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Biomedical subjects

A Cuvelier

Publications and source records attributed to A Cuvelier.

At least 55 records · Page 3Linked to original sources
PubMed1998

[Treatment of tracheobronchomegaly using the Freitag prosthesis].

Tracheobronchomegaly (TBM) is a rare disorder. It is characterised by a dilatation of the trachea and subsequent bronchial divisions associated with a dynamic pathology, in particular a cough which explains the symptomatology of the patients. We report the observation of a patient suffering from TBM whose clinical progress rapidly improved after the insertion of a Freitag prosthesis. This 60-year-old male presented with a year's history of chronic cough which was painful, cavernous and had been incapacitating associated with moderate dyspnoea of effort. Bronchial endoscopy showed dyskinesia extending almost totally throughout the tracheobronchial tree with complete expiratory collapse. The FEV1, the Vital Capacity and the TLC were subnormal and the PEF was 57% of the predicted. The total airways resistance (RAW) was elevated (306% of the predicted), the arterial blood gases were normal. A CT scan showed a deformed trachea with increased diameter. A tracheobronchial prosthesis of Freitag or Dynamic stent (Rüsch) was inserted with the help of a rigid bronchoscope. One month later the cough had regressed and the effort dyspnoea had disappeared. One year later the clinical improvement persisted with very good tolerance of the prosthesis with normal spirometry despite the persistence of an elevated RAW. Despite a recoil which is still imperfect the tracheobronchial endoprosthesis seems to be a useful treatment for forms of TBM which are potentially progressive.

Airway Resistance↗
PubMed1998

[Instrumental management of chronic respiratory insufficiency: contribution of long-term therapeutic assistance at home].

Chronic respiratory failure represents an important problem of public health if we consider the potential high number of patients needing to be treated and the expenses linked to a complex treatment having to be applied at home. Progress of knowledge about chronic respiratory failure conducted in the early' 80 to the publication of the BMRC and NOTT studies where long-term oxygen therapy was demonstrated to be efficient in severe hypoxic patients with chronic obstructive pulmonary disease, reducing need for hospitalisation for acute respiratory failure and thus improving quality of life. In the early '80, several retrospective studies showed the interest of mechanical ventilation in the management of chronic respiratory failure secondary to restrictive defects mainly due to chest wall deformities, neuromuscular diseases and tuberculous sequelae. Tracheostomy was initially used as a connection mode to the respiratory; the technological progress obtained with the treatment of sleep apnea syndrome with nasal continuous positive airway pressure made convenient masks available, which were in turn used with success to ventilate "non invasively" patients with restrictive defects at home as well as in acute respiratory failure. Nowadays, chronic respiratory failure is largely managed at home with the help of respiratory assistance organizations, which manage in France through the public ANTADIR network more than 50,000 patients.

Chronic Disease↗
PubMed1998

Modalities of ventilation in obesity.

Obesity is nowadays the most frequently found health risk in the USA, where more than 1 in 3 adults have a weight > or = 20% over the ideal value. Obese patients are more prone to developing sleep apnoea syndrome and obesity hypoventilation syndrome as well as more frequent postoperative complications. Thus, acute and chronic respiratory failure episodes represent current presentations in clinical practice where noninvasive ventilation is very efficient and must be guided by polysomnographic data in order to decide on long-term respiratory treatment to avoid recurrence of acute on chronic decompensation.

Acute Disease↗
PubMed1997

Long-term efficiency of home nasal mask ventilation in patients with diffuse bronchiectasis and severe chronic respiratory failure: a case-control study.

The aim of this study was to evaluate long-term efficacy and tolerance of nasal mask ventilation (NMV) in a comparative case-control study. Fourteen patients with diffuse bronchiectasis and severe chronic respiratory failure (CRF), treated by long-term oxygen-therapy (LTO) and NMV, were case matched with 14 patients with diffuse bronchiectasis and severe CRF treated with only LTO. Patients and control subjects were compared based on the following parameters: blood gases, FEV1, vital capacity, hospitalizations, and survival. Symptoms, Karnofsky function score, and clinical evolution were also monitored in patients. Three subgroups may be identified according to outcome: two early deaths (subgroup 1), six patients with initial improvement and subsequent deterioration (subgroup 2), and six patients whose conditions remained improved for >2 years (subgroup 3). PaO2 decrease slope was slighter in this last subgroup than subgroup 2. The days of hospitalization were significantly reduced after institution of NMV in the patient group. Comparison between patients and control subjects did not show any difference on PaO2 evolution and on the overall median survival (46 and 40 months in NMV and control group, respectively). Long-term tolerance and compliance remained satisfactory for 11 patients. These results suggest that NMV is feasible as a long-term home treatment in patients with diffuse bronchiectasis. Although our results may have failed to prove a long-term efficiency on the course of blood gases and survival, a beneficial effect is observed with reduction of hospitalizations and improvement of functional status. This study warrants further investigation, in a prospective series, with a larger number of patients.

