Biomedical subjects
Publications and source records attributed to A Bertoye.
By means of an original method of laser nephelometry with a capillary cell, it is possible to detect the immune complexes in human sera. For instance, the detection of antigen and immune complex during the course of the whooping-cough allows a pathological study of the disease.
Retrospective study of 14 cases of Staphylococcus aureus meningitis and of data from the literature shows that this as yet infrequent disease which carries a high mortality rate (40%) is always related to neurosurgery, primary or iatrogenic septicemia, or local infection, usually in the lumbar area (spinal, abscess, spondylitis). The major clinical problem is the search for the meningeal lead point of Staphylococcus aureus penetration, whose eradication is more essential than in usual bacterial meningitis. Prognosis is mainly dependent upon the eventual existence of associated severe septicemia. Antibiotics active on Peni-M resistant Staphylococcus aureus and meningeal infection are reviewed.
Sixteen adult patients with respiratory distress syndrome requiring mechanical respiratory assistance entered this study, the purpose of which was to obtain the same blood gas values under high frequency jet ventilation as under conventional ventilation. When high frequency jet ventilation without spontaneous breathing was compared to continuous positive pressure ventilation, peak airway pressure was the same, but mean airway pressure, positive end-expiratory pressure and pleural pressure were higher and cardiac index lower. When high frequency jet ventilation with spontaneous breathing was compared to intermittent mandatory ventilation, peak airway pressure was lower, mean airway pressure and positive end-expiratory pressure were higher, and pleural pressure and cardiac index were not different.
Sixty minutes intravenous infusions of Acyclovir were given at 5 to 10 mg/kg 3 times daily for 6 to 11 days in 20 immunodeficient children with varicella (9 cases) and herpes zoster (11 cases) in a controlled open study. Twelve patients had a life-threatening illness. All patients who received therapy before the first 4 days had a more rapid cessation of new vesicles formation and more rapid scarring. Fourteen controlled children had accelerated clearance of viral antigens from vesicles. In 19 cases, virus was no longer isolated after the 3rd day. Eighteen patients recovered within 6 to 10 days. No relapse of varicella zoster virus infections had been observed 1 to 18 months after the end of treatment. Two children with varicellous interstitial pneumonia died 8 and 32 days after the end of treatment. In 3 cases, zoster pains reappeared 8 days after Acyclovir therapy was stopped. The drug was well-tolerated, but control of renal functions is necessary.
This study describes our experience from 1960 onwards of 222 patients suffering from terminal chronic respiratory failure; we report our results of domiciliary mechanical ventilation for 11-17 hours per day using tracheotomy. The method was easy to use at home at a reasonable cost and was far less than in a medical environment. The results were excellent both for length of survival and quality of life for all cases where respiratory failure was due to chest wall problems (neurological, muscular or restrictive syndromes due to chest deformity). The majority of cases were sequelae of polio, myopathies, kyphoscoliosis or tuberculosis. The results were less good for patients with intrinsic pulmonary disease such as chronic airflow obstruction; for this the superiority of mechanical ventilation compared to long term oxygen therapy is not proven. The results were very poor for patients suffering from bronchial dilatation. However, a positive correlation between the efficacy of the method and the duration of a normal PaO2 during a 24 hour period seemed to exist, both during periods of mechanical ventilation and weaning from the machine.
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We evaluated Acyclovir therapy in 16 immunodeficient children with varicella (7 cases) and zoster (9 cases) in a controlled open study. infections were serious in 12 patients. Each patient had daily clinical, biological and virological tests. Sixty minutes intra-venous infusions of Acyclovir were given three times a day (5 to 10 mg/kg/8 hours) for 6 ou 11 days. All patients who received therapy before the first four days, ahd a more rapid cessation of new vesicles formation and more rapid scaring, than those with delayed treatment. Ten controlled children had accelerated clearance of viral antigens from vesicles. In 15 cases, virus was not isolated after the third day. Two children with varicellous interstitial pneumonia died, 8 and 25 days after the end of treatment. Fourteen patients recovered in 8 to 10 days. No relapses of varicella-zoster virus infections had been observed 1 to 14 months after therapy. The drug was well-tolerated, but supervising of renal functions is necessary. Acyclovir had a good therapeutic efficacy to treat chickenpox and shingles in the immunocompromised patients.
