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Resume Depuis environ trois decennies, la prise en charge endovasculaire a represente une progression majeure dans le traitement des complications des dissections aortiques aigues (DAA), dont certaines sont mortelles. Si le traitement endovasculaire est devenu la premiere ligne therapeutique dans le traitement des malperfusions, il tend a devenir une routine dans les DAA de type B non compliquees, a la lumiere d’etudes qui montrent de bons resultats a moyen terme. Recemment, les chirurgiens se sont attaques a l’aorte ascendante (DAA de type A), consideree jusque-la comme etant du seul ressort de la chirurgie ouverte. S’il reste a ce jour beaucoup de limitation en rapport avec une anatomie contraignante de l’aorte ascendante et avec l’absence de materiel dedie a son traitement, les resultats montrent une faisabilite et un succes technique chez un tiers des patients traites, grandement aides par une imagerie de plus en plus performante.

Arteriovenous malformation (AVM) are vascular anomalies that arise due to abnormal connection with shunting of blood from arteries to veins without an intervening capillary network. They are mostly found intracranially but extracranially, the scalp AVM cases are also well reported. However, arteriovenous malformation (AVM) of the scalp is a rare lesion whose natural history is not clearly understood. The clinical manifestation of AVM includes asymptomatic state, local discomfort, headaches and occasional scalp necrosis leading to massive haemorrhage. CT or MR angiography remains the cornerstone for investigation. The options of treatment include complete surgical excision, embolization or a combination of the two modalities. We present the successful management of a young man who presented with a torrential bleeding from a ruptured scalp arteriovenous malformation and had to undergo emergency complete excision followed with a rotational flap for the scalp reconstruction.

Working equids rely on sound, balanced hooves, but data describing the typical morphology of the legs and feet of working donkeys are currently lacking. To address this gap in knowledge, the front and hind feet of twenty healthy working donkeys were measured and compared. Hoof width, weight-bearing lengths, heel width, dorsal hoof wall length and lateral and medial heel length of the hoof wall were determined, as well as toe angle, heel angle, hoof pastern axis, coronary band angle and a measure of 'ground surface size'. Viewed from the ground surface of the foot, front feet were more rounded and significantly larger than hind feet. Measures of medial-lateral balance and toe-heel angle ratio were within the recommended healthy guidelines for horses. Hoof pastern axis was broken forward for the studied animals, which supports previous research suggesting that a broken forward hoof pastern axis is normal for donkeys, although further study would be required to confirm whether this conformation is natural. Significant correlations were found between estimated body mass and hoof width in both the front and hind feet. These measurements provide valuable insight into the relationship between hoof and body characteristics, which may aid the development of guidelines for the trimming and management of working donkey hooves. Further study is, however, advised to confirm natural hoof conformation.

Polymorphism of GSTT1 had been known to be associated with nasopharyngeal carcinoma. The polymorphism induces oxidative stress and enhances IgA level through increasing EBV lytic reactivation. IgA levels are important for screening NPC patients and also for consideration of NPC therapy. We did the study to analyze the correlation of GSTT1 polymorphism and IgA level. This study was an analytical study with a cross-sectional design. We used the blood of NPC patients and identified GSTT1 polymorphism by PCR and IgA level by ELISA. There were 18 (62.0%) patients with GSTT1 null and 11 (38.0%) patients with GSTT1 positive. Patients with increased IgA were 21 (72.4%) patients, and normal IgA were 8 (27.6%) patients. There was no significant association of GSTT1 polymorphism with the IgA level. These can be affected by other factors, including the antioxidant level of NPC patients. The study could be used as an initial study for identifying the association of other risk factors with the IgA level of NPC patients.

Several cancers including nasopharyngeal carcinoma (NPC) is associated with antioxidant status of the patients. Polymorphism of enzyme responsible in metabolizing carcinogen such as GSTT1 enzyme can decrease total antioxidant status (TAS). This study was done in order to analyze the association of GSTT1 polymorphism and TAS level. There were 29 samples which underwent PCR-electrophoresis to identify GSTT1 polymorphism and ELISA for measuring TAS level. The study found 18 (62.0%) patients with GSTT1 null and 11 (38.0%) patients with GSTT1 positive. There were 21 (72.4%) patients with lower TAS level and 8 (27.6%) patients with normal TAS level. We did not found the significant association of GSTT1 polymorphism and TAS level. Lifestyles also influence the variety of antioxidant level of NPC patients. The study can help the clinicians to consider adding antioxidant intake in NPC therapy, particularly in individual with GSTT1 polymorphism and related enzymes.

