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Biomedical subjects

P Auzepy

Publications and source records attributed to P Auzepy.

At least 19 recordsLinked to original sources
PubMed1990

Vitamin E deficiency and lipoperoxidation during adult respiratory distress syndrome.

Vitamin E (Vit E) is an important component of the lung's defense against oxidant injury. The aim of this study was to determine a) if adult respiratory distress syndrome (ARDS) was associated with a decrease in Vit E plasma level linked to an enhancement of plasma lipoperoxidation, and b) if this Vit E deficiency might be explained by malnutrition and/or a consumption defect. Vit E, lipoperoxides (LP), total lipids, and fatty acid plasma levels were measured in 12 patients with ARDS (PaO2 less than or equal to 60 Torr with FIO2 0.6 on mechanical ventilation). At the onset of ARDS (T0), the decrease in Vit E plasma level was significant (p less than .001) 7.73 +/- 0.54 (n = 12) vs. 11.46 +/- 0.55 mg/L (n = 7) in the control group (healthy subjects breathing room air). A significant (p less than .05) increase in LP was simultaneously observed (4.12 +/- 0.35 [n = 12] vs. 2.94 +/- 0.30 nmol/ml [n = 17]) in the control group. At T0, LP were inversely correlated with Vit E plasma levels (r = .78, p less than .01). Vit E deficiency was associated with low levels of total plasma lipids (3.68 +/- 0.25 g/L) and plasma cholesterol (0.97 +/- 0.07 g/L). Thus, the Vit E/total lipids ratio (2.18 +/- 0.17 mg/g) was always above the accepted normal limit value for this ratio (0.8 mg/g).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Systemic and regional hemodynamic effects of perindopril in congestive heart failure.

The acute systemic and regional hemodynamic responses to a single oral dose (4 mg) of the angiotensin converting enzyme inhibitor perindopril were investigated in 10 patients with severe congestive heart failure. Perindopril produced significant and long-lasting decreases in systemic vascular resistance (-18%), right atrial pressure (-60%), and mean pulmonary capillary wedge pressure (-28%), whereas it significantly increased cardiac index (+ 12%). Brachial (+ 130%, pulsed Doppler technique) and renal (+ 34%) blood flows were also significantly increased whereas hepatic blood flow remained unchanged. Brachial flow/cardiac output and renal flow/cardiac output ratios increased significantly from 0.8 to 1.6 and from 13.2 to 16.5, respectively. The maximal decreases in forearm and renal (but not in systemic) vascular resistances were correlated with the basal plasma norepinephrine concentrations but not plasma epinephrine concentrations or plasma renin activity. We conclude that in severe heart failure (a) perindopril considerably improves systemic hemodynamics and exerts an inhomogeneous vasodilating effect, resulting in a redistribution of flows toward the forearm and renal territories, (b) norepinephrine is a major determinant of the arteriolar tone in these two vascular beds, and (c) the pulsed Doppler is a particularly suitable method to non-invasively detect and assess hemodynamic improvements in heart failure patients.

Administration, Oral↗
PubMed1990

[Acute respiratory distress caused by distal neoplastic pulmonary emboli].

In contrast to pulmonary parenchyma metastases or lymphangitic carcinomatosis, neoplastic emboli of small pulmonary arteries and capillaries frequently go unrecognized and are only discovered at autopsy. Five patients (48 +/- 12 years old) were admitted to 3 intensive care units for severe acute respiratory failure and died between the first and the tenth day following hospitalization. Each patient had a history of rapidly progressive dyspnea, and physical examination showed clinical evidence of right ventricular failure. The lungs were clear on chest X-rays and the ECG revealed sinus tachycardia with a right QRS axis. The mean partial pressures of oxygen (PaO2) and carbon dioxide (PaCO2) were, respectively, 50.8 +/- 9.1 mm Hg and 22.2 +/- 2.4 mm Hg. A swan-Ganz catheter, inserted into 4 patients, revealed pulmonary arterial hypertension (55, 43, 37, 28) with capillary wedge pressure within the normal limits and cardiac output normal or low (3.0, 3.8, 4.4, 5.0 l/min). Pulmonary angiograms from each patient showed decreased distal lung perfusion without any proximal defects suggestive of pulmonary embolism. The inferior vena cava always appeared clear. Malignant cells were found upon autopsy (4 cases) in the lumina of the pulmonary arterioles and the primary site of the cancer was determined in 3 patients (2 hepatomas and 1 pancreatic carcinoma). The last patient had a known breast cancer with bone marrow metastases and clinical, hemodynamic and angiographic evidence of neoplastic emboli. The clinical course of neoplastic emboli can suggest acute pulmonary embolism, but the diagnosis can only be advanced after pulmonary angiography, especially if the patient is to have a cancer.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1989

Relationship between mixed venous oxygen saturation and cardiac index in patients with chronic congestive heart failure.

