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Biomedical subjects

A Roch

Publications and source records attributed to A Roch.

18 recordsLinked to original sources
PubMed2005

Effects of PEEP on oxygenation and respiratory mechanics during one-lung ventilation.

BACKGROUND: One-lung ventilation-related hypoxaemia (OLV-RH) can occur in patients with healthy lungs. In this case, PEEP frequently improves oxygenation. The aim of this study was to determine, in a healthy lung model of OLV, whether the increase in PEEP improved oxygenation and whether the mechanisms involved include both inspiratory lung recruitment and an end-expiratory lung volume increase. Since inhaled nitric oxide (iNO) may have a synergistic effect on oxygenation in the case of PEEP-induced recruitment, their association was also tested. METHODS: Twenty pigs were studied during open-chest, left OLV. Arterial blood gases and haemodynamic variables were measured at different levels of PEEP (0, 5, 10 and 15 cm H(2)O) applied in random order with or without iNO 4 p.p.m. Pressure-volume curves were measured at each level of PEEP. RESULTS: PEEP(5) and PEEP(10) improved Pa(O(2))/FI(O(2)) ratio (P<0.005) and shunt (P<0.005) regardless of the presence of iNO. PEEP(15) improved oxygenation and shunt only when it was associated with iNO (P<0.001). Whereas PEEP(5), PEEP(10) and PEEP(15) were associated with a significant increase in end-expiratory volume (P<0.001), only PEEP(5) and PEEP(10) were associated with continuous lung volume recruitment (P<0.01). Moreover, PEEP(15) induced a significant decrease in linear compliance (P<0.001). CONCLUSIONS: In a healthy porcine lung model of OLV-RH, moderate PEEP can improve oxygenation. This effect implies both expiratory and inspiratory pulmonary recruitment. Co-administration of 4 p.p.m. iNO was ineffective.

Animals↗
PubMed2005

[Endovascular treatment of isthmic aortic rupture: use of second generation stent grafts].

OBJECTIVE: Prospective analysis of endovascular management of traumatic isthmic rupture with second generation stent grafts. STUDY DESIGN: Prospective analysis and follow-up. PATIENTS: Ten consecutive multiple injured patients presenting an acute isthmic traumatic rupture who underwent an endovascular repair with second generation stent grafts. METHODS AND RESULTS: The aortic injury was diagnosed by spiral computed tomography scan. The appropriate time to repair was decided according to multidisciplinary decision after analysis of associated injuries status and mediastinal lesions evolution. Endovascular repair was successfully completed in all patients under general anaesthesia without requirement of haemodynamic manipulations. Despite a prolonged length of stay related to associated injuries, all patients were discharged from hospital without migration of devices or complication related to the endovascular procedure. After a 20 months follow-up (range 6 - 38 months), all patients were alive with a satisfactory CT scan analysis. CONCLUSION: The immediate availability of the second generation of stents-grafts allowed the endovascular treatment of isthmic rupture without haemodynamic manipulations or massive heparinization. The analysis of this selected series reinforces the interest of this non-invasive technique for anaesthetists especially in polytraumatized patients.

Adult↗
PubMed2004

[Somatostatin for the treatment of a post-oesophagectomy chylothorax].

Chylothorax is a rare but serious complication after oesophagectomy procedure. We report the case of a 59-year-old man who underwent an oesophagectomy by Akiyama procedure. A persistent postoperative chylothorax occurred requiring drainage and conservative management. After one week, the failure of this management motivated the institution of continuous infusion of somatostatin. This led to a rapid cessation of chyle production without side effect and to the discharge of the patient from the intensive care unit.

Chylothorax↗
PubMed2004

[Deep lactic acidosis after valproate self-poisoning].

A sixty-year-old woman was admitted in the ICU after Depamide (Valpromide) self-poisoning (430 mg/kg). Four hours after the ingestion, the patient presented coma (Glagow coma score of 3) with bilateral mydriasis requiring tracheal intubation and mechanical ventilation, hypotension requiring epinephrine infusion (0.9 microg/kg per minute), acidosis and hyperlactatemia (29.7 mmol/l at 12 hours) without any kidney or liver failure. The maximal serum valproic acid concentration measured was 342 mg/l after twelve hours (therapeutic rate: 35-85 mg/l). A continuous infusion of sodium bicarbonate was associated with continuous venovenous haemodiafiltration. Progressive haemodynamic improvement and neurologic recovery leaded to extubation at 36 hours.

Anticonvulsants↗
PubMed2001

High or low doses of almitrine bismesylate in ARDS patients responding to inhaled NO and receiving norepinephrine?

