Biomedical subjects
Publications and source records attributed to M Thirion.
Intravenous immunoglobulins (IVIg) exert a broad range of immunoregulatory functions that provide a basis for the beneficial effects of IVIg in autoimmune and systemic inflammatory disorders. This review focuses on the effects f IVIg on humoral and cellular immunity that may be of relevance for the treatment of inflammatory neurological diseases.
We studied the influence of circulating parathyroid hormone-related protein (PTHrP) concentrations on the response of hypercalcemic cancer patients to bisphosphonate therapy. We also examined the changes in circulating PTHrP levels during the normalization of serum Ca to determine if part of the increase in PTHrP concentrations is not secondary to hypercalcemia itself, as suggested by some in vitro data. We sequentially measured in 45 hypercalcemic cancer patients treated by pamidronate the circulating concentrations of PTHrP (by an amino-terminal RIA; normal values < 9 pmol/liter), Ca, Ca2+, Pi, intact PTH, and the fasting urinary excretion of Ca (Ca/Cr) and cyclic AMP (cAMP). Mean +/- SEM baseline PTHrP levels were 9.5 +/- 1.3, with a median (range) value of 6.0 (< 3.4-43) pmol/liter. PTHrP levels were elevated in 18 of 45 patients, more often in epidermoid than in glandular carcinomas (P < 0.05), and they were significantly (P < 0.05) correlated with the concentrations of Pi (r = -0.46), Ca/Cr (r = -0.31), and urinary cAMP (r = 0.47). Mean pretreatment Ca levels were not significantly different between patients with elevated and patients with normal PTHrP levels, 13.3 +/- 0.4 versus 12.9 +/- 0.4 mg/dl, but the concentrations became significantly different (P < 0.005) 4 days after therapy, 10.2 +/- 0.3 versus 9.2 +/- 0.1 mg/dl, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
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The usefulness of radionuclide imaging in the detection of cardiac tumors has been demonstrated previously in left atrial myxomas. We report a case of right sided myxoma successfully diagnosed by radionuclide imaging and evaluated by cine display, Fourier phase analysis and paradox image. These three techniques are now available in many computer programs for gated cardiac blood pool imaging and provide an additional tool for assessing cardiac tumors. Particularly, functional paradox and Fourier phase analysis seem promising tools in the detection of both left and right sided tumors.
Fifty-two patients with vesicoureteral reflux (age: 6.4 +/- 6.2 years) were examined by IVP, voiding cystouretrography and 123 I-Hippuran studies. 17 patients were not operated; 26 had an antireflux, 9 an urethral surgery. The follow-up was 2 years for 39 of these patients, with at least one evaluation per year. The observations were: Unoperated patients were younger, had a lower radiological grade of reflux and renal functional impairment was less frequent. Functional impairment was initially equally distributed in unilateral (53%) and bilateral (54%) reflux. Radiological grade of reflux had an unsatisfactory predictive value for functional renal status. Functional renal status at 2 years was unchanged in 82% of patients. Improvement was observed in 8%, deterioration in 10%. These results were not influenced by the choice of treatment. However, reflux persistence was more frequently observed in the un-operated group (50% versus 5%). Renal transit times of 123 I-Hippuran did not correlate with the functional status or the radiological grade of reflux.
In 14 critically ill patients in stable cardiopulmonary status, right ventricular ejection fraction (RVEF) was measured by thermodilution technique and by radionuclear (gated first pass) technique. The pulmonary artery catheter was equipped with a fast-response thermistor and an intracardiac ECG monitor. In addition, the proximal lumen ended in a 3-hole port 21 cm from the tip of the catheter to facilitate mixing of the cold bolus above the tricuspid valve. The use of a new algorithm based on an exponential curve analysis of the thermodilution curve limited the variability of RVEF determinations to 7.6%. The correlation between RVEF measured by thermodilution and radionuclear techniques was significant (y = 12.7 +/- 0.49x, r = 0.67, p less than 0.01). However, the values obtained by thermodilution were usually lower, especially for high RVEF. Nevertheless, although some discrepancy was found, thermodilution techniques allow simple, accurate and repetitive bedside measurements of right ventricular volumes in the critically ill.