Donkeys are a cornerstone in human existence, having played an important role throughout history in different economic activities, such as working in brick kilns in Egypt. This study was conducted from January 2017 to the end of April 2017 in the El-Saf brick kilns, which are located to the south of the Giza Governorate and 57 Km away from Cairo. Physical clinical health and behavior data were collected from 179 donkeys spanning over a random sample of 20 brick kilns selected from the El-Saf brick kilns. Behavioral, physical health, harness, and environmental parameters were assessed and recorded. The study found that 80 &plusmn, 3% (n = 179) of kiln donkeys have some type of wound, and the most serious wound is a beating wound (49 &plusmn, 3.7%), which is caused by drivers hitting the donkeys. The drivers are mostly children, who have insufficient knowledge, skills, and attitudes to effectively communicate with their donkeys and no motivation to enhance the welfare of these equids. Other wounds are related to the harness, such as the breeching (10 &plusmn, 2.2%), saddle (43 &plusmn, 3.7%), neck collar (40 &plusmn, 3.6%), and shaft of the cart (12 &plusmn, 2.4%). A poor body condition was seen in 56 &plusmn, 3.7% of kiln donkeys. A correlation in terms of the prevalence of wounds was found between the body condition (p-value &lt, 0.01) and/or cleanliness of the harness. There was a negative association between the body condition and wound prevalence in brick kilns (Pearson coefficient of correlation &minus, 0.71). The physical enviromental factors that affect the body condition of working donkeys are the working hours of donkeys/day, the number of donkeys in a kiln, the distance from loading to the oven, and the concentrated food/donkey (p-value &lt, 0.01). These three variables can explain 78.85% of the variability in body conditions based on a 1&ndash, 5 scale. In addition to health parameters, behavior parameters, such as the donkeys&rsquo, general attitude, reaction to observers, and chin contact are associated with the body condition (p-value &lt, 0.01). As a consequence, it is important for the owners of working donkeys to pay attention to their body condition in order to avoid compromising their body condition and welfare.

This paper is devoted to study the elastic–plastic damage behavior of heterogeneous shale rocks. The representative microstructure of this kind of rocks is first studied in order to define the representative elementary volume for the implementation of homogenization procedure. Three relevant material scales are considered. Inter-particle pores are distributed at the nanoscopic scale. Fine grains of calcite and kerogen are immersed at the microscopic scale. Large grains of minerals are embedded at the mesoscopic scale. Effective elastic properties of shale rocks are first determined by using a three-step linear homogenization procedure. The plastic damage behavior is estimated by developing a three-step nonlinear homogenization method. The effective plastic behavior of porous clay matrix with nanoscopic pores is described by an analytical model. The effects of small and large grains of various mineral inclusions are investigated by using a two-step incremental model. The damage due to progressive debonding of mineral inclusions is taken into account. After the implementation of the proposed model, comparisons between numerical results and experimental data are presented.

Purpose/Objective(s) Craniospinal irradiation (CSI) is a standard treatment for pediatric medulloblastoma. The conventional CSI technique is associated with incidental radiotherapy (RT) to organs at risk (OARs). In growing children, RT can cause subsequent skeletal abnormalities such as curvature and bone growth retardation. However, these effects have not been sufficiently studied for children receiving symmetrical spinal fields. We tested the null hypothesis that narrow spinal fields (NSFs) typical of CSI would cause in 10 degrees increased curvature and 10 cm less spinal growth longitudinally than standard wide spinal fields (WSFs), with lambs as an animal model for children. Materials/Methods RT treatment plans were designed for 6 MV photon fields and delivered to lambs of ages 6 weeks or younger—four receiving NSFs that targeted the thecal sac, four receiving wide fields, and four not receiving radiation. Half of the lambs in each set were male and half were female. We chose lambs as a model for children because of their skeletal behavioral resemblance to that of humans. RT fields were expanded laterally with 3 mm margins to produce planning target volumes. RT dose was 27 Gy in 8 fractions, biologically equivalent to the standard total dose of 36 Gy in 20 fractions. Every 6 months and at 2 years, after full growth of lambs in all three arms of the study, thoracic scoliosis Cobb angle, thoracic and lumbar kyphosis Cobb angle, and vertebral hypoplasia in the thoracic spine were measured using computed tomography and compared. Results Although differences were observed between the experimental and control (no RT) sets, our hypothesis was found to be false for each spinal abnormality measure. Specifically, between the sheep receiving NSF and WSF, less than 10 degrees increased curvature and 10 cm shorter spinal growth was observed. Mean scoliosis Cobb angles were 0.7, 4.0 and 4.7 degrees for the control, WSF and NSF arms, respectively. Mean thoracic kyphosis Cobb angles were 10.7, 9.0 and 7.0 degrees for the control, WSF and NSF arms, respectively. Mean lumbar kyphosis Cobb angles were 12.3, 7.7 and 9.3 degrees for the control, WSF and NSF arms, respectively. Spinal lengths from occipital bone to sacrum were 78, 70 and 66 cm, for the control, WSF and NSF arms, respectively. Conclusion We found no differences in spinal curvature or length in fully-grown sheep between targeted and wide spinal RT characteristic of CSI that had been irradiated as young lambs. This suggests that targeted photon fields may be applied to children receiving CSI, potentially reducing their risks of long-term toxicities, including secondary malignancies. Studies on human subjects are needed to confirm the same findings with children receiving CSI.

