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Biomedical subjects

F Barale

Publications and source records attributed to F Barale.

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

Myocardial and vascular adrenergic alterations in a rat model of endotoxin shock: reversal by an anti-tumor necrosis factor-alpha monoclonal antibody.

OBJECTIVES: a) To investigate responsiveness to exogenous catecholamines in rat endotoxin shock by studying both myocardial and vascular functional parameters, and to determine the relationship of these parameters with other relevant biological parameters of the adrenergic pathway, such as myocardial beta-adrenergic receptors and cyclic adenosine monophosphate (cAMP); b) to investigate the role of tumor necrosis factor (TNF)-alpha via prophylactic anti-TNF-alpha monoclonal antibody administration. DESIGN: Experimental, comparative hospital. SETTING: Laboratory in a university hospital. SUBJECTS: Male Sprague-Dawley rats, weighing 280 to 340 g. INTERVENTIONS: Intravenous injection of Escherichia coli endotoxin (5 mg/100 g) in the first group; injection of the same dose of endotoxin preceded by 2 mg/100 g of anti-TNF-alpha monoclonal antibody in the second group; injection of saline in the third (control) group. MEASUREMENTS AND MAIN RESULTS: TNF-alpha concentration was measured before and during the first 3 hrs in all three groups. Myocardial and vascular functional parameters were obtained, respectively, from Langendorff perfused hearts and isolated aortic rings. Adrenergic biochemical parameters (catecholamines, density and affinity of beta-receptors, and isoproterenol-stimulated myocardial cAMP) were determined 3 hrs after injections in the three groups. After endotoxin injection, serum TNF-alpha concentrations peaked at 60 mins (2496 +/- 412 pg/mL) and returned slowly to control values at 3 hrs; serum TNF-alpha concentrations remained under the limit of detection in the other two groups. When compared with the control group, plasma concentrations of epinephrine and norepinephrine were significantly (p < .05) increased. Baseline values for differential left ventricular pressure and coronary flow were significantly (p < .001, p < .01, respectively) reduced in the endotoxin group; heart rate remained unchanged. In the endotoxin and control groups, isoproterenol induced a similar increase in differential left ventricular pressure and in heart rate. Anti-TNF-alpha antibody increased cardiac response by partially preventing the decrease by endotoxin in differential left intraventricular pressure. Maximal specific binding of 125iodocyanopindolol and myocardial cAMP accumulation were significantly (p < .01) reduced in the endotoxin group in comparison with the control group. Anti-TNF-alpha antibody prevented the endotoxin-induced decrease in cAMP synthesis (p < .05) but did not modify the density of receptors. Affinity of receptors was similar in the three groups. In aortic rings, endotoxin administration significantly (p < .01) shifted the dose-response curve to norepinephrine to the right, both in the presence and absence of endothelium. NG-monomethyl-L-arginine significantly increased the contractions to attain the control level: p < .001 in the presence of endothelium; p < .05 in the absence of endothelium. Anti-TNF-alpha antibody did not prevent endotoxin-induced vascular hyporeactivity to norepinephrine in either endothelium-intact or -denuded rings, but partially attenuated the decrease in maximal response. CONCLUSIONS: In ex vivo experiments, 3 hrs after endotoxin injection, vascular responsiveness was sharply decreased. This impaired response was improved in vitro by the inhibition of nitric oxide. The heart response to isoproterenol, nevertheless, was maintained, even though there was an obvious decrease in receptor density and an impaired myocardial accumulation of cAMP. Anti-TNF-alpha antibody partially prevented the alteration of both myocardial pressure response to isoproterenol and biochemical parameters, and was not efficacious in preventing vascular hyporeactivity to vasoconstrictor agents.

Animals↗
PubMed1997

Nasal mucosa inflammation induced by oxygen administration in humans.

