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Biomedical subjects

C Clément

Publications and source records attributed to C Clément.

At least 37 records · Page 2Linked to original sources
PubMed1997

Association of private isolation rooms with ventilator-associated Acinetobacter baumanii pneumonia in a surgical intensive-care unit.

OBJECTIVE: To determine the rates and routes of Acinetobacter baumanii colonization and pneumonia among ventilated patients in a surgical intensive-care unit (SICU) before and after architectural modifications. DESIGN: A nonsequential study comparing two groups of patients. All isolates from systematic and clinical samples were genotyped by pulsed-field gel electrophoresis (PFGE). Records of patients hospitalized during the first and second periods were reviewed and findings were compared. Between the two periods, the SICU was remodeled from enclosed isolation rooms and open rooms to only enclosed isolation rooms with handwashing facilities in each room. SETTING AND PATIENTS: All patients hospitalized and mechanically ventilated for more than 48 hours in the 15-bed SICU of the University Hospital of Besançon (France). RESULTS: For the first and second periods, the rates of colonization were, respectively, 28.1% and 5.0% of patients (P < 10(-7); relative risk [RR], 2.23; 95% confidence interval [CI95], 1.8-2.75) and the specific rates of bronchopulmonary (BP) colonization were, respectively, 9.1 and 0.5 per 1,000 days of mechanical ventilation (P < 10(-5). Seven major PFGE isolate types were identified, 4 of which were isolated from 44 of the 47 colonized or infected patients. Logistic regression analysis showed that colonization was not associated with patient characteristics. CONCLUSION: Conversion from open rooms to isolation rooms may help control nosocomial BP tract acquisition of A baumanii in mechanically ventilated patients hospitalized in an SICU.

Acinetobacter↗
PubMed1997

Novel transferable beta-lactam resistance with cephalosporinase characteristics in Salmonella enteritidis.

An isolate of Salmonella enteritidis was found to produce a plasmid-encoded beta-lactamase (DHA-1) that conferred resistance to extended-spectrum cephalosporins and cephamycins. The substrate and inhibition profiles of this enzyme resemble a class C beta-lactamase. This is the first report of a plasmid-mediated cephalosporinase of this class in the Salmonella genus.

Anti-Bacterial Agents↗
PubMed1996

A plasmocyte selective monoclonal antibody (B-B4) recognizes syndecan-1.

We developed a new monoclonal antibody. B-B4, which specifically identifies human plasma cells. It strongly reacts with all multiple myeloma cell lines and with malignant plasma cells of all tumour samples of the multiple myeloma patients tested. B-B4 does not react with any peripheral blood, bone marrow or tonsil cells. Cloning of the B-B4 antigen reveals that the monoclonal antibody recognizes syndecan-1. It appears that the monoclonal antibody B-B4 is a suitable marker for human plasmocyte identification among haemopoietic cells and a useful probe for the diagnosis of haematological malignancies. Furthermore, this monoclonal antibody can be used for depletions prior to CD34 grafting.

Antibodies, Monoclonal↗
PubMed1995

Interleukin-6 signal transducer gp130 has specific binding sites for different cytokines as determined by antagonistic and agonistic anti-gp130 monoclonal antibodies.

The cytokines interleukin (IL)-6, IL-11, ciliary neurotrophic factor (CNTF), leukemia inhibitor factor (LIF), oncostatin M (OSM) and probably the recently cloned cytokine cardiotrophin-1, signal, in combination with their specific receptors, through the common signal transducer gp130. Here, we report that the signaling activities of IL-6, IL-11, CNTF and OSM/LIF can be specifically blocked by different anti-gp130 monoclonal antibodies (mAb). Furthermore, we found two mAb, B-P8 and B-S12, which directly activate gp130 independently of the presence of cytokines or their receptors. This agonistic activity includes induction of cytokine-dependent cell proliferation and stimulation of acute-phase protein synthesis in liver cells. Compared to B-P8 mAb, the B-S12 mAb exhibited the strongest agonistic activity, while both mAb are synergistic in their action. This activity could not be blocked by inhibiting mAb against IL-6 and the IL-6 receptor. In contrast to F(ab')2 of B-S12 which still could activate gp130, Fab fragments completely lost their agonistic activity. Activation by tyrosine phosphorylation of the transcription factors Stat1 and APRF/Stat3 was also induced by B-S12 and B-P8, suggesting that both mAb induce homodimerization of gp130. Since hematopoietic stem cells express gp130 on their plasma membrane, it was anticipated that the agonistic anti-gp130 mAb could stimulate the proliferation of these stem cells. Indeed, B-S12 and B-P8 were able to stimulate CD34+ cells. In summary, our data show for the first time that mAb against gp130 can specifically block the action of distinct IL-6-type cytokines that signal through gp130. Such mAb might be of great value for therapeutic applications in diseases where a single cytokine action needs to be inhibited. In addition, the agonistic gp130 mAb may be used as growth factors for maintenance and expansion of stem cells prior to grafting.