Body fluid volumes were determined by impedance measurements in several groups of patients. Boys with Duchenne muscular dystrophy had decreased intracellular and extracellular fluid volumes. Patients with severe sequelae of poliomyelitis and with other severely disabling neurological diseases did not exhibit such profound alterations of their body fluid compartments.
Orthostatic hypotension results from an alteration in the baroreflex at any level with subsequent disturbance in blood pressure homeostasis in response to variations. The second part of this reflex arc, from the bulbar vasopressor centre to the peripheral effector sites, can be explored directly by studying the hemodynamic response to an increase in arterial CO2 levels. Normally the response is an increase in blood pressure, but under abnormal conditions there is a reduction. Orthostatic hypotension with a normal hemodynamic response to increased CO2 levels indicates that the first part of the reflex arc is involved, an abnormal response is due to the second part being affected. The CO2 test was conducted in 8 subjects with orthostatic hypotension (bulbar lesions, medullary lesions, idiopathic orthostatic hypotension, polyradiculoneuritis, primary amylosis). Comparing the typical anatomoclinical characteristics of each of the lesions explored with the results of the hemodynamic response to CO2 test suggests that the interpretation proposed is a valid one.
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The theoretical fluid volume of 41 normal children (mean age 8 years 9 months) was estimated from anthropometric data: height, weight, wrist circumference, and body surface. The correlation between this method and the conventional methods of determining total body water using tritiated water or of extracellular fluid volume using stable bromide or bromide 82 is very good. The real fluid volumes have been measured using total body electrical impedance at low frequency (Z5 kHz) and high frequency (Z1 MHz). The correlation of these results with those obtained by anthropometry is very satisfactory (r = 0.89; p < 0,001).
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Plasma proteins, triglyceridemia, body composition and delayed hypersensitivity were determined in 154 critically ill patients after admission. Plasma proteins levels were significantly increased in patients that were subsequently discharged vs. those that died: albumin: 33 +/- 6 g/l vs 28 +/- 6 g/l (p < 10(-6)); transferrin 2,18 +/- 0,65 g/l vs. 1,54 +/0 0,55 g/l (p < 10(-7)); prealbumin: 14,32 +/- 7,79 mg/100 ml vs. 7,28 +/-5,36 mg/100 ml (p < 10(-7)) and triglyceridemia was decreased: 1,07 +/- 0,38 g/l vs. 1,66 +/- 1,12 g/l (p not equal to 10(-3)). Body weight, fat weight and lead body mass were not correlated to subsequent mortality. Muscle cell mass was decreased (-17%, p < 10(-2)) and extracellular water was increased (+14%, p < 10(-4)), in patients who subsequently died. Total body water and visceral cell mass did not change. Initial anergy (tested with 3 antigens: candidin, tuberculin, varidase) did correlate with mortality: 35/62 died when delayed hypersensitivity was negative vs. 13/71 when it was positive (p < 10(-4)). Mortality was associated with decreased total lymphocyte count: 884 +/- 1025 vs. 1270 +/- 870 (p < 0,02) and serum iron: 51 +/- 40 micrograms/100 ml vs. 74 +/- 45 micrograms/100 ml (p < 10(-2)). Sepsis correlated with mortality (p < 10(-3)) and could produce these changes. These results suggest that critically ill paients have a protein-calorie malnutrition syndrom marktly different from that observed in simple starvation. Nutritional therapy must be, in this group of patients, adapted to this concept.
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A boy, aged 18 months, presented with bullous chickenpox due to simulutaneous skin infection with varicella and staphylococci. Two strains of staphylococci phage type II were identified. The child was treated with strict asepsis and antistaphylococcal therapy. Systematic steroids are contra-indicated.
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