BACKGROUND: The effect of oxygen toxicity in human airways is still poorly documented. We prospectively evaluated the inflammatory reaction induced by nasal oxygen exposure in an experimental setting. METHODS: Healthy subjects without nasal symptoms were exposed to high FIO2 during 5 h. Oxygen was delivered from a tank at a flow of 4 l/min to one nostril of each subject and both nostrils were studied. Mucociliary clearance was measured as saccharine nasal transit time (SNTT). Nasal lavage was performed with 5 ml normal saline and the fluid recovered was processed for cytology and measurements of cytokines concentrations: TNF alpha, IL-6, IL-8 and soluble ICAM-1. Under local anaesthesia, biopsies were performed for immunochemistry and electron microscopy. RESULTS: After oxygen exposure mucociliary clearance decreased and SNTT increased from 16 [9-21] to 20.5 [14-32] min (median and extremes; P < 0.1). In the lavage fluid, concentration of IL-6 was higher in the oxygen-exposed nostril (40.5 [11-128] pg/ml) than in the non-exposed one (7 [0-34] pg/ml; P < 0.05). There was also a trend for a higher IL-8 in the exposed than in the non-exposed nostril, (respectively 501 [214-587] pg/ml and 214 [122-616] pg/ml, P < 0.08), and for a higher number of polymorphonuclear cells in exposed nostril. In the mucosal biopsies substance P was not found, but ICAM-1 expression was higher in the mucosa and submucosa of the exposed nostrils where mast cells were also more abundant and showed piecemeal degranulation. CONCLUSION: In summary, we found clinical, functional and biological evidence of ongoing nasal inflammation following high FIO2 inhalation for 5 h. Since the histology and behaviour of nasal and bronchi mucosa are very similar, the same inflammatory events are likely to be occurring in the bronchi upon high concentrations of inhaled oxygen.

Administration, Inhalation↗
PubMed1996

Alterations of myocardial and vascular adrenergic receptor-mediated responses in Escherichia coli-induced septic shock in the rat.

OBJECTIVES: To investigate responsiveness to exogenous catecholamines in rat bacteremic shock by studying both myocardial and vascular functional parameters; to determine in the same study the relationship of these parameters with other relevant biological parameters of the adrenergic pathway, such as myocardial beta-adrenergic receptors and cyclic adenosine monophosphate (cAMP); and to indirectly approach the roles of tumor necrosis factor-alpha (TNF-alpha) and nitric oxide. DESIGN: Experimental, comparative study. SETTING: Laboratory in a university hospital. SUBJECTS: Male Sprague-Dawley rats, weighing 270 to 320 g. INTERVENTIONS: Intravenous injection of live Escherichia coli DH5 alpha (2 x 10(10) organisms/kg) or saline (0.6 mL) and comparison of the two groups. MEASUREMENTS AND MAIN RESULTS: Mean arterial pressure and heart rate (HR) were recorded, and circulating TNF-alpha concentrations were measured, during the first 3 hrs after E. coli administration. Myocardial and vascular functional parameters were obtained, respectively, from Langendorff-perfused hearts and isolated aortic rings. Adrenergic biochemical parameters (catecholamines, density and affinity of beta-receptors, and isoproterenol-stimulated myocardial cAMP) were determined 3 hrs after E. coli injection. Mean arterial pressure decreased within 5 to 60 mins after bacteria injection and returned to basal levels in the last 2 hrs; HR was unchanged. Serum TNF-alpha concentrations peaked at 120 mins (7333 +/- 672 pg/mL) and were still increased at 3 hrs. Plasma concentrations of epinephrine and norepinephrine were significantly (p < .05) increased. Baseline values for differential left ventricular pressure and coronary flow were significantly (p < .0001, p < .001, respectively) reduced; HR remained unchanged. Isoproterenol induced a similar increase in differential left ventricular pressure and in HR. There was no decrease in the functional myocardial response to adrenergic stimulation. beta-adrenergic receptors were similar in density and in affinity in the two groups. Isoproterenol-stimulated myocardial cAMP was significantly (p < .01) reduced compared with the control group. In aortic rings, bacteria administration significantly (p < .01) shifted the dose-response curve to norepinephrine to the right, both in the presence and absence of endothelium. NG-monomethyl-L-arginine significantly increased the contractions to attain the control level: p < .001 in presence of endothelium; p < .05 in absence of endothelium. CONCLUSIONS: In ex vivo experiments, 3 hrs after E. coli injection, vascular responsiveness was sharply decreased. This impaired response was improved by inhibition of nitric oxide. The heart, nevertheless, was still able to modulate its inotropic and chronotropic response to isoproterenol, even though an impaired beta-adrenergic-receptor stimulation of cAMP was already present.

