[Bilateral femoral neuropathy after laparotomy].
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Biomedical subjects
Publications and source records attributed to C Gay.
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Two patients were treated with CPT-11 for colorectal cancer and had a percutaneous biliary catheter for extrahepatic biliary obstruction. The first patient was treated with CPT-11 according to the 100-mg/m2 weekly therapeutic schedule, and the second patient was treated every 3 weeks, with a dose of 350 mg/m2 being given at the first course, after which it was decreased to 300 mg/m2 for the following courses. In plasma, the active identified metabolite of CPT-11, SN-38, occurred mainly in the form of a glucuronide conjugate. CPT-11 was mainly excreted in bile and urine as CPT-11. The cumulative biliary and urinary excretion of CPT-11 and its metabolites (SN-38 and SN-38 glucuronide conjugate) over a period of up to 48 h ranged from 25% (100 mg/m2 weekly) to 50% (300 mg/m2 every 3 weeks). This means that CPT-11 can be excreted under other, not yet identified metabolite forms.
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A comparison has been made between pre-column and post-column derivatisation of aflatoxin B1 (AFB1) during estimation by high-performance liquid chromatography of this toxin in groundnut meal. The effect of the use of different derivatisation reagents on the quantification of aflatoxin B2 (AFB2) has also been evaluated. Both AFB1 and AFB2 were analysed at eight levels of artificial contamination. Five replicate analyses were carried out at each level on both groundnut meal extract (acetone-water, 85:15, v/v) and extraction solvent alone. A statistical evaluation of the results gave limits of detection of 1.1 and 0.3 micrograms/kg for AFB1 and AFB2 respectively, using pre-column derivatisation compared with 1.5 and 0.8 micrograms/kg for the post-column method. Recoveries of over 90% from the spiked groundnut meal extracts were achieved for both derivatisation methods.
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In order to enhance radiation effects in the treatment of unresectable Head and Neck squamous cell carcinoma, we initiated a phase I-II study in February 1991 with concomitant radiation and cisplatin in the treatment of resectable Head and Neck squamous cell carcinoma. The first patient was treated in a palliative intend for a cervical recurrence (cutaneous metastatic lymphangitis) of laryngeal cancer. The seven other patients had a Stage IV M0, previously untreated, oropharyngeal carcinoma. Standard external radiation was carried out up to a total dose of 60 Gy/6 weeks (7 MeV electron beam) for the 1st patient and 72 Gy/8 weeks (Co60 beam) for the 7 other patients. Cisplatin was given during the entire radiation treatment, by continuous infusion, 5 days a week, at doses of 4 mg/m2/d for the 1st patient, 5 mg/m2/d for the two following patients and 6 mg/m2/d for the last five patients. One patient with a poor initial performance status (three in the WHO scale) stopped his treatment on the 6th week due to a grade 3 mucositis with deglutition pneumonia. He died 2 months later with progressive carcinoma. For one other patient, treatment was discontinued for 1 week after 48 Gy, due to a grade 3 mucositis. The other patients completed the planned protocol without any interruption. Mucositis (grade 3 in two cases, grade 2 in four cases), dermitis (grade 3 in two cases, grade 2 in four cases) and neutropenia (grade 2 in two cases) were the most frequent acute toxicity. Of the seven patients treated with a curative intend, six are free of disease at 6 to 28 months after completion of treatment. A pharmacokinetic study showed a total platinum accumulation. The mean value at the end of treatment reached 1157 ng/ml. Only one patient experienced an accumulation of the ultrafilterable platinum (137 ng/ml at the end of treatment).
The information available to the patient and to his family today pose new conditions for the care of the depressed; it facilitates the acceptance of the illness and of its effects, it is indispensable for the therapeutic relationship as well as for the effective observance by the patient of his treatment, and thus contributes to the improvement of the quality of life of the depressed. Certain rules must be observed in the transmission of this information: it must be accessible and understandable to everyone, it must be concise, it must be repeated and revised according to circumstances, it must discourage self-diagnosis and self-prescription by the patient. This information is to be transmitted chiefly by the doctor and the pharmacist. The depressed may also appeal to complementary sources of informations: books, journals and more rarely scientific publications. Patients' associations provide another potential source for the dissemination of information. Their chief objective is to provide this information not only to the patients and their immediate entourage, but also to the population at large.
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We used computerized videokeratography to analyze corneal topographical changes in 39 eyes of 39 patients who had phacoemulsification and posterior chamber lens implantation through 4 mm incisions. In one group of patients, the incisions were closed with a single vertical mattress suture; in the other group, no sutures were used. Computerized videokeratography was performed preoperatively and at one and five to six weeks postoperatively; corneal curvatures were assessed at radial distances of 0.75, 1.5, 2.5, and 3.5 mm along the 0-, 90-, 180-, and 270-degree semimeridians. At one week postoperatively, there was slightly more steepening along the 90- and 270-degree semimeridians (up to 0.9 diopters [D]) and slightly more flattening along the 0- and 180-degree semimeridians (up to 0.6 D) in the sutured group. At six weeks postoperatively, all mean semimeridional changes were less than 0.5 D. Computerized videokeratography demonstrated that sutured and unsutured 4 mm incisions induced clinically small corneal topographic changes and detected local variations in corneal curvature that may be due to sutures, cautery, and other operative factors.