GSTP1 polymorphism is one of the genetic factors contributed to (NPC). The polymorphism alters its function in detoxifying carcinogen and inhibits oxidative stress. Oxidative stress induces EBV lytic reactivation and enhances IgA response. This study was aimed to analyze the association of GSTP1 polymorphism and serum IgA levels in NPC patients. The study was analytic research with a cross-sectional design. The samples were the blood of NPC patients who underwent PCR-RFLP-electrophoresis and ELISA method to identify GSTP1 polymorphism and IgA level. We found 21 (72.4%) patients with Ile/Val genotype, 6 (20.7%) patients with Ile/Ile, and 2 (6.9%) patients with Val/Val. Patients with elevated IgA levels were 21 (72.4%) patients. In this study, there was no significant association of GSTP1 polymorphism and serum IgA level. We found the GSTP1 polymorphism and serum IgA elevation in nasopharyngeal carcinoma patients, but there was no significant association between them. Future research with the inclusion of environmental risk data is needed as well as larger samples. The study may help to determine effective prevention, treatment, and monitoring therapy of nasopharyngeal carcinoma.

Resume But de l’etude La mort subite cardiaque d’un jeune athlete est toujours un evenement dramatique. Certaines societes savantes recommandent ainsi la realisation systematique d’un electrocardiogramme pour la pratique du sport en competition afin d’eliminer une cardiopathie genetique a risque de mort subite. Parmi celles-ci, on retrouve le syndrome du QT long genetique dont le diagnostic peut etre particulierement difficile chez l’athlete car un entrainement physique intense et prolonge peut etre responsable d’un allongement de l’intervalle QT au-dela des valeurs retenues comme normales chez les sujets sedentaires. Il apparait donc essentiel de disposer d’une formule de correction de l’intervalle QT la moins dependante de la frequence cardiaque pour limiter le risque de diagnostic par exces ou par defaut de syndrome du QT long genetique. Patients et methodes Quatre cent quarante-six jeunes athletes (âge moyen : 14,8 ± 1,8 an) ont ainsi beneficie d’un electrocardiogramme avec mesure de l’intervalle QT et comparaison de 4 formules de correction parmi les plus utilisees en pratique courante. Resultats La formule la plus dependante de la frequence cardiaque est la formule de Bazett. Les deux formules les moins dependantes de la frequence cardiaque quels que soient l’âge et le sexe sont les formules de Hodges et Fridericia. Comme chez les sujets non sportifs, l’intervalle QT corrige est plus long chez les filles. Conclusion La formule de correction de Bazett, malheureusement la plus utilisee en pratique courante, devrait etre delaissee au profit d’autres formules comme celles de Hodges ou Fridericia, dans les populations de sportifs en particulier.

Paramphistomosis is a chronic, debilitating parasitic disease of livestock prevalent in the tropical and sub-tropical countries. Globally there is a heavy reliance on anthelmintics but concerns over drug resistance encourage the search for new leads. Metalloproteinases play a significant role in the biology and life cycle of parasitic helminths. The efficacy of metalloproteinase inhibitor, 1,10-Phenanthroline (1,10-phe) which is commonly used as a specific enzyme inhibitor in biochemical assays, was tested in vitro on Gigantocotyle explanatum tegument as a marker of anthelmintic action. The scanning electron microscopy revealed that the tegumental surface exhibited considerable changes in the worms treated with the metalloenzyme inhibitor, 1,10-phe. The untreated control worms appeared normal showing smooth tegumental surface with abundant dome shaped papillae in the anterior to mid region, while their density was less around the acetabulum which serves as a hold-fast organ helping the worms to remain attached in biliary passage. The 1,10-phe produced significant tegumental damage when the liver amphistomes were in vitro exposed to this compound at 12.5 µM concentration. The surface changes appeared in the form of edematous ridges with prominent furrows and erosion of the dome shaped papillae with rosette shaped deep lesions as a result of which deep parenchymatous tissues were exposed. The collapse of sensory bulbs as well as sloughing of tegument, particularly in the anterior-mid region was observed. The nature of damage could be comparable to various anthelmintics used in previous studies. To the best of our knowledge this is the first report of direct exposure of amphistome worms to zinc metallo-enzyme inhibitor, however, further in vivo studies are required to ascertain the anthelmintic efficacy of 1,10-phe.

