Lésions iatrogènes des voies biliaires lors de la cholécystectomie laparoscopique

Objective: Laparoscopic cholecystectomy (LC) has become the gold standard in the treatment of symptomatic cholelithiasis. The aim of this study was to determine the frequency of occurrence and risk factors of iatrogenic bile duct injuries (IBDI) in the LC and study their treatment modalities. Methods: Between January 2000 and December 2011, a series of 13 patients (6 men, 7 women, mean age 66.7 years, mean BMI 27.9 kg/m2) underwent IBDI in our institution for 2'840 LC performed. These patients were identified retrospectively using a wide range of classification codes in our medical center for archiving. Their medical records were examined individually to identify a IBDI. Results: The frequency of IBDI was 0.46% (n=13). The most common indication for surgery was acute cholecystitis (69.2%). The main cause was the confusion of the common bile duct with the cystic duct in 38.5% of cases. Strasberg classification applied to our sample identified the following injuries: A (n=4), D (n=4), E1 (n=3) and E5 (n=2). They were diagnosed intraoperatively in 46.2% of cases and postoperatively in 53.8% of cases. The rate of type D lesions was significantly higher in the group with intraoperative recognition (p= 0.009), while the rate of type A lesions was significantly higher in the group with postoprative recognition (p = 0.026). Intraoperatively, 83.3% of the lesions were treated by primary suture with a biliary drainage and a hepatico-jejunal anastomosis was performed immediately in one case (16.7%). Postoperatively, 85.7% of the lesions were treated by non-surgical techniques in first- line and 4 of them have undergone biliary surgery later. The total number of therapeutic procedures for each IBDI after LC was significantly higher when the diagnosis was made postoperatively (3.4 vs. 1.5, p= 0.040). Conclusion: This study has identified a patient at risk of IBDI, this one is relatively old, overweight and has an inflammatory environment. Misidentification of biliary anatomy remains the main cause. There is a clear relationship between the timing of recognition and the type of injury involved. The primary suture with adequate drainage seems to be the method of choice for intraoperative discovery, while in case of postoperative recognition, the treatment must be adapted after a multidisciplinary consensus by combining interventional radiology, endoscopy and surgery.

Smoked cannabis and doping control: looking for the wrong target analyte?

Introduction: Since 2004, cannabis is prohibited by the World Anti-Doping Agency (WADA) for all sports in competition. In the years since then, about half of all positive doping cases in Switzerland have been related to cannabis consumption. In most cases, the athletes plausibly claim to have consumed cannabis several days or even weeks before competition and only for recreational purposes not related to competition. In doping analysis, the target analyte in urine samples is 11-nor-delta-9-tetrahydrocannabinol- 9-carboxylic acid (THC-COOH), the reporting threshold for laboratories is 15 ng/mL. However, the wide detection window of this long-term THC metabolite in urine does not allow a conclusion concerning the time of consumption or the impact on the physical performance. Aim: The purpose of the present pharmacokinetic study on volunteers was to evaluate target analytes with shorter urinary excretion time. Subsequently, urines from athletes tested positive for cannabis should be reanalyzed including these analytes. Methods: In an one-session clinical trial (approved by IRB, Swissmedic, and Federal Office of Public Health), 12 healthy, male volunteers (age 26 ± 3 yrs, BMI 24 ± 2 kg/m2) with cannabis experience (> once/month) smoked a Cannabis cigarette standardized to 70 mg THC/cigarette (Bedrobinol® 7%, Dutch Office for Medicinal Cannabis) following a paced-puffing procedure. Plasma and urine was collected up to 8 h and 11 days, respectively. Total THC, 11-hydroxy-THC (THC-OH), and THC-COOH were determined after enzymatic hydrolyzation followed by SPE and GC/MS-SIM. The limit of quantitation (LOQ) for all analytes was 0.1 ng/mL. Visual analog scales (VAS) and vital functions were used for monitoring psychological and somatic side-effects at every timepoint of specimen collection (up to 480 min). Results: Eight puffs delivered a mean THC dose of 45 mg. Mean plasma levels of total THC, THC-OH and THC-COOH were measured in the range of 0.1-20.9, 0.1-1.8, and 1.8-7.5 ng/mL, respectively. Peak concentrations were observed at 5, 10, and 90 min. Mean urine levels were measured in the range of 0.1-0.7, 0.10-6.2, and 0.1-13.4 ng/mL, respectively. The detection windows were 2-8, 2-96, and 2-120 h. No or only mild effects were observed, such as dry mouth, sedation, and tachycardia. Besides high to very high THC-COOH levels (0-978 ng/mL), THC (0.1-24 ng/mL) and THC-OH (1-234 ng/mL) were found in 90 and 96% of the cannabis-positive urines from athletes. Conclusion: Instead of or in addition to THC-COOH, the pharmacologically active THC and THC-OH should be the target analytes for doping urine analysis. This would allow the estimation of more recent Cannabis consumption, probably influencing performance during competition. Keywords: cannabis, doping, clinical trial, plasma and urine levels, athlete's samples

