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In this article, we will review major therapeutic advances in neonatology over the past ten years. We will discuss the antenatal administration of magnesium sulfate, the interest of hypothermia in the context of hypoxic ischaemic encephalopathy, the benefits and modalities of placental transfusion, less invasive techniques for ventilation and administration of the surfactant, possibilities to fortify breast milk and the concept of developmental care. These therapeutic advances are sometimes based on new therapeutics, sometimes on new concepts and, sometimes, on new less invasive techniques. They have made it possible to optimize the care of premature babies but also of term newborns.Dans cet article, nous allons passer en revue les grandes avancées thérapeutiques dans le domaine de la néonatologie au cours des dix dernières années. Nous traiterons de l’administration anténatale du sulfate de magnésium, de l’intérêt de l’hypothermie contrôlée dans le cadre de l’encéphalopathie d’origine hypoxo-ischémique, des bénéfices et modalités de la transfusion placentaire, des techniques moins invasives pour la ventilation et pour l’administration du surfactant, de la fortification du lait maternel et du concept de soins de développement. Ces avancées thérapeutiques reposent tantôt sur des nouveautés thérapeutiques, tantôt sur de nouveaux concepts et, parfois, sur de nouvelles techniques moins invasives. Elles ont permis d’optimiser la prise en charge des prématurés, mais aussi des nouveau-nés à terme.

A new formulation of an anti-dandruff shampoo containing a surfactant devoid of a sulfate-type anionic part has been assessed in vivo in 41 subjects. Introducing a welltried agent, the 0.5 % piroctone olamine confers to this shampoo a high anti-dandruff efficacy, a reduction in the density in Malassezia spp, as well as a good remanence after shampoo. In addition, piroctone olamine appears to influence the sebum rheology by reducing the hair greasing.Une nouvelle formulation d’un shampoing antipelliculaire, basée sur l’utilisation de tensio-actifs sans groupe anionique de type sulfate («sulfate free») a été évaluée in vivo sur 41 sujets. L’introduction d’un agent éprouvé, la piroctone olamine à 0,5 %, confère à ce shampoing une efficacité antipelliculaire élevée, une réduction de la densité de Malassezia spp, ainsi qu’une bonne rémanence de l’effet après shampoing. La piroctone olamine semble, de plus, modifier la rhéologie du sébum en ralentissant le phénomène de regraissage des cheveux.

Vitamin K antagonists (VKA) are difficult to use because of a narrow therapeutic index and of a marked inter- and intra-individual variability among patients in the required dosage. This drug may interact with many other drugs and same with certain food compounds. We report the case of potential interaction between soy lecithin and Vitamin K antagonists in a 46 years-old woman. Subtherapeutic INR values were detected despite the increase gradually in dose and replacing acenocoumarol by fluindione. An enquiry of pharmacovigilance was conducted found the consumption of soy lecithin capsules. Fifteen days after its stopping, the INR values have really increased. Clinicians should think to the possibility of interaction between oral anticoagulants and food supplement that is increasingly used.

Opioid-induced constipation (OIC) is a side effect of opioid therapy that can affect quality of life, adherence to treatment, and morbidity and possibly mortality. Objectives: To investigate whether docusate sodium, sennosides, and lactulose have equal efficacy and side effect profiles compared to PEG in the management of OIC in adults. Methods: A systematic review was undertaken. Randomized controlled trials of adults taking opioids for cancer or non-cancer pain were considered if they met inclusion criteria. Conclusions: Statistical pooling was not possible as no studies met inclusion criteria. Large, well-powered, randomized controlled trials are feasible. Standard definitions of OIC would assist with the execution of these studies and contribute to their internal and external validity. Further research is strongly encouraged.

Toothpastes remain a frequently used auxilary in oral hygiene. Although some new components have been introduced, the base composition does not differ much between toothpaste types. Concerning toothpastes there is a thin border between cosmetics and drugs and it becomes more and more difficult for oral health care workers to prescribe the right toothpaste for the right patient. Production companies are frequently using commercial advertisements to promote their product. In this way, it's getting more and more difficult for the dentist (and patient) to find the suitable product. This literature review aims to search for scientific evidence for toothpaste components and their clinical use. In this way the review can be used as a compendium for health care workers to make the right choice in prescribing toothpastes. Furthermore all available toothpastes on the Belgian market are listed, following their composition.

