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Biomedical subjects

D Gosset

Publications and source records attributed to D Gosset.

At least 19 recordsLinked to original sources

[Pericardial C-reactive protein. A marker of agonal cardiac disease ?].

We studied the influence of the agonal period on the concentrations of acute phase proteins in biological fluids obtained from 26 autopsy cases. We found significant differences for C-reactive protein concentrations in serum and in pericardial fluid, between short and long agonies. The other acute phase proteins studied (alpha-1 antitrypsin, alpha-2 macroglobulin, haptoglobin) failed to show any significant difference in serum and pericardial fluid levels between the two types of agony. The increase in C-reactive protein level in the pericardial fluid is attributed to an "agonal pericarditis" which may result from an agonal myocardial necrosis. Our results could be of interest in forensic medicine.

Adult

[Alcohol and psychotropic drugs in fatal traffic accidents (the Nord-Pas-de-Calais region, France)].

UNLABELLED: Consumption of alcohol and tranquilizers reaches a very high level in France. Studies about simultaneous alcohol and psychotropic drugs involvement in motor related fatalities have never been described in this country. A retrospective study was done on 482 fatalities broken down by drivers and pedestrians within one year (1987) in Région Nord-Pas de Calais (France). METHOD: 132 cases met the criteria for complete study. Blood samples obtained at the time of death were analysed for alcohol (BAC) by gas-chromatography and assayed for barbiturates (BA), benzodiazepines (BE) and tricyclic antidepressants (TA) by Emit. RESULTS: Out of 132 fatalities there were 86% men (mean age 38.5 years) and 14% women (mean age 46 years). 57% belonged to the working population. Of the fatalities, 38% occurred from Friday 8 p.m. to Sunday 12 p.m. We distinguished 3 categories: pedestrians (18.2%), 2-wheel vehicles (19%) and 4-wheel vehicles (62.8%). Alcohol involvement is given in Table 2. [table: see text] Notice that 53% were above the legal limit (0.8 g/l) and 34.8% had no alcohol. Psychotropic drugs were detected in 10.6% of the cases (Table 3). [table: see text] BZ were found in 50% of men and 100% of women. drugs and alcohol were present simultaneously in 8.3% of the individuals. Results are in % of total in Table 4: [table: see text] Positive BAC and positive drugs are not related. No significant difference was found in the distribution of alcohol between positive or negative drugs findings. Our results are consistent with those described by North-American authors, but largely superior to those from French or other studies done only on injured persons.

Accidents, Traffic

[Significance of arterial Doppler in Horton's disease. Prospective study of 59 case reports].

Several preliminary studies drew attention to the value of Doppler examination in temporal arteritis. This study involving 59 cases aimed to define the value of Doppler examination in the diagnosis of the disease, evaluation of ophthalmic risk and in the monitoring of treatment. The study involved 59 patients and 47 controls with no evidence of temporal arteritis, but of comparable mean age. The following arteries were investigated before treatment: arteries of limbs, subclavian, vertebral, carotid, temporal, occipital, facial and ophthalmic recorded via the internal nasal branch and also transocularly. The results were expressed in the form of a score from 0 to 3 describing the degree of deterioration of the curves. A mean score corresponding to the mean of the scores of the cephalic arteries was calculated for each patient and each control. The specificity and sensitivity of the investigation were studied, based on this mean score by ROC analysis. The progression under treatment was monitored for more than 24 months in 20 patients divided into 3 groups: group I: 6 patients cured; group II: 6 patients with late recurrence of temporal arteritis after steroid withdrawal; group III: 8 patients with progressive disease. 81.5% of temporal arteries were pathological, including 60% with tight stenosis (score 2 and 3). Morphological anomalies in the curves were also noted at the level of the occipital arteries (69%), facial arteries (80%), as well as the ophthalmic artery at both recording sites (internal nasal: 84.5%, transocular: (73%) (table I).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged

[Antitrypsin activity of the urine and alpha 1 protease inhibitor].

The urinary trypsin inhibitory capacity (TIC) is mainly due to the excretion of an inhibitor which is immunologically related to inter-alpha:trypsin inhibitor (ITI). However, alpha 1 protease inhibitor (alpha 1 PI) can be found in urine of patients with proteinuria. When this one is greater than 1 g/l, the measured TIC is more or less markedly related to the amount of alpha 1 PI present in the analyzed sample. The antitryptic activity of alpha 1 PI can be ruled out by incubating urine with specific anti-alpha 1 PI immunoglobulins. An identical result is obtained by acidification of the sample prior to TIC determination. Moreover, after freezing of urine, only the antitryptic activity of alpha 1 PI is strikingly decreased. Thus, in the presence of a significant proteinuria (greater than 1 g/l), a preliminary acidification of urine allows a suitable and specific measurement of TIC due to the inhibitor immunologically related to ITI. Thus, this one is a sensitive, useful and easy test for detecting and monitoring infections.

Bacterial Infections

T lymphocyte activation in systemic lupus erythematosus analysed by proliferative response to nucleoplasmic proteins on nitrocellulose immunoblots.

