Search

Summary OBJECTIVES Adrenocortical tumours in man are characterized mainly on biochemical, anatomical and histological grounds which establish their secretory pattern and, with some uncertainty, their benign or malignant nature. To study further these tumours and eventually to shed some light on their pathogenesis, we determined their clonal composition. METHODS Clonal composition was determined by X-chromosome inactivation analysis on tumour and leucocyte DNA using three markers: M27β, phosphoglycero-kinase (PGK) and hypoxanthine-phosphoribosyl transferase (HPRT) with 88, 33 and 27% heterozygosity rates respectively. PATIENTS Clonal analysis was performed on 25 tumours from 19 heterozygous female patients: four had a carcinoma, 14 had a single secreting adenoma, and one had autonomous bilateral macronodular hyperplasia with Cushing's syndrome (seven adenomas examined). RESULTS The malignant tumours had patterns indicative of monoclonality. The single adenomas displayed contrasting results with patterns indicative of monoclonality in eight cases, and patterns indicative of polyclonality in six cases; monoclonal adenomas were larger and had a higher prevalence of nuclear pleomorphism than the apparently polyclonal adenomas. In the patient with bilateral macronodular hyperplasia, different clonal patterns were present in different adenomas: whereas a clear monoclonal pattern was observed in the three adenomas of the right gland, in which the active X-allele was not always the same, in two interpretable adenomas of the left gland, a moderately skewed pattern suggested a partial monoclonal component. CONCLUSIONS These data show that adrenocortical carcinomas are monoclonal and suggest that adenomas may arise from a single cell or from more than one cell under the putative action of local growth factors. In adenomas, which until now had appeared homogeneous, this genetic heterogeneity may reflect different pathophysiological mechanisms or it may represent different stages of a common multistep process exceptionally occurring in a single patient with bilateral macronodular hyperplasia.

BACKGROUND The i-gel™ is a supraglottic airway device not requiring inflation of a cuff for lung ventilation. Its design allows for unobstructed passage of a tracheal tube and previous studies have demonstrated a favorable alignment with the glottic inlet. In this prospective randomized study, we compared the success rate of blind tracheal intubation using the i-gel and the laryngeal mask airway (LMA) Fastrach™. METHODS One hundred sixty patients requiring general anesthesia and airway management were randomized to tracheal intubation using the i-gel or the LMA Fastrach. After induction of general anesthesia, the allocated device was inserted and adequate lung ventilation was confirmed. Blind tracheal intubation was then attempted. First attempt and overall tracheal intubation success rates were evaluated and tracheal intubation times were measured. RESULTS Eighty patients were recruited in each study group. Successful tracheal intubation was obtained on the first attempt in 69% of patients with the i-gel and 74% of patients with the LMA Fastrach (95% confidence interval [CI] of difference, -9% to 19%, P = 0.60). The overall intubation success rate was lower using the i-gel than it was using the LMA Fastrach (73% vs 91%, 95% CI of difference, 7% to 31%, P < 0.0001). CONCLUSIONS On first attempts, successful blind tracheal intubation was obtained at comparable rates using the i-gel and the LMA Fastrach. However, when the first attempt was unsuccessful, subsequent attempts through the i-gel did not significantly increase tracheal intubation success rate. The LMA Fastrach yielded a higher overall intubation success rate.

This study presents results from electrical resistivity campaigns performed around a housing estate located downstream to an old coke tar site in France. This coke tar has been previously studied with geochemical analyses and geophysical prospections. The previous results have shown a possible migration of the contaminant plume toward the housing estate. As geophysical measurements are difficult to perform in such an urban environment, the electrical array has been deployed all around the housing estate with an innovative arrangement of surface electrodes in C-shape and acquisition geometries in order to achieve a real 3D imaging of the subsoil and locate the contaminant plume above the housing estate. The electrical resistivity data were inverted with the ERTLabTM 3D inversion software developed by Multi-Phase Technologies and Geostudi Astier. Results show, at the depth of the aquifer, a very conductive plume emanating from old tar ponds and a slag heap and spreading through the housing estate.

International audience; In this paper, we present results of a laboratory and in situ study of a domestic waste landfill using magnetic resonance measurements. For our study, we used a laboratory Earth's field nuclear magnetic resonance (NMR) instrument developed at LTHE and a large-scale commercial magnetic resonance sounding (MRS) system NUMISLITE from IRIS Instruments. We show that NMR could be a tool for investigating different processes in water-saturated waste samples. Our results show that domestic waste material contains ferromagnetic or paramagnetic particles that perturb the homogeneity of the geomagnetic field at a microscopic scale and render an NMR signal short. Consequently, only the spin echo technique can be applied for measuring. At a macroscopic scale, waste and different buried objects may also perturb the natural geomagnetic field. While investigating the landfill, we observed that magnetic anomalies (±2500 nT) are localized around some cells. This is probably linked to the presence of a higher percentage of metallic objects within the waste disposal. Our first appraisal of the possibility of investigating water-saturated waste in a laboratory using an Earth's field NMR instrument shows that, with existing instruments, waste samples can be studied when the dry density of waste is less than approximately 450 kg/m3. Because the relaxation times of magnetic resonance signals in landfill may be short (T2 < 100 ms and T2*

Publisher Summary Cushing's disease is the most frequent cause of spontaneous Cushing's syndrome in adults. In most series its prevalence is approximately 70% with a definite female preponderance, the female/male ratio ranging between 3:1 and 10:1. In reference series of 809 adult patients with spontaneous Cushing's syndromes, Cushing's disease accounts for 68% of the cases, and the female/male ratio is 2.8. Distribution of the age at diagnosis shows a peak in adult females in the 25-45-year range. In children, the causes of Cushing's syndrome have a different distribution. Primary adrenocortical tumors are more frequent and Cushing's disease accounts for about 50% of the cases. Children with this condition are usually older than nine with an equal sex ratio. Cushing's disease accounts for 50% of Cushing's syndrome and is almost always caused by a pituitary microadenoma. Cushing's syndrome refers to the manifestations of chronic glucocorticoid excess and may result from various causes. In Cushing's disease pituitary adrenocorticotropic hormone (ACTH) over secretion induces bilateral adrenocortical hyperplasia and excess production of cortisol, adrenal androgens and 11-deoxycorticosterone, which together provoke the clinical and biologic features of the disease. Cushing's disease is rare; its true incidence, which varies with age and sex, is difficult to evaluate.

