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Biomedical subjects

G Pinganaud

Publications and source records attributed to G Pinganaud.

At least 19 recordsLinked to original sources
PubMed2006

[Evaluation of pulmonary function in the elderly. Intergroupe Pneumo Gériatrie SPLF-SFGG].

Aging is associated with a progressive decrease in lung function. As a consequence of aging, individual's reserve is diminished, but this decrease is heterogeneous between individual subjects. Many factors are involved in the overall decline in lung function. The prevalence of asthma in the elderly is estimated between 6 and 10%. Mortality due to COPD is increasing, especially among older subjects. Older subjects are at an increased risk of developing chronic diseases such as Parkinson's disease, which can have consequences for lung function. Under-nutrition is also common in the elderly and can produce sarcopenia and skeletal muscle dysfunction. The presentation of respiratory disorders may differ in the elderly, especially because of a lack of perception of symptoms such as dyspnea. The impact of bronchodilatators or corticosteroids on respiratory function has not been studied in the elderly. Drugs usually used for the treatment of hypertension or arrhythmias, which are often observed with aging, can have pulmonary toxicity. There is no difference between functional evaluation in younger and older subjects but it is more difficult to find predicted values for older patients. Performing pulmonary function tests in older patients is often difficult because of a higher prevalence of cognitive impairment and/or poor coordination. When assessing pulmonary function in the elderly, the choice of tests will be depend on the circumstances, with the use of voluntary manoeuvres dependent on the condition of the patient.

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PubMed2003

Prospective audit of diabetes care and outcomes in a group of geriatric French care homes.

BACKGROUND: In geriatric institutions, diabetes prevalence varies from 10 to 20%. However, little is known about patterns of care and their outcomes. To assess both, an 18-month prospective audit was conducted in 240-bed nursing and 80-bed residential care homes. METHODS: In diabetic subjects, items of care were compared to the corresponding French guideline end-points. Dependency in activities for daily living (ADL) was evaluated at inclusion and at the end of the survey for survivors. Diabetic residents were compared to others for age, sex, mortality and one-year change of iso-resource group ranging (IRG), a need-of-care scale. RESULTS: The 73 diabetic patients among 494 residents (14.8%) were not different from the others for age and sex (respectively age: 76.0 y +/- 7.9 compared to 78.2 y +/- 9.4; M/F sex ratio: 0.59 compared to 0.31). Oral hypoglycemic agents were prescribed in 29 (39.7%) and insulin in 26 (35.6%). Control of diabetes with HbA(1C) was in keeping with guidelines in 23.3%, HbA(1C) was never performed in 26%, and > 8% in 20.5%. Rates of items of guidelines that were never addressed ranged from 2 to 80%. During the stay, ADL dependency worsened in diabetic patients, but their one-year change in GIR range was not different from that in the others. Mortality was 30.1% compared to 37.1% in the others (NS). This mortality rate and the evolution of functional dependency were not influenced by the quality of diabetes control. CONCLUSION: In these disabled elderly patients, diabetes management needs to be improved. However, mortality and the evolution of functional dependency were similar in diabetic people than in others. Interventional studies for controlling with reference to geriatric evaluation, i.e. function, nutrition and mental health, are needed in order to establish specific guidelines based on benefit-burden analysis.

Activities of Daily Living↗
PubMed2002

Is a 24-h cyclic closed enteral feeding system microbiologically safe in geriatric patients?

BACKGROUND AND AIMS: The microbiological quality of a 1-l closed enteral feeding system (CS) was prospectively monitored under clinical conditions simulating cyclic feeding over a 24-h period in geriatric patients. METHOD: The set was connected after diet sampling (T0). After 5-h feeding, the set was disconnected and a sample taken (T5). Diet was sampled after 12 h before (T12A) and after a 10 ml diet-flush of the set (T12B), after 24-h (T24) and in the pouch (P24). Concentrations of micro-organisms were considered significant when above 10(4) colony-forming units per millilitre. RESULTS: Twenty-one CS were examined. T0 samples were all sterile; 10 out of 21 T5 were contaminated. The microbiological content of the diet was lower in T12B, compared to T12A (P=0.002). None of the P24 samples was contaminated; 19 were sterile and two contained low levels of micro-organisms that had been previously found in the sets. CONCLUSION: The CS was sterile before connecting to the patient. Retrograde contamination of the set was observed without contamination of the pouch after 24-h hanging time. Performing a diet-flush decreased the rate of diet contamination at the distal extremity of the set. Thus, cyclic enteral nutrition using the same pouch during a 24-h period seems to be safe in geriatric patients.

