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Resume La pratique de plus en plus frequente d’activites sportives ou de loisir en haute altitude amene a se poser la question des facteurs de risque de la pathologie engendree par l’exposition aigue a l’hypoxie : mal aigu des montagnes, œdeme pulmonaire et œdeme cerebral de haute altitude. Des etudes epidemiologiques recentes ont permis d’identifier ces facteurs de risque : antecedents de pathologie d’altitude lors de sejours precedents, montee rapide en altitude, migraine, entrainement regulier en endurance, ainsi que des donnees physiologiques obtenues lors d’un test d’effort en hypoxie : reponse ventilatoire et cardiaque a l’hypoxie a l’exercice, desaturation a l’exercice en hypoxie. Ces dernieres donnees physiologiques evaluent la sensibilite des chemorecepteurs a l’hypoxie et permettent une bonne detection des sujets a risque. Lors d’une consultation specialisee de medecine d’altitude, on s’attachera dans un premier temps a eliminer les contre-indications medicales a un sejour en altitude et, a l’aide du score clinicophysiologique elabore a l’issu du test d’effort en hypoxie, on donnera des conseils adaptes au profil du consultant desireux de se rendre en haute altitude.

Resume Introduction La fin de l’annee 2012 a ete marquee par des alertes mediatiques sur les contraceptions hormonales combinees (CHC) et des plaintes de patientes contre les laboratoires commercialisant ces pilules. Nous nous sommes interroges sur l’impact de ces annonces sur le nombre d’interruptions volontaires de grossesse (IVG). Patientes et methode Etude prospective evaluant le nombre de femmes ayant demande une IVG et qui declaraient spontanement que cet echec de contraception etait survenu suite a un arret de leur contraception orale parce qu’elles avaient eu peur des informations vehiculees dans les medias. Resultats Onze centres sur 16 ont repondu a l’enquete totalisant 2300 IVG sur cette periode dont 98 (4,2 %) pour des grossesses survenues suite a un arret de contraception que les femmes declaraient comme une consequence des alertes mediatiques. L’âge moyen etait de 26 ans. Ces grossesses avaient debute dans 4 cas (6 %) en decembre 2012, soit 3 mois apres le debut de l’alerte, dans 11 cas (16 %) en janvier, dans 24 cas (36 %) en fevrier et dans 18 cas (27 %) en mars 2013, soit 4 a 6 mois apres. Les CHC interrompues par « peur » des informations vehiculees dans les medias etaient de 2e generation dans 7 cas (10 %), de 3e generation dans 17 cas (25 %), de 4e generation dans 32 cas (48 %) ou microprogestative dans 2 cas (3 %). Conclusion Les demandes d’IVG de femmes declarant avoir interrompu leur contraception par peur des informations vehiculees dans les medias ont represente 4 % des IVG entre le 18/02/2013 et le 30/04/2013.

The ease of endotracheal intubation has been recently shown to affect the incidence of laryngeal injury. There remains controversy as to whether or not a muscle relaxant is routinely required for tracheal intubation. This study examined conditions of intubation in our routine practice, which employs a relaxant-sparing approach.All adult patients scheduled for surgery with general anaesthesia were prospectively included. A muscle relaxant was used to facilitate intubation when it was required for the surgical procedure and/or otherwise regarded as necessary by the anaesthesiologist. In the remaining patients, a relaxant-free intubation was performed. Intubating conditions were evaluated in all the patients as well as the post-intubation laryngeal symptoms.Between March and July 2003, 612 patients were consecutively included. A muscle relaxant was used in 32% of patients and no relaxant in the remaining patients (68%). Clinically acceptable intubating scores were observed in 98.4% overall with no significant difference between the two groups. Excellent conditions occurred more frequently in the relaxant group as compared to the relaxant-free group, 87% vs. 72%, P = 0.005. Laryngeal symptoms occurred in 184 (33%) patients with no difference between the two groups.Our relaxant-sparing approach did not increase the incidence of poor conditions of intubation nor laryngeal symptoms. However, excellent conditions occurred more frequently in the relaxant group. A more flexible approach to the issue of the need for neuromuscular blockade prior to intubation is proposed.

