Paracentèse abdominale [Abdominal paracentesis]

La paracentèse abdominale est un geste fréquemment réalisé en pratique clinique. Il est indispensable de procéder à ce geste dans un but diagnostique en cas d'ascite nouvellement mise en évidence. Chez un patient connu pour une ascite, chaque détérioration clinique ou des paramètres biologiques nécessite une nouvelle paracentèse. Ce geste peut être également réalisé dans un but thérapeutique en cas d'ascite réfractaire, d'inconfort abdominal ou de dyspnée. Comme pour toute procédure invasive, il convient d'en connaître les indications et contre-indications, le matériel nécessaire ainsi que les complications et leur traitement. Abdominal paracentesis is frequently performed in the clinical setting. Every newly developed ascites need to be investigated by abdominal paracentesis. Any clinical or biological deterioration in patients with chronic ascites also requires a new paracentesis. Therapeutically abdominal paracentesis is performed for refractory or symptomatic ascites. As other invasive procedures, it is critical to master its indications, contra-indications and complications. The aim of this article is to review the basics of abdominal paracentesis in order to help physicians to carry out this technical skill

Hémorragie intra-alvéolaire [Alveolar hemorrhage].

Diffuse alveolar hemorrhage (DAH) is defined by the presence of red blood cells originating from the lung capillaries or venules within the alveoli. The diagnosis is established on clinical features, radiological pattern, and especially bronchoalveolar lavage. Diffuse alveolar hemorrhage may have many immune or non-immune causes. Immune causes of DAH include vasculitides, connective tissue diseases, especially systemic lupus erythematosus, and antiglomerular basement membrane antibody disease (Goodpasture's syndrome). Treatment is both supportive and causal, often based on high dose corticosteroids and immunosuppressive therapy (especially intravenous cyclophosphamide). Plasma exchanges are performed in antiglomerular basement membrane antibody disease and systemic lupus erythematosus, and are considered in systemic vasculitis. Non-immune causes of DAH mainly include heart diseases, coagulation disorders, infections, drug toxicities and idiopathic DAH. Treatment of non-immune DAH is that of its cause. Whatever the cause, DAH is an emergency requiring prompt assessment and early treatment.

Níveis protéicos na ração de frangos de corte na fase de crescimento

O objetivo deste trabalho foi determinar o nível mínimo de proteína bruta para atender às exigências nutricionais de frangos de corte Hubbard, machos e fêmeas, na fase de crescimento. Oitocentos e oitenta pintos machos e fêmeas de 22 a 42 dias de idade foram distribuídos ao acaso em esquema fatorial 5x2 (níveis de proteína bruta x sexos), com quatro repetições de 22 aves. Os níveis de proteína testados foram 15%, 17%, 19%, 21% e 23%. Houve efeito quadrático dos níveis de proteína no ganho de peso e na conversão alimentar dos machos. Em relação às fêmeas, o efeito foi quadrático no ganho de peso e linear na conversão. A relação entre o rendimento de carcaça e o nível de proteína bruta da ração foi linear e independente do sexo. O consumo de ração, a gordura abdominal e o rendimento de peito foram influenciados apenas pelo sexo. Recomenda-se 21,70% de proteína bruta para os machos e 19,00% para as fêmeas, na fase de crescimento.

Comparaison de l'excrétion urinaire de methylprednisolone après injection unique de 80 mg par voie intra-articulaire ou péridurale

