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Resume Les principaux agents responsables des reactions anaphylactiques peroperatoires sont bien connus. Cependant lorsque le bilan allergologique initial est negatif, des explorations complementaires doivent etre realisees afin d’identifier un nouvel allergene potentiel comme les antiseptiques. Nous presentons un cas de choc anaphylactique peroperatoire rapporte a la Betadine®.

To date, indications for distal femoral varus osteotomy (FVO) in cases of associated patellofemoral osteoarthritis (PFO) have yet to be clarified. The purpose of this prospective study is to assess the short-term symptoms, functional and radiological impact of a medial closing-wedge femoral varus osteotomy on the patellofemoral joint in patients with valgus deformities who are afflicted with lateral tibiofemoral osteoarthritis (LTFO) associated with PFO.Fourteen patients (15 knees) received a medial closing-wedge femoral varus osteotomy. The functional impact of an FVO on the patellofemoral joint was assessed based on the KOOS-PF (Knee Injury and Osteoarthritis Outcome Score-Patellofemoral Subscale), the Kujala score and the patellofemoral symptoms. Realignment of the patella was measured by the Merchant's patellofemoral congruence angle. The pre- and post-operative symptoms and functional scores were compiled prospectively and compared two years after the surgery.The Kujala patellofemoral functional scores and the KOOS-PF showed considerable improvement with a differential of +37.5 points ± 20.4 and +42.7 points ± 19.3 (p .01) respectively. The average Merchant's congruence angle went from 8.8° laterally to 3.6° medially, resulting in medialization of the patella, with a significant difference (p .01). Based on the specific clinical analysis of the patellar joint, preoperative J-sign was identified in 26.7% of patients (n = 4) and was not found during postoperative examination (p = .1). Preoperative apprehension test was identified in 33.3% of patients (n = 5) against 13.3% (n = 2) after surgery (p = .39). Preoperative pain extension test was identified in 40% of patients (n = 6) against 20% during postoperative clinical analysis (p = .43).Although the threshold of significance for patellofemoral symptoms was not reached, the medial closing-wedge femoral varus osteotomy induces a significant medialization of the patella (Merchant's congruence angle) and improves short-term functional results even with co-existing patellofemoral osteoarthritis. Due to the lack of specificity of the patellofemoral scores, patellofemoral osteoarthritis improvement is difficult to determine on its own, but does not represent a contraindication to FVO.III. Prospective clinical study.

Resume La consultation d’anesthesie en pediatrie est obligatoire avant tout geste realise sous anesthesie generale ou locoregionale. Elle permet de connaitre l’enfant et ses antecedents et ainsi d’evaluer le risque anesthesique. Elle permet aussi de prescrire un bilan preoperatoire si necessaire. Une information est faite sur le parcours patient, les conditions d’hospitalisation en ambulatoire le cas echeant, la technique anesthesique envisagee, les complications possibles en fonction du terrain de l’enfant, les conditions qui peuvent faire reporter une intervention non urgente (maladie intercurrente). La consultation se conclut par le recueil du consentement de l’enfant et des parents autorisant ainsi l’intervention.

Introducción. La inteligencia emocional se ha relacionado con diversas variables, como el género y el rendimiento académico. En el ámbito de la capacidad intelectual, la literatura muestra controversia, sin que exista un resultado unánime sobre la relación que existe entre estas variables En el presente estudio se analiza el efecto modulador que tiene el rendimiento académico, en una muestra de estudiantes universitarios recién ingresados, comparando por grupos, uno con inteligencia promedio y otro con inteligencia superior, y el género.Método. La muestra estuvo constituida por 129 estudiantes que ingresaron al centro universitario de ciencias de la salud en el curso escolar 2011-2012, de los cuales 64 presentaban inteligencia superior y 65 promedio. Para medir la inteligencia emocional se utilizó el Mayer, Salovey and Caruso Emotional Intelligence Test (MSCEIT), el test de Matrices Progresivas Escala Avanzada para la medida de la inteligencia y como indicador de rendimiento académico, el promedio de calificaciones.Resultados. Los resultados muestran que el rendimiento juega un papel diferencial en algunas de las ramas apresadas por el instrumento. Igualmente, aparecen diferencias entre los grupos en Facilitación emocional, Inteligencia Emocional Estratégica y en Comprensión Emocional, siendo en todos los casos mayor la puntuación de las mujeres y de los más inteligentes.Discusión. Los resultados señalan relación entre inteligencia emocional y rendimiento, si bien difieren, en función del indicador de rendimiento que se tome. Además, se comprueba una relación entre inteligencia emocional, género y capacidad intelectual, apoyando los resultados parcialmente la hipótesis de que las mujeres y las personas con mayor capacidad intelectual presentan más inteligencia emocional.

International audience; Animals in urban environments face challenging situations and have to cope with human activities. This study investigated the ecology and behaviour of a population of European hamsters (Cricetus cricetus) living in the city centre of Vienna (Austria). We recorded the surface activities of 35 hamsters in May 2015. Each focal animal was observed for 15 minutes , and a total of 66 focal samples were analysable. As a prey species in an environment teeming with human activities, we predicted a high level of vigilance by the hamsters. The results show that while animals dedicated a lot of time to vigilance, most of their time was spent foraging. The study also explores whether the frequency of vigilance behaviours differ between males and females. We found that vigilance behaviours were expressed in a different manner by males and females. Finally, we investigated the distribution of the burrows on green spaces depending on proximity to trees and on noise levels. We found a biased distribution of burrows, with a spatial preference for location protected by the vegetation and distant to noise sources. Although burrows were located preferentially under vegetation cover, levels of noise did not determine their positions. Moreover, this species does not respond to disturbances like daily urban noises, probably due to habituation. The common hamster is an endangered species; our results lead to a greater knowledge of its behaviour in a persistent urban population.