Summary Background Patients who are immunocompromised because of malignancy have an increased risk of herpes zoster and herpes zoster-related complications. We aimed to investigate the efficacy and safety of an inactivated varicella zoster virus (VZV) vaccine for herpes zoster prevention in patients with solid tumour or haematological malignancies. Methods This phase 3, two-arm, randomised, double-blind, placebo-controlled, multicentre trial with an adaptive design was done in 329 centres across 40 countries. The trial included adult patients with solid tumour malignancies receiving chemotherapy and those with haematological malignancies, either receiving or not receiving chemotherapy. Patients were randomly assigned (1:1) to receive four doses of VZV vaccine inactivated by γ irradiation or placebo approximately 30 days apart. The patients, investigators, trial site staff, clinical adjudication committee, and sponsor's clinical and laboratory personnel were masked to the group assignment. The primary efficacy endpoint was herpes zoster incidence in patients with solid tumour malignancies receiving chemotherapy, which was assessed in the modified intention-to-treat population (defined as all randomly assigned patients who received at least one dose of inactivated VZV vaccine or placebo). The primary safety endpoint was serious adverse events up to 28 days after the fourth dose in patients with solid tumour malignancies receiving chemotherapy. Safety endpoints were assessed in all patients who received at least one dose of inactivated VZV vaccine or placebo and had follow-up data. This trial is registered ( NCT01254630 and EudraCT 2010-023156-89). Findings Between June 27, 2011, and April 11, 2017, 5286 patients were randomly assigned to receive VZV vaccine inactivated by γ irradiation (n=2637) or placebo (n=2649). The haematological malignancy arm was terminated early because of evidence of futility at a planned interim analysis; therefore, all prespecified haematological malignancy endpoints were deemed exploratory. In patients with solid tumour malignancies in the modified intention-to-treat population, confirmed herpes zoster occurred in 22 of 1328 (6·7 per 1000 person-years) VZV vaccine recipients and in 61 of 1350 (18·5 per 1000 person-years) placebo recipients. Estimated vaccine efficacy against herpes zoster in patients with solid tumour malignancies was 63·6% (97·5% CI 36·4 to 79·1), meeting the prespecified success criterion. In patients with solid tumour malignancies, serious adverse events were similar in frequency across treatment groups, occurring in 298 (22·5%) of 1322 patients who received the vaccine and in 283 (21·0%) of 1346 patients who received placebo (risk difference 1·5%, 95% CI −1·7 to 4·6). Vaccine-related serious adverse events were less than 1% in each treatment group. Vaccine-related injection-site reactions were more common in the vaccine group than in the placebo group. In the haematological malignancy group, VZV vaccine was well tolerated and estimated vaccine efficacy against herpes zoster was 16·8% (95% CI −17·8 to 41·3). Interpretation The inactivated VZV vaccine was well tolerated and efficacious for herpes zoster prevention in patients with solid tumour malignancies receiving chemotherapy, but was not efficacious for herpes zoster prevention in patients with haematological malignancies. Funding Merck & Co, Inc.

Rhabdomyosarcoma (RMS) occurs rarely in adults and constitutes 2-6% of all uterine neoplasms. The authors report the case of a 26-year-old woman diagnosed with botryoid RMS that presented discordant progression results on follow up imaging and cytodifferentiation on pathologic control. This case showed that radiological evaluation could be misleading as the tumor demonstrated chemotherapy-induced differentiation without volume reduction. This case illustrates the limitations of using the imaging anatomical dimensions of sarcomas for treatment planning and highlights the potential role of functional imaging to assess the response to treatment.

Essentials Cancer patients receiving anticoagulants for venous thromboembolism have an elevated bleeding risk. This secondary analysis of CATCH assessed characteristics of clinically relevant bleeding (CRB). CRB occurs in 15% of cancer patients with thrombosis using therapeutic doses of anticoagulation. After multivariate analysis, risk factors for CRB were age >75 years and intracranial malignancy. Summary Background Cancer patients with acute venous thromboembolism (VTE) receiving anticoagulant treatment have an increased bleeding risk. Objectives We performed a prespecified secondary analysis of the randomized, open-label, Phase III CATCH trial (NCT01130025) to assess the rate and sites of and the risk factors for clinically relevant bleeding (CRB). Patients/Methods Patients with active cancer and acute, symptomatic VTE received either tinzaparin 175 IU kg-1 once daily or warfarin (target International Normalized Ratio [INR] of 2.0-3.0) for 6 months. Fisher's exact test was used to screen prespecified clinical risk factors; those identified as being significantly associated with an increased risk of CRB then underwent competing risk regression analysis of time to first CRB. Results Among 900 randomized patients, 138 (15.3%) had 180 CRB events. CRB occurred in 60 patients (81 events) in the tinzaparin group and in 78 patients (99 events) in the warfarin group (hazard ratio [HR] 0.64; 95% confidence interval [CI] 0.45-0.89). Common bleeding sites were gastrointestinal (36.7%; n = 66), genitourinary (22.8%; n = 41), and nasal (10.0%; n = 18). In multivariate analysis, the risk of CRB increased with age > 75 years (HR 1.83, 95% CI 1.14-2.94) and intracranial malignancy (HR 1.97, 95% CI 1.07-3.62). In the warfarin group, 40.4% of CRB events occurred in patients with with an INR of 75 years and intracranial malignancy.

This article considers a plane strain problem, which is known in conventional linear elasticity as cylindrical bending of simply supported plates and cross-ply laminates. By considering fibrous composites containing fibers resistant to bending, it formulates and solves corresponding polar elasticity equations governing the static and dynamic behavior of beam-like components made of a homogeneous or layered transversely isotropic material; each layer has embedded a single family of fibers. Fiber bending stiffness is accounted for through involvement of an extra elastic modulus, which, unlike its conventional elasticity counterparts that have dimensions of stress, has dimensions of force. Its involvement in the analysis implies existence of some intrinsic material area or length parameter, which may be associated, for instance, with fiber thickness of fiber spacing. A considerable amount of relevant numerical results are presented for thick beam components made of either homogeneous or two-layered transvers...

