Biomedical subjects

J C Bertrand

Publications and source records attributed to J C Bertrand.

At least 37 records · Page 2Linked to original sources

PubMed2000

Serum and ascitic procalcitonin levels in cirrhotic patients with spontaneous bacterial peritonitis: diagnostic value and relationship to pro-inflammatory cytokines.

OBJECTIVE: To assess the potential role of procalcitonin and pro-inflammatory cytokines, TNF-alpha, and IL-6, in the diagnosis of spontaneous bacterial peritonitis (SBP). DESIGN: Prospective study. SETTING: The emergency unit of a teaching hospital. PATIENTS: We included 21 patients with SBP and 40 patients with sterile ascitic fluid. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: For the diagnosis of SBP, the best markers were serum levels of procalcitonin with a cut-off value of 0.75 ng/ml, a sensitivity of 95%, a specificity of 98%, and ascitic fluid levels of IL-6 with a cut-off value of 5,000 ng/ml, a sensitivity of 100%, and a specificity of 88%. C-reactive protein and serum polymorphonuclear count have low sensitivity/specificity at 62/92% and 57/90%, respectively. From 21 patients with SBP, ascitic fluid to serum ratio of TNF-alpha and IL-6 was greater than to 2 in all cases with a mean at 6.2 +/- 6.5 and 34 +/- 31, respectively. By contrast, this ratio for procalcitonin was less than 1 in all cases with a mean at 0.31 +/- 0.25. We found no correlation between procalcitonin levels and cytokine levels in either ascitic fluid or serum. CONCLUSIONS: Serum procalcitonin level may become a useful marker for the diagnosis of SBP in cirrhotic patients. The low ratio of ascitic fluid to serum procalcitonin supports the hypothesis that procalcitonin is not produced intraperitoneally.

Ascitic Fluid↗

PubMed2000

Influence of oxygen supply on heptadecane mineralization by Pseudomonas nautica.

The influence of different states of oxygen supply on heptadecane mineralization has been investigated in resting cell suspensions of Pseudomonas nautica. The rate of heptadecane biodegraded was constant for oxygen concentrations between 21% and 10% (v/v) (about 100% and 50% of air saturation, 230 and 110 microM, respectively). A decline in biodegradation rates occurred for oxygen concentrations below 10% (about 50% of air saturation, 110 microM) and biodegradation stopped with 0.21% oxygen (2.3 microM). In the presence of 1% (11 microM) of oxygen, no CO2 was produced, showing that complete mineralisation of heptadecane was blocked.

Alkanes↗

PubMed2000

[Orbital filling using a vascularized parietal bone graft: a case report of rehabilitation with an orbital graft of axial implants].

Orbital and intracranial complications of dental cellulitis are exceptional. The authors report such a case with orbital cellulitis and frontal abscess that dictated orbital exenteration with resection of the eyelids. Before realization of an implant supported epithesis, the orbit was filled with a prefabricated vascularized fascio-osseous parietal bone flap. This allowed placement of two extra-oral fixtures (Nobel biocare) in an antero-posterior axis. In some cases, preimplant orbital bone graft appears to be the only solution when implant placement in the orbital rim is impossible or contra-indicated. Indications, advantages and disadvantages of this technique will be discussed.

Adult↗

PubMed2000

Ethics and aims of cosmetic surgery: a contribution from an analysis of claims after minor damage.

MAIN OBJECTIVES: Cosmetic surgery raises the ethical problem of the balance of risks and benefits of an operation the benefit of which is psychological and difficult to evaluate. The aim of this study is to improve the understanding of the factors that influence an unsatisfactory outcome. In this context, we have analyzed complaints from patients the alleged damage to whom proved to be ultimately non-existent or minimal. METHODS: Review of the case notes of 20 patients who had sought damages through the French judicial system for minimal or non-existent alleged damage. Data were collected in 1999. FINDINGS: We found fifteen complaints of insufficient results, two for cause and effect relations with pathologies without any connection, and three for lack of information. 5 patients received compensation, the rest having been ruled out of court. The gender ratio (17 F/3 M), the average age (38 years old), the distribution of the operations and the socio-professional categories reflect the characteristics of a standard cosmetic surgery population. The average period of time between an operation and a complaint was 4.3 years (SD = 4.2). Among the medical histories we found two cases of depression, one treatment "for the nerves", one suicide attempt, and two cases of alcoholism without possible interpretation in the framework of this study. In six cases, the surgeon's qualification was not appropriate to the type of operation. The unprofessional conduct of colleagues had an influence on the effect of the procedure as an independent factor. CONCLUSION: These results call for more responsibility from professionals and encourage the undertaking of prospective complementary studies in order to evaluate more precisely the balance of risks and benefits.