Introduction: Plusieurs études ont démontré qu'une injection unique de methylprednisolone était suivie d'une adsorption systémique significative (1) alors que cela ne semble pas être le cas si le produit est injecté par voie péridurale (2) Le but de ce travail est de comparer l'excrétion urinaire du produit, témoin de l'absortion sytémique après une injection unique de 80 mg de méthylprednisolone soit par voie intra-articulaire soit péridurale. Patients et Méthodes: 8 patients ont recu une injection de 80 mg methylprednisolone (4 par voie intra-articulaire 4 par voie péridurale).Ces dernières ont été pratiquées via le hiatus sacré sous contrôle fluoroscopique. Les injections intra articulaires ont été faites selon les repaires cliniques habituels dans les genoux. Les urines ont été prélevées 1 heure avant l'injection puis 4 x le premier jour, suivi de 3 receuils par semaine pendant 2 semaines. Les dosages urinaires comprennent la fraction libre et conjugée du stéroide. Ils ont été effectués dans le laboratoire d'analyse au centre universitaire romand de médecine légale. Résultats: Les résultats ont été exploités de facon à obtenir des cinétiques d'excrétion. Ils montrent de grandes différences individuelles surtout les patients ayant bénéficié d'une infiltration intra-articulaire. Après infiltrations intra-articulaires les concentrations maximales varient de 90 à 2500ng/ml pour la forme conjugée et de 60 à 4976 ng/ml pour la forme libre.La moyenne des taux individuels les plus élevés+ 3 SD est de 8269 ng/ml. Elles sont sigificativement inférieures après injection péridurale : pic maximaux de 40 à 483 ng/ml pour la forme conjugée et 40 à 80 ng/ml pour la forme libre. La moyenne des taux individuels les plus élevés est de 747 ng/ml. Dans les 2 cas le pic d'excrétion a lieu durant les 24 premières heures . L'éllimination est totale après 200 heures dans les deux situations. Conclusion: Cette étude confirme que l'absorption systémique de methylprednisolone est beaucoup plus faible après une infiltration péridurale que intra-articulaire, puisque son excrétion urinaire est moyenne 10 X inférieure. Le risque de complications systémiques secondaires à la corticothérapie est donc probablement négligeable après une infiltration péridurale.

Desempenho reprodutivo de fêmeas suínas inseminadas pela técnica intra-uterina ou tradicional

O desempenho reprodutivo de fêmeas suínas foi avaliado com o objetivo de comparar duas técnicas de inseminação. Foram inseminadas, em delineamento inteiramente casualizado, 608 fêmeas com ordem de parto de dois a quatro, em dois tratamentos: inseminação intra-uterina com 1,5 bilhão de espermatozóides em 60 mL e inseminação tradicional, com 3 bilhões em 90 mL. Foi possível introduzir o cateter intra-uterino em 97,4% das fêmeas e houve sangramento em 9,5%, as quais apresentaram retorno ao estro superior (p<0,05). O porcentual de volume refluído até duas horas após a inseminação foi maior (p<0,05) na inseminação intra-uterina do que na tradicional, enquanto o porcentual de espermatozóides refluídos foi semelhante. Não houve influência do porcentual de espermatozóides refluídos sobre a taxa de parto e tamanho da leitegada. Não houve diferença nas taxas de retorno ao estro (3,6% e 4,3%), de prenhez aos 21 dias (99,5% e 97,2%), de parto ajustada (94,9% e 94,3%) e tamanho da leitegada (11,6 e 11,8 leitões) entre os dois tratamentos, respectivamente. A inseminação intra-uterina permite a obtenção de desempenho reprodutivo semelhante ao observado na tradicional, porém com uso de menor número de espermatozóides.

Vectorisation intra-oculaire [Drug delivery to target the posterior segment of the eye].

Retinal diseases are nowadays the most common causes of vision threatening in developed countries. Therapeutic advances in this field are hindered by the difficulty to deliver drugs to the posterior segment of the eye. Due to anatomical barriers, the ocular biodisponibility of systemically administered drugs remains poor, and topical instillation is not adequate to achieve therapeutic concentrations of drugs in the back of the eye. Ocular drug delivery has thus become one of the main challenges of modern ophthalmology. A multidisciplinary research is being conducted worldwide including pharmacology, biomaterials, ophthalmology, pharmaceutics, and biology. New promising fields have been developed such as implantable or injectable slow release intravitreal devices and degradable polymers, dispersed polymeric systems for intraocular drug delivery, and transscleral delivery devices such as iontophoresis, osmotic pumps or intra-scleraly implantable materials. The first clinical applications emerging from this research are now taking place, opening new avenues for the treatment of retinal diseases.