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PubMed2001

Reticular premotor neurons projecting to both facial and hypoglossal nuclei receive trigeminal afferents in rats.

The distribution of premotor neurons projecting to motor nuclei of both the VIIth (VII) and XIIth (XII) nerves was examined in the pontomedullary reticular formation (RF) of the rat by using retrograde double labeling. After injection of two different tracers in the VII and the XII, most of the double labeled neurons were found caudally in the dorsal RF whereas rostrally they were located in the ventral RF. In some experiments, additional injections of an anterograde tracer were made in the sensory trigeminal nuclei. Anterogradely labeled trigeminal boutons were found in contact with retrogradely double labeled neurons throughout the pontomedullary RF. These neurons were mainly encountered ventral to the trigeminal motor nucleus and dorsal to the VII. Functionally, this region is known to be involved in eye protection mechanisms.

Animals↗
PubMed2001

Trigemino-reticulo-facial and trigemino-reticulo-hypoglossal pathways in the rat.

This study was undertaken to identify premotor neurons in the pontomedullary reticular formation serving as relay neurons between the sensory trigeminal complex and the motor nuclei of the VIIth and XIIth nerves. Trigeminoreticular projections were first investigated after injections of anterogradely transported tracers (biotinylated dextran amine, biocytin) into single subdivisions of the sensory trigeminal complex. The results show that the trigeminoreticular projections were abundant from the pars interpolaris (5i) and caudalis (5c) and moderate from pars oralis (5o) of the spinal trigeminal nucleus. Injections into the 5i and 5c produce dense anterograde labeling (1) in the dorsal medullary reticular field; (2) in the parvocellular reticular field, medially adjacent to the 5i; and (3) more rostral in the region dorsal and lateral to the superior olivary nucleus. Some labeled terminals were also found in the intermediate reticular field, whereas only light anterograde labeling was observed in the gigantocellular and oral pontine reticular formation. The 5o sends fibers and terminals throughout the whole reticular formation, with no clear preferential projections within a particular field. Only light projections originated from the principal nucleus (5P). In a second series of experiments, we examined whether premotor neurons in the reticular formation are afferented by trigeminal fibers. Double labeling was performed by injection of an anterograde tracer in the 5i and 5c and retrograde tracer (gold-horseradish peroxidase complex) into the VII or the XII motor nucleus on the same side. Retrogradely labeled neurons in contact with anterogradely labeled boutons were found throughout the reticular formation with predominance in the parvocellular and intermediate reticular fields. These experiments demonstrate the existence of trigeminal disynaptic influences, via reticular neurons of the pontomedullary reticular formation, in the control of orofacial motor behaviors.

Animals↗
PubMed2001

[Annual incidence and risk factors for nosocomial bacterial infections in an acute care geriatric unit].