Polypyrrole films doped with tetrathiomolybdate anions and containing molybdenum trisulfide have been studied by electrochemical impedance spectroscopy. Quantitative estimate of the charge-transport rate in the composite material as a function of potential have been obtained. The dependence of the impedance behavior of the film on potential and film thicknesses have been also systematically studied. The results are interpreted on the basis of an adatom model. An equivalent circuit based on this model is proposed. The validity of this model to describe the behavior of the polymer electrode both in its neutral and oxidized states has been demonstrated, and a comparison with another model has been made

Amorphous molybdenum sulfide and polypyrrole-tetrathiomolybdate/molybdenum sulfide thin films obtained by electrodeposition from aqueous solutions of ammonium tetrathiomolybdate and pyrrole + ammonium tetrathiomolybdate, respectively, have been characterized by elemental analysis, Auger electron spectroscopy, X-ray photoelectron spectroscopy, infrared spectroscopy, and X-ray absorption spectroscopy. The authors' data revealed that the structure of electrochemically and thermally produced molybdenum trisulfide are identical but that additional sulfur is also present in the electrodeposited material. On the other hand, polypyrrole films grown in the presence of tetrathiomolybdate as the counterion also contains molybdenum trisulfide. Elemental analysis and X-ray absorption spectroscopy of polypyrrole-tetrathiomolybdate/molybdenum trisulfide thin film suggest that 30% of molybdenum is under the MoS[sub 4][sup 2[minus]] form and 70% is present as MoS[sub 3]. 34 refs., 9 figs., 1 tab.

OBJECTIVE To assess the corticotrophic response to ovine corticotrophin releasing hormone (CRH) with the lowest dose of lysine vasopressin able to induce both the greatest stimulation and the lowest degree of side-effects. SUBJECTS Fourteen healthy young adult males. DESIGN Increasing intravenous doses (either 0, 0.03, 0.1, 0.3, or 1 IU) of lysine vasopressin, infused over 20 minutes, combined with a bolus of 100 micrograms ovine CRH. MEASUREMENT Radioimmunoassay of plasma ACTH, lipotrophin hormones and cortisol levels. RESULTS (1) Responses to stimulation tests were evaluated as the area under the curves of plasma levels versus sample times, from 0 to 120 minutes after injection or start of perfusion (six subjects). The lowest dose of lysine vasopressin that induced an additional stimulation in the CRH-stimulated ACTH response was 0.3 IU. The combination of 1 IU lysine vasopressin with CRH doubled values of the area under the curve for the ACTH. Lysine vasopressin alone (0.3 and 1 IU) failed to stimulate ACTH responses. (2) The combined test (100 micrograms CRH and 1 IU lysine vasopressin) was carried out on eight additional control subjects. From a mean basal level of 23 +/- 5.6 (SEM), plasma ACTH peaked to 104.5 +/- 8 ng/l (23.0 +/- 1.8 pmol/l) as early as 20-30 minutes after the start of injection. When repeated after a two-week interval, the combined test induced identical stimulation in a given subject. Results of lipotrophin hormone determinations roughly paralleled those of ACTH. However the effects on cortisol levels were less clear. Subjects injected with CRH experienced slight facial flush. Following the 1 IU lysine vasopressin dosage, side-effects were reduced to skin pallor. No changes in heart-rate or blood-pressure were observed. CONCLUSIONS Under these conditions, the combination of 100 micrograms CRH with 1 IU lysine vasopressin constitutes a powerful test for direct assessment of the pituitary reserve and therefore can be employed as a routine investigational tool.

Twenty-four hourly urinary growth hormone excretion (24-h uGH) has been quantified using a combination of ultrafiltration and conventional immunoradiometric assay. Twenty-four hourly uGH was measured in 20 normal adults and in 42 patients with acromegaly (9 untreated, 28 treated but with above-normal IGF-I levels, and 5 treated and cured). The means and ranges were as follows: 3.7 (1–9) ng/24 h for normals and 160(40–540), 66(2–380) and 5.2 (4–8) ng/24 h for the three groups of acromegalic patients, respectively. Ten patients with pituitary adenomas without acromegaly had 24-h uGH within the normal range. Twenty-four hourly uGH therefore gives a clear differentiation between controls and untreated patients. Log-transformed values for subjects with acromegaly showed significant correlations between 24-h uGH and levels of IGF-I (r=0.63, p

In this study, we compared the quality of transitional analgesia provided by bilateral superficial cervical plexus block (SCPB) or morphine following a remifentanil-based anesthesia for infratentorial or occipital craniotomy.In this randomized controlled and double-blind study, 30 patients scheduled for infratentorial or occipital craniotomy were divided randomly into two groups: group morphine (morphine 0.1 mg·kg⁻¹ iv after dural closure and a SCPB performed with 20 mL of 0.9% saline at the end of the surgery) or group block (10 mL of 0.9% saline iv instead of morphine after dural closure and a SCPB performed with 20 mL of a 1:1 mixture of 0.5% bupivacaine and 2% lidocaine at the end of the surgery). Postoperative pain was assessed at one, two, four, eight, 12, 16, and 24 hr using an 11-point (0-10) numerical rating scale (NRS). Analgesia was provided with subcutaneous codeine.Average NRS scores were similar between the two groups at each time interval over the study period. The average scores (with 95% confidence interval) were 3.9 (3.4-4.4) and 4.3 (3.8-4.9) for the block and morphine groups, respectively (P = 0.25). The delay before administration of the first dose of codeine was not statistically different between the two groups: 25 min (5-2,880) vs 21.5 min (5-90), median and range for the block and morphine groups, respectively. The incidence of nausea and vomiting was similar between the two groups.Bilateral superficial cervical plexus block provides transitional analgesia that is clinically equivalent to morphine following remifentanil-based anesthesia in patients undergoing occipital or infratentorial craniotomies.

The indications for red blood cell (RBC) transfusions remain unclear despite published guidelines. Our hypothesis was that the transfusion practice varies inside the Centre hospitalier de l'Université de Montréal (CHUM).A total of 701 charts of patients who underwent a knee or hip arthroplasty or prosthesis revision in three hospitals of the CHUM were reviewed. Demography, hemoglobin (Hb) concentrations, details on transfusions, and postoperative adverse events (AEs) were collected up until discharge. The primary outcome was the presence or absence of RBC transfusion. Secondary outcomes were the nadir Hb, number of units transfused, discharge Hb, blood losses, and postoperative AEs.The rate of postoperative transfusion was 29%. We found no significant difference between odds ratios of each site for sex, coronary artery disease, chronic heart failure, type of procedure, American Society of Anesthesiologists physical status, weight, height, body mass index, body surface area, and estimated blood volume. Overall, patients were transfused at a Hb between 75 and 80g/L. Eighty-five percent of postoperative transfusions could be predicted using only nadir Hb and adding patient characteristics did not substantially improve the model (86.1%). Discharge Hb was below 100g/L in 66% of patients.There was no difference among hospitals regarding the way RBC transfusions are used. Our data suggest that physicians mainly based their decision to transfuse on a single variable, the Hb concentration, with the use of a restrictive strategy. Future trials should focus on the optimal transfusion trigger to adopt in major orthopedic surgery.

