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Copyright of Nouveau Praticien Vétérinaire Élevages et Santé is the property of EDP Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Résumé: Le nombre de patients en attente de transplantation hépatique ne cesse d'augmenter mais la pénurie d'organes augmente le temps d'attente, les sorties de liste et les décès sur liste. Afin d'améliorer l'accès à la greffe, les équipes de transplantation sont donc à la recherche de solutions innovantes pour améliorer la quantité et la qualité des greffons disponibles. Les donneurs cadavériques en état de mort encéphalique représentent la principale source de greffons, sans augmentation prévisible du fait du taux d'opposition et de l'amélioration de la prise en charge médicale. Il a donc fallu depuis de nombreuses années se tourner vers des donneurs dits à critères élargis : patients âgés, stéatose hépatique, arrêt cardiaque prolongé. L'utilisation croissante de ces donneurs justifie le développement, l'évaluation, l'utilisation de techniques de préservation dynamique (machines de perfusion) afin d'une part de mieux préserver voire optimiser ces greffons marginaux mais aussi permettre une évaluation ex vivo plus précise de la qualité du foie prélevé. Les donneurs cadavériques avec arrêt cardiocirculatoire Maastricht III représentent également une source de greffons, avec une augmentation du recensement ces dernières années. Les transplantations avec donneurs vivants sont rares et surtout privilégiées en pédiatrie avec un don intrafamilial. Dans le futur, le développement des machines de perfusion, du foie bio-artificiel et la xénogreffe pourrait, à terme, pallier en partie à la pénurie d'organes. The number of patients waiting for liver transplantation is constantly increasing, but the shortage of organs is increasing the waiting time, the number of patients coming off the list and deaths on the list. In order to improve access to transplantation, transplant teams are therefore looking for innovative solutions to improve the quantity and quality of available grafts. Brain-dead cadaveric donors represent the main source of grafts, with no foreseeable increase due to the rate of opposition and improved medical management. It has therefore been necessary for many years to turn to so-called expanded criteria donors: elderly patients, hepatic steatosis, prolonged cardiac arrest. The increasing use of these donors justifies the development, evaluation, and use of dynamic preservation techniques (perfusion machines) in order to better preserve or even optimise these marginal grafts and also to allow a more precise ex-vivo evaluation of the quality of the liver. Cadaveric donors with Maastricht III cardiocirculatory arrest also represent a source of grafts, with an increase in the census in recent years. Transplants with living donors are rare and mostly favoured in paediatrics with intra-family donation. In the future, the development of perfusion machines, bioartificial livers and xenotransplantation could in the long run reduce the organ shortage. [ABSTRACT FROM AUTHOR]

Résumé: La cardio-oncologie requiert une connaissance fine de la cardiotoxicité des traitements anticancéreux, de leur mécanisme et de leur diagnostic pour mieux les prendre en charge. Les traitements anticancéreux sont responsables de dommages cardiaques à différentes échelles, jusqu'à une altération microvasculaire. Leur cardiotoxicité repose aujourd'hui principalement sur l'altération de la fraction d'éjection ventriculaire gauche (FEVG). L'imagerie de perfusion cardiaque cherche à rendre compte de l'apport de l'oxygène et des nutriments aux tissus au travers du flux sanguin, suggérant ainsi l'évaluation de la microcirculation coronaire. Cette imagerie de perfusion cardiaque peut être réalisée en pratique clinique par imagerie nucléaire ou imagerie par résonance magnétique (IRM) cardiaque. Dans cette mini-revue, nous exposons la cardiotoxicité de différents traitements anticancéreux et décrivons l'évaluation de la perfusion myocardique pour détecter précocement cette cardiotoxicité avant toute altération de la FEVG. Cardio-oncology requires a good knowledge of the cardiotoxicity of anticancer drugs, their mechanisms and diagnosis for better management. Anticancer drugs are responsible of cardiac damages at different levels that could involve microvascular dysfunction. Anticancer drugs cardiotoxicity are currently mainly based on left ventricle ejection fraction alteration (LVEF). Cardiac perfusion imaging involves assessing the delivery of oxygen and nutrients to tissues through blood flow, and thus suggest assessment of the coronary microcirculation. This can be realized in clinical practice by nuclear imaging or cardiac magnetic resonance imaging. In this mini-review, we provide a comprehensive overview of the cardiotoxic effects of anticancer drugs and describe myocardial perfusion approaches to detect them before overt LVEF impairment. [ABSTRACT FROM AUTHOR]