The use of mixed venous oxygen saturation (SvO2) in patients with chronic congestive heart failure (CHF) has been advocated to analyze the action of therapy on cardiac index (CI). To evaluate the relationship between CI and SvO2, ten CHF patients (mean age 65 years) were studied before and one, two, three, four (T4), six, eight and 24 hours after oral administration of an angiotensin converting enzyme (ACE) inhibitor (perindopril, 4 mg). At T4, a 12 percent increase in CI (p less than 0.01) was associated with a 16 percent decrease in arteriovenous oxygen difference (p less than 0.01), a 13 percent increase in mixed venous oxygen pressure (PvO2) (p less than 0.01), and a 9 percent increase in SvO2 (p less than 0.05) with no significant change in arterial oxygen pressure. There was no correlation between CI and SvO2 (r = 0.22) and between CI and PvO2 (r = 0.23). Individual analyses were performed and patients were divided into two groups based on CI versus SvO2 r value; group 1, n = 6, r greater than 0.65 (0.65-0.90), group 2, n = 4, r less than 0.65 (0.14-0.20). The lack of correlation in group 2 was due to a drug-dependent increase in oxygen consumption (VO2) +18 percent vs -3 percent in group 1 (p less than 0.05) associated with a lack of increase in PvO2 +3 percent vs +14 percent in group 1 (p less than 0.05) despite a similar increase in oxygen availability +19 percent versus +16 percent. It was concluded that (1) a correlation between CI and SvO2 is not found in every patient with CHF; (2) the lack of correlation in four out of our ten patients was due to an associated and significant increase in CI and VO2 in group 2; (3) group 2 patients probably had an important oxygen debt before treatment; (4) SvO2 cannot be used instead of CI to determine the hemodynamic consequences of the use of cardiovascular drugs.

Administration, Oral↗
PubMed1988

Comparison of non-protected lower respiratory tract secretions and protected specimen brush samples in the diagnosis of pneumonia.

The aim of this prospective study was to compare the results obtained with the non-protected lower respiratory tract secretions samples (LRS) with the protected specimen brushes (PSB) performed through a fiberoptic bronchoscope in mechanically ventilated patients, when pneumonia was suspected. The diagnosis of pneumonia was ultimately made at the end of the hospitalisation, in a double-blind manner by 2 members of the medical staff not aware of the bacteriologic results of LRS and PSB. LRS and PSB were performed in 24 patients. PSB culture was considered as positive at a level of 10(3) colony-forming units per milliliter (cfu/ml) microorganisms. Twenty-five samples from 24 patients were divided as follows: (1) LRS (-) and PSB (-) 5 samples: the clinical diagnosis of pneumonia was never established. (2) LRS (+) and PSB (+) 10 samples: the clinical diagnosis of pneumonia was always established, 2 microorganisms were involved 4 times and 1 microorganism 6 times. (3) LRS (+) and PSB (-) 10 samples: the clinical diagnosis pneumonia was retained in 3 with the possibility of false negative PSB. We conclude that (1) a negative LRS eliminated the diagnosis of pneumonia without PSB; (2) a positive LRS was not sufficient to diagnose pneumonia since PSB was negative in 50% of all LRS (+) cases; (3) the possibility of a false negative PSB must be kept in mind particularly in patients previously treated with antibiotics; (4) 2 microorganisms may be responsible for the pneumonia if the previously determined, as significant, bacteriological count (greater than or equal to 10(3) cfu/ml) appears to be accurate.

Adult↗
PubMed1988

Pharmacokinetics of pefloxacin and amikacin administered simultaneously to intensive care patients.