Silagem de grãos úmidos de milho em substituição ao milho seco da ração de frangos de corte criados em dois sistemas

O objetivo do trabalho foi avaliar a inclusão de silagem de grãos úmidos de milho, em substituição ao milho seco, em rações para frangos de corte criados nos sistemas convencional e alternativo. Foram utilizados 720 pintos machos Cobb, com um dia de idade, distribuídos em blocos ao acaso, em esquema fatorial 2x3 (dois sistemas de criação: convencional e alternativo; três níveis de silagem de grãos úmidos, em substituição ao milho seco: 0%, 30% e 60%), com quatro repetições cada. Foram obtidas médias de peso, ganho de peso, consumo de ração, conversão alimentar, fator de produção e mortalidade aos 21, 42 e 49 dias de idades. Aos 49 dias, foram abatidas 28 aves, por tratamento, para determinação do rendimento de carcaça, cortes e gordura abdominal. A inclusão de até 60% de silagem de grãos úmidos, em substituição ao milho seco, reduziu o custo da ração, sem alterar o desempenho das aves aos 21, 42 e 49 dias, nem o rendimento de carcaça aos 49 dias. No sistema de criação alternativo, independentemente do nível de inclusão de silagem de grãos úmidos, o desempenho dos frangos foi inferior, porém o retorno econômico foi maior.

Dietas de baixa proteína no desempenho de frangos criados em diferentes temperaturas

O objetivo deste trabalho foi avaliar o desempenho de frangos, entre 42 e 49 dias, alimentados com dietas de baixa proteína e criados em diferentes temperaturas. Foram utilizados 360 frangos, machos, Cobb-500, distribuídos em um delineamento inteiramente ao acaso em esquema fatorial 3x3 (temperatura ambiente de 20, 25 e 32ºC e dietas com teores de proteína bruta de 18,0, 16,5 e 15,0%), com quatro repetições de dez aves cada. As dietas com baixa proteína prejudicaram o desempenho e a eficiência de retenção de nitrogênio dos frangos criados em 32ºC. Os rendimentos de carcaça e de coxa e sobrecoxa foram maiores nas aves criadas a 32ºC. Os demais cortes e a deposição de gordura abdominal não foram alterados. O estresse por calor reduziu o teor de proteína e aumentou o de gordura na coxa e sobrecoxa, ao passo que os teores protéicos não alteraram a composição bromatológica dos cortes. A utilização de dietas com baixa proteína piora o desempenho de frangos, de 42 a 49 dias, criados em estresse por calor. No entanto, essas dietas podem ser utilizadas em frangos criados em 20 ou 25ºC, pois não alteram o desempenho, a qualidade da carcaça e diminuem a excreção de nitrogênio.

Lambert-Eaton myasthenic syndrome revealing an abdominal neuroblastoma.

Lambert-Eaton myasthenic syndrome is a paraneoplastic syndrome that may reveal a primitive tumor. Neuroblastoma in children and small cell lung carcinoma in adults are the leading tumors revealed or expressed by paraneoplastic phenomena. The clinical neurologic manifestations of Lambert-Eaton myasthenic syndrome are muscular weakness, sleepiness, absence of reflexes, and dysautonomia. Neurologic manifestations are explained by the induction of an autoimmune response because of the presence of antigens that are expressed by the tumor. Neurologic paraneoplastic disorders may also be the result of toxicity of drugs, coagulopathy, infection, or metabolic diseases. We describe the case of a 13-month-old child with unusual neurologic symptoms because of the presence of an abdominal neuroblastoma.

Prenatal diagnosis of a fetal abdominal eventration: a rare congenital abdominal wall defect.

We report a case of abdominal eventration associated with cystic fibrosis, diagnosed by mid-trimester ultrasonography. The defect concerned the abdominal muscles and their aponevrotic sheath, but respected the skin. There was no associated malformation. The outcome was favorable after surgery, and the infant is well at the age of 6 months.

Moderate postnatal hyperoxia accelerates lung growth and attenuates pulmonary hypertension in infant rats after exposure to intra-amniotic endotoxin.