Copyright of Annales Françaises de Médecine d'Urgence is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The presence of angiographic thrombus is associated with poor outcomes in contemporary cardiology practice. Percutaneous coronary intervention (PCI) in such lesions is associated with slow flow and no-reflow phenomenon which translate into poor clinical outcomes., Methods: This was a single-centre, prospective, open-label, randomized controlled study with 50 patients each in intervention group and control group. Patients with angiographically proven large thrombus burden were recruited. In the intervention group, patients were given loading dose of intracoronary tirofiban (25 mcg/kg infused over 5 minutes) followed by prolonged infusion of tirofiban (0.15 mcg/kg/min for 12-18 hours) followed by PCI after 48-72 hours interval. In control group patients were taken up directly for PCI during the index procedure. Outcomes were assessed angiographically and in terms of clinical endpoints., Results: The primary composite-endpoint of recurrent angina, myocardial infarction, cardiovascular death, target lesion revascularization and unscheduled CABG was significantly lower in the intervention arm compared to control arm (4% vs 16%, p = 0.04). Amongst the secondary endpoints, a statistically significant 30-day increase in ejection fraction from baseline was observed in the intervention group compared to the control group (1.6 ± 1.3 vs 0.2 ± 0.4, p = 0.0001). Overall mortality was similar in the two groups (4% vs 8%, p = 0.39). The primary safety endpoint of major bleeding was also similar in the 2 groups (2% vs 0%, p = 0.31)., Conclusions: Tirofiban use prior to PCI in high thrombus burden was associated with improved clinical and angiographic endpoints with similar adverse events compared to controls., Competing Interests: Competing interests The Authors declares no conflict of interest., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

La perfusion permet l’administration d’une substance à visée thérapeutique ou nutritionnelle par injection, par voie veineuse périphérique ou centrale. Cette technique utilise la voie parentérale par opposition à la voie entérale qui s’effectue par l’intermédiaire du tube digestif. Elle nécessite l’emploi de nombreux matériels et trouve son application dans la mise en œuvre d’une nutrition parentérale ou d’une chimiothérapie à domicile. [ABSTRACT FROM AUTHOR]

Résumé: Les accidents de perfusion sont des complications fréquentes, qui surviennent pendant une perfusion à visée diagnostique ou thérapeutique, par les voies veineuses périphériques ou centrales. En milieu pédiatrique, les extravasations iatrogènes sont graves. Vues tardivement, elles sont sources de séquelles fonctionnelles. Le but de cette étude était de rapporter notre expérience de la prise en charge des extravasations iatrogènes à visée thérapeutique. Entre janvier 2010 et décembre 2012, quinze nouveau-nés ont été pris en charge pour des accidents de perfusion aux membres. Le sexe masculin était majoritairement atteint. L’âge moyen était de 3,6jours, avec des extrêmes d’un et neuf jours. Le poids moyen à la naissance était de 2900g. Les extrêmes étaient de 1200g et 3550g. Le sérum glucosé à 10 % et le chlorure de calcium étaient incriminés dans tous les cas. Les lésions étaient vues tardivement au stade III dans six cas et au stade IV dans neuf cas. Les membres supérieurs étaient fréquemment atteints. Neuf lésions siégeaient aux membres supérieurs et six aux membres inférieurs. Les faces dorsales des pieds et des mains étaient fréquemment atteintes, respectivement, dans six et cinq cas. Deux lésions siégeaient à la face antérieure de l’avant-bras et du coude. Aux coudes, les lésions étaient circulaires et réalisaient un effet garrot. Le traitement était conservateur dans onze cas, dont cinq pansements gras pro-inflammatoires et six pansements alcoolisés. La chirurgie était secondaire dans quatre cas. Elle associait une excision-greffe de peau totale, une excision-pansement-greffe de peau mince, et deux débridements-greffe de peau totale pour des cicatrices rétractiles au poignet. Deux décès étaient liés au terrain et aux pathologies associées. Un seul patient était perdu de vue. Nos résultats étaient satisfaisants au plan fonctionnel, esthétique et psychosocial. Les accidents de perfusion sont des lésions iatrogènes graves. Si, en d’autres circonstances, les lésions sont vues à un stade précoce, en situation d’exercice extrême, elles sont vues tardivement, parfois au stade de séquelles fonctionnelles, psychologiques et cosmétiques. La difficulté de la prise en charge thérapeutique de ces lésions impose la prévention, par l’élaboration de protocoles de suivi et la formation continue du personnel à une pratique efficiente des perfusions. [ABSTRACT FROM AUTHOR]