Prevalence of normal weight obesity in Switzerland: effects of various definitions

Background: normal weight obesity (NWO) is defined as an excessive body fat associated with a normal body mass index (BMI<25 kg/m2), but its prevalence in the general population is unknown. Objective: to assess the prevalence of NWO in Switzerland according to different cut points used to define excess body fat. Design: cross-sectional study including 3,213 women and 2,912 men aged 35-75 years. Body fat was assessed by bioimpedance and prevalence of NWO was assessed using four previously published definitions for excess body fat. Results: % body fat increased with age: in men, the values (mean SD) were 20.2 5.4, 23.0 5.4, 26.3 5.2 and 28.2 4.6 for age groups [35 - 44], [45 - 54], [55 - 64] and [65 - 75] years, respectively; the corresponding values for women were 29.9 7.8, 33.1 7.4, 36.7 7.5 and 39.6 6.9. In men, prevalence of NWO was <1% irrespective of the definition used. Conversely, in women, a one to twenty fold difference (from 1.4% to 27.8%) in NWO prevalence was found. The prevalence of NWO increased with age when age-independent cut points were used in women, but not in men. Conclusions: prevalence of NWO is low in the general population and higher in women than in men. The prevalence is highly dependent on the criteria used to define excess body fat, namely in women. The use of gender- and age-specific cut points to define excess body fat is better than fixed or gender-specific only cut points.

Adiponectin and C-reactive protein are positively associated with microalbuminuria in an adult Caucasian population

Objective: Microalbuminuria (MAU) is a marker of early kidney injury and cardiovascular risk. We assessed the association of MAU with plasma adiponectin, leptin, and hsCRP as inflammatory marker, accounting for hypertension, diabetes and obesity. Design and Methods: Population based, cross-sectional study in Caucasian subjects aged 35 to 75 years in Lausanne, Switzerland. MAU, measured by quantitative immunonephelometry on spot morning urine, was used either as a continuous (MAU) or dichotomized variable (MA defined as MAU > 2.5 and >3.5 mg/mmol creatinine in men and women, respectively). Results: The 2955 women (age 53.3_10.7, mean_SD years) had mean body mass index (BMI) 24.9_4.5 kg/m. The 2479 men (age 53.1_10.8 years) hadmean BMI 27.0_3.9 kg/m2.Median hsCRP was 1.3 and 1.3 mg/L, median adiponectin 6.2 and 10.6mg/mL in men and women, respectively. MA prevalence was 4.9% in women and 9.8% in men. In multivariate regression analysis adjusting for potential confounders (age, sex, hypertension, diabetes, eGFR, BMI, percent fat mass, insulin and smoking), logtransformed MAU was positively associated with hsCRP (P<0.001) and adiponectin (P¼0.002), but not with leptin. The association of adiponectin with MAU was stronger in subjects with low hsCRP, and vice versa (P interaction<0.001). Conclusion: Adiponectin and hsCRP are significant positive determinants of MAU, independently of diabetes, hypertension and fat mass. A negative interaction between hsCRP and adiponectin was found for their effect on MAU. Whether hyperadiponectinemia represents an adequate protective response to vascular stress or has negative causal impact on the development of MAU should be assessed in further studies.

