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Biomedical subjects

P Bachmann

Publications and source records attributed to P Bachmann.

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

[Good clinical practice in nutritional management in cancer patients: malnutrition and nutritional assessment].

CONTEXT: The "Standards, Options and Recommendations" (SOR) project, started in 1993, is a collaboration between the Federation of the French Cancer Centres (FNCLCC), the 20 French Cancer Centres and specialists from French Public Universities, General Hospitals and Private Clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and outcome for cancer patients. The methodology is based on literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery. OBJECTIVES: To develop clinical practice guidelines according to the definitions of the Standards, Options and Recommendations project for the nutritional evaluation of cancer patients. METHODS: Data were identified by searching Medline and personal reference lists of members of the expert groups. Once the guidelines were defined, the document was submitted for review to 83 independent reviewers, and to the medical committees of the 20 French Cancer Centres. RESULTS: The main recommendations for the nutritional evaluation of cancer patients are: 1) Clinical and anthropometric evaluation should measure height, current weight, ideal weight, weight lost and rate of loss, and Body Mass Index. Social and economic data, details of previous history, current treatment and clinical examination results should also be collected. Gastrointestinal disorders and energetic needs should be assessed. 2) Nutritional intervention is recommended for all patients with a weight loss of 10% or more. 3) A multidimensional assessment can be performed using three validated nutritional and clinical scales: the Subjective Global Assessment, the Scored PG-SGA and the Mini Nutritional assessment. 4) The predictive value of biological factors (albumin) is not sufficient individually, risk scales combining several factors should be used: the Prognostic Inflammatory and Nutritional Index (PINI), the Nutritional Risk Index (NRI), the Prognostic Nutritional Index (Mullen) or the Sadan. 5) Minimal nutritional assessment should include clinical data, patient interview, height, current weight, ideal weight and weight change. 6) The efficacy of the nutrional management should be followed by assessing weight, and the presence of oedema and ascitis. The ratio of calorie to nitrogen intake should be calculated regularly.

Humans↗
PubMed1998

Energy expenditure during allogeneic and autologous bone marrow transplantation.

Resting energy expenditure (REE) was measured by indirect calorimetry during allogeneic and autologous bone marrow transplantation in order to evaluate the evolution in allogeneic and autologous recipient patients. REE values obtained with indirect calorimetry and compared with values using the Harris-Benedict formula were different. Evolution of REE during aplasia were significantly different in autologous and allogeneic recipients with an increase 11.5 ' 10.8 cent for autologous and a decrease of - 7.3 ' 8.9 cent in allogeneic bone marrow transplantation (BMT) patients. There were no differences in nutritional status and REE before BMT, at discharge and 1 month after discharge between the two groups but all patients had inflicted damage on their nutritional status at discharge from hospital after BMT. However, these patients differed because of the decrease in oral nutritional intake and an increase in the length of aplasia and hospital stay in allogeneic patients. Currently, there is no proof that recommendations for nutritional interventions or results of nutritional investigations in allogeneic BMT can be extrapolated in autologous patients. Harris-Benedict formula does not estimate the energy expenditure of patients submitted to massive chemotherapy and BMT with enough precision because of the great differences in individuals.

Adult↗
PubMed1998

Detection of Tritrichomonas foetus by PCR and DNA enzyme immunoassay based on rRNA gene unit sequences.

Tritrichomonas foetus is the causative agent of bovine tritrichomonosis, a sexually transmitted disease leading to infertility and abortion. Diagnosis is hampered by putative contamination of samples with intestinal or coprophilic trichomonadid protozoa which might be mistaken for T. foetus. Therefore, we developed a PCR test optimized for applicability in routine diagnosis. Amplification is based upon primers TFR3 and TFR4 directed to the rRNA gene units of T. foetus. In order to avoid potential carryover contamination by products of previous amplification reactions, conditions were adapted to the use of the uracil DNA glycosylase system. Furthermore, documentation and interpretation of results were facilitated by including a DNA enzyme immunoassay for the detection of amplification products. Specificity was confirmed with genomic material from different related trichomonadid protozoa. The high sensitivity of the test allowed the detection of a single T. foetus organism in diagnostic culture medium or about 50 parasites per ml of preputial washing fluid. The present methods are thus proposed as (i) confirmatory tests for microscopic diagnosis following diagnostic in vitro cultivation and (ii) a direct T. foetus screening test with diagnostic samples.

