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Biomedical subjects

J Prudent

Publications and source records attributed to J Prudent.

At least 19 recordsLinked to original sources
PubMed2000

A high voltage electrical burn of lung parenchyma.

High voltage electrical trauma may cause severe visceral injuries. We report a case of direct electrical injury to the lung parenchyma, without evidence of any thoracic wall contact injury, in an electrician who sustained a 20 kV-electrical shock while working in a substation cubicle. The diagnosis of a true electrical burn of the left lower lobe was suggested early on by imaging and then confirmed by surgical exploration, histological findings and the significant improvement of the patient's condition following resection of the infarcted lobe. All possible causes of bronchial and pulmonary pathologies in such a context were ruled out. The fatal outcome of two previous similar cases and the generally high mortality of any electrical visceral injury support early surgical management as the only rational life-saving treatment. Current pathophysiological knowledge substantiates the theory of an isolated visceral injury located far away from the contact wounds. However, the pathogenesis of such severe injuries is not entirely understood.

Adult↗
PubMed1996

Blood vessel and lymphatic vessel invasion in resected nonsmall cell lung carcinoma. Correlation with TNM stage and disease free and overall survival.

BACKGROUND: The objective of this prospective study was to assess in 96 patients with resected nonsmall cell lung carcinoma (NSCLC) the prevalence of both blood and lymphatic vessel invasion (BVI and LVI) according to stage, as well as their prognostic value for disease free and overall survival. METHODS: BVI and LVI were evaluated by hematoxylin and eosin stains on surgical specimens after resection. Associations among variables were tested by Fisher's exact test or the chi-square test; prognostic values on time-failure data were analyzed by the log rank test and the multivariate Cox model. RESULTS: BVI was present in 52% of NSCLC cases and LVI in 59%. Venous but not arterial vascular invasion correlated with the T factor and pTNM, whereas LVI correlated with the N factor and pTNM. In univariate analysis, LVI but not BVI was associated with a short disease free interval (P = 0.0007) and poor survival (P = 0.0001). The estimated relative risk of death in patients with LVI was 3.2 compared with patients without LVI. In multivariate analysis, LVI and pTNM were additional predictors for poor disease free and overall survival. In this series, BVI had no prognostic value. CONCLUSIONS: The prevalence of BVI and LVI appeared high in patients with NSCLC, especially those with advanced pTNM stages. LVI was predictive of poor outcome, both time to recurrence and death.

Adenocarcinoma↗
PubMed1993

Increasing the chemical potential of the germ-line antibody repertoire.

To augment the chemical potential of the immunological repertoire, a metal ion-binding light chain has been introduced into the murine genome. Mice containing the transgene were subsequently immunized with a fluorescein conjugate. The transgenic light chain was found at a high frequency in the anti-fluorescein memory B-cell compartment. This general method should be applicable to other cofactors and small molecules and should lead to generation of antibodies with unique catalytic activities.

Animals↗
PubMed1992

Acquired von Willebrand disease: correction of hemostatic defect by high-dose intravenous immunoglobulins.

High-dose intravenous immunoglobulins (ivIG) were used in a 57-year-old patient with acquired von Willebrand disease in order to correct a hemostatic defect before pneumonectomy for lung carcinoma. IvIG induced a rapid and complete correction of factor VIII (F VIII) and von Willebrand factor (vWF) and allowed surgery without additional factor coverage. F VIII and vWF returned to baseline values within 10 days after ivIG.

Dose-Response Relationship, Drug↗
PubMed1991

[Wegener's granulomatosis. Therapeutic indications and follow-up course. Apropos of 5 cases].

Five cases of Wegener's granulomatosis treated with cyclophosphamide (CPM) and prednisolone are reported. Four of these patients received intermittent intravenous boluses of cyclophosphamide with the aim of improving the prognosis and renal function and at the same time to attenuate any haematological or vesical toxicity of CPM. The initial response to treatment by boluses of CPM was favourable in all cases but three patients presented with relapses, which were sometimes repeated and boluses of CPM did not enable a remission to be maintained at the time. Recourse to continuous oral therapy in place of bolus therapy proved viable for the maintenance of remission in two cases. The bladder and haematological tolerance to the bolus was satisfactory but an episode of severe neutropenia led to an adaptation of the dose of CPM. The intermittent administration above all the low cumulative dose of CPM obtained with the boluses will explain the better vesical and haematological tolerance observed depending on the capacity to maintain a prolonged remission. The indications for boluses of CPM in the treatment of Wegener's granulomatosis remain uncertain and do not seem to be totally without inconvenience.

Administration, Oral↗
PubMed1990

[Castleman's disease (giant lymph node hyperplasia): clinical, biological and developing polymorphism. Apropos of 4 cases].