The authors report two cases of citrullinemia in siblings which add to 68 observations from the literature. They overview the clinical presentation, diagnosis and therapeutic management of the disease. The prognosis of severe neonatal form remains poor but an early adequate management may contribute to an acceptable outcome.
The choice of an antidepressant is not necessary during the initial phase of only treatment (acute treatment), it can be reviewed after one or two months (continuation treatment) and a prophylactic treatment may be discussed after a 6 months period (long-term maintenance treatment). Many reasons explain the need to readjust the dosage of antidepressant treatment or to change it: the nature and the gravity of the depression, the family and personal history of affective disorders, the level of side effects and above all the quality of the recovery. Thus the modification of a treatment can be considered according to 4 methods: modification of the psychotropes associated to antidepressant treatment, association of a second antidepressant medication, change of antidepressant medication, institution of a prophylactic treatment. A special aspect concerns the decision and the choice of the antidepressant treatment after recovery by E.C.T. Two types of treatment can be considered: most often a maintenance treatment of antidepressant medication is suggested. Prolongation of ECT may be justified for consolidation: 6 or 8 sessions after recovery, or for prevention of relapse: session every 3-4 weeks after recovery, and for a period of 2-3 years.
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The pharmacokinetics of amikacin has been studied in 40 intensive care unit patients using the bayesian estimation method implemented in the USC PC PACK program of Jelliffe. The volume of the central compartment was significantly higher in these patients than in the reference population, while other pharmacokinetic parameters did not differ significantly from the reference values. The population values may be employed, in addition to those supplied with the software, to adapt dosage regimens of amikacin in ICU patients.
1. The effects of drying cassava root at different rates on its composition and toxicity to broiler chicks were examined. Unpeeled roots from a high-cyanide cultivar of cassava were chipped and dried at 25 degrees C to a moisture content of below 100 g/kg over 24 h for fast-dried meal (FD) or 72 h for slow-dried meal (SD). The meals were incorporated at 250 and 500 g/kg into semi-synthetic diets which were fed to day-old broiler chicks as mash or pellets in separate experiments. 2. The two drying rates produced meals with similar concentrations of polyphenols, but different concentrations of cyanogens, the latter being 38 and 482 mg total cyanide/kg for SD and FD, respectively. The linamarin, acetonecyanohydrin or total cyanide content measurements of pelleted diets were highly correlated. 3. Growth rates of chicks fed on SD-based diets were significantly higher than those of chicks fed on FD-based diets. Compared with a control diet, weight gain of chicks fed on the 500 g FD/kg diet (containing 258 mg total cyanide/kg) was 77% lower, although performance also appeared to be reduced at 142 mg total cyanide/kg. 4. The ratio of water:food intake of chicks was higher in FD than in SD groups, and this was reflected in the high water content of excreta. There was increased bile excretion, the chloretic effect increasing with the cyanogen content of diet. Pancreas weights were lower in FD than in SD groups in experiment 1 (mash diets), but not in experiment 2 (pelleted diets), while there was a significant interaction between drying method and cassava inclusion rate on liver weight in experiment 2, but not in experiment 1. There were no effects on the mortality rate. 5. Pelleting of diets generated high temperatures, but did not significantly alter the cyanogen concentration or the growth of the chicks. 6. Thus, slower rates of drying cassava roots produce meals with lower cyanogen concentration that are, consequently, less toxic to broiler chicks. Cassava root meal of less than 40 mg total cyanide/kg can be fed to broiler chicks at 500 g/kg without any adverse effects.
Neonatal mortality and morbidity were reported over a 4-yr period from 1986-1989 in premature infants weighing less than 1,500 g, 278 of whom were born in the same obstetrico-neonatal unit. Total mortality was 15%, and was higher in premature infants weighing less than 1,000 g (38%) and lower if the gestational age was greater than 27 wk. Mortality was lower in small for gestational age (SGA) infants than in appropriate for gestational age (AGA) infants (5% vs 19%, P less than 0.001), and lower in inborn babies than in outborn (12% vs 19%, P less than 0.02) but only in neonates weighing less than 1,000 g. Neonatal morbidity was mainly due to hyaline membrane disease and cerebral haemorrhage. The incidence of broncho-pulmonary dysplasia was low (4%). These results indicate that gestational age, birth weight and place of delivery play a role in mortality and morbidity in very low birth weight premature infants.