OBJECTIVE: To evaluate the effects on oxygenation and pulmonary haemodynamics of almitrine bismesylate (AB) 5 microg/kg per minute and 16 microg/kg per minute in ARDS patients responding to and receiving inhaled NO (iNO) and presenting septic shock requiring norepinephrine, while no difference was observed in a previous trial including iNO responders and nonresponders. DESIGN: Prospective, cohort study. SETTING: Adult medico-surgical intensive care unit of a university hospital. PATIENTS: Fifteen patients with ARDS receiving and responding to iNO (10 ppm) and presenting septic shock requiring norepinephrine (mean 0.5+/-0.45 microg/kg per minute, range 0.08- 2.08). INTERVENTIONS: The protocol consisted of two consecutive phases in a fixed order: continuous intravenous infusion of AB 5 microg/kg per minute for 30 min, and continuous intravenous infusion of AB 16 microg/kg per minute for 30 min. MEASUREMENTS AND MAIN RESULTS: AB 5 microg/kg per minute significantly increased PaO2/FiO2 ( P<0.05) compared with iNO alone [160 (range 77-450) mmHg vs 122 (range 70-225) mmHg]. AB 16 microg/kg per minute produced a greater increase of PaO2/FiO2 ( P<0.05) when compared with 5 microg/kg per minute [227 (range 84-501) mmHg]. AB did not improve shunt at any dose regimen. AB produced an increase in mean pulmonary arterial pressure (MPAP) from 22+/-5 to 25+/-4 mmHg ( P<0.03). MPAP did not significantly increase between the two doses. Pulmonary vascular resistances and other haemodynamic and respiratory parameters were not affected by almitrine bismesylate. CONCLUSIONS: These results suggest that it is possible to obtain a further improvement in oxygenation by increasing AB infusion rate in ARDS patients iNO responders receiving norepinephrine. Due to the potential deleterious effects of AB, this strategy should be used in the most severely hypoxaemic patients.

Administration, Inhalation↗
PubMed2001

Ultrasmall particulate iron oxides as contrast agents for magnetic resonance spectroscopy: a dose-effect study.

Long-distance effects of a superparamagnetic contrast agent (AMI227) were investigated by phosphorus-31 NMR spectroscopy at 7.05 Tesla. In an initial methodological approach, the effects observed on phantoms were compared to the results of theoretical calculations. In a second step, the particles were administered to excised and perfused rat livers (N = 5) and hearts (N = 5) through the perfusion medium for 12 minutes at various concentrations (0.9, 1.8, and 3.6 mM Fe). Organs were subsequently rinsed with the perfusion medium for 42 minutes. During particle perfusion, the spectral lines were shifted and exhibited a strong broadening, although the peak area remained constant, testifying to the inocuity of the material. For hearts only, these disturbances disappeared upon organ rinsing. These through-space susceptibility effects of the particles located in the vessels on phosphorus nuclei, which are strictly confined to the intracellular space, show that high-susceptibility intravascular agents could be useful to evaluate tissue perfusion by contrast-enhanced spectroscopy.

Analysis of Variance↗
PubMed2001

Water relaxation by SPM particles: neglecting the magnetic anisotropy? A caveat.

Magnetometric and relaxometric data from SPM particles are revisited, leading to a double conclusion rather different from the original one: accounting for the anisotropy energy not only allows a considerable improvement of the fit of the data to theory, but it also invalidates the conclusion obtained from the high field data (without accounting for anisotropy) concerning an important reduction of the diffusion coefficient by the coating of the particles.

Anisotropy↗
PubMed2001

Nuclear magnetic relaxation dispersion of ferritin and ferritin-like magnetic particle solutions: a pH-effect study.

The relaxation mechanism of water protons in the presence of ferritin is still being debated. In this work, the pH dependence of the relaxation induced by ferritin and Fercayl, a ferritin-like akaganeite particle, is studied through T1 and T2 nuclear magnetic relaxation dispersion (NMRD) profiles. To differing extents, the relaxation brought about by both systems is significantly affected by pH. A proton exchange time of 33 ns (at pH 6 and 37 degrees C) is deduced from the fittings of Fercayl T1 NMRD profiles. The linearity of the relationship between 1/T2 and the magnetic field B0 for ferritin and Fercayl solutions is not altered by changes in pH. The parameters of this linearity strongly depend on pH for the latter, while remaining unchanged for the former. These results are interpreted in terms of an exchange between protons belonging to hydroxyl groups at the surface of the particle and bulk water protons.

Animals↗
PubMed2000

Relaxation induced by ferritin and ferritin-like magnetic particles: the role of proton exchange.

