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Biomedical subjects

L Foubert

Publications and source records attributed to L Foubert.

At least 37 records · Page 2Linked to original sources
PubMed1997

A study of mixing conditions during nitric oxide administration using simultaneous fast response chemiluminescence and capnography.

We have evaluated the mixing properties of nitric oxide in inspired gases for five different administration techniques. Nitric oxide and carbon dioxide were delivered to the ventilator system before the ventilator or after the ventilator as a continuous flow, either directly into the inspiratory limb or into a mixing chamber positioned in the inspiratory limb. Both gases were delivered as above but synchronized with inspiration. Mixing conditions were evaluated using fast response chemiluminescence for nitric oxide and capnography for carbon dioxide analysis. Administration of nitric oxide and carbon dioxide directly into the inspiratory limb as a continuous flow or with a magnetic valve-controlled synchronized flow resulted in peak concentrations of 236% and 220%, respectively, of expected values. The use of a mixing chamber reduced these values to 104% and 102%, respectively. Administration of nitric oxide as a continuous flow into the tubing of an intermittent flow ventilator resulted in highly fluctuating inspiratory peak concentrations, which could be avoided with a mixing chamber.

Capnography↗
PubMed1997

Assessment of French patients with LPL deficiency for French Canadian mutations.

Mutations in the LPL gene show high levels of allelic heterogeneity between and within different populations. Complete LPL deficiency has a very high prevalence in French Canadians, where only three missense mutations account for > 97% of cases, most consistent with founder mutations introduced early in Quebec by French immigrants. In order to determine whether these mutations were present in France, 12 unrelated French families with defined LPL deficiency were investigated for the presence of the mutations found in French Canadians. Of the 24 expected alleles, six (25%) represented mutations in French Canadians (Gly188Glu four alleles, Asp250Asn and Pro207Leu one allele each). Comparison of French Canadian and French alleles identified the same haplotype in all carriers of the Gly188Glu and of the Asp250Asn, suggesting a common origin. In contrast, the Pro207Leu occurred on different haplotypes in France and Quebec, compatible with a different ancestral origin.

Alleles↗
PubMed1997

[Lipid risk factors of atherosclerosis: who, when, how to treat?].

Hyperlipidemia, particularly hypercholesterolemia, is a well established risk factor for cardiovascular disease, specially coronary heart disease. Lipid-lowering therapies are associated with a reduction in cardiovascular morbidity and mortality in secondary as well as primary prevention. A precise lipid pattern is necessary before any treatment. The target level depends on the clinical data and associated cardiovascular risk factors. Diet is the first step approach and should always be continued. Cholestyramine and statins are the treatments of choice in case of hypercholesterolemia (type IIa). In case of isolated or associated hypertriglyceridemia (types IV and IIb) fibrates are the most efficient. No treatment is really efficient on Lp(a) level. A good observance is required for a lifelong treatment.

Child↗
PubMed1996

Premature atherosclerosis in patients with familial chylomicronemia caused by mutations in the lipoprotein lipase gene.

BACKGROUND: Patients with lipoprotein lipase deficiency usually present with chylomicronemia in childhood. The syndrome has been considered nonatherogenic primarily because of the low levels of low-density lipoprotein (LDL) cholesterol. We prospectively evaluated patients with lipoprotein lipase deficiency for atherosclerosis. METHODS: Evidence of carotid, peripheral, and coronary atherosclerosis was sought in four patients (two men and two women) with the phenotype of familial chylomicronemia by clinical examination over a period of 14 to 30 years and by Doppler ultrasonography, B-mode ultrasonography [corrected], and exercise-tolerance testing after the age of 40. Angiography was performed when indicated. Lipoprotein lipase deficiency was assessed in vivo and in vitro by functional assays and DNA-sequence analysis. RESULTS: All four patients had a profound functional deficiency of lipoprotein lipase with a reduced enzymatic mass due to missense mutations on both alleles of the lipoprotein lipase gene. In all four patients, peripheral or coronary atherosclerosis (or both) was observed before the age of 55. Despite following a low-fat diet in which fat composed 10 to 15 percent of the daily caloric intake, the patients had hypertriglyceridemia (mean [+/- SD] triglyceride level, 2621 +/- 1112 mg per deciliter [29.59 +/- 12.55 mmol per liter]), low plasma levels of high-density lipoprotein cholesterol (17 +/- 7 mg per deciliter [0.43 +/- 0.18 mmol per liter]), and very low levels of LDL cholesterol (28 +/- 16 mg per deciliter [0.72 +/- 0.41 mmol per liter]). Three patients had one risk factor for atherosclerosis, whereas in one male patient, heavy smoking and diabetes were associated with an accelerated course of the disease. CONCLUSIONS: Premature atherosclerosis can occur in patients with familiar chylomicronemia as a result of mutations in the lipoprotein lipase gene. Defective lipolysis may increase susceptibility to atherosclerosis in humans.

Aged↗
PubMed1996

[Lipoprotein lipase: a multifunctional enzyme in lipoprotein metabolism].

