Automated systems for propofol delivery and decision support system (DSS) have been shown to decrease anesthesiologists' workload and increase their vigilance during surgery, respectively. However, automated systems have been used mainly for general anesthesia but never for controlled sedation alone. In addition, DSSs have never been used before to help anesthesiologists to monitor patients receiving a spinal anesthesia with sedation. Thus, we have developed the first medical device incorporating a closed loop system for sedation and a decision support system for controlled sedation for patients undergoing knee or hip arthroplasty under spinal anesthesia with controlled sedation. The present project aims to determine the performances and the safety of this novel hybrid medical device. The hypothesis is that this novel device provides better sedation than manual control and could help to detect critical events, which could occur during spinal anesthesia with sedation, more promptly. The hybrid system tested in this trial can control sedation better than manually delivered propofol sedation and can detect critical events in a shorter time length allowing faster therapeutic treatments. / Les systèmes automatisés pour l'administration de propofol et les systèmes d'aide décisionnel (DSSs) permettent de diminuer la charge de travail des anesthésistes et d'accroître leurs vigilances pendant la chirurgie, respectivement. Cependant, les systèmes automatisés d'injection de prpofol ont été utilisés principalement pour l'anesthésie générale, mais jamais pour la sédation consciente. De plus, les DSSs n'ont jamais été utilisés auparavant pour aider les anesthésistes à surveiller les patients recevant une rachianesthésie avec sédation. Ainsi, nous avons développé le premier dispositif médical incorporant un système en boucle fermée pour la sédation automatisée avec propofol incluant un DSS pour la surveillance de patients subissant une intervention d'arthroplastie du genou ou de la hanche sous rachianesthésie et sédation consciente. Le projet vise à déterminer les performances et la sécurité de ce nouveau dispositif médical hybride. L'hypothèse est que ce nouveau dispositif offre une meilleure sédation que le contrôle manuel et une détection plus précoce des événements critiques qui peuvent survenir pendant la rachianesthésie avec sédation utilisant le propofol. Le système hybride testé dans cet essai permet de contrôler la sédation avec propofol mieux que l'administration manuelle et peut détecter les événements critiques plus vite permettant un traitement de ces derniers plus rapide.

There are many and varied lesions afflicting children which effect the growth of long bones in the body. When this disturbance in growth involves one or all of the bones in the lower extremities, its results are particularly distressing. The difference in length of the lower extremities, even though otherwise normal, produces a limp and a pelvic obliquity with a compensatory scoliosis of the spine. We can dismiss the problem of a discrepancy in the upper limbs as there is no functional disability from a pure difference in length. A discrepancy in the weight-bearing lower limbs is, however, far more serious.

Histological examination of the brains of experimental animals subjected to convulsive seizures shows an evidence of tissue damage which could be the result, to some extent, of increased vascular permeability. Diapedesis of red cells, edema and nerve cell damage in acute stages, and perivascular hematogenous pigment, nerve cell deficit and gliosis around the blood vessels in chronic conditions are examples of such changes. More direct evidence was obtained in experiments in which trypan blue was used to test the permeability of the blood-brain barrier (BBB) in various pathological conditions - among others, in the electrically-induced epileptic seizures.

Hunt and Taveau (19o6} were the first to demonstrate its depressor action. Dale (1914}, with the help of his colleague Ewins, identified it in some samples of ergot and studied its pharmacology extensively. In his classical report, he described its evanescent action and suggested that it is hydrolysed rapidly in the body. He also described that it has two kinds of actions: (1) muscarinic and (2) nicotinic. The muscarinic action, a depressor effect on the effector cell, is exerted at the postganglionic endings of the parasympathetic; and its nicotinic action, which consists of an initial stimulation followed by an inhibition is exerted on the ganglionic cells of both the divisions of the autonomic nervous system.

The purpose of this investigation was to study the urinary corticosteroid pattern in adrenal cortical and anterior pituitary disease. Patients with both adrenal cortical hyperfunction and hypofunction were investigated in the untreated disease state, after hormonal therapy and also in two cases after surgical treatment. Normal subjects were studied for purposes of comparison. The qualitative and quantitative differences in the patterns were thus evaluated under various physiological conditions.