When hemodynamic or respiratory instability occurs intraoperatively, the inciting event must be determined so that a therapeutic plan can be provided to ensure patient safety. Although generally uncommon, one cause of cardiorespiratory instability is anaphylactic reactions. During anesthetic care, these most commonly involve neuromuscular blocking agents, antibiotics, or latex. Floseal is a topical hemostatic agent that is frequently used during orthopedic surgical procedures to augment local coagulation function and limit intraoperative blood loss. As these products are derived from human thrombin, animal collagen, and animal gelatin, allergic phenomenon may occur following their administration. We present 2 pediatric patients undergoing posterior spinal fusion who developed intraoperative hemodynamic and respiratory instability following use of the topical hemostatic agent, Floseal. Previous reports of such reactions are reviewed, and the perioperative care of patients with intraoperative anaphylaxis is discussed.

Introduction Si les agents responsables des reactions d’hypersensibilite immediate (HSI) lors d’une anesthesie generale (AG) sont bien connus [1] , il existe d’autres allergenes caches. Methodes Un patient de 62 ans opere d’anevrisme de l’aorte presente 3 episodes d’HSI de grade III/IV, 10 minutes apres induction par propofol, ketamine, sufentanil, atracurium et cefazoline, apres paracetamol, nefopam et apres re-injection d’atracurium. Une nouvelle administration des memes antalgiques est sans complication. Resultats La tryptasemie lors du choc est de 125 μg/L (taux basal 8 μg/L). Les tests cutanes (TC) sont negatifs pour atracurium, sufentanil, ketamine, propofol, cephalosporines, heparine et les produits de contraste iodes. Les IgE specifique (IgEs) ammoniums quaternaires sont positives (FEIA) mais negatives pour atracurium et latex. Le test d’activation des basophiles (TAB) est negatif pour atracurium. Seul le TC Betadine® est positif en prick (solution pure) et en IDR au 1/100. Le TAB a Betadine® et les IgEs (FEIA) Betadine® et povidone sont positifs. Discussion Si l’allergie IgE mediee a la povidone iodee est exceptionnelle, une dizaine de cas sont rapportes, survenant apres contact avec les muqueuses ou lors d’un passage intravasculaire [2] , [3] , [4] . Ici on retient l’implication de la Betadine®, seul allergene identifie (TC, IgEs et TAB positifs) et expliquant l’absence de correlation entre les manifestations d’anaphylaxie et l’administration IV des medicaments. Conclusion Un test de provocation affirmerait le choc anaphylactique a la Betadine® mais refuse par le patient.

In vertebrates, brain lateralization has been described as a left hemispheric specialization for information processing and decision-making and a right hemispheric specialization for intense emotional reactions and fear responses. Accordingly, we may expect that ungulates will instinctively orientate their body in order to use their left eye for the detection of threats and social information. In this study, we investigate the factors influencing the body orientation of individuals during feeding activities in 55 captive common elands in two socially stable captive herds. Do lateralized postures differ while individuals perform activities with different vulnerability risks, and what are the factors affecting lateral exposure preferences? We recorded a large number of observations of the activity of the elands, the number of animals on each side, the positions and distances of the closest neighbour, the dominant individual and the closest visual barrier. Statistical analyses determined the positioning preferences of the animal according to these factors, including the influence of age, sex and ranking (own and that of the closest). At herd and individual levels, common elands have a left bias in lateral exposure preference to herdmates, dominant and closest individuals. Body orientation choice seems to be based on a trade-off between the perceived threat a nearby animal represents and the distance between them. Situations of higher vulnerability, like grazing, are characterized by a more intense lateralized pattern. This supports the theory that the animal would use its left side senses to more quickly and accurately detect and process danger and social stimuli. Common elands exhibit a left bias in lateral exposure preference to close surrounding individuals in order to process that information more efficiently with the right brain hemisphere. Body orientation choice is also based on a trade-off between the threat an animal in close proximity represents and the distance to it. Both tendencies are amplified when the dominant individual is present in the paddock. In the same way, situations of higher vulnerability degree, like grazing, are characterized by a more intense left bias in lateral exposure preference compared with other cognitive non-demanding activities like standing or ruminating.

Lactic acid and base deficit (BD) values are frequently monitored in the intensive care unit and operating room setting to evaluate oxygenation, ventilation, cardiac output, and peripheral perfusion. Although generally obtained from an arterial cannula, such access may not always be available. The current study prospectively investigates the correlation of arterial and peripheral venous values of BD and lactic acid. The study cohort included 48 patients. Arterial BD values ranged from −8 to 4 mEq/L and peripheral venous BD values ranged from −8 to 4 mEq/L. Arterial lactic acid values ranged from 0.36 to 2.45 μmol/L and peripheral venous lactic acid values ranged from 0.38 to 4 μmol/L. The arterial BD (−0.4 ± 2.2 mEq/L) was not significantly different from the peripheral venous BD (−0.6 ± 2.2 mEq/L). The arterial lactic acid (1.0 ± 0.5 μmol/L) was not significantly different from the peripheral venous lactic acid (1.1 ± 0.6 μmol/L). Pearson correlation coefficients demonstrated a very high correlation between arterial and peripheral venous BD ( r = .88, P < .001) and between arterial and peripheral venous lactic acid ( r = .67, P < .001). Bland-Altman plots of both pairs of measures showed that the majority of observations fell within the 95% limits of agreement. Least-squares regression indicated that a 1-unit increase in arterial BD corresponded to a 0.9-unit increase in peripheral venous BD (95% confidence interval [CI]: 0.7-1.0; P < .001) and a 1-unit increase in arterial lactic acid corresponded to a 0.9-unit increase in peripheral venous lactic acid (95% CI: 0.6-1.2; P < .001). These data demonstrate that there is a clinically useful correlation between arterial and peripheral venous lactic acid and BD values.