Adult↗
PubMed1997

Metalloelastase expression in a mouse macrophage cell line--regulation by 4beta-phorbol 12-myristate 13-acetate, lipopolysaccharide and dexamethasone.

The regulation of the expression of mouse macrophage elastase (MME) was investigated using the murine tumor cell line P388D1. The effects of three factors were studied: a phorbol ester (4beta-phorbol 12-myristate 13-acetate, PMA), an endotoxin (lipopolysaccharide, LPS) and a corticosteroid (dexamethasone). Both in situ hybridization and northern blot analysis showed that P388D1 cells constitutively express the MME gene. Quantification of the MME mRNA by northern blot analysis showed that only PMA and dexamethasone significantly regulate MME gene expression in a time-dependent and dose-dependent manner. After PMA treatment, the MME mRNA level was maximal between 4 h and 9 h (medium-term response), and the mean amplitude of the response to a concentration of 100 nM was 2.5-fold (P<0.01). LPS did not induce any significant change in MME mRNA level even when 1% serum was added to the cultures. Following dexamethasone treatment, the MME mRNA level was minimal between 21 h and 33 h (long-term response), and the mean amplitude of the response to a concentration of 100 nM was 0.49-fold (P < 0.05). Using actinomycin D, it appeared that the inhibition of RNA synthesis reduces the ulterior stimulating effect of PMA from 184% to 121%, and that MME mRNA has a half-life longer than 8 h, which is not diminished by dexamethasone. These results strongly suggest that the two factors modify MME mRNA level by stimulating (PMA) or inhibiting (dexamethasone) the transcription of the gene, rather than by modifying the transcript stability. Analysis of the cell-conditioned media by elastin zymography showed the MME as a lysis band in the 22-kDa region, the intensity of which varied with the treatments. The MME secretion is stimulated by PMA, inhibited by dexamethasone and does not show any variation after LPS treatment.

Animals↗
PubMed1997

[Purulent pleurisy].

Management of thoracic empyema remains controversial considering local treatment and place of surgical intervention. If French practitioners use primarily iterative thoracentesis and pleural lavage, reserving thoracic drainage for cases of failure of thoracentesis, American authors recommend a more aggressive initial approach, with thoracic drainage and surgical intervention. However, conservative attitude, combining immediate thoracocentesis and pleural lavage with intrapleural fibrinolytic therapy of loculation occurs, may also be proposed. Prospective studies are warranted to evaluate the different methods used to evacuate empyema and validate new procedures as pleural catheters inserted under radiologic guidance and thoracoscopy versus conventional approach.

Biopsy, Needle↗
PubMed1997

[Metalloproteinases in the extracellular matrix: structure and activity].

The matrix metalloproteinases (MMP) are a multigenic family involving 14 enzymes which can cleave most, if not all, the components of the extracellular matrix (interstitium and basement membranes). The present work reports on the main structural characteristics, the substrate preference and the site synthesis of these proteinases and their inhibitors (TIMP). Human MMPs are produced by various cell types and are involved in the remodelling of the extracellular matrix in many physiological and pathophysiological circumstances. Elastolytic MMPs produced by monocytes and/or macrophages (matrilysin, gelatinases, macrophage elastase) are likely to be implicated in the development of acquired pulmonary emphysema.

Extracellular Matrix↗
PubMed1997

Noninvasive mechanical ventilation and acute respiratory failure: indications and limitations.

Noninvasive mechanical ventilation (NMV) now represents the first step in the management of acute on chronic respiratory failure (A/CRF). During the last 5 yrs, many studies have confirmed the feasibility of NMV in an acute setting, either by facial or nasal interface, used in addition to volumetric or barometric respirators, to manage A/CRF. The best indications for NMV are slowly progressive A/CRF, frequently represented by chronic obstructive pulmonary disease (COPD), or restrictive pulmonary disease. The criteria to initiate NMV in such patients are worsening of respiratory status and arterial blood gas (ABG) values, with increased hypoxia, hypercapnia and respiratory acidosis, despite optimal management with medication, physiotherapy and oxygen therapy. Respiratory encephalopathy is not an absolute contraindication; however, bronchial hypersecretion indicates that care is needed under NMV. Invasive mechanical ventilation with endotracheal (ET) intubation is discussed in the case of failure of NMV, when clinical status and ABG values worsen in spite of it. The signal for ET intubation is then obvious, represented by severe dyspnoea leading to respiratory pauses or arrest, severe cyanosis, and signs of haemodynamic instability. Despite immediate evidence of ominous cardiorespiratory inefficiency, ET intubation may be delayed and often avoided with the help of NMV. Criteria should be studied to identify guidelines for cessation of NMV, in order not to continue with the technique too long considering the safety of the patient. Indications for NMV in other kinds of ARF have received less study and are more controversial.