Mediastinal lymph node clearance after docetaxel-cisplatin neoadjuvant chemotherapy is prognostic of survival in patients with stage IIIA pN2 non-small-cell lung cancer: a multicenter phase II trial.

PURPOSE: A multicenter, phase II trial investigated the efficacy and toxicity of neoadjuvant docetaxel-cisplatin in locally advanced non-small-cell lung cancer (NSCLC) and examined prognostic factors for patients not benefiting from surgery. PATIENTS AND METHODS: Ninety patients with previously untreated, potentially operable stage IIIA (mediastinoscopically pN2) NSCLC received three cycles of docetaxel 85 mg/m2 day 1 plus cisplatin 40 mg/m2 days 1 and 2, with subsequent surgical resection. RESULTS: Administered dose-intensities were docetaxel 85 mg/m2/3 weeks (range, 53 to 96) and cisplatin 95 mg/m2/3 weeks (range, 0 to 104). The 265 cycles were well tolerated, and the overall response rate was 66% (95% confidence interval [CI], 55% to 75%). Seventy-five patients underwent tumor resection with positive resection margin and involvement of the uppermost mediastinal lymph node in 16% and 35% of patients, respectively (perioperative mortality, 3%; morbidity, 17%). Pathologic complete response occurred in 19% of patients with tumor resection. In patients with tumor resection, downstaging to N0-1 at surgery was prognostic and significantly prolonged event-free survival (EFS) and overall survival (OS; P =.0001). At median follow-up of 32 months, the median EFS and OS were 14.8 months (range, 2.4 to 53.4) and 33 months (range, 2.4 to 53.4), respectively. Local relapse occurred in 27% of patients with tumor resection, with distant metastases in 37%. Multivariate analyses identified mediastinal clearance (hazard ratio, 0.22; P =.0003) and complete resection (hazard ratio, 0.26; P =.0006) as strongly prognostic for increased survival. CONCLUSION: Neoadjuvant docetaxel-cisplatin is effective and tolerable in stage IIIA pN2 NSCLC. Resection is recommended only for patients with mediastinal downstaging after chemotherapy.

Does lipid oxidation differ in gynoid and android obese women?

This study was performed to investigate whether body fat distribution influences resting metabolic rate and lipid oxidation in obese individuals. Eighty-nine obese women were divided in two groups (android obese, n = 36, BMI = 31.1 +/- 4.5 kg/m2 (mean +/- s.d.); gynoid obese, n = 53, BMI = 29.9 +/- 4.5 kg/m2 on the basis of their waist/hip ratio (0.86 +/- 0.05 vs 0.75 +/- 0.04 respectively). Body weight, per cent body fat and fat-free mass were similar in the two groups. Moreover, resting metabolic rate and respiratory quotient were also identical in android and gynoid obese women, indicating that there was no intergroup difference in the absolute level of lipid oxidation. If, like most other android obese women, they had higher rates of lipolysis and plasma FFA concentrations, the failure of android obese individuals to exhibit a higher lipid oxidation than gynoid obese women may partly explain their increased risk to develop metabolic complications.

