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Biomedical subjects

P Blanc

Publications and source records attributed to P Blanc.

At least 19 recordsLinked to original sources
PubMed1992

Microgranulomatous aspergillosis after shoveling wood chips: report of a fatal outcome in a patient with chronic granulomatous disease.

Chronic granulomatous disease is characterized by recurrent infections that result from an inability of phagocytes to kill organisms effectively. We describe a patient with this disease who developed aspergillus pneumonia after shoveling moldy cedar wood chips. Despite aggressive therapy, the patient's condition deteriorated and he died. At autopsy, the lungs revealed diffuse granulomas, all of the same age, with aspergillus organisms confined to the granulomas. We propose the term "microgranulomatous aspergillosis" for this response, which does not conform to the commonly described aspergillus syndromes. We conclude that susceptible immunosuppressed patients should be advised to avoid occupational situations where high spore concentrations are generated.

Adult↗
PubMed1992

Lactitol or lactulose in the treatment of chronic hepatic encephalopathy: results of a meta-analysis.

Lactitol (beta-galactosido-sorbitol) has been recently compared with lactulose for the treatment of chronic hepatic encephalopathy in a few studies, each comprising a small number of patients. The results are controversial. We studied the efficiency and tolerance of both compounds by using a meta-analysis on the basis of published controlled trials. Our study only included controlled or randomized trials comprising cirrhotic patients with chronic hepatic encephalopathy. Analyzed parameters were the portosystemic encephalopathy index of Conn after treatment, the percentage of improved patients and the percentage of patients who had ill effects related to the treatment (flatulence, diarrhea). Bibliographical screening revealed five studies comparing the effects of lactitol and lactulose in chronic hepatic encephalopathy. Four crossover studies were done that included 48 patients and one parallel study that included 29 patients. The duration of the treatment ranged from 3 to 6 mo. All studies found a similar efficiency with both drugs. However, they exhibited some discrepancies in the relative frequency of adverse reactions (flatulence). Meta-analysis showed no statistical differences in the portosystemic encephalopathy index after lactitol or lactulose treatment. The percentage of improved patients after lactitol or lactulose was similar. In contrast, the analysis revealed a higher frequency (p less than 0.01) of flatulence in patients treated with lactulose compared with those treated with lactitol. In conclusion, this meta-analysis shows no statistical difference between therapeutic effects of lactitol and lactulose, but it does show a higher frequency of flatulence with lactulose. This suggests that lactitol should be preferred to lactulose for the treatment of chronic hepatic encephalopathy.

Chronic Disease↗
PubMed1992

Influence of the rt-PA dose (1 mg/kg versus 1.5 mg/kg) and duration of administration on the patency of infarct-related coronary arteries in 81 patients.

This open study compared the efficacy and side effects of two dose regimens of intravenous rt-PA initiated before the fifth hour after the onset of myocardial infarction. The first 40 patients (group A) received 1 mg/kg of rt-PA infused over 90 minutes, including a 10-mg initial bolus. The following 41 patients (group B) received 1.5 mg/kg (20-mg initial bolus, 60% over 60 minutes and 40% over 120 minutes). Noninvasive clinical, electrocardiographic, and biochemical parameters of reperfusion were recorded systematically, along with serial measurements of fibrinogen and hemoglobin levels. Coronary arteriography and left ventriculography were performed at the 48th hour or earlier, on an emergency basis, in the absence of signs of reperfusion, or if there were clinical and ECG signs of rethrombosis. Patency of the infarct-related artery (TIMI grades 2 and 3) was achieved in 55% of the group A patients vs. 83% of the group B patients (p less than .01). Twelve emergency coronary arteriographies were performed in each group. No significant difference was observed in the ejection fraction (48% in group A vs. 52% in group B). The peak CPK level was similar in both groups, but the peak occurred earlier in group B (p less than .001). There was no statistically significant difference between the two dose regimens in terms of reduction in fibrinogen or plasminogen levels. Two deaths occurred in group A vs. one death in group B. No cerebrovascular accidents occurred in either group.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

Glucose and insulin supply before cardiopulmonary bypass in cardiac surgery: a double-blind study.