To determine the separate and interactive effects of fetal inflammation and neonatal hyperoxia on the developing lung, we hypothesized that: 1) antenatal endotoxin (ETX) causes sustained abnormalities of infant lung structure; and 2) postnatal hyperoxia augments the adverse effects of antenatal ETX on infant lung growth. Escherichia coli ETX or saline (SA) was injected into amniotic sacs in pregnant Sprague-Dawley rats at 20 days of gestation. Pups were delivered 2 days later and raised in room air (RA) or moderate hyperoxia (O₂, 80% O₂ at Denver's altitude, ∼65% O₂ at sea level) from birth through 14 days of age. Heart and lung tissues were harvested for measurements. Intra-amniotic ETX caused right ventricular hypertrophy (RVH) and decreased lung vascular endothelial growth factor (VEGF) and VEGF receptor-2 (VEGFR-2) protein contents at birth. In ETX-exposed rats (ETX-RA), alveolarization and vessel density were decreased, pulmonary vascular wall thickness percentage was increased, and RVH was persistent throughout the study period compared with controls (SA-RA). After antenatal ETX, moderate hyperoxia increased lung VEGF and VEGFR-2 protein contents in ETX-O₂ rats and improved their alveolar and vascular structure and RVH compared with ETX-RA rats. In contrast, severe hyperoxia (≥95% O₂ at Denver's altitude) further reduced lung vessel density after intra-amniotic ETX exposure. We conclude that intra-amniotic ETX induces fetal pulmonary hypertension and causes persistent abnormalities of lung structure with sustained pulmonary hypertension in infant rats. Moreover, moderate postnatal hyperoxia after antenatal ETX restores lung growth and prevents pulmonary hypertension during infancy.

Farelo de castanha de caju em rações para frangos de corte

O objetivo deste trabalho foi avaliar o desempenho de frangos de corte alimentados com ração com farelo de castanha de caju (FCC). O delineamento experimental foi inteiramente casualizado, com seis tratamentos e oito repetições de 15 aves cada. Os tratamentos consistiram em seis rações isonutrientes com inclusão de 0, 5, 10, 15, 20 e 25% de ração com farelo de castanha de caju. O consumo de ração não foi influenciado pelos tratamentos. Entretanto, o aumento do FCC na ração promoveu aumento linear no ganho de peso, em todas as fases, e melhora linear na conversão alimentar, na fase inicial e no período total. Em relação ao controle, observou-se que, na fase inicial, as aves alimentadas com a ração com 25% de FCC apresentaram maior ganho de peso e melhor conversão alimentar. Na fase final e no período total de criação, a conversão melhorou a partir de 10% de inclusão, enquanto o ganho de peso foi maior a partir de 15% de inclusão. O rendimento de carcaça e a gordura abdominal não foram influenciados; os índices econômicos melhoraram com a inclusão do FCC. O FCC pode ser incluído nas rações de frangos de corte em proporções de até 25%.

Late Cretaceous to Eocene geology of the South Central American forearc area (southern Costa Rica and western Panama) : initiation and evolution of an intra-oceanic convergent margin

