[Eruptive disseminated superficial porokeratosis associated with acute hepatitis E]. / Porokératose éruptive superficielle disséminée associée à une hépatite virale E aiguë.

BACKGROUND: Porokeratosis (PK) is a rare form of dermatosis characterized by a keratinization disorder of unknown etiology. Herein we describe the first case associated with hepatitis E virus infection. PATIENTS AND METHODS: A 69-year-old patient with colorectal cancer treated with radiation and chemotherapy followed by surgery in April 2017 presented two months later with jaundice associated with annular keratotic lesions of the skin with a raised border. Blood tests revealed elevated liver enzymes and hyperbilirubinemia. Viral hepatitis E was diagnosed based on serology and viral PCR after other aetiologies such as obstruction, auto-immune disease and other viruses (HAV, HBV, HCV, HSV, HIV, EBV and CMV) had been ruled out. A skin biopsy showed a cornoid lamella. Disseminated superficial porokeratosis associated with hepatitis E infection was then diagnosed. DISCUSSION: The mechanism of PK is unknown and probably involves a combination of different factors. PK has been described in patients with treatment-induced immunosuppression, solid cancer or AIDS, sometimes promoted by HCV viral infection, but never with concomitant HEV infection. A combination of immunosuppression induced by radio-chemotherapy and HEV infection could have prompted the development of PK in our patient. CONCLUSION: We report the first case of eruptive disseminated superficial porokeratosis associated with hepatitis E infection. The exact role of hepatitis E infection in the development of PK is still unclear.

Involvement of the cytoplasmic loop L6-7 in the entry mechanism for transport of Ca2+ through the sarcoplasmic reticulum Ca2+-ATPase.

We have found that despite a markedly low calcium affinity the D813A/D818A mutant is capable, after complexation with Cr.ATP, of occluding Ca(2+) to the same extent (1-2 Ca(2+) per ATPase monomer) as wild- type ATPase. The inherent ability of the synthetic L6-7 loop peptide to bind Ca(2+) was demonstrated with murexide and mass spectrometry. NMR analysis indicated the formation of specific 1:1 cation complexes of the peptide with calcium and lanthanum with coordination by all three aspartate residues D813/D815/D818 that resulted in an altered conformation of the peptide chain. Overall our observations suggest that, in addition to mediating contact between the intramembranous Ca(2+) binding sites and the cytosolic phosphorylation site as previously suggested, the L6-7 loop, in a preceding step, participates in the formation of an entrance port important for lodging Ca(2+) at a high-affinity binding site inside the membrane.

Efficiency of inhaled nitric oxide as rescue therapy during severe ARDS: survival and factors associated with the first response.

PURPOSE: The purpose of this study was to determine if the response to inhaled nitric oxide (NO) as salvage therapy is an independent factor for survival in adult respiratory distress syndrome (ARDS) patients and to identify the factors that predict the response to inhaled NO during ARDS. MATERIALS AND METHODS: This was a multicenter, 2-year retrospective, clinical study in five university surgical or medical intensive care units, including all consecutive patients with ARDS in whom inhaled NO was tried. Clinical data (medical history, diagnoses), general severity scores (SAPS II, OSF), biological data, radiological and hemodynamic data at admission, at the beginning of the ARDS, and under treatment with inhaled NO were recorded. The NO response was defined as the variation of PaO2/Fio2 ratio before initiation and after 30 minutes of NO inhalation (VarPaO2/FiO2). RESULTS: Ninety-three patients aged 49 +/- 18 years were studied. Mean SAPS II was 45 +/- 16. Before the beginning of inhaled NO, PaO2/Fio2 ratio was 95 +/- 53 mm Hg and lung injury score 2.7 + 0.3. VarPao2/Fio2 when NO was started (11 +/- 4 ppm) was 26 +/- 44.5 mm Hg (median 17 mm Hg). Intensive care unit mortality was 74%. None of the parameters studied were predictors of response to inhaled NO, although there was a tendency for the youngest patients with the more severe hypoxemia to have a better response. Response to first inhaled NO test (VarPaO2/FiO2) was univariately associated with survival (Survivors: 45 +/- 44 mm Hg vs. Nonsurvivors: 20 +/- 43 mm Hg, P = .01), but this difference disappeared after adjusting for other prognostic factors (P = .16) selected by multivariate analysis. Finally, inhaled NO was continued for more than 1 day for 75 patients, and definitively stopped for 18 patients. Intensive care unit mortality (73% vs. 78%) was not different between these groups (P = .25, Log-rank test). CONCLUSIONS: We conclude that (1) efficacy of inhaled NO in improving oxygenation was moderate and difficult to predict, (2) response to first NO inhalation was not associated with prognosis, and (3) treatment of the most severe ARDS patients with inhaled NO did not influenced their intensive care unit survival.