Die Töpferin und der Schmied : Basel-Gasfabrik, Grabung 1989/5

RésuméDie Grabung 1989/5 der Archäologischen Bodenforschung Basel-Stadt im Zentrum der Siedlung Basel-Gasfabrik umfasste eine Fläche von etwa 900 m2. Auf etwa 370 m2 konnten intakte latènezeitliche Strukturen festgestellt werden. Der ehemalige Gehhorizont und die darunter liegende Siedlungsschicht waren jedoch nirgends erhalten geblieben.Die in den gewachsenen Boden eingetieften Pfostengrub en erlaubten die Rekonstrulction von zwei rechteckigen Häusern mit je vier Eckpfosten, die als Wohngebäude gedeutet werden.Über das ganze Areal verteilt wurden 14 Gruben unterschiedlicher Form und Grösse ganz oder teilweise ausgegraben. Bei der flachen Grube 261 handelt es sich wohl um den eingetieften Bereich eines kleinen Grubenhauses, das für nicht näher bestimmbare handwerkliche Aktivitäten genutzt wurde. Die beiden mit einem Pfostenbau überdeckten Gruben 258 und 259 können hingegen mit grosser Wahrscheinlichkeit als Schmiedegruben gedeutet werden. In Grube 258 waren gar die Reste von zwei Feuerstellen und der Unterbau eines kaminartigen Abzugs in situ erhalten. Die Gruben 253, 254A, 254B, 255,256 und 257 mit Resten von Lehmausideidungen dienten vermutlich als Getreidesilos. Sie liegen alle im Zentrum des Grabungsareals im Bereich einer anstehenden Lehmschicht. Bei einigen weiteren Gruben könnte es sich um Keller handeln.Im Westen der Grabungsfläche kamen die Heizkanäle von zwei Töpferöfen zum Vorschein. Es handelt sich um einfache Kuppelöfen mit gegenständiger Feuerung. In geringer Entfernung lagen drei kleine Gruben, die vielleicht zur Aufbereitung des Töpferlehms dienten. Aufgrund der klimatischen Verhältnisse ist mit einem saisonalen Betrieb der Töpferöfen während der Sommermonate zu rechnen. Die notwendigen Arbeiten wurden mit grosser Wahrscheinlichkeit von Frauen ausgeführt, da die Männer während dieser Jahreszeit in der Landwirtschaft beschäftigt waren. Der Töpfereibetrieb produzierte grössere Serien scheibengedrehter, reduzierend gebrannter Feinkeramik, von der im Bereich der Öfen zahlreiche Scherben gefunden wurden.Die räumliche Organisation der Bebauung zeugt von einer einheitlichen und wohl kontinuierlichen Nutzung der Grabungsfläche. ImWesten gruppieren sich Haus 1 und die Einrichtungen des Töpfereibetriebs um eine unbebaute Hofzone. Nach Osten zu folgt dann die Zone mit den Getreidesilos. Das östliche Bauensemble besteht aus Haus 2, den Schmiedegruben, dem Grubenhaus sowie einer mutmasslichen Kellergrube. Stratigra-phische Überschneidungen von Befunden sind nur im Bereich der Töpferöfen vorhanden.Die Grubenfüllungen erwiesen sich als sehr fundreich. Die gegen 20000 Keramikscherben repräsentieren das gesamte Spektrum der aus Basel-Gasfabrik bekannten einheimischen Grobund Feinkeramik. Bei den seltenen Scherben von Graphittonkeramik handelt es sich um Importe aus dem ostkeltischen Bereich.Die zahlreichen Amphorenscherben stammen von mindestens 35 verschiedenen Gefässindividuen des Typs Dressel 1A, von denen aber immer nur ein kleiner Prozentsatz vorhanden war. Die Typologie und die Datierung der Befunde zeigen, dass der Amphorenimport erst im Laufe von LT D1 einsetzte.Unter den Kleinfunden verdienen die zahlreichen Silber- und Potinmünzen sowie die Glasfunde besondere Erwähnung. Das Fragment eines möglicherweise latènezeitlichen Glasgefässes stammt leider aus einem unsicheren Fundzusammenhang.Die über 70 Fibeln und Fibelteile sind zu 70% aus Bronze gefertigt. Das Fibelspektrum wird von den Nauheimer Fibeln dominiert. Besonders bei den Eisenfibeln konnten aber auch typologisch ältere Typen identifiziert werden, welche in die Stufen LT C2 und LT D1a gehören. Bei den Glasarmringen machen mittellatènezeitliche Typen gegen 20 % der Fundmenge aus.Von besonderer Bedeutung sind die 23 Menschenknochen von 19 verschiedenen Individuen. Es handelt sich dabei um einen fast vollständigen Schädel, Schädelteile und Fragmente von Langknochen sowie wenige weitere Skelettteile. Die Zusammensetzung des Ensembles und der Zustand der Einzelknochen lässt sich sehr gut mit den Menschenknochen aus den Altgrabungen von Basel-Gasfabrik und aus Manching vergleichen. Eine detaillierte Untersuchung zeigt, dass die Knochen am Ende eines langwierigen Totenrituals, das aufgrund ethno - logischer Vergleiche als mehrstufige Bestattung bezeichnet werden kann, in der Siedlung vergraben wurden. In der Umgebung der Menschenknochen wurden in einigen Fällen auffallend viele Amphorenscherben gefunden, die bezeugen, dass der importierte Wein bei diesen Riten eine bedeutende Rolle spielte. Wahrscheinlich wurden diese Knochen auch als Ahnenrelikte verehrt.Neben den mehrstufigen Bestattungen konnten auch zwei Säuglingsbestattungen identifiziert werden.Die Analyse von Fundmenge und Fundverteilung in den Gruben zeigt, dass die Funde nicht direkt, sondern auf dem Umweg über primäre Deponien in die Gruben gelangten. In den pri-mären Deponien wurden Funde über längere Zeit akkumuliert und mit verschiedenen Erdmaterialien intensiv vermischt.Für den Grossteil der Funde wird eine profane Deutung als Abfälle vorgeschlagen. Daneben können aber auch einige Funde als gezielte Deponierungen angesprochen werden. Ver-schiedene Fibelpaare und wahrscheinlich auch Münzen wurden wohl als Opfergaben in die Gruben gegeben. Ein Zusammenhang dieser Opfergaben mit den Bestattungen von Men-schenknochen ist nicht erkennbar.Die Datierung der Funde zeigt einen Siedlungsbeginn in LT C2 und ein Ende noch vor dem Beginn der Stufe LT D2. Die Kombination dieser Datierungen mit den stratigraphischen Überschneidungen einiger Befunde erlaubt eine Rekonstruktion der Besiedlungsentwicklung auf dem Grabungsareal. Die Gruben 259 und 260 wurden bereits in LT C2 verfüllt, die Schmiedegrube 259 anschliessend durch Grube 258 ersetzt. Die beiden Töpferöfen waren nacheinander in LT D1 in Betrieb. Die beiden Häuser können leider nicht genauer datiert werden.Die Besiedlung des Area's setzte noch vor 150 V. Chr. ein und dauerte maximal 80 Jahre.Die Synthese aller Untersuchungen zeigt, dass auf dem Grabungsareal eine Gruppe von etwa 15 Personen ansässig war, die sich v. a. der Landwirtschaft widmete. Die handwerkliche Tätigkeit (Töpferei, Metallverarbeitung) erreichte keinen vollberuflichen Standard.Die dörfliche Siedlungsgemeinschaft bestand aus bäuerlichen Selbstversorgern, mit anderen Gemeinschaften wurden jedoch Keramik, Handwerksprodukte und Schlachtvieh ausge-tauscht. Von besonderer Bedeutung war offenbar das Getreide, das in grossen Mengen in der Siedlung gelagert wurde und mit grosser Wahrscheinlichkeit für den Export bestimmt war. Die Herkunft dieses Getreides und die sozialen Strukturen hinter diesem Austausch sind nicht ldar, aber mit hoher Wahrscheinlichkeit wurden durch den Getreideexport die Importe wie Salz, Rohstoffe (Metall) und Wein ermöglicht.