Polyclonal B cell activity in systemic lupus erythematosus (SLE) may be under T cell control. The use of nitrocellulose immunoblots for the analysis of recognition by peripheral blood lymphocytes of nucleoplasmic proteins in SLE patients led to the characterization of significant proliferative responses to 68K (U1 RNP); SS-B; B-B' and D (Sm) antigen in 15 of 20 patients. Variations of proliferative response were parallel to disease activity over a follow-up period of greater than or equal to 6 months, conferring some prognostic value to the assay of lymphocyte response to nucleoplasmic antigens. The pattern of reactivity differs from the corresponding serum antibody profile, and purified T cell suspensions (greater than 95% pure) were shown to proliferate in response to soluble nucleoplasmic antigens, indicating that T and B cell repertoires against nucleoplasmic proteins may differ. This suggests that activated helper T cells contribute to the fine modulation of B cell reactivity to subcellular particles to determine the particular antibody profile of the patients.

Adolescent

[Clinical value of the determination of urinary antitrypsin activity].

Urinary trypsin inhibitory capacity is mainly due to the excretion of a glycoprotein which is immunologically related to the inter alpha-trypsin inhibitor and may be a proteolytic degradation product of that substance. It was tested in 133 subjects divided into 7 groups: 24 healthy controls (group A), 21 patients with bacterial infection (group B), 37 with bacterial infection under antibiotic therapy (group C), 25 with connective tissue disease (group D), 8 with infected connective tissue disease (group E), 14 with cancer (group F) and 4 with infected cancer (group G). Urinary trypsin inhibitory capacity level was very low in controls (3.32 +/- 0.8 U/g urinary creatinine), but it was dramatically increased when infection was present (149.67 +/- 23.6 U/g urinary creatinine). This test appeared to be more effective than serum C-protein measurement simultaneous carried out in the same patients. Urinary trypsin inhibitory capacity is not related to the degree of proteinuria in the urine sample, but it is increased in patients with chronic renal failure excluded from this study. Thus, its measurement is a sensitive, easy and useful test for detecting and monitoring infections. The return to its physiological value is a very good argument in favour of therapeutic effectiveness.

Bacterial Infections

Acquired type II von Willebrand's disease: demonstration of a complexed inhibitor of the von Willebrand factor-platelet interaction and response to treatment.

An acquired von Willebrand's disease developed in two patients in association with a monoclonal gammopathy plus a Sjögren's syndrome and a chronic lymphocytic leukaemia (CLL). In both cases a plasma inhibitor to von Willebrand factor (vWf) was suspected and characterized after plasma gel filtration. The inhibitor was shown to be entirely complexed with vWf and was only demonstrated after complex dissociation by heating. The inhibitor was able to inhibit the binding of 125I-vWf to platelets in the presence of ristocetin in both cases and to thrombin-stimulated platelets in one case. In the two patients, the highest molecular weight multimers (HMWM) of vWf were absent when assessed by sodium dodecyl-sulphate agarose plasma electrophoresis. Intravenous infusion of 1-deamino-(8-D-arginine) vasopressin (DDAVP) resulted in the appearance of the HMWM in both cases and of the satellite bands of each multimer subunit which were lacking prior to the infusion in one patient. After transfusion of a VIII/vWf concentrate containing a significant amount of HMWM, there was a rapid plasma clearance of the vWf-related activities and of the HMWM when compared to that seen in a patient with type III constitutional vWD. We conclude that in the two patients studied the coagulation defect was related to the presence of a circulating inhibitor to vWf which could be responsible for the disappearance of the HMWM from plasma.

Aged

Subclinical lung inflammation in primary Sjögren's syndrome. Relationship between bronchoalveolar lavage cellular analysis findings and characteristics of the disease.

To directly evaluate whether a subclinical alveolar inflammation is associated with primary Sjögren's syndrome (SS), we evaluated the distribution of cells obtained by bronchoalveolar lavage (BAL) from the lower respiratory tract in 29 patients who had primary SS, but who were free of clinical pulmonary symptoms and had normal findings on chest roentgenograms. There was no difference in total cell counts of specimens from patients versus those of controls. An abnormal differential cell count was noted in 16 patients (55%). Two patterns of alveolitis were observed: a pure lymphocyte alveolitis (greater than 18% lymphocytes, present in 11 patients) and a neutrophil alveolitis (greater than 4% neutrophils, present in 5 patients). There was associated lymphocytosis in 4 of the patients with neutrophil alveolitis. All patients had normal results on pulmonary function tests. Patients with abnormal BAL findings showed clinical and biologic indexes of more severe disease than did those with normal BAL results, as demonstrated by greater extraglandular extension of the disease, higher mean values of serum gamma globulins and serum beta2-microglobulin, and higher prevalence of rheumatoid factor and of antinuclear antibody. Thus, our data demonstrate that BAL permitted the detection of subclinical inflammatory alveolitis in 55% of our patients with primary SS. A long-term followup is required to determine whether these patients will develop obvious pulmonary involvement.

Adult

[Severe pulmonary embolism disclosing a deficiency in protein C].

A constitutional deficit in protein C is a rare disorder. Our report concerns a 35 year old non-smoking male, presenting with a past history of uncomplicated phlebitis of the lower limbs. In the course of a new episode of phlebitis, the patient presented with a severe pulmonary embolus treated by embolectomy under extracorporal circulation, with interruption of the inferior vena cava. The plasma level of protein C (Elisa technique) measured before treatment with antivitamin K was 40% (normal 70-140%). The absence of associated hepatic or haematological anomalies confirmed the constitutional character of the deficit. The immediate and subsequent progress turned out favourably on treatment with heparin, then anti-vitamin K.

Adult