PubMed Health⌕ Search

Biomedical subjects

B Fleury

Publications and source records attributed to B Fleury.

At least 19 recordsLinked to original sources
PubMed1995

Enhancement of postoperative desaturation in heavy snorers.

The risk of postoperative decreases of arterial saturation in oxygen (SpO2) could be enhanced in patients with previous history of sleep-induced respiratory impairment. To test this hypothesis, patients scheduled for orthopedic surgery were classified preoperatively as heavy snorers, light snorers, and nonsnorers, according to their answers to a questionnaire. During the first postoperative night, the patients were breathing room air and both the arterial saturation and the tracheal sounds were monitored. Although the cumulated duration of snore was similar in the three groups, the number of desaturations (decrease in SpO2 > or = 4%) was more in the heavy snorers (14.9 +/- 27.9) than in the light snorers (0.1 +/- 0.3) and the nonsnorers (0.2 +/- 0.3) (P < 0.05). The percent duration of recording at SpO2 < 90% was longer in the heavy snorers (52.0% +/- 41.9% of the recording time) than in the two other groups: 9.3% +/- 12.4% (light snorers) and 17.5% +/- 21.8% (nonsnorers) (P < 0.05). Patients with a previous history of sleep-disordered breathing risked postoperative desaturation and could be detected preoperatively by the answers to certain questions.

Anesthesia, Inhalation↗
PubMed1995

[A new technique of gene transposition in the surgical treatment of sleep apnea syndrome].

Pharyngotomy appears to be insufficient for the treatment of severe sleep apnea. For patients who refuse or abandon mechanical ventilatory assistance, surgery can be used to widen the retrobasilingual space adapting it to the cephalometric profile defined by cineradiography and MRI in combination with velopharyngeal plasty. For patients with no maxillomandibular or lingual malformation, the pharyngotomy can be combined with an anterior transposition of the genial insertions of the tongue without rotation. A method different from that described by Riley and Powel is proposed. The details of the surgical procedure are exposed. The operation is indicated in snorers with sleep apnoea with an Apnea Index Superior to 30 who refuse nocturnal ventilatory assistance and who do not have a hypertrophied tongue (Surface less than 30 cm2) or maxillomandibular retroposition.

Cephalometry↗
PubMed1994

[Respiratory effects of midazolam in patients with obstructive sleep apnea syndromes].

The administration of benzodiazepines at sleeping doses can be followed by an increased rate of upper airways obstruction episodes, especially in patients with an obstructive sleep apnea syndrome (OSAS). However, the effects of benzodiazepines at premedication doses have not yet been assessed. Therefore, fourteen patients were studied after administration of midazolam 0.08 mg.kg-1 i.m.: seven with an OSAS diagnosed previously (baseline recording) (= OSAS group) and seven without risk factors for OSAS (= Control group). The recordings were undertaken in the sleep laboratory. The airflows were assessed by nasal and oral thermistors and chest and abdominal movements by strain gauges. The electromyogram of the chin muscles was recorded, the electroencephalogram and the electro-oculogram electrodes were placed as described by RECHTSCHAFFEN and KALES. The arterial saturation in oxygen (Spo2) was monitored by pulse oximetry. All the signals were digitized and fed into a computer. The apnea was defined as a cessation of airflows for a least 10 s. The hypopnea was defined as a 10 s decrease in airflow with a drop in Spo2 of 4% or more. The respiratory event (apnea or hypopnea) was qualified as obstructive if the thoraco-abdominal movements persisted. The rate and the duration of respiratory events per sleep hour (mean +/- SEM) in OSAS group after midazolam (respectively 29.6 +/- 10 and 11.2 +/- 3.5 min) were not different from those of the baseline recording (respectively 38.4 +/- 11.6 and 12 +/- 3.5 min) and were significantly higher than in the control group (respectively 38.2 +/- 2 and 1.8 +/- 1.3 12 +/- 3.5 min) and were significantly higher than in the control group (respectively 3.8 +/- 2 and 1.8 +/- 1.3 min; p < 0.05). In the OSAS group, the percentage of sleeping time spent with a Spo2 < 90% was 1.5 +/- 1.4% during the baseline recording and 4.7 +/- 1.9% after midazolam (difference n.s.). However, a dramatic increase was observed in two patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Long-term compliance to continuous positive airway pressure therapy (nCPAP) set up during a split-night polysomnography.

