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C Vergnes

Publications and source records attributed to C Vergnes.

At least 19 recordsLinked to original sources
PubMed2006

Intrathecal bupivacaine protects against extension of lesions in an acute contusive spinal cord injury model.

BACKGROUND AND OBJECTIVE: We recently demonstrated that intrathecal bupivacaine before or after acute photochemical spinal injury improved functional outcome in rats. However, the closest model to spinal trauma is the contusive weight-drop method. The aim of this study was to evaluate functional, electrophysiological and anatomical consequences of a contusive spinal-cord lesion in rats with or without an intrathecal injection of bupivacaine. METHODS: Fifteen minutes before a contusive spinal lesion, 18 rats received intrathecally either 0.5% bupivacaine (Group T) or saline (Group C). During an 18-days period, motor and sensory functions were evaluated, and bladder voiding dysfunction was noted. Somatosensory evoked potential testings were performed at day 18. Then, the intact spinal cord area at the epicentre of the lesion and the extent of the lesion were measured. RESULTS: Motor deficit was less and inclined-plane stability was better in treated animals at all times, the scores were statistically different from day 7. There were no differences concerning the sensory test. Despite no significant difference, there were less spinal bladders in the T group from day 7. Somatosensory evoked potential latencies were longer in T group, but only the first negative component (N1) was statistically significant. Amplitudes were higher in T group, but were not statistically different. The spinal cord intact area at the epicentre of the lesion was higher in the T group (1.23 +/- 0.8 mm(2) vs. 0.81 +/- 0.39 mm(2); P < 0.05). The extent of the lesion was higher in the C group (9.4 +/- 2.9 mm vs. 6.4 +/- 3.4 mm; P < 0.05). CONCLUSION: Intrathecal 0.5% bupivacaine provide a neuroprotective effect by decreasing functional, electrophysiological and anatomical consequences after a contusive spinal cord injury.

Anesthetics, Local↗
PubMed2005

[MURCS association: a challenging diagnosis].

MURCS association includes Mullerrian duct aplasia-hypoplasia (MU), renal malformations (R) and cervicothoracic somite dysplasia (CS). This rare disease (1/50 000 females) is sporadic and of unknown aetiology. The reported case is the first one with additional esophageal atresia and ovarian mature teratoma. Esophageal atresia first led to the diagnosis of VACTERL association, which is more frequent and well known, showing that the identification of such malformative association may be challenging. The presence of mullerrian abnormality has allowed the diagnosis of MURCS association, as there is no mullerrian hypoplasia in VACTERL association. Therefore the association of isolated or combined renal and cervical malformation with VACTERL features should lead to the search for mullerrian abnormalities.

Abnormalities, Multiple↗
PubMed2003

Haemodynamic features during high-frequency oscillatory ventilation in preterms.

AIM: To compare the haemodynamic status during high-frequency oscillatory ventilation and conventional mechanical ventilation in very preterm infants with respiratory distress syndrome. METHODS: Thirty-two neonates of less than 30 wk gestation randomly assigned to high-frequency oscillatory ventilation (n = 15) or conventional mechanical ventilation (n = 17) had three echocardiographies and one cerebral Doppler-echography under the same ventilation during the first 48 h of life. RESULTS: Mean airway pressure was 2 cm H2O higher in infants ventilated with high-frequency oscillatory ventilation at the different echocardiographies. Comparable right ventricular indexes were observed in the two groups. Reduction of the ductus arteriosus diameter and ductal closure were significant only in neonates ventilated conventionally. Left ventricular performance and left ventricular contractility did not differ between the groups. The high-frequency group had lower end diastolic velocity and a higher resistance index in the anterior cerebral artery. CONCLUSION: Compared with conventional mechanical ventilation, high-frequency oscillatory ventilation was achieved without altering cardiac function. However, the inability of the left ventricle to improve its performance in the presence of a significant ductal shunt suggests a narrow range of optimal pressures under this ventilatory mode.

Blood Flow Velocity↗
PubMed2003

Endoscopic surgical treatment of sinonasal polyposis-medium term outcomes (mean follow-up of 5 years).

