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Biomedical subjects

J Pascal

Publications and source records attributed to J Pascal.

At least 19 recordsLinked to original sources
PubMed2006

Patient-controlled cervical epidural fentanyl compared with patient-controlled i.v. fentanyl for pain after pharyngolaryngeal surgery.

BACKGROUND: Analgesia after pharyngolaryngeal surgery is commonly provided through the i.v. route. The aim of the study was to compare cervical epidural administration of fentanyl with the i.v. route for postoperative analgesia after pharyngolaryngeal surgery. METHODS: In a randomized double-blind study 42 patients received fentanyl via patient-controlled analgesia (PCA) either through the i.v. route (PCA-IV group, n=22) or through the cervical epidural route (PCA-Epid group, n=20). Identical PCA settings were used in the two groups (bolus dose: 1.5 microg kg(-1), bolus: 25 microg, lockout interval: 10 min, maximum cumulative dose: 400 microg per 4 h). Analgesia at rest and during swallowing was evaluated using a visual analogue scale. RESULTS: Analgesia at rest was better in the PCA-Epid group than in the PCA-IV group but only 2 and 6 h after surgery (P<0.02). There was no difference in analgesia during swallowing. Cumulative doses of fentanyl were similar {PCA-Epid group: 1412 microg (912), PCA-IV group: 1287 microg (1200) [median (IQR)]}. The Pa(o(2)) showed a significant decrease between the preoperative and postoperative period, but this decrease was identical in the two groups [PCA-IV-group: 11.47 (2.4) kPa vs 8.27 (0.9) kPa; PCA-Epid group: 11.33 (1.9) kPa vs 9.20 (2.4) kPa for preoperative and postoperative period respectively]. CONCLUSIONS: The study results show that cervical epidural analgesia provides marginally better pain relief at rest with no decrease in the fentanyl consumption. The use of the cervical epidural administration of fentanyl is questionable because of the possible complications of the technique.

Adult↗
PubMed2005

[Epidemiological survey of a suspected nosocomial case of tuberculosis by spoligotyping].

Transmission of tuberculosis within hospitals has been increasingly recognized as a hazard for patients and health care workers. A case of pulmonary tuberculosis was detected in September 2003 in a nursing auxiliary working at Avicenne's Hospital. This 49 year-old woman was considered infected since April 2003. During this 6 months period, she worked in 23 distinct hospital units and could have contaminated patients and hospital staffs. The epidemiological survey was comprised for 1735 individuals (701 hospital staffs and 1034 patients). It encompassed clinical, para-clinical investigations and bacteriological investigations. Furthermore, between January 2003 and September 2004, a systematic comparison of 62 Mycobacterium tuberculosis strains isolated in the hospital was conducted by spoligotyping, a molecular typing method in order to access an eventual transmission. The nursing auxiliary's strain clearly showed a distinct spoligotype from the other investigated strains. This spoligotype was unique in the international spoligotype database. In this large epidemiological survey of a case of suspected nosocomial of tuberculosis, spoligotyping appeared as an interesting, easy and rapid method of molecular typing. It allowed to demonstrate that the nursing auxiliary tuberculosis case was unrelated to the others cases of tuberculosis diagnosed in the hospital during this period.

Bacterial Typing Techniques↗
PubMed2005

[Social vulnerability of out-patients consulting the dentistry service of a public hospital].

There are social inequalities in oral and dental health. It can be useful to identify people in socially vulnerable or marginalised situations because they require a particular kind of care. Through a survey of patients in a dentistry services in a public hospital, we sought to identify those people in a precarious socio-economic situation by the use of a tool designed and validated by multi-disciplinary experts. The tool includes five criteria, and is presented in the format of an index card which is filled in by the patient upon his arrival. This data collection was carried out in two distinctly separate period of time (winter and summer). 865 cards were collected, and the rate of collection of complete data was 73%. 94% of the cards allowed us to determine the socio-economic status of the patient, and 48% (n=382) of them were classified as having a socially vulnerable situation. Among them, 69% of them benefited from CMU or AME, and 59% of them do not have any supplementary health insurance. 47% of them admit to having difficulties in paying for their medications or covering the cost of their medical consultations, and 48% perceive a social service aide. The prevalence of social vulnerability of the dental centre's patients is estimated at 32%. This data collection tool has made it possible to measure the significance and the nature of the social vulnerability of the patients who receive care and services from this public hospital's dentistry unit. Its capacity to identify patients whose care needs are often not met remains to be seen, as well as the capacity of the hospital to make up for these lost opportunities thus remains to be highlighted.