The end of 2012 was marked by some media alerts regarding combined hormonal contraceptives (CHC) and lawsuit against pharmaceutical companies selling these birth control pills. In this study, we analyzed whether these information had an impact on the number of abortion.Prospective study determining the number of women asking for abortion and who spontaneously declare that the contraception defect was due to an abandon of their oral contraception as they were scared of some information they received from media about the medication.Eleven centers out of 16 did participate to the study, allowing the study of 2300 abortion during this time frame. Ninety-eight of these pregnancies (4.2%) were due to an interruption of the contraceptive treatment as a consequence of media alerts. Average age was 26 years old. Within these pregnancies, 4 (6%) started in December 2012, 3 months after the beginning of the alerts, 11 (16%) in January, 24 (36%) in February and 18 (27%) in March 2013 (4-6 months later). In 7 cases (10%) CHC stopped by fear of information reported by media were of 2nd generation, in 17 cases (25%) of 3rd generation, in 32 cases (48%) of 4th generation and microprogestative in 2 cases (3%).Women who declared that they stopped their birth control medication by fear of information reported in media, represented 4% of the number of abortions performed between 2013 February 18th and 2013 April 30th.

Resume La contribution du systeme parasympathique aux modifications de l'activite chronotrope cardiaque a l'exercice induites par l'hypoxie d'altitude a ete etudiee chez 10 sujets sains natifs de basse altitude. Un exercice sous-maximal (60% de la puissance maximale aerobie) de 10 minutes a ete pratique apres ou non-injection intraveineuse d'atropine (1 mg) en normoxie et en hypoxie (le 2 e et le 3 e jour a 4 350 m d'altitude). Une analyse de variance montre que l'effet de l'atropine sur la frequence cardiaque est le meme en normoxie et en hypoxie: le tonus vagal s'estompe a l'exercice de facon equivalente en normoxie et en hypoxie. La mesure des concentrations des catecholamines circulantes montre que l'hypoxie s'accompagne d'une augmentation de l'activite adrenergique, mais l'activation adrenergique suscitee par l'exercice n'est modifiee ni par l'hypoxie ni par l'atropine. Au total, le role du systeme parasympathique dans l'activite chronotrope cardiaque lors d'un exercice sous-maximal n'est pas modifie par l'hypoxie aigue.

Reports about anaphylactic and anaphylactoid reactions to rocuronium have increased recently. We report two new cases of documented grade III anaphylaxis, leading to death in one patient. The first case occurred in an 81-year-old ASA II woman scheduled for emergency abdominal surgery. Severe hypotension and tachycardia were observed after rocuronium, without bronchospasm. Neosynephrine allowed rapid resuscitation, and the patient recovered fully. The second patient was a 64-year-old ASA II man scheduled for abdominal surgery. Severe haemodynamic instability and bronchospasm occurred after rocuronium. Despite immediate life support, the postoperative period was complicated by persistent low systolic pressure, acute respiratory distress syndrome, acute renal failure, disseminated intravascular coagulation and pancreatitis, leading to the death of the patient.

The variability in sensitivity to acute mountain sickness among individuals is a phenomenon well known to physicians and high altitude alpinists. The measurement of cardiac and respiratory responses to hypoxia (FIO2 = 0.115) at rest and during exercise (50% VO2max) allows the detection of those subjects who are more liable to suffer from high altitude diseases. In a retrospective study performed on 288 subjects evaluated with a hypoxic test during a Mountain medicine consultation, we found that the most clinically susceptible subjects had at least one abnormal response to the hypoxic tests, especially during exercise. The observation of one or several abnormal values in cardiac or respiratory responses to hypoxia leads us to advise a modification in the alpine or trekking objective, an increase in the acclimatization time and/or prevention by acetazolamide.

We have investigated residual block after anaesthesia which included the use of the neuromuscular blocking agent vecuronium but no anticholinesterase, in 568 consecutive patients on admission to the recovery room. The ulnar nerve was stimulated submaximally using TOF stimulation (30 mA). Postoperative residual curarization was defined as a TOF ratio0.7. Of the 568 patients, 239 (42%) had a TOF0.7 in the recovery room. These patients had received a larger cumulative dose of vecuronium than patients who had full recovery (mean 7.7 (SD 3.6) mg vs 6.2 (2.7) mg; P0.05) and a shorter time had elapsed since the last vecuronium dose (117 (70) min vs 131 (80) min; P0.05). Of 435 patients whose trachea was extubated, 145 (33%) exhibited inadequate recovery from neuromuscular block. Six of these had one or no response to TOF stimulation and were reintubated. In the remaining 139 patients, neuromuscular block was successfully antagonized. Only 20 patients (3.5%) remembered TOF stimulation when questioned 2 h later in the recovery room, and discomfort associated with it was assessed using a visual analogue scale before discharge. We conclude that it is necessary to antagonize residual block produced by vecuronium.