Proton T1 and T2 in solutions of ferritin and fercayl (a ferritin-like iron-dextran particle) solutions were measured, over a wide range of various parameters (Bo, temperature, interecho-time and pH). The window of the previously referred linear dependence of 1/T2 on the static field was increased, up to 500 MHz, and the independence of T2 on the echo time was confirmed. Correlation times were extracted from T1 nuclear magnetic relaxation dispersion profiles. In the pH range studied, no strong variation of the relaxivities of ferritin solutions was noticed. Fercayl, which, unlike ferritin, remains stable under large pH variations, is characterized by strongly pH-dependent relaxation rates. This feature is interpreted as due to the effect of proton exchange in the water relaxation process. Outer sphere theory, which ignores proton binding, is shown to be unable to describe the relaxation of ferritin and ferritin-like particles solutions, first because it predicts a quadratic rate dependence on Bo, but also because it severely underestimates the relaxation rate. Explaining relaxation induced by ferritin and ferritin-like particle solutions will likely require a model that accounts for proton binding.

Animals↗
PubMed1999

Corrected equations for susceptibility-induced T2-shortening.

Local field gradients created by paramagnetic entities shorten water proton relaxation times, particularly T2. This "novel" relaxation mechanism, now known as susceptibility-induced relaxation, was described twenty years ago by Gueron, and later extended by others to superparamagnetic particles which have a much larger magnetization. Unfortunately, because of subtle but significant errors, those results are valid only in the strict zero-field limit. These errors are corrected in the present article, and new versions of the relaxation equations are presented. The correction is shown to be significant, not only for transverse and longitudinal relaxation in aqueous superparamagnetic colloids, where the "Gueron" effect is known to be important, but even in some cases for transverse paramagnetic relaxation.

Colloids↗
PubMed1999

Inhaled nitric oxide and vasoconstrictors in acute respiratory distress syndrome.

It has been suggested that the increase in PO(2) observed with nitric oxide (NO) should be enhanced by the addition of a vasoconstrictor agent. The vasoconstrictor used in combination with NO should mimic or enhance hypoxic vasoconstriction. The aim of this study was to evaluate the respiratory and hemodynamic effects of norepinephrine (a nonspecific vasoconstrictor), almitrine bismesylate (a specific pulmonary vasoconstrictor), and inhaled NO, alone or together. During a 6-mo period, 16 patients presenting with ARDS were prospectively investigated. On inclusion, no patient was receiving cardiovasoactive drugs. The protocol consisted of seven consecutive phases: baseline, norepinephrine (in order to obtain a 3 mm Hg rise in mean pulmonary arterial pressure [Ppa]), almitrine bismesylate (16 micrograms/kg/min), inhaled NO (20 ppm delivered during inspiration), norepinephrine + inhaled NO, almitrine bismesylate + inhaled NO, almitrine bismesylate + norepinephrine + inhaled NO. General factorial analysis of variance showed that inhaled NO and almitrine bismesylate increased oxygenation (p < 0.0001). Norepinephrine had no effect on oxygenation. A synergistic effect between inhaled NO and almitrine bismesylate was found (p < 0.05), whereas norepinephrine did not affect the response to inhaled NO. Nitric oxide produced a significant decrease in Ppa and pulmonary vascular resistances (PVRI) (p < 0.0001). Both almitrine bismesylate and norepinephrine induced an increase in Ppa (p < 0.0001). Norepinephrine increased PVRI (p < 0.002), whereas almitrine bismesylate had no effect on PVRI. The present results support the hypothesis that a selective pulmonary vasoconstrictor enhances the increase in oxygenation induced by inhaled NO, whereas norepinephrine attenuates this effect.

Administration, Inhalation↗
PubMed1999

Inhaled NO and almitrine bismesylate in patients with acute respiratory distress syndrome: effect of noradrenalin.

The combination of inhaled nitric oxide with almitrine bismesylate has been proposed for the management of acute respiratory distress syndrome in order to divert pulmonary blood flow away from poorly ventilated toward well-ventilated areas. The aims of this prospective and comparative study were to: 1) confirm the beneficial effects on oxygenation of this association; 2) evaluate the haemodynamic effects of this association; and 3) evaluate the influence of noradrenaline (a nonspecific vasoconstrictor) on the modification of gas exchange related to inhaled NO and/or almitrine bismesylate. Forty-one sedated paralysed and ventilated patients were investigated. Haemodynamic and blood gas measurements were performed in a fixed order: baseline; inhalation of NO for 30 min.; intravenous infusion of almitrine bismesylate; and concomitant administration of inhaled NO and almitrine bismesylate. Inhaled NO and almitrine bismesylate increased arterial oxygen tension (Pa,O2)/inspiratory oxygen fraction (FI,O2) (p<0.001). The association of inhaled NO with almitrine bismesylate resulted in a dramatic improvement in Pa,O2/FI,O2 (p<0.0001 versus almitrine bismesylate, p<0.05 versus inhaled NO). In patients receiving noradrenalin (n = 19), almitrine bismesylate had no effect on oxygenation. The present study confirmed that the combination of inhaled NO with almitrine bismesylate improved oxygenation, and demonstrated that almitrine bismesylate has no effect on oxygenation in patients receiving noradrenalin.