PURPOSE: Elderly inpatients are particularly exposed to the risk of nosocomial infections, thus the study of their risk factors and consequences is of interest. METHODS: Among 1,565 subjects referred to a short-term geriatric unit, patients hospitalised for a year for an acute event and unable to move themselves were followed up for the occurrence of nosocomial infections. RESULTS: Among these 402 immobilised patients (age: 86.3 +/- 7.6 years), 102 nosocomial infections occurred in 91 patients (22.6%), whereas the estimation of the incidence in the total hospitalised population (1,565 subjects, age: 85.1 +/- 6.2 years) was 9.4% (95% confidence interval [CI] 8.3-11.2). Forty-seven point seven percent of nosocomial infections were urinary tract nosocomial infections, 27.5% were lower respiratory nosocomial infections, 9.2% were cutaneous nosocomial infections, 7.3% were septicaemia and 8.2% were of unknown origin. The relative risk (RR) of NI linked to functional dependency for mobility was 5.5 (95% CI: 3.93-7.7, P < 0.001). Other risk factors were: for all nosocomial infections: cancer diagnosis (RR 1.1, 95% CI: 1.1-1.2, P = 0.01); and respectively for urinary tract NI: bladder indwelling (RR 4.8, 95% CI: 2.9-7.7, P < 0.001), pulmonary NI: swallowing disorders (RR 5.4, 95% CI: 2.8-10.5, P < 0.001); and septicaemia: venous catheter (RR 5.4, 95% CI: 1.3-23.3, P = 0.002). NI were associated with an increased length of stay (22.1 +/- 11.7 days in infected patients vs 16.3 +/- 9.5 days in immobilised non-infected subjects, P < 0.001). The mean length of stay for the 1,565 subjects was 10.3 +/- 7.6 days. Death was attributed to nosocomial infections in 13 subjects. In conclusion, functional dependency for mobility, bladder indwelling, venous catheter, swallowing disorders and diagnosis of cancer were risk factors for nosocomial infections in hospitalised elderly subjects in an acutecare setting.

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PubMed2000

Connections between the trigeminal mesencephalic nucleus and the superior colliculus in the rat.

Retrograde tracing methods are employed here to demonstrate that neurons in the trigeminal mesencephalic nucleus (5me) project to the superior colliculus (SC) in the rat. These neurons, mainly of small size, are situated bilaterally in the caudal part of the nucleus. Anterograde tracing studies demonstrated the existence of SC projections to neurons in 5me. The SC fibers contact 'en passant' small as well as large cell bodies of 5me neurons. These pathways suggested a role of the 5me neurons in oculomotor control and associated oro-facial functions.

Animals↗
PubMed1999

Trigeminal projections to hypoglossal and facial motor nuclei in the rat.

This study was undertaken to identify the trigeminal nuclear regions connected to the hypoglossal (XII) and facial (VII) motor nuclei in rats. Anterogradely transported tracers (biotinylated dextran amine, biocytin) were injected into the various subdivisions of the sensory trigeminal complex, and labeled fibers and terminals were searched for in the XII and VII. In a second series of experiments, injections of retrogradely transported tracers (biotinylated dextran amine, gold-horseradish peroxidase complex, fluoro-red, fluoro-green) were made into the XII and the VII, and labeled cells were searched for in the principal sensory trigeminal nucleus, and in the pars oralis, interpolaris, and caudalis of the spinal trigeminal nucleus. Trigeminohypoglossal projections were distributed throughout the ventral and dorsal region of the XII. Neurons projecting to the XII were found in all subdivisions of the sensory trigeminal complex with the greatest concentration in the dorsal part of each spinal subnucleus and exclusively in the dorsal part of the principal nucleus. Trigeminofacial projections reached all subdivisions of the VII, with a gradual decreasing density from lateral to medial cell groups. They mainly originated from the ventral part of the principal nucleus. In the spinal nucleus, most of the neurons projecting to the VII were in the dorsal part of the nucleus, but some were also found in its central and ventral parts. By using retrograde double labeling after injections of different tracers in the XII and VII on the same side, we examined whether neurons in the trigeminal complex project to both motor nuclei. These experiments demonstrate that in the spinal trigeminal nucleus, neurons located in the pars caudalis and pars interpolaris project by axon collaterals to XII and VII.

Animals↗
PubMed1999

Primary trigeminal afferents to the vestibular nuclei in the rat: existence of a collateral projection to the vestibulo-cerebellum.