Animals↗
PubMed1996

Modeled responses to training and taper in competitive swimmers.

This study investigated the effect of training on performance and assessed the response to taper in elite swimmers (N = 18), using a mathematical model that links training with performance and estimates the negative and positive influences of training, NI and PI. Variations in training, performance, NI, and PI were studied during 3-, 4-, and 6-wk tapers. The fit between modeled and actual performance was significant for 17 subjects; r2 ranged from 0.45 to 0.85, P < 0.05. Training was progressively reduced during tapers. Performance improved during the first two tapers: 2.90 +/- 1.50% (P < 0.01) and 3.20 +/- 1.70% (P < 0.01). Performance improvement in the third taper was not significant (1.81 +/- 1.73%). NI was reduced during the first two tapers (P < 0.01 and P < 0.05, respectively), but not during the third. PI did not change significantly during tapers. Thus, the present results show that the model used is a valuable method to describe the effects of training on performance. Performance improvement during taper was attributed to a reduction in NI. PI did not improve with taper, but it was not compromised by the reduced training periods.

Adult↗
PubMed1996

Creatine supplementation does not improve sprint performance in competitive swimmers.

This study was conducted to examine the effects of creatine (Cr) supplementation on sprint swimming performance and energy metabolism. Twenty highly trained swimmers (9 female, 11 male) were tested for blood ammonia and for blood lactate after the 25-, 50-, and 100-m performance in their best stroke on two occasions 7 d apart. After the first trial, subjects were evenly and randomly assigned to either a creatine (5 g creatine monohydrate 4 times per day for 5 d) or a placebo group (same dosage of a lactose placebo) in a double-blind research design. No significant differences in performance times were observed between trials. Post-exercise blood ammonia concentration decreased in the 50- and 100-m trials in the creatine group and in the 50-m trial in the placebo group. The supplementation period had no effect on post-exercise blood lactate. Therefore, creatine supplementation cannot be considered as an ergogenic aid for sprint performance in highly trained swimmers although adenine nucleotide degradation may be reduced during sprint exercise after 5 d of creatine ingestion.

Adult↗
PubMed1996

L-NAME aggravates pulmonary oxygen toxicity in rats.

Exposure to high oxygen concentration leads to acute lung injury and death in rats after 72 h. The pathophysiology of this phenomenon relies on several mechanisms, including alteration of vascular reactivity, recruitment and activation of neutrophils and alveolar macrophages, production of cytokines and excess production of free radicals. In addition to its potent vasodilating effect, nitric oxide (NO) has also been reported to prevent free radical-mediated damage. We wanted to determine whether NG-nitro-L-arginine methyl ester (L-NAME), a NO synthase inhibitor, might modulate oxygen toxicity. In rats exposed to continuous high oxygen concentration, we studied the effect of administration of 50 mg.kg-1 of intraperitoneal L-NAME twice a day on the first day of oxygen exposure. L-NAME resulted in earlier death, since 57% of the animals exposed to oxygen and injected with L-NAME died within 60 h as compared to 22% of the animals exposed to oxygen and treated with saline (p < 0.01). Haematocrit and bronchoalveolar lavage fluid protein were also significantly increased in animals exposed to oxygen and receiving L-NAME. The lung water content was higher in the oxygen-exposed groups (p < 0.01) and slightly decreased by L-NAME (p < 0.05). Thiobarbituaric acid reactive substances (TBARS) were elevated in plasma (p < 0.01) and decreased in lung (p < 0.001) of oxygen-exposed animals, but no significant effect of L-NAME was observed. NG-nitro-L-arginine methyl ester had a deleterious effect in rats exposed to hyperoxia, which might suggest that endogenous nitric oxide has a protective role against hyperoxia-induced pulmonary lesions.

Animals↗
PubMed1996

[Obstetrical epidural analgesia: an epidemiological in Bourgogne and Franche-Comté 1993].