A double-blind study versus placebo was carried out to evaluate the effects of a 500-mL infusion of 30% glucose containing 300 units of ordinary insulin and 5 g of potassium chloride administered at a rate of 1.66 mL.kg-1.h-1 for 1 hour before cardiopulmonary bypass. The hemodynamic parameters measured before and after administration of the solution, after cardiopulmonary bypass, after administration of protamine, and 3 hours after leaving the operating room showed the beneficial effect of the glucose-insulin-potassium infusion on cardiac index (+23.6% after protamine infusion) and left (+16.3% 3 hours postoperatively) and right (+47.3% after cardiopulmonary bypass) ventricular workload index with a decrease in systemic vascular resistance. For patients with a cardiac index of less than 2.5 L.min-1.m-2 before administration of the glucose-insulin-potassium solution, the beneficial effect on the cardiac index was further increased 3 hours postoperatively (+33%). During the postoperative period, the requirements in inotropic drugs and disturbances of rhythm were not significantly different between the two groups, although they were twofold lower in patients receiving glucose-insulin-potassium. Laboratory tests showed that postoperative hypoglycemia was more common in the glucose-insulin-potassium group but had no detrimental effects; it no longer occurs since we began administering the glucose infusion at 15 g/h over 8 hours. The data reflect the beneficial effect associated with the action of glucose-insulin-potassium on myocardial protection during heart operations and were confirmed by the hemodynamic results. This argues in favor of the routine use of this technique, especially in patients with poor ventricular function.

Cardiac Surgical Procedures↗
PubMed1992

Cardiomyoplasty does not preclude heart transplantation.

Stimulated skeletal muscle grafts have been proposed to improve left ventricle function in patients with severe myocardial failure. In 1 particular case reported here, however, the postoperative functional improvement was only transient and disabling heart failure recurred after 9 months in spite of a vigorous latissimus muscle contraction. Heart transplantation was proposed to this patient and performed successfully. Technically, the key to heart removal depends on the retrograde dissection of the ventricular cavities, starting from the right atrioventricular groove. The intraoperative observations confirmed the viability of the latissimus dorsi muscle, inefficient on a highly dilated cardiomyopathy. Histopathological examination of the latissimus dorsi muscles showed that the transformation process of the stimulated muscle was good. Thus, severe cardiac dilatation seems to be one of the limitations of cardiomyoplasty. Cardiomyoplasty, when it fails, does not preclude heart transplantation. The histochemical studies confirm the electrophysiologic principle of cardiomyoplasty in humans.

Assisted Circulation↗
PubMed1992

Reduction in blood loss and blood use after cardiopulmonary bypass with high-dose aprotinin versus autologous fresh whole blood transfusion.

Ninety patients undergoing cardiac surgery were randomly divided into three groups of 30 patients to compare the effects on bleeding and transfusion requirements of either intraoperative infusion of high-dose aprotinin (GpI) or reinfusion of autologous fresh whole blood (GpII) versus a control group (GpIII). Standardized anesthetic, perfusion, and surgical techniques were used. Platelet counts, hemoglobin concentration, hematocrit, fibrinogen, and Ivy-Nelson bleeding times determined at fixed times perioperatively did not differ among the three groups. The total loss from the chest drains was significantly reduced in GpI (328 +/- 28 mL; mean +/- SEM) as compared with the loss in GpII and GpIII (775 +/- 75 mL and 834 +/- 68 mL, respectively). There was a threefold difference in the total hemoglobin loss (GpI, 14.2 +/- 1.7 g; GpII, 50.1 +/- 5.0 g; GpIII, 45.0 +/- 5.2 g). GpI patients also received less banked blood: 250 +/- 53 mL versus 507 +/- 95 mL in GpII and 557 +/- 75 mL in GpIII. No GpI patient required transfusion of platelets or fresh frozen plasma. Fresh whole autologous blood transfusions had no significant hemostatic effect and failed to reduce the homologous blood requirement. Conversely, high-dose aprotinin reduced blood loss and transfusion requirements.

Adult↗
PubMed1992

Acute colitis associated with prolonged administration of neuroleptics.

