacterial activity.

Twenty plants, belonging to sixteen families, used in traditional New Caledonian and Vanuatu medicine for treatment of symptoms potentially related to tuberculosis (cough, fever or inflammation) were screened for antimycobacterial activity. We also screened an original endemic plant, Amborella trichopoda, only member of the monogeneric family Amborellaceae and considered the most primitive living angiosperm. In total, 55 extracts were evaluated for inhibitory activity against Mycobacterium bovis BCG strain at a concentration of 100 microg/ml. Methanolic and dichloromethane extracts of Amborella trichopoda, Codiaeum peltatum, Myristica fatua, and essential oils Myoporum crassifolium showed an activity at this concentration. Methanolic extract of Amborella trichopoda fruits presented a significant activity with a minimal inhibitory concentration included between 1 and 2.5 microg/ml. In the same conditions, this activity was comparable with those of the reference drugs pyrazynamide and ethambutol, at 20 and 2.5 microg/ml, respectively.

In vitro microbicidal activity of W/O/W multiple emulsion for vaginal administration.

The microbicidal activity of a W/O/W multiple emulsion destined for vaginal application, containing lactic acid in the internal aqueous phase, octadecylamine (ODA) in the oily phase and benzalkonium chloride (CBZ) in the external aqueous phase was evaluated against three microbial strains: Escherichia coli, Staphylococcus aureus and Candida albicans. The results were different depending on the procedure used. Interpretable results were obtained if only a gentle agitation was used just after the introduction of the microbial suspension to the product. This suggested that vigorous agitation lead to a variable fraction of CBZ or ODA entrapped in the micelles of ethylene and propylene oxide copolymer (COE).

Combined lung and heart extraction in clinical transplantation.

The anatomical conditions for single lung and double lung transplantation allow a heart transplant and one or two lung transplants to be performed in two or three different recipients from a single donor with healthy lungs. The extraction of the heart and lung block for the purposes of these separate transplantations is described on the basis of our experience of 6 single lung transplants with 6 extractions for cardiac transplantation in different recipients, of a total of 8 lung transplants. We report these 12 successful operations and the particular technical modalities of cardiopulmonary extraction for separate transplantation. After cannulation for cooling of the abdominal viscera (kidneys, liver, pancreas), thoracic and mediastinal dissection, cardioplegia and surface pulmonary cooling by iced saline on the collapsed lungs, the heart and lungs were extracted as a single block and were separated ex situ. After periods of cold ischaemia of 1 h to 3 h 30 min for the hearts and 1 h 30 min to 5 h for the lungs, the immediate and medium term functions were satisfactory. Logistical difficulties involved in matching the population of recipients have prevented the grafting of three different recipients up until now. These successes make it essential to preserve the lungs from donors with healthy lungs. A rigorous coordination between the various transplantation teams helps to avoid competition between the three types of transplantation: heart-lung, double lung and single lung.

Attachment of Salmonella choleraesuis choleraesuis to beef muscle and adipose tissues.

The attachment of Salmonella choleraesuis subsp. choleraesuis ATCC 15790 to beef muscle and adipose tissues was investigated. S. choleraesuis was found to adhere in higher numbers to muscle than to fat. The charge and the hydrophobicity of the surface of S. choleraesuis were evaluated by measurement of electrophoretic mobility, the contact angle with water, adhesion to hexadecane, and hydrophobic interaction chromatography. The overall negative charge of S. choleraesuis was masked by the high electrolyte concentration in the attachment medium (0.15 M phosphate-buffered saline). This bacterium was shown to possess a hydrophilic surface. Electrostatic interactions do not affect the attachment of S. choleraesuis to both lean and fat tissue, and there was no evidence for a role of hydrophobic interactions. However, the attachment of S. choleraesuis was reduced by 90% after mechanical removal of the flagella or after treatment of the bacteria with specific antiflagella serum. This reduction was attributed to a loss of bacterial mobility leading to a reduction in the number of cells reaching the tissue during the period of contact. Treatment of the tissue with a concentrated suspension of flagella or treatment of the bacteria with antisomatic serum (OMD) did not reduce the attachment of S. choleraesuis to tissues, indicating an absence of specific attachment sites for flagella or antigen O on the beef tissue surface.

["Logic" and doubts in the surgery of associated carotid and vertebral lesions]. / "Logique" et incertitudes dans la chirurgie des lésions associées carotidiennes et vertébrales.