International audience; We study the feasibility of using electrical/EM methods for monitoring the injection of supercritical CO2 at a depth of 1700 m in a saline aquifer of the Paris Basin (Dogger carbonates). We first establish the theoretical interest of resistivity methods for CO2 monitoring through the basic laws of electrical physics in porous sedimentary rocks, assuming that supercritical CO2 is a perfect insulator. Various combinations of EM sources and sensors are discussed and it is shown that the best type of array consists of a galvanic source (i.e. injection of current via a pair of electrodes A and B) and of a grid of electric (and possibly magnetic) sensors at the ground surface. Given the usual depth and thinness of CO2 storage layers, current injection at depth was investigated in order to increase the current density in the reservoir and thus enhance the CO2 response. Point injection at the reservoir depth in the so-called “Mise À la Masse” (MAM) configuration is generally impossible in deep wells due to the presence of metallic casings. Therefore, the possibility of using a deep metallic casing as a long electrode distributing the current all along a borehole is studied. This kind of source is named “LEMAM” (Long Electrode Mise À la Masse) in order to differentiate it from the conventional MAM.Numerical simulations are presented for the LEMAM array and for the gradient or rectangle array (RECT), for which the current is injected by a pair of point electrodes at the ground surface. The geoelectric model used is based on an area close to the Saint-Martin-de-Bossenay (SMB) oilfield, in the south-east of the Paris Basin. The storage reservoir considered in this study is the 75-m-thick “Oolithe Blanche” formation (Mid Jurassic or Dogger, Bathonian age), located at a depth of about 1700 m below ground surface. In the models presented, the CO2 plume is simplified to a square horizontal slab of 2 km side, 70 m thick, floating at the top of the oolite aquifer. A uniform CO2 saturation of 80% is assumed, yielding a resistivity contrast of 25 with the initial reservoir.Two variants of the model with different reservoir resistivities are compared. The first model is calculated with a realistic reservoir resistivity of 20 ohm.m, reflecting the low salinity of the aquifer in this part of the Basin (≈ g g/L of NaCl). With this model, the time-lapse electric response of the CO2 plume is less than 0.5% of the initial electric field, which is below the estimated “repetition noise”. This poor result can be explained by the fact that the reservoir, in this case, is far from being the most conductive layer of the model. As a consequence, only a minor part of the injected current is used for energizing the CO2 plume: a rough calculation shows that only about 2% of the injected current crosses the reservoir, hence the poor response of the plume.A second model is calculated with an idealistic reservoir resistivity of 1 ohm.m, corresponding to about 50-70 g/L of NaCl in the aquifer (though such salinity is not observed anywhere in the Dogger aquifer of the Paris Basin, it is common in many storage aquifers). With this favourable model, it is estimated that about 30% of the injected current crosses the reservoir and energizes the plume, resulting in a time-lapse electric response as high as 6% of the initial field, which is quite measurable. For comparison, the timelapse electric response obtained with the same model for a surface current injection (RECT array) is only 2% of the initial field. With this same model, the time-lapse magnetic response obtained for the LEMAM injection is about 3% of the initial magnetic field.We conclude that the LEMAM array is very promising for the resistivity monitoring of a CO2 injection in a deep aquifer, provided that the water salinity is high enough for the reservoir to channel a significant fraction of the injected current (say > 10%).

Polypyrrole films containing tetrathiomolybdate anions and molybdenum trisulfide have been prepared on platinum and tin oxide coated glass electrodes by anodic electrochemical deposition from an aqueous solution containing pyrrole and ammonium tetrathiomolybdate. The scanning electron micrographs of these films show a porous structure. Cyclic voltammetry at a tin oxide electrode in a solution containing pyrrole and tetrathiomolybdate suggests that the formation of the polymer proceeds initially by a nucleation process. The current-time transient for film deposition remains fairly constant for long elapsed times, after the initial decrease and rise, indicating the formation of a fairly conducting layer. A linear relationship is observed between both film thickness, the weight of molybdenum in the polypyrrole-tetrathiomolybdate film and the charge passed during film formation. The cyclic voltammogram of the polypyrrole-tetrathiomolybdate film is characterized by an apparent redox potential, taken as the average between the anodic and cathodic peaks, of approx. −0.3 V vs. SCE. The latter is shifted to a more negative potential in comparison with that of a polypyrrole-chloride film electrode. This negative shift is characteristic of polypyrrole film doped with some “immobile” dopant. In this case the redox processes involve insertion of cations from the supporting electrolyte during film reduction and expulsion during oxidation. This was confirmed by cyclic voltammetry which is strongly dependent on the size of the electrolyte cation and independent of the electrolyte anion. Elemental analysis shows that the polypyrrole-tetrathiomolybdate film contains 70% MoS3 and 30% MoS42− relative to the molybdenum content. The conductivity of a polypyrrole-tetrathiomolybdate film is at least two orders of magnitude larger than that of a molybdenum trisulfide film.

The pathophysiological mechanism of pituitary ACTH oversecretion in Cushing's disease remains unclear. The question of whether a collection of corticotroph cells is a primary pituitary event or is driven by increased production of hypothalamic corticotropin releasing factor is still debated. Establishing whether or not there is a clonal nature of such pituitary lesions has important conceptual and practical implications. Clonal composition of corticotroph cell adenomas was determined by X chromosome inactivation analysis using a DNA probe, M27 beta, which detects a multiallelic polymorphism in 90% of females. A first digestion by PstI reveals the polymorphism. A second digestion by MspI or its methylation sensitive isoschizomer HpaII, distinguishes the active from the inactive copy. DNA was extracted from 11 corticotroph macroadenomas responsible for Cushing's disease or Nelson's syndrome. Eight of the 11 female patients were heterozygous for the locus and included in the study. Blood leukocytes were available for 5 females and were used as controls. All 8 tumors demonstrated a monoclonal pattern while the 5 leukocyte DNA were polyclonal. Ours results show that a somatic modification plays an important role in the pathogenesis of corticotroph macroadenomas allowing monoclonal expansion of a genetically aberrant cell.