Adult↗

PubMed2000

[Two new cases of cardiac papillary fibroelastoma with ischemic stroke].

A 22 and 25 year-old man were admitted to our emergency care unit for a stroke of the left superficial middle cerebral artery territory and vertebrobasilar infarction. Complete assessment of ischemic attack retained, in both cases, the presence of a valvular cardiac tumor. After heparin treatment, surgery confirmed the data provided by echocardiography. Histology confirmed the diagnosis of a papillary fibroelastoma. The diagnosis of cardiac tumors is based on transthoracic echocardiography and transesophageal echocardiography (TEE). High definition TEE allows localizing the tumor and determining its relationship with the contiguous anatomical structures. TEE is also a better guide for surgical procedure. Echocardiography is essential in the management of cerebral ischemic attacks in young patients.

Adult↗

PubMed1999

In-vitro study of interaction between photooxidation and biodegradation of 2-methylphenanthrene by Sphingomonas SP. 2MPII.

This work reports a study of interactions between reactions of photooxidation and reactions of bacterial degradation of an alkylated polyaromatic hydrocarbon (2-methylphenanthrene). Bacterial growth was carried out using artificial sunlight as light source. Among the various products detected, the major product was identified as the 2-methylphenanthrene aldehyde. Sunlight allows accelerated elimination of the substrate. This enhancement of the biodegradation rate of 2 methylphenanthrene is due to the use of assimilable photoproducts by the bacterium.

Aldehydes↗

PubMed1999

Cinegammography and 3-D emission tomoscintigraphy for evaluation of revascularized mandibular bone grafts: a preliminary report.

The following reports a study conducted to investigate a scintigraphic monitoring procedure for bone free flap in mandibular reconstruction. This procedure is based on the one hand, on vascular and bone cinegammography, and on the other hand, on vascular and bone 3-D tomoscintigraphy. We used a prospective cohort study design. All patients who underwent free flap mandibular reconstruction from April 1993 to April 1998 in the Salpêtrière University Hospital, France (20 cases) have been evaluated in relation to this scintigraphic procedure. Vascular and bone scintigraphy were performed within the second week after surgery during 2 consecutive days. All images were read by one author (J.- Y. B.), who did not know the skin status of the flap. The results were compared with the viability of revascularized bone grafts as evaluated by the skin status and Greenberg classification based on bone radiographs three months after reconstruction. Vascular cinegammography seems to be closely related to anastomosis patency. Bone cinegammography gives appreciable information on bone viability. 3-D vascular tomoscintigraphy remains difficult to interpret. 3-D bone tomoscintigraphy gives precise information on the viability of the different segments of the bone flap. These results suggest that vascular and bone 3-D tomoscintigraphy coupled with cinegammography have an excellent prognostic value. In the event of partial failure it can give information on the location of the impaired patency and on the osseous fragment which has lost any viability.

Adolescent↗

PubMed1999

Enhanced biodegradation of phenanthrene by a marine bacterium in presence of a synthetic surfactant.

The biodegradation of phenanthrene by the marine strain Sphingomonas sp. 2MPII (DSMZ 11572) was enhanced by the solubilizating properties of the nonionic surfactant Tween 80. After 197 h of incubation, 85 +/- 4% of the initial amount of phenanthrene (0.4 g l-1) was biodegraded in presence of Tween 80 (0.5 g l-1) as opposed to 52 +/- 5% without this synthetic surfactant. These results confirm that the activity of the strain 2MPII is limited by the bioavailability of the polycyclic aromatic hydrocarbon (PAH) substrate in the aqueous phase. Tween 80 appears to be efficient in increasing the bioavailability of hydrophobic compounds such as PAHs.

Biodegradation, Environmental↗

PubMed1999

High sensitivity and specificity of serum procalcitonin levels in adults with bacterial meningitis.

It was shown in children that serum procalcitonin was the best marker to use to differentiate bacterial from viral meningitis. To evaluate procalcitonin in the diagnosis of acute bacterial and viral meningitis, we conducted a prospective study including adult patients who were suspected of having meningitis and who were admitted to an emergency department. Cerebrospinal fluid (CSF) and serum levels of procalcitonin were measured in 105 consecutive patients. The diagnosis of meningitis was based on clinical findings, gram staining, culture, and chemical analysis of CSF. Twenty-three patients had bacterial meningitis, 57 had viral meningitis, and 25 did not have meningitis. Bacteriologic and chemical analysis of CSF did not allow correct differentiation of viral from bacterial meningitis. On the other hand, a serum procalcitonin level >0.2 ng/mL had a sensitivity and specificity of up to 100% in the diagnosis of bacterial meningitis. Serum procalcitonin levels seem to be the best marker in differentiating between bacterial and viral meningitis in adults.