Objectives Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) are sexually transmitted infections (STIs). Most infections are asymptomatic, representing an important reservoir for transmission. Without treatment, complications such as infertility may occur. Moreover, 33% of CT/NG co-infection rate has been reported. Since 2010, combined screening of CT and NG by PCR in asymptomatic population has been recommended by the French Health Authority. Thus, the aim of this study was to assess the interest of the new Cepheid Xpert ® CT/NG Assay, a real-time PCR test for the automated and rapid detection and differentiation of CT and NG genomic DNA, in population with systematically screening such as induced abortion. Methods Between July and November 2012, 634 urogenital samples were received in our laboratory to detect CT and/or NG infections with the Xpert CT/NG assay. Results Of the 634 samples included in this study, 61 (9.6%) were CT positive, 19 (2.9%) were NG positive. Among the 61 CT positives, 10 (1.6%) were positive for both CT and NG. Concerning the 177 samples performed in case of induced abortion, 27 (15.3%) were CT positive, 9 (5.1%) were NG positive and 5 (2.8%) were positive for both pathogens. Conclusion The results revealed a global prevalence (9.6%) of CT infections, this percentage being higher in women screened for induced abortion. Although, many clinicians tend to only request testing for CT, our results demonstrate the value of the detection of both CT and NG by Xpert CT/NG. This new test allows a more rapid, accurate detection and optimises the management of STIs by clinicians. Finally, the screening of asymptomatic population helps also to reduce the transmission and is a more cost effectiveness alternative in screening settings.

Disruption of a mainstream bronchus is a rare but dreaded complication of pneumonectomy. When the bronchial tump measures at least 15 mm, the conventional therapeutic strategy is to drain the pleural cavity followed by closure of the fistula via trans-mediastinal sternotomy. After an experimental study on cadavers to test the technical feasibility of main bronchus closure via a cervical approach using a video-mediastinoscope, we used video-assisted mediastinal surgery successfully in a patient with a left main bronchus fistula.

To explore the hypothesis that acute exposure to altitude hypoxia and acute mountain sickness (AMS) are associated with the release of vasoactive eicosanoids, 10 adult subjects were studied at sea-level and after 1-8 days (H1-H8) of exposure to an altitude of 4350 m (Observatoire Vallot). Plasma concentrations of 6 eicosanoids were determined in peripheral venous blood samples by radioimmunoassay after extraction with cooled ethanol and chromatographic separation by HPLC. All subjects experienced symptoms of AMS. Maximal clinical scores were observed at H1 or H2. Symptoms were no longer noted at H8. Hypoxia induced a very large increase in plasma concentration of most eicosanoids; thromboxane B2 (TxB2) and leukotriene B4 (LTB4) were maximum at H1 and H2 (about 5 times the normoxic value); prostaglandins PGE2, 6-keto-PGF1 alpha and PGF2 alpha were maximum at H3 or H4 (about 2.5-5 times of normoxic value). All eicosanoids returned almost to normoxic values by H8. Vasoconstricting mediators were released mostly at the initial phase (H1, H2), vasodilating mediators becoming predominant thereafter (H3, H4). The time pattern of appearance in blood of mediators acting on vascular permeability was strikingly parallel to the clinical score of AMS. In conclusion, exposure to acute hypoxia induced a large increase in plasma concentration of eicosanoids, the variation with time of which is compatible with a hydrostatic-permeability hypothesis of AMS pathophysiology.

The influence of classical atherosclerosis risk factors (male sex, smoking, hypercholesterolemia, diabetes, overweight and hypertension on peri-hospital mortality and morbidity were studied in 83 patients (68 men and 15 women) aged 63 +/- 13 years and undergoing peripheral arterial surgery. None of these factors was statistically correlated with peri-operative complications with the exception of hypertension but the correlation was slight (0.5 less than p less than 0.10). In contrast, there was a powerful statistical (p less than 0.0003) link between age and morbidity and mortality associated with this type of surgery.