Liver transplantation for hepatic arteriovenous malformation with high-output cardiac failure in hereditary hemorrhagic telangiectasia: hemodynamic study.

We describe a case of orthotopic liver transplantation used as a therapeutic method to correct high output cardiac failure related to a liver arteriovenous fistula due to hereditary hemorrhagic telangiectasia. Detailed hemodynamic changes as they occurred during liver transplantation are described.

[Semiology and etiology of anosmia: apropos of 306 patients]. / Sémiologie et étiologie des anosmies: à propos de 306 patients.

Chemosensory dysfunction is relatively common. This article describes a series of 306 patients who presented with anosmia. We divided olfactory disorders into those associated with interruption of the transport of stimulus and those associated with damage to either peripheral or central nervous system structures. Nasal and paranasal sinus disease (transport interruption) was found to be causative in 67% of patients presenting with anosmia. These patients are generally 45 years old, the loss of olfaction is progressive and associated with additional nasal symptoms. Upper respiratory infection was found to be causative in 18% of patients. They are generally older, with a mean age of 58 years and are predominantly female (78%). The loss of smell is sudden and anosmia is often accompanied by troublesome parosmias (50%). CT-scan is necessary for the evaluation of a smell dysfunction.

[Drainage after thyroid surgery: 264 patients]. / Drainage dans la chirurgie thyroïdienne.

OBJECTIVES: A prospective study was conducted in 1996-1997 in 100 patients who underwent thyroid surgery and who were randomly assigned to receive drainage or not. No statistical difference in complication rate was observed. The aim of the present retrospective study was to assess the consequences of this attitude in patients undergoing surgery since that time and to determine the number of postoperative complications, length of hospital stay, and type of thyroidectomy where cervical drains still appear to be indicated. PATIENTS AND METHODS: Total or partial thyroid surgery was performed in 264 patients between June 1997 and October 2000. Neck dissection was associated with 24 patients. RESULTS: Cervical drains were used in 29 patients (10.9%). Postoperative complications were comparable to those commonly reported. CONCLUSION: Except for neck dissection and mediastinal extension, thyroidectomy can be safely performed without drainage. This attitude reduces the overall hospital stay.

Neuromuscular disorders.

Neuromuscular diseases form an heterogeneous group of illnesses. These diseases are rare and studies concerning their anaesthetic management are difficult. Patients with neuromuscular disease represent a challenge for the anaesthesiologist because of the frequent perioperative complications. Cardiac and respiratory functions are often involved, and the severity of the lesions are difficult to estimate. The possible interactions of different drugs necessitates a good knowledge of the drugs' actions and pathophysiological mechanisms.

[First results of a surgical treatment of a persistant low-back pain of dorso-lumbar origin]. / Premiers résultats d'un traitement chirurgical de la lombalgie basse rebelle d'origine dorso-lombaire.

Low-back pain may originate in the thoraco-lumbar joints. Due to motion and stress, the latter constitute a high-risk transitional zone. Pain is transmitted by the posterior branches of the D11, D12 or L1 spinal nerves, which innervate the cutaneous and subcutaneous levels of the low-back and upper buttocks region. It is experienced as a deep-seated pain. Clinical examination makes it possible to determine the level responsible. The lumbar pain disappears with anesthesia of the interapophysary articulation. Appropriate medical treatment most often succeeds. If its fails, surgery can provide a solution. It consists of a capsulectomy on the level responsible, and on the upper and lower adjoining regions. This operation also destroys the posterior branch, which is closely joined to the capsule. Out of the 10 cases operated on, there was 1 failure, 6 very good results and 3 good results after follow-up periods of 20 months to 6 months. Without prejudging the future, it seems that there is hope for the treatment of unexplained back pains or those persisting after operations on lumbar disks that are not relieved by appropriate medical treatment of the thoraco-lumbar joints.