In this study, the kinetics of Zn–Fe codeposition was investigated in chloride acidic solution using cyclic voltammetry. Anomalous codeposition is detected and this mechanism depends on the Zn(II)/Fe(II) concentration ratio in the electrolytic bath. Influence of deposition parameters on the morphology and structure of the coatings is discussed using characterization techniques and using the anodic linear sweep voltametry (ALSV). The ratio between Zn(II)/Fe(II) considerably influences the structure of the alloys. Dense, uniform, and single-phased Zn–Fe coatings could be obtained.

We report the case of an unexpected respiratory complication after a surgical treatment of scoliosis during postoperative period in an adolescent patient. This complication results of a vascular compression of the left main bronchus between the aorta and the pulmonary artery, which induces severe atelectasis of left lower lobe. Prolonged non-invasive ventilation with high level of positive end-expiratory pressure prevents aorto-pulmonary compression, allows a pulmonary recruitment associated with a favorable prognostic for the adolescent.

La plaque anterieure est devenue le traitement de reference pour les fractures de l’extremite distale du radius. Les dernieres meta-analyses ne peuvent conclure a sa superiorite sur le brochage. Notre etude a pour but de comprendre pourquoi les donnees actuelles sont insuffisantes. Une revue de litterature a ete realisee dans PubMed en janvier 2018. Les etudes comparant les deux techniques ont ete recherchees. Nous avons retenu les essais randomises. Une analyse critique des methodologies a ete realisee. Les resultats sur les criteres de jugement principal ont ete detailles. Sept etudes ont ete trouvees dont cinq avaient defini un critere de jugement principal. Trois criteres etaient un score fonctionnel — le PRWE a un an, le DASH a 6, 9, 12 semaines, 12 mois, le PEM a 6, 12 semaines, 12 mois. Deux criteres etaient radiologique — le gain de variance ulnaire entre le preoperatoire et 5 semaines, la perte de variance ulnaire et bascule anterieure entre le postoperatoire immediat et 24 semaines. Il n’y avait pas de difference significative sur les scores fonctionnels a 12 mois. Il y avait une difference en faveur de la plaque sur les scores DASH a 6, 9, 12 semaines et PEM a 6 semaines. Le gain sur la variance ulnaire etait plus important dans le groupe plaque (−2 mm, 0 mm + p = 0,04). La perte de variance ulnaire etait plus importante dans le groupe broche (−1,3 mm, −0,7 mm + p = 0,02) mais pas la perte de bascule anterieure. Seul cinq etudes ont defini un critere de jugement principal. Uniquement les resultats sur ce critere respectent le risque alpha de 5 % et autorisent de conclure a l’efficacite d’un traitement. La modalite d’immobilisation etait comparable entre les deux groupes dans deux etudes sur cinq. Les deux etudes qui ont trouve une difference en faveur de la plaque ont introduit un biais d’evaluation en immobilisant les broches entre 4 a 5 semaines de plus que les plaques. Les resultats sur les scores radiologiques manquent de validite externe puisqu’une difference millimetrique sur la moyenne du gain ou de la perte de variance ulnaire manque de pertinence clinique. Les criteres d’inclusions de ces etudes sont plus larges que les indications ciblees de l’osteosynthese par broche. Des faiblesses methodologiques expliquent qu’il n’est pas possible de conclure a la superiorite de la plaque. Le critere de jugement principal doit porter sur les complications dans les futurs essais controles randomises.

CeO2 layers were electrodeposited on a Zn-electroplated steel from relatively high concentrations of cerium nitrate. Increasing the current density resulted in a better coverage of the surface but cracks also appeared. Partial dissolution of the substrate occurred, but no defined conversion layer was observed by SEM. XRD, Raman and FT-IR indicated however the formation of zinc hydroxides and hydrozincite as corrosion products. The addition of polyethylene glycol (PEG) limited such dissolution. DSC results showed that PEG was trapped in the coating. This limited the reduction of water, hence to decrease the number of cracks. The coatings microstructure remained however similar.

Infants with Pierre Robin syndrome are known to be difficult to intubate. We evaluated the paraglossal approach combined with a gum elastic bougie for intubation of these infants. Whilst under general anaesthesia, a conventional laryngoscopy was performed; if it failed to obtain a laryngoscopic grade I or II view, intubation was attempted using a paraglossal approach and a gum elastic bougie. Six consecutive infants were studied. Conventional laryngoscopy failed in all infants whilst the paraglossal approach combined with a gum elastic bougie was successful in five of the cases. The paraglossal approach combined with a gum elastic bougie made intubation easy in most children with severe Pierre Robin syndrome and difficult laryngoscopy. Therefore we recommend this as the first line for airway management in such children. However, a fibreoptic bronchoscope and an anaesthetist trained in fibreoptic intubation must still be present when dealing with severe Pierre Robin syndrome infants.

Objective Bladder spasms are a common cause of pain after surgical procedures that call for postoperative catheter drainage. Several therapeutic methods have been used to lessen these spasms but none have received widespread success. Patients and methods Twenty-six children were included in a prospective randomized trial to evaluate the safety and efficacy of daily intravesical instillation of ropivacaine as prophylactic treatment for bladder spasms following ureteroneocystostomy. Results Although six patients experienced mild transient pain during instillation, there was no systemic toxicity attributable to the ropivacaine. The average number of spasms per day fell by half in the instillation group (p Conclusion Intravesical instillation of ropivacaine is a feasible alternative prophylactic treatment for postoperative bladder spasms.