Dans l'impossibilité d'une alimentation orale ou entérale, les patients souffrant de dénutrition sévère nécessitent des perfusions de poches de nutrition parentérale. Celles-ci peuvent être principalement de 2 types. Les poches industrielles ont une formule fixe sans vitamines ni oligoéléments, mais elles ont une longue durée de péremption avec un stockage sans contrainte. Les poches selon la formule (SLF) ont une composition entièrement personnalisable mais nécessitent de recourir à une unité de fabrication adaptée. L'inadaptation nutritionnelle et les risques subséquents de contaminations de voies de perfusion, lors de l'usage des poches industrielles, peuvent constituer un facteur de ré-hospitalisation. L'objectif est de comparer les coûts de production des poches selon la formule et les coûts d'achat des poches industrielles, rapportés au critère d'efficacité (nombre d'hospitalisations en lien avec la nutrition). La cohorte se compose de patients adultes atteints du syndrome du grêle court suivis par le service de nutrition clinique intensive. Les coûts de fabrication des poches selon la formule sont calculés en additionnant le coût des ingrédients en fonction du volume ajouté dans chaque poche et le coût du matériel utilisé (consommables, équipements) selon un forfait fixe applicable à chaque poche. Le coût des poches industrielles est composé du coût d'achat de la poche (prix public) et du coût d'achat des médicaments ajoutés (vitamines, oligoéléments, électrolytes). Le critère d'efficacité est inversement représenté par le nombre de jours d'hospitalisation en 2018 et 2019 liés à la nutrition parentérale (complications mécaniques, infectieuses, métaboliques). Voir Tableau 1. Il y a une différence statistiquement significative entre les coûts des poches SLF et industrielles en € mais pas sur les coûts en €/L. Cela est dû au fait que les volumes des poches industrielles et leurs ajouts sont compris entre 513 mL et 2 L, alors que les poches SLF ont un volume allant jusqu'à 4 L. Le critère en €/L s'affranchissant du facteur volume, la comparabilité des coûts est meilleure. Il n'y a pas de différence statistiquement significative de durée d'hospitalisation entre les deux groupes, ce qui signifie que leur efficacité est comparable. À coûts comparables et efficacité comparable, la préférence clinique se portera sur les poches selon la formule qui s'adaptent en volume, en composition à chaque patient et à chaque situation physiopathologique. La principale limite est la capacité de fabrication de l'unité, dans le cas présent, qui est en adéquation avec les moyens qui lui sont octroyés. [ABSTRACT FROM AUTHOR]

Résumé: Objectif: L’objectif était de tester l’hypothèse d’un lien entre la valeur observée de l’index bispectral (BIS) et la survenue d’une hypoperfusion cérébrale cliniquement significative en clinique humaine, en dehors de toute anesthésie. Type d’étude: Étude observationnelle. Patients et méthodes: Nous avons mesuré la valeur du BIS de manière bilatérale au cours de procédure de tests de clampage carotidien temporaire par voie endovasculaire, chez des patients éveillés. Résultats: Vingt-huit patients ont été inclus. Vingt et un ont bien toléré le test cliniquement et radiologiquement. Leur BIS est resté stable pendant la procédure. Chez les patients ayant présenté seulement des signes de mauvaise tolérance artériographique (n =4), la valeur du BIS du côté clampé a présenté une légère diminution avec une valeur minimale de 83 (79–87). Chez les patients n’ayant pas toléré le test sur le plan artériographique et clinique (n =3), la valeur initiale du BIS était de 96 (89–97) du côté du clampage et a chuté de manière très nette après le clampage (50 [45–60] du côté clampé ; 48 [45–52] du côté opposé). Chez tous les patients, la normalisation du BIS a été immédiate après le dégonflage du ballonnet. Conclusion: En l’absence de sédation, la mesure du BIS semble associée à la survenue d’une hypoperfusion cérébrale cliniquement significative. [ABSTRACT FROM AUTHOR]