Background In this study, we compared the effect of light sedation with remifentanil versus propofol on intracranial (ICP) and cerebral perfusion pressure (CPP) of patients undergoing stereotactic brain tumor biopsy under regional anesthesia. Methods This was a prospective, open-label, randomized, and controlled study. Forty patients undergoing stereotactic brain tumor biopsy under regional anesthesia were randomized into two groups to receive remifentanil or propofol titrated to a level of four on the modified Assessment of Alertness/Sedation Scale. ICP was measured via the biopsy needle. Results At the targeted level of sedation, the rates of infusion for remifentanil and propofol were, respectively, 4.2 +/- 1.8 microg x kg(-1) x h(-1) and 4.3 +/- 2.5 mg x kg(-1) x h(-1). At the time of ICP measurement, patients in the remifentanil group had a slower respiratory rate (11/min +/- 3 vs 15 per min +/- 3, P = 0.0001) and a higher PCO2 (48.3 +/- 6.2 mm Hg vs 43.1 +/- 5.5 mm Hg, P = 0.009) than patients in the propofol group. The mean was similar for both groups, 19.0 +/- 11.9 mm Hg vs 16.4 +/- 11.1 mm Hg for remifentanil and propofol, respectively (P = 0.48). Higher mean arterial blood pressure in the remifentanil group (101.1 +/- 13.7 mm Hg vs 85.8 +/- 12.7 mm Hg, P = 0.0008) resulted in a higher CPP than the propofol group: 82.0 +/- 19.0 mm Hg vs 69.5 +/- 17.0 +/- 19.0 mm Hg (P = 0.03). Conclusion Light sedation with remifentanil does not result in a higher ICP than propofol in patients undergoing stereotactic brain tumor biopsy. CPP might be better preserved with remifentanil.

International audience; In the framework of the management of karstic aquifers, geophysical reconnaissance can be used to locate conduits and caves, and to characterise the surrounding limestone matrix. Suitable characterisation of heterogeneities in the karstic environment is, however, challenging for ground-based geophysical methods. The present article describes the results, and evaluates the response and accuracy of combined geophysical measurements carried out at the Poumeyssen test site in France, involving electrical resistivity imaging (ERI), magnetic resonance sounding (MRS), ‘‘mise-à-la-masse'' electrical mapping, and seismic tomography. This site provides the opportunity to study a relatively wide, shallow, water-filled conduit whose location and shape are known from topographic work carried out by cave divers. Seismic and MRS provided the exact location and width of the conduit, to within a few meters. The seismic and electrical data suggest that the limestone medium surrounding the conduit is not homogeneous. To cite this article: R. Guérin et al., C. R. Geoscience 341 (2009).

In model-driven software development as much as in classical code-driven development maintenance costs make up the bulk of the total life cycle costs of a software system. However, as development methods in MDSD differ from classical methods, assuring the maintainability of systems built with MDSD requires companies to adjust their quality assurance to work with the new paradigm and the novel type of development artefacts. As the automotive industry has already applied model-driven approaches for some time (usually in the form of Matlab/Simulink) it proves to be a fertile ground to advance assurance methods for the maintainability of model-based systems. In this chapter we describe a two-dimensional quality metamodel and present an instance that defines maintainability for MDSD with Matlab/Simulink and TargetLink. We exemplify how such a model serves as the basis of all quality assurance activities and report on experiences made in an industrial case study with one of the leading international providers of commercial vehicles and transport solutions.

International audience; We consider a series of hydrogeophysical techniques that provide a multiscale investigation of the water content in the vadose zone and of the perched aquifer at the experimental site of “La Soutte” in the Vosges Mountains (France). It is located in a catchment area where several springs and streams occur along fractured volcanic and weathered plutonic rocks. The site is the object of a long-term study that uses both continuous and repeated measurements to monitor hydrogeological processes. The main results from AMT and DC resistivity techniques allow the determination of a high-resolution 3D resistivity model over a large range of depths (from 100 to 103 m). We discuss their use and propose a hydrogeological model (porosity, water conductivity and water content). We also use MRS and GPR for a detailed investigation of the shallow part of the catchment that consists of soil and weathered rocks of highly varying thickness (0 to 15 m). MRS is used to map the thickness and total water volume content by unit surface of the saturated weathered zone. It also yields estimates of the vadose zone thickness through the depth to the top of the saturated zone. Moreover, we show results from GPR CMP measurements that yield estimates of the water content and porosity in the shallowest layer (0–30 cm) by simple interpretation of the ground direct wave.

IRD is a French public scientific and technological institution, jointly overseen by the Ministries of Research and Overseas Cooperation. It has three main vocations: research, evaluation and training It meets these objectives by conducting scientific programs, centered around the relationship between humans and their environment in poor countries, in order to contribute to sustainable development. IRD has a budget of 218,9 millions euros. It employs 2 235 staff including 830 researchers, 1 021 engineers and technicians, and local personnel. Forty-two percent of IRD staff are employed overseas, many technicians originate from poor countries, and IRD research programs involve researchers from many countries. IRD is engaged in several European and international scientific programs, and plays a coordinating role for research institutions and universities working towards third-world development.

Purpose Clopidogrel, a potent antiplatelet drug, increases hemorrhagic adverse events when its use is continued up to five days before cardiac surgery but data are lacking in non-cardiac surgery. We sought to determine the dose of clopidogrel which has a maximal antiplatelet and hemorrhagic effect in a rabbit model of non-cardiac surgery. Methods Twenty-four rabbits were divided into three groups according to the dose of clopidogrel administered (5, 10 and 20 mg.kg -1 ). Baseline measurement of platelet aggregation induced with ADP, platelet reactivity index (PRI) of the VASP-phosphorylation assay and hematologic variables were obtained the day before the experiment. Two hours after clopidogrel administration, the same variables were measured, along with intra abdominal bleeding following standardized hepato-splenic lesions. Results Platelet aggregation was inhibited in a dose-dependent manner: 46%±16% with 5 mg.kg -1 and 93%±7% with 20 mg.kg -1 of clopidogrel. PRI was reduced by 61%±25% with 5 mg.kg -1 of clopidogrel and by 92%±11% and 94%±10% with 10 mg.kg -1 and 20 mg.kg -1 respectively ( p =0.01). Percentage reduction of platelet aggregation was positively correlated with the percentage reduction of PRI (r=0.69; CI 95 , 0.40 to 0.86). Bleeding from hepato-splenic lesions was more important in the 10 and 20 mg.kg -1 groups compared to the 5 mg.kg -1 group ( p Conclusion Higher doses of clopidogrel are associated with a more profound inhibition of platelet aggregation and PRI and increased blood losses following standardized hepato-splenic lesions. We conclude that our animal model demonstrates clopidogrel's propensity to increase intra abdominal bleeding after standardized hepato-splenic lesions and may help develop blood sparing strategies for patients undergoing surgery while on clopidogrel.