Gonadotropic activity in human pregnancy urine was demonstrated for the first time by Aschheim and Zondek in 1927 by injecting unaltered urine into immature female rats. The early subsequent work was concerned mostly with gonadotropins secreted in large amounts by the human placenta. Pituitary gonadotropins, however, occur in much smaller amounts in human urine. They therefore must be concentrated from urine in order to be demonstrable by bioassay methods. The concentration of urinary extract, in turn, requires detoxification in order to allow the laboratory animals to survive several injections.

The functional statue of the thyroid in old age and its role in the genesis of some manifestations of senescence have been subjects of speculation tor many years. Numerous studies have been done but few, if any, conclusions based on sound evidence have been reached. The ovary has a life span shorter than that of the total organism, and concomitant with a decline in ovarian function undesirable physical and emotional disturbances may occur. Some features of human senescence are similar to those of the hypothyroid states for example, one sees in both diminished motor activity, impaired muscle strength, dryness or the skin, diminished cold tolerance, and falling of the hair.

The earliest documentary evidence of hypertensive disease associated with adrenal cortical tumours has been ascribed to Neusser in 1897 by Perera. The presser properties of the medullary extracts from the suprarenal glands had already been described by Oliver and Schaefer in 1895. With this background hyperepinephrinemia was cautiously suggested as/ possible cause of hypertension by several authors around the turn of the present century, but it was Vaquez in 1904, who propounded it as a theory based on the observation that suprarenal hyperplasia was frequently seen in patients with hypertension.

Note: Missing Page 288. / It has been estimated that of the total deaths due to heart disease one-third may be attributed to primary coronary artery insufficiency related to atherosclerosis as the dominant factor, one third to primary coronary insufficiency associated with cardiac hypertrophy and increased work arising from valvular lesions and hypertension, and one-third to primary myocardial insufficiency. In other words, two-thirds of the deaths from heart disease may be traced directly or indirectly to coronary artery insufficiency (Rowe 1960). Wearn in 1933 described arterioluminal vessels running from the coronary arteries through the myocardium to the ventricular cavities, arterioluminal sinusoids passing deviously through the myocardium, connecting the arterial lumen to the ventricular cavity and the Thebesian veins communicating with the coronary venous system and ventricular lumen.

