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Biomedical subjects

M F Hellot

Publications and source records attributed to M F Hellot.

At least 37 records · Page 2Linked to original sources
PubMed1999

Amniotic fluid alpha-fetoprotein is not a useful biological marker of pregnancy outcome.

The aim of our study was to determine if the amniotic fluid alpha-fetoprotein (AFP) level could be a useful predictive biochemical marker of pregnancy outcome. Amniotic fluid AFP measurement was prospectively carried out over a three-year period. After excluding factors susceptible to modifying AFP measurements, 587 subjects with gestational age between 14 and 20 weeks were selected to compare the amniotic fluid AFP mean levels depending on the occurrence of an adverse outcome. No significant associations between amniotic fluid AFP level and poor pregnancy outcome, i.e. pre-eclampsia, preterm delivery, premature rupture of fetal membranes, fetal growth retardation and placental abnormalities were observed. The routine measurement of amniotic fluid alpha-fetoprotein during an amniocentesis procedure was not considered useful in predicting pregnancy complications.

Adult↗
PubMed1999

Influence of age on characteristics of polymyositis and dermatomyositis in adults.

In a retrospective study of 79 consecutive patients, we evaluated characteristics of polymyositis (PM) and dermatomyositis (DM) and compared clinical presentation, biochemical findings, histologic changes, evolution, complications, and mortality rate of elderly patients (aged > or = 65 yr) and younger patients (aged < or = 64 yr) at the onset of PM/DM. We found a high prevalence of PM/DM in elderly patients: 23 patients (29%) were aged 65 years or over. We also found that esophageal involvement (34.8% versus 16.1%, respectively) and bacterial pneumonia related to both ventilatory insufficiency and esophageal impairment (21.7% versus 5.4%, respectively) were more common in elderly patients compared with younger patients, resulting in increased morbidity and mortality rates. Moreover, malignancy frequency was higher in elderly patients compared with younger patients (47.8% versus 9.1%, respectively, p = 0.0001), particularly patients with DM (10/11). Fifty percent of malignancies were colon malignancies in elderly patients. Erythrocyte sedimentation rate, C-reactive protein, fibrinogen, and ferritin levels were also higher in the elderly patient group compared with the younger group, and the presence of serum hypoprotidemia, hypoalbuminemia, and anemia was more frequent. Finally, PM/DM complete remission was less frequent (13.6% versus 41.1%) and the mortality rate (47.8% versus 7.3%) was higher in elderly patients than in younger patients. The main causes of death in elderly patients were bacterial pneumonia, due to ventilatory insufficiency and esophageal impairment, and malignancies. Our findings therefore indicate that PM/DM-related esophageal and lung involvement should be systematically searched for in elderly patients. Esophageal manometry and pulmonary function tests should become an integral part of initial evaluation in elderly patients for early detection of impairment. Moreover, as we observed a marked overrepresentation of colon cancer in elderly patients with DM, we suggest that the search for malignancies in elderly patients with DM should include lower gastrointestinal tract investigations.

Activities of Daily Living↗
PubMed1999

Newborn shoulder width: a prospective study of 2222 consecutive measurements.

OBJECTIVES: To relate maternal and infant characteristics to newborn shoulder width and to evaluate the predictive value of newborn shoulder width measurement in cases of shoulder dystocia. DESIGN: Newborn shoulder width was systematically measured at birth during a period of 18 months. SETTING: Department of Obstetrics and Gynaecology of Saint-Antoine University Hospital, Paris, France. POPULATION: A total of 2222 newborn shoulder width measurements were performed and 22 cases of true shoulder dystocia occurred during the study period. METHODS: Newborn shoulder width measurements were reviewed and correlated with maternal age, parity, nonpregnant weight, weight gain during pregnancy, height, race, fasting glucose and one hour glucose levels, gestational age, birthweight and sex of the neonate. A receiver-operating characteristics curve was constructed to evaluate newborn shoulder width as a test for predicting shoulder dystocia. RESULTS: The mean newborn shoulder width was 122.06 mm (10.50 SD). Stepwise multiple regression showed that newborn shoulder width was significantly associated with birthweight (P < 0.001), parity (P = 0.04), and nonpregnant weight (P = 0.04). We estimated that the best cut off for shoulder dystocia prediction was a newborn shoulder width measurement with a low false positive rate (< 10%) in association with a high sensitivity rate. Therefore, newborn shoulder width measurement > or = 140 mm was selected. This measurement should have a low sensitivity of 27.27%, a specificity of 91.82%, a positive predictive value of 4.02%, and a negative predictive value of 99.01% for shoulder dystocia prediction. Nevertheless, birthweight > or = 4000 g should have a better predictive value retrospectively for shoulder dystocia. CONCLUSIONS: Newborn shoulder width measurement, which is strongly correlated with birthweight, still remains a poor predictor for shoulder dystocia, even when this evaluation is correct antenatally.