[Ibuprofen in osteo-articular (author's transl)]. / L'ibuprofène en pathologie ostéo-articulaire.

The authors point out the good results which are obtained in osteo-articular pathology, in particular vertebral, with ibuprofen (Brufen 400). Providing that a sufficient dosage is given (1 600 mg - 2 400 mg per day), an obvious and fast favourable effect is noticed in 75% cases. According to these results, tolerance is quite satisfactory.

[Low back pain of dorse-lumbar origin: surgical treatment of postérlor articular capsule excision (author's transl)]. / Lombalgies basses d'origine dorso-lombaire: traitement chirugical par excision des capsules articulaires postérieures. Rapport préliminaire.

Low back pain may be of dorso-lumbar spinal origin. Pain is transmitted via the posterior branches of the D11, D12, and L1 spinal nerves. The existence in the patient with lumbago of an area of localised pain along the iliac crest, of subcutaneous tenderness or pain in the buttock and of pain over the dorso-lumbar joints is indicative of the diagnosis. Local infiltration at the site of dorso-lumbar tenderness often causes the low back pain to disappear, often temporarily. Since the posterior branches of the spinal nerves are struck down to the capsules of the inter-apophyseal joints, it was felt that excision of these capsules would reproduce, in a permanent manner, the effects of these infiltrations. On the basis of initial results these are grounds for hope relief for certain cases of unexplained lumbar pain or of the sequellae of low lumbar surgery.

Visual estimation of onset time at the orbicularis oculi after five muscle relaxants: application to clinical monitoring of tracheal intubation.

UNLABELLED: The onset time of neuromuscular blockade at the adductor pollicis (AP) is different among neuromuscular blocking drugs, but these discrepancies had never been studied at the orbicularis oculi (OO). The purpose of this study was to verify if the differences in onset time observed at the AP still existed at the OO and to score the intubating conditions using monitoring at the OO after five muscle relaxants. The study included 172 adults aged 18-75 yr. Anesthesia was induced with fentanyl and propofol. Atracurium (0.5 mg/kg), mivacurium (0.20 mg/kg), rocuronium (0.6 mg/kg), succinylcholine (1.0 mg/kg), or vecuronium (0.08 mg/kg) was injected by random allocation. Time to complete disappearance of the response at the OO was assessed visually after train-of-four stimulation of the facial nerve. Laryngoscopy was then performed, and intubating conditions were determined on a scale of 1-4. Results were based on 150 patients. Onset time at the OO was (mean +/- SD): succinylcholine (57 +/- 17 s) < mivacurium (99 +/-19 s) = rocuronium (99 +/- 47 s) < atracurium (129 +/-33 s) = vecuronium (135 +/- 38 s) (P < 0.05). Overall intubating conditions were excellent (84%), good (14%), poor (1.3%), impossible (0.7%), and were similar among the five groups. We conclude that differences in onset time of muscle relaxants observed at the AP were also found at the OO. Visual estimation of the response at the OO correctly predicted good-to-excellent intubating conditions in more than 90% of cases for all the currently available muscle relaxants. IMPLICATIONS: Onset time of neuromuscular blockade, as estimated visually at the orbicularis oculi, depends on the muscle relaxants given. Regardless of the relaxant used, intubating conditions at loss of orbicularis oculi are acceptable.

A comparative study of the mitochondrial genome organization in in vitro cultures of diploid, tetraploid, and hexaploid Triticum species.

Southern-blot hybridizations of total DNA to mitochondrial DNA (mtDNA) probes were used to investigate the extent of mtDNA variability in cultures derived from immature embryos of diploid (Triticum monococcum, genomic formula: AA, T. tauschii, genomic formula: DD), allotetraploid (T. durum cv "Creso", genomic formula: AABB), and allohexaploid (T. aestivum, genomic formula: AABBDD) wheat species. Similar distinct changes in mtDNA organization were observed in in vitro cultures of the derived tetraploid and the hexaploid species with related genomes. The tetraploid and hexaploid species share the B genome and mtDNA variability in in vitro culture is known to be under nuclear control. These results suggest that a study of B genome diploids and other polyploid combinations would now shed light on whether or not mtDNA variability in tissue cultures is under B-genome control.