Résumé: Objectif: Dans cette revue de la littérature, nous nous proposons de décrire les effets physiologiques de la pompe respiratoire pour améliorer la perfusion des organes vitaux. L’utilisation de la pompe respiratoire se fait en augmentant la négativation de la pression thoracique. Sources des données: Medline et MeSH database. Sélection des travaux: L’ensemble des publications obtenues de niveau de preuve I à III a été retenu. Extraction des données: Les articles ont été analysés par rapport aux modifications physiologiques provoquées par les différentes méthodes de modification de la pression intrathoracique. Synthèse des données: La fonction primaire de la respiration est de permettre l’échange des gaz respiratoires. Les études expérimentales et cliniques centrées sur la respiration fournissent des éléments physiologiques pour comprendre que la ventilation a également des effets sur l’hémodynamique. La valve d’impédance inspiratoire crée une faible résistance à l’inspiration entraînant une négativation de la pression intrathoracique jusqu’à −7cmH2O. Cela induit une augmentation du retour veineux, de la fraction d’éjection du ventricule gauche (FEVG) et de la pression artérielle (PA), une diminution de la pression intracrânienne, une réinitialisation du baroréflexe cardiaque ainsi qu’une augmentation du gradient de perfusion des organes. Conclusion: L’utilisation de cette pompe respiratoire permettrait de contribuer positivement au traitement des pathologies liées à l’hypotension artérielle telles que le choc hémorragique, l’hypotension orthostatique, le choc septique et l’arrêt cardiaque. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Indications for short-term circulatory and/or respiratory support (STCRS) increased during the last years. The goal of this survey was to characterize this activity in France in 2009. Study design: Observational retrospective pluricentral. Materiel and methods: Each center of cardiothoracic surgery received a questionnaire validated by the Société française de perfusion about the activity, materials and organization used for STCRS. Data were expressed as percentages or median (25–75 percentiles). Results: Forty-one centers on 61 (67%) answered. STCRS was performed respectively by 33 (80.5 %), 36 (87.8 %) and 39 (95.1 %) of centers in 2007, 2008 and 2009 including 10 [4–26], 18 [6–29] and 18 [5–33] cases/center per year. In 2009, types of STCRS installed were veno-arterial in 39 centres (95.1 %), veno-venous in 27 (65.9 %) and Novalung® in four (9.8 %), including 18 [5–32], five [2–7] and 15 [1–17] cases respectively. Twenty-nine centers (70.7%) installed STCRS outside the operating theater, and 24 (58.5%) in non-cardiothoracic surgery. A mobile circulatory support unit was created in eight centers (19.5%), however 21 (51.2%) have installed STCRS externally, at distances between 10 [5–55] to 100 [15–200] km, using emergency vehicles in most of the cases (90.5%), but helicopter seldom (19%). Conclusion: STCRS has increased over the last few years in France. Externalized activity outside the operating theater was important, time-consuming and used hospital resources therefore modifying the professional activity of perfusionists. [Copyright &y& Elsevier]

Abstract: The authors report three cases in which cerebral ischemia occurred during arthroscopic shoulder surgery performed in beach chair position under general anaesthesia and interscalene plexus block. Several similar cases have been published in the literature. This rare but extremely severe complication is related to the decrease in cerebral perfusion pressure (CPP). Monitoring of CPP in the beach chair position using the measurement of arterial pressure and taking into account the hydrostatic gradient is essential. Prevention includes correction of preoperative hypovolaemia, treatment of postural arterial hypotension, adequate installation of the patient''s head, aggressive treatment of perioperative arterial hypotension (whatever the cause) and avoidance of deliberate perioperative arterial hypotension. Routine use of non-invasive monitoring of cerebral oxygenation has been advocated to avoid this accident but its usefulness has to be confirmed by clinical studies. [Copyright &y& Elsevier]