Resume Objectif Connaitre les modalites de prise en charge anesthesique dans les CHU pour realiser les IRM pediatriques. Type d'etude Enquete. Methodes Apres avoir obtenu les coordonnees des equipes pratiquant l'anesthesie des enfants a l'IRM, un questionnaire leur a ete adresse par Internet. Resultats Parmi les 28 CHU contactes, un n'a pas repondu et deux ne pratiquaient pas d'anesthesie pour cette imagerie. Dans 80 % des autres centres, c'etait l'equipe d'anesthesie pediatrique qui pratiquait ces anesthesies. Un monitorage compatible avec l'IRM etait utilise par tous. Pres d'une fois sur deux, l'enfant etait premedique, ses parents etaient presents a l'induction realisee dans 52 % des cas au sevoflurane. L'entretien de l'anesthesie etait realise dans 84 % des cas avec des halogenes. La mise en place d'une voie veineuse peripherique etait systematique dans 92 % des cas. Le controle des voies aeriennes etait obtenu : par l'intubation tracheale systematique dans 36 %, le masque larynge systematique dans 20 %, l'un des deux au choix dans 24 % des cas et dans 20 % des CHU un masque a O2 avec canule de Guedel. Dans 52 % des cas, la ventilation spontanee etait privilegiee. Les enfants etaient tous admis en SSPI, pour une duree de surveillance inferieure a une heure dans 72 %. Dans 83 % une hospitalisation de jour etait realisee. Conclusion L'anesthesie des enfants a l'IRM en CHU n'obeit pas a un protocole particulier mais elle est confiee a des equipes specialisees en pediatrie.

Resume Objectifs Comparer le masque larynge reutilisable LMA–classic (MLC) et le LMA–ProSeal (MLP), taille 2 et 2,5 en termes de facilite d'insertion, de pression de fuite, d'effets secondaires a l'insertion et a l'ablation du dispositif au reveil. Type d'etude Prospective, randomisee. Materiels et methodes Tous les enfants entre 10 et 30 kg programmes pour une anesthesie generale avec masque larynge etaient inclus. Aucun protocole d'anesthesie n'etait impose. La taille du masque etait determinee en fonction du poids. Le MLC etait introduit selon la technique standard. Le MLP etait introduit selon les recommandations avec ou sans le manche, selon le choix de l'operateur. Les donnees recueillies etaient : type d'induction, facilite de l'insertion du masque, de la sonde gastrique (SG), le nombre de tentatives d'insertion, les complications, les fuites gastriques. Resultats Cent vingt enfants ont ete inclus. Aucune difference statistique en termes de difficulte d'insertion, de nombre de tentatives, de pression de fuite et d'effets secondaires n'a ete retrouvee. L'utilisation du manche pour le MLP n'a pas modifie la facilite d'insertion. L'insertion de la SG etait possible dans 92 % des cas. Conclusion Pour une equipe n'ayant pas l'experience du MLP, son utilisation clinique chez l'enfant est aussi simple que le MLC. Il n'y a pas de difference entre le MLC et le MLP en termes de difficulte a l'insertion et d'effet secondaire. En revanche, le MLP a l'avantage de permettre un acces facile et rapide a l'estomac, cela permet de confirmer la bonne position du masque et si besoin de vidanger l'estomac.

The delay for loss of consciousness can be shortened by using high concentration sevoflurane > 6% and by adding N2O during inhalation induction with sevoflurane in paediatrics. Mean time for tracheal tube insertion is lower than 5 min in the majority of studies. This shorter delay is not associated with any significant increase in clinical side effects. However, recent studies have demonstrated the epileptogenic effect of high effect site sevoflurane concentration (occurrence of spike wave on the EEG). Inhalation induction with high alveolar sevoflurane concentration is questionable mainly when it is associated with hyperventilation. Positive pressure ventilation or pressure support ventilation make it possible to maintain normocapnia and to monitor FeSevo. Adding a narcotic decreases the target cerebral concentration required to perform tracheal intubation and consequently the risk of spike wave occurrence.

Resumen Objetivo Valorar los resultados obtenidos con la utilizacion del sistema Dynesys (Dynamic Neutralizacion System for the spine), en un grupo de 94 pacientes, como nuevo concepto para el tratamiento de la patologia degenerativa lumbar basado en la estabilizacion lumbar con conservacion de la funcion articular en contra de la restriccion de la artrodesis clasica. Material y metodos Presentamos 94 pacientes en los que se utilizo este sistema de los cuales 62 fueron hombres y 32 mujeres con una edad media de 46.4 anos. La patologia de los pacientes fue de hernia discal en 27 casos, discopatia degenerativa en 54 casos y estenosis de canal en 13 casos. Se realizo un seguimiento entre 14 t 24 meses valorando la clinica segun la escala de Oswestry y la reincorporacion al trabajo. Resultados Los resultados en la escala de Oswestry fue del 21.4% definitivo con respecto al 56.8% previo al tratamiento y la reincorporacion al trabajo fue del 82%. El cuadro ciatico ha remitido practicamente en todos los casos, asi como la lumbalgia y una mejoria del 60% en casos de claudicacion. Como complicaciones resenamos dos casos debidas a la tecnica, con malposicion de tornillos en un caso y rotura pedicular en otro, dos casos de seroma subcutaneo y dos infecciones subclinicas tardias. Conclusiones La neutralizacion dinamica obtenida mediante este sistema, no debe ser considerada como una artrodesis. El tratamiento con Dynesys amplia la poblacion de pacientes en los que se puede intervenir a aquellos que en principio no son tributarios de una fijacion estandar, pero que planteaban dudas al cirujano al aplicar tecnicas sin apoyo instrumental, incorporando el concepto de funcionalidad frente a la restriccion del movimiento. Se puede definir como una protesis discal colocada extra-discalmente. Hemos obtenido un buen resultado en la mayoria de nuestros pacientes, aunque pensamos que es preciso ampliar el tiempo de seguimiento.