Animals↗
PubMed1996

Oral ifosfamide/mesna versus intravenous ifosfamide/mesna in non-small-cell lung cancer: a randomized phase II trial of the EORTC lung cancer cooperative group.

BACKGROUND: Chronic oral administration of anticancer drugs may offer therapeutic advantages. PATIENTS AND METHODS: A total of 68 patients with advanced non-small-cell lung cancer, not previously treated by chemotherapy, were randomized to receive either ifosfamide given orally (OSI) at a dose of 1 g/day for 14 days every 4 weeks, or as a 1-hour intravenous infusion (IVI) at a dose of 1.6 g/m2/day for 5 days every 4 weeks. According to the route of ifosfamide administration, patients received either mesna i.v. or mesna film-coated tablets for uroprotection. RESULTS: Eight patients were found to be ineligible for the study and therefore excluded for all analyses. Thirty-three patients received IVI, and 27 patients OSI. One patient randomized to OSI died before treatment was initiated, leaving 59 patients fully evaluable for toxicity. Hematological toxicity was less severe for patients on OSI, but CNS toxicity was reported more frequently on OSI (39%; 12% grade III/IV), than on IVI (15%; 9% grade III/IV), which caused the premature close of the study. Other non-hematological adverse events were of modest clinical significance and comparable in both arms. Forty-nine patients were considered evaluable for response: in the IVI arm, 5 (17%) of the 29 evaluable patients obtained a partial remission, and 7 patients a no change (24%). In the OSI arm, 2 (10%) of the 20 evaluable patients obtained a partial remission, and 11 (52%) a stable disease. CONCLUSIONS: Both arms have some activity in non-small-cell lung cancer; while OSI was less myelosuppressive than IVI, it was associated with a higher incidence of CNS toxicity. Oral administration of ifosfamide, in the schedule and daily dose tested here cannot be recommended.

Administration, Oral↗
PubMed1996

Comparison of two antilymphocyte globulins replacing cyclosporin A after first kidney allotransplantation and prolonged graft ischemia.

ATG/Fresenius (5 mg/kgBW) and ATGAM (Upjohn, 12.5 mg/ kgBW) replacing cyclosporin A were given during 7 d after transplantation to 20 patients in 1992 and 30 patients in 1993, respectively. Numbers of mismatches, combined kidney-pancreas transplantation and severe infections were not different for the two groups. However, prednisone pulse therapies and additional antilymphocyte globulin treatments were more frequent after ATGAM than after ATG induction (p < 0.01, chi 2-test).

Antilymphocyte Serum↗
PubMed1995

Postoperative infections in immunocompromised patients after oncological surgery.

Immunodeficiency secondary to cancer chemotherapy (chemotherapy for less than 3 months, or intensive chemotherapy with bone marrow transplant) may be responsible for postoperative infections. To estimate the value of this hypothesis, a prospective study was done over a period of 18 months in patients who had undergone pulmonary surgery. Antibiotic prophylaxis was by pefloxacin, one tablet (400 mg) 1 h before surgery then 11 h after. Clinical examination, a chest X-ray and blood cell count were carried out every day for 10 days and on the 15th day. All the drain-tips were cultured. In a case of infection, samples were obtained and cultured. One group comprised 22 immunodeficient patients (group A), and 33 patients (group B) had received no prior chemotherapy (bone-marrow transplantation = 36.7%). There were differences between the two groups in age (A:33.5 +/- 12.3 years; B:50.8 +/- 18.4 years), and type of tumour (A: metastasis = 95.5%; B: lung cancer = 51.5%). Surgical operation was bilateral for 36.4% of the patients in group A. There was more anatomical resection (pneumonectomy and lobectomy) in group B. Lung function did not differ between the two groups (abnormalities: A = 54.6%; B = 63.6%). In group A, there were 3 pulmonary infections (13.7%), but in group B 10 infections (30.3%) with 9 pulmonary infections (4 with bacteraemia) and 1 wound infection. The bacteriological finding showed two pathogens in 7 cases and no bacteriological isolates in 2 cases. With broad-spectrum antibiotherapy all the patients were cured except 1. There was one postoperative death in group B. This patient died of respiratory distress after pneumonectomy complicated by pneumonia and septicaemia (Streptococcus pneumoniae) in the remaining lung. Surgical procedures are performed with increasing frequency on patients with immunocompromised status. Classically the risk of infection is more important for these patients. In this study prior cancer chemotherapy or bone marrow transplantation did not seem to be an aggravating factor of the risk of infection. But further methodological analysis would not allow us to distinguish between a real impact of chemotherapy and the influence of group heterogeneity.