Adult↗
PubMed1998

Manometry of the upper intestinal tract in patients with systemic sclerosis: a prospective study.

OBJECTIVE: To assess both the prevalence and the characteristics of motor disorders of the small bowel in patients with systemic sclerosis (SSc) and to investigate for an association between clinical manifestations in the upper intestinal tract, capillaroscopic features, esophageal motor impairment, and manometric evidence of motor disturbances. METHODS: Fasting and postprandial motor activity of the upper intestinal tract was studied in 17 consecutive patients with SSc (6 with and 11 without clinical manifestations of small bowel involvement) and 17 age- and sex-matched healthy control subjects. RESULTS: The prevalence of manometric evidence of intestinal involvement was as high as 88% in the SSc patients; normal motor activity was present in only 2 patients. The median values for duodenal and jejunal interdigestive phase III migrating motor complex duration, amplitude, and velocity and the postprandial motility index were therefore lower in SSc patients compared with controls. Our manometric findings indicated that there are both neuropathic and myopathic stages of upper intestinal tract dysfunction in SSc. Furthermore, no association could be found between the severity of the intestinal manometric abnormalities and clinical presentation, SSc subsets, disease score, capillaroscopic findings, or esophageal manometric impairment. CONCLUSION: We suggest that manometry of the upper intestinal tract may be useful in SSc patients with clinical manifestations in the small bowel (i.e., malabsorption syndrome or pseudoobstruction) in that it can be used to accurately evaluate both the nature and the severity of motor disturbances. Furthermore, this procedure can be used to assist in the selection of patients who may require octreotide therapy.

Adult↗
PubMed1997

Transvenous versus perinervous stimulation of the phrenic nerve to assess the diaphragmatic strength in rabbits.

Diaphragmatic strength can be measured by transdiaphragmatic pressure during phrenic nerve stimulation. In order to avoid phrenic nerve dissection, a transjugular approach of the phrenic nerve can be performed. The objective of this study was to verify the identity of perinervous and transvenous techniques of phrenic nerve stimulation to assess diaphragmatic force. In intact (n = 9) or right phrenicotomized (n = 12) rabbits, we compared esophageal pressure (Peso) induced by supramaximal perinervous stimulation of the phrenic nerve with that obtained by transvenous stimulation of the phrenic nerve. Electromyography (EMG) of the thoracic muscles was studied in four animals. We found no difference between Peso induced by perinervous (PNS) and transvenous (TVS) unilateral or bilateral phrenic nerve stimulation. During unilateral stimulation, no EMG activity was recorded in the non stimulated diaphragm, or in the middle part of the esophagus, or in ipsi- and contralateral accessory inspiratory muscles. We conclude that in rabbits, unilateral or bilateral TVS of the phrenic nerve is functionally equivalent to PNS, whatever the side of stimulation; Peso is not altered by esophageal contraction in TVS. Transvenous stimulation can replace perinervous stimulation in experimental studies, when cervical access is difficult.

Animals↗
PubMed1997

Selective resection of the phrenic nerve roots in rabbits. Part II: Respiratory effects.

This study evaluates the delayed respiratory consequences of selective resection of one or several roots of the right phrenic nerve in rabbits. A total of 50 animals were operated on according to five modalities of root resection. A total of 11 animals served as control. The breathing pattern was analysed 8 weeks after surgery. Transdiaphragmatic pressure was measured during transjugular supramaximal stimulation of the phrenic nerve, unilaterally or bilaterally and during prolonged tracheal occlusion (PImax). No difference was observed between the esophageal pressure observed during bilateral phrenic nerve stimulation (BilPeso) in control animals when compared to animals with resection of the highest root of the right phrenic nerve (16.2 +/- 1.0 versus 14.5 +/- 1.0 cmH2O (mean +/- SE). Resection of the two highest or of the two lowest roots of the right phrenic nerve resulted in a similar BilPeso (11.3 +/- 0.8 versus 11.1 +/- 1.2 cmH2O). Preservation of only the accessory phrenic nerve (PN) resulted in a low value of BilPeso (9.8 +/- 1.0 cmH2O) similar to that obtained with complete denervation of the right hemidiaphragm. Ventilation and PImax were not different between the denervated or intact rabbits during quiet breathing. We conclude that in rabbits: (1) Diaphragmatic function is preserved after resection of the highest root of the phrenic nerve. (2) Diaphragmatic function is altered if only the APN is preserved.