BACKGROUND: Between 30 and 50% of patients with sinonasal polyposis (SNP) will require surgical treatment. OBJECTIVE: To determine the medium term risks and benefits of endonasal ethmoidectomy in SNP. METHOD: 132 cases of SNP have been retrospectively studied before and after endoscopic nasal surgery with a mean follow-up of 5 years. Functional symptoms and appearances on endoscopic examination were recorded on graded scales. Non-parametric statistical analyses for matched series were used in the assessment of data. RESULTS: Post-operative normalisation of nasal function was obtained in 62% of cases. Each of the four main nasal symptoms (nasal obstruction, rhinorrhoea, facial pain and anosmia) was improved (p = 0.001). Patients with associated asthma or ASA triad had higher scores for nasal obstruction and rhinorrhoea (Fisher's exact test; p < 0.02). The pre-operative clinical stage of SNP correlated neither with recurrence nor with functional outcomes (Fisher's exact test; p > 0.05). The requirement for steroid treatment of concurrent asthma was also reduced post-operatively (p = 0.001). The association with asthma and its level of treatment was not related to the frequency of recurrence of SNP (Chi2; p > 0.6). CONCLUSIONS: Functional outcomes for patients with SNP and asthma were significantly improved by endoscopic surgical treatment, even if the appearance of the nasal mucosa did not always return to normal.

Asthma↗
PubMed2002

[Lower limb occlusive arteriopathy: retrospective analysis of 73 patients with onset before the age of 50 years].

OBJECTIVES: Juvenile peripheral obstructive arterial diseases (POAD) have been poorly investigated but account for 1 to 7% of POAD. We analyzed retrospectively a cohort of patients with onset before the age of 50 years. PATIENTS AND METHODS: Seventy-three patients (60 males and 13 females) were divided into 4 groups (Buerger's disease: TAO, atheromatous PAOD, auto-immune POAD, arteriopathy of undetermined origin). RESULTS: The first symptoms occurred at 38 +/- 8 years of age. Fourteen patients (20%) had TAO, 51 (70%) atheromatous POAD, 4 (5%) POAD with systemic or autoimmune disease, and 4 (5%) undetermined POAD. Age of onset was earlier in TAO (35 +/- 8 vs 40 +/- 8 years, p=0.046), smoking greater in the atheroma group (33 +/- 16 vs 24 +/- 14 pack-years, p=0.033). Fifty-three POAD patients had dyslipidaemia and 26% hypertension. Regular cannabis intake was more frequent in the TAO group (21 vs 8%). At the time of medical care, Fontaine's stage was more frequently stage II in atheroma patients (57 vs 14%) and stage IV in TAO patients (86 vs 35%). TAO was diagnosed in 43% cannabis users and in 19% non users. CONCLUSION: The main etiology of juvenile POAD is atheroma, followed by TAO. Cannabis users account for at least 10% of these patients. They are characterized by lower tobacco intake, more distal lesions, more frequent involvement of the upper limbs. They present more frequently as TAO.

Adult↗
PubMed2002

Absence of placental transfer of pentasaccharide (Fondaparinux, Arixtra) in the dually perfused human cotyledon in vitro.

The synthetic pentasaccharide, fondaparinux, is the first of a new antithrombotic class: selective factor Xa inhibitors. Comparative clinical trials of fondaparinux versus heparins in prevention and treatment of venous thromboembolism are ongoing. Little is known about fondaparinux during pregnancy, as women of child-bearing potential were excluded from clinical trials. No particular safety issue, for either mother or fetus, has been reported for heparins. The objective of this study was to compare in vitro the steady state placental transfer of fondaparinux and enoxaparin at the plasma concentrations reached during acute treatment of venous thromboembolism (1.75 microg/mL and 1 anti-Xa IU/mL respectively), using antipyrine (20 mg/L) as reference. No biological activity was detectable in the fetal venous effluent during perfusion of enoxaparin-antipyrine, fondaparinux-antipyrine or control media. Furthermore, fetal venous samples did not differ significantly from fetal arterial samples. This apparent absence of placental transfer supports further evaluation of fondaparinux in pregnant women.