Administration, Inhalation↗
PubMed1992

Optimization schemes for selective excitations: application to the DIGGER pulses.

In this work, two distinct approaches to the tailoring of selective radiofrequency (RF) pulses were applied to a cos-sinc pulse of the DIGGER sequence used in localized spectroscopy. Ideally, three such pulses combined with a gradient in each direction destroy the Mz component of the magnetization everywhere but in the volume of interest. In the first approach, the optimal RF amplitude modulation is found by minimizing the difference between the ideal and the computed Mz profiles. In the second strategy, the RF pulse envelope is adjusted by optimization of the tip angle profile. Computed slice profiles optimized by each of these methods have been compared to experimental results. Simulations as well as experiments show that the second approach, which optimizes tip angles, is the most efficient.

Magnetic Resonance Spectroscopy↗
PubMed1991

Transverse relaxivity of particulate MRI contrast media: from theories to experiments.

Computer simulations and experimental approach have been used to characterize the properties of particulate MRI contrast agents with special attention paid to the influence of particle size. Up to approximately 50 nm, an increase of the particle diameter leads to a strong enhancement of the transverse magnetization decay rate. For larger grains or aggregates, the decay rate measured without spin-echo formation reaches a plateau. When observed through a spin-echo sequence, the transverse magnetization decay rate becomes slower on increasing the particle size or on shortening the echo time. For these large particles, multiexponential decay rates are observed. Definition and measurement of relaxivity in such systems is discussed.

Computer Simulation↗
PubMed1988

The importance of nuclear magnetic relaxation dispersion (NMRD) profiles in MRI contrast media development.

Observation of the relaxivity of MRI contrast media over a wide range of magnetic fields is not only necessary for predicting their efficiency at any field but also compulsory for understanding and improving their mechanisms of action. The best experimental approach to this problem is the field cycling method, which allows the exploration of nuclear relaxation over a broad interval of magnetic field intensity but requires a specially dedicated instrument called a relaxometer. Particularly relevant are the relaxivity profiles of the two chelates Gd-DOTA and Gd-DTPA. Both show an important decrease from low to high fields within the current imaging range (0.02 T to 1.5 T). Although high field relaxivities of these chelates are similar, Gd-DTPA becomes less efficient in facilitating water protons relaxation at fields lower than 0.15 T. This behavior has to be related to different electronic relaxation times due to a different chelate symmetry.

Animals↗
PubMedDate not supplied

Inhibition of growth and induction of apoptosis by androgens of a variant of LNCaP cell line.

Here are described the effects of androgens, and other molecules known to bind to androgen receptors (AR), on MOP cells established from the human prostate cancer cell line LNCaP. MOP cells contained AR: 100000 binding sites/cell, K(D) for 5alpha dihydrotestosterone (DHT) 0.5 nM, size 110 kDa. The AR gene has the same repetition polymorphism in exon 1 and the T876A mutation in exon 8 as LNCaP. The proliferation of MOP cells in culture was repressed by the synthetic androgen 17beta-hydroxy-17-methyl-estra-4,9,11-trien-3-one (R 1881), the antiandrogen cyproterone acetate (CYPA), estradiol (E2), progesterone and the synthetic progestin promegestone: 17,21 dimethyl-19 nor-4,9 pregnandiene-3,20 dione (R 5020). The number of cells recovered after 7 days decreased to approximately 40% of controls. ED(70)s ranged between 50 pM for R 1881 to 50 nM for E2 and CYPA. Treatment with R 1881 decreased [3H]thymidine incorporation into DNA and increased dramatically the doubling time. R 1881, CYPA and E2 blocked the cell cycle between G1 and S phases and they induced apototosis as demonstrated by the increase of blebs on the plasma membrane, nuclear fragmentation, TdT-mediated dUTP nick end-labeling (TUNEL)-positive cells and internucleosomal DNA breaks. In athymic nude mice, testosterone enanthate prevented the growth of MOP tumors and, when tumors did develop, brought about regression. However, the tumors did not regress completely and finally escaped treatment. In conclusion, a variant of the LNCaP cell line has been established. With these cells it was possible to confirm that androgens paradoxically repress the growth of some prostate cancer cells both in culture and in vivo. In addition it is demonstrated in culture but not in vivo, for the first time to the authors' knowledge, that a synthetic androgen is able to induce apoptosis of cells established from human prostate carcinoma.

Androgens↗