The effects of acute hypoxia (2 days at 4350 m) on whole saliva flow and composition were studied on 12 sea-level natives, at rest and following a maximal exercise. Exercise, performed in normoxia and hypoxia, did not induce variations in saliva flow rate, saliva potassium or alpha-amylase concentrations. In contrast, acute hypoxia did lead to an increase in mean saliva flow rate both at rest (0.63 ml.min-1 to 0.93 ml.min-1, P less than 0.01) and after exercise (0.56 ml.min-1 to 1.06 ml.min-1, P less than 0.05) and a decrease in mean saliva potassium concentration at rest (20.8 mmol.l-1 to 14.7 mmol.l-1, P less than 0.01) as well as after exercise (21.7 mmol.l-1 to 16.5 mmol.l-1, P less than 0.05). This effect might be the consequence of a hypoxia-induced stimulation of the parasympathetic nervous system.

The hypothesis of a blunted chronotropic response of cardiac beta-adrenergic receptors in altitude hypoxia was tested in nine subjects at sea level (SL) by infusion of isoproterenol. Observations were made at SL, in acute hypoxia (2 days at 4,350 m, condition H1), in more prolonged hypoxia [13 days between 850 and 4,800 m, condition H2] and in chronic hypoxia [21 days at 4,800 m, condition H3]. Resting heart rate was higher in all hypoxic conditions. Resting norepinephrine concentrations were found to be significantly higher in conditions H2 (1.64 +/- 0.59) and H3 (1.74 +/- 0.76) than at SL (0.77 +/- 0.18 ng/ml). Isoproterenol, diluted in saline, was infused at increasing doses of 0.0, 0.02, 0.04, and 0.06 micrograms.kg-1.min-1. For the highest dose, there was a significantly smaller increase in heart rate in conditions H1 (35 +/- 9), H2 (33 +/- 11), and H3 (31 +/- 11) than at SL (45 +/- 8 min-1). The increase in pulse (systolic/diastolic) pressure, considered as the vascular response to isoproterenol infusion, was smaller in condition H3 (29 +/- 16) than at SL (51 +/- 24 mmHg). There was a significant increase in the dose of isoproterenol required to increase heart rate by 25 min-1 and decrease in slope of heart rate increase vs. log(dose) relationship in conditions H2 and H3. Thus an hypoxia-related attenuated response of beta-adrenergic receptors to exogenous stimulation was found in humans.(ABSTRACT TRUNCATED AT 250 WORDS)

From October 1983 to January 1985, 46 patients (38 men and 8 women; mean age 60 years, range 37-83) underwent peripheral vascular surgery either of the internal carotid artery or of arteries of the lower limbs. All patients had thorough clinical examination, ECG and thallium dipyridamole myocardial scanning before operation, as a result of which they were divided into 20 with, and 26 without chronic ischemic heart disease. Three major cardiac events were noted during or following a period of one month after surgery: two deaths due to a cardiac ischemic event and one post-operative unstable angina pectoris. The three patients with these complications were classified in the coronary group (NS). When the patients were reclassified according to the presence or absence of thallium redistribution on serial images after dipyridamole, 14 had redistribution and 32 had no redistribution. The three major cardiac events were found to have occurred in the group with redistribution (P less than 0.04). Our study suggests that patients with redistribution have a high incidence of postoperative ischemic events. They should be considered for a particular pre-operative coronary management to avoid post-operative major cardiac events and to improve survival.

From October 1983 to January 1985, 46 patients (38 men and 8 women; average age, 60 years; range, 37 to 83 years) underwent peripheral vascular surgery of either the internal carotid artery or the arteries of the lower limbs. Each patient had a thorough clinical examination, an ECG, and a dipyridamole-thallium-201 myocardial scan before operation. On the basis of results, they were divided into two groups: 20 patients with and 26 patients without chronic ischemic heart disease. Three major cardiac events were noted during or after a period of 1 month after surgery: There were two deaths due to cardiac ischemic events and one patient had postoperative unstable angina pectoris. These three patients were classified in the coronary group (NS). When the patients were classified on the basis of whether or not there was thallium redistribution on serial images after infusion of dipyridamole, 14 with redistribution and 32 without redistribution were noted. The three patients who had major cardiac events were in the former group (p less than 0.04). Our data suggest that patients in whom redistribution occurs have a high incidence of postoperative ischemic events. These patients should be considered for particular preoperative coronary care to avoid major postoperative cardiac events and to increase chances of survival.