Background: NAFLD is one of the most common causes of liver disease worldwide. It is a spectrum of disease characterized by macrovesicular steatosis of the liver that ranges from simple fatty liver (steatosis), to non-alcoholic steatohepatitis (NASH). NASH may eventually evolve to cirrhosis and end stage complication. Liver biopsy has long been considered the gold standard of reference to diagnose NAFLD but it is costly and invasive. Recently, non-invasive methods have been proposed. Aims and methods: The aim of this study was to investigate the accuracy of non-invasive methods including (Ultrasound, computed tomography scan, Xenon-133 scan, Hepatic steatosis index, Fibroscan, NAFLD fibrosis score, APRI index, and FIB-4 index) and their combination to diagnose steatosis and to diagnose significant liver fibrosis (>F2) and cirrhosis (F4) as compared to liver biopsy. We conducted a retrospective study of 114 NASH patients (79 males, mean age 49.6±10.6). All had adequate liver histology. Results: The distribution of fibrosis stage was as follows: F0-F1= 50%, F2=16.8%, F3=19.2%, F4=14%. The distribution of steatosis grade was as follows: grade 0-1=16%, grade2=53.3%, grade3=30.7%. The following tests correlated with fibrosis: APRI index (r=0.554), FIB-4(r=0.555), NAFLD fibrosis score (r=0.473), Fibroscan(r=0.586) and Hepatic Steatosis Index (HSI) (r=0.245). The FIB-4 and APRI index showed the best diagnostic accuracy for significant fibrosis as indicated by an Area Under the Curve (AUC) of 0.801 and 0.782, respectively. The FIB-4 showed the best AUC= 0.886 for cirrhosis. None of the following tests US, CT, HSI, and xenon-133 scan were considered correlated significantly. The best combination algorithm for the detection of cirrhosis was gender and FIB-4 with an AUC of 0.8937. Conclusion: this study demonstrates that non-invasive methods for liver fibrosis are accurate to diagnose >F2 and F4. Severe steatosis cannot be reliably diagnosed by non-invasive methods. Notably, a combination of FIB-4 and gender significantly improves the performance of the single method for cirrhosis. These methods may help reducing the number of liver biopsies stratifying NASH patients that should start a screening program for HCC and esophageal varices. / Contexte : La stéatose hépatique non alcoolique (SHNA) est l'une des causes les plus répandues des maladies du foie à l'échelle mondiale. Il s'agit d'un spectre de maladies qui se caractérise par une stéatose hépatique macrovésiculaire allant de la stéatose hépatique simple (stéatose) à la stéatohépatite non alcoolique (NASH). La NASH peut éventuellement évoluer vers une cirrhose et des complications en phase terminale. La biopsie du foie a longtemps été considérée comme la norme de référence par excellence pour le diagnostic de la SHNA, mais elle est coûteuse et invasive. Des méthodes non invasives ont récemment été proposées. Objectifs et méthodes : La présente étude avait pour objectif d'évaluer la précision de certaines méthodes non invasives (notamment les ultrasons [US], la tomographie par ordinateur [TO], la scintigraphie au xénon 133, l'indice de stéatose hépatique (ISH), la technique Fibroscan, le score de fibrose de SHNA, l'indice de ratio entre l'aspartate aminotransférase et les plaquettes [APRI] et l'indice FIB-4) et de l'utilisation combinée de ces méthodes pour le diagnostic de la stéatose et pour le diagnostic d'une fibrose hépatique significative (> F2) et de la cirrhose (F4), par comparaison à la biopsie du foie. Nous avons réalisé une étude rétrospective sur 114 patients atteints de NASH (79 patients de sexe masculin, âge moyen de 49,6 ans ± 10,6). Tous ces patients présentaient une histologie hépatique adéquate.Résultats : La répartition des stades de fibrose était la suivante : F0 F1 = 50 %, F2 = 16,8%, F3 = 19,2 %, F4 = 14 %. La répartition des stades de stéatose était la suivante : stade 0-1 = 16 %, stade 2 = 53,3 %, stade 3 = 30,7 %. Les tests suivants ont été mis en corrélation avec la fibrose : l'indice APRI (r = 0,554), l'indice FIB-4 (r = 0,555), le score de fibrose de SHNA (r = 0,473), la technique Fibroscan (r = 0,586) et l'indice de stéatose hépatique (r = 0,245). L'indice FIB-4 et l'indice APRI ont offert la meilleure précision diagnostique en ce qui concerne la fibrose significative, comme l'indiquent la surface sous la courbe (SSC) de 0,801 et la SSC de 0,782 respectivement. L'indice FIB-4 a présenté la meilleure SSC, soit 0,886, pour ce qui est de la cirrhose. Aucun des tests suivants, c'est à dire les tests aux US, la TO, l'ISH, et la scintigraphie au xénon 133, n'était considéré comme étant corrélé significativement. Le meilleur algorithme de combinaison pour le dépistage de la cirrhose était le sexe et l'indice FIB-4 avec une surface sous la courbe de 0,8937. Conclusion: cette étude démontre que les méthodes non invasives de diagnostic de la fibrose hépatique sont précises en ce qui concerne les stades > F2 et F4. La Stéatose sévère ne peut être diagnostiqué de façon fiable par des méthodes non invasives Notamment, une combinaison de l'indice FIB-4 et du sexe améliore considérablement le rendement de la méthode unique en ce qui a trait à la cirrhose. Ces méthodes pourraient aider à réduire le nombre de biopsies du foie visant à stratifier les patients atteints de NASH qui devraient entreprendre un programme de dépistage du carcinome hépatocellulaire (CHC) et des varices œsophagiennes.