Many publications report the number of epidural analgesias carried out for the last years in English-speaking countries. On the other hand, very little information exists about the incidence of obstetrical epidural analgesia performed in South and Central Europe, particularly in France. A retrospective study within the regions of Bourgogne and Franche-Comté was carried out for the year 1993 firstly, to determine the number of obstetrical epidural analgesias performed and the drugs used; and secondly, to describe the organization and the problems encountered. The result of this study leads to one major question: what is the best type of organization in order to guarantee the highest safety, given the increasing demand for epidural analgesia in obstetrics?

Analgesia, Epidural↗
PubMed1995

Nasal carriage of Staphylococcus aureus and cross-contamination in a surgical intensive care unit: efficacy of mupirocin ointment.

A six month prospective study was carried out in a surgical intensive care unit (SICU) of a university hospital to assess the incidence and routes of exogenous colonization by Staphylococcus aureus. A total of 157 patients were included in the study. One thousand one hundred and eleven specimens (nasal, surgical wound swabs, tracheal secretions obtained on admission and once a week thereafter, and all clinical specimens) were collected over a four month period from patients without nasal decontamination (A). They were compared with 729 specimens collected over a two month period from patients treated with nasal mupirocin ointment (B). All S. aureus strains were typed by restriction fragment length polymorphism (RFLP) pulsed-field gel electrophoresis after SmaI macrorestriction. The nasal colonization rates on admission were 25.5 and 32.7% in groups A and B, respectively. Thirty-one untreated patients (31.3%) and three patients (5.1%) treated with nasal ointment, acquired the nasal S. aureus in the SICU (P = 0.00027). Nasal carriers were more frequently colonized in the bronchopulmonary tract (Bp) and surgical wound (Sw) (62%) than patients who were not nasal carriers (14%) (P < 0.00001). The patterns were identical for nasal, Bp and Sw strains from the same patient. RFLP analysis characterized seven epidemic strains of methicillin-resistant S. aureus (MRSA) which colonized 60% of group A and 9% of group B patients (P < 0.00001). The bronchopulmonary tract infection rate was reduced in group B (P = 0.032). In conclusion, in an SICU, nasal carriage of S. aureus appeared to be the source of endogenous and cross-colonization. The use of nasal mupirocin ointment reduced the incidence of Bp and Sw colonization, as well as the MRSA infection rate.

Administration, Intranasal↗
PubMed1995

Effects of halothane, enflurane and isoflurane on contraction of rat aorta induced by endothelin-1.

Volatile anaesthetics induce hypotension by both indirect and direct effects; they have been reported to inhibit vasoconstriction produced by a variety of agonists. These studies were performed to see if halothane, enflurane and isoflurane attenuate endothelin-1-evoked contraction and if they interact with endothelium-dependent or -independent vasoactive substances. Rat aortic rings were suspended in aerated Krebs' solution (37 degrees C) and contracted by incremental doses of endothelin-1 5 x 10(-10) to 5 x 10(-8) mol litre-1. Volatile anaesthetics at 1 and 2 MAC were tested on endothelium intact and denuded rings. They were tested also on L-NAME incubated endothelium intact and indomethacin-incubated endothelium intact and denuded rings. Responses to endothelin-1 were compared in the presence and absence of volatile anaesthetics. Isoflurane at 1 and 2 MAC concentration, and enflurane at 2 MAC, induced a rightward shift of the dose-response curve obtained with endothelin-1 in both endothelium denuded and intact rings, associated with a decrease in maximal tension generated in the latter rings. In L-NAME-incubated endothelium intact rings and in indomethacin endothelium denuded rings, the anaesthetics induced a rightward shift of the dose-response curve without modification of maximal tension. In indomethacin-incubated endothelium intact rings there was significant attenuation of endothelin-1 contraction in control rings which was not enhanced by volatile anaesthetics in treated rings. The present study indicates that isoflurane at 1 and 2 MAC, and enflurane at 2 MAC, significantly decreased endothelin-1-induced contraction of isolated rat aorta. This inhibition was observed in both intact and denuded rings and probably involves mechanisms within the smooth muscle. Nevertheless, our results suggest that part of the anaesthetic-induced inhibition of endothelin-1-evoked vasocontraction involves an "indomethacin-like" effect on an endothelial-derived vasoconstricting cyclo-oxygenase product.