We assessed the incidence of nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) on admission, the rate of acquisition during the hospital stay and the relationship with subsequent infection in a digestive disease unit. The efficacy of a program of nasal carriage eradication with mupirocin was evaluated simultaneously. Over one year 484 patients were studied prospectively on admission for nasal and stool carriage of MRSA, then every week for nasal carriage. Nearly 70% (68.8%) of patients had chronic liver diseases. Nasal carriers were assigned to a five-day course of intranasal mupirocin ointment. One hundred and seventeen (24.2%) patients were MRSA positive, 57 (11.8%) of which were carriers on admission and 60 (12.4%) acquired carriage. Of these, 86 were treated with mupirocin with a success rate of 98.8% and 25.9% of them recolonized. Fourteen patients were retreated, to allow eradication in 71.4% of cases. Seventy percent of these became carriers again. One high-level mupirocin-resistant strain was isolated before treatment and seven during or after treatment. Hospital stay and stool carriage were independently associated with reacquisition (P = 0.0105 and P = 0.0462, respectively). Molecular analysis showed identity between the strains isolated from infection samples and from nasal swabs during the same week. For every patient who became recolonized, nasal strains isolated before and after eradication were the same in 70% of cases. Mortality during hospital stay was independently associated with age (P = 0.0081), MRSA nasal carriage (P = 0.02631), MRSA infection (P0.0001) and liver disease (P = 0.0017). This study did not show a change in the prevalence rate of infection in the unit during treatment with mupirocin. This treatment should only be attempted once due to the risk of emergence of high-level resistant strains.

The TRIM.SP Monte Carlo type program is used to calculate the escape depths for sputtered aluminum and magnesium target materials in physical vapor deposition processes involving argon plasma. Escape distributions are established for all sputtered atoms, as well as for sputtered atoms at several energies, in the case of normal impinging Ar ions. Distributions are also performed for several incidence angles up to 80°, in connection with recoils in collision cascades at a given energy. Mean escape depth calculations show that sputtered Mg atoms originate deeper underneath the surface compared to Al atoms, in accordance with their total stopping powers and sputtering yields. But, as a whole, the majority of sputtered Al and Mg atoms would come from the first two top layers.

Calculations of sputtering yields are performed for aluminum and magnesium target materials with the use of a homemade software based on the analytical expression of Garcia-Rosales. The theoretical yield of magnesium is about twice the value related to aluminum in accordance with the experimental ratio of the Mg/Al deposition rates. We show that the deposits of the same materials must be subjected to densification followed by resputtering phenomena when a bias voltage is set to the substrates. These predictions are confirmed by atomic force microscopy observations, especially for magnesium deposits owing to their texture and the high sputtering yield of this material.

Per- and postoperative analgesia of patients with chronic pain is a challenging issue for anaesthetists and can be achieved with locoregional anaesthesia, unless it is contraindicated. We report the case of a thrombocytopenic child presenting for thoracotomy and in whom intravenous analgesia failed after previous surgeries. Due to the central origin of the thrombocytopenia, thoracic epidural analgesia could be achieved, after platelet transfusions. When clinical advantage of thoracic epidural is unquestionable, central thrombocytopenia is a relative contraindication.

CaSki and HeLa cell lines, isolated from human uterine carcinomas and containing integrated human papillomavirus (HPV) DNA type 16 and 18, respectively were used to evaluate the sensitivity of HPV-DNA detection on suspended cells by fluorescent in situ hybridization using flow cytometry and on corresponding cell deposits using confocal laser scanning microscopy (CLSM). HPV DNAs were detected in cell suspensions with biotinylated DNA probes and revealed with a three-step technique: a rabbit antibiotin antibody, a biotinylated goat anti-rabbit antibody and a streptavidin-fluorescein isothiocyanate complex. By flow cytometry, HPV DNA was detectable only in CaSki cells which contained about 600 copies of HPV DNA per cell. In HeLa cells, with only 20-50 copies of HPV DNA, flow cytometry could not detect HPV DNA, whereas CLSM permitted visualization of fluorescent labelling of HPV DNA hybrids. Furthermore, CLSM showed good preservation of cellular morphology and the nucleus was clearly recognizable after fluorescent in situ hybridization and counterstaining with propidium iodide. Moreover, this examination confirmed that the fluorescent foci were specifically confined to the cell nuclei.

We report the case of an unexpected respiratory complication after a surgical treatment of scoliosis during postoperative period in an adolescent patient. This complication results of a vascular compression of the left main bronchus between the aorta and the pulmonary artery, which induces severe atelectasis of left lower lobe. Prolonged non-invasive ventilation with high level of positive end-expiratory pressure prevents aorto-pulmonary compression, allows a pulmonary recruitment associated with a favorable prognostic for the adolescent.

We used successfully Airtraq-combined to a gum-elastic boogie to intubate twice a dysmorphic infant with mucolipidosis, in whom direct laryngoscopy failed. If this result is confirmed by prospective studies, Airtraq could be a first-line device to intubate infants with difficult intubation.