Adult↗
PubMed1994

Background prevalence of tetracycline-like fluorescence in teeth of free ranging red foxes (Vulpes vulpes), striped skunks (Mephitis mephitis) and raccoons (Procyon lotor) in Ontario, Canada.

We collected and examined teeth from 3406 red foxes (Vulpes vulpes) collected in Ontario, Canada, from 1978 to 1986, prior to large scale rabies vaccine baiting. We found tetracycline-like fluorescence in five (0.2%) of the samples. Also, we observed similar fluorescences in five (0.4%) of 1103 striped skunks (Mephitis mephitis) and in six (0.8%) of 744 raccoons (Procyon lotor). The low prevalence of such marks would not appear to invalidate the use of tetracycline as a marking agent in vaccine baiting trials.

Animals↗
PubMed1993

Tactics for the control of wildlife rabies in Ontario (Canada).

Two different tactics are currently being utilized to control rabies in foxes, skunks and raccoons in Ontario, Canada. The first tactic, which involves live-capturing with cage-traps and vaccinating by intramuscular injection, was successful in immunizing 54%-72% of the skunk and raccoon populations in a 60 km2 area of Toronto, Ontario. This area has been free of rabies for two-and-a-half years. The second tactic, involving the distribution of baits containing modified live-virus (ERA) rabies vaccine, was implemented to control rabies in foxes in both urban and rural areas of Ontario. In Toronto, 50% and 63% of the foxes were vaccinated during 1989 and 1990, respectively. Over the same period, 45% and 61% of the foxes in a 30,000 km2 area of south-eastern Ontario were immunized. Rabies is declining in both of these areas. A contingency plan has been devised to control an epizootic of raccoon rabies which is threatening to invade Ontario from the United States of America.

Administration, Oral↗
PubMed1992

Studies on efficacy and stability of a vaccine bait containing ERA strain of rabies virus propagated in a BHK-21 cell line.

In a dose response study in foxes, the median protective dose of ERA BHK21 vaccine in a blister pack bait was 10(6.0) tissue culture infective doses (TCID)/mL, while artificially aged baits with titers of 10(6.3) TCID/mL induced seroconversion in 78% of foxes. There was no significant difference in the development of antibodies in foxes receiving 1, 2 or 3 mL volumes of vaccine in the bait. When baits were exposed to the elements and fed to foxes over a 21 day period, 85% of the animals seroconverted. Age, sex and the way in which the vaccine container was contacted did not appear to be factors in the responses of these animals. Juvenile foxes, approximately six months of age, were marked more readily with the tetracycline bait marker than older animals. Approximately 25% of foxes did not appear to respond well to vaccination and the titer of the vaccine was a critical factor in producing seroconversion in these animals.

Age Factors↗
PubMed1991

The formation of 3 alpha- and 3 beta-acetoxytropanes by Datura stramonium transformed root cultures involves two acetyl-CoA-dependent acyltransferases.

Tropine (tropan-3 alpha-ol) is an intermediate in the formation of hyoscyamine. An acyltransferase activity that can acetylate tropine using acetylcoenzyme A as cosubstrate has been found in transformed root cultures of Datura stramonium. A further acyltransferase activity that acetylates pseudotropine (tropan-3 beta-ol) with acetyl-coenzyme A is also present. These two activities can be partially resolved by anion-exchange chromatography, some fractions containing only the pseudotropine-utilizing activity. The basic properties of these two enzymes are reported and their roles in forming the observed alkaloid spectrum of D. stramonium roots discussed.

Acetyltransferases↗
PubMed1991

Serum concentrations of immunoglobulins and of antibody isotypes in bone marrow transplant recipients treated with high doses of polyspecific immunoglobulin or with cytomegalovirus hyperimmune globulin.