Four cases of plasma cell type Castleman's disease (CD) are described. Two patients had localized forms (one mediastinal and the other mesenteric) and presented systemic manifestations associated with hypergammaglobulinemia and severe anemia. In both cases, the lesions were revealed by computerized tomography scans and cures were obtained by the complete surgical removal of the masses, which led to the rapid disappearance of the systemic manifestations. The other 2 patients had the multicentric form of CD and presented more extensive clinical and biological symptoms. One of these developed severe peripheral neuropathy and endocrine anomalies during the late phase of his disease, which led us to discuss the relationship between multicentric CD and the POEMS (polyneuropathy, organomegaly, endocrinopathy, M-protein, skin change) syndrome first described in Japan. Three of our patients presented with hypochromic microcytic anemia too severe to be explained by an inflammatory syndrome alone, and was likely due to several mechanisms. The etiology of CD remains unknown. The histological characteristics of angiofollicular lymph node hyperplasia are among the most important criteria for the diagnosis of localized and multicentric forms of CD, which can easily be made on a lymph node biopsy. However, it must be noted that this lesion can also be observed (but only rarely) in HIV (human immunodeficiency virus) - infected patients. The localized form is always considered to be benign, but, to date, there is no formal argument definitively supporting the malignancy of the multicentric one, in spite of its clinical similarity to a lymphoproliferative syndrome.

Adult↗
PubMed1990

[Fatal hemoptysis during bronchial aspergillosis with multiple pulmonary artery aneurysms].

Aspergillosis with fatal outcome are usually pulmonary invasive aspergillosis with or without dissemination, developed in patients with severe immunosuppression. We report a fatal case of bronchial necrotizing aspergillosis in a young woman with diabetes mellitus, who developed similar lesions to "Semi-invasive Aspergillosis", so-called "Chronic Necrotizing Pulmonary Aspergillosis". This aspergillosis was complicated by large pulmonary artery aneurysms requiring an hemostatic lobectomy. These aneurysms, secondary to the bronchial lesions, contrast with infectious aneurysms (so-called mycotic) secondary to septic embols. They differ from Rasmussen's aneurysms, due to tuberculosis, by their size, fusiform shape and extent. Lesions of vessels' walls and parietal fungal invasion in the vicinity of an endo-bronchial aspergilloma explain the vascular rupture. The multiplicity of these aneurysms, showed on C T Scan, is responsible for death by post-surgical recurrence of hemoptysis.

Adult↗
PubMed1989

Observations of colloidal gold labelled platelet microtubules: high voltage electron microscopy and low voltage-high resolution scanning electron microscopy.

18 nm colloidal gold-antitubulin and 4 nm colloidal gold-antitubulin were used to label microtubules in adherent, fully spread platelets. Both sizes of marker effectively labelled microtubules in the partially extracted platelets. However only the 4 nm gold penetrated the dense microfilament matrix of the inner filamentous zone so that portions of microtubules within this cytoskeletal zone could be tracked. The gold marker could be visualized well with 1 MeV high voltage transmission EM and with 5 kV or greater secondary imaging or 20 kV backscattered imaging of carbon only coated samples. 1 kV secondary imaging permitted high resolution imaging of the surface of tubules and the microfilaments with their respective associated material. Individual gold-antibody complexes were difficult to identify by shape alone due to the tendency of the antibody coats to blend together when in very close approximation and due to the presence of other molecules or molecular aggregates similar in size to the gold-antibody labels. Microtubules were seen to wind in and out of the inner and outer filamentous zones as they encircled the granulomere. Some tubules were seen to "dead end" at the peripheral web. Numerous smaller microtubule loops were present principally in the outer filamentous zone and tubules could be followed as they went from the outer filamentous zone through the inner filamentous zone and into the granulomere.

Blood Platelets↗
PubMed1986

[Postoperative analgesia with thoracic peridural morphine in pulmonary surgery. 117 cases].

Post-operative analgesia by peridural injection of morphine in the thoracic spine was evaluated in a series of 117 successive patients with pulmonary pathology operated upon by the same surgeon. The catheters were introduced, either on the day preceding the operation or at the end of it, above or below T6-T7, after localization of the peridural space by the hanging drop technique or by loss of resistance to a liquid mandrel; 5 mg of preservative-free morphine diluted in 3 ml isotonic saline were injected. The catheter was left in situ for 3 days, then systematically removed and cultivated. Analgesia was considered excellent in 66.7% of the cases, good in 26.5% and insufficient or non-existent in 6.8%. Each dose was effective for 15 hours on average. The mean total dose administered was 18.2 mg and did not exceed 40 mg during the first three post-operative days. There was no respiratory depression requiring naloxone or mechanical ventilation. Urinary retention occurred in 62% of the patients and troublesome pruritus in 0.3%. No death attributable to the method and no neurological or infectious complication was noted. There was no problem in removing the catheter, and no redness, pain or haematoma was observed at the site of injection. In view of the potential risk of insidious and delayed respiratory depression, the patients must be closely supervised specialized by staff. This technique must not be used unless the conditions required are fulfilled.

Adult↗
PubMed1986

[Thoracic actinomycoses. General illustrated review of 4 surgical cases].

Actinomycosis of the lung is rare and difficult to diagnose. Its good prognosis after medical treatment contrasts with the high frequency of surgical excision, due to the fact that pre-operative diagnosis is exceptional. Following a review of the recent bacteriological, radiological and therapeutic data available in the literature, 4 personal cases are presented. In all 4 cases actinomycosis was diagnosed post-operatively on the presence of yellow grains in the histological specimens. In 2 cases surgical excision proved impossible, but an almost complete radiological recovery could be obtained after prolonged treatment with co-trimoxazole. This shows how important it is to be aware of the disease, to improve its diagnostic approach and to remember its sensitivity to antibacterial agents, even in well organized forms.

Actinomycetales Infections↗