Résumé : L'arc volcanique du sud de l'Amérique Centrale se situe sur la marge SW de la Plaque Caraïbe, au-dessus des plaques subduites de Cocos et Nazca. Il s'agit de l'un des arcs intra-océaniques les plus étudiés au monde, qui est généralement considéré comme s'étant développé à la fin du Crétacé le long d'un plateau océanique (le Plateau Caraïbe ou CLIP) et se trouvant actuellement dans un régime de subduction érosive. Au cours des dernières décennies, des efforts particuliers ont été faits pour comprendre les processus liés à la subduction sur la base d'études géophysiques et géochimiques. Au sud du Costa Rica et à l'ouest du Panama, des complexes d'accrétions et structures à la base de l'arc volcanique ont été exposés grâce à la subduction de rides asismiques et de failles transformantes. Des affleurements, situés jusqu'à seulement 15 km de la fosse, offrent une possibilité unique de mieux comprendre quelques uns des processus ayant lieu le long de la zone de subduction. Nous présentons de nouvelles contraintes sur l'origine de ces affleurements en alliant une étude de terrain poussée, de nouvelles données géochimiques, sédimentaires et paléontologiques, ainsi que des observations structurales effectuées en télédétection. Une nouvelle stratigraphie tectonique entre le Campanien et l'Éocène est définie pour la région d'avant-arc située entre la Péninsule d'Osa (Costa Rica) et la Péninsule d'Azuero (Panama). Nos résultats montrent que la partie externe de la marge est composée d'un arrangement complexe de roches ignées et de séquences sédimentaires de recouvrement qui comprennent principalement le socle de l'arc, des roches d'arc primitif, des fragments de monts sous-marins accrétés et des mélanges d'accrétion. Des preuves sont données pour le développement de l'arc volcanique du sud de l'Amérique Centrale sur un plateau océanique. Le début de la subduction le long de la marge SW de la Plaque Caraïbe a eu lieu au Campanien et a généré des roches d'arc primitif caractérisées par des affinités géochimiques particulières, globalement intermédiaires entre des affinités de plateau et d'arc insulaire. L'arc était mature au Maastrichtien et formait un isthme essentiellement continu entre l'Amérique du Nord et l'Amérique du Sud. Ceci a permis la migration de faunes terrestres entre les Amériques et pourrait avoir contribué à la crise fin Crétacé -Tertiaire en réduisant les courants océaniques subéquatoriaux entre le Pacifique et l'Atlantique. Plusieurs unités composées de fragments de monts sous-marins accrétés sont définies. La nature et l'arrangement structural de ces unités définissent de nouvelles contraintes sur les modes d'accrétion des monts sous-marins/îles océaniques et sur l'évolution de la marge depuis la formation de la zone de subduction. Entre la fin du Crétacé et l'Éocène moyen, la marge a enregistré plusieurs épisodes ponctuels d'accrétion de monts sous-marins alternant avec de la subduction érosive. A l'Éocène moyen, un événement tectonique régional pourrait avoir causé un fort couplage entre les plaques supérieure et inférieure, menant à des taux plus important d'accrétion de monts sous-marins. Durant cette période, la situation le long de la marge était très semblable à la situation actuelle et caractérisée par la présence de monts sous-marins subductants et l'absence d'accrétion de sédiments. L'enregistrement géologique montre qu'il n'est pas possible d'attribuer une nature érosive ou accrétionnaire à la marge dans le passé ou -par analogie- aujourd'hui, parce que (1) les processus d'accrétion et érosifs varient fortement spatialement et temporellement et (2) il est impossible d'évaluer la quantité exacte de matériel tectoniquement enlevé à la marge depuis le début de la subduction. Au sud du Costa Rica, certains fragments de monts sous-marins accrétés sont représentatifs d'une interaction entre une ride et un point chaud dans le Pacifique au Crétacé terminal/Paléocène. L'existence de ces fragments de monts sous-marins et la morphologie du fond de l'Océan Pacifique indiquent que la formation de la ride de Cocos-Nazca s'est formée au moins ~40 Ma avant l'âge proposé par les modèles tectoniques actuels. Au Panama, nous avons identifié une île océanique d'âge début Éocène qui a été accrétée à l'Éocène moyen. L'accrétion a eu lieu à très faible profondeur par détachement de l'île dans la fosse, et a mené à une exceptionnelle préservation des structures volcaniques. Des affleurement comprenant aussi bien des parties basses et hautes de l'édifice volcanique on été étudiées, depuis la phase sous-marine bouclier jusqu'à la phase subaérienne post-bouclier. La stratigraphie nous a permis de différencier les laves de la phase sous-marine de celles de la phase subaérienne. La composition des laves indique une diminution progressive de l'intensité de la fusion partielle de la source et une diminution de la température des laves produites durant les derniers stades de l'activité volcanique. Nous interprétons ces changements comme étant liés à l'éloignement progressif de l'île océanique de la zone de fusion ou point chaud. Abstract The southern Central American volcanic front lies on the SW edge of the Caribbean Plate, inboard of the subducting Cocos and Nazca Plates. It is one of the most studied intra-oceanic convergent