The aluminium industry produces wastes polluted with polycyclic aromatic hydrocarbons (PAH). The most important PAH found in these wastes is benzo(b,j,k)fluoranthene (BJK) at concentrations exceeding the permitted levels (1000 mg kg(-1)). The objective of this research was to compare the performances of amphoteric (BW and CAS) and non-ionic surfactants (Triton X-100 and Tween 80), at a concentration of 0.5% (w w(-1)), for PAH removal (and particularly for BJK) during washing treatment of aluminium industry wastes. The best removal yield of BJK (35%) has been measured during treatment with CAS. The efficiency of this surfactant has been further improved by using a flotation process. Flotation tests have also been realized at different CAS concentrations (0.1, 0.2, 0.25 and 0.5% w w(-1)) and using different total solids (7, 10, 15 and 20% w v(-1)). The highest BJK removal yield (68%) has been obtained using 0.5% CAS and a total solids concentration of 15%. The rate of hazardous wastes produced in these conditions represents 10% of the initial weight of aluminium wastes treated.

Most ocular solutions enter the eye through the corneal epithelial barrier. In order to pass through this barrier, these hydrosoluble drugs require to be associated with a detergent agent to increase topical efficiency. Although these agents have a preservative action, it was recently demonstrated that, after short or long term use, toxic side effects on the ocular surface will occur.

The valorization of black sludge is an environmental problem of the aluminium industry because of Polycyclic Aromatic Hydrocarbon (PAH), fluoride and alumina contents. A soil washing operated in a cell flotation with non-ionic surfactants (Brij 35, Igepal CA-720, Triton X-100, Tween 80) at different concentrations has been tested in order to remove the PAH (benzo(a)anthracene, benzo(a)pyrene, benzo(b)fluoranthene, benzo(j)fluoranthene, benzo(k)fluoranthene, fluoranthene) detected in black sludge. The Tween 80 at 0.5% gave the best results with PAH removal rates between 35 and 50%. These percentages remain low due to the presence in large quantity of fine solid particles (45%) in the PAH concentrate produced by the flotation process. The substitution of the cell flotation by a column flotation allowed the reduction of this problem. Thus, the PAH removal rates reached 60%. This removal yield has been obtained with the lowest wash water flow-rate (150 ml min(-1)) and pulp total solids (10% p p(-1)) tested.

To survey practices in 14 European countries and to describe strategies for the prevention and treatment of pulmonary morbidity in very preterm newborns.Questionnaires covering the use of prenatal steroids, surfactant and postnatal steroids were sent in 1999-2000 to every neonatal unit taking very preterm newborns in charge in population-based areas covering at least 20,000 births annually. One questionnaire was sent by surveyed unit.Results are given concerning these three treatments and compared to evidence based recommendations.Antenatal steroids were given at recommended terms. Surfactant was prescribed with respect of best practices. Postnatal steroids utilisation was not well described.

In the stratum corneum, the water binds to the intracellular hygroscopic and hydrosoluble substances called "natural moisturizing factors" or NMF. These "natural moisturizing factors" contained in the corneocytes are formed during epidermal differentiation and may represent up to 10 p. cent of the corneocyte mass. They are principally amino acids, carboxylic pyrrolidone acid, lactic acid, urea, glucose and mineral ions. Keratinization plays an important part in the formation of NMF that exhibit strong osmotic potential attracting the water molecules. The binding of water to NMF is the static aspect of cutaneous hydration. The second, dynamic, aspect is related to the selective permeability of the stratum corneum and to its lipid barrier properties, the permeability of which depends on the integrity and nature of the inter-corneocyte lipids and their lamellar organization between the cells. In these conditions, hydration cosmetics rely on two concepts that can be isolated or associated: the supply of hydrophilic substances to the stratum corneum, capable of attracting and retaining water (moisturizer) or capable of restoring the barrier in order to restore normal water loss or of protecting it against aggression (occlusive).

Salivary secretions protects the teeth and the oral mucosa. The physiology and biochemistry of saliva are discussed in detail. Following functions of saliva such as mechanical protection of teeth and mucosa; antimicrobial properties of saliva, regulation of pH and the role of saliva in de- and remineralisation of dental enamel are reviewed. Salivary gland dysfunction (etiology and treatment) emphasises the item of caries prevention.