Adult↗
PubMed2001

Does transvaginal hydrolaparoscopy render standard diagnostic laparoscopy obsolete for unexplained infertility investigation?

OBJECTIVE: To evaluate the feasability of transvaginal hydrolaparoscopy in infertile patients undergoing basic infertility investigations, and to determine its usefulness in comparison with standard laparoscopy. MATERIALS AND METHODS: Twenty-three unexplained infertile women were prospectively included. Selected patients had no history of pelvic disease or previous pelvic surgery and had normal findings on gynecological examination and vaginal sonography. The patients received general anesthesia and underwent the transvaginal hydrolaparoscopy immediately prior to a standard laparoscopy by a different operator. The main outcome measures were the rate of successful access to the pouch of Douglas, the duration of the procedure, and the rate of complications. In order to compare the accuracy of the transvaginal hydrolaparoscopy to the standard laparoscopy, findings in terms of tubal pathology, endometriosis, and adhesions were analyzed. RESULTS: The successful rate of access to the pouch of Douglas was 95.7%. The rate of complications was 4.3%. The mean duration of the transvaginal hydrolaparoscopy procedure was 8 min. The concordance between transvaginal hydrolaparoscopy and laparoscopy for pelvic cavity examination was statistically significant (k=0.57, P=0.02). In 40.9% of cases, the transvaginal hydrolaparoscopy procedure has shown a normal pelvic examination confirmed by laparoscopic diagnosis. According to the findings by laparoscopy, transvaginal hydrolaparoscopic diagnosis was correlated well in 81.8% of cases. When transvaginal hydrolaparoscopy showed pathological findings, there were no normal laparoscopies. Pathological laparoscopies were found in 18.2% of the normal transvaginal hydrolaparoscopies. CONCLUSION: The transvaginal hydrolaparoscopy is a reproducible and safe method to investigate the pelvis and its structures. The diagnostic accuracy of the transvaginal hydrolaparoscopy suggests that more than 40% of standard laparoscopies for unexplained infertility could be avoided.

Adult↗
PubMed2001

[Family socioeconomic deprivation and vulnerability in the pediatric emergency room: evaluation and management].

OBJECTIVE: The aim of this study was to evaluate the importance of socioeconomic deprivation and other forms of vulnerability in families attending the pediatric emergency unit (PEU). It was based on a five-level classification of family types and an analysis of responses provided by the French healthcare system. METHOD: The prospective study involved 150 families admitted to the PEU on the basis of open-response interviews that analyzed demographic and socio-economic characteristics, motivations for consultation, the child's quality of life, family problems experienced by the parents, and their support network. RESULTS: Five categories of families were defined as follows: complete destitution necessitating immediate social measures (0.7%); acknowledged and well-managed economic deprivation (13.3%), unacknowledged and/or complex economic deprivation with a significant deterioration in the quality of life (22.2%), familial psychological vulnerability without economic deprivation (30.4%), and families without any apparent problems (33.7%). Consultation at the PEU appears to be a multifactorial phenomenon motivated by socioeconomic, psychological and cultural factors. This phenomenon is connected with the present-day imbalance in the healthcare system, which does not adequately respond to the needs of vulnerable families. CONCLUSION: This survey contributes to the current reflection on the integration of psychosocial factors in child healthcare at both the hospital and local community level. The method described herein has determined the factors of vulnerability and the risks of economic deprivation. It can contribute to the development of improved communication and cooperation between practitioners, the hospital and local social workers.

Adult↗
PubMed2001

Diagnostic value of quantitative EEG in Alzheimer's disease.