Combined vertebral artery and carotid artery surgery may be performed in patients with proximal subclavian or vertebral artery stenosis provided that general anesthesia is not contraindicated? Others indications may be considered in patients with proved arterial thrombo-embolism or in patients for whom arteriography, cerebral angioscintigraphy and ultrasound velocimetry enable the physician to suspect a cerebral low flow and the lack of collateral pathways between the posterior and anterior cerebral system.

[Aneurysms of the abdominal aorta. Value and mode of detection]. / Les anévrismes de l'aorte abdominale. Intérêt et modalités de leur dépistage.

Despite improvements in the treatment of risk factors for atherosclerosis, the incidence and mortality rate for aneurysms of the abdominal aorta have increased during the past 40 years. The prevalence of these aneurysms is 2.5 percent in unselected populations but reaches 13.5 percent in selected populations. The pathogenesis of aneurysms involves multiple factors and the lesion is progressive, leading to lethal rupture in 25 percent of the cases. In elective surgery of abdominal aortic aneurysms the mortality rate is about 2 percent, as against 60 percent in emergency surgery for rupture. The presence of such aneurysms must be detected primarily in populations at risk, using physical examination and abdominal ultrasonography. If this is done, the ratio of detection costs to benefits of preventive surgery is in favour of a decidedly active approach of this dangerous disease.

[Value of X-ray computed tomography of the brain in controlled carotid surgery]. / Intérêt de la scanographie cérébrale dans la chirurgie carotidienne réglée.

The usefulness of computerized tomography (CT) in elective carotid surgery was evaluated in a prospective study of 402 patients who had a surgical operation on one or two atheromatous arteries and were explored by pre and post-operative CT of the brain. Pre-operative CT scans revealed an ischaemic lesion in 22 per cent of asymptomatic patients and in 29 per cent of patients who had experienced a transient ischaemic accident. Abnormal pre-operative CT scans were associated with a statistically significant increase in per-operative electroencephalographic changes, but there was no significant increase in post-operative neurological complications. Post-operative CT scans showed a "silent" infarct in 6 per cent of the cases; 59 per cent of patients with neurological complications had normal or unchanged post-operative CT images. This study suggests that pre-operative CT is not necessary to evaluate the neurological risk and that post-operative CT alone is inadequate to quantify the morbidity of carotid surgery.

Renal artery emboli: the role of surgical treatment.

Twelve cases of emboli to the renal artery (one of which was recurrent) were reviewed. In seven patients, emboli were unilateral and the opposite kidney was functional. In five patients, emboli were bilateral or occurred in a solitary kidney, leading to anuria. Cardiac rhythm disorders were encountered in eight patients and were responsible for emboli in other areas in three. Arteriography in ten patients demonstrated seven complete truncal occlusions (one bilateral), two incomplete truncal occlusions, and one distal embolus. One patient with a distal embolus was treated by heparin alone with satisfactory results. One patient in poor general condition was treated with intraarterial streptokinase, resulting in incomplete lysis of the clot. The five patients with anuria were operated on: four regained satisfactory renal function whereas the other patient died. In five patients without anuria who were operated upon, renal function returned to normal in four, and one patient required nephrectomy. Surgical treatment is imperative with anuria and is indicated in unilateral emboli with a functional contralateral kidney, especially when there is complete occlusion of the renal trunk. If the embolus is recent, intraarterial fibrinolytic treatment or percutaneous embolectomy can be attempted, but these techniques are not of proven efficacy. Patients with distal emboli or contraindications to operation should be treated by anticoagulant therapy, alone or with local fibrinolytic treatment.

Cell surface characteristics of Lactobacillus casei subsp. casei, Lactobacillus paracasei subsp. paracasei, and Lactobacillus rhamnosus strains.

Hydrophilic and electrostatic cell surface properties of eight Lactobacillus strains were characterized by using the microbial adhesion to solvents method and microelectrophoresis, respectively. All strains appeared relatively hydrophilic. The strong microbial adhesion to chloroform, an acidic solvent, in comparison with microbial adhesion to hexadecane, an apolar n-alkane, demonstrated the particularity of lactobacilli to have an important electron donor and basic character and consequently their potential ability to generate Lewis acid-base interactions with a support. Regardless of their electrophoretic mobility (EM), strains were in general slightly negatively charged at alkaline pH. A pH-dependent behavior concerning cell surface charges was observed. The EM decreased progressively with more acidic pHs for the L. casei subsp. casei and L. paracasei subsp. paracasei strains until the isoelectric point (IEP), i.e., the pH value for which the EM is zero. On the other hand, the EM for the L. rhamnosus strains was stable from pH 8 to pH 3 to 4, at which point there was a shift near the IEP. Both L. casei subsp. casei and L. paracasei subsp. paracasei strains were characterized by an IEP of around 4, whereas L. rhamnosus strains possessed a markedly lower IEP of 2. The present study showed that the cell surface physicochemical properties of lactobacilli seem to be, at least in part and under certain experimental conditions, particular to the bacterial species. Such differences detected between species are likely to be accompanied by some particular changes in cell wall chemical composition.