A 75 year old man presented with left upper lobe squamous cell carcinoma. Severe aortic stenosis has been discovered during preoperative assessment. In this situation, two therapeutic strategies are described: concomitant or two-staged procedures. The debate has not yet led to the conclusion on whether preferably performing one or the other. Furthermore, in an oncologic context, using cardiopulmonary bypass is still controversial. So, thoracic and cardiac surgeons jointly proposed to the patient a transcatheter aortic valve implantation followed, 72 h later, by lung cancer resection. This case report describes a way to treat both diseases avoiding cardiopulmonary bypass adverse effects and without delaying lung cancer treatment.

Resume Introduction Les anevrismes infectieux de l’aorte sont rares, representant environ 2 % des anevrismes aortiques. La majorite des cas decrits dans la litterature proviennent de series chirurgicales et concernent l’aorte abdominale. Dans ce travail retrospectif, nous avons analyse les caracteristiques cliniques, paracliniques et evolutives de patients presentant un anevrisme infectieux de l’aorte thoracique. Patients et methodes Le diagnostic a ete porte sur l’association d’une imagerie thoracique evocatrice et d’une documentation microbiologique ou de l’evolution favorable sous traitement anti-infectieux. Etude retrospective de cas. Resultats Il s’agissait de 6 hommes et une femme, d’âge moyen 66 ans. Tous presentaient au moins un facteur de risque cardiovasculaire ou de l’atherome. La fievre (71 %) et les douleurs thoraciques (42 %) etaient les signes cliniques les plus frequents. Les germes identifies etaient : Salmonella enteritidis (n = 3), Staphylococcus aureus (n = 1), et Candida albicans (n = 1). L’angioscanner montrait un aspect inflammatoire de l’aorte (n = 4), un anevrisme superieur a 50 mm (n = 5) ou augmentant rapidement de diametre (n = 5). La prise en charge etait medicale et interventionnelle : chirurgie (n = 3) ou prise en charge endovasculaire (n = 4). L’evolution etait favorable pour 6 patients ; le dernier decedait de complications liees a l’anevrisme. Conclusion La presentation clinique d’un anevrisme infectieux de l’aorte thoracique est peu specifique. Il convient d’evoquer ce diagnostic devant un anevrisme volumineux ou augmentant rapidement de diametre, associe a un syndrome inflammatoire. Le traitement endovasculaire semble une bonne alternative a la chirurgie. La place du TEP-scanner dans le diagnostic et le suivi reste a definir.

Resume Objectif Decrire l’experience d’un centre referent pour le transport interhospitalier des patients traites par assistance circulatoire ou respiratoire extracorporelle (extracorporeal life support [ECLS]), les difficultes rencontrees et les resultats obtenus. Type d’etude Etude retrospective et observationnelle. Patients et methodes Tous les patients justifiant d’une indication d’ECLS et trop severes pour un transport conventionnel. L’analyse statistique comportait une analyse descriptive par mediane et ecart interquartile. Les variations des parametres biologiques etaient comparees par un test non parametrique de Wilcoxon. Une analyse de survie actuarielle par etablissement d’une courbe de Kaplan-Meier etait realisee jusqu’a cinq ans apres la prise en charge. Resultats Sur une periode de 55 mois, 29 patients ont justifie d’un transport sous assistance circulatoire de type ECLS. L’indication etait respiratoire dans 38 % des cas, hemodynamique dans 52 % des cas et mixte dans 10 % des cas. En moyenne, les distances parcourues etaient de 40 km (9–64 km). Aucune complication liee au transport n’a ete deploree. La mortalite finale intrahospitaliere observee etait de 57 %, toute indication confondue. Il n’existait pas de relation entre le deces et le type d’assistance. La survie a cinq ans etait de 55 et 39 % pour les ECLS veinoveineuses et arterioveineuses, respectivement. Conclusion Dans notre experience, le transport interhospitalier des patients sous assistance circulatoire est realisable dans des conditions satisfaisantes de securite avec une equipe entrainee et une protocolisation des procedures.

The aim of this study was to compare fixation and mobility of adjustable single-incision (Ajust) and standard transobturator midurethral sling (TVT-O) tapes based on postoperative ultrasound monitoring of the position of the tape at rest and at maximal Valsava (tape descent). The hypothesis was that fixation of SIMS Ajust is comparable to that achieved by the standard transobturator midurethral sling.Gynecology and Obstetrics Department, GUH and 1st Charles University Prague; Gynecology and Obstetrics Department Masarykova nemocnice Ústí nad Labem.Randomized trial, secondary analysis of ultrasound follow-up.Between May 2010 and May 2012 100 women with proven urodynamic stress urinary incontinence were included in this randomized trial.All patients underwent a complete urogynecological investigation before the procedure (clinical examination, urodynamics, ultrasound examination), and they filled in the ICIQ and iQol questionnaires; after surgery, to evaluate their satisfaction with the procedure, VAS and Likert scales were added.Ultrasound examination as part of each post-operative check-up was performed the first day after surgery, two weeks, three months and one year after surgery. Ultrasound measurements were taken in a supine position at rest and during maximal Valsalva. Position of the bladder neck was assessed, and the position of the tape with respect to upper and lower tape margins.At one-year follow up no differences in subjective cure rates and objective cure rates were observed. In all checks after surgery there was no difference between the position of the tape at rest and at maximal Valsalva between the Ajust and TVT-O groups.The length of the upper and lower tape descent was similar. In TVT-O patients the mean length of upper tape margin descent increased from 8.8 mm on the first day after surgery to 10.0 mm three months after surgery; afterwards it remained stable. For Ajust patients there was virtually the same development - from 9.1 to 12 mm - and there was no further increase in the tape descent following the three-month measurement.The quality of the tape fixation after the Ajust procedure is as good as after standard transobturator midurethral sling. We did not observe any statistically significant differences in tape position and descent, indicating that the function is similar to obturator tape, which in turn suggests the same clinical efficacy. Ultrasound monitoring should be the part of post-operative monitoring whenever novel surgical techniques are introduced.