Magnetic resonance sounding (MRS) is a geophysical technique developed for groundwater exploration. This technique can be used for investigating karst aquifers. Generally, the study of a karst requires a 3D field setup and corresponding multichannel data-acquisition instruments. Now only single-channel MRS equipment is available; i.e., the time needed for a 3D MRS field survey is multiplied by a factor of four or five. Where karst caverns are natural hazards, as in the Dead Sea coastal area at Nahal Hever, Israel, even an approximate localization of potentially dangerous zones and a corresponding estimation of the hazard dimensions are useful. We studied numerically the accuracy of MRS estimations of the volume of different 3D targets aroundNahal Hever, shifting a 3D target inside the MRS loop and calculating the volume-estimation errors for each target position. The calculations covered targets of different sizes. The size and position of a target being unknown factors in a field survey, the numerical data were considered as random values to be analyzed statistically. Using a 1D approximation of the MRS solution and assuming a [Formula: see text] MRS loop, the volume of a 3D target under Nahal Hever conditions is estimated within a [Formula: see text] error when the target is smaller than the MRS loop, and within a [Formula: see text] error when the target size is about the same as the MRS loop. The lower threshold of karst-cavity detection with MRS is about [Formula: see text]. For such estimation, only one sounding is required.

The IGF-I gene from leukocyte DNA of a control population of normal stature was studied using Southern blotting. Restriction fragment lengths for 21 enzymes were determined and three restriction fragment length polymorphisms (RFLP) were found (EcoRV, HindIII, and PvuII). In addition, the IGF-I gene of 64 constitutionally short subjects, five Pygmies, and 10 constitutionally tall subjects was analyzed. No IGF-I gene alterations were detectable by Southern blot in any of these conditions. Linkage analysis using genetic markers (RFLP) yielded results that were uninformative for five constitutionally short families investigated, owing to the limited number of RFLP and their low incidence (17% for the 5.2-kb HindIII, 5-kb PvuII RFLP alleles, and 13% for the 13-kb EcoRV RFLP allele). The EcoRV RFLP was found to map near Exon 1. The incidence of the 13-kb polymorphic allele with EcoRV proved to be lower (4%) in the group with constitutionally short stature than in controls. These results could suggest that modifications in the region of the IGF-I gene may be involved in constitutionally short subjects.

This retrospective study was designed to assess the intensity of postoperative pain in relation to the location of craniotomy.After Research Ethics Board approval, data were collected from the charts of all patients who underwent a craniotomy at our institution between January 2004 and December 2005. The severity of post-craniotomy pain was assessed by collecting scores obtained using an 11-point verbal rating scale and calculating the cumulative analgesic requirements for the first 48 hr postoperatively. Data were compared according to the craniotomy location.Data from 299 patients was available for analysis. On average, 76% of patients experienced moderate to severe postoperative pain. Frontal craniotomy was associated with lower pain scores than four of six craniotomy sites analyzed, with 49% of patients reporting mild pain, a significant difference (P0.05) compared with all other groups except for parietal craniotomies. Frontal craniotomy patients also had lower opioid analgesic requirements compared to patients who underwent posterior fossa craniotomy (P0.05). Logistic regression analysis showed that craniotomy location (P0.0001) and age (P = 0.004) were both independent predictors of the intensity of postoperative pain, with lower pain scores as age increased. Postoperative use of steroids, gender and presence of preoperative pain were not statistically linked to postoperative pain intensity. The prevalence of postoperative nausea and vomiting was 56% and it did not vary according to the location of craniotomy.This study shows that the intensity of postoperative pain in neurosurgery is affected by the site of craniotomy. Frontal craniotomy patients experienced the lowest pain scores, and required significantly less opioid than patients undergoing posterior fossa interventions.

Le pentobarbital est l’anesthesiant type utilise dans un modele experimental de reductions cycliques de flot (CFR) chez les lapins. Nos observations initiales, en utilisant une technique anesthesique basee sur l’isoflurane, n’ont pas reproduit les observations rapportees precedemment. Par consequent, nous avons compare les effets de ces deux techniques anesthesiques chez le lapin. Un modele de Folts modifie de lesion de l’artere carotide et de stenose a ete utilise. Douze lapins ont pris part au protocole experimental : cinq dans le groupe pentobarbital (P), et sept dans le groupe isoflurane (I). L’artere carotide a ete exposee et le debit reduit par une clampe. Une lesion standardisee a ete faite par clampage de l’artere carotide avec un forceps fin, ce qui a provoque des CFR. Le nombre de CFR ainsi que la duree pendant laquelle ces reductions avaient lieu ont ete enregistres. L’incidence de thrombose a ete comparee dans chaque groupe, tout comme les valeurs hemodynamiques, hematologiques, et le temps de saignement. La valeur de l’hematocrite, la numeration plaquettaire et le temps de saignement ont ete similaires dans les deux groupes. Le nombre moyen et la portee des CFR [groupe P : 9 (4–16); groupe I: 9 (5–14)] ainsi que la duree pendant laquelle les CFR avaient lieu (groupe P : 39 ±17; groupe I: 38 ± 25 min) ont donne des resultats comparables dans les deux groupes. L’incidence de thrombose complete de l’artere carotide a ete similaire dans les deux groupes. La stabilite du modele est de courte duree, mais le nombre de CFR n’est pas affecte par le type d’anesthesie. Nos resultats suggerent que la duree ideale du protocole experimental devrait e tre de 30 a 45 min afin de maximiser le nombre d’animaux developpant des CFR de maniere soutenue.