Projections from the mesencephalic trigeminal nucleus to the vestibular nuclei were analyzed using retrograde and anterograde tracing methods. The results show that neurons in the caudal part of the trigeminal mesencephalic nucleus project mainly to the medial, inferior and lateral vestibular nuclei and moderately to the peripheral part of the superior vestibular nucleus. Using the double-labeling technique we demonstrate that individual neurons of the mesencephalic nucleus send collaterals to the vestibular nuclei and the vestibulo-cerebellum. These results suggest that these anatomical connections are involved in mechanisms of eye-head coordination.

Animals↗
PubMed1999

Prospective audits of quality of PEM recognition and nutritional support in critically ill elderly patients.

BACKGROUND AND AIMS: Undereating is a frequent concern in acute care geriatric settings and is supposed to worsen the outcomes of the underlying diseases, while the quality of nutritional support could be improved. METHODS: Two consecutive and prospective audits (A and B) with team training over a 1 year period investigated the quality of malnutrition recognition and nutritional support and outcomes in immobilized, critically ill elderly subjects. RESULTS: Audit A included 170 patients (86.3+/-6.1 years old) and audit B, 232 patients (86.3+/-6.3), respectively 20.6% and 31.4% of the hospitalized population. Misclassifications occurred in A in 54.0% compared to 34.05% in B (P < 0.001). 32.6% in A versus 86.9% in B adequately received oral supplements (P = 0.02). Significant risk factors for the adverse outcomes in the combined two audits were: dementia (RR: 1.8, 95%CI: 1.0 to 3.0, P= 0.04) and dehydration (RR: 2.0, 95%CI:1.0 to 4.1, P= 0.05) for pressure ulcer incidence; stroke (RR: 8.8, 95%CI: 4.8 to 16.0, P < 0.001) for pressure ulcer prevalence at discharge; neoplasms (RR: 1.1, 95%CI: 1.0 to 1.2, P = 0.02) for nosocomial infections; bladder indwelling for urinary tract infections (RR: 4.8, 95%CI: 2.9 to 7.7, P<< 0.001); swallowing problems for pulmonary infections (RR: 5.4, 95%CI: 2.8 to 10.5, P < 0.001); venous indwelling for septicaemia (RR: 5.4, 95%CI: 1.3 to 23. 3, P= 0.02). However, after adjustment on significant risk factors, the outcome rate was similar in audit B: death rate: A (15.6%), B (14.2%); length of stay: A (17.3+/-10.4 days), B (17.4+/-10.0); pressure ulcer incidence: A (26.4%), B (20.2%), (83% were erythema); pressure ulcer prevalence at discharge: A (14.7%), B (10.3%), (40% were erythema); nosocomial infections: A (26.4%), B (19.0%). CONCLUSION: The improvement of malnutrition recognition and nutritional support was not followed by a perceptible decrease in adverse outcome rate, this latter being mainly related to the underlying conditions of these critically ill elderly patients.

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PubMed1997

Projection from trigeminal nuclei to neurons of the mesencephalic trigeminal nucleus in rat.

The mesencephalic trigeminal nucleus contains cell bodies of primary somatic sensory neurons that innervate the head region. The neurons resemble dorsal root ganglion cells but a striking difference is the presence of synaptic boutons in the nucleus. The present report demonstrates with anterograde tracers, the existence of a direct trigeminal projection from secondary sensory neurons of the principal and spinal nuclei to the mesencephalic nucleus. Our observations strongly suggest that synaptic contact may be established on the cell bodies as well as on the neurites of the mesencephalic neurons. These pathways could play a modulatory role in the processing of sensory afferent information and in the control of orofacial and/or oculomotor functions.

Animals↗
PubMed1997

Audit of percutaneous endoscopic gastrostomy in long-term enteral feeding in a nursing home.