Copyright of Reanimation is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Objectives: Intravenous infusion takes an important place in the current therapy in hospitals and pharmaceutical firms keep improving their infusion medical devices, particularly with the development of an intravenous administration set with an automatic infusion stop. The aim of our study consists in an evaluation of the stability of acetaminophen, ketoprofen and amoxicillin during infusion and stasis of drugs for several hours in the dropper chamber and in the tube of this device. Study design: Analytical study. Materials and methods: Ten milligram per millilitre acetaminophen (acetaminophen 1 and acetaminophen 2), 1mg/mL ketoprofen and 20mg/mL amoxicillin were prepared and infused individually and successively with the intravenous administration set under ambient light and temperature. Collected samples of each drug during the infusion and after 24hours of stasis in the medical device were monitored by a visual inspection, pH and osmolality assessment and chromatographic analysis of each drug with a validated stability-indicating method. Results: Repeated individual perfusions of 10mg/mL acetaminophen 1 or 1mg/mL ketoprofen are possible through a fail-safe intravenous administration set, while repeated individual amoxicillin infusions are not because of the unstability of this drug. There is also no problem to infuse successively acetaminophen and ketoprofen through this medical device because these drugs are stable. However, we underlined an incompatibility between acetaminophen 2 and ketoprofen, which advises against the use of intravenous administration set for successive infusions of these two drugs. Conclusion: Despite the technical innovation of a fail-safe intravenous administration set, we have to stay aware of mixture consequences in intravenous infusion field. [Copyright &y& Elsevier]

Abstract: This is a case of an 82 year old female patient with myasthenia gravis, who following treatment with Human Normal Immunoglobulin (Tegeline®), developed dyspnoea, chest pain without cardiac insufficiency, inverted T wave on ECG with slight increase in Troponine T 0.43ng/mL (<0.2ng/mL normal value in our hospital) and marked increase in Pro-BNP 4900 (Nl≤450pg/mL for an age greater than 65 years old). Her coronary angiogram showed hypokinesia of apical area but was otherwise normal. Also, MRI ruled out inflammatory and ischemic cardiac diseases. The most likely diagnosis for us was Tako-Tsubo syndrome in relation with injection of Human Normal Immunoglobulin (Tegeline®) according to the Mayo clinic criteria. [Copyright &y& Elsevier]

Copyright of Journal of Cardiovascular Echography is the property of Wolters Kluwer India Pvt Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Reanimation is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Reanimation is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article reports on research comparing biomechanical outcomes and physiological responses during sit-stand, sitting and standing postures among non-varicosed and varicosed women. Different postures are found to have both biomechanical and physiological advantages and disadvantages. Better lower limb perfusion appears to be linked to smaller vertical distance between heart and foot. Short static posture maintenance seems inadequate to lead to varicose veins in non-varicosed persons.

Abstract: Introduction: Cardiopulmonary bypass (CPB) is a medical act that can be performed by nurses as long as they are constantly supervised by a physician. No initial formalized training course is required. The personal responsibilities of nurses and physicians about CPB have not been defined. Objectives: The purpose of this study was: to list perfusionists; to evaluate the training of perfusionists; to determine which physicians are considered as in charge during actions performed by paramedics, as well as their qualification; to point out the changes since 1997. Type of study: Professional practice assessment. Methods: A questionnaire was sent to all perfusionists in activity in France. Results: There were 71% of replies. We found an aging of perfusionists (median 49 years vs. 40 years in 1997), a fall in the proportion of trained physicians (13% of perfusionists had a training course in adequacy with professional guidelines, 25% of perfusionists said they worked with a physician who could intervene at all time, and 61% declared only one physician was in charge). There is no CPB referent in 26% of perfusion units. Conclusion: An urgent need appears to define the respective responsibilities of medical and paramedical perfusion staff, especially as this technique spreads out of the conventional cardiac surgery operating theatres. [Copyright &y& Elsevier]

