Biomedical subjects
Publications and source records attributed to M Garré.
Cell-mediated immunity was investigated in 50 patients with severe protein malnutrition. It appeared that protein malnutrition by itself immune defence mechanisms and aggravates the prognosis. The best markers are prealbumin for protein malnutrition and T and T-active lymphocytes for cell-mediated immunity, as these are extremely sensitive.
Fifty three critically ill patients (two of the following criteria : thyroxin - binding - prealbumin less than or = to 24 mg/dl, creatinin - height - index less than or = to 80 percent and transferrin less than or = to 225 mg/dl) were divided into two groups according to the level of folic acid (FA). Group A consisted of 29 with FA less than or = to 3 ng/ml and group B of 24 with FA greater than 3 ng/ml. The phagocytic activity (PA) was significantly lower in group A and significantly corrected by AB sera, whereas the NBT reduction capacities were within the normal range. A correlation is shown between PA and level of FA as well in autologous sera as in AB sera.
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One case of lecithin cholesterol acyltransferase (LCAT) deficiency is discovered by renal biopsy. Through the study of a French family, native to Brittany, one sister is found to be carrier of the trait. This finding suggests that the gene defect hitherto reported from Scandinavia is not restricted to this region. The patient shows typical signs of the disease, corneal opacities, anemia with a hemolytic component and lack of plasma LCAT activity. She has proteinuria, HTA, hematuria, no renal insufficiency. Signs previously unreported were noted: sensorineural hearing loss and platelet environment disorder. Histological abnormalities of two types are found: foam cells and subendothelial deposits, of which the tinctorial characteristics indicate a lipid composition. The lack of glomerular fluorescent staining observed is not in favor of an immune complex nephropathy. The study of this case suggests the determining role of lipid abnormalities in the genesis of anemia and of the vascular depositions in the induction of renal failure encountered in several cases of LCAT deficiency.
The demonstration of a double albumin line on blood protein electrophoresis has important practical applications: after eliminating congenital bisalbuminaemia, with no pathological consequences, this abnormality may make it possible to detect an overdose of beta-lactamines, requiring the interruption of treatment, or a serious effusion of pancreatic origin justifying surgery.
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Distal bronchial brushing is one of the methods used in the in vivo indentification of Pneumocystis carinii, a parasite associated with severe pneumonia, the development of which is induced by immuno-depression, particularly after renal transplantation. In three patients the pathogenic agent was demonstrated in alveolar material obtained in this way. The technique is simple and risk-free. It may be used early and repeatedly.
On the basis of a series of 53 cases of irreversible coma maintained in circulatory survival with the aim of removing the kidneys, the authors discuss the mode of treatment, with particular reference to the intravenous fluids used and the use of medications influencing the circulation. Fluid and electrolytes given must be adjusted hourly to ensure the exact replacement of urinary losses. Isoprotenerol is the only medication usually necessary. In the event of circulatory insufficiency, which is difficult to foresee and hence prevent, immediate volume expansion in a short a time as possible and isoprotenerol most frequently correct the situation (14 out of 17 cases). Thus effective circulation may be maintained until the kidneys are removed (48 out of 53 cases). 92 p.cent of the grafted kidneys functioned from the first day onwards.
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The spectrum of 182 hospital Mycoplasma pneumoniae infections, collected over a five-year period, is reviewed. The diagnosis was based on complement fixation test. Mycoplasma infection was encountered mainly in young people, mean age 29 years. Eighty-four per cent presented with an atypical pneumonia, 33 per cent had extrapulmonary manifestations mainly neurological and cutaneous. Acute respiratory failure occurred in 32 cases. Only 5 patients died. Macrolides or tetracyclines remain the most effective antibiotics but spontaneous recovery is usual.
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