The Analyse Infections Respiratoires (AIR) II study is a prospective, multicentre survey of the management of lower respiratory tract infections in patients aged 15-65 yrs by general practitioners (GPs) in France. To obtain real-time data recording, practitioners were required to submit an anonymous copy of their drug prescriptions. They were then interviewed over the telephone about the patients' sociodemographic data, signs and symptoms, as well as their presumptive diagnosis and the investigations they had decided upon. GPs (n=3,144) reported 5,469 evaluable cases. Pneumonia accounted for 9.6% of diagnoses, acute exacerbations of chronic bronchitis 14.9% and acute bronchitis 72.5%. The symptomatology covered an extremely wide range of clinical features, which, although statistically different in terms of incidence, overlapped to a large extent across diagnoses. By contrast, hospitalization, investigations or referral to a specialist were much more prevalent in pneumonia, although still very infrequent in general terms (0.5, 1.2 and 10.8%, respectively). Antibiotics were prescribed in 96.5% of patients, with minor differences between diagnoses. However, other medications such as nonsteroid, anti-inflammatory drugs, steroids, nonspecific antitussives and bronchial liquefiers accounted for two-thirds of the prescriptions. This study demonstrates the lower respiratory tract infections encountered by general practitioners are usually mild. However, antibiotic prescription was more systematic than in previous studies and the prescription of nonspecific symptomatic treatments was twice as frequent. General practitioners did not perform additional examinations or refer on a regular basis. There was a high prescription rate for symptomatic treatment.

Objective. To identify the risk factors of failure and immediate complication of subclavian vein catheterization (SVC).

Objectives: Measurement of the time elapsed from the decision to use a pulmonary artery catheter to the onset of the adapted treatment.Design: Prospective study.Setting: Critical care unit of a university hospital.Patients: A total of 104 critically ill patients.Interventions: The time elapsed from the decision to use a pulmonary artery catheter to the onset of the adapted treatment, Five time intervals (availability, preparation, catheterization, data collection, and therapeutic intervals) were individualized according to the times of decision of pulmonary artery catheter insertion, operator's hand washing, venipuncture, postoperative dressing, data collection, and the effective onset of subsequent therapy.Measurements and Main Results: Among 120 used pulmonary artery catheters, seven could not be inserted. The time to use the pulmonary artery catheter was never shorter than 45 mins (median value = 120 mins), For availability, preparation, catheterization, data collection, and therapeutic intervals, the median values were 30, 20, 20, 20, and 10 mins, respectively. The availability and data collection intervals were shortened during the night period and the fourth quarter of the study, respectively,Conclusions: The pulmonary artery catheter use is time consuming. However, the availability and data collection intervals could be shortened.

The aim of the study was to determine whether facilitation of reentry by potassium-channel openers is related to dispersion of refractoriness and/or modification of anisotropic properties of ventricular myocardium. The dispersion of ventricular effective refractory period (VERP), longitudinal and transverse ventricular conduction velocities (theta L and theta T, respectively), and wavelength [lambda = VERP x theta(L or T)] were studied in Langendorff-perfused left ventricular epicardium in 20 rabbits during infusion of incremental doses of levcromakalim or nicorandil. Dispersion of refractoriness was assessed using standard deviation of VERP mean (SD-VERP), dispersion index (DI; SD-VERP/mean VERP), and maximum dispersion (D-max = VERPmax - VERPmin). Ventricular conduction velocities and anisotropic ratio were not modified, whatever the dose used. VERP and lambda were significantly shortened at high concentrations of levcromakalim and nicorandil. At these doses, SD-VERP, DI, and D-max were increased significantly. Analysis of ventricular tachycardia induction, performed using a high-resolution ventricular mapping system, confirmed that heterogeneity and shortening of VERP were factors inducing functional conduction block. Our data suggest that, in rabbit left ventricular epicardium, functional conduction block facilitating the occurrence of reentry could be initiated by shortening and, especially, by dispersion of refractoriness during infusion of potassium-channel openers.