Ten adult patients with severe infections in an intensive care unit were treated simultaneously with 6 mg/kg pefloxacin and 7.5 mg/kg amikacin, infused i.v. over 1 h every 12 h for 5 days. Twelve h after the last infusion, pefloxacin alone was administered orally (400 mg tablet) every 12 h for 10 days. The pharmacokinetics of pefloxacin and its main metabolites, norfloxacin and pefloxacin N-oxide, were determined after the first (Day 1) and last (Day 5) infusions and after the last oral dose (Day 15). The kinetics of amikacin was determined after the first and the last infusion. The maximal and minimal steady-state plasma concentrations of amikacin were 27.3 and 3.3 mg/l. The total plasma clearance was 83.1 and 67.0 ml/min after the first and the last infusions, respectively, and the half-life was 3.9 and 5.0 h. The maximal and minimal steady-state plasma concentrations of pefloxacin were 13.1 and 7.9 mg/l after i.v. infusion and 13.4 and 9.0 mg/l after oral administration. Pefloxacin elimination (t1/2) increased from 11.3 h after the first infusion to 19.4 h after the last infusion and 21.1 h after the last oral dose. Total body clearance decreased from 90.8 (Day 1) to 51.9 (Day 5) and 56.4 ml/min (Day 15). The volume of distribution did not change significantly over the course of pefloxacin. Mean steady-state plasma concentrations of norfloxacin and pefloxacin N-oxide were respectively 0.5-0.6 mg/l and 0.9-1.3 mg/l after intravenous and oral administration of pefloxacin. There were no pharmacokinetic interaction between the drugs. The dosage regimen led to plasma concentrations of pefloxacin and amikacin within their therapeutic range.

Aged↗
PubMed1988

Enterococcal bacteremia in a medical intensive care unit.

We reviewed retrospectively from 1982 through 1984 35 cases of enterococcal bacteremia in a medical ICU. Of these, 27 patients acquired nosocomial infections; their mean previous hospital stay was 17 +/- 4 days. Thirteen had a serious debilitating disease; 20 received previous antibiotic therapy. The infection focus was not found in 16 patients. The deaths of nine patients were related directly to enterococcal bacteremia. Mortality was significantly lower in patients with nosocomial infections, with appropriate antibiotic therapy just after the start of the infection, without debilitation, and when the infection focus was discovered. In a medical ICU, some patients appear to be particularly predisposed to enterococcal bacteremia. When these patients develop a serious infection without obvious source, an appropriate antibiotic therapy for Enterococcus should be promptly initiated.

Adult↗
PubMed1987

Serum selenium deficiency in myocardial infarction and congestive cardiomyopathy.

Serum selenium concentration was prospectively measured using the method of thermoelectric atomic absorption spectrophotometry in 129 study participants distributed as follows in three groups: control group (n = 48) volunteers without known cardiac or lung disease; group I: patients with congestive cardiomyopathy (n = 48), group II: patients with myocardial infarction (n = 31). Serum selenium level was 84.73 +/- 1.79 micrograms.l-1 (m +/- sem) in the control group, 68.53 +/- 2.26 micrograms.l-1 in group I and 73.55 +/- 2.33 micrograms.l-1 in group II. The difference between group I and group II versus the control group was significant (p less than 0.01). There was no significant difference between group I and II.

Adult↗
PubMed1985

[Antibiotic resistance of Escherichia coli. Importance of the resistance to trimethoprim-sulfamethoxazole].

Antimicrobial sensitivities, especially trimethoprim-sulfamethoxazole, were studied in all clinical isolates of Escherichia coli in an intensive care unit for over 18 months. Twenty-four per cent of strains were resistant to trimethoprim-sulfamethoxazole. Combined resistance to ampicillin +/- chloramphenicol (+/- tetracycline) and streptomycin (+/- kanamycin) with resistance to trimethoprim-sulfamethoxazole was demonstrated. These data confirm the previously reported increasing trimethoprim-sulfamethoxazole resistance which is probably plasmid-mediated and specify the resistances associated with trimethoprim-sulfamethoxazole resistance. These findings suggest that widespread prophylaxis in granulocytopenic patients with lower urinary tract infection by the trimethoprim-sulfamethoxazole association should be re-examined.

Anti-Bacterial Agents↗