Paradoxical air embolism during orthoptic liver transplantation: diagnosis by transoesophageal echocardiography.

We describe a case of paradoxical air embolism during orthotopic liver transplantation, early diagnosis, using intra-operative transoesophageal echocardiography after a circulatory failure, allowed early management by hyperbaric oxygen therapy.

Organ/tissue-specific changes in the mitochondrial genome organization of in-vitro cultures derived from different explants of a single wheat variety.

We have previously shown that the mitochondrial genome of long-term tissue cultures prepared from immature embryos of several varieties of cultivated wheat underwent variety-specific rearrangements resulting from either changes in the relative amounts of subgenomic components or from the appearance of novel genomic configurations. In the present work, both categories of rearrangements were studied in long-term tissue cultures initiated from other explants (shoot meristem, young leaf base, young root tip, immature inflorescence) of the same wheat variety (Chinese Spring) and were compared to those previously obtained with immature embryo cultures. Two main patterns of reorganization were found in a region of the mitochondrial genome known to be hypervariable in structure. In addition, some of the novel subgenomic configurations were obviously organ/tissue-specific whereas others were present in more than one type of organ. In several instances, the age of culture was found to determine the degree of mitochondrial DNA rearrangement. The data presented in this study strengthen the hypothesis of an association between a particular organization of the mitochondrial genome in tissue culture and its regeneration capacity.

The cytoplasmic loop located between transmembrane segments 6 and 7 controls activation by Ca2+ of sarcoplasmic reticulum Ca2+-ATPase.

During active cation transport, sarcoplasmic reticulum Ca2+-ATPase, like other P-type ATPases, undergoes major conformational changes, some of which are dependent on Ca2+ binding to high affinity transport sites. We here report that, in addition to previously described residues of the transmembrane region (Clarke, D. M., Loo, T. W., Inesi, G., and MacLennan, D. H. (1989) Nature 339, 476-478), the region located in the cytosolic L6-7 loop connecting transmembrane segments M6 and M7 has a definite influence on the sensitivity of the Ca2+-ATPase to Ca2+, i.e. on the affinity of the ATPase for Ca2+. Cluster mutation of aspartic residues in this loop results in a strong reduction of the affinity for Ca2+, as shown by the Ca2+ dependence of ATPase phosphorylation from either ATP or Pi. The reduction in Ca2+ affinity for phosphorylation from Pi is observed both at acidic and neutral pH, suggesting that these mutations interfere with binding of the first Ca2+, as proposed for some of the intramembranous residues essential for Ca2+ binding (Andersen, J. P. (1995) Biosci. Rep. 15, 243-261). Treatment of the mutated Ca2+-ATPase with proteinase K, in the absence or presence of various Ca2+ concentrations, leads to Ca2+-dependent changes in the proteolytic degradation pattern similar to those in the wild type but observed only at higher Ca2+ concentrations. This implies that these effects are not due to changes in the conformational state of Ca2+-free ATPase but that changes affecting the proteolytic digestion pattern require higher Ca2+ concentrations. We conclude that aspartic residues in the L6-7 loop might interact with Ca2+ during the initial steps of Ca2+ binding.

Vascular properties of isoflurane: comparison between normal and cirrhotic rats.

Isoflurane is known to dilate blood vessels and to modulate nitric oxide production. Because cirrhosis is characterized by over production of endothelial nitric oxide, isoflurane-induced vasodilatation may be altered in this situation. We have compared the vasodilator effects of isoflurane in normal rats and rats with secondary biliary cirrhosis. Aortic rings (intact or endothelium denuded) from normal and cirrhotic rats were suspended in HEPES solution and preconstricted with KCl 40 mmol litre-1. Isoflurane dose-dependently relaxed vessels in both groups. Maximal relaxation was comparable between normal and cirrhotic rats in intact (mean 80 (SEM 4) vs 81 (6)%; ns) and in denuded (100 (4) vs 95 (5)%; ns) vessels. Intact vessels relaxed more than denuded vessels in both groups (100 (4) vs 80 (4)% (P = 0.0008) in normal rats and 95 (5) vs 80 (6)% (P = 0.0008) in cirrhotic rats). We conclude that cirrhosis did not modify isoflurane-induced vasodilatation and that the modulator effect of endothelium was conserved.