Abstract: Various therapies take place in autism treatment. Cerebral hypoperfusion, neuro-inflammation and oxidative stress findings in autistic children have led clinicians to experiment hyperbaric oxygen therapy. To date, except two single case descriptions, only available results are about five case series, three of whom very briefly described, and two randomized comparative studies. Improvement in cerebral perfusion is found in one study but results concerning oxidative stress are not significant. Globally, these studies seem to show an improvement in autistic symptoms, but their validity is not demonstrated because of their small samples and their questionable methods. Further studies are currently carried out. Analysis and results interpretation will be distorted by oxygen concentrations and pressure variability from one study to another one. To date, hyperbaric oxygen therapy should be considered as an experimental therapeutic modality and should be used only in the context of a well defined research. [Copyright &y& Elsevier]

Les avancées technologiques en imagerie par résonance magnétique (IRM) permettent à présent d’analyser certains biomarqueurs (densité cellulaire, microcirculation et métabolisme) caractérisant le développement tumoral. L’imagerie dite ≪ fonctionnelle ≫ de ces différents biomarqueurs tumoraux tend à compléter les données de l’imagerie morphologique classique et à améliorer les performances diagnostiques, prédictives de l’IRM en cancérologie. Enfin, les derniers développements technologiques, permettant l’utilisation conjointe demultiples antennes, permettent d’examiner le corps entier. Ainsi, l’IRM corps entier prend une place croissante dans la prise en charge des patients en oncologie. [ABSTRACT FROM AUTHOR]

L’évaluation des traitements est un enjeu de plus en plus important en cancérologie, qu’il s’agisse de l’évaluation des nouveaux traitements ou du monitoring individuel d’un patient. Les critères utilisés actuellement sont morphologiques, basés sur l’évolution de la tailledeslésions, telsque les critères RECIST. Mais les variations de tailles sont retardées, et avec les nouveaux traitements ciblés tels que les antiangiogéniques, elles sont faibles. Cela implique l’utilisation de larges cohortes pour mettre en évidence l’efficacité d’un traitement et rend difficile le monitoring individuel. L’utilisation des techniques d’imagerie fonctionnelle, en scanner, en IRM, en échographie ou en tomographie par émission de positrons (TEP), apporte de nouveaux espoirs. Les paramètres obtenus grâce à ces techniques(perfusion, perméabilité, diffusion, métabolisme, composition, élasticité) sont modifiés précocement par les traitements. Ces paramètres fonctionnels pourraient devenir des biomarqueurs pour l’évaluation et le suivi des traitements. Les études ayant démontré leur utilité sont préliminaires, il reste à standardiser les techniques d’acquisition et à évaluer à plus large échelle, en fonction des situations cliniques, quels sont les paramètres fonctionnels les plus adaptés. [ABSTRACT FROM AUTHOR]

Copyright of IRBM is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: The imaging of gliomas, as well as diffuse infiltrative gliomas or as more recently individualized entities, has been profoundly modified these last years. Correlated with the classic morphological MRI, numerous new sequences have appeared that allowed a more metabolic approach of the tumors, such as diffusion, perfusion – related to angiogenesis – and spectroscopy – reflecting metabolic data. Their development in daily practice allows to precise the diagnostic, to definite the more active areas (correlated with the hyperperfused or more metabolic active areas in relation with the Ki67 index) and so optimize the biopsy and/or evaluate the evolution of the lesion. When associated, they allow also and perhaps especially to precise the diagnostic, particularly with other tumoral masses such as lymphomas or metastases that can present misleading patterns, but also with other more benign lesions such as abcesses. Always critically analysed, and reevaluated along the time if necesary, they can sometimes help the histological diagnosis, but never can be used in place of it. [Copyright &y& Elsevier]

Abstract: Mechanical cardiac support represents a large spectrum of devices. The duration of assistance may vary from a few hours in the cath lab to several weeks. The goals for a temporary support by percutaneus assistance are: improve end-organ perfusion; decrease pulmonary capillary wedge pressure; decrease myocardial oxygen consumption. The potential indications are: acute left ventricular dysfunction; “bridge to recovery”: acute myocarditis, acute myocardial infarction, valve disease bridge to surgery; “bridge to implantable LVAD”; “bridge to transplant”; high risk PCI and surgery. [Copyright &y& Elsevier]