SummaryRecombinant human activated factor VII (rHuFVIIa) can reduce bleeding but may be associated with arterial thrombosis. We hypothesized that rHuFVIIa would increase the occurrence of cyclic flow reductions (CFR) and reduce intra-abdominal bleeding in an experimental model. An adapted Folts’ model of carotid artery lesion and stenosis was used. Twenty four rabbits were randomized to receive rHuFVIIa (group F) or placebo (group P) in a double-blind fashion. A standardized injury to the common carotid artery resulted in CFR and/or thrombosis. Hematological values, coagulation and thromboelastographic (TEG) variables were compared. Intra-abdominal bleeding was evaluated by measuring blood loss from standardized hepatosplenic lesions. The median number (range) of spontaneous CFR [group P: 6 (0–15); group F: 8 (0–16)] was comparable between groups. The number of induced CFR (by “shaking” of the artery) needed to avert thrombosis (group F: 2; group P: 0 ; p < 0.05) and the incidence of complete carotid artery thrombosis (group F: 3; group P : 0; p < 0.05) were higher in group F. Intra-abdominal bleeding was similar in both groups. TEG analysis demonstrated a hypercoagulable state in both groups but the magnitude of the change was statistically more important in group F. rHuFVIIa increases thrombosis in a rabbit model of carotid artery injury. The bleeding from hepatic and splenic lesions is not reduced by administration of rHuFVIIa despite a hypercoagulable state confirmed by standard TEG analysis.

International audience; Karstic conduits play a crucial role for water supply in many parts of the world. However, the imaging of such targets is generally a difficult task for most geophysical methods. Magnetic Resonance Sounding (MRS) is a geophysical method designed for imaging of water bearing structures. Initially, MRS was developed for characterizing horizontally stratified aquifers. However, when applying a 1D MRS measuring setup to the imaging of 2D–3D targets, the size of which may be much smaller than the loop, the accuracy and the lateral resolution may not be sufficient. We have studied the possibility of simultaneously processing several MRS aligned along a profile to perform a Magnetic Resonance Tomography (MRT). This work emphasizes the gain of resolution for 2D–3D imagery of MRT versus the interpolation of 1D inversion results of MRS along the same profile. Numerical modelling results show that the MRT response is sensitive to the size and location of the 2D target in the subsurface. Sensitivity studies reveal that by using the coincident transmitting/receiving (TX/RX) setup and shifting the loop around the anomaly area, the depth, section and position of a single karstic conduit with a size smaller than the MRS loop size can be resolved. The accuracy of the results depends on the noise level and signal level, the latter parameter being linked to the depth and volume of the karstic conduit and the water content in the limestone matrix. It was shown that when applying MRT to the localization of 2D anomalies such as karstic conduits, the inclination of the geomagnetic field, the orientation of the MRT profile and the angle of crossover of the conduit by the MRT profile must be taken into account. Otherwise additional errors in interpretation should be expected. A 2D inversion scheme was developed and tested. Both numerical and experimental results confirm the efficiency of the developed approach.

To study the prevalence and impact of pain on the quality of life (QOL) of lung transplant recipients.Prospective, observational, cross-sectional study. Ninety-six lung transplant recipients (3 months after transplantation) completed questionnaires measuring the severity and impact of pain (Brief Pain Inventory), anxiety (State Trait Anxiety Inventory), QOL (Short Form-36 version 2 [SF-36v2]), and depression (Beck Depression Inventory [BDI]).University medical center lung transplant outpatient clinic.The prevalence of pain in lung transplant recipients was 49%. Patients with pain were older, more likely to have undergone unilateral lung transplantation (64% vs 40%, p = 0.03), and were more likely to have lung emphysema (55% vs 38%, p = 0.004). Only a pulmonary diagnosis of lung emphysema remained an independent predictor for postoperative pain in a logistic regression model. Average (+/- SD) score of the BDI was 9.6 +/- 7.8 and 5.8 +/- 5.8 (p = 0.005) for patients with and without pain, respectively. Patients with and without pain did not significantly differ in terms of anxiety. Pain-free patients had a significantly higher physical component score than patients with pain in the SF-36v2 (mean, 48.7 +/- 8.6 vs 38.6 +/- 9.8, p0.0001, respectively), while the mental component scores were not statistically different between the two groups.Lung transplant recipients have a high prevalence of pain. Patients with lung emphysema as their preoperative diagnosis are more likely to have pain. The occurrence of pain is associated with a decreased QOL in lung transplant recipients.

We compared transitional analgesia provided by scalp nerve block (SNB) or morphine after remifentanil-based anesthesia in neurosurgery. Fifty craniotomy patients were randomly divided into two groups: morphine (morphine 0.1 mg x kg(-1) IV after dural closure and an SNB performed with 20 mL of 0.9% saline at the end of surgery) and block (10 mL of 0.9% saline instead of morphine after dural closure and an SNB performed with a 1:1 mixture of bupivacaine 0.5% and lidocaine 2% at the end of surgery). Postoperative pain was assessed at 1, 2, 4, 8, 12, 16, and 24 h using a 10-point numerical rating scale. Analgesia consisted of subcutaneous codeine. Average numerical rating scale scores were similar between the two groups at each time interval. Total codeine dosage was also similar, except at 4 h postoperatively when it was higher in the block group. The delay before administration of the first dose of codeine was not statistically different between groups: 45 min (20-2880) vs 30 min (10-2880), median and range for the block and morphine group, respectively. Postoperative hemodynamics were similar for both groups. The incidence of nausea and vomiting was slightly more frequent in the morphine group, but the occurrence of confusion did not differ between groups. In conclusion, SNB provides a quality of transitional analgesia that is similar to that of morphine with the same postoperative hemodynamic profile.

Background and Objectives: This prospective study compared the initial block quality and surgical anesthesia rates of ultrasound-guided infraclavicular blocks with local-anesthetic injected through a catheter versus through a needle. We hypothesized that positioning of the catheter immediately posterior to the axillary artery would produce through-the-catheter (TTC) anesthesia with rates of complete block not inferior to through-the-needle (TTN) injection. Methods: Eighty patients undergoing hand or forearm surgery extensive enough to require regional anesthesia were randomized into 2 groups of 40. In group TTN, local anesthetic was deposited posterior, lateral, and medial to the axillary artery using as few injections as necessary. In group TTC, a 20-gauge, multiorifice catheter was positioned between the posterior wall of the axillary artery and the posterior cord of the brachial plexus. All blocks were performed by use of ultrasound visualization with a 6-MHz to 10-MHz 38-mm linear probe. Local-anesthetic solution consisted of 0.5 mL/kg lidocaine 2% with epinephrine. Sensory and motor blocks, as well as supplementation rates, were evaluated for the musculocutaneous, median, radial, and ulnar nerves. Results: Complete sensory block of all nerve territories was achieved in 92% of patients in group TTN and 90% in group TTC (P = .51). In group TTN, 90% of patients had satisfactory anesthesia for surgery (no discomfort and no need for anesthetic supplementation of any type) compared with 92% in group TTC (P = .51). Conclusion: Ultrasound-guided TTC infraclavicular block produced perioperative anesthesia that was not inferior to a TTN technique.