Animals↗
PubMed1994

[Gastroesophageal reflux. Comparison of clinical, pH-metric and manometric results of Nissen's and of Toupet's procedures].

OBJECTIVES: The aim of this prospective study was to evaluate and to compare the results of the circular fundoplication (Nissen) and the posterior hemifundoplication (Toupet) for the treatment of gastro-oesophageal reflux. METHODS: For each of the 71 included patients (Nissen, n:43; Toupet, n:28) the following data were collected: surgical complications, clinical symptoms, pH-metric and manometric data, before and 4 and 28 months after operation. RESULTS: Rates of perioperative complications were 26% and 7% in the Nissen and Toupet groups respectively. The Nissen induced more late complications (14%) than the Toupet (0%). At early postoperative evaluation (mean follow-up: 4 months), the rates of clinical and pH-metric recurrences were 2% and 2.5% respectively in the Nissen group and 4% and 9% in the Toupet group (NS). Thirty-seven percent of the patients in the Nissen group and 38% in the Toupet group experienced dysphagia (NS). Disturbances in oesophageal motility, which were present in both groups before surgery, were not significantly modified. At the late evaluation (mean follow-up 28 months), some symptoms of reflux were present in 8% and 17% of patients of the Nissen and Toupet groups respectively (NS). The pH-metric recurrence rate was 10% versus 44% in the Nissen and Toupet groups respectively (P < 0.01). Dysphagia was present in 39% of patients in the Nissen group versus 13% in the Toupet group (P < 0.02). Oesophageal motility remained unchanged in the Nissen group whereas it was significantly improved in the Toupet group where the peristaltic velocity rose from 3.2 cm/s before surgery to 4.4 cm/s after (P < 0.05), giving a value comparable to that of controls (4.2 cm/s). CONCLUSIONS: These results suggest that the short term effectiveness of both procedures is comparable. The effectiveness of the Nissen is more durable, but its morbidity is higher than for the Toupet. Moreover, oesophageal motility is significantly improved by the latter.

Adult↗
PubMed1992

[Diffusion of amikacin into the sinuses in patients with nosocomial sinusitis. Administration of a single dose per day].

Twenty mechanically ventilated patients with nosocomial sinusitis were treated with amikacin 15 mg/kg administered either once a day (group 1 patients) or twice a day (group 2 patients). Amikacin was assayed in serum and in the liquid drained from the sinuses 8 times over a 24 hours' period (group 1) or 7 times over a 12 hours' period (group 2). The amikacin concentration peak was 10.9 mg/l in group 1 and 5.1 mg/l in group 2. It is concluded that amikacin can be used to treat patients with nosocomial sinusitis. High amikacin concentrations are reached with the once a day dosage.

Adult↗
PubMed1990

Treatment of corticosteroid resistant acute graft-versus-host disease by in vivo administration of anti-interleukin-2 receptor monoclonal antibody (B-B10)

In a multicenter pilot study, 32 patients showing steroid-resistant acute graft-versus-host disease (GVHD) were treated by in vivo administration of anti-interleukin-2 (IL-2) receptor monoclonal antibody (MoAb B-B10). Twenty-three patients received marrow from HLA-matched related donors, four from matched unrelated donors and five from partially matched related donors. The overall grade of GVHD was II in 16 patients, III in two, and IV in five. Five milligrams of B-B10 MoAb was infused in bolus daily for 10 days and then every second day for a further 10 days in an attempt to reduce GVHD recurrence. No clinical side effects were noted during the B-B10 treatment period. A complete response (CR) acute GVHD was achieved in 21 patients (65.6%). Six patients (18.7%) showed partial improvement (PR) and 5 patients (15.6%) no response (NR). A significant factor associated with GVHD response was the delay between the onset of the GVHD and the first day of B-B10 infusion. The earlier B-B10 was introduced, the greater the probability of CR (P = .03). There was no correlation between the serum B-B10 level and GVHD response (P = .69). There was, however, a significant correlation between the clinical response and the B-B10 kinetics as a function of time: serum B-B10 levels attained a plateau level more rapidly in the CR group than in the PR/NR group. Among the 26 complete and partial evaluable responders, GVHD recurred in 10 cases (38.4%). Host anti-B-B10 MoAb immune response occurred in only one (7.1%) of the 14 patients analyzed. Fourteen of the 32 patients (43.7%) are currently alive between 2 and 14 months after GVHD treatment with B-B10 was completed.

Adolescent↗
PubMed1990

Extrinsic compression of the renal artery by diaphragmatic crus.