We studied prospectively the acute and long-term compliance with nasal continuous positive airway pressure (nCPAP) therapy set up during a split-night polysomnography in 31 patients suffering from severe obstructive sleep apnea syndrome (OSAS). The mean apnea-hypopnea index (AHI) was 66 +/- 23/hour. An effective nCPAP (AHI < 10/hour in all sleep stages in the dorsal decubitus) was titrated in 27/31 patients. The mean effective nCPAP was 11 +/- 2 cm H2O. In three patients, a subsequent night was necessary to determine the effective nCPAP during rapid eye movement sleep, and one patient did not support the treatment. Of the 27 patients with successful titration, 21 accepted home treatment, three chose a surgical procedure and three refused to be treated. Of the 21 accepting home treatment, one patient did not receive his insurance agreement and could not participate in follow-up. Among the 20 other patients, four interrupted their treatment during the 1st month because of discomfort, and 16 were followed for 285 +/- 84 days. The daily rate of nCPAP use for the compliant patients was 6.7 +/- 1.5 hours. These preliminary results indicate that a split-night technique is reliable and cost saving in a majority of patients suffering from severe OSAS.

Adult↗
PubMed1994

Multispecific and heterogeneous recognition of the gag protein by cytotoxic T lymphocytes (CTL) from HIV-infected patients: factors other than the MHC control the epitopic specificities.

The HIV gag polyprotein is a major target for recognition by CTL in infected humans. Using recombinant vaccinia viruses (rVV) expressing truncations of the p24gag, and the p18gag, p15gag and HIV-2 p56gag proteins, the characterization of epitope regions recognized by in vitro-stimulated peripheral blood mononuclear cells (PBMC) from 18 infected patients has been studied. The gag-specific response of most individuals is polyclonal and multispecific, and interindividual variations between target epitope regions were frequently observed, despite shared MHC alleles. As CTL may play an important role in the control of HIV replication in infected hosts, these results have important implications for designing vaccine strategies.

Adult↗
PubMed1994

Total amounts of circulating human chorionic gonadotrophin alpha and beta subunits can be assessed throughout human pregnancy using immunoradiometric assays calibrated with the unaltered and thermally dissociated heterodimer.

The aim of the present study was to determine the variations in the balance between total (free plus combined) circulating alpha and beta subunits of human chorionic gonadotrophin (hCG) throughout human pregnancy. The equivalence between the International Units (IU) of hCG (IRP 75/537) and those assigned to the alpha (IRP 75/569) and beta (IRP 75/551) free subunits was experimentally determined by using intact and thermally dissociated hCG. Heat exposure (2 min at 100 degrees C) of hCG preparations resulted in a complete dissociation of hCG into free, soluble and intact alpha and beta subunits. The hCG and alpha and beta subunit contents of unaltered and heated hCG preparations were assessed by specific immunoradiometric assays. The amount of immunoreactive subunits dissociated by heat from hCG could then be evaluated on a molar basis. Circulating hCG and its free alpha and beta subunits were immunoassayed in 836 blood samples collected from healthy pregnant women at different gestational ages. After conversion of hCG and its subunits into a common IU system, the gestational profiles of the total amounts (free plus combined) of alpha- and beta hCG subunits increased together and peaked at 9-10 weeks of gestation. Thereafter, total alpha and beta subunits decreased and subsequently remained stable until term. The decline in total alpha hCG subunit was less marked than that of total beta hCG subunit. The alpha- to beta hCG ratio was equimolar until 10 weeks of gestation when it increased almost fourfold until term (P < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)

Chorionic Gonadotropin↗
PubMed1993

Free triiodothyronine (FT3) EIA-BioMerieux. Analytical and clinical evaluation.

We tested a new immuno-enzymatic kit: FT3-EIA BioMerieux, for direct measurement of FT3. Precision is good, with coefficients of variation below 10%. Detection limit is 0.4 pmol/l. We tested some anticoagulants and the specificity of the antibody. Results appear to be independent of plasmatic concentration of albumin and TBG. Reference range was determined to be 3.7 to 8.7 pmol/l. A clinical study, in comparison with isotopic method FT3-Coat-RIA BioMerieux shows that this non-isotopic kit is available, even for low concentrations.