Measurement of right ventricular ejection fraction (RVEF) by the thermodilution technique has become routinely available at the bedside of the critically ill. We describe 2 patients with tricuspid regurgitation in whom RVEF values were considerably lower by thermodilution than by radionuclide techniques. Discrepancies could be due to the regurgitation of the thermodilution signal and possibly to the different nature of the two measurements (forward stroke volume with the thermodilution technique and total stroke volume with the radionuclide technique). We suggest that lower RVEF measurement by the thermodilution technique could be related to unrecognized tricuspid regurgitation. Measurement of an unexpectedly low RVEF by the thermodilution technique should suggest the presence of tricuspid regurgitation.
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Deep abdominal palpation was performed prospectively in 900 newborns. Normal kidneys were felt in all but 8. 2 of these had a normal ultrasonography, 2 had an obstructive hydronephrosis, 1 had bilateral renal hypoplasia and 3 had a previously undiagnosed unilateral renal agenesis. Despite the increasing use of prenatal ultrasonography, careful abdominal examination should be performed in all newborns.
Forty-six patients presenting typical or non-typical angina pectoris were all submitted to analysis of effort angina, traditional or automatic, and to analysis of the amplitude of the R wave and to an effort myocardial scan using thallium 201 (taken as reference substance) during maximal muscle exercise. The following conclusions may be drawn from this study. 1) Autoanalysis of the ECG improves considerably the sensitivity without changing the specificity of the method (92 and 82 p. cent for 79 and 82 p. cent). Analysis of the variations in amplitude of the R wave gave no further information. It should be reserved for patients whose effort ECG was difficult to interpret: e.g. left or right bundle branch block, digitalis effect, very abnormal resting ECG, or average age female population.
Specificity and sensitivity of exercise ECG were compared to exercise stress thallium 201 scanning and coronary arteriograms in 70 male patients with typical or atypical chest pain complaints, without previous myocardial infarction. 50 patients (group I) did not receive any treatment; 20 patients (group II) received digitalis as preventive treatment of atrial arrhythmias or for no particular reason. Only subjects with concordant results in radionuclide and angiography examinations were considered as coronary artery disease patients. Exercise stress tests were performed sitting on the bicycle ergometer using a progressive loading profile (30 W for 3 min), to the symptom-limited capacity (VO2SL). Positive exercise ECG were confirmed on ST decrease (1.5 mm) or on absence or increase in R-wave-amplitude modifications (V5). In the group I patients, ECG-ST-modification sensitivity, specificity, predictive value (+) and efficiency were, respectively, 92, 82, 86 and 88%. R-wave-variation sensitivity, specificity, predictive value (+) and efficiency were, respectively, 41, 74, 65 and 56%. In the group II patients, ST-depression sensitivity, specificity, predictive value (+) and efficiency were, respectively, 100, 33, 59 and 65%. R-wave-variation sensitivity, specificity, predictive value (+) and efficiency were, respectively, 50, 70, 63 and 60%. It was concluded that R-wave-amplitude variations induced lower false positive responses than ST-segment depression in patients under digitalis treatment. False negative responses were unfortunately 50% using the R-wave criterion. Exercise ECG was finally judged as a poor indicator of CAD in patients under digitalis treatment.
Electromyograms of the parasternal intercostal muscles and of the diaphragm were obtained with surface electrodes in 20 patients with early flaccid hemiplegia due to cerebrovascular accident. In most patients, a striking reduction in activity was observed during voluntary inspirations in both the intercostal muscles and the diaphragm on the side of the paresis. These findings suggest that in most persons the respiratory muscles are innervated primarily by decussated fibers. Dysfunction of the respiratory muscles might be implicated in the respiratory tract infections of patients with early hemiplegia.
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