Lipoprotein lipase (LPL) is a rate-limiting enzyme for the hydrolysis of triglycerides. Recently new insights into non-enzymatic functions have emerged. Complete lipoprotein lipase deficiency associated with chylomicronemia is an uncommon (1/10(6) in the general population) autosomal recessive disorder caused by many different lipoprotein lipase gene mutations and is characterized by high fasting plasma triglyceride levels, that can be complicated with acute pancreatitis. To date, about sixty gene mutations have been described throughout the world. Conversely to the homozygous state, the heterozygous state predisposes to a lipid profile that may be atherogenic evenly frequent (approximately 1/500) in the general population. These new clinical and biological insights reinforce the multifunctional role of lipoprotein lipase.

Acute Disease↗
PubMed1996

Impact of oxygenator design on hemolysis, shear stress, and white blood cell and platelet counts.

OBJECTIVE: To determine whether relative pressure drop, shear stress, hemolysis, and white blood cell and platelet counts are influenced by different oxygenator designs. To compare the oxygenator results with the average shear stress over an arterial cannula. DESIGN: Prospective; patients enrolled consecutively. SETTING: University hospital. PARTICIPANTS: Three groups of 12 adults patients, scheduled for routine cardiac surgery. INTERVENTIONS: Each group was submitted to a different oxygenator design: group 1 to a high-pressure hollow-fiber membrane oxygenator (Sarns Turbo); group 2 to a medium-pressure hollow-fiber membrane oxygenator (Cobe optima); and group 3 to a flat-sheet membrane oxygenator (Cobe Duo). MEASUREMENTS AND MAIN RESULTS: Although the investigated oxygenators have important differences in pressure drop and shear stress, no statistical differences were found in hemolysis generation or blood handling among the different groups. Actually, the study shows much higher shear stress levels over an average arterial cannula than over any of the evaluated oxygenators. CONCLUSIONS: The pressure drop over an oxygenator does not correlate well with shear stress and hemolysis because the dimensions of the system (radius and length) must be included in the calculation of shear stress from pressure drop.

Adult↗
PubMed1996

Extraction of nitric oxide and nitrogen dioxide from an oxygen carrier using molecular sieve 5A.

Nitric oxide (NO) is effective in the management of pulmonary hypertension and shunt-related hypoxia. Nitrogen dioxide (NO2) is formed when the gas is delivered with oxygen. Both oxides of nitrogen have well recognized adverse effects. The scavenging properties of several forms of soda lime have been investigated. A gas flow containing NO 70 ppm and NO2 5 ppm in oxygen was introduced into a vertically mounted Waters' canister containing: (i) 125 g of molecular sieve 5A (a calcium aluminosilicate zeolite) and (ii) 135 g of soda lime containing a potassium permanganate marker. NO and NO2 concentrations were measured at hourly intervals at the entry and exit points using an electrochemical analyser. Extraction ratios (gradient/ inlet x 100) were calculated for a 24-h period. High extraction ratios (in excess of 90%) of NO and NO2 were observed with both compounds for up to 1 h but these declined rapidly after this time with soda lime. In contrast, the molecular sieve produced extraction ratios in excess of 98% for both gases over the 24-h period. We conclude that the molecular seive 5A is a highly effective scavenger of NO and NO2.

Absorption↗
PubMed1996

Effect of the inhalation of nitric oxide on 5-hydroxytryptamine-induced pulmonary hypertension in calves.

In healthy anaesthetized Friesian-Holstein calves, pulmonary hypertension was induced by means of a continuous intravenous administration of serotonin (0.025 mg/kg body/weight/min). Afterwards, the anaesthetized calves inhaled 40 and 80 ppm of nitric oxide using an open system. The influences of the administration of serotonin and the inhalation of nitric oxide on the haemodynamic and blood gas parameters were investigated. The inhalation of 40 and 80 ppm of nitric oxide during serotonin-induced pulmonary hypertension in calves resulted in a significant fall of the mean pulmonary artery pressure. The inhalation of nitric oxide also induced an amelioration of intrapulmonary oxygen transport. The intravenous administration of serotonin in calves resulted in severe systemic hypotension. Hence, the influence of the inhalation of nitric oxide on the systemic arterial pressure could not be evaluated.

Administration, Inhalation↗
PubMed1996

Low extracorporeal priming volumes for infants: a benefit?

An extracorporeal circuit consisting of an oxygenator especially designed for neonatal use and appropriately sized tubing, with an average total priming volume of 205 ml, was used on 80 infants undergoing cardiac surgery for congenital heart-disease. The priming volume and foreign surface area of the circuit were determined. The influence of low priming volumes on the use of blood products and the management of cardiopulmonary bypass was studied. No whole blood or platelets were used in this study. The mean volume of packed red blood cells used over the hospital stay was 202 +/- 67 ml. The mean volume of fresh frozen plasma (FFP) used until the second postoperative day was 62 +/- 72 ml. The mean total blood loss until the second postoperative day was 15.8 +/- 9.2 ml/kg. The priming volume of the extracorporeal circuit was 62% lower than values commonly reported in the literature. The low priming volume had a strong influence on the use of platelets and FFP and to a lesser extent on the use of packed red blood cells.