Extrinsic compression of the renal artery due to a fibromuscular band originating from the diaphragm was encountered in a 26-year-old patient who had systemic hypertension associated with stenosis and kinking of one of her renal arteries. After surgical decompression, the renal artery assumed a normal expansion with disappearance of hypertension. Six other cases of extrinsic compression of the renal artery have been found in the literature. Surgical treatment is mandatory in all cases because the mechanism that causes the lesion makes percutaneous transluminal angioplasty illusory.

Adult↗
PubMed1990

[Acute necrotizing hemorrhagic pancreatitis].

There is no etiologic treatment for acute necrotizing pancreatitis. Advances in intensive care resulted in a reduction in early death rate by a better control of systemic complications. Delayed death rate from infection is high (20-60%). Diagnostic problems are an important cause, in spite of the aid of computed tomography and echography. The prognosis will further be improved by earlier diagnosis, a better definition of surgical treatment when complications arise, and constant medicosurgical collaboration.

Acute Disease↗
PubMed1990

Transluminal angioplasty performed by the surgeon in lower limb arterial occlusive disease: one hundred fifty cases.

From February 1985 through November 1988, we performed 159 transluminal angioplasty in 135 patients with arterial occlusive disease of the lower limb. The indications were claudication, 114 cases (72%) and limb salvage, 45 cases (28%). Lesions consisted of one or more critical stenoses in 142 cases (61 iliac, 69 femoropopliteal, and 12 following surgical revascularization) and single segmental occlusion in 17 cases (one iliac and 16 femoropopliteal). Angioplasty failed because the guidewire could not be inserted in nine (5.7%) cases. Angioplasty was performed intraoperatively in 44 (29%) cases and as an isolated procedure in 106 cases (71%). When performed as an isolated procedure, the percutaneous approach was preferred in 34 of the iliac lesions (73%), 28 of the femoropopliteal lesions (50%), and four of the postsurgical lesions (50%). Early postoperative mortality was 3.3% (five patients). Eight early occlusions (5.3%) were observed, two after iliac and six after femoropopliteal angioplasty. Secondary clinical surveillance and hemodynamic and venous digital angiographic follow-up detected 35 instances of stenosis (25%), 18 of which were equal to or greater than 60%. Nine occlusions occurred (6.5%), six after iliac angioplasty and three after femoropopliteal angioplasty. At 24 months, primary cumulative patency of all transluminal angioplasties was 84% and secondary patency was 89%. Transluminal angioplasty performed by the surgeon in the operating room provides good results whether performed as an isolated procedure or as a complement to surgery. The study of secondary deteriorations confirms the value of morphologic surveillance by arteriograms. Arteriography appears to be of paramount importance in the evaluation of results and the codification of indications.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Transluminal angioplasty in a surgical setting. 150 cases].

Since 1985, 150 transluminal angioplasty operations have been performed by surgical teams, in the operating theater, for treatment of atheromatous lesions of the lower extremities, either as a complement to or in replacement of direct surgical repair. 150 angioplasties were carried out on patients with severe stage II lesions (72%). There was one or several significant stenosis in 140 of cases, and one short segmental thrombosis in 10 cases (1 common iliac and 9 superficial femoral or popliteal). These angioplasties fell into the following categories: 60 iliac, 78 femoral-popliteal and 12 angioplastic repairs of stenosis to iliac or distal femoral surgery (anastomosis, grafting, endarterectomy...). Angioplasty was combined with revascularization or lumbar sympathectomy in 29% of cases. It was performed singly in most cases (71%) and carried out percutaneously (45%) or by limited superficial proximal femoral approach under local anesthesia (26%), either directly or when the percutaneous approach failed. Eight cases of thrombosis (5.3%) developed during the first month: 2 cases after iliac angioplasty and 6 cases after femoral-popliteal angioplasty. Five deaths occurred consecutively to myocardial infarction. At long term, 4 cases of iliac thrombosis and 3 cases of thrombosis complicating femoral-popliteal angioplasty were detected. The overall cumulative permeability rate was 89% at 30 months, and there was no significant difference at one year's time between iliac and femoral-popliteal angioplasty patients (90% and 86%, respectively). Data collected from digital angiographic monitoring allowed to detect 9 cases of residual or recurrent stenosis (2 iliac, 6 femoral-popliteal and 1 postoperative lesions). Two repeat femoral-popliteal angioplasties were successfully performed.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon↗
PubMed1989

[A case of chronic ischemic erosive gastropathy healed after surgical revascularization].