This study was a prospective study, it was undertaken on 172 subjects who had no prior central or peripheral nerve supply pathology and who had not an antecedent of anal surgery. The subjects had a normal value of the sacral reflex latency to be included in this study. In this population the value of the pudendal motor nerve latency was compared by age and sex in order to determine precise norms. There was 92 men whose age adveraged 36 +/- 14.57 years and 80 women with an average age of 55.03 +/- 15.7. The motor latency was obtained by stimulating the nerve by rectal or vaginal tuch-near the sciatic spine with a St Mark's electrod and taking a reading in the intemediate part of the external anal sphincter muscle. The intensity of the stimulation was 70 to 80 mA. The stimulation and the recording was repeteded five both on each side and the shorter latency whose choised. The value of the motor latency taken at the positive peak was analysed statiscally. The average value was 5.52 +/- 1.9 ms on right pudendal nerve and 5.74 +/- 1.6 ms on the left in male subjects and 6.16 +/- 1.8 in the right pudendal nerve and 6.42 +/- 1.96 on the left in female subjects. The values on right pudendal nerve latency varied from 4.9 +/- 1.28 ms in men and 4.76 +/- 1.6 ms. in women at under 28 years and to 5.06 +/- 2.06 ms in men and 7.7 +/- 1.8 ms in women at over 70 years. The values on the left side varied from 5.53 +/- 1.5 ms in men and 4.78 +/- 1.35 ms in women at under 28 years and to 5.06 +/- 2.06 ms in men and 8.47 +/- 1.95 ms in women at over 70 years. In men population, the value of the motor latency of the pudendal nerve is not correlated with age. In women population, the value is correlated with age.

Cervical epidural anesthesia (CEA) can affect diaphragmatic function.We investigated the effects of CEA on the diaphragm muscle performance, breathing pattern, and respiratory drive of 10 healthy patients undergoing hand surgery before and after the administration of 0.25% and 0.375% bupivacaine. The lung volumes and flows, respiratory rate (RR), minute ventilation, respiratory cycle time, occlusion pressure, maximal inspiratory pressure (MIP), and hand grip strength were determined. ETCO2 and SpO2 were continuously monitored. The diaphragmatic excursion was evaluated using ultrasonography. Although CEA allowed painless hand rehabilitation, both 0.25% and 0.375% bupivacaine impaired diaphragmatic excursion, with values decreasing from 5.6 to 4.4 and 3.3 cm (P < 0.05), respectively, during forced sniff maneuvers. In the 0.25% and 0.375% bupivacaine groups, the values of MIP decreased from 74 to 56 and 44 cm H2 O, forced vital capacity decreased from 3.8 to 3.2 and 2.8 L, and hand grip strength decreased from 43.3 to 27.8 and 20.5 kg force, respectively (P < 0.05). The tidal volume decreased from 0.8 to 0.6 and 0.5 L in the 0.25% and 0.375% bupivacaine groups, respectively, the RR increased from 14 to 18 breaths/min in both groups, and the occlusion pressure increased from 1.5 to 2.1 and 2.9 cm H2 O in the 0.25% and 0.375% bupivacaine groups, respectively (P < 0.05). ETCO2 increased from 35.2 to 38.1 and 39.3 mm Hg in the 0.25% and 0.375% bupivacaine groups, respectively, and SpO2 decreased by 2% +/- 1% in the 0.375% bupivacaine group. CEA affects diaphragmatic function and the resulting lung volumes and MIP values. The observed alterations in breathing pattern and the significant increase in ventilatory drive may be caused by changes in the diaphragmatic muscle tension and an augmented CO (2) load. In conclusion, we do not recommend this technique for routine postoperative hand rehabilitation using the studied bupivacaine concentrations. Implications: We studied cervical epidural anesthesia in healthy patients undergoing hand surgery. The technique allowed painless rehabilitation but affected breathing pattern, diaphragmatic function, and respiratory drive. We cannot recommend this technique for routine clinical use. (Anesth Analg 1998;86:1033-8)