Femorodistal bypass using cryopreserved venous allografts for limb salvage.

Critical ischemia due to extensive femoropopliteal occlusive disease often leads to amputation in patients in whom an autologous vein is unavailable for reconstruction. The purpose of this nonrandomized prospective study is to evaluate the usefulness of cryopreserved venous allografts (CPVA) as an arterial substitute in these cases. Between October 1990 and March 1993, long bypass to a tibial or a foot artery using a CPVA was performed in 25 consecutive patients with ulcerations or gangrene. There were 19 women and six men with a mean age of 72 years (range: 51-90). The indication for allograft reconstruction was absence (17 cases) or unsuitability (eight cases) of an autologous vein graft. Greater saphenous vein allografts were harvested from multiple organ donors and frozen at -80 degrees C with 12% dimethylsulfoxide (DMSO). Sixteen patients had undergone one or more previous unsuccessful limb salvage attempts. The plantar arch was absent or incomplete in 16 patients (64%). Patients were followed up prospectively for a mean of 21 months (range: 3-32). One patient died early (32 days) and three patients died late with patent bypasses. Cumulative survival rate was 77% at 1 year and 72% at 2 years. Cumulative secondary patency rate (Kaplan-Meier) was 88% at 1 months, 72% at 6 months, and 52% at 1 year. The cumulative limb salvage rate was 78% at 2 years. When an autologous vein is unavailable, long bypass using a CPVA is a simple, quick, minimally traumatic, economical, and effective method to achieve limb salvage in patients with severe distal arterial occlusive disease. However, CPVA causes immunoreaction and there is a risk of proximal postanastomotic stenosis. Doppler ultrasound surveillance of a subcutaneous graft allows accurate assessment and repair of the abnormalities with no increase in mortality or morbidity.

Mesenteric infarction in Takayasu's disease.

Obstructive lesions of the visceral arteries in Takayasu's disease are common but rarely symptomatic. This report concerns two patients with Takayasu's disease who died of mesenteric infarction due to superior mesenteric artery thrombosis. Prophylactic revascularization of the visceral arteries in Takayasu's disease remains controversial, and lesions can be more severe than classically recognized.

False aneurysm infected by Aspergillus fumigatus: an unusual complication of aortofemoral bypass graft.

Two cases of Aspergillus fumigatus infection of aortobifemoral prosthetic grafts are reported. Both patients were treated successfully by excision of the infected prosthetic material, axillofemoral extra-anatomic bypass, and prolonged medical treatment. The patients received amphotericin B, 5-flucytosine and itraconazole until negative aspergillus serology was obtained (at 9 and 18 months, respectively). Later, repeat disobliteration procedures for thrombosis of the axillofemoral bypass were required. No recurrent aspergillus infection was found.

[Carotid surgery under cervical plexus block. 405 consecutive operations]. / Chirurgie carotidienne sous bloc plexique cervical. 405 interventions consécutives.

There is controversy over the choice of anaesthesia for carotid surgery. The aim of this retrospective study was to report the early results of carotid surgery performed with loco-regional anaesthesia by blockade of the cervical plexus. From 1987 to 1992, 405 consecutive operations on the carotid bifurcation were performed using this technique. Among these patients, 202 (50%) were asymptomatic, the indication being carotid narrowing of 80% or more, while clinical signs were observed in the other 203 patients (50%). According to the Sundt classification, 360 patients (89%) had a medical risk and 45 (11%) had a neurological risk. Occlusion of the controllateral internal carotid was present in 47 patients (12%). The deep blocade affected roots C2-C3-C4 followed by a superficial block using 0.5% Bupivacaine. An endarteriectomy was performed in 96% of the cases. In 10 (2.5%), there were complications or the cervical plexus blocade was insufficient: 6 caused the operation to be postponed and/or use of general anaesthesia, but none of these led to postoperative complication. In 35 patients (8.6%) neurological events during clamping required establishing a shunt (6.1% and 27.6% in cases with permeable or occluded controlateral carotids respectively). Neurological recovery was rapid and complete except in 4 cases. There were 8 central neurological complications which persisted or appeared postoperatively: 5 regressive ischaemic events, 2 persistent ischaemic events and one which led to the patient's death. No cardiac complications were seen. We conclude that blocade of the cervical plexus is a simple and effective technique for surgery of the carotid bifurcation. With this method, detection of clamp intolerance is more reliable and it gives enough time for endarteriectomy. The risk of coronarian complications is low due to good haemodynamic stability. This method is a low-cost technique and is better adapted to understanding the mechanisms of neurological complications.