Background We studied 63 ASA I children (age 2–8 yr) to determine the sufentanil dose needed to facilitate intubation under excellent conditions after inhalation induction with various end-tidal concentrations of sevoflurane without neuromuscular block. Methods Subjects were allocated randomly to receive sevoflurane end-tidal concentrations (e′ sevo ) of 2.5%, 3%, or 3.5%. Anaesthesia was induced with sevoflurane 6% without nitrous oxide for 2 min, and then inspired sevoflurane concentration was adjusted to keep e′ sevo at 2.5%, 3%, or 3.5% according to the group. Subjects received i.v. sufentanil according to an ‘up and down' design. Tracheal intubation by direct laryngoscopy was performed 6 min after sufentanil injection. Intubation was considered successful, if intubation conditions were excellent as determined by the laryngoscopist. Results The ED 50 [effective dose for 50% of subjects; mean (sd)] of sufentanil required for excellent intubation conditions was 0.6 (0.12), 0.32 (0.10), or 0.11 (0.07) μg kg −1 for e′ sevo of 2.5%, 3%, or 3.5%, respectively. Using logistic analysis, the 95% effective dose (ED 95 ) of sufentanil was 1.02 [95% confidence intervals (CI) 0.31–1.74] μg kg −1 , 0.58 (95% CI 0.17–0.99) μg kg −1 , or 0.28 (95% CI 0.04–0.52) μg kg −1 for e′ sevo of 2.5%, 3%, or 3.5%, respectively. Conclusions Excellent intubation conditions could be obtained in children after inhalation induction with low sevoflurane concentrations and adjuvant sufentanil.

Background: The I-gel® is a new single-use supraglottic airway device with a non-inflatable cuff. It is composed of a thermoplastic elastomer and a soft gel-like cuff that adapts to the hypopharyngeal anatomy. Like the LMA-ProSeal, it has an airway tube and a gastric drain tube. Little is known about its efficiency in pediatric anesthesia. Methods: Fifty children above 30 kg, ASA I–II, undergoing a short-duration surgery were included in this prospective, observational study. We evaluated ease in inserting the I-gel®, seal pressure, gastric leak, complications during insertion and removal, ease in inserting the gastric tube and ventilatory parameters during positive pressure ventilation. Results: All devices were inserted at the first attempt. The mean seal pressure was 25 cmH2O. There was no gastric inflation and gastric tube insertion was achieved in all cases. The results appear similar to those in a previous study concerning laryngeal mask airway in terms of leak pressure and complication rates. Conclusion: Because the I-gel® has a very good insertion success rate and very few complications, it seems to be an efficient and safe device for pediatric airway management.

This study is concerned with the development of a tool to predict the long term behaviour of adhesively bonded steel joints aged in sea water. First, diffusion kinetics and the mechanisms governing the degradation of mechanical properties of an epoxy adhesive are described. These two sets of data were used in a Coupled finite element (FE) analysis to determine the stress state in double lap shear (DLS) specimens before and after aging. However, subsequent tests on DLS specimens indicated an adhesive and not cohesive failure mode, so this approach could not be used to predict failure in the present case without introducing an interfacial damage parameter. A second approach was therefore employed, in which modified Arcan samples were designed in order to identify directly how the failure envelope changed with aging. Tests were performed on these modified Arcan specimens under shear, tensile/shear and tensile loads before and after aging. The results from these tests have enabled a tension-shear failure envelope to be constructed, which may be used to predict failure in joints with more complex stress states. The application of a coupled diffusion-mechanical property approach is illustrated for the Arcan specimen loaded in tension, and its application to the prediction of failure behaviour after aging is discussed. (C) 2009 Elsevier Ltd. All rights reserved.

Infants with Pierre Robin syndrome are known to be difficult to intubate. We evaluated the paraglossal approach combined with a gum elastic bougie for intubation of these infants. Whilst under general anaesthesia, a conventional laryngoscopy was performed; if it failed to obtain a laryngoscopic grade I or II view, intubation was attempted using a paraglossal approach and a gum elastic bougie. Six consecutive infants were studied. Conventional laryngoscopy failed in all infants whilst the paraglossal approach combined with a gum elastic bougie was successful in five of the cases. The paraglossal approach combined with a gum elastic bougie made intubation easy in most children with severe Pierre Robin syndrome and difficult laryngoscopy. Therefore we recommend this as the first line for airway management in such children. However, a fibreoptic bronchoscope and an anaesthetist trained in fibreoptic intubation must still be present when dealing with severe Pierre Robin syndrome infants.

Background This prospective, randomized, crossover study had two purposes: first, to determine whether pressure-controlled ventilation (PCV) is safer than volume-controlled ventilation (VCV) by preventing gastric insufflation in children ventilated through an laryngeal mask airway (LMA); second, to assess whether the measurement of LMA leak pressure (P(leak)) is useful for preventing leakage during positive pressure ventilation (PPV). Methods Forty-one, 2 to 15-year-old children underwent general anesthesia with an LMA. The expiratory valve was set at 30 cmH(2)O and P(leak) was measured using constant gas flow. Children were randomly ventilated using PCV or VCV for 5 min in order to reach a P(ET)CO(2) not exceeding 45 mm Hg, and then they were ventilated with the alternative mode. If the target P(ET)CO(2) could not be obtained in one mode, we switched to the other. If both modes failed, children were intubated. Tidal volumes, P(ET)CO(2) and airway pressures were noted and compared between modes. Gastric insufflation was checked by epigastric auscultation. Results PCV provided more efficient ventilation than VCV, as targeted P(ET)CO(2) was obtained without gastric insufflation using PCV in all cases except one, whereas VCV failed in three cases. No gastric insufflation occurred when ventilating below peak. Conclusions These findings suggest that in the age group studied, PCV is more efficient than VCV for controlled ventilation with a laryngeal mask. Gastric insufflation did not occur with this mode.

The delay for loss of consciousness can be shortened by using high concentration sevoflurane6% and by adding N2O during inhalation induction with sevoflurane in paediatrics. Mean time for tracheal tube insertion is lower than 5 min in the majority of studies. This shorter delay is not associated with any significant increase in clinical side effects. However, recent studies have demonstrated the epileptogenic effect of high effect site sevoflurane concentration (occurrence of spike wave on the EEG). Inhalation induction with high alveolar sevoflurane concentration is questionable mainly when it is associated with hyperventilation. Positive pressure ventilation or pressure support ventilation make it possible to maintain normocapnia and to monitor FeSevo. Adding a narcotic decreases the target cerebral concentration required to perform tracheal intubation and consequently the risk of spike wave occurrence.