The aim of this study was to determine the performance of several spectral indices of the EEG (ratios between fast and slow EEG activities) as descriptors of the EEG changes occurring at the onset and during the evolution of Alzheimer's disease (AD). These indices were calculated from quantitative analysis of EEGs recorded in AD patients and from a matched non-demented group of control subjects. One advantage of such indices is to be independent of the absolute value of power spectral densities, which may vary from subject to subject, another being to take into account fast EEG activities. Conventional statistic tests and Receiver Operating Curves (ROC) analysis were performed upon these data to determine the accuracy of the power ratios to discriminate a) between controls and patients (i.e., to detect dementia) and b) between subgroups of patients defined according to the Global Deterioration Scale of Reisberg (GDS). The defined ratios provided a good classification of AD patients for all cerebral regions except the frontal areas, because of eye movement artefacts; the results confirm the increase in slow activities and the concomitant decrease in fast activities early in AD patients. Moreover, our results demonstrate that these indices are adapted tools to perform a good discrimination between demented and non-demented patients in routine clinical practice. We therefore propose the use of these EEG power ratios to discriminate between different stages of Alzheimer's disease, and to perform long-term monitoring of AD patients.

Aged↗
PubMed2001

Piezoelectric extracorporeal shockwave lithotripsy of distal ureteric calculi: assessment of shockwave focusing with unenhanced spiral computed tomography.

OBJECTIVE: To assess the effects of the interposition of pelvic bones and abdominal gas in the shockwave pathway during piezoelectric extracorporeal shock wave lithotripsy (ESWL) of distal ureteric stones. PATIENTS AND METHODS: The study included 35 patients who were evaluated with unenhanced spiral computed tomography (CT), used according to their positioning during ESWL. The shockwave pathway was simulated on the sagittal and coronal views crossing the ureteric calculi, allowing a theoretical evaluation of the effective shockwave focusing (with no bone or gas interference). Vertical and oblique approaches were statistically compared for bone and gas interposition. RESULTS: Overall, the effective shockwave focusing during in situ piezoelectric ESWL of distal ureteric stones was 71% of the theoretical area. The interposition of bone and gas was significantly lower for an oblique access than for a vertical approach in the sagittal plane (P < 0.001 and 0.03 on the sagittal and coronal views, respectively). Using stepwise logistic regression, the difference between vertical and oblique accesses in the sagittal plane was mainly affected by the bladder volume (P < 0.001). On the coronal views, the interposition of bone and gas affected 31 patients (89%). Such interference was eliminated in 73% of the patients with a contralateral inclination of the shockwave axis in the coronal plane. CONCLUSION: The interposition of pelvic bones and abdominal gas in the shockwave pathway can affect the performance of piezoelectric ESWL of distal ureteric stones. While awaiting clinical confirmation of these theoretical data, we recommend that patients are treated with the bladder full and that the shockwave generator is inclined in both the coronal and sagittal planes.

Adult↗
PubMed2001

Urinary excretion of free cysteine in critically ill neonates.

UNLABELLED: In preliminary observations, significant amounts of free cysteine, a neurotoxic amino acid, were noted in the urine of asphyxiated or septic-shocked neonates. The present study was conducted to determine whether free urinary cysteine was elevated in these critically ill neonates compared with a control group, and to assess the clinical significance of this generation. Free cysteine was measured in the urine of newborn infants with perinatal asphyxia (n = 16) or neonatal sepsis (n = 14) and the urine of a control group (n = 10) by ion-exchange chromatography. Relationships between cysteine levels and the clinical severity, sulfite supply and neurological outcome of the patients were then studied. Urinary cysteine was 27.6 (15-49) mmol mol(-1) creatinine for the patients but was not detectable in the control group. Cysteine levels were correlated with the severity of neonatal septic shock but not with the grade of perinatal asphyxia and did not have a specific influence on the neurological outcome of these patients. The correlation between cysteine level and the severity of neonatal septic shock was indirect and probably linked to higher sulfite administration in this population. CONCLUSION: The mean daily supply of sulfites is high in critically ill neonates, mainly originating from dopamine and generating significant amounts of cysteine. Although a worsening effect attributable to cysteine on the neurological outcome of the patients could not be demonstrated, the appropriateness of cryptic administration of sulfites by way of drug excipients is called into question.

Apgar Score↗
PubMed2001

[Results of coronary artery surgery in octogenarians].