Evaluación de la respuesta cardiovascular a dobutamina en la disfunción miocárdica asociada al shock séptico

Objetivos: 1. Evaluar la respuesta cardiovascular a dobutamina en la disfunción miocárdica secundaria a shock séptico. 2. Determinar si el análisis de la respuesta cronotrópica refleja la respuesta inotrópica. Material y métodos: pacientes con shock séptico y disfunción miocárdica (Fracción eyección ventrículo izquierdo, FEVI < 45%) que recibieron dobutamina (5 µg/kg/min) por persistencia de hipoperfusión tisular. Antes y 30 min después de su administración se recogieron parámetros ecocardiográficos y parámetros hemodinámicos. Datos: media y SD. Análisis estadístico mediante test de Wilcoxon /Mann Whitney. Resultados: Se incluyeron 22 pacientes. Dobutamina produjo un incremento significativo en la FC (90 ± 17 vs 107 ± 20 lpm, p < 0.0001), la FEVI (34 ± 7 vs 47 ± 10 %, p < 0.0001), el VSi eco (24.9 ± 5.9 vs 30 ± 7.4 ml/m2, p < 0.01) y el VSi td (28.6 ± 10.3 vs 34.7 ± 13.8 ml/m2, p < 0.005). Sólo tres pacientes no incrementaron ni FC ni VSi td. Respuesta cronotrópica significativa: sensibilidad 69% y especificidad 37% para detectar la respuesta inotrópica. Conclusiones: Dobutamina mejora la función cardiovascular en la disfunción miocárdica asociada a sepsis.