A 82-year-old man equipped with a cardiac resynchronisation therapy defibrillator for dilated cardiomyopathy with normal coronary arteries, in complete atrioventricular block, develops six months after a change of the generator-pocket a severe endocarditis due to a methicillin-resistant Staphylococcus epidermidis with a large lead vegetation. After 4 days of adapted antimicrobial therapy, a surgical device removal is realised with unfortunately a fatal end during extraction. This observation points out the severity of cardiovascular device infections in old and weak population, as well as the difficulty of treatment choices because of both infectious and rhythmic constraints. The lead extraction is a strong recommendation but the modality and timing of extraction are not consensual, especially in cardioverter defibrillator-dependent patients. Surgical removal remains an alternative to percutaneous lead extraction but with a higher operative risk.

2-Ylidene and 2,5-diylidene-4-thiazolidinones 2a – d were synthesized and converted into pyrazole derivatives 4a – d by reaction with hydrazine hydrate. A mechanism of this novel conversion is suggested.

The association between severity of exposure to sulfur mustard (SM) and late respiratory complications is not clear. The aim of this study was to determine the presence of late pulmonary complications in patients with mild, moderate, and severe initial symptoms of sulfur mustard exposure. This was a retrospective cohort study on patients with mild, moderate, and severe initial symptoms of sulfur mustard exposure (during 1983–1988) in Baqyatallah University of medical sciences (2004–2005). The ‘mild’ group ( n = 115) had no early symptom at the time of exposure. The ‘moderate’ group ( n = 273) had early symptoms after exposure and were not hospitalized for that reason. The ‘severe’ group ( n = 215) had early symptoms and had been hospitalized accordingly. Pulmonary function tests and high-resolution computed tomography of the chest were performed. The chi-square test was used for data analysis. The severe and moderate groups had a similar frequency of obstructive pattern (21%), whereas only one patient in the mild group showed this pattern. Air trapping did not significantly differ between groups. In the mild group, 74.8% ( n = 86) showed significant air trapping, whereas it was 62.3% ( n = 170) in moderate and 67.0% ( n = 144) in severe groups ( P = 0.057). Moderate and severe exposure to sulfur mustard causes an equal risk of late pulmonary complications, while mild exposure has lesser risk. Bronchiolitis obliterans is the main underlying respiratory consequence of sulfur mustard exposures and may relate to host factors rather than to severity of early symptoms.

Ketene N,S-acetal potassium salts (2a–g), prepared via reaction of active methylenes (1a–g) with phenyl isothiocyanate in the presence of potassium hydroxide, were allowed to react with ethyl chloroacetate or chloroacetamide to afford the corresponding 2-ylidene-4-thiazolidinones (3a–g) in good yields. Compounds (3a–g) reacted with a variety of aromatic aldehydes to afford the corresponding 5-arylidene-2-ylidene-4-thiazolidinone derivatives (10a–e). Reaction of compound (3a) with triethylorthoformate afforded 5-ethoxymethylene-2-ylidene-4-thiazolidinone derivative (7), which was allowed to react with ammonia or phenyl hydrazine to give the corresponding enamino or hydrazino derivatives (8a) or (8b), respectively.

The dried leaves hydrodistillation of seven species of the genus Eucalyptus Herit. (E. eremophila (Diels) Maiden, E. oleosa F. Muell, E. patellaris F. Muell, E. astringens (Maiden) Maiden, E. striaticalyx W.V. Fitz, E. salubris F. Muell and E. transcontinentalis Maiden) harvested of Hajeb Layoun arboreta (region of Kairouan, Tunisia) in two periods (June 2004 and January 2005), shows that essential oil yields, related to the dry material, vary from 0.1 to 5.3 % according to the species and to the date of harvest. The best yields were recorded in January harvest. 74 components were identified by GC-MS. Contents of the different samples vary according to the species and to the harvest. Main compounds are 1,8-cineole (8.6 – 58.5 %), α-pinene (2.8 – 29.4 %), viridiflorol (1.7 % –23.6 %), limonene (0.4 – 19.7 %) and pinocarvone (0.1 – 8.2 %). E. eremophila presents the most raised yield in essential oil and the best rate in 1,8-Cineole.