Adolescent↗

PubMed1999

Does bicarbonate therapy improve the management of severe diabetic ketoacidosis?

OBJECTIVE: The use of bicarbonates in the treatment of severe diabetic ketoacidosis remains controversial, especially regarding the benefit/risk ratio. The aim of this study was to assess the efficacy of bicarbonate therapy during severe diabetic ketoacidosis (pH <7.10). DESIGN: Retrospective study. SETTING: The emergency unit of a teaching hospital. PATIENTS: The records of 39 patients consecutively admitted for severe diabetic ketoacidosis were analyzed (pH <7.10). The patients were divided into two groups: group 1 (n = 24; patients with bicarbonate treatment) and group 2 (n = 15; patients without bicarbonate treatment). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We compared two groups of patients presenting with severe diabetic ketoacidosis (pH values between 6.83 and 7.08) treated with or without bicarbonate. A group of 24 patients received 120+/-40 mmol sodium bicarbonate. The two groups were similar at admission with regard to clinical and biological parameters. No difference could be demonstrated between the two groups concerning the clinical parameters or the normalization time of biochemical parameters. If the number of patients with hypokalemia was comparable between the two groups, the potassium supply was significantly more important in group 1 compared with group 2 (366+/-74 mmol/L vs. 188+/-109 mmol/L, respectively; p < .001). CONCLUSIONS: Data from the literature and this study are not in favor of the use of bicarbonate in the treatment of diabetic ketoacidosis with pH values between 6.90 and 7.10.

Adult↗

PubMed1999

[Osteosynthesis of subcondylar fractures using compression screws with the Eckelt technic. Experiences and difficulties with the technic over 5 years].

With creation of new fixation material, the surgical treatment of displaced subcondylar fractures is most frequently used in adults. The Eckelt compression osteosynthesis is described as an easy procedure in the current literature, but, in our experience, several problems require our attention. We report the treatment of 57 patients with displaced subcondylar fractures where compression osteosynthesis was indicated. The difficulty of this technique is presented on the basis of a 5-years experience.

Adult↗

PubMed1999

[Eckelt's technic: an evaluation of the access route used at Salpêtrière Hospital].

AIM: We report a prospective study undertaken to investigate the morbidity connected with the approach of lag screw osteosynthesis for the treatment of subcondylar fractures in the department of Maxillo-Facial Surgery at the Salpêtrière University Hospital. METHOD: 24 patients have been operated between November 1997 and December 1998. We estimated the accessibility, the size and quality of scars the satisfaction index, and the complication rate. RESULTS: The average size of scars was 3 cm (2.5-4). Their quality was satisfactory, except for an hypertrophic and an invaginated one. The satisfaction index was always excellent and often superior to the surgeon one. COMPLICATIONS: three paresis in the mental territory of the facial nerve regressive in three months, a salivary fistula regressive in three weeks, an hematoma and a subcutaneous infection. These different criteria improved during the study. CONCLUSION: The approach is not free of risks but these ones seem to decrease with surgeon's experience.

Bone Screws↗

PubMed1999

[Post-traumatic enophthalmos. Physiopathologic considerations and current therapeutics].

The article is an overview of the available literature on post-traumatic enophthalmos (PTE). The PTE has a clinical definition and its diagnosis is based on a clinical examination. Fully assessment of the deformity requires complete ophthalmological examination and a measurement of the globe backward displacement by the mean of Hertel's ophthalmometer. Focusing on the pathophysiology, we insist on the role of periorbit and extraocular muscle retraction; nevertheless, according to most of the author's, opinion, the main pattern of the PTE seems to be the increased orbital post-traumatic volume, as it can be demonstrated by computed tomography (CT scan). In fact, thorough evaluation of the deformity needs at less a CT scan examination, providing horizontal and coronal slices. Sometimes, even a three-dimensional reconstruction can be obtained, helping the surgeon assessing the orbital deformity pre-operatively. We present five patients victims of a high-energy facial injury (motor vehicular accidents is responsible for an overwhelming majority of cases) leading to severe orbital lesions, and presenting a PTE as the main sequelae. We use homologous bone grafts to repair orbital fractures, especially calvarial bone. Osteotomy of the zygomatic bone (total or partial) can be proposed, combined with grafting of the orbit, to improve the correction of PTE. Most of all, patients with acute orbital trauma must be operated on as quick as possible: the sooner the surgery, the lower the probability for the PTE to occur.