Albumins↗
PubMed1992

Polymorphism of alcohol dehydrogenase, alcohol and aldehyde dehydrogenase activities: implication in alcoholic cirrhosis in white patients. The French Group for Research on Alcohol and Liver.

Two types of factors can theoretically modulate alcohol metabolism toward increased acetaldehyde production. These factors are the following: (a) individual, genetically determined isoenzymes with distinct catalytic properties, and (b) modifications of enzyme activity induced by alcohol itself or liver damage. To investigate the respective roles of these factors in white individuals, we studied the alcohol dehydrogenase phenotype, together with liver alcohol dehydrogenase and aldehyde dehydrogenase activities, in 161 patients. Patients with alcoholic cirrhosis (n = 31) were compared with three types of controls: patients with nonalcoholic cirrhosis (n = 25) and excessive (n = 62) and moderate drinkers (n = 43) without liver disease. No association between alcohol dehydrogenase-3 phenotype and alcoholic cirrhosis was found. The prevalence of atypical alcohol dehydrogenase in the four groups was less than 1%. Patients with cirrhosis, regardless of its cause, had significantly lower alcohol dehydrogenase activity than the patients without cirrhosis (p less than 0.05 and p less than 0.01 vs. excessive and moderate drinkers, respectively). Among the noncirrhotic patients, alcohol dehydrogenase activity was significantly lower in the excessive drinkers than in the moderate drinkers (p less than 0.001). Aldehyde dehydrogenase activity was not different between cirrhosis-free excessive and moderate drinkers; in contrast, compared with these two groups, it was significantly lower in the two cirrhosis groups (p less than 0.01). These results suggest that no phenotypic pattern of alcohol dehydrogenase-3 associated with alcoholic cirrhosis in white patients exists, that liver alcohol dehydrogenase activity falls as a consequence of both alcohol abuse and cirrhosis and that liver aldehyde dehydrogenase activity is unaffected by alcohol abuse and only falls after the onset of cirrhosis.

Adult↗
PubMed1992

Sleep apnea syndrome in the elderly.

Sleep apnea syndrome (SAS) is a well established sleep disorder with high morbidity and mortality. Patients are most often middle-aged men. SAS occurs in at least 1% of the adult population. Several studies have suggested that SAS is extremely frequent in the elderly, its prevalence ranging from 18 to 73% in this group. However, the generalization of these results to elderly cohorts is questionable because of several limitations of these studies, including lack of standard selection criteria, variation in recording techniques, the night to night variability of sleep apnea and the use of a moderate level of sleep disordered breathing (SDB) to define SAS (5 apneas per hour). The study best designed for valid extrapolation to the whole aged population estimates the frequency of SAS at 18%. However, most of these patients reported satisfactory sleep, and epidemiologic criteria for a causal association between SAS in the elderly and cardiovascular disease have not been satisfied. The conclusions of numerous studies dealing with impairment in cognitive function and SAS in the elderly are controversial. In fact, if the diagnostic threshold is increased from 5 apneas to 10 apneas plus hypopneas per hour, elderly SAS patients have more sleep disturbances, are more depressed and have cognitive deficits as compared to normal old persons. When an appropriate diagnostic index is used, SAS in the elderly resembles SAS described in the middle-aged population. In addition, a high apnea plus hypopnea index is an ominous predictor of mortality in the elderly population, and a very high level of SDB is an extremely significant risk factor for mortality during sleep phase in these patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

[Treatment of simple snoring. Surgical pharyngoplasty vs. laser CO2 pharyngotomy].

CO2 laser pharyngotomy is a newly described technique used in treatment bronchopathy without sleep apnea syndrome. Retrospective results of 70 CO2 laser pharyngotomies and 63 surgical pharyngoplasties are studied and compared. All patients were SAS free snoring patients. The results were rated satisfactory by 54% of the CO2 Laser treated patients against 78% for classical surgery. CO2 laser pharyngotomy is an easy procedure done in the office. The complication rate is very low. The predictive criteria upon which one can select the best procedure for each particular patient remain largely unknown.