Purpose of review In this article we aim to review the recent literature concerning the management of traumatic brain injury patients, summarize the main findings, and discuss the impact of these findings on clinical practice. Recent findings Several authors have focused on the development of more reliable and informative tools to predict outcome in traumatic brain injury as well as refining the definition of cerebral ischemia in last year's literature. The validity of the current cerebral perfusion pressure management guidelines has also come under scrutiny. It appears that a one size fits all therapy is not a suitable approach for traumatic brain injury patients. An individualized approach, depending on the integrity of pressure autoregulation mechanisms, would be more advisable. Clinical trials investigating brain protective treatments in head injured patients have been disappointing so far. Increasing the homogeneity of patients entering brain protective studies might be an answer. Finally, the use of hyperoxia as well as factors contributing to secondary brain injury such as the occurrence of hyperthermia, with or without an infectious process, have been assessed in head injury patients. Summary The key term for the management of traumatic brain injury patients in the early twenty-first century will clearly be ‘individualized therapy’. The search of an ideal cerebral perfusion pressure target that would fit every head-injured patients is a utopia. More energy should be focused on the development of reliable tools for outcome prediction and outcome assessment for traumatic brain injured patients. That, and a better targeting of patients entering brain protective trials, should increase the likelihood of demonstrating a significant salvaging effect of a particular treatment in humans.

A new methodology for magnetic resonance sounding (MRS) data acquisition and interpretation was developed for locating water-filled karst cavities. This methodology was used to investigate the Ouysse karst system in the Poumeyssens shaft in the Causse de Gramat (France). A new 2D numerical MRS response model was designed for improved accuracy over the previous 1D MRS approach. A special survey performed by cave divers confirmed the accuracy of the MRS results. Field results demonstrated that in favourable conditions (a low EM noise environment and a relatively shallow, large target) the MRS method, used with a coincident transmitter/receiver loop, can be an effective tool for locating a water-filled karst conduit. It was shown numerically that because an a priori orientation of the MRS profile with the karst conduit is used in the inversion scheme (perpendicular for instance), any error in this assumption introduces an additional error in locating the karst. However, the resulting error is within acceptable limits when the deviation is less than 30°. The MRS results were compared with an electrical resistivity tomography (ERT) survey. It was found that in Poumeyssens, ERT is not able to locate the water-filled karst. On the other hand, ERT provides additional information about heterogeneities in the limestone.

In this prospective study we compared ultrasound-guided (USG) infraclavicular and supraclavicular blocks for performance time and quality of block. We hypothesized that the infraclavicular approach would result in shorter performance times with a quality of block similar to that of the supraclavicular approach. Eighty patients were randomized into two equal groups: Group I (infraclavicular) and Group S (supraclavicular). All blocks were performed using ultrasound visualization with a 7.5-MHz linear probe and neurostimulation. The anesthetic mixture consisted of 0.5 mL/kg of bupivacaine 0.5% and lidocaine hydrocarbonate 2% (1:3 vol.) with epinephrine 1:200,000. Sensory block, motor block, and supplementation rates were evaluated for the musculocutaneous, median, radial, and ulnar nerves. Surgical anesthesia without supplementation was achieved in 80% of patients in group I compared with 87% in Group S (P = 0.39). Supplementation rates were significantly different only for the radial territory: 18% in Group I versus 0% in group S (P = 0.006). Block performance times were not different between groups (4.0 min in Group I versus 4.65 min in Group S; P = 0.43). Technique-related pain scores were not different between groups (I: 2.0; S: 2.0; P = 1.00). We conclude that USG infraclavicular block is at least as rapidly executed as USG supraclavicular block and produces a similar degree of surgical anesthesia without supplementation.

The pharmacodynamics of muscle relaxants in patients with oculopharyngeal muscular dystrophy (OPMD) have never been studied. We designed this study to compare the pharmacodynamics of cisatracurium in OPMD patients versus a control group. Forty patients were enrolled: 20 OPMD patients requiring general anesthesia for cricopharyngeal myotomy and 20 age-matched controls undergoing an operation of similar duration and expected blood loss. Anesthesia was standardized, and both groups received a bolus of cisatracurium 0.1 mg/kg. Onset time, time to 10% T1 recovery, and the intervals 10%-25% and 25%-75% were calculated for both groups. A subgroup analysis was performed in patients with a more severe form of OPMD. Demographic and intraoperative data were similar. Onset time was significantly longer in OPMD patients compared with the control group (4.6 +/- 1.5 min versus 3.4 +/- 1.0 min; P = 0.001). There was no difference in recovery times or indices between groups, regardless of the severity of the disease. In conclusion, there was no difference in the duration of a cisatracurium-induced neuromuscular block between OPMD patients and a control group. A delayed onset of action of the drug may occur.

Bilateral sixth nerve palsy is a known though uncommon complication following dural puncture. The recommended treatment consists of hydration and alternate monocular occlusion. The value and the timing of an epidural blood patch (EBP) for sixth nerve palsy remains controversial as some authors have demonstrated benefits in performing an EBP early in course of the nerve palsy whereas others have not found any advantage when an EBP was performed later.A 40-yr-old woman developed bilateral sixth nerve palsy ten days after an unintentional dural puncture. An EBP was done within 24 hr after the onset of the symptoms and immediate improvement of the diplopia was noted by the patient and confirmed by an ophthalmologist. Complete resolution of the diplopia occurred 36 days after the dural puncture.Blood patching within 24 hr of the onset of diplopia may be a reasonable treatment for ocular nerve palsy as it relieved the postdural puncture headache and produced partial improvement of the diplopia.

UNLABELLED Several pharmacological interventions reduce perioperative stress hormone release during surgery under general anesthesia. Listening to music and therapeutic suggestions were also studied, but mostly in awake patients, and these have a positive effect on postoperative recovery and the need for analgesia. In this study, we evaluated the effect of listening to music under general anesthesia on the neurohormonal response to surgical stress as measured by epinephrine, norepinephrine, cortisol, and adrenocorticotropic hormone (ACTH) blood levels. Thirty female patients scheduled for abdominal gynecological procedures were enrolled and randomly divided into two groups: group NM (no music) and group M (music). In group M, music was played from after the induction of anesthesia until the end of surgery. In the NM group, the patients wore the headphones but no music was played. We established three sample times for hormonal dosage during the procedure and one in the recovery room. Hemodynamic data were recorded at all times, and postoperative consumption of morphine in the first 24 h was noted. There was no group difference at any sample time or in the postoperative period in terms of mean arterial blood pressure, heart rate, isoflurane end-tidal concentration, time of the day at which the surgery was performed, bispectral index (BIS) value, doses of fentanyl, or consumption of postoperative morphine. There was no difference between the two groups with regard to plasmatic levels of norepinephrine, epinephrine, cortisol, or ACTH at any sample time, although the blood level of these hormones significantly increased in each group with surgical stimulation. In conclusion, we could not demonstrate a significant effect of intraoperative music on surgical stress when used under general anesthesia. IMPLICATIONS Listening to music under general anesthesia did not reduce perioperative stress hormone release or opioid consumption in patients undergoing gynecological surgery.