margins around the world, which is generally interpreted to have developed in the late Cretaceous along an oceanic plateau (the Caribbean Large Igneous Province or CLIP) and to be currently undergoing a regime of subduction erosion. In the last decades a particular effort has been made to understand subduction-related processes on the basis of geophysical and geochemical studies. In southern Costa Rica and western Panama accretionary complexes and structures at the base of the volcanic front have been exposed in response to subduction of aseismic ridges and transforms. Onland exposures are located as close as to 15 km from the trench and provide a unique opportunity to better understand some of the processes occurring along the subduction zone. We provide new constraints on the origins of these exposures by integrating a comprehensive field work, new geochemical, sedimentary and paleontological data, as well as structural observations based on remote imaging. A new Campanian to Eocene tectonostratigraphy is defined for the forearc area located between the Osa Peninsula (Costa Rica) and the Azuero Peninsula (Panama). Our results show that the outer margin is composed of a complicated arrangement of igneous complexes and overlapping sedimentary sequences that essentially comprise an arc basement, primitive island-arc rocks, accreted seamount fragments and accretionary mélanges. Evidences are provided for the development of the southern Central American arc on the top an oceanic plateau. The subduction initiation along the SW edge of the Caribbean Plate occurred in the Campanian and led to formation of primitive island-arc rocks characterized by unusual geochemical affinities broadly intermediate between plateau and arc affinities. The arc was mature in the Maastrichtian and was forming a predominantly continuous landbridge between the North and South Americas. This allowed migration of terrestrial fauna between the Americas and may have contributed to the Cretaceous-Tertiary crisis by limiting trans-equatorial oceanic currents between the Pacific and the Atlantic. Several units composed of accreted seamount fragments are defined. The nature of the units and their structural arrangement provide new constraints on the modes of accretion of seamounts/oceanic islands and on the evolution of the margin since subduction initiation. Between the late Cretaceous and the middle Eocene, the margin recorded several local episodes of seamount accretion alternating with tectonic erosion. In the middle Eocene a regional tectonic event may have triggered strong coupling between the overriding and subducting plates, leading to higher rates of seamount accretion. During this period the situation along the margin was very similar to the present and characterized by subducting seamounts and absence of sediment accretion. The geological record shows that it is not possible to ascribe an overall erosive or accretionary nature to the margin in the past and, by analogy, today, because (1) accretionary and erosive processes exhibit significant lateral and temporal variations and (2) it is impossible to estimate the exact amount of material tectonically eroded from the margin since subduction initiation. In southern Costa Rica, accreted seamount fragments point toward a plume-ridge interaction in the Pacific in the late Cretaceous/Paleocene. This occurrence of accreted seamount fragments and morphology of the Pacific Ocean floor is indicative of the formation of the Cocos-Nazca spreading system at least ~40 Ma prior to the age proposed in current tectonic models. In Panama, we identified a remarkably-well preserved early Eocene oceanic island that accreted in the middle Eocene. The accretion probably occurred at very shallow depth by detachment of the island in the trench and led to an exceptional preservation of the volcanic structures. Exposures of both deep and superficial parts of the volcanic edifice have been studied, from the submarine-shield to subaerial-postshield stages. The stratigraphy allowed us to distinguish lavas produced during the submarine and subaerial stages. The lava compositions likely define a progressive diminution of source melting and a decrease in the temperature of erupted melts in the latest stages of volcanic activity. We interpret these changes to primarily reflect the progressive migration of the oceanic island out of the melting region or hotspot.

Anévrismes complexes de l'aorte abdominale: la chirurgie ouverte est-elle obsolète [The complex aortic abdominal aneurysm: is open surgery old fashion?].

Open surgery is still the main treatment of complex abdominal aortic aneurysm. Nevertheless, this approach is associated with major complications and high mortality rate. Therefore the fenestrated endograft has been used to treat the juxtarenal aneurysms. Unfortunately, no randomised controlled study is available to assess the efficacy of such devices. Moreover, the costs are still prohibitive to generalise this approach. Alternative treatments such as chimney or sandwich technique are being evaluated in order to avoid theses disadvantages. The aim of this paper is to present the endovascular approach to treat juxtarenal aneurysm and to emphasize that this option should be used only by highly specialized vascular centres.