To assess the results obtained using the Dynesys system (Dynamic Neutralisation System for the spine), in a group of 94 patients. This new system for treating lumbar degenerative pathologies is based on lumbar stabilisation and preservation of articular function, as opposed to traditional arthrodesis restrictions.We analyze series of 94 patients in whom this system was used. 62 were males and 32 females with an average age of 46.4 years. The pathologies treated were disc herniation in 27 cases, degenerative discopathy in 54 cases and lumbar channel stenosis in 13 cases. Follow-up was carried out between 14 and 24 months, assessing the clinical picture according to the Oswestry scale and the return to work.The final results on the Oswestry scale were 21.4% with respect to 56.8% prior to the treatment and the return to work was 82%. There was a remission of the sciatica symptoms in almost all the cases, as well as of the lumbar pain, and there was a 60% improvement in the claudication cases. With regard to complications, we would like to point out two cases due to the technique, one because of the wrong positioning of the screws and the other due to the rupture of the pedicle. There were two cases of subcutaneous seroma and two late subclinical infections.The dynamic neutralisation obtained using this system, should not be considered as an arthrodesis. Treatment using Dynesys enlarges the population of patients candidates for surgery to who initially do not apparently need a standard fixation, but who raise doubt regarding the application of techniques without instrumental support, incorporating the functionality concept as opposed to restricting movement. This system can be defined as a disc prosthesis fitted externally to the disc. We have obtained good results in the majority of our patients, although we believe that the follow-up should be increased.

Per- and postoperative analgesia of patients with chronic pain is a challenging issue for anaesthetists and can be achieved with locoregional anaesthesia, unless it is contraindicated. We report the case of a thrombocytopenic child presenting for thoracotomy and in whom intravenous analgesia failed after previous surgeries. Due to the central origin of the thrombocytopenia, thoracic epidural analgesia could be achieved, after platelet transfusions. When clinical advantage of thoracic epidural is unquestionable, central thrombocytopenia is a relative contraindication.

To compare the Classic laryngeal mask airway (MLC) and the ProSeal LMA (MLP), size 2 and 2.5 in terms of ease of insertion, leak pressure and side effects during insertion and extraction in the recovery room.Randomised prospective.All children between 10 and 30 kg scheduled for general anaesthesia with laryngeal mask (ML) were included. There was no imposed protocol for the anaesthesia. The ML size was determined according to the child's weight. The MLC was inserted using the standard technique. The MLP was inserted following the recommendations, with or without the handle according to the operator's choice. The data analysed were: insertion type, ease of insertion of the mask, of the nasogastric tube (SG), number of attempts of mask insertion, complications, gastric leaks.One hundred (and) twenty children were included. There was no statistical difference in terms of difficulty of insertion, number of failed attempts, leak pressure or side effects. The use of the handle did not make insertion easier. Insertion of a nasogastric tube was possible in 92% cases.MLP is as easy to use in children as the MLC. MLP has the advantage of allowing rapid access to the stomach. It seems that the MLP is safer since its correct position is confirmed by easy gastric tube insertion.

We present recent developments on the fabrication process of Buried Ridge Stripe (BRS) Laser Diodes (LDs) integrated with a butt-coupled passive Spot Size Converter (SSC). Hydrogenation of the buried passive section has been successfully implemented on a 2-inch wafer technology. Hydrogenated SSC-BRS LDs exhibit excellent high temperature CW performances. Improvement of external efficiency (0.24 and 0.16 W/A respectively measured at 85/spl deg/C on hydrogenated and as-grown 500 /spl mu/m-long SSC devices) confirms that hydrogenation significantly reduces the free carrier optical absorption losses. Moreover, its long-term stability is demonstrated through 2000 hrs Automatic Power Control test.

Using macrorestriction of genomic DNA and pulsed-field gel electrophoresis, we examined 504 non-redundant, infection-causing human isolates of methicillin-resistant Staphylococcus aureus susceptible (G(S): 238 isolates) or resistant to gentamicin (G(R): 266 isolates). The strains were isolated at Albert Chenevier Hospital (Créteil, France) between 1 January 1991 and 31 December 1998. Their susceptibility to erythromycin, lincomycin, tetracycline, rifampicin, fusidic acid and fosfomycin was also studied. Seventy-six genotypes were identified (percentage similarity80). Ten types, each containing at least eight strains, predominated. G(R) strains showed higher genetic polymorphism than G(S) strains: the 266 G(R) isolates belonged to 67 genotypes, five of which predominated (44, 42, 38, 30 and 15 isolates); the 238 G(S) isolates belonged to only 18 types, four of which predominated (112, 83, 11 and 10 isolates). Fifty-six percent of G(R) strains (34 Gt) were resistant to erythromycin, lincomycin, tetracycline and rifampicin, and were isolated at relatively stable frequencies. Resistance to five antibiotics studied (susceptible to fusidic acid) was observed among 16.5% of G(R) strains. The frequency of strains with this profile diminished from 30% in the early 1990s to 10% in 1998. One hundred and twenty-six G(S) isolates were susceptible to all six antibiotics; this profile was only found from 1993 onwards, and was increasingly frequent (60% of G(S) strains in 1996). Resistance to erythromycin and lincomycin only was found in 70 G(S) isolates; this profile accounted for approximately half the isolates in 1992/1993 and only one-third in 1998. These results, obtained over an eight-year period, show an overall increase in antibiotic susceptibility. They confirm the spread of two major clones of MRSA-G(S) and support the hypotheses that G(S) strains derive from G(R) strains that have lost the aac6'-aph2" gene; and that G(S) strains are genetically related to those that were present before the use of gentamicin and persisted at a low frequency until 1992-1993.