Sudden cardiac death in young athlete is always tragic. Some international guidelines recommend the realization of an electrocardiogram before practicing competitive sports to carry out the risk of sudden cardiac death due to genetic cardiopathy like QT long syndrome. Unfortunately, the diagnosis can be difficult because intensive sport can increase the QT interval over normal recognized values for sedentary people. Using a QT correction formula free of heart rate appears essential.Four hundred and forty-six young athletes (aged 10 to 18) had an electrocardiogram. QT intervals were measured and four methods were used to correct the QT interval for heart rate.The Bazett formula performed the worst in terms of rate adjustment success. Hodges and Fridericia formulas are the best both in males and females, independently of age. Female had longer QTc intervals than males.The most widely used Bazett formula should be surrendered whereas Hodges and Fridericia formulas should be preferred, particularly in young athletes.

Resume L'augmentation des interventions de chirurgie cardiaque chez l'octogenaire est due au vieillissement de la population qui presente davantage de valvulopathies dites ≪degeneratives≫, en particulier retrecissement aortique et regurgitation mitrale. Les comorbidites preoperatoires sont souvent liees a l'atherome. La presence d'une broncho-pneumopathie chronique obstructive, une diminution de la clairance de la creatinine ou un score de Parsonnet eleve sont des elements de mauvais pronostic. La gestion des medicaments cardiovasculaires preoperatoires et de l'anesthesie doit etre adaptee a l'âge pour eviter les hypotensions arterielles perioperatoires. La frequence plus elevee de complications postoperatoires cardiovasculaires (bas debit cardiaque), des troubles rythmiques, des complications renales, neurologiques et infectieuses explique l'augmentation de la duree de sejour et da la mortalite. La qualite de vie dans les mois suivants est peu differente de celle des patients plus jeunes operes. Une evaluation soigneuse et une information du patient et de ses proches apparaissent donc indispensables avant la chirurgie cardiaque chez l'octogenaire.

Bis[thieno(3,2-b)-1,4-diazepine] (4) and bis[imidazo(1′,2′)thieno(3,2-b)-1,4-diazepine (7) derivatives were prepared starting with thieno(2,3-b)thiophenes (1) and (2), respectively. Also, benzodiazepine derivatives (11a–f) were prepared via a reaction of cyclohexenone carboxylates (8a–f) with cyclohexylamine and chloroacetyl chloride followed by cyclization. Also, dibenzoazepines (13) and (14a,b) were prepared via a reaction of (8a) with o-phenylenediamine and o-aminophenol or o-aminothiophenol.

Resume L'apparition d'une chute brutale de la pression teleexpiratoire de dioxyde de carbone au cours d'une chirurgie de hernie discale evoquant une embolie gazeuse est rare et d'evolution souvent dramatique. Nous rapportons un cas clinique a l'origine du diagnostic de plaie operatoire des gros vaisseaux retroperitoneaux. Les differents diagnostics de chute de la capnographie sont evoques pour la chirurgie generale et en position genu-pectorale. Nous recommandons de suspecter precocement ce diagnostic en cas d'apparition d'une symptomatologie evoquant une embolie gazeuse au cours de la chirurgie de hernie discale lombaire.

Infectious aortic aneurysms are rare conditions, being responsible of 2% of aortic aneurysms. Most published results are surgical case series concerning infected abdominal aorta. In this retrospective study, we assessed clinical features and outcome of patients presenting infectious thoracic aortic aneurysms.Diagnosis was based upon a combination of imaging evidence for thoracic aorta aneurysm and evidence for an infective aetiology including a culture of a causative pathogen, or a favourable outcome with anti-infective therapy. Retrospective case series.Six men and one woman were included, with a mean age of 66 years. All the patient presented at least one cardiovascular risk factor or atherosclerosis localisation. Fever (71%) and chest pain (42%) were the most common clinical presenting manifestations. The causative pathogens were: Staphylococcus aureus (N=1), Salmonella enteritidis (N=3) and Candida albicans (N=1). The contrast-enhanced computed-tomography disclosed an aneurysm whose diameter reached more than 50 mm (N=5), that increased rapidly in size (N=5), or presented an inflammatory aspect of the aortic wall (N=4). Management was both medical and interventional: surgery (N=3) or endoluminal repair (N=4). Outcome was favourable in six patients; one patient died from aneurysm-related complications.Clinical manifestations revealing an infectious thoracic aneurysm are variable. Diagnosis should be considered in patients presenting a rapidly-growing aneurysm, especially in the presence of elevated acute phase reactants. Endoluminal repair constitutes a treatment option. The role of FDG-PET for diagnosis and follow-up remains to be defined.

The behavior of the molten system acetamide-electrolyte, including the peculiarity of the structure and the consequent relevant properties, such as the megavalue of the dielectric constant, was reported earlier. The probable structure is a micellar system composed of salt micelles dispersed in an amorphous solvent. The present paper reports measurements in a related system: fluoroacetamide-sodium trifluoroacetate. The phase diagram, the ultrasonic absorption of both longitudinal and shear waves, and the longitudinal relaxation time of the nuclear magnetic momentum were measured at different temperatures. The most importnat result was thatT 1 (NMR relaxation time) on the19F nucleus shows that the amide and salt participate in different environments. The amide environment is less rigid; this proves that the system must be considered microheterogeneous. Moreover, the present system exhibited: 1) a less extended concentration area where supercooling phenomena occur; 2) a much broader curve of the re...