Acute Disease↗
PubMed1997

[Asymptomatic mediastinal parathyroid adenoma].

A 74-year-old woman was hospitalised for pleuro-pneumonia of the right base. The chest x-ray showed the presence of a right paratracheal opacity which persisted during the course of the infectious episode. A computed tomographic scan of the thorax showed a voluminous anterior mediastinal mass which compressed the trachea without invading it. Surgical excision enabled the ablation of a tumour which was haemorrhagic and the histological examination established a diagnosis of cystic parathyroid adenoma. At anytime did the patient present either clinical symptoms or biochemical signs suggesting primary hyperparathyroidism.

Adenoma↗
PubMed1996

Substitution of carbonate by acetate buffer for IgG coating in sandwich ELISA.

The first step of sandwich ELISA, namely adsorption of antibodies to plastic microtiter plates, was studied as a function of the pH of the coating buffer. Coating efficiency was assessed in terms of maximum signal (absorbance) observed in ELISA and also estimated by measuring the amount of functional antibodies adsorbed to the plate. While goat antibodies displayed better results after coating with acetate pH 5 buffer, rabbit IgGs generally worked well at pH 7.4. On average, the classical carbonate pH 9.6 buffer was only 50% as efficient.

Acetates↗
PubMed1996

[Recurrent pleural pericarditis].

Primary pulmonary lymphoma is a rare disorder often clinically latent. We report a case of a pulmonary lymphoma diagnosed following a recurrent pleuro-pericarditis and its progress to a diffuse lymphoma of high-grade malignancy.

Female↗
PubMed1995

[Home care of severe COPD].

Home management of patients with severe chronic obstructive pulmonary disease implies to consider in parallel with optimal medical treatment and chest physiotherapy, the status of chronic respiratory failure needing initiation of long-term oxygentherapy. Chronic hypoxemia (PaO2 < or = 55 mmHg) is present with chronic respiratory failure, which may be stabilized under long-term oxygentherapy if oxygen is given at least 15 h/24 h, with long-term improvement of life expectancy and quality of life. With the help of home respiratory care networks which are developed on a large extent in France, it is possible to prescribe in good technical conditions long-term oxygentherapy at home, which is a life-long treatment. Home mechanical ventilation concerns the most severe patients, with unstable chronic respiratory failure, where long-term oxygentherapy fails to prevent acute respiratory failure episode, sometimes also in patients who are waiting on a lung transplantation program.

France↗
PubMed1994

Diagnostic usefulness of radiolabeled pentetreotide scintigraphy and therapeutic efficiency of octreotide in a case of insulinoma.

Although the functional diagnosis of insulinoma is quite easy, its topographic diagnosis still constitutes a major challenge since conventional radiological techniques, e.g. ultrasonography, computed tomography and even selective angiography, fail to recognize the tumor in numbers of insulinomas. We report an observation of a benign insulinoma in an 81-year-old woman that escaped detection by ultrasonography and CT but was later localized by both endoscopic ultrasonography and somatostatin receptor scintigraphy. It illustrates the usefulness of such recent imaging techniques for the localization of islet cell tumors that escaped detection by ultrasonography and CT. Moreover, in our elderly patient who refused surgical intervention, hypoglycemia was corrected by octreotide administration emphasizing the predictive value of 111In-pentetreotide scintigraphy on the subsequent response to octreotide therapy in patients in whom the optimal treatment (surgical resection) is not possible.

Aged↗
PubMed1990

[Efficacy and tolerability of morniflumate in acute otitis in infants: results of a randomized study versus placebos].

In a randomized double-blind placebo-controlled, parallel group study, 79 infants with acute otitis media received treatment with suppositories containing either Nifluril (400 mg daily, morniflumate) or placebo for five days. Both groups of patients also received amoxicilline (50 mg/kg daily) for eight days. The combination of Nifluril with antibiotic therapy gave significantly greater relief from abnormalities of the tympanic membrane (after two days treatment), inflammation of the throat and nasal congestion than did antibiotic therapy alone. Overall clinical assessment confirmed a significantly greater recover rate in the Nifluril group compared with the placebo group. Very few side effects were recorded, limited to diarrhoea, without any drug interruption. Nifluril may be recommended as an effective safe adjuvant to the antibiotic treatment of acute otitis media in infants.

Acute Disease↗