Bone Transplantation↗

PubMed1999

[Halitosis in 1999].

Bad breath is a major concern to the general population and a source of an important profit industry world wide. Between 50 and 60 per cent of the population suffer from chronic halitosis. This can have consequences for private or professional life. Reasons can imply many specialities: ENT, gastro-enterology, pneumology, hepatology, genetics and psychiatry (a high percentage of the patients who come to the clinic with a primary complaint of halitosis do not have a detectable problem). Nevertheless, 85% are stomatological and are explained by the release of volatile sulfur compounds. These substances have a very offensive odor in very low concentrations. A specialized device called a halimeter is available to measure the volatile sulphur compounds in mouth air but in practice the objective assessment of malodor is still best performed by the organoleptic method. A careful examination can determine the patient's problem in most cases. Initial treatment strategy should focus on the exact cause and on oral hygiene. In addition to the usual recommendations, the daily use of tongue cleaners is very beneficial. Other than etiologic therapy, masking can be achieved by oral care products (mouth rinses, toothpastes, chewing gums) which contain metal ions, especially zinc, that inhibit odor formation because of its affinity to sulphur compounds.

Chelating Agents↗

PubMed1998

[Fatal voluntary poisoning with cibenzoline. Failure of conventional therapies].

BACKGROUND: Massive voluntary ingestion of cibenzoline causes major cardiotoxicity. We report on two cases where conventional treatments were ineffective. CASE REPORTS: Two patients were admitted to the intensive care unit of a University Hospital after massive voluntary intoxication with cibenzoline. Delay to admission after ingestion of cibenzoline was 1.5 and 4 hours. Circulatory impairment developed rapidly in both patients due to major atrioventricular and ventricular conduction disorders. Conventional intensive care procedures (sodium lactate and adrenaline) were performed but only provided temporary and incomplete efficacy. Outcome was fatal in both cases. DISCUSSION: The lethal potential of cibenzoline is very high. Extra-corporeal cardiocirculatory assistance might be an advisable measure if conventional therapy is unsuccessful. No clearly defined prognosis factors in cibenzoline intoxications have been reported.

Anti-Arrhythmia Agents↗

PubMed1998

Myositis ossificans progressiva: five generations where the disease was exclusively limited to the maxillofacial region. A case report.

Myositis ossificans progressiva is an unusual autosomal-dominant inherited disease characterized by congenital malformations and osseous metaplasia of the fascia of the muscles and connective tissue leading to ossification of the relevant area. The case report is remarkable in that eight members of the same family over five generations manifested the exclusive localization of the disease in the maxillofacial region.

Adult↗

PubMed1998

Mesenchymal chondrosarcoma of the jaws. Report of four cases.

Mesenchymal chondrosarcoma (MCS), described in 1959 by Lichtenstein & Bernstein, is a very rare malignant tumour. Only 46 cases have been previously reported in the jaws. Over a period of 30 years, four chondrosarcomas of mesenchymal type (of which one has already been published in 1987 with a three-month follow up) were treated in our department. Two patients have been followed for more than 17 years, of whom one has died of an intracranial extension and the other is still alive after surgical treatment of numerous recurrences and metastases. The two others are tumour-free with a follow up of 18 months and 11 years respectively. Histological, epidemiological and clinical features and treatment of MCS are discussed relevant to the data published in the literature.

Adolescent↗

PubMed1998

Infrahyoid myocutaneous flap in reconstructive maxillofacial cancer and trauma surgery.

We report the use of an island infrahyoid myocutaneous flap, pedicled on the superior thyroid vessels, in a group of 21 patients. This flap allows reconstruction of intraoral defects or defects of the lower portion of the face, as large as 10 x 4 cm. We used it in 15 cases to repair parts of the oral cavity, after tumour resection, in 2 patients with mandibular osteoradionecrosis and in 4 patients with gunshot injuries. Among the 21 flaps, no muscular necrosis was observed; however, 4 total necrosis and 4 partial necrosis (< or = 25% of the skin area) of the skin paddle were recorded. Loss of the skin paddle was primarily attributable to the anatomical variations of the veins draining this flap.

Adult↗