An ultrasonic field may activate chemical reaction according to two principal theories: a thermal activation theory [1, 2] and an electric discharge theory [3]. An experiment to discriminate between these models does not yet exist [4]. We have recently shown that molten binary mixtures of CH3CONH2 and CICH2CONH2, which are thermally stable, become unstable when CF3COONa is added as third component [5]. The rapid reaction produces a viscous oily liquid, which from a spectroscopic point of view shows the presence of new groups: CH=N--O and CH2OH. To explain the final product, we hypothesized the thermal breaking of the C--CI bond of CICH2CONH2 and attack by the carbonation on CH3CONH2. The cavitation phenomenon, in an acoustically intense field, gives rise to a locally high value of temperature [ 1, 2], which can increase to several thousand degrees. With the aim of extending the possibility of study and application of this reaction to different media at room temperature, we have now studied a mixture of CF3COONa and CICH2CONH2 in aqueous solution in the presence of organic substances capable of reacting with a strong acid such as (CH2CONH2) + under intense acoustic radiation. The organic substances present in the reaction mixture were adenine and ribose.

Case report of an obese patient who suffered a bilateral rhabdomyolysis after major abdominal surgery under general anaesthesia combined with thoracic epidural analgesia. The patient was in the lithotomy position during the ten hours time period of the surgery. As the patient was sedated in the intensive care unit, the diagnosis was made more difficult. Clinical signs consisted of pain, oedema and neurosensitive deficit in both legs. Creatinine kinase plasma concentration was increased. Treatment included fluid infusions and fasciotomy. The sequelae were major and consisted mainly in muscular deficiency of both legs. This complication is favoured by prolonged surgery and muscular compression elicited by non physiological positions.

Describing the experience of a referral center for interhospital patients transport treated with extracorporeal circulatory or respiratory support (ECLS), the difficulties encountered and the results obtained.Retrospective and observational study.All patients with respiratory or circulatory failure accepted for extracorporeal assistance for which routine medical transport was life threatening.A descriptive analysis was performed (median and interquartile deviation). Comparison of biological data was performed using a non-parametric Wilcoxon test and 5 years overall survival was determined by a Kaplan-Meier analysis.Over a 55-month period, 29 patients were selected for transportation under ECMO or ECLS. Indication was respiratory failure in 38 % of cases, hemodynamic instability in 52 % of cases and combined symptoms in 10 % of cases. Average duration of transportation was 40 km (9-64 km). No complication related to transport was observed. Incidence of intrahospital death was 57 %. There was no correlation between death and indication of ECLS. Five-year survival was 55 % and 39 % for venovenous and arteriovenous ECLS, respectively.In our experience, interhospital transport of patients under ECMO is feasible in satisfactory conditions of safety with trained team and standard procedures.

Endovascular coiling has become a well-established treatment method for cerebral aneurysms. The primary drawback of the technique is aneurysm recanalization requiring periodic angiographic follow-ups and possible aneurysm re-treatment. A recent review [1] estimates that 20% of treated aneurysms re-canalize and that half of those aneurysms (10%) are re-treated. Aneurysm recanalization is, in turn, largely caused by compaction of the coil mass due to hemodynamic impingement forces every cardiac cycle. Currently, the only quantitative measure used to characterize effectiveness of the treatment is the aneurysm packing density (ratio of total volume of coils inserted into the aneurysm and the volume of the aneurysm). Lower packing densities have been correlated with higher coil compaction rates [2], so aneurysms are generally coiled to maximal packing. A wider aneurysm neck is also correlated with higher coil-compaction rates. Coiling in such wide-neck aneurysms is performed either with the support of a balloon that is removed post-coiling or with the support of an intracranial stent that is implanted. Such assist devices also improve aneurysm packing densities [3].Copyright © 2011 by ASME

The aldehyde group of 2,4-dichlorothiazole-5-carbaldehyde was protected and the chlorine atom at position 2 was replaced by hydrogen and a methylthio group, via Cl → Li exchange, to give 4-chloro-thiazole-5-carbaldehyde and its 2-methylthio derivative, respectively. Ethyl 2-mercaptoacetate reacted with 4-chlorothiazole-5-carbaldehydes to give thieno[2,3-d]thiazoles. Saponification of ethyl thieno[2,3-d]thiazole-5-carboxylate and attempted decarboxylation of the resulting acid failed to yield enough of the parent thieno[2,3-d]thiazole to allow full characterisation owing to its high volatility.4-Azidothiazole-5-carbaldehydes were prepared by nucleophilic displacement of the chlorine atom in the corresponding 4-chlorothiazole-5-carbaldehyde and converted into alkenes and Schiff's bases by standard procedures. On being heated in toluene these afforded the corresponding 4H-pyrrolo-[2,3-d]thiazole or 2H-pyrazolo[3,4-d]thiazole. lsoxazolo[3,4-d]thiazole and its 2-methylthio derivative, both unstable, were obtained by heating the corresponding 4-azidothiazole-5-carbaldehyde in bromobenzene.

The water-3-Chloropropionitrile biphasic system reacts in an ultrasonic bath, producing the corresponding amide, at room temperature. The C-Cl bond does not react; in this sense the attack is selective.