Dental Care↗
PubMed2003

[Facial anesthetic blocks in the treatment of acute pain during ophthalmic zoster].

BACKGROUND: Ophthalmic zoster is frequently accompanied by severe pain in the frontal and nasal divisions of the ophthalmic nerve. Treating this pain is often difficult, particularly in elderly patients, owing to iatrogenic effects and to interactions with the pre-existing diseases and treatments frequently present in this age group. The aim of our study was to consider the efficacy and toxicity of the frontal and nasal nerve blocks in the treatment of severe pain during acute ophthalmic zoster in the elderly. MATERIAL AND METHODS: A prospective study was conducted on 20 patients (mean age, 76 +/-7 years; range, 63-88) presenting with acute ophthalmic zoster with severe pain (less than 1 month since onset), which had resisted analgesic medication. All patients had a visual analogue score for pain (VAS) of 4 or more and received one or more anesthetic blocks of a compound of bupivacaine with adrenaline associated with clonidine at the frontal branch and sometimes the nasal branch levels of the ophthalmic nerve. Pain was measured daily by VAS for 5 days, and the blocks were repeated if the VAS was still 4 or higher. Patients were checked for local or systemic side effects. RESULTS: The number of anesthetic blocks per patient ranged from one to four (mean: 2.3 +/-0.7). All patients experienced less pain after the first injection. The mean preinjection VAS was 7.4 +/-1 and fell to 4.8 +/-1.0, 4.1 +/-1.1, 3.5 +/-1.0, 3.2 +/-0.6 and 2.8 +/-0.9 at day 1, day 2, day 3, day 4 and day 5, respectively (p<0.001). It was possible to reduce analgesic medication permanently in all patients. No local or systemic side effect was observed. CONCLUSION: Anesthetic blocks of the frontal and nasal branches, repeated if necessary, give fast and effective relief from the severe pain of acute ophthalmic zoster. They are fully tolerated and simple to administer, making them an excellent indication in the complementary treatment of the pain of hyperalgic acute zoster in the elderly.

Acute Disease↗
PubMed2000

Minimal peptide length requirements for CD4(+) T cell clones--implications for molecular mimicry and T cell survival.

CD4(+) T lymphocytes usually recognize peptides of 12-16 amino acids in the context of HLA class II molecules. We have recently used synthetic peptide combinatorial libraries to dissect in detail antigen recognition by autoreactive CD4(+) T cell clones (TCC). The results of these studies demonstrated that antigen recognition by T cells is highly degenerate and that many cross-reactive ligands can be defined, some of which much more potent than the selecting autoantigen. Based on these observations, we examined the response of a myelin basic protein-specific HLA class II-restricted CD4(+) TCC to truncation variants of optimal ligands. Surprisingly, pentapeptides, tetrapeptides and even tripeptides derived from different segments of the optimal ligands were recognized by the TCC, and some were even more potent than the selecting autoantigen. In addition, these peptides enhanced the survival of the TCC at low concentration. The relevance of this finding was supported by the generation of pentapeptide-specific CD4(+) TCC from peripheral blood lymphocytes. These observations not only change existing views on the length requirements for activation of CD4(+) HLA class II-restricted T cells, but also extend our knowledge about the flexibility of TCR recognition and the potential for cross-reactivity in the immune system.

Antigen Presentation↗
PubMed2000

[Difficulties with the implementation and institutional stakes in the continuing education of private physicians].

The Formation Medical Continue (FMC) is a continuing education programme for private practice doctors (generalists and specialists), and was established in the legislation of April 1996. In analysing the stages of the policy's introduction, an attempt was made to understand the difficulties encountered in its implementation. Using a semi-directive questionnaire, the opinions concerning the policy were collected from the different actors in the process: professionals, social welfare organisations, government agencies and health organisations. The analysis of their perceptions was complemented by an analysis of historical data and a review of the literature. The greatest difficulties with implementation related to the interactions among the stakeholders: the "game" of the medical unions, among themselves and with social security and government agencies; the under-representation of the medical profession, exacerbated by its divisions and the split between generalists and specialists; the indecision of government agencies, leaving the stakeholders waiting; the "game" of the social security funds, which act as if the principle of "mutualisation" of FMC funds can be by-passed. Conflicts of interest regarding the FMC have "crystallised" among the different stakeholders, as well as within the medical corpus. These conflicts relate in particular to the creation of the memorandum agreement and to the definition of the relationship with the pharmaceutical industry.

