Comparison of aortic elasticity determined by cardiovascular magnetic resonance imaging in obese versus lean adults.

The vascular properties of large vessels in the obese have not been adequately studied. We used cardiovascular magnetic resonance imaging to quantify the cross-sectional area and elastic properties of the ascending thoracic and abdominal aorta in 21 clinically healthy obese young adult men and 25 men who were age-matched lean controls. Obese subjects had greater maximal cross-sectional area of the ascending thoracic aorta (984 +/- 252 vs 786 +/- 109 mm(2), p <0.01) and of the abdominal aorta (415 +/- 71 vs 374 +/- 51 mm(2), p <0.05). When indexed for height the differences persisted, but when indexed for body surface area, a significant difference between groups was found only for the maximal abdominal aortic cross-sectional area. The obese subjects also had decreased abdominal aortic elasticity, characterized by 24% lower compliance (0.0017 +/- 0.0004 vs 0.0021 +/- 0.0005 mm(2)/kPa/mm, p <0.01), 22% higher stiffness index beta (6.0 +/- 1.5 vs 4.9 +/- 0.7, p <0.005), and 41% greater pressure-strain elastic modulus (72 +/- 25 vs 51 +/- 9, p <0.005). At the ascending thoracic aorta, only the pressure-strain elastic modulus was different between obese and lean subjects (85 +/- 42 vs 65 +/- 26 kPa, respectively; p <0.05), corresponding to a 31% difference-but arterial compliance and stiffness index were not significantly different between groups. In clinically healthy young adult obese men, obesity is associated with increased cross-sectional aortic area and decreased aortic elasticity.

Chirurgie de réduction de volume pulmonaire: Suivi des 26 premiers patients à Lausanne

Ce travail concerne les 26 premiers patients opérés à Lausanne de juillet 1995 à avril 1998 d?une gie de réduction de volume pulmonaire pour un emphysème sévère. Il présente leurs actéristiques préopératoires générales, leur évaluation radiologique et cardiologique, ainsi que mesures fonctionnelles pulmonaires. Il examine ensuite la technique opératoire, la période ériopératoire, ainsi que les résultats fonctionnels postopératoires des patients. De plus il présente les entretiens ayant eu lieu avec chaque patient pour connaître son évaluation de l?opération et de ges résultats. Ces informations sont ensuite comparées avec les résultats présents dans la littérature. Le profil préopératoire, la technique opératoire, la période péripopératoire, et les résultats fonctionnels postopératoires sont comparés. Un groupe de patients qui n?a pas répondu au point de vue fonctionnel A la chirurgie est ensuite examiné afin de tenter de définir des critères préopératoires de bonne ou mauvaise réponse, et ceux-ci sont mis en relation avec les données de la littérature. On compare ensuite le groupe de mauvais répondeurs fonctionnels avec le groupe des patients ne s?estimant pas améliorés par l?opération. En faisant une étude statistiques des valeurs fonctionnelles pré et postopératoire, on observe une amélioration significative du VEMS, du volume résiduel, de la PaC02, de la distance parcounie au test de marche de six minutes et de la dyspnée engendrée par le test sur une échelle de Borg. L?amélioration de la Pa02 postopératoire et de la saturation en oxygène pendant le test de marche n?était pas significative statistiquement. On peut voir que ce collectif de patients lausannois est comparable aux autres séries au niveau du profil préopératoire et de la gravité de l?atteinte fonctionnelle, au niveau de la technique opératoire, de la mortalité et morbidité, et des résultats fonctionnels postopératoires. On observe comme différence un volume résiduel moyen préopératoire plus élevé et davantage amélioré en postopératoire que dans la littérature. Cette étude ne met pas en évidence - et c?est également le cas dans la littérature - de critères clairs préopératoires prédictifs d?une bonne réponse à la chirurgie. De même elle n?a pas mis en évidence de concordance entre l?amélioration de la symptomatologie des patients et les résultats fonctionnels postopératoires. 11 serait donc intéressant de poursuivre ce travail par une évaluation prospective plus systématique des patients opérés et de pouvoir la comparer avec les résultats des patients récusés ou refusant la chirurgie de réduction de volume pulmonaire, afin de pouvoir mieux en évaluer les bénéfices à long terme.

Pontages veineux in situ. Indications, technique et résultats. A propos d'une étude prospective de 26 cas consécutifs [In situ venous grafts. Indications, technique and results. Prospective study of 26 consecutive cases].