OBJECTIVES: Percutaneous endoscopic gastrostomy (PEG) is now easily used in the event of long-term enteral nutrition. Tolerance of long-term enteral feeding has been documented in different populations but the documentation is incomplete in the case of older and frail people. Our aim was to describe early and late tolerance in this population, and to propose ways in which it could be improved. DESIGN: Retrospective study in two parts: tolerance and quality of care; case-control study for tolerance. SETTING: A nursing home with 240 beds in south-west France. who had undergone PEG insertion between January 1990 and June 1994. Fifty-eight patients were involved, 12 under 65 years (48 +/- 10.6), and 46 over 65 (80.7 +/- 9.3). The gastrostomy insertion was performed because of a vegetative state in 6 patients, swallowing difficulties in 31 and anorexia in 21. A control group was gathered in December 1996, which included all patients for whom the question of nutritional support was mentioned books but where no artificial nutrition had been implemented due to the patients' or families' refusal or to a staff decision. This group included 50 patients, 5 younger than 65 years (54 +/- 8.3), and 45 older (84.7 +/- 7.6). In 22 cases the nutritional problem was swallowing difficulties and in 28 cases anorexia. Pressure ulcers were present before insertion in 34 patients in the PEG group and in 7 of the control group (p < 0.001). MAIN OUTCOME MEASURES: Prognosis, early and late cutaneous digestive (ileus, vomiting, gastroesophageal reflux) and pulmonary (bronchorrhea, dyspnea and aspiration pneumonia) complications for PEG and control groups, and patients with signs of poor behavioural tolerance of PEG were recorded in the chart. Audit of quality of care was performed in the PEG group using eight criteria: two concerned the pre-insertion period, two the early follow-up and four the long-term follow-up. RESULTS: Early mortality (4 weeks) was 13.8% in PEG (vs 10%, NS), mid-term mortality (between 4 and 8 weeks) was 12.1% (vs 14%, NS) and late mortality was 19.0% (vs 42.0%, length of follow-up 63.4 +/- 42.1 weeks compared to 53.1 +/- 63.8 weeks, NS). The duration of follow-up of the living patients was 71.6 +/- 61.8 weeks in PEG compared to 48.0 +/- 70.5 in the control group. Only 20% in PEG were free of any cutaneous complication around the insertion site, and 8 abscesses occurred during the first week. Pulmonary complications occurred in 39% of the PEG group (vs 30.0, NS). Aspiration pneumonia was significantly associated with swallowing difficulties in both groups (p < 0.05). Vomiting occurred for 15.5% of the PEG group (vs 12%, NS), ileus in 13.8% (vs 6%, NS). Gastroesophageal reflux was found in 2 PEG patients, compared to 1 case among the control patients. Pressures sores were healing in 20 out of 34 patients in the PEG group (vs 2 out of 7) and new ulcers appeared in 6 out of 24 (vs 8 out of 43). Fifteen (25.8%) of the PEG patients attempted to withdraw the tube.

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PubMed1996

Development of retino-tectal arborizations in the trout.

In order to visualize the organization and the morphology of developing retinal axons in the trout (Oncorhynchus mykiss), HRP or DiI crystals were applied on the central part of the retina at different stages ranging from 21 days postfertilization (stage 27) to one month post-hatching (stage 36). Retinal axons and arborizations were observed on tectal whole mounts with a light microscope. The earliest stage investigated (stage 27) showed two groups of axons entering the tectum by its ventro-rostral part and extending in a dorso-caudal direction. As the tectum grows, these two groups separate to outline the dorsal and the ventral borders of the tectum. At three weeks post-hatching (stage 35) we observed three distinct brachia: the dorsal and ventral fascicles, and a small group in the middle that we called the intermediate fascicle. At hatching (stage 30), retinal axons start to arborize in the centre of the tectum. During the first month post-hatching, these axons migrate dorso-caudally and exhibit various morphologies. Until two weeks post-hatching (stage 34), they sprout a few long side branches, bearing numerous filopodial growth cones, in a phase of exploratory growth towards their target site. At stage 36, four types of terminal arborizations can be identified on the basis of their tangential and radial location in the tectum, and on their gross morphology. Three of these arbor types are already present at earlier stages and undergo refinements in their shape--reduction in their branching axes, loss of branches that are behind the terminal arborization, and the sprouting of more numerous branches at their extremities. These findings confirm that the widely branched arborizations are transient during development.

Age Factors↗
PubMed1994

[Expression of vimentin and GFAP and development of the retina in the trout].