A case of chronic ischemic erosive gastropathy secondary to chronic abdominal vascular insufficiency is reported. This gastropathy healed after revascularization procedure but then recurred after stenosis of the aortomesenteric graft. The clinical picture was characterized by post-prandial abdominal pain, weight loss and an abdominal bruit. The upper gastrointestinal endoscopy showed multiple non hemorrhagic antral erosions with irregular outlines and a pseudomembranous floor. Reduction of the resistance of the gastric mucosal barrier by a chronic decrease of mucosal blood flow probably accounted for the gastric erosions. Although the prevalence is unknown, ischemic injury to the stomach is unexpected, because of the rich collateral circulation of this organ. Increased awareness of the disease and its prognostic implications should lead to suggest abdominal vascular insufficiency based on their clinical and gastroscopic aspects, thus leading to operation before acute mesenteric infarction occurs.

Celiac Artery↗
PubMed1988

Superficial and deep lymphoscintigraphic findings before and after femoro popliteal bypass.

The aim of this work is to explore the patients operated on for a femoro popliteal bypass (FPB) with lymphoscintigraphy (LS) of the lower limbs. Data concerning 35 limbs from 33 patients operated on for a FPB have been included in a prospective study. Superficial and deep LS have been performed by injecting 74 MBq 99mTc-Rhenium Sulphide Colloid into the subcutaneous tissue of the first interdigital space and of the lateral malleolus region respectively. Both superficial and deep LS have been performed before and after surgery. A postoperative oedema was found in 17 of the 35 limbs. The value of the lymphatic flow indices and their variation after surgery do not significantly differ between the oedematous and non oedematous groups. Thirteen of the 17 limbs with oedema have presented an interruption of the lymphatic circulation or a diffuse activity outside the lymphatic vessels on the postoperative superficial and/or deep LS. This proportion is only 1/18 in the non oedematous group. The difference between the two groups is highly significant (P less than 0.001). By contrast, the proportion of lymph cyst does not differ significantly between the two groups. In conclusion, this study confirms the close relationship between the oedema following FPB and surgical damage to the lymphatics.

Colloids↗
PubMed1987

Dynamic modifications of the popliteal arterial axis in the sagittal plane during flexion of the knee.

The authors have studied, on the basis of purely radiologic data, the modifications of the popliteal arterial axis during flexion of the knee. They note the appearance in the sagittal plane of very marked flexures of the upper part of the artery, while the lower part describes a harmonious curve. These modifications take place between two fixed points: a cranial fixed point, represented by the origin of the descending artery of the knee, and a caudal fixed point represented by the origin of the anterior tibial artery. The pathologic importance of these modifications of the course of the artery should not be underestimated when obtaining revascularization by means of an arterial prosthesis.

Humans↗
PubMed1987

[Value of exploring the deep lymphatic system of the lower limbs using lymphoscintigraphy. Preliminary study of 18 patients with arteritis].

Lymphoscintigraphy of lower limbs generally involves bilateral subcutaneous injection of a radioactive colloid into the first or second interdigital space: only the superficial internal saphenous pathway is visualized in this way (superficial lymphoscintigraphy: SL). However, the external saphenous and deep pathways can be explored by an external retromalleolar injection as demonstrated in radiology. Isotopic exploration of the external saphenous pathway and deep lymphatics (deep lymphoscintigraphy: DL) was carried out in 18 patients with arteritis also investigated by SL. The study forms part of a prospective trial of edema developing after femoro-popliteal shunts. The deep lymphatics are correctly and easily visualized, and in about 20% of cases there exist anomalies of distribution of superficial or deep lymphatic flow, morphologic anomalies developing postoperatively in one pathway only, or in both pathways. DL is a simple, reliable method of investigation of deep lymphatics, and complete exploration of lymphatics of lower limbs should include both SL and DL.

Aged↗
PubMed1986

[Acute respiratory distress disclosing leptospirosis].

The respiratory manifestations of leptospirosis are usually benign. A case is reported of anicteric leptospirosis with serious pulmonary affection. The clinical symptoms, the radiological manifestations and haemodynamic investigation were suggestive of an acute respiratory distress by non-haemodynamic pulmonary oedema. In accordance with other authors, one would be justified in including this acute respiratory failure as part of the acute respiratory distress syndrome of the adult (ARDS).

Acute Disease↗
PubMed1986

[General anesthesia and preoperative changes in plasma beta-endorphin].

The variations of plasmatic beta-endorphin and cortisol levels are studied in 3 groups of patients. These subjects are submitted to abdominal surgery following 3 different anaesthetic schemes: neuroleptanalgesia (droperidol and fentanyl), pure analgesia (fentanyl), association halothane - small dose of fentanyl. The study covers the period from premedication through recovery. The results of this work demonstrates that the average level of beta-endorphin in neuroleptanalgesia and pure analgesia series is stable; there is an increase in the halothane series just after the incision until waking up. The average level of cortisol is stable for the 3 series until incision. It is strongly increased in the neuroleptanalgesia series and in the halothane series. This increase is delayed and reduced in the fentanyl series.

Adult↗