Cardiac Surgical Procedures↗
PubMed1996

Complete paternal isodisomy for chromosome 8 unmasked by lipoprotein lipase deficiency.

Uniparental disomy (UPD)-the inheritance of two homologous chromosomes from a single parent-may be unmasked in humans by the unexpected appearance of developmental abnormalities, genetic disorders resulting from genomic imprinting, or recessive traits. Here we report a female patient with familial chylomicronemia resulting from complete lipoprotein-lipase (LPL) deficiency due to homozygosity for a frameshift mutation in exon 2 of the LPL gene. She was the normal term product of an unremarkable pregnancy and had shown normal development until her current age of 5.5 years. The father (age 33 years) and the mother (age 24 years) were unrelated and healthy, with no family history of stillbirths or malformations. The father was a heterozygous carrier of the mutation, whereas no mutation in the LPL gene was detected in the mother. Southern blotting did not reveal any LPL gene rearrangement in the proband or her parents. The proband was homozygous for 17 informative markers spanning both arms of chromosome 8 and specifically for the haplotype containing the paternally derived LPL gene. This shows that homozygosity for the defective mutation in the LPL gene resulted from a complete paternal isodisomy for chromosome 8. This is the first report of UPD for chromosome 8 unmasked by LPL deficiency and suggests that normal development can occur with two paternally derived copies of human chromosome 8.

Adult↗
PubMed1996

[Chemodectoma secreting carotid glomus: characteristics and contribution of magnetic resonance imaging. Apropos of 2 cases].

Two cases of carotid glomus chemodectomas with production of catecholamines are reported. The place of chemodectomas among the neuroendocrine tumors called paragangliomas is recalled. Chemodectomas only very infrequently produce catecholamines (1 to 10%). Magnetic resonance imaging is superior to computerized tomography and metaiodobeuzylguanidine scintigraphy in the detection and the characterization of adrenal and extra-adrenal functioning paragangliomas of the orthosympathic system. Few data are available for the imaging of functioning parasympathetic paragangliomas (chemodectomas). The two case reports illustrate the contribution of the magnetic resonance imaging in the detection and the characterization of chemodectomas.

Adult↗
PubMed1995

Comparative study of limited intentional normovolaemic haemodilution in patients with left main coronary artery stenosis.

Intentional normovolaemic haemodilution is a blood saving technique which can be performed when major blood loss is expected. Severe coronary artery disease and particularly left main stenosis are considered a contraindication for intentional normovolaemic haemodilution. The effects and complications of limited intentional normovolaemic haemodilution in patients with left main coronary artery stenosis scheduled for coronary artery bypass grafting were evaluated. Patients were randomly allocated to two groups: group A (n = 15) underwent limited intentional normovolaemic haemodilution to a haematocrit of 34%; group B (n = 15), no intentional normovolaemic haemodilution was performed. In both groups succinyl-linked gelatin was used to maintain normovolaemia. Haemodynamic parameters were kept as constant as possible. In group A, a mean (SD) volume of 785 (250) ml of blood was withdrawn [range 500-1200 ml]. ST segment changes occurred on the ECG in three patients in each group. There were no statistically significant differences for frequency, maximum deflection and duration of ST-segment changes. Limited intentional normovolaemic haemodilution can be performed safely in patients with left main coronary artery stenosis. In this study it was not associated with increased frequency, severity or duration of ST-segment changes, or with arrhythmias or haemodynamic instability.

Aged↗
PubMed1995

Awareness during anaesthesia for implantable cardioverter defibrillator implantation. Recall of defibrillation shocks.

Implantable cardioverter defibrillator implantation is performed under general anaesthesia. This report describes awareness or recall in two of 33 patients scheduled for implantation. After induction, anaesthesia was maintained using continuous infusions of propofol and atracurium and intermittent boluses of alfentanil. Propofol was given in the same arm as the implantation side. In these two patients propofol flowed out of the bleeding central venous access. To minimise the possibility of awareness, we advise that continuous infusions should be administered intravenously on the contralateral side to the implantation and that neuromuscular blocking agent be given by intermittent bolus injections.

Anesthesia, General↗
PubMed1995

Homozygous deletion of exon 9 causes lipoprotein lipase deficiency: possible intron-Alu recombination.

We studied a homozygous deletion in the lipoprotein lipase gene at the molecular level. Comprising the end of intron 8, the whole of exon 9, and about two-thirds of intron 9, this 2.136-kb deletion caused complete lipoprotein lipase deficiency and severe hypertriglyceridemia (type I hyperlipoproteinemia). Intron 9 of a normal control subject was also sequenced in order to define the exact borders of the deletion. Up to now, only the first 0.721 kb of intron 9 had been sequenced. Thus the complete sequence of intron 9 (3.090 kb) is now available. Three Alu sequences were characterized in the normal intron 9, while the proband had only the third complete Alu sequence. The first Alu sequence was located in the deleted region, and only the left arm of the second was present, as the deletion began near its center. A stem-loop structure involving a 14-nt region towards the end of intron 8 and an Alu sequence in intron 9 might have led to the deletion. Sequence analysis showed that the three Alu sequences belonged to the 40-million-year-old Alu-Sa subclass.

Adult↗