It is reported the first observation of cardiogenic shock without delay, in a leukemic patient during a first injection of Rubidazone (22050 RP) which is recognized so far, as one of the least cardiotoxic anthracyclines. It has been concluded: --anthracyclines, beside the risk of a progressive cardiomyopathy which is related to the dose and very well known, can induce immediate cardiac injuries, which cannot be predicted yet; --the perfect myocardial protector is still to be discovered; --in this case, beta-adrenergic stimulators appeared to be able to control the cardiotoxic effect of Rubidazone; --the last fact could be considered in the decision to maintain the treatment when such an injury occurs during a chemotherapy or when it seems absolutely necessary to use such a drug.

The renin-aldosterone system may be depressed in subjects exercising at high altitude, thereby preventing excessive angiotensin I (ANG I) and aldosterone levels, which could favor the onset of acute mountain sickness. The role of beta-adrenoceptors in hormonal responses to hypoxia was investigated in 12 subjects treated with a nonselective beta-blocker, pindolol. The subjects performed a standardized maximal bicycle ergometer exercise with (P) and without (C) acute pindolol treatment (15 mg/day) at sea level, as well as during a 5-day period at high altitude (4,350 m, barometric pressure 450 mmHg). During sea-level exercise, pindolol caused a reduction in plasma renin activity (PRA, 2.83 +/- 0.35 vs. 5.13 +/- 0.7 ng ANG I.ml-1.h-1, P less than 0.01), an increase in plasma alpha-atrial natriuretic factor (alpha-ANF) level (23.1 +/- 2.9 (P) vs. 10.4 +/- 1.5 (C) pmol/1, P less than 0.01), and no change in plasma aldosterone concentration [0.50 +/- 0.04 (P) vs. 0.53 +/- 0.03 (C) nmol/1]. Compared with sea-level values, PRA (3.45 +/- 0.7 ng ANG I.ml-1.h-1) and PA (0.39 +/- 0.03 nmol/1) were significantly lower (P less than 0.05) during exercise at high altitude. alpha-ANF was not affected by hypoxia. When beta-blockade was achieved at high altitude, exercise-induced elevation in PRA was completely abolished, but no additional decline in PA occurred. Plasma norepinephrine and epinephrine concentrations tended to be lower during maximal exercise at altitude; however, these differences were not statistically significant. Our results provide further evidence that hypoxia has a suppressive effect on the renin-aldosterone system. However, beta-adrenergic mechanisms do not appear to be responsible for inhibition of renin secretion at high altitude.

In the group of adenomas of the trachea and bronchi, cystic adenocarcinomas or cylindromas are malignant tumours, whose outcome is much slower than those of the usual type of cancer. An unusual case is reported in which treated was firstly carried out with laser therapy and then surgery.

The authors report a case of haemorrhage due to cephalexin therapy. The bleeding started after an orthopedic operation in a patient without renal failure, receiving 3 g/day of cephalexin. Platelet function was very abnormal at the time of the haemorrhage with a bleeding time of over 20 minutes, which returned to normal when treatment was stopped. This case seems to be similar to other reports of haemorrhages during treatment with other beta-lactams.

The finding of a hereditary deficiency of factor XI in a Portuguese family confirms that this abnormality is not confined to Ashkenazi Jews. Its transmission is autosomal, recessive and of variable expression, and in this particular family it appeared to be asymptomatic. When infused post-operatively in fresh frozen plasma, Factor XI has a half-life of about 24 hours and a recovery rate of almost 100%. The propositus, a 57-year-old woman, appears to have been "protected" by a homozygous deficiency of Factor XI against the thromboembolic complications of a Behçets disease which had been present for 30 years. Plasma exchange and perfusions of fresh frozen plasma were probably responsible for the regression observed in the symptoms (particularly ocular symptoms) of the disease, then in active phase.

Sixty patients were studied during non cardiac thoracic surgery. In 21,6 p. cent a culture of organism was isolated and for 53.8 p. cent of them developed a pneumonic process during postoperative period. The organism'role was confirmed by clinical correlation and an abnormal chent radiograph. The same organism was isolated in blood culture sputum or empyema. On the other side the patients with sterile cultures had always a favorable course. The results confirmed the interest of the method which would permit a prophylactic antibiotherapy.