Anesthetics, Inhalation↗
PubMed1995

Effects of training on performance in competitive swimming.

The relationships between the mean intensity of a training season, training volume and frequency, and the variations in performance were studied in a group of 18 elite swimmers. Additionally, differences between the swimmers who improved their personal record of the previous year during the follow-up training season (GIR, n = 8) and those who did not (GNI, n = 10) were investigated. The improvement in performance during the follow-up season was significantly correlated with the mean intensity of the training season (r = 0.69, p < 0.01), but not with training volume or frequency. The performance improvement during the follow-up season was negatively related to the initial performance level (r = 0.90, p < 0.01). The decline in performance during detraining from the previous year was less for the GIR than for the GNI (6.21 +/- 2.30% vs. 9.79 +/- 2.18%, p < 0.01). The present findings suggest that training intensity is the key factor in performance improvement in a group of elite swimmers. Factors such as previous detraining and initial performance level could jeopardize success in spite of a good adaptation to training.

Adaptation, Physiological↗
PubMed1995

Pilot clinical trial of an anti-TNF alpha monoclonal antibody for the treatment of septic shock.

OBJECTIVE: To determine the safety and pharmacokinetics of an anti-tumour necrosis factor (TNF alpha) monoclonal antibody in the treatment of septic shock, and to evaluate the biological evolution of cytokine response. DESIGN: Open-label, prospective, pilot trial with escalating doses of a murine monoclonal antibody (B-C7) directed against TNF alpha. SETTING: University medical centre intensive care unit. PATIENTS: Nine patients with septic shock, who received standard supportive care and antimicrobial therapy in addition to the anti-TNF alpha antibody. INTERVENTIONS: Patients were treated intravenously with one of three escalating doses of B-C7 monoclonal antibody (MoAb): 0.4 mg/kg, 0.8 mg/kg, 1 mg/kg. RESULTS: MoAb was well tolerated despite the development of human anti-mouse antibodies (HAMA) for each patient; B-C7 plasma levels were dose-dependent. At study entry, TNF alpha and IL-6 levels were detected in six and seven patients respectively; IL-1 levels were low and interferon-gamma was undetectable. CONCLUSIONS: No side effects were noted during treatment regardless of the dose used; however, further studies are needed to determine the clinical efficacy of this agent in septic shock.

APACHE↗
PubMed1995

[Hemodynamic effect of intrathecal clonidine].

Intrathecal administration of bupivacaine and clonidine results in a significant prolongation of both motor and sensitive blocks but side effects-hypotension and bradycardia-are observed. We compared two groups of patients allocated randomly. One group received intrathecal bupivacaine-morphine and the other one received clonidine-bupivacaine-morphine. In the group which received clonidine a blood pressure decrease was observed from 2nd to 8th hour, independently from the sympathetic block and easily corrected by i.v. ephedrine. Some possible explanations are discussed. No complications due to clonidine were observed.

Aged↗
PubMed1994

[Angioneurotic edema and anesthesia: preparation and perioperative monitoring].

Hereditary angioneurotic oedema is an autosomal dominant disease associated with serum deficiency of functional C1-inhibitor. It is characterized by periodic swelling of subcutaneous tissues, abdominal viscera and upper airways. Lethal acute episodes of oedema can occur during anaesthesia and surgery. It is essential to prepare such patients before surgery. This article describes three cases (kidney transplantation, caesarean section, normal delivery) and the various preventive measures used to avoid acute episodes during anaesthesia and surgery. Antibrinolytic agents, androgens, fresh frozen plasma, C1-inhibitor concentrate can be administered. Their various indications are discussed.

Adult↗
PubMed1994

[Heart transplantation experience: Rorschach test five years after surgery].

This paper presents some reflections on the experience of heart transplantation on the basis of Rorschach tests, collected from fifteen patients who underwent cardiac transplantation five years before. We suggest the use of six criteria: responses to Card I; movement (M, MA, m) as a key determinant; importance of surfaces and middle line; responses to Cards IV and VI; responses to Card X; complexual response, if present. Performances show problems related to the integration of the acquired organ. This process is long and difficult but easier in those patients who succeeded in working-through the graft re-acquisition.

Adult↗