Over an 11 year period from January 1990 to December 2000, 3282 patients underwent isolated or combined surgical myocardial revascularisation. In this group, 42 were aged 80 or over (maximum 87 years), 1.3% of the total patient population. The mean age of this subgroup was 81.8 +/- 1.75 years) with a male predominance (61.9%). All patients were autonomous and considered to be in good general and psychological health. Preoperative coronary angiography showed 33.3% of left main stem lesions either alone or associated with a right coronary lesion. The ejection fraction was over 50% in 78.6% of cases. Saphenous vein grafts were used in all but 5 patients who also had left internal mammary artery grafts. Thirteen patients (31%) underwent combined valvular surgery (11 aortic and 2 mitral valve) and 2 patients underwent combined vascular surgery. Three patients were operated as an emergency. A total of 5 patients died in the first 30 postoperative days, a hospital mortality of 11.9%. There were 2 postoperative hemiplegias and 2 cases of renal failure which were aggravated in the postoperative period. The other patients were discharged from hospital with a satisfactory cardiac and functional status. The global mortality was 14% at 3 years and 18% at 5 years. The main bad prognostic factor for survival was the association of aortic valve surgery. In selected octogenarians in good general and psychological health without severe co-morbid conditions, surgical myocardial revascularisation may be considered with an acceptable operative risk.

Aged↗
PubMed2000

Multifetal reduction of triplets to twins: a prospective comparison of pregnancy outcome.

The aim of this study was to compare the outcome of triplets managed expectantly or by multifetal reduction to twins to assess the potential benefit of fetal reduction. The study design was prospective, comparative and monocentric and the study was conducted in a teaching hospital. Out of 148 women with triplets mostly obtained after infertility treatment, 83 were expectantly managed while 65 chose reduction to obtain twins. Main outcome measures were fetal loss before 24 weeks, premature deliveries before 28, 32 and 34 weeks, rate of low birthweight infants and neonatal and perinatal mortality rates. The fetal loss rate before 24 weeks did not differ between the ongoing group and the reduced group (6 versus 5.4%). Reducing triplets was associated with a significantly lower incidence of the following: prematurity before 28, 32 and 34 weeks (P < 0.001), low birthweight infants whose weights were under the third centile (P < 0.002) and infants whose weights were less than 1000, 1500 and 2000 g (P < 0.001). Neonatal (although apparently lower in the reduced group) and perinatal mortality did not significantly differ. Our results indicate that reduction of triplets to twins is effective to improve preterm birth and fetal growth.

Adult↗
PubMed1999

The relationship among carbon dioxide pneumoperitoneum, vasopressin release, and hemodynamic changes.

UNLABELLED: We assessed the role of vasopressin (VP) for the hemodynamic response to pneumoperitoneum in pigs. Four groups of anesthetized pigs were investigated. Nine pigs were intraabdominally insufflated with CO2 and eight were intraabdominally insufflated with argon; eight pigs received an i.v. injection of 1 mg/kg SR 49059, a VP antagonist, before CO2 insufflation; and six pigs received SR 49059 alone. Hemodynamics, plasma concentrations of VP and vasoactive hormones, and Paco2 were measured. Data were analyzed by using analysis of variance, Student's t-test, and Mann-Whitney U-test. Five minutes after insufflation, changes in systemic vascular resistance (SVR) were significantly correlated with changes in VP (r = 0.72; P = 0.005) but not with changes in epinephrine, norepinephrine, renin activity, or Paco2. SVR increased during CO2 insufflation but not during argon insufflation or CO2 insufflation with a preceding infusion of SR 49059. The SR 49059 injection itself resulted in increases in heart rate and cardiac output and decreases in blood pressure and SVR. We conclude that, during CO2 pneumoperitoneum in pigs, absorbed CO2 initiates a pathophysiological process that stimulates VP release. Hence, VP most likely plays a key role in the hemodynamic response to a CO2-induced pneumoperitoneum. IMPLICATIONS: Intraabdominal insufflation of CO2 is associated with hemodynamic and hormonal changes. Investigating CO2 and argon-insufflated pigs and using a vasopressin antagonist, we found that CO2 insufflation released vasopressin, which, in turn, induced hemodynamic perturbances.

Animals↗