The kinetics of immunoglobulins (Ig) and antibodies were followed in 10 bone marrow transplant recipients who received either high doses (0.5 g/kg body weight) of polyspecific intravenous Ig (HD-IVIG) weekly or cytomegalovirus hyper-Ig (CMV-IVIG, 0.1 g/kg body weight) every 3 weeks. In the HD-IVIG group, the mean total IgG concentration more than tripled and similar significant increases were seen for IgG1 and IgG2. IgG antibodies to CMV showed a marked increase in the HD-IVIG and a less pronounced rise in the CMV-IVIG group. IgM antibodies to CMV were present initially or became detectable in five patients, unrelated to the IVIG preparation. HD-IVIG induced a significant increase of IgG antibodies to streptococcal group A carbohydrate (A-CHO) and to smooth strain lipopolysaccharides (LPS) but not of antibodies against lipid-A. When the Ig treatment was discontinued, levels of total IgG and of IgG antibody to CMV decreased with an apparent half-life of 30 days. Both IVIG preparations were well tolerated and had no negative feedback on total Ig and on specific antibody production or other antimicrobial defence mechanisms. In patient nos. 4 and 10 who developed severe graft-versus-host-disease, transient serum Ig peaks including several Ig isotypes appeared after day 14. In patient no. 10 this peak contained an IgG antibody to H. influenzae type b (Hib), and IgM antibodies to CMV, Hib, A-CHO and LPS. This study clearly shows that serum concentrations of Ig isotypes, subtypes and specific antibodies, depend on at least four factors: total amount and composition of Ig infused, consumption, catabolism and endogenous production.

Adult↗
PubMed1990

Human immunodeficiency virus DNA amplification and serology in blood donors.

The significance of indeterminate screening antibody test for human immunodeficiency virus (HIV) serology is still difficult to evaluate, especially in low-risk populations. One hundred twenty-seven blood donors with an initially reactive screening test for HIV antibodies were enrolled in this study. The sera of 95 of these blood donors were reactive on repetition of the test, and none had detectable circulating p24 antigen. Western blot (WB) analysis of the repeatedly reactive sera was as follows: 9 positive, 31 indeterminate, and 55 negative. One of the blood donors with indeterminate WB later presented a seroconversion. On subsequent control 3 to 12 months later, the sera from donors with indeterminate or negative WB did not present any parameters that may indicate a seroconversion. DNA was purified from citrated blood collected from the 127 blood donors at the time of the initial antibody screening. Five micrograms of each DNA sample corresponding to 7 x 10(5) nucleated white blood cells was amplified by polymerase chain reaction (PCR) in the presence of oligonucleotides (primers) corresponding to a highly conserved segment of the pol gene. The detection of amplified DNA was achieved by dot blot and Southern blot using appropriate 32P-labeled oligonucleotides. Ten DNA samples were positive, 9 corresponded to blood donors with a positive HIV serology, and 1 to the blood donor who later presented a seroconversion. These results confirm the sensitivity of the PCR for the diagnosis of HIV infection; they also suggest that repetition of the serology at 3- to 12-month intervals is a valuable procedure for the control of HIV infection status in blood donors.

Base Sequence↗
PubMed1990

Intestinal decontamination in a polyvalent ICU. A double-blind study.

A double blind, placebo-controlled trial was performed to test the efficacy of prevention of nosocomial infections by selective digestive decontamination. Placebo or tobramycin (80 mg) and colistin (100 mg) was given four times daily via the gastric tube. Amphotericin B (500 mg/6 h) was administered to all patients. As our ICU is divided into two separate subunits, intestinal decontamination or placebo was administered alternatively to patients of the two subunits during two 3-month periods, separated by a 2-month period without prevention. The decontamination (n = 97) and placebo groups (n = 84) were similar with respect to age, sex, severity score and diagnostic categories on admission. Intestinal decontamination alone failed to significantly reduce the number of infected patients (26% vs 34.5%, p = 0.20), but was effective on ICU-acquired infections (0.33 vs 0.60, p = 0.02) especially gram-negative infection rates (0.17 vs 0.43, p = 0.01). The onset of the first ICU-acquired infection was delayed (9 vs 13 days, p less than 0.001) and incidence of pneumonia (2 vs 13 cases, p less than 0.01) including bacterial pneumonia (0 vs 8 cases, p less than 0.01) was significantly decreased. However, mean ICU stay and mortality were not significantly modified by intestinal decontamination.

Amphotericin B↗
PubMed1990

The effects of norepinephrine infusion on oxygen consumption in a patient with septic shock.

A 65-year-old man developed postsurgical septic shock, unresponsive to plasma volume expansion and administration of dopamine and dobutamine. A continuous norepinephrine infusion was then started and the dose increased to 0.62 micrograms.kg-1.min-1 until the mean arterial pressure was 70 mmHg. Prior to and during the norepinephrine infusion, oxygen consumption was continuously measured with a mass spectrometer system. There was a parallel increase in mean arterial pressure and oxygen consumption (+ 35%). There was also an increase in cardiac index and oxygen delivery. Systemic vascular resistance was only transiently increased. In this case with septic shock, norepinephrine infusion improved hemodynamic variables with an associated increase in oxygen consumption.

Aged↗