BACKGROUND:Catheterization of the subclavian vein may lead to severe complications. The current randomized study compared a technique of pulsed Doppler ultrasonography guidance and the standard method for subclavian vein catheterization.METHODS:Standard and Doppler ultrasonography guidance methods were performed by the same physician in 286 patients, 143 in each group. Primary end points were immediate complications (arterial puncture, pneumothorax, wrong position of catheter tip), failures, the number of subclavian vein catheterizations with immediate complication or failure, the number of skin punctures per catheterization, and the time to placement of the guide wire. The secondary end points were the determination of predicting factors of successful cannulation in each group.RESULTS:Both groups were similar according to morphologic parameters of the patients. A greater number of subclavian vein catheterizations were performed on the right side using Doppler guidance (105 vs. 73, P < 0.01). Doppler guidance decreased complications (5.6% vs. 16.8%, P < 0.01), largely because of a smaller number of catheters for which the tip was defined to be in incorrect position (0.7% vs. 7.7%, P < 0.01). The time to catheterization was longer with Doppler guidance (300 vs. 27 s, P < 0.001). Failures, catheterizations of the subclavian vein with immediate complications or failure, and the total number of skin punctures per catheterization were similar in both groups. Using Doppler guidance, the presence of a good Doppler signal (124 of 143) was predictive of successful catheterization (123 successful cannulations, P < 0.001).CONCLUSIONS:Doppler guidance reduces the incidence of inappropriately positioned subclavian catheters.

OBJECTIVE This study examined, using noninvasive means, the changes in breathing pattern and inspiratory muscle pressure-time indices during difficult progressive withdrawal of pressure-support ventilation. DESIGN A prospective analysis of the temporal evolution of several respiratory variables in difficult-to-wean patients. SETTING A university hospital intensive care unit. PATIENTS A heterogeneous group of 17 patients receiving prolonged mechanical ventilation. INTERVENTIONS Daily measurements of breathing pattern and respiratory muscle performance parameters in difficult-to-wean patients. MEASUREMENTS AND MAIN RESULTS We examined breathing pattern variables, rapid shallow breathing (respiratory rate/tidal volume), tracheal occlusion pressure, maximal inspiratory pressure (P(I)max), and the tension-time index of the inspiratory muscles (TTmus = P(I)/P(I)max x Ti/Ttot) (where Ti/Ttot is inspiratory fraction of the cycle). All measurements were repeated at 24-hr intervals throughout the difficult weaning period. The patients were extubated on satisfying ten of 12 classical weaning criteria. Eleven patients were successfully weaned from mechanical ventilation while six patients were not. Weaning failure was associated with the following: a) longer periods of mechanical ventilation before weaning; b) high values of tracheal occlusion pressure, respiratory rate, minute ventilation, and effective impedance maintained throughout the difficult weaning period; and c) persistent high PaCO2 and intrinsic positive end-expiratory pressure values. As the weaning failure patients' inspiratory muscles confronted an increasing inspiratory load, values of the tension-time index of the inspiratory muscles entered or remained in the fatigue zone. In contrast, weaning success patients normalized their breathing pattern and decreased their tracheal occlusion pressure, effective impedance, and tension-time index values. CONCLUSIONS Breathing pattern alterations and respiratory muscle performance impairments lead to ventilator dependency after prolonged mechanical ventilation. The measurement of variables such as the noninvasive tracheal occlusion pressure, inspiratory power of breathing, and tension-time index of the inspiratory muscles facilitate the management of difficult-to-wean patients.

This prospective study was undertaken on 190 subjects who had no prior central or peripheral nerve supply pathology and where the value of the sacral reflex latency was compared by age and sex in order to determine precise norms. There were 90 men whose age averaged 56.9 +/- 13 years and 100 women with an average age of 54 +/- 13.1. The reflex was obtained by stimulating the dorsal nerve of the penis and the clitoris and taking a reading in the intermediate part of the external anal sphincter muscle. An averaging technique was used (over 30 stimulation occurrences). The average intensity of the stimulation was 15 mA. The value of the stimulus reaction latency taken at the positive peak was analyzed statistically. The average value was 37.6 +/- 5.36 ms in male subjects and 46.6 +/- 8.08 in female subjects. In men, values varied from 36.6 +/- 4.26 ms at under 35 years of age and reached 42 +/- 3.52 ms at over 75 years. In women, values varied from 37.33 +/- 7.69 ms at under 35 years to 55.6 +/- 4.39 ms at over 75 years of age. In a previous article we discussed ageing features in nerves and muscles. These features are largely responsible for the occurrence of static pelvic problems. The purpose of this study is to compare the sacral reflex latency by sex and age in normal subjects.