Peritoneal colonization is a crucial event in the pathogenesis of peritonitis and its local complications. Adherence to the serosal mesothelium is mediated in a number of microorganisms derived from the digestive tract (especially E. coli) by type-1 fimbriae which have an oligosaccharide specificity.To evaluate the effect of repeated peritoneal washes with saline solution and oligosaccharides on E. coli peritoneal adherence in a rat peritonitis model.Sixty rats were randomized in 3 groups of 20. E. coli was inoculated at a constant concentration of 10(8)/mL per 100 g of weight. Then, peritoneal washes were achieved daily during three consecutive days (D1, D2, D3), with saline solution in Group I (control group), Methyl alpha-D-Mannoside (MADM) in Group II, and p-Nitro-phenyl alpha-D-Mannoside (pNADM) in Group III. Peritoneal samples were obtained before and after lavage at D1, D2, and D3. Microbial recovery was expressed as cfu/mg of tissue, and converted into a percentage of the initial value. A 10% threshold defined efficiency of the wash (inhibition of adherence for 90% of bacteries).Compared with data from Group I, E. coli peritoneal adherence was significantly lower after washes in Group III (D1: p = 0.03; D2: p = 0.009; D3: p = 0.003). Repeated washes were more efficient in Group III than in Group II (D1: p = 0.1; D2: p = 0.5; D3: p = 0.001).These results suggest that the addition of oligosaccharides, especially of pNADM, reduces the peritoneal adherence of E. coli when a peritoneal wash is performed for peritonitis.

In order to provide a closer analogy between micelles and enzymes, the design of functionalized micellar systems have been undertaken. This paper presents the synthesis of surfactant cationic molecules which contains either a free or a protected aldehyde group. An ammonium quaternary surfactant with two functional groups, aldehyde dimethyl acetal and imidazole, has also been synthesized.

Leg ulcers are the source of high social and economical costs in the domain of geriatric dermatology. The present review summarizes the indications of antiseptics and of sophisticated wound dressings including hydrogels, hydrocolloids, alginates, polyurethane foams and films, as well as formulations combatting the smelly aspects of ulcers.

Indication for intubation and mechanical ventilation in premature infants may be reduced by initiating continuous positive airway pressure (CPAP) in delivery room.Immediately after birth, respiratory support with CPAP was given to all infants with gestational age less than 32 weeks. In case of apnea or progressing symptoms with hypoxemia or carbonic acidosis, with PCO2 increasing to more than 60 mmHg, infants were treated with nasotracheal intubation and ventilation.One hundred and fifty one infants, with mean gestational age 29.6 +/- 1.9 weeks and mean birth weight 1,326 +/- 378 g were delivered in the obstetrical department of Marseille. In delivery room, 63% were treated with CPAP, and only 13% with nasotracheal intubation. The need for subsequent mechanical ventilation was reduced to 40% of the population. Surfactant therapy was used in 17% of this cohort. Two infants were given surfactant and extubated. Three of 14 deaths (9.2%) were caused by respiratory disease.Early CPAP reduces the indication of mechanical ventilation in premature infants. Incidence of pulmonary complications such as pneumothorax or bronchopulmonary dysplasia is low among those infants who require mechanical ventilation later. Early CPAP takes place in a general policy to decrease neonatal morbidity.

The inhibition of lipoprotein catabolism after triton WR-1339 intravenous administration is associated with an impressive modification in the balance between plasma peroxidable substrates and antioxidants. Treated rat plasma and membrane lipids become peroxiaable when they are incubated with phenylhydrazine in standardized conditions and the production of thiobarbituric acid-reactive substances (lipoperoxidation markers) significantly increases. An accumulation of native lipoproteins which present a decreased alpha-tocopherol on triglycerid ratio and a modification in the plasmatic balance between alpha-tocopherol and ascorbate could explain these observations.

The use of exogenous surfactant (ES) is an essential component for prevention and treatment of hyaline membrane disease (HMD). The ES available for clinical use are of two therapeutic classes: natural surfactants prepared from mammalian lung and artificial surfactants. The choice between these two classes of ES is controversial. In this overview, we present the arguments in favour of the preferential use of natural ES. The presence of hydrophobic specific proteins (SP-B and SP-C) provides to natural ES better surface tension properties than artificial ES. The in vitro greater efficacy of natural ES has been confirmed in vivo in experimental models of surfactant deficiency, human pharmacodynamic studies, and comparative clinical trials. Furthermore, the excellent clinical tolerance and harmlessness of natural ES has been firmly established. A meta-analysis of the comparative clinical trials between natural ES and one artificial ES (enrolling as many as 4400 babies treated for HMD) suggests that the use of natural ES compared to this artificial ES significantly reduces the neonatal mortality by 20%. In conclusion, all these arguments are in favor of the preferential use of natural ES for prevention and treatment of HMD.