Animals↗
PubMed1994

Plasma 5-fluorouracil and alpha-fluoro-beta-alanin accumulation in lung cancer patients treated with continuous infusion of cisplatin and 5-fluorouracil.

This study was undertaken to investigate the day-to-day pharmacokinetic variability of 5-fluorouracil (5FU) given as a continuous i.v. infusion concomitantly with cisplatin. Ten lung cancer patients were investigated during the first course of chemotherapy. All patients had advanced, previously untreated, inoperable non-small-cell lung cancer. They received continuous infusions of cisplatin given at 100 mg/m2 over 5 days and of 5FU given at 1 g/m2 daily from day 2 to day 5. Both drugs were infused i.v. for 24 h/day at a constant rate with a volumetric pump. Blood samples were drawn from day 2 to day 5, every 4 h from 8 a.m. to 8 p.m. and every 2 h during the night (8 p.m. to 8 a.m.). Plasma 5FU and FBAL concentrations were determined simultaneously by gas chromatography-mass spectrometry. Plasma 5FU concentrations varied widely over the 4-day treatment course for each patient. Despite continuous constant-rate 5FU administration, plasma 5FU concentrations were significantly lower between 8 a.m. and 8 p.m. than during the night. Mean plasma concentrations of 5FU and FBAL increased significantly from the 1st day (0.42 and 1.19 micrograms/ml for 5FU and FBAL, respectively) to the 4th day of 5FU infusion (0.67 and 1.78 micrograms/ml for 5FU and FBAL, respectively). Further study is warranted to elucidate the mechanisms of the observed increase in plasma 5FU concentrations as well as its relationship with cisplatin coadministration and to assess the clinical relevance of this plasma 5FU accumulation.

Aged↗
PubMed1993

Respiratory response to CO2 in patients with chronic obstructive pulmonary disease in acute respiratory failure.

The aim of our study was to determine the importance of chemoreceptor stimulation by carbon dioxide in setting the level of ventilation in patients with chronic obstructive pulmonary disease (COPD) in acute respiratory failure. We studied the ventilatory and mouth occlusion pressure (P0.1) responses to CO2 in 25 COPD patients under treatment for episodes of acute respiratory failure, and in 24 normal subjects. Carbon dioxide rebreathing tests were performed in the spontaneously breathing, intubated patients, after arterial blood gases had been quasi-normalized by mechanical ventilation, which allowed us to compare both groups at similar resting arterial carbon dioxide tension (PaCO2) and acid-base status. The slopes of the ventilatory responses were markedly lower in the patients (mean +/- SEM, 1.28 +/- 0.23 versus 12.53 +/- 1.13 l.min-1.kPa-1). The slopes of the P0.1 responses were lower in the patients (0.27 +/- 0.05 versus 0.45 +/- 0.05 kPa.kPa-1), but the absolute P0.1 values were not significantly different from the normals. Increasing PaCO2 from 5.3 to 8 kPa (40 to 60 mmHg) resulted in a mean increase of 34% in ventilation. These results show that CO2 drive is a major determinant of respiratory stimulation in many COPD patients with acute respiratory failure.

Acute Disease↗
PubMed1989

Yogurt and fermented-then-pasteurized milk: effects of short-term and long-term ingestion on lactose absorption and mucosal lactase activity in lactase-deficient subjects.

Lactase-deficient subjects absorb lactose in yogurt more effectively than lactose in other dairy products. However, as all previous studies were performed without a double-blind design and only after a single ingestion of the test product, the mechanism of this enhanced absorption remains unclear. The aims of this double-blind study were 1) to evaluate lactose absorption after prolonged ingestion of yogurt and fermented-then-pasteurized milk (FPM) and 2) to assess the modification of the lactase activity of the duodenal mucosa. In 16 lactase-deficient subjects we confirmed that yogurt enhances lactose digestion, this beneficial effect being destroyed by pasteurization. Moreover, the long-term (8 d) ingestion of either yogurt or FPM does not modify the results of hydrogen breath tests in comparison with a 24-h ingestion. The mucosal lactase (Dahlquist method) and beta-galactosidase (ONPG method) activities were not significantly modified by yogurt or FPM ingestion. These results suggest that in lactase-deficient subjects no adaptation occurs after eating yogurt or FPM and that the increased lactose absorption in yogurt must be mainly related to an intraluminal process.