This study was designed (a) to test and (b) to compare proarrhythmic effects of levcromakalim and nicorandil; and (c) determine the mechanism of arrhythmia initiation by using high-resolution ventricular epicardial mapping on 44 Langendorff-perfused rabbit hearts. Eighteen hearts were kept intact and received incremental doses (1-500 microM) of levcromakalim, nicorandil, and isosorbide dinitrate. In 26 hearts, a thin layer of epicardium was obtained after endocardial cryotechnique (frozen hearts). In intact hearts, isosorbide dinitrate did not produce any arrhythmia. In contrast, levcromakalim induced spontaneous ventricular fibrillation (VF) in all hearts at 50 microM, whereas only one VF occurred at 500 microM nicorandil. These three drugs produced a dose-dependent bradycardia in intact hearts. In frozen hearts, arrhythmias were induced by 5 microM levcromakalim and 50 microM nicorandil. Isosorbide dinitrate had no proarrhythmogenic effect. Epicardial mapping showed that most of induced ventricular tachycardias were based on reentry around an arc of functional conduction block. Ventricular conduction velocities did not change, but levcromakalim and nicorandil shortened ventricular effective refractory period. We conclude that (a) levcromakalim and nicorandil, used in toxic concentrations, have direct proarrhythmic effects; (b) nicorandil proarrhythmogenic effects are 10 times less marked than those of levcromakalim (arrhythmia is solely the result of the potassium channel opener property of nicorandil); and (c) most of ventricular tachycardias induced are based on reentry.

Background The aims of the study were to verify the effects of ketamine on ventricular conduction velocity and on the ventricular effective refractory period, to determine its effects on anisotropy and on homogeneity of refractoriness, and to use wavelength to determine whether ketamine has antiarrhythmic or arrhythmogenic properties. Methods A high-resolution epicardial mapping system was used to study the effects of 50, 100, 150, and 200 microM racemic ketamine in 15 isolated, Langendorff-perfused rabbit hearts. Five hearts were kept intact to study the effects of ketamine on spontaneous sinus cycle length (RR) interval and its putative arrhythmogenic effects. In 10 other hearts, a thin epicardial layer was obtained by an endocardial cryoprocedure (frozen hearts) to study ventricular conduction velocity, ventricular effective refractory periods (five sites), and ventricular wavelength. Results Ketamine induced a concentration-dependent lengthening of the RR interval. Ketamine slowed longitudinal and transverse ventricular conduction velocity with no anisotropic change, and it prolonged the ventricular effective refractory period with no significant increase in dispersion. Ventricular longitudinal and transverse wavelengths tend to increase, but this was not statistically significant. Finally, no arrhythmia could be induced regardless of the ketamine concentration. Conclusion Ketamine slowed ventricular conduction and prolonged refractoriness without changing anisotropy or increasing dispersion of refractoriness. Although these effects should result in significant antiarrhythmic effects of ketamine, this should not be construed to suggest a protective effect in ischemic or other abnormal myocardium.

BACKGROUND:The aims of the study were to verify the effects of ketamine on ventricular conduction velocity and on the ventricular effective refractory period, to determine its effects on anisotropy and on homogeneity of refractoriness, and to use wavelength to determine whether ketamine has antiarrhythmic or arrhythmogenic properties.METHODS:A high-resolution epicardial mapping system was used to study the effects of 50, 100, 150, and 200 microM racemic ketamine in 15 isolated, Langendorff-perfused rabbit hearts. Five hearts were kept intact to study the effects of ketamine on spontaneous sinus cycle length (RR) interval and its putative arrhythmogenic effects. In 10 other hearts, a thin epicardial layer was obtained by an endocardial cryoprocedure (frozen hearts) to study ventricular conduction velocity, ventricular effective refractory periods (five sites), and ventricular wavelength.RESULTS:Ketamine induced a concentration-dependent lengthening of the RR interval. Ketamine slowed longitudinal and transverse ventricular conduction velocity with no anisotropic change, and it prolonged the ventricular effective refractory period with no significant increase in dispersion. Ventricular longitudinal and transverse wavelengths tend to increase, but this was not statistically significant. Finally, no arrhythmia could be induced regardless of the ketamine concentration.CONCLUSION:Ketamine slowed ventricular conduction and prolonged refractoriness without changing anisotropy or increasing dispersion of refractoriness. Although these effects should result in significant antiarrhythmic effects of ketamine, this should not be construed to suggest a protective effect in ischemic or other abnormal myocardium.

