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F Gagnadoux

Publications and source records attributed to F Gagnadoux.

27 records · Page 2Linked to original sources
PubMed1999

Long-term efficacy of fixed CPAP recommended by Autoset for OSAS.

The Autoset autotitration system (Resmed, Australia) was designed as an aid for determination of the effective level of CPAP. Two studies have shown that the 95% pressure centile during a night with Autoset, after excluding any periods with severe leak (P95), was well correlated with the pressure determined manually according to the reference method. However, the suitability of P95 under Autoset for treatment with conventional CPAP needed to be evaluated outside of the context of titration. The objective of this study was to measure the compliance and efficacy of CPAP at P95 determined by Autoset, after 3 months. Twenty-four patients who had undergone routine autotitration by Autoset under polysomnographic control in the laboratory for previously untreated OSAS were evaluated after 3 months of treatment with CPAP at P95. This evaluation was based on compliance, daily usage, determined by reading the hourly counter, Epworth sleepiness score and home respiratory recording under CPAP. Polysomnography under Autoset showed a significant reduction of abnormal respiratory events (apnea-hypopnea index (AHI): 5.7 (+/-4.6) vs 69.6 (+/-29.8) n/h; p<0.001). P95 was between 8.5 and 15 cm H2O (mean: 11.2 (+/-1.6)). Two patients were lost to follow-up. At 3 months, 18 out of 22 (82%) patients declared that they were still using their machine with a daily usage of 5.25 (+/-1.82) h. The Epworth sleepiness scale was significantly decreased (5 (+/-4.1) vs 11.4 (+/-5.4); p<0.05). P95 recommended by Autoset remained effective on abnormal respiratory events with a low AHI (4.1 (+/-3.2) n/h) and a low 4% oxygen desaturation index (3.6 (+/-4.5) n/h) under CPAP. This study confirms the efficacy of autotitration and the suitability of P95 determined by Autoset for long-term treatment by conventional CPAP at home.

Female↗
PubMed1999

[Mycoplasma pneumoniae pneumopathy. 10 cases].

OBJECTIVES: Describe the different features of a common disease: Mycoplasma pneumoniae pneumonia. PATIENTS AND METHODS: The hospital files of 10 consecutive patients with microbiologically proven Mycoplasma pneumoniae pneumonia were reviewed retrospectively. These 10 patients were hospitalized over a 15-month period among 150 patients admitted to the Versailles general hospital for community-acquired pneumonia. We compared our series with data in the literature. RESULTS: Most of the patients with Mycoplasma pneumoniae pneumonia were young apparently healthy adults. A bronchial risk factor (smoking, allergy) was however found in 60% of the patients. The principle symptom was persistent cough (100%), with fever and joint pain, or sometimes headache and signs of ENT involvement. Dyspnea was frequent, related more to associated bronchospasticity than to the severity of the pneumonia. Radiographic findings were quite variable. In one case hemolytic anemia and cold agglutinins suggested the diagnosis. Certain diagnosis was based on positive serology after hospitalization due to the long delay between symptom onset and hospitalization. The prehospital period was characterized by a succession of ineffective empirical antibiotic regimens. In routine practice, macrolides or fluoroquinolones administered for 2 to 3 weeks are the empirical antibiotics of choice. Outcome is generally favorable with rapid clinical and radiological improvement. Antibiotic therapy is not however sufficient alone to achieve improvement in the respiratory impairment: bronchodilators and corticosteroids are necessary to treat the bronchospasticity. CONCLUSION: Despite the benign nature of community-acquired pneumonia due to Mycoplasma pneumoniae, clinical manifestations, particularly bronchial inflammation may have important consequences.

Adrenal Cortex Hormones↗
PubMed1999

Economic studies and 'technical' evaluation of telemedicine: the case of telemonitored polysomnography.