La postcollita de la cirera

 Treball de recerca realitzat per un alumne d’ensenyament secundari i guardonat amb un Premi CIRIT per fomentar l'esperit científic del Jovent l’any 2010.Objectius del projecte: Determinar les característiques físiques de cada varietat de cirera, mesurant la fermesa i els graus brix (sucre). Avaluar el comportament dels fruits (cireres) en les seves característiques físiques i sensorials als dies 0 i 7 de l'inici de la collita. Avaluar l'efecte de la inducció de pitting a cada varietat per determinar quina és millor per al mercat d'exportació. Determinar la vida útil de la cirera varietat Sweet Heart i Sweet Late. Passos seguits: collir dels fruits i una posterior tria d'aquests. Aquests fruits van ser sotmesos a un tractament d'inducció de pitting per una part i a un anàlisi sensorial per l'altra. Aquests tractaments es van realitzar a fi de poder determinar quina de les dos varietats escollides era la millor per al mercat internacional. A l'anàlisi sensorial es van poder determinar els paràmetres de textura, maduració, sabor... En les dos varietats, la CSS és més alta amb (M2); Ja que a mesura que augmenta el grau de maduració dels fruits, la CSS també augmenta. La fermesa disminueix a mesura que augmenta la maduració. En les dues varietats, el majors percentatges d'acceptació van ser per (M2). No obstant, Sweet Late va resultar la varietat amb major grau de rebuig. La varietat Sweet Heart, amb M2, va reflexar una menor aparició de pitting. La que va tenir el millor comportament al tractament d'inducció va ser la varietat Sweet Heart, que va obtenir una menor diferència entre els diferents estats de maduració.

High-dose sequential chemotherapy (ICE) under circulating progenitor cells (CPC) protection in patients with small cell lung carcinoma (SCLC). Preliminary report on a multicentric study

Starting in February 1994, 20 patients (pt) with a median age of 50 years(range 41-63) from 7 European centers have been included. Completedata were obtained in 16 patients so far. CPC were mobilized with chemo(Epirubicine 75 mg/m2 /d, 01 + 02) followed by G-CSF 5 p.gfkg/d for14 days. HD chemo consisted in 3 sequential courses of ICE regimen(UOs. 10 g/m2 , Carbo. 1200 mg/m2 and Etop. 1200 mg/m2 ) underCPC protection and G-CSF 5 p.g/kg/d. Out of the 16 pt, 12 completedfull program (3 cycles). One pt died of septic shock before receivingany ICE course. One pt died during the first ICE of renal insufficiency.Two pt had only 2 courses because of toxicity. Among the 16 pt, responserate (RR) was: 7 CR, 6 PR, 1 PO; 3 pt are not evaluable dueto early withdrawal (overall RR: 13/16 = 81 %). Thirty-nine cycles ofHD chemo were given with a median hematological recovery of 9 days(range 7-12) until neutro. counts> 1.0 x 109 /1 and 9 days (range 717)until thrombo. > 20 x 109 /1. No cumulative, hematological toxicitywas seen. Accrual of patients is still ongoing and updated results will bepresented.

Prevalence of normal weight obesity in the general population

Background and Aims: normal weight obesity (NWO) has been defined as an excessive body fat (BF) associated with a normal body mass index (BMI). Little is known regarding its prevalence in the general population or which cut-offs for BF should be used. Methods: convenience sample of 1,523 Portuguese adults. BF was measured by validated hand-held bioimpedance. NWO was defined as a BMI<25 kg/m2 and a %BF mass>30%, along other published criteria. Results: prevalence of NWO was 10.1% in women and 3.2% in men. In women, prevalence of NWO increased considerably with age, and virtually all women aged over 55 with a BMI<25 kg/m2 were actually considered as NWO. Using gender specific cut-offs for BF (29.1% in men and 37.2% in women) led to moderately lower of NWO in women. Using gender- and age-specific cut-points for %BF considerably decreased the prevalence of NWO in women (0.5 to 2.5% depending on the criterion) but not in men (1.9 to 3.4%). Conclusions: gender- and age- specific or at least gender-specific, instead of single cut-offs for %BF, should be used to characterize and study NWO.