The general objective of ISAAC (Inter-national Study of Asthma and Allergies in Childhood) is to better know the distribution and risk factors of allergic diseases. The objective of phase I survey, which will be dealt with in this special issue, is to get prevalence figures about asthma, rhinitis and eczema worldwide using a simple and validated questionnaire, In France, 18000 teenagers from the area of Bordeaux Fos l'Etang de Berre, Languedoc-Roussillon, West-Marne and Strasbourg and 8700 children fi om Bordeaux and Strasbourg participated to the survey in 1994 and 1995. In Fos l'Etang de Berre and Strasbourg areas, teenagers answered to a video-questionnaire about asthmatic symptoms following the paper questionnaire. The paper questionnaire was translated from English and back-translated. Reproducibility of the paper questionnaire and comparison of answers provided by teenagers and their parents was studied in a small additionnal survey completed in a sample of 300 adolescents. Data analysis include first a descriptive analysis within each center, then comparison of prevalence figures between centers.

Electrophysiologic and proarrhythmogenic effects of imipramine were studied by use of 21 Langendorff-perfused rabbit hearts and high-resolution mapping to analyze epicardial activation of the left ventricle. In 16 hearts, a thin layer of epicardium was obtained by an endocardial cryotechnique (frozen hearts). Five hearts were kept intact (nonfrozen imipramine-treated group). Preparation stability was verified in six frozen hearts. In 10 frozen and in 5 nonfrozen hearts, 0.01, 0.1, 1.0, 2.0 and 5.0 micrograms/ml imipramine were administered. In nonfrozen imipramine-treated hearts, imipramine induced bradycardia at 5.0 micrograms/ml (291.8 +/- 40.5 vs. 495.2 +/- 54.4 msec, P = .02), one A-V block at 5.0 micrograms/ml and two monomorphic ventricular tachycardias (MVT) at 2.0 and 5.0 micrograms/ml. In 4/10 frozen hearts, three MVT were induced at 1.0 microgram/ml imipramine and one MVT at 2.0 micrograms/ml imipramine. All MVT were based on reentry around a line of functional conduction blocks. Imipramine (2.0 micrograms/ml) slowed longitudinal and transversal ventricular conduction velocities at a pacing cycle length of 1000 msec from 71.7 +/- 6.1 to 63.0 +/- 7.7 cm/sec (P = .008) and from 32.9 +/- 2.6 to 27.7 +/- 2.8 cm/sec (P = .009), respectively, and prolonged ventricular effective refractory period from 141.9 +/- 9.3 to 279.1 +/- 112.6 msec (P = .03). Imipramine induced dose- and use-dependent slowing of ventricular conduction velocity facilitating functional conduction blocks and reentrant MVT.

Au cours d'une consultation de statique pelvienne, certaines femmes adressées pour incontinence urinaire sont sous traitements anxiolytiques seuls ou associés à des antidépresseurs et/ou neuroleptiques et/ou hypnotiques. Par l'étude d'une cohorte homogène de 51 femmes, dont 21 étaient traitées par ces substances, nous avons observé le retentissement de ces médications sur leur équilibre mictionnel.

Pour répondre à la quaestion «La constipation est-elle cause, facteur d'entretien ou d'aggravation des troubles de la statique pelvienne?, nous avons analysé statistiquement 27 items dans une population de 500 femmes consultantes, dont 250 se présentaient comme constipées ou constipées traitées. Nous avons pu mettre en évidence l'intrication des multiples facteurs intervenant sur la constipation. Dans les troubles de la statique pelvienne, le facteur prédominant lié à la constipation est la rectocèle. Au stade III–IV, elle est à la fois la conséquence d'une constipation ancienne et la cause d'aggravation d'une dyschésie avec anisme. Cette rectocèle stade III–IV peut être aussi la décompensation d'une cure de prolapsus antérieur et/ou hystérectomie chez les femmes constipées. Et cette rectocèle paraît aggravée avec l'âge. En conséquence, il semble utile de dépister et traiter précocement les constipations avec contracture des releveurs en rompant le cercle vicieux de l'anisme (constipation → rectocèle → anisme) par une relaxation des releveurs de l'anus. Par ailleurs, avant toute chirurgie de l'étage antérieur ou moyen du pelvis, il faut évaluer les facteurs possibles de décompensation de rectocèle. Enfin, on ne luttera jamais assez contre la constipation chez les jeunes femmes qui, en vieillissant, auront un risque supplémentaire de voir s'installer une rectocèle grave entretenant la constipation.