Information and communication technology (ICT) is not yet integrated into current medical practice and frequently, organizational patterns of health care production are held responsible for this situation. However, and quite paradoxically, measures recently taken in France indicate that a preferential role is granted to ICT in order to promote the development of healthcare networks. In this context, one should carefully examine which factors, other than organizational ones, can explain the very slow diffusion of telemedicine. Actually, medical assessment of telemedicine is very seldom and the medical community is unable to appreciate the extent that this technology would modify the quality of care provided. Furthermore, and as a consequence of the former, there is no economic evaluation of telemedicine applications and its effects, in terms of productivity, remain virtual. In this article, based on an early evaluation of telemonitored polysomnography to diagnose sleep apnea syndrome, we show that it is possible, even at an experimental stage, to produce appropriate and convincing clinical results stating the true technological effectiveness (choice of an adequate clinical trial, selection of appropriate endpoints). Specific attention is given to the technical conditions in which the technology is assessed, we also provide most of the data that should be taken into account to foresee the major organizational transformations of the production processes. Our results show that early clinical ad hoc evaluations of telemedicine applications can be conducted promptly, providing strong clinical results and useful data for any forthcoming economic evaluation.

Adult↗
PubMed1999

[Anti-infective aerosols].

Anti-infectious agents such as pentamidine, antibiotics (mainly colistine and aminoglycosides) and amphotericin B can be administered by aerosol. This route of administration is not officially approved and it constitutes an empirical approach which has benefited from recent research which is summarized hereafter. The most fundamental question is related to the potentially deleterious effects of nebulization processes, especially ultrasound, on the anti infectious properties of the drugs. Colimycin, which was chosen as a reference because its polypeptide structure makes it unstable a priori, proved to be resistant to high frequency ultrasound, which is encouraging for other molecules such as aminoglycosides or betalactamins. The nebulizer characteristics have also to be taken into account. An aerosol can be produced from an amphotericin B suspension and from colistine using both an ultrasonic nebulizer and a jet nebulizer. Distinction between good and bad nebulizers does not depend upon the physical process involved to nebulize the drug, but on the intrinsic characteristics of the device and its performance with a known drug. The inhaled mass of an aerosol in the respirable range must be high and dosimetric nebulizers represent a significant progress. Finally, adminnistration of anti infectious aerosols requires a new pharmacological approach to monitor treatment and urinary assays are promising.

Aerosols↗
PubMed1997

Nebulization and anti-Pseudomonas aeruginosa activity of colistin.

Colistin aerosols are frequently administered to patients with cystic fibrosis. However, questions arise concerning the effect of both jet and ultrasonic nebulizers on the properties of the drug. The aim of this study was to characterize the anti-Pseudomonas aeruginosa (PA) activity of colistin after jet (Pari LL) and ultrasonic (DP100) nebulization. A bench study was performed by capturing the aerosols, determining the drug mass, and assessing its anti-PA activity. Because the inhaled mass of colistin had to be entirely recovered for the bacteriological study, it was assessed by isotopic methods, mixing the drug with a 99mTc-labelled tracer and demonstrating that 99mTc activity accurately predicted the mass of colistin. Colistin was extracted from the filters and its antibiotic activity was determined using the method employed for the study of the bacteriostatic and bactericidal power of serum on the ATCC 27853 PA strain. The postnebulization minimum inhibitory concentrations (MIC) were 1.9 micrograms.mL-1 with DP100 and 0.5 microgram.mL-1 with Pari LL. These values were less than two dilutions different from the 1 microgram.mL-1 MIC of non-nebulized colistin. We conclude that neither jet nebulization nor ultrasonic nebulization alter the antibiotic properties of colistin and that both systems can be used to nebulize colistin.

Administration, Inhalation↗
PubMed1997

[Hematopoietic growth factors and anti-infective respiratory defenses].

Colony-Stimulating Factors (CSFs) are a family of glycoproteins that are required for the proliferation and differentiation of hematopoietic progenitor cells. Among these factors, G-CSF and GM-CSF are principally involved in the production of neutrophils. They have been demonstrated to be effective in correcting neutropenia during cytotoxic chemotherapy or bone marrow transplantations. Beside their hematopoietic action, recent data indicate that G-CSF and GM-CSF also have stimulatory effects on mature neutrophils function. The functional properties of neutrophils that are enhanced by G-CSF and GM-CSF are those related primarily to the host's defense against microorganisms. For Gm-CSF those stimulatory effects also concern the macrophages. Investigations of several animal models of severe bacterial infection and specially pneumonia have indicated that exogenous recombinant G-CSF or GM-CSF can significantly enhance host defenses and improve rates of survival. Trials of recombinant G-CSF in combination with antibiotics for the treatment of severe pneumonia in noneutropenic patients have recently been initiated. First results confirm the good tolerance of recombinant G-CSF. Further prospective studies are required to determine the effectiveness and the conditions of administration of G-CSF and GM-CSF in this indication.