A MAJOR RISK: The infection of immunodepressed patients by Aspergillus-type fungi increases morbidity and mortality, particularly in hematology units or during solid organ transplantation. Although present diagnostic means benefit from the progress over the last years, they remain limited and chemoprophylaxis protocols have still not demonstrated significant efficacy. THE NEED FOR RECOMMENDATIONS: Today, the handling of environmental risks is the only strategy that has proved its efficacy and usefulness. On the basis of administrative recommendations and data from the literature, a multicentric and pluri-disciplinary task force, grouping clinicians, microbiologists and hygienists, has assessed different methods and has proposed recommendations for the standardization and optimization of fungal surveillance of the environment.

We used successfully Airtraq-combined to a gum-elastic boogie to intubate twice a dysmorphic infant with mucolipidosis, in whom direct laryngoscopy failed. If this result is confirmed by prospective studies, Airtraq could be a first-line device to intubate infants with difficult intubation.

Multidrug-resistant (MDR) cells are characterized by a defect in drug accumulation caused by overexpression of a transmembrane glycoprotein, the P-glycoprotein (P-gp). The MDR phenotype can be characterized either by use of monoclonal antibodies raised against P-gp or with functional tests based on the intracellular accumulation of fluorescent molecules. The aim of the present study was to compare the effectiveness of functional tests performed by flow cytometry including uptake of daunorubicin (DNR) (2 micrograms/ml), Hoechst 33342 (5 micrograms/ml), or rhodamine 123 (RH 123) (0.1 microgram/ml); and to evaluate the effect of cell death induced by heating at 60 degrees C for 2 h on incorporation of DNR and RH 123. Sensitive and resistant human hematopoietic K 562 cells expressing P-gp were identified by monoclonal antibodies C 219 and MRK-16. Fluorescence of the dyes was always higher in sensitive than in resistant cells. However, DNR and Hoechst 33342 produced a slight incorporation in resistant cells, while RH 123 showed lack of incorporation in resistant cells. Thus, RH 123 allows sensitive and resistant cells to be clearly distinguished. In case of cell death, accumulation of RH 123 and DNR were different. With RH 123, fluorescence intensity strongly decreased in sensitive cells. With DNR, fluorescence intensity was enhanced in resistant cells. Thus, when the MDR phenotype is defined by uptake of DNR or RH 123, artifactual results due to cell death may be avoided by using a dye such as propidium iodide to eliminate dead cells.

CaSki and HeLa cell lines, isolated from human uterine carcinomas and containing integrated human papillomavirus (HPV) DNA type 16 and 18, respectively were used to evaluate the sensitivity of HPV-DNA detection on suspended cells by fluorescent in situ hybridization using flow cytometry and on corresponding cell deposits using confocal laser scanning microscopy (CLSM). HPV DNAs were detected in cell suspensions with biotinylated DNA probes and revealed with a three-step technique: a rabbit antibiotin antibody, a biotinylated goat anti-rabbit antibody and a streptavidin-fluorescein isothiocyanate complex. By flow cytometry, HPV DNA was detectable only in CaSki cells which contained about 600 copies of HPV DNA per cell. In HeLa cells, with only 20-50 copies of HPV DNA, flow cytometry could not detect HPV DNA, whereas CLSM permitted visualization of fluorescent labelling of HPV DNA hybrids. Furthermore, CLSM showed good preservation of cellular morphology and the nucleus was clearly recognizable after fluorescent in situ hybridization and counterstaining with propidium iodide. Moreover, this examination confirmed that the fluorescent foci were specifically confined to the cell nuclei.

Objectif Le traitement endoscopique du reflux vesico-ureteral est reconnu comme etant une alternative fiable pour la prise en charge des reflux vesico-ureteraux, notamment de bas grade (taux de reussite > 90 %). Bien que la plupart des equipes ne realisent plus de cystographie de controle apres chirurgie ouverte du reflux, nombre d’entre elles en realisent encore apres traitement endoscopique. Materiel et methode Entre novembre 2004 et decembre 2006, 72 ureteres chez 41 patients (34 filles et 7 garcons) ont ete traites par injection sous-ureterale de Deflux® (Q-Med Scandinavia, Uppsala, Sweden). L’indication dans chaque cas etait la recidive de pyelonephrite sous anti-bioprophylaxie. Tous presentaient un reflux de bas-grade (≤ III) uni (18/41) ou bilateral (20/41) et des cicatrices renales.Trois patients n’avaient pas de reflux a la cystographie mais presentaient des infections urinaires febriles a repetition et des cicatrices renales a la scintigraphie. Dans 8 cas, malgre un reflux unilateral a la cystographie, les deux ureteres ont ete traites en raison de l’aspect du meat lors de la cystoscopie. Une echographie renale a ete realisee a trois mois. Une cystographie postoperatoire n’etait realisee qu’en cas de recidive de pyelonephrite. Le follow-up moyen etait de 20 mois. Resultats L’echographie renale etait normale dans tous les cas. Deux enfants ont presentes une infection urinaire febrile : l’un n’avait pas de reflux objective a la cystographie preoperatoire, l’autre n’en avait plus a la cystographie postoperatoire. Discussion Le traitement endoscopique du reflux vesico-ureteral de bas-grade presente un taux de reussite important confirme par de nombreuses etudes cliniques. Par ailleurs, meme si il persiste un reflux asymptomatique, il n’est pas certain qu’il faille le traiter puisque le but de la prise en charge du reflux est de supprimer les infections et non pas le reflux lui-meme. Conclusion Nous pensons donc qu’il n’est necessaire de realiser une cystographie de controle apres traitement endoscopique d’un reflux de bas-grade qu’en cas de recidive de pyelonephrite.