Adult↗
PubMed1992

Effects of celiprolol, a cardioselective beta-blocker, on respiratory function in asthmatic patients.

The aim of this study was to compare the pulmonary effects of a single dose of celiprolol 400 mg, versus bisoprolol 20 mg and the combination of celiprolol 400 mg plus propranolol 40 mg versus placebo plus propranolol 40 mg. We conducted a double-blind randomized cross-over study in 10 stable asthmatic patients (mean age +/- SD 31 +/- 7 yrs) with forced expiratory volume in one second (FEV1): 2.5 +/- 0.7 l. A three-day washout period preceded each treatment period. Measurements of respiratory function were done before treatment and after 90, 120 and 180 min. There was a significant increase of FEV1 (+12%) and forced vital capacity (FVC) (+8%) after celiprolol (p less than 0.05) and a decrease of FEV1 (-9%) after propranolol. Concerning the combination, celiprolol inhibits the bronchoconstrictor effects of propranolol. We conclude that celiprolol has bronchosparing properties in asthmatic patients, and even improves some of the ventilatory parameters.

Adrenergic beta-Antagonists↗
PubMed1992

Polymorphism of class I alcohol dehydrogenase in French, Vietnamese and Niger populations: genotyping by PCR amplification and RFLP analysis on dried blood spots.

The polymorphism of human alcohol dehydrogenase (ADH) can contribute to the explanation of the important ethnic differences towards alcohol metabolism. Its assessment at the genomic DNA level with a procedure, excluding labelled probes, consisting of PCR (Polymerase chain reaction) amplification on dried blood spots and analysis of allele-specific RFLP (Restriction fragment length polymorphism) profiles, is well adapted to extensive studies in population samples. It can emphasize the importance of ADH as a genetic marker of population. Three ethnic groups (French Caucasians, Vietnamese Orientals, Black Africans from Niger) were studied. ADH2 and ADH3 genotypes were in equilibrium according to the Hardy-Weinberg law. Important differences were noted in the distribution of ADH2 and ADH3 alleles.

Alcohol Dehydrogenase↗
PubMed1991

Glutathione S-transferase class mu in French alcoholic cirrhotic patients.

The lack of glutathione S-transferase mu (GST mu) was examined in 45 healthy French Caucasians and 45 alcoholic cirrhotic French Caucasians: microsamples of blood were taken and DNA amplified by the polymerase chain reaction. We have concluded that there is no relationship between this genotype and the development of alcoholic cirrhosis in these heavy consumers of ethanol.

Adult↗
PubMed1991

Decreased oxyhemoglobin affinity in patients with sleep apnea syndrome.

Oxyhemogloblin affinity (P50 at pH 7.4, PaCO2 = 40 mm Hg, temperature = 37 degrees C) and 2,3-DPG concentration were assessed in 15 nonsmokers (14 men and one woman 46 to 63 yr of age) with sleep apnea syndrome (SAS) and in 10 normal subjects (eight men and two women 22 to 48 yr of age). In patients with SAS, mean nocturnal apnea index was 46 +/- 20/h, and mean nocturnal SO2 was 86 +/- 6% versus 94.6 +/- 1.8% during the daytime. Daytime mean P50 of the patients was 28.5 +/- 1.2 mm Hg versus 27.1 +/- 0.3 mm Hg in the normal subjects (p less than 0.05). Daytime mean 2.3-DPG was 1.23 +/- 0.25 moles DPG/mole hemoglobin versus 0.80 +/- 0.15 (p less than 0.05). Significant correlations were found in patients between P50 and mean nocturnal SO2 (r = -0.62, p less than 0.01) and between P50 and 2,3-DPG (r = 0.68, p less than 0.01). The measurements were repeated in five patients after surgical or positive-pressure treatment. P50 and 2,3-DPG both decreased and returned to normal values. In conclusion, the oxyhemoglobin dissociation curve is shifted to the right in patients with SAS and there is an increase in 2,3-DPG. These could be protective mechanisms against the development of polycythemia, pulmonary hypertension, and cor pulmonale.

2,3-Diphosphoglycerate↗