Animals↗
PubMed1996

[Pulmonary deposition of colistin aerosols in cystic fibrosis. Comparison of an ultrasonic nebulizer and a pneumatic nebulizer].

The objective of this study was to quantify the deposition in the lung of a Colistine aerosol generated using a pneumatic nebuliser (Pari LL(R) equipped with a Pari Master, Pari, Germany) and to compare this with the results obtained with an ultrasonic nebuliser (DP100, DP Medical, France) in four subjects suffering from cystic fibrosis being colonised with Pseudomonas aeruginosa. To quantify the pulmonary deposition of the aerosols we have used an indirect isotopic method which consists in assimilating the kinetics of the molecules studied with a serum albumin tagged with Technetium 99m (Tc99mm) and added to a preparation of Colistine. We have previously verified that the addition of a radioactive tracer does not change the normal distribution or dynamics of the medication within the aerosol and the radioactive counter linked to the tracer reflects the mass of the medicament. The pulmonary deposition was expressed as a percentage of the nebuliser dose. A regional analysis of the deposition (central, peripheral, superior and inferior) was carried out and in central deposition compared to the periphery (C/P) and superior compared to inferior (S/I) were calculated. With the DP100 nebuliser the pulmonary deposition of the aerosol was very reproducible from one patient to another, varying only between 9.5 to 14 percent of the nebuliser dose. With the Pari LL the fraction deposited varied more from one patient to another from 5.6 to 27% of the nebuliser dose. In three of four patients, the pulmonary deposition was superior or equal to that obtained with the ultrasonic nebuliser. The patients whose pulmonary deposition was inferior, using the pneumatic nebuliser, was the youngest in the group and co-ordinately poorly the triggering of the nebuliser with the beginning of inspiration. With the two nebulisers, the pulmonary deposition of Colisitine was very heterogeneous throughout the pulmonary parenchyma. The mean of the ratio C/P and S/I obtained in all four patients was identical (1.35 an 0.86 respectively), indicating a deposition of the aerosol which was predominantly central and inferior but was distributed equally in the peripheral parts of the lung. Pneumatic nebulisers offer a reliable alternative notably for domiciliary treatment for Colistine aerosols in patients suffering from cystic fibrosis. In younger patients who have not yet acquired good motor co-ordination, nebulisers which function continuously or are triggered by inspiration seem to be the preferred choice.

Administration, Inhalation↗
PubMedDate not supplied

[Pulmonary embolism. Risk factors of venous thromboembolic disease].

RISK FACTORS: Management of deep venous thromboembolism both in terms of diagnosis and therapeutic and prophylactic strategies has been greatly improved by advances in knowledge of the main acquired and intrinsic risk factors. RESISTANCE TO ACTIVATED PROTEIN C: This is by far the most frequent coagulation disorder predisposing to venous thromboembolism. Other intrinsic factors favoring thrombus formation (anti-thrombin II, protein C or protein S deficiencies) are much more uncommon. Laboratory tests in search for these anomalies are indicated essentially for patients who develop repeated episodes of venous thrombus formation. PROPHYLAXIS: Excepting specific cases, anticoagulant prophylaxis is not indicated in any of these anomalies beyond the usual treatment of a first episode. Among the risk factors for acquired deep vein thromboembolism, only surgery and certain obstetrical indications have been investigated sufficiently to define validated prophylaxis strategies. For medical risks, the benefit of anticoagulant prophylaxis has been demonstrated in certain disease states such as cancer, antiphospholipid syndrome and the acute phase of myocardial infarction although no widely accepted strategy has yet been established.

Anticoagulants↗