Certaines pessieres a lichens de la foret boreale commerciale ont deja supporte des peuplements denses d'epinettes noires avant que des accidents de regeneration n'en causent l'ouverture du couvert arborescent. La presente etude s'inscrit dans un vaste programme de recherche portant sur la remise en production des denudes secs, dont les pessieres a lichens. Cette etude a pour but de comparer des pessieres a mousses et a lichens amenagees quant a leur solution de sol et de plants d'epinette noire (Picea mariana (Mill.) B.S.P.). Quatre traitements de preparation de terrain effectues dans des plantations d'epinettes noire de trois ans a 200 km au nord du Lac St-Jean, Quebec,-Canada ont ete etudies, soit 1) Scarifiage dans une pessiere noire a mousses recemment recoltee, 2) Scarifiage dans une pessiere a lichens, 3) Taupe dans une pessiere a lichens, 4) pessiere a lichens sans preparation de terrain. A la lumiere des resultats obtenus, il s'est avere que trois ans apres plantation, les plants ont presente des croissances en hauteur et en diametre similaires dans les pessieres a mousses et a lichens scarifiees. Toutefois, les plants d'epinette noire des traitements Taupe et sans traitement presentaient des reductions de croissance considerables. Leur feuillage presentait de tres faibles concentrations en azote et en calcium. Neanmoins, la solution de sol des pessieres a lichens amenagees et celle des pessieres a mousses scarifiees presente une teneur similaire en nutriments. La vegetation influence faiblement la teneur en nutriments dans la solution de sol, soit entre 20 et 30 %. Les memes especes vegetales influencent la solution de sol et ce, d'une facon differente dans les pessieres a lichens que dans les pessieres a mousses. Les traitements de preparations de terrain diminuent la vegetation competitive sans toutefois supprimer son influence residuelle sur la solution de sol.

Up to 80% of patients report moderate to severe pain after craniotomy. In this study, we assessed the efficacy of scalp block for decreasing postoperative pain in brain surgery. Thirty patients scheduled for supratentorial craniotomy were enrolled. They were randomly divided into two groups: Ropivacaine (scalp block with 20 mL of ropivacaine 0.75%) and Saline (scalp block with 20 mL of saline 0.9%). Anesthesia was standardized. The scalp block was performed after skin closure and before awakening. Postoperative pain was assessed at 4, 8, 12, 16, 20, 24, and 48 h by using a 10-cm visual analog scale. Analgesia was provided with sub- cutaneous codeine as requested by the patient. Average visual analog scale scores were higher in the Saline group as compared with Ropivacaine (3.7 +/- 2.4 vs 2.0 +/- 1.6; P = 0.036). The total dose of codeine did not differ, nor did the duration of time before the first dose of codeine was required in the Ropivacaine (571 +/- 765 min) versus Saline (319 +/- 409 min; P = 0.17) group. In conclusion, we found that postoperative scalp block decreases the severity of pain after craniotomy and that this effect is long lasting, possibly through a preemptive mechanism.Up to 80% of patients report moderate to severe pain after craniotomy. This randomized double-blinded study demonstrated that ropivacaine scalp block decreases the severity of pain after supratentorial craniotomy.

UNLABELLED To prevent hypercapnia, voluntary hyperventilation is recommended for patients with increased intracranial pressure before the induction of general anesthesia. We sought to determine whether this maneuver results in a lower PaCO2 than breathing 3 min of oxygen 100% by face mask (preoxygenation) after intubation. Thirty patients requiring general anesthesia were randomly assigned to breathe either 3 min of oxygen 100% by face mask (Group P) or 1 min of oxygen 100% followed by 2 min of voluntary hyperventilation with oxygen 100% (Group H). All patients received a standard rapid-sequence induction of anesthesia followed by a 90-s period of apnea. Patients were then tracheally intubated and mechanically ventilated. Five arterial blood gas samples were taken: with room air, after preoxygenation or hyperventilation, after 60 and 90 s of apnea, and after tracheal intubation. Voluntary hyperventilation decreased PaCO2 before rapid-sequence induction (hyperventilation, 30.0 +/- 3.5 mm Hg versus preoxygenation, 37.9 +/- 5.2 mm Hg; P < 0.0001), but after 60 s of apnea, both groups had similar PaCO2 (hyperventilation, 36.1 +/- 3.3 mm Hg versus preoxygenation, 35.6 +/- 3.4 mm Hg; P = 0.673), and no benefit was found after intubation (hyperventilation, 40.5 +/- 3.9 mm Hg versus preoxygenation, 41.4 +/- 2.7 mm Hg; P = 0.603). We conclude that voluntary hyperventilation before rapid-sequence induction does not provide protection against potential hypercapnia during intubation. IMPLICATIONS Voluntary hyperventilation before anesthesia induction is recommended for patients with increased intracranial pressure to prevent hypercapnia. This randomized, prospective study demonstrated that this maneuver does not result in a lower postintubation PaCO2 than standard preoxygenation.

Hepatodiaphragmatic interposition of the colon is rare. The posterior type is rarer than the anterior type. We observed a case of combined anterior and posterior types and used an original operative technique with a Prolene® mesh to exclude the dead space and prevent recurrence.

Range of values of the Sun’s mass quadrupole moment of coefficient J 2 arising both from experimental and theoretical determinations enlarge across literature on two orders of magnitude, from around 10−7 until to 10−5. The accurate knowledge of the Moon’s physical librations, for which the Lunar Laser Ranging data reach an outstanding precision level, prove to be appropriate to reduce the interval of J 2 values by giving an upper bound of J 2. A solar quadrupole moment as high as 1.1 10−5 given either from the upper bounds of the error bars of the observations, or from the Roche’s theory, is not compatible with the knowledge of the lunar librations accurately modeled and observed with the LLR experiment. The suitable values of J 2 have to be smaller than 3.0 10−6.