Resistance of Escherichia coli growing as biofilms to disinfectants.

The bactericidal activity of various disinfectants (cationic or amphoteric surfactants, oxidizing agents, phenolic derivatives) was determined against Escherichia coli CIP 54127 obtained by culture on tryptic soy agar (in-suspension or on-germ-carrier test) or in the form of biofilms produced in a continuous culture system. The bacteria tested on germ-carriers or included in biofilms were more resistant than the same strain in suspension. The extent of the reduction in activity depended on the nature of the disinfectant. In the two cases, the greatest reduction was observed with benzalkonium chloride and hexadecyl trimethylammonium bromide, the agents with the lowest hydrophile-lipophile balance. The activity of the oxidizing agents (sodium hypochlorite, peracetic acid/H2O2) and alkyl trimethylammonium derivatives (C12 and C14) was somewhat reduced, while that of the phenolic derivatives (o-cresol, phenol) was either slightly attenuated or unaffected. The reduction in sensitivity was attributed to a reduced accessibility of the bacterial cells to the disinfectants, due to the fact that the former adhered to a support. Furthermore, the interfering action of the substances in contact with the bacteria (milk in the germ-carrier test and exopolymers in the biofilms) could play a role. The reduced sensitivity of the bacteria in the biofilms was not due to any alteration in the metabolic state of the bacteria (mostly in a quiescent state) since this resistance was lost after the mechanical resuspension of the cells before the contact with the disinfectants.

Above-knee femoropopliteal bypass grafting using endothelial cell seeded PTFE grafts: five-year clinical experience.

Early clinical trials using endothelial cells seeded vascular grafts failed to confirm the successful results observed in animals. Differences in seeding methods could at least partially account for this failure. The purpose of the present study was to ascertain the feasibility and intraoperative efficacy of a two-stage technique that allowed high-density seeding as in animals. The first stage of the technique consists of harvesting an autologous vein specimen under local anesthesia followed by enzymatic isolation and in vitro culture of endothelial cells. The second stage is vascular repair. During the procedure the prosthesis is precoated with autologous whole blood or plasma for 30 minutes and seeded at high density with endothelial cells incubated for 45 minutes. Between May 1988 and June 1993, 32 patients were enrolled in this study. In 11 of them, however, the technique could not be completed for various reasons including preoperative infarction in one case, failure to achieve isolation and/or cell cultures in nine cases, and contamination of cell culture in one case. Twenty-one patients (18 men and 3 women) whose mean age was 62 years (range 38 to 78) underwent above-knee femoropopliteal bypass using an endothelial cell seeded polytetrafluoroethylene graft (7 mm). The indication for surgery was intermittent claudication in 20 patients and rest pain in one. The mean size of the vein specimen was 10.5 +/- 3.5 cm2. The mean duration of in vitro cell culture was 23.5 +/- 8.5 days. The mean density of seeding was 2.9 +/- 0.8 x 105 cells/cm2 prosthesis. No major complications were encountered during the immediate postoperative period (30 days). During follow-up two patients with patent bypasses died of intercurrent causes at 2 and 36 months, respectively, one patient had an abscess in the femoral triangle that required removal of the prosthesis (75 days), and three patients presented with bypass failure (2 occlusions and 1 thromboembolic complication) at 3, 10, and 53 months, respectively. Mean follow-up in the 20 patients surviving at 3 months was 42 +/- 15 months. Cumulative primary patency (Kaplan-Meier analysis) was 95% (+/- 10) at 3 months, 89% (+/- 13) at 10 and 48 months, and 67% (+/- 39) at 53 and 76 months. The two-stage seeding technique described herein was feasible in 69% of patients not requiring emergency reconstruction and did not increase perioperative morbidity and mortality. Bypass patency in patients who underwent above-knee femoropopliteal bypass for intermittent claudication was promising.