Adolescent↗
PubMed1987

Radiopaque markers transit and anorectal manometry in 16 patients with multiple sclerosis and urinary bladder dysfunction.

Fecal incontinence and/or constipation are frequent complaints in multiple sclerosis associated with urinary bladder dysfunction, incontinence, and/or retention. Total and segmental colonic transit were studied by determination of radiopaque markers, and anorectal function by anorectal manometry, in 16 multiple sclerosis patients clinically defined (with urinary bladder dysfunction shown by urodynamic examination). Fifteen multiple sclerosis patients had constipation and 14 had increased colonic transit time; ten multiple sclerosis patients had fecal incontinence and five had spontaneous rectal contractions. It is suggested that increased colonic transit and anorectal dysfunction were secondary to neurologic disorders just as urinary bladder dysfunction is due to neurologic disorders in multiple sclerosis.

Adult↗
PubMed1987

Gastro-oesophageal reflux and alcoholic cirrhosis. A reappraisal.

The oesophageal pH was recorded for 3 h after a test-meal in 27 healthy control subjects (group I), 40 patients with alcoholic cirrhosis (group II), and 22 patients with a normal liver and symptoms of gastro-oesophageal reflux (control refluxers). Gastro-oesophageal reflux was observed in 10 of the cirrhotic patients. Marked reflux episodes lasted longer in cirrhotic refluxers than in control refluxers (P less than 0.05). The frequency of ascites, bleeding from ruptured oesophageal varices, peripheral neuropathy and hepatic encephalopathy were not significantly different according to presence or absence of reflux. Plasma concentrations of gastrin, somatostatin, motilin and vasoactive intestinal peptide (VIP) were measured in groups I and II. Fasting plasma motilin levels, and the release of motilin and of VIP after the meal were higher in group II than in group I. Basal levels and post-prandial profiles of the four peptides tested did not differ between cirrhotics with or without gastro-oesophageal reflux. We conclude that in patients with alcoholic cirrhosis: gastro-oesophageal reflux is frequent (25%) and characterized by prolonged reflux episodes; reflux is not correlated with the degree of liver failure and plays no significant role in the rupture of oesophageal varices; and raised plasma motilin and VIP levels cannot account for the high incidence of reflux in cirrhotics.

Adult↗
PubMed1985

[Anorectal motility in idiopathic constipation. Study of 200 consecutive patients].

The aim of our work was to study anorectal motility and tension of the rectal wall in 200 constipated adult patients. Anorectal manometry was normal in 88 patients (group A), showed abnormal amplitude of the anorectal inhibitory reflex in 33 patients (group B) and hypertonia and ultraslow waves in 70 patients (group C). These anomalies were: a) reproducible in the 20 patients studied twice; b) observed in patients with enterocolitis, thus not specific of constipation; c) associated with an increased frequency of fecal evacuation difficulties. Despite normal values of tension of the rectal wall: a) the threshold of conscious perception of distension was increased in 14 p. 100 of patients; b) a paradoxical relationship between the anorectal inhibitory reflex and rectal tension was observed in group B patients. Our results support the concept of outlet obstruction due to anorectal dysfunction and suggest the possibility of neurologic and or ischemic mechanisms in group B patients.

Adolescent↗
PubMed1984

[Esophageal pH-metry and gastroesophageal reflux in infants and children].

Twenty five infants, all under 3-year-old, 16 with symptoms of gastroesophageal reflux and 9 controls, were studied by continuous pH esophageal monitoring during 18 to 24 h. The diagnostic value of several pH parameters was calculated in reference to the upper limits of normal ranges previously determined in other studies performed in similarly aged children. Sensitivity and specificity of these parameters were respectively 69 and 89 p. 100 for the time elapsed below pH 4, 44 and 100 p. 100 for the number of reflux episodes per hour, 56 and 89 p. 100 for the duration of the longest episode of reflux, and 31 and 100 p. 100 for the number of reflux episodes lasting more than 5 min. These results confirm that a percentage Of reflux time (less than pH 4) longer than 5.2 p. 100 of the total duration of pH recording has the best discriminative value. However in clinical practice 2 or 3 h postprandial pH recording have a good diagnostic value when the results are expressed using a reflux score, as in adult patients. In further studies concerning gastroesophageal reflux in infants, it is concluded that diagnostic criteria must include evidence of reflux using a discriminant pH parameter.

Child, Preschool↗