Attitude of Health Personnel↗
PubMed2000

[Critical analysis of health priorities determination in France].

Since the mid 1970's, reforms to the health care system were aimed at controlling expenditures. Furthermore, there was not much of a relationship between public health policies and expenditure control policies. The reforms of 1996 aimed to introduce a new paradigm. The French health care system, based until then upon the biomedical model, now must adopt public health tools: Definition of health objectives; Development of priorities; Evaluation; Allocation of resources based on needs; Public debates. The objective of this study is to evaluate the move toward defining priorities, three years after the introduction of this reform. The study focused on the type of priorities implemented (e.g. implicit or explicit priorities, access to health care services, or severity of health problems) and their links to the allocation of resources; and the practical development of priorities (e.g. political or technocratic procedure, the role of public debates). In France, priorities are defined by health problem and not by service. They are explicit, but the link to allocation of resources isn't clear. Despite a wide consultation, the system of defining priorities is more technocratic than political. Moreover, the system is more concerned with including health professionals (doctors, administrators) in this new approach to public health, than with taking public opinion into account.

Cost Control↗
PubMed1999

Preferential expansion of autoreactive T lymphocytes from the memory T-cell pool by IL-7.

We have developed a new technique that allows us to quantify antigen-specific T cells, and to determine their functional phenotype and origin from naive versus memory populations. Using this methodology, we have characterized a total of 286 T-cell lines specific for myelin basic protein (MBP) and influenza hemagglutinin from 16 multiple sclerosis (MS) patients and nine healthy donors. Our data support the notion that MBP-specific T cells undergo in vivo activation in MS patients and indicate a presence of immune dysregulation that renders MS patients prone to develop autoimmunity. Our methodology offers a way to study antigen-specific T-cell characteristics as a surrogate marker in immunotherapy trials.

Adult↗
PubMed1999

Identification of candidate T-cell epitopes and molecular mimics in chronic Lyme disease.

Elucidating the cellular immune response to infectious agents is a prerequisite for understanding disease pathogenesis and designing effective vaccines. In the identification of microbial T-cell epitopes, the availability of purified or recombinant bacterial proteins has been a chief limiting factor. In chronic infectious diseases such as Lyme disease, immune-mediated damage may add to the effects of direct infection by means of molecular mimicry to tissue autoantigens. Here, we describe a new method to effectively identify both microbial epitopes and candidate autoantigens. The approach combines data acquisition by positional scanning peptide combinatorial libraries and biometric data analysis by generation of scoring matrices. In a patient with chronic neuroborreliosis, we show that this strategy leads to the identification of potentially relevant T-cell targets derived from both Borrelia burgdorferi and the host. We also found that the antigen specificity of a single T-cell clone can be degenerate and yet the clone can preferentially recognize different peptides derived from the same organism, thus demonstrating that flexibility in T-cell recognition does not preclude specificity. This approach has potential applications in the identification of ligands in infectious diseases, tumors and autoimmune diseases.

Adult↗
PubMed1999

[The definition of acoustic impedance and its application to the human hearing organ].

Acoustic impedance measurement at the point of entry into the external auditory meatus provides a rapid means to detect malfunctions of the middle ear in the region of the tympanic membrane, without having recourse to perforating the tympanic membrane. In this article we define acoustic impedance and provide a brief reminder of its physical properties. In the last part, we review the possibilities offered by measurement of the impedance to acoustic stimuli, not only for clinical diagnosis, but also in the understanding ot the physical phenomena occurring within the hearing organ.

Acoustic Impedance Tests↗
PubMed1998

Environment- and sequence-dependent modulation of the double-stranded to single-stranded conformational transition of gramicidin A in membranes.