Abstract: In addition to the initial lesions related to the brain injury, the final outcome depends also largely on the secondary ischaemic lesions. These lesions result from hypoperfusion whatever the mechanisms. It is then essential to detect early the conditions at risk of ischaemia, to be treated aggressively since the initial care. The multimodal monitoring is the only way to diagnose these conditions, to provide information about the mechanisms, and then to better adapt the treatment. Such an early detection helps to limit the consequences of the initial trauma, and may improve outcome. [Copyright &y& Elsevier]

Abstract: This review analyzes the clinical studies concerning the automated perfusion, or closed-loop, of propofol guided by the bispectral index (BIS). To carry out the maintenance of general anaesthesia by a closed loop propofol–BIS is feasible as shown by studies comprising few low risk patients. We showed that induction of anaesthesia is feasible with a closed loop, haemodynamic stability being similar to a manual titration. A second study, bearing on the whole of the anaesthesia of patients ASA I to III undergoing very diverse surgical acts, showed that the closed loop propofol–BIS was more precise than a manual perfusion. This confirms that the closed loop propofol–BIS is not an esoteric research and that it represents a tool with a future for the clinician. [Copyright &y& Elsevier]

MRI demonstrates low sensitivity in detecting concentrations of metabolites, but can be set to detect a large number of other parameters, including perfusion, diffusion, and oxygenation patterns. Contrast agents allow the investigation of microvasculature and the visualisation of phagocytosis. For some tumours, MR spectroscopy makes it possible to determine the biochemical profile of tissues and their responses to various treatments. [ABSTRACT FROM AUTHOR]

MRI now offers an alternative imaging technique that combines functional tools with expanded anatomical coverage. Technical progress in magnetic resonance has reduced acquisition times, allowed perfusion and diffusion imaging to be combined with whole body scanning, and made it possible to perform whole body scanning without irradiation. Here we detail the technical advances in whole body MRI and the emerging clinical applications resulting from this new imaging tool. [ABSTRACT FROM AUTHOR]

Abstract: Functional MRI is a technique of imaging which is developing fast as it allows non-aggressive evaluation of brain functions. Diffusion, perfusion and activation are each used to study brain responsiveness to a given task. As a pretherapeutic routine investigation, in brain tumours, it can be helpful as an additional tool to morphological MRI in evaluating the prognosis of patients. [Copyright &y& Elsevier]

Copyright of EMC-Cardiologie-Angeiologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of EMC-Cardiologie-Angeiologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of EMC-Radiologie is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: To evaluate what could be the benefit in terms of alarm suppression, of a new syringe pumps system, which allows automatic relay without alarms.Patients and methods: We have prospectively recorded the nature and the mode of relay of all syringe pumps for administration of drugs to patients in two ICU. The perfusion regimen was studied in 61 patients over the complete duration of their stay in two ICU. Alarms were also recorded in one ICU room, over 13 days consecutive. The records were processed off-line with an automatic detection-recognition system in order to assess the origin of each alarm. Accordingly, the amount of alarm corresponding to monitor, ventilator and syringe pumps was computed.Results: We found that syringe pumps, which would provide automatic relays without alarm, would suppress 17% of alarms in ICU and automatize 65% of the relay procedures, which are usually performed often in emergency, on response to the end of perfusion alarm.Conclusion: New syringe pumps allow both reduction of alarms in ICU and a better management of nurse workload. Indeed syringe relay can be planned in advance. [Copyright &y& Elsevier]

The approach to take in trying to establish or disprove a diagnosis of pulmonary embolism in the presence of deep vein thrombosis is the subject of some controversy nowadays. Systematic perfusion lung scan can be proposed, given the mediocre specificity of the clinical symptoms of embolism or the high frequency of asymptomatic pulmonary embolism. This strategy, however, is not validated in terms of cost-efficacy. In practical terms, favourable evolution and the low rate of recurrent embolism observed with a well executed anticoagulant treatment pleads against systematic scintigraphy. Because of its moderate sensitivity, systematic echocardiography probably should not be an element of the assessment of asymptomatic pulmonary embolism. The advent of spiral CT scan in the management of such patients could however make it necessary to reconsider this position, by allowing complete venous and pulmonary examination in thrombo-embolic disease. [Copyright &y& Elsevier]