Estimation du débit de filtration glomérulaire par la formule DFG = K x T/Pcr [Estimation of glomerular filtration rate by the formula GFR = K x T/Pc].

BACKGROUND: Creatinine clearance is the most common method used to assess glomerular filtration rate (GFR). In children, GFR can also be estimated without urine collection, using the formula GFR (mL/min x 1.73 m2) = K x height [cm]/Pcr [mumol/L]), where Pcr represents the plasma creatinine concentration. K is usually calculated using creatinine clearance (Ccr) as an index of GFR. The aim of the present study was to evaluate the reliability of the formula, using the standard UV/P inulin clearance to calculate K. METHODS: Clearance data obtained in 200 patients (1 month to 23 years) during the years 1988-1994 were used to calculate the factor K as a function of age. Forty-four additional patients were studied prospectively in conditions of either hydropenia or water diuresis in order to evaluate the possible variation of K as a function of urine flow rate. RESULTS: When GFR was estimated by the standard inulin clearance, the calculated values of K was 39 (infants less than 6 months), 44 (1-2 years) and 47 (2-12 years). The correlation between the values of GFR, as estimated by the formula, and the values measured by the standard clearance of inulin was highly significant; the scatter of individual values was however substantial. When K was calculated using Ccr, the formula overestimated Cin at all urine flow rates. When calculated from Ccr, K varied as a function of urine flow rate (K = 50 at urine flow rates of 3.5 and K = 64 at urine flow rates of 8.5 mL/min x 1.73 m2). When calculated from Cin, in the same conditions, K remained constant with a value of 50. CONCLUSIONS: The formula GFR = K x H/Pcr can be used to estimate GFR. The scatter of values precludes however the use of the formula to estimate GFR in pathophysiological studies. The formula should only be used when K is calculated from Cin, and the plasma creatinine concentration is measured in well defined conditions of hydration.

Chirurgie bariatrique en 2013: principes, avantages et inconvénients des interventions a disposition [Bariatric surgery in 2013: principles, advantages and disadvantages of the available procedures].

For severe obesity (BMI > 35 kg/m2), bariatric surgery is not only the best, but often the only means of obtaining sufficient and durable weight loss. This article aims to review the available bariatric procedures. Gastric bypass remains the reference when it comes to the risk/benefit ratio. Gastric banding is declining rapidly due to the high prevalence of long-term complications. Primary malabsorptive procedures remain largely unpopular because of their potential nutritional complications. Sleeve gastrectomy, although it is not reversible as it includes a significant gastric resection, increases currently in popularity because of its apparent simplicity and the fact that early results regarding weight loss mimic those obtained with gastric bypass.

The CoLaus study : a population-based study to investigate the epidemiology and genetic determinants of cardiovascular risk factors and metabolic syndrome