The glial cell development was studied during the edification of the retina and the optic tract, in a teleost, the rainbow trout. The intermediate filament proteins, vimentin and glial fibrillary acidic protein (GFAP) were visualized by an indirect immunohistochemical method. Results show that both vimentin and GFAP are early expressed in the developing retina and, particularly in the Müller cells, a coexpression of vimentin and GFAP is observed from embryonic to adult stages. The ganglion cell layer and the optic fiber layer both exhibit GFAP-positive structures. The deep staining for GFAP is also seen in the optic nerve and induces us to credit astrocyte-like cells with a leading role in the pattern formation of this tract.

Animals↗
PubMed1990

[Conservative treatment of chronic renal insufficiency in the aged patient].

Patients over 70 years old constitute a large percentage of those with chronic renal insufficiency (CRI) (27% in our series). Vascular renal lesions appear to represent a predominant etiology in this age range that is equally remarkable for this multiplicity of potential etiologies and associated pathologies. The prognostic severity of CRI aggravated by hypovolemia or by the toxicity of prescribed drugs calls for great carefulness in prescribing diets and drugs for the elderly. It is hard to say whether an effective nephro-protection can be obtained through a hypoprotein diet supplemented with ketoanalogs, a diet very acceptable from a nutritional standpoint. On the other hand, the corrective effect of this diet upon certain metabolic abnormalities that occur during CRI seems to be undeniable.

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PubMed1990

Quantitative and morphological study of cell proliferation during morphogenesis in the trout visual system.

Cell proliferation in the retina and tectum was investigated in a teleost (the trout Salmo gairdneri Rich.) at embryonic and larval stages in order to determine the pattern of growth in retinotectal organization. The tritiated thymidine was injected into the coelom: 1 microCi at stage 27 and 30, 2 or 5 microCi at stage 34. The morphological and quantitative analysis of the growth in the retina and tectum indicate the existence of two modes of development. In the retina, the thymidine labelled cells are located in a peripheral area with an important dorso-ventral asymmetry near the optic disc. This asymmetry decreases at hatching and disappears at stage 34. In the tectum, the proliferative zone is periventricular and lies along the medial, lateral and caudal rim. During ontogenesis, the lateral and caudal proliferative zones are moving back. The quantitative analysis of the retina, tectum and of their proliferative zones show that the volumes are highly correlated for all the specimens over the three stages. The volume variation is subordinate to the growth, low between stages 27 and 30, high between stages 30 and 34. Nevertheless the tectal proliferative zone exhibits a typical change: it decreases at hatching then increases at stage 34. At this stage the volume of the proliferative zones of the retina and tectum are discordant. The peculiar quantitative development of tectal proliferative zone predict the shifting of the retino-tectal projections and may be correlated with the timing of tectal developmental events.

Animals↗
PubMed1987

[Retinotopic organization in the development of the young trout Salmo gairdneri Rich].

The progression of the retinotopic organization in the optic nerve projections to the contralateral thalamus and tectum was studied in Salmo gairdneri from hatching stage to 3 month old stage. After quadratic lesions of the temporal, dorsal, nasal, or ventral retina, the animals were separated in two groups: one used for Fink and Heimer method or electron microscopic observation and the other one for radioautography after injection in the operated eye of 14C or 3H proline. The analysis of the projections of each retinal quadrant shows that: Projections to thalamus and pretectum are ignorganized and appear progressively during development. On the contrary in tectum and corpus geniculatum, the visual projections are retinotopically organized since hatching. In the whole retino-tectal system, two subsystems develop differently: the naso-ventral retina reaches precociously its permanent target (the posterior tectum), the temporo-dorsal part of the retina links to the anterior tectum and shifts laterally during the first month after hatching, from medial to antero-lateral tectum for temporal projections. The shifting of projections is correlated with development of the medial fascicle of the optic tract. So it appears that the pathways play an important role in the spatio-temporal ordered pattern of terminations of retinal fibers on the tectal surface during development.

Aging↗