Anal fissure is a common and painful disorder. Conservative treatment must be reserved for acute forms. Hygiene rules, stool softeners and topical local anaesthetic agents are the mainstays of treatment. Healing often takes long time. Recurrences can be prevented with chronical prescription of stool softeners. Surgical treatment is indicated for chronic fissures, acute fissures refractory to 2 monthes conservative treatment and persistent painful forms.

Epithelia of the gastrointestinal tract both synthesize and secrete surfactant-like materials. Like the pulmonary surfactant, these materials contain not only phospholipids, but also surfactant apoproteins, regarded until recently as specific products of the bronchoalveolar epithelium. Presented here are the various roles, most of them still speculative, of these phospholipids-containing products in the gastro-intestinal tract.

Disrupting bacterial biofilms is necessary for a wide application domains such as reusable medical devices, or systems of pipes for water or fluids in cosmetics, food and chemicals industry. Bacterial cells embedded in a biofilm are less susceptible to disinfectants than suspended cells. This property is referable to the structure of the biofilm itself. The gangue of exopolymers and the thickness of a 5-day-old biofilm of Escherichia coli (more than 200 layers of bacteria), contribute to this decrease of susceptibility. The present work deals with the release of an Escherichia coli biofilm by the sequential action of enzymes and a phenolic disinfectant on the one hand, and by the sequential or simultaneous action of surfactants and the previous disinfectant on the other hand. The decrease of bacteria count per mm2 and the Scanning Electron Microscope observations exhibited a synergic action in every case. Nevertheless, Escherichia coli biofilms quickly reconstructed even after exposition to the previous treatment.

The emissions of light by biorganisms or these obtained by alchemists were known since long time ago but the are used in analytical chemistry only when STOKES discovered that the intensity of this light was proportional to the quantity of the matter. The very large sensibilities reached, associated with the great separation's ability of the liquid chromatography allows to develop new processes for quantification of very low concentrations of luminescent or no luminescent molecules. Many pharmaceutical, biological toxicological environmental or alimentary applications show that it is possible in liquid chromatography to obtain a detection limit about the pico or femtomole when simple chemical process are used: direct potentialization of luminescence by addition of modifiers of the chemical environment of the analytes: solvents, cyclodextrins, surfactants, metallic ions, indirect potentialization of the luminescence by transfer of energy from an excited molecule: sensitized fluorescence and phosphorescence, excitation of the molecule by a chemical reaction or chemiluminescence. These aspects are emphasized and illustrated by some examples in three articles.

Over the last decade there has been major progresses in the pathophysiology, diagnosis and treatment of the respiratory distress syndrome of the neonate (RDS). This has resulted in a better understanding of the function of the surfactant system of the lung, whose deficiency almost invariably causes the onset of RDS. In the last eight years, great efforts have been devoted to the development and validation of surfactant replacement therapy for RDS. Natural, semi-synthetic and synthetic surfactants have been developed and tested in a variety of clinical settings, and many clinical trials have shown the validity of such therapeutical options. Surfactant replacement therapy is now routinely used in neonatal intensive care units. However, many questions need to be answered concerning the first choice between the different surfactant preparations and their administration modalities.

Trans Epidermal Water Loss (TEWL) was used to evaluate the skin permeability modifications in vivo in man with an evaporimeter Servo Med. Measurements were performed on the forearms of healthy volunteers. At first, influence of the stabilization of the subjects and reproducibility of measurements between morning and evening, and from day to day were determined. The effect on the stratum corneum of 3 surfactants (Tween 60, sodium dodecyl sulfate and cetyl trimethyl ammonium bromide) was studied. The results showed a variability of TEWL during the first 30 minutes, but there were no significant chronobiologic variations. After treatment by surfactants, TEWL increase was in relation with the importance of the aggression and the time after the end of the treatment. 3 hours were necessary to be sure that TEWL increase was only due to surfactants.

The authors analyse the results of the different trials of exogenous surfactants for the treatment of hyaline membrane disease. Whether artificial and used for prevention, or of human or animal origin and used for prevention or treatment, exogenous surfactants appear to improve the survival of premature infants. The improvement does not occur at the expense of increased morbidity. Indeed, there seems to be no increase in the frequency of patent ductus arteriosus, broncho-pulmonary dysplasia appears to be less frequent, and results on the effects of the frequency of intraventricular hemorrhage are contradictory. Current trials using new therapeutic schemes with multiple doses may further improve the protective effects of exogenous surfactants in premature infants.