The role of the membrane lipid composition and the individual Trp residues in the conformational rearrangement of gramicidin A along the folding pathway to its channel conformation has been examined in phospholipid bilayers by means of previously described size-exclusion high-performance liquid chromatography HPLC-based strategy (Bañó et al. (1991) Biochemistry 30, 886). It has been demonstrated that the chemical composition of the membrane influences the transition rate of the peptide rearrangement from double-stranded dimers to beta-helical monomers. The chemical modification of Trp residues, or its substitution by the more hydrophobic residues phenylalanine or naphthylalanine, stabilized the double-stranded dimer conformation in model membranes. This effect was more notable as the number of Trp-substituted residues increased (tetra > tri > di > mono), and it was also influenced by the specific position of the substituted amino acid residue in the sequence, in the order Trp-9 approximately Trp-13 > Trp-11 > Trp-15. Moreover, it was verified that nearly a full contingent of indoles (Trp-13, -11, and -9) is necessary to induce a quantitative conversion from double-stranded dimers to single-stranded monomers, although Trp-9 and Trp-13 seemed to be key residues for the stabilization of the beta-helical monomeric conformation of gramicidin A. The conformation adopted for monomeric Trp --> Phe substitution analogues in lipid vesicles resulted in CD spectra similar to the typical single-stranded beta6.3-helical conformation of gramicidin A. However, the Trp --> Phe substitution analogues showed decreased antibiotic activity as the number of Trp decreased.

Amino Acid Sequence↗
PubMed1998

The use of soluble synthetic peptide combinatorial libraries to determine antigen recognition of T cells.

T cells identify by their T-cell receptor (TCR) short peptides in the context of major histocompatibility complex (MHC) molecules. The interaction of the trimolecular complex composed of the TCR and MHC bound peptide was extensively studied using substitution analogs of the original peptide ligands to define those residues important for T-cell recognition in the peptide chain. This approach has led to the observation that T-cell recognition is highly flexible and that many different peptides can be recognized by an individual TCR. Others and we have recently introduced synthetic peptide combinatorial libraries (SCL) to investigate T-cell recognition. Here we review the SCL-based approaches and describe our current techniques for mapping TCR motifs for CD4+ T cells. The implications of our findings for the understanding of T-cell recognition, as well as for future applications to study T-cell responses in infectious diseases, autoimmune disorders and cancer are discussed.

Amino Acid Sequence↗
PubMed1998

Linear and nonlinear model of the human middle ear.

The measurement of the middle ear transfer function usually requires invasive methods. An equivalent analog equivalent model enables us to evaluate its characteristics without damaging any part of the ear. A linear and a nonlinear model of the middle ear have been developed to predict intracochlear pressure and the stapes volume velocity for various sound pressure levels (SPL). The linear model results have been compared with human eardrum impedance and middle ear transfer function data. The nonlinear phenomena due to the contraction of the stapedius muscle over 80 dB and to the stapes clipping displacement above 120 dB are represented by a set of variable electrical components. The model of the acoustic reflex is based on experimental observations. The study of the annular ligament behavior was performed on cats and extrapolated to humans with some hypothetical restrictions. These approximations provide information on the middle ear transfer function and enable us to better understand the nonlinear middle ear mechanisms in an intense acoustic field.

Ear, Middle↗
PubMed1996

[Cerebral chromoblastomycosis. Apropos of a case. Review of the literature].

We present a case of brain abscess caused by Cladosporium trichoides which reappeared fifteen months later, in spite of a surgical procedure and antifungal chemotherapy. The importance of a complete neurosurgical resection of the lesion which determines the prognosis is emphasized. Based on amphotericine B, flucytosine, and itraconazole, the antifungal treatment is not fully standardized. Regular clinical and CT scan controls are necessary because of frequent recurrence.

Brain Abscess↗
PubMed1992

AIDS outreach workers: an exploratory study of job satisfactions/dissatisfactions.

AIDS outreach workers operate at the frontlines of the AIDS epidemic to provide information and education to high-risk individuals. Recent reports indicate that these workers have been effective in helping to reduce high-risk behaviors. However, a review of retention data for 62 outreach workers employed from 1986 to 1988 at a private nonprofit research institute indicated a high rate of turnover, especially among males. The literature provides little information regarding the demographic characteristics of outreach workers and their sources of job satisfaction and dissatisfaction. This exploratory investigation was undertaken to address these topics. Structured interviews were conducted with 20 currently active outreach workers. Results indicate that altruistic motives were most frequently cited as reasons why people became outreach workers and also provided the primary source of satisfaction. Stress was most frequently mentioned as a source of dissatisfaction and also as a reason previous workers had left outreach work. Conclusions focus on the outreach workers' suggestions for job improvements. These included: improvement in the terms of employment (e.g., salary, benefits); more education and training opportunities; and more support groups or help with recovery.

Acquired Immunodeficiency Syndrome↗