Rapport de synthèse : Les maladies cardio-vasculaires constituent les causes principales causes de morbidité et de mortalité dans les pays industrialisés. Des études épidémiologiques ont démontré l'implication de facteurs de risques comme l'hypertension, l'hypercholestérolémie, l'obésité abdominale, le diabète et le tabagisme dans le développement des affections cardiovasculaires comme l'infarctus du myocarde ou l'accident vasculaire cérébral. De larges études génétiques cas-contrôle ont contribué modestement à l'identification de gènes de susceptibilité au développement de ces FRCV. Une étude populationnelle offre par contre l'avantage d'effectuer des études associatives pour des traits phénotypiques continus correctement mesurés et aussi pour des traits de catégories utilisant des protocoles d'étude cas-contrôle très discordants. ~ Elle permet l'exploration des déterminants génétiques comme par exemple le syndrome métabolique. Cette approche permet également de procéder à des analyses de séquençage sur l'ADN des participants chez qui un trait phénotypique spécifique est étudié mais distribué de manière opposée. A titre d'exemple, le séquençage de l'ADN de participants à taux très élevé d'HDL-cholestérol versus très bas de ce marqueur lipidique permet d'identifier des variants génétiques rares localisés sur les parties codantes de gènes spécifiques associés aux dyslipidémies. Pour ce faire, nous avons recruté 6'188 personnes âgées de 35 à 75 ans, d'origine caucasienne et résidant en ville de Lausanne (3251 femmes et 2937 hommes). L'obtention d'un tel collectif a nécessité l'échantillonnage aléatoire de quelque 19'830 personnes de cette tranche d'âge. Les participants ont fait l'objet d'une anamnèse approfondie et d'un examen clinique. Le bilan était complété par une prise de sang pour le dosage de paramètres biologiques ainsi qu'une analyse .génétique. Cette dernière a été effectuée après extraction d'ADN au moyen d'une puce Affimetrix qui évalue la présence de quelques 500'000 SNPs. Les données récoltées lors de cette étude dévoilent que l'obésité (index de masse corporelle > 30 kg/m2), le tabagisme, l'hypertension (pression artérielle >_ 140/90 mmHg et/ou hypertension traitée), une dyslipidémie (LDL cholestérol élevé et/ou HDL cholestérol bas et/ou triglycéride élevé) et le diabète (glucose à jeun >_ 7 mmol/l et/ou traitement) affectent respectivement 947 (15,7%), 1673 (27%), 2268 (36,7%), 2113 (34,2%) et 407 (6,6%) participants. La prévalence de ces FRCV est plus marquée chez les hommes que chez les femmes. Dans les deux genres les prévalences de l'obésité, de l'hypertension et du diabète augmentent drastiquement avec l'âge. En conclusion la prévalence des FRCV est élevée au sein d'une population représentative de Lausanne âgée de 35 à 75 ans. A l'avenir, l'étude CoLaus constituera par la richesse de ses données phénotypiques et génétiques, une source unique pour investiguer l'épidémiologie et l'identification de gènes associés à ces FRCV.

O papel do ar e água ambientais como veículos de transmissão de infeções fúngicas no Hospital Agostinho Neto, Cidade da Praia, Cabo Verde.

Os fungos são um grupo de microrganismos diversificado com uma grande ubiquidade na natureza, podendo ser encontrados no solo, no ar e na água. Alguns destes microrganismos são considerados como verdadeiros agentes patogénicos para humanos e, embora na grande maioria sejam inofensivos para indivíduos saudáveis, tornam-se patogénicos para indivíduos com fragilidade imunológica. A infeção por estes agentes em ambiente hospitalar tem sido relatada neste últimos anos como a principal causa de morte nos pacientes internados com debilidade imunológica. Neste estudo foi feita a avaliação da presença de fungos no ambiente de algumas unidades mais críticas do Hospital Agostinho Neto na cidade da Praia em Cabo Verde durante o mês de Janeiro de 2012, nomeadamente no Bloco Operatório do hospital e nos serviços de internamento Cirúrgico e Queimadura, Neonatologia, Infeciologia, Oncologia e de Hemodiálise. No total foram recolhidas 34 amostras de diferentes locais, detectadas 393ufc/m3 no ar, 685ufc/m3 na água e 2696ufc/m2 nas superfícies e isolados 104 fungos morfologicamente diferentes, sendo sido obtidos 29 a partir do ar, 21 de amostras da água e 54 de superfícies. A maior diversidade fúngica foi encontrada nos serviços de internamento Cirúrgico e Queimadura e de Neonatologia onde, em cada um, foram detectados nove géneros diferentes de fungos no ambiente hospitalar. Observou-se ainda uma forte presença dos géneros Aspergillus, Penicillium e Cladosporium em todos os locais estudados. Sabendo que a contaminação por estes agentes pode ser um fator de risco para infeção nosocomial em pacientes com sistema imunitário muito debilitado, sugerimos no final do trabalho algumas linhas orientadoras para minimizar os fatores de risco e propor trabalhos futuros para correlacionar esses fatores com casos de ocorrência de infeções fúngicas no Hospital Agostinho Neto na cidade da Praia, Cabo Verde.