The hyaline membrane disease (HMD) is a respiratory distress occurring at birth of some premature infants, attributed to an endogenous pulmonary surfactant deficiency. The present treatments are iatrogenic and inefficient for the most diseased infants. The exogenous surfactant supplementation intends to give to the baby formulations playing in vivo the role of the natural surfactant. The research developed for the formulation and the diffusion of these exogenous surfactants have to solve physicochemical problems but also of industrial production and of safety use. In spite of their adequate physicochemical and pharmacological properties, surfactants of natural sources, for industrial grounds, are not still distributed at a large scale. The efficiency of artificial surfactants is variable, and the use of non-biodegradable molecules in several preparations let to safety problems. The development of new types of artificial surfactants, more efficient and safe, implies a better knowledge of the physico-chemical mechanisms intervening in the pulmonary surfactant dynamics.

In 18 strains of M. tuberculosis and M. bovis it has been possible to demonstrate the existence, in pure cultures, of elements able to grow in vitro in scotochromogenic mycobacteria. The experimental method used includes a dispersion, under shaking, of organisms in different surface-active agents. The chromogenic strains isolated during the experimentation are eugonic, and PAS- and INH-resistant. Their experimental virulence is different from that of tubercle bacillus. We discuss the signification of this dissociation phenomenon inductible by surface-active agents.

Among the chemicals which might be used against the larvas of Schistosoma, some surface active substances show some high activity at very low concentrations (0,1-5 ppm) against the miracidiums and the cercariae. The laurylamidopropylbetain has shown out of a group of products which were tested, a very high activity by lowering considerably the infection by the larvas of the hosts, like molluscs and mice, which were in contact with them. After a serie of tests made in Nigeria, these products showed a satisfactory remanence in tropical waters, in spite of the biodegradation and the adsorption on the suspended particles. It was faced to put that betain into soaps at a concentration of 5% which will permit to renew constantly the active product and which will reduce heavily any infection.

The laurylamidopropylbétaïne, a surface active substance, has been tested in field conditions, in Niger, against Schistosoma mansoni miracidia. Experiments were carried out in artificial ponds of 20 m3, in which conditions were similar, as far as possible, to conditions found in transmission sites. The product showed a satisfactory remanence and the percentage of infected molluscs dropped down to zero with a low (2 ppm) concentration. It is suggested that laurylamidopropylbetaïne could be used into soaps in order to renew constantly the product in washing and bathing places and reduce schistosome transmission.

Bacterial communities that can degrade surfactants have been selected from coastal seawaters contaminated by urban sewages. Only the linear fraction of commercial anionic surfactants was quickly degraded, and a residual fraction representing 10% of the initial concentration always remained. The highest concentrations of surfactant tolerated by these communities depend on the nature of the co-substrate and on the degree of adaptation of the selected bacteria.

Hyaline membrane disease is attributed to a temporary lack of pulmonary surfactant. Its diagnosis, relatively easy, is based on clinical signs (respiratory distress with a 3-4 days cycle in a premature infant) and on radiological signs (reduced chest expansion, diffusion microgranulations, air-filled bronchi). In patients with few symptoms or when the disease is associated with infection or aspiration, the diagnosis is facilitated by biochemical methods, notably measurement of the lecithin/sphyngomyelin ratio and phosphatidylglycerol assay. The principal therapeutic prospects are based on the development of exogenous surfactant supply. This is either natural surfactants extracted from animal lungs or human amniotic fluid, or synthetic surfactants of varied composition. The first results of clinical trials are in favour of natural surfactants, but many technical, pharmacological and clinical problems will have to be solved before these products can be used on a wide scale.

The study on the action of eight synthetic detergents of various types of well defined structure and properties (neutral, anionic, cationic) has been realized on fourteen highly purified enzymes of animal or vegetal origin of great metabolic importance, on these of homogenates of intestine or liver of normal rats and of rats fed during a relatively long period with food containing synthetic detergents. The action of all studied detergents on highly purified enzymes has been characterized as this of specific effectors, producing a reversible denaturation of enzymatic proteins to whom they combine. Ingestion of detergents by rats leads, probably by the same mechanism, to a diminution in vivo of the activity of some intestinal and hepatic enzymes.

We describe here the effects of natural and synthetic detergents on the D-glucose transport into brush-border membranes of vesicles of rabbit's intestine. Two synthetic detergents: Triton X-100 and dodecyltrimethylammonium bromide have been found very strong inhibitors (more than 50 p. 100 of inhibition of maximal D-glucose uptake). Kinetic studies showed that these detergents behaved as mixed type inhibitors. The Na+-dependent transport of amino acids (aspartic acid, lysine, phenylalanine) is only poorly affected by dodecyltrimethylammonium bromide, while Triton X-100 inhibits unspecifically all the transport studied.