The in situ saphenous vein bypass has been introduced in our department since 1989. A total of 26 bypasses in 22 patients have been followed prospectively. Indications for revascularisation have been severe arterial insufficiency in 73% of the cases (stage III or IV). With the exception of one postoperative death (myocardial infarction), all the patients have recovered uneventfully, with a regression to stage I. No amputation has been necessary. Morbidity has been 30%, with mainly minor local complications. The primary patency rate is 83% at one year and 78% after 2 and 3 years, whereas the secondary patency rate is 91% at one year, and remains constant thereafter up to 3 years. Considering our results and those from the literature, we believe that the in situ technique is very valuable, especially for below-knee vascular reconstruction. Technical difficulties of the method are analysed.

IUMSP : extraits de la bibliographie et liste compléte des références à l'occasion du 40ème anniversaire, 25-26 janvier 2011

ce document, multi-paginé, recense un choix d'articles publié entre les années 1970-2010 par les six Unités de l'Institut: UEC-RVT, UEPP, UEC-CEPIC, UPC, US, USS, GRSA

TH17 cells promote microbial killing and innate immune sensing of DNA via interleukin 26.

Interleukin 17-producing helper T cells (TH17 cells) have a major role in protection against infections and in mediating autoimmune diseases, yet the mechanisms involved are incompletely understood. We found that interleukin 26 (IL-26), a human TH17 cell-derived cytokine, is a cationic amphipathic protein that kills extracellular bacteria via membrane-pore formation. Furthermore, TH17 cell-derived IL-26 formed complexes with bacterial DNA and self-DNA released by dying bacteria and host cells. The resulting IL-26-DNA complexes triggered the production of type I interferon by plasmacytoid dendritic cells via activation of Toll-like receptor 9, but independently of the IL-26 receptor. These findings provide insights into the potent antimicrobial and proinflammatory function of TH17 cells by showing that IL-26 is a natural human antimicrobial that promotes immune sensing of bacterial and host cell death.

Neuroenergetic Response to Prolonged Cerebral Glucose Depletion after Severe Brain Injury and the Role of Lactate.

Lactate may represent a supplemental fuel for the brain. We examined cerebral lactate metabolism during prolonged brain glucose depletion (GD) in acute brain injury (ABI) patients monitored with cerebral microdialysis (CMD). Sixty episodes of GD (defined as spontaneous decreases of CMD glucose from normal to low [<1.0 mmol/L] for at least 2 h) were identified among 26 patients. During GD, we found a significant increase of CMD lactate (from 4±2.3 to 5.4±2.9 mmol/L), pyruvate (126.9±65.1 to 172.3±74.1 μmol/L), and lactate/pyruvate ratio (LPR; 27±6 to 35±9; all, p<0.005), while brain oxygen and blood lactate remained normal. Dynamics of lactate and glucose supply during GD were further studied by analyzing the relationships between blood and CMD samples. There was a strong correlation between blood and brain lactate when LPR was normal (r=0.56; p<0.0001), while an inverse correlation (r=-0.11; p=0.04) was observed at elevated LPR >25. The correlation between blood and brain glucose also decreased from r=0.62 to r=0.45. These findings in ABI patients suggest increased cerebral lactate delivery in the absence of brain hypoxia when glucose availability is limited and support the concept that lactate acts as alternative fuel.

Complications After Laparoscopic Roux-en-Y Gastric Bypass in 1573 Consecutive Patients: Are There Predictors?

BACKGROUND: Roux-en-Y gastric bypass (RYGBP), one of the commonest performed bariatric procedures, remains a technically challenging operation associated with significant morbidity in high-risk patients. This study was conducted in order to identify predictors of complications after laparoscopic RYGBP. METHODS: Our prospectively established database has been assessed to review 30-day and in-hospital complications graded according to a validated scoring system (Clavien-Dindo) and separated into minor (Clavien-Dindo I-IIIa) and major (Clavien-Dindo IIIb-IV) complications. Patient- and procedure-related factors were analyzed using univariate analysis. Significant factors associated with morbidity were introduced into a multivariate analysis to identify independent predictors. RESULTS: Between 1999 and 2012, 1573 patients underwent laparoscopic RYGBP, 374 male and 1199 female. Mean age was 41 years, and mean body mass index (BMI) was 44.5 kg/m(2). One hundred fifty-nine procedures were reoperations. One hundred fifty (9.5 %) patients developed at least one complication, and 43 (2.7 %) had major complications, leading to death in one case (0.06 %). Risk factors for morbidity were male gender (p = 0.006) and overall experience of the team (p < 0.0001). Prolonged 3-day antibiotic therapy was associated with significantly reduced overall (p < 0.0001) and major (p = 0.005) complication rates. Major complications were associated with smoking (p = 0.016). CONCLUSIONS: The most significant individual risk factors for early complications after RYGBP are male gender, limited surgical experience, and single dose of antibiotics. RYGBP should be performed by experienced teams. Smoking should be discontinued before surgery. Prolonged antibiotic therapy could be considered, especially if a circular stapled gastrojejunostomy is performed with the anvil introduced transorally.