We describe a 29-year-old patient who developed acute colitis limited to the sigmoid and left colon with features mimicking ischemic injury after a prolonged administration of trifluoroperazine and levomepromazine, two phenothiazines in association with haloperidol, another neuroleptic, and biperidene, an anticholinergic compound. The discontinuation of these drugs was followed by a prompt and complete recovery, and no other cause of acute colitis was found. The subsequent administration of sultopride, a neuroleptic from the benzamide family and then the readministration of haloperidol were well tolerated. No colonic disorder occurred for the following months. This case strongly supports the view that neuroleptic agents, in particular phenothiazines, may induce acute colitis and that haloperidol, a butyrophenone derivative, or sultopride, a benzamide-related neuroleptic, can be administered thereafter without recurrence of the disease.

Adult↗
PubMed1992

[Cerebral embolism revealing aneurysm of the interauricular septum].

BACKGROUND: Aneurysm of the interatrial septum is a potential cause of systemic embolism, but it is rarely responsible for a cerebral embolism in childhood. CASE REPORT: A girl, aged 14 years, presented with a sudden right hemiplegia. The coagulation factors were normal, as was the CSF. The CT scan was normal and the EEG showed some theta waves (3-4/s) on the left temporal lobe. MRI, performed 6 days later, showed ischemic lesions leading to a search for the origin of the embolism. One-dimensional echocardiography revealed no abnormality, but two-dimensional echocardiography showed an aneurysm of the interatrial septum bulging into the right atrium. The child was treated with low doses of acetylsalicylic acid, but still had a moderate degree of spastic hemiplegia one year later. CONCLUSION: Cardiopathies can be among the causes of cerebral embolism in children. An aneurysm of the interatrial septum requires treatment throughout patient's life.

Adolescent↗
PubMed1992

[How to evaluate the cost/effectiveness ratio of different therapies of coronary disease].

The results of epidemiologic studies on the efficacy of different strategies of prevention or improvement of the prognosis of coronary artery disease are generally expressed in terms of percentage reduction of risk; for example, the treatment of hypercholesterolaemia reduces the risk of coronary death by 21%. In order to improve the assessment of the efficacy of these approaches the authors propose to take into account the number of subjects which needs to be treated each year to prevent one cardiovascular event more than the control group (for example, in hypercholesterolaemia, 1,736 patients). This number depends on the reduction of risk and also on the incidence of complications in the control group. Using this method, the authors classified different therapeutic strategies in order of their efficacy: thrombolytic therapy in the acute phase of myocardial infarction, then aortocoronary bypass grafting of left main coronary or triple vessel disease, secondary prevention with stopping smoking, and betablocker therapy. Finally, primary prevention with anti-smoking campaigns, treatment of hypertension and hypercholesterolemia. Based on this figure and knowing the annual cost of patient treatment, it is possible to calculate a cost-effectiveness ratio for each of these therapeutic interventions.

Adrenergic beta-Antagonists↗
PubMed1992

Interstitial deletion of the proximal region of the long arm of chromosome 18, del(18q12) a distinct clinical entity? A report of two new cases.

Two unrelated mentally retarded patients were found to have an interstitial deletion of 18q12. They were a 2-year-old, short, macrocephalic and autistic girl, and a 5-year-old boy. Six other liveborn patients with comparable deletion have been so far identified. The common findings are mild dysmorphic features (telecanthus, epicanthal folds, flaring eyebrows, small mouth with thin upper lip), hypotonia, behavioural disorders, mental retardation with speech delay and lack of major malformation.

Child, Preschool↗
PubMed1992

Rapid identification of high affinity peptide ligands using positional scanning synthetic peptide combinatorial libraries.

We describe here a conceptually unique set of individual synthetic peptide combinatorial libraries (SPCLs), termed a positional scanning SPCL (PS-SPCL), that can be used for the rapid (i.e., a single day) identification of peptide sequences that bind with high affinity to antibodies, receptors or other acceptor molecules. The PS-SPCL described here is made up of six individual positional peptide libraries, each one consisting of hexamers with a single position defined and five positions as mixtures. As an example of the utility of such PS-SPCLs, the antigenic determinants recognized by two different monoclonal antibodies were correctly identified upon a single screening.

Amino Acid Sequence↗
PubMed1992

[The fate of very early premature babies. Mortality, morbidity and 2-year follow-up in a population of 96 very early premature babies].

The neonatal fate, and outcome at 2 years in a population of 96 premature babies born after no more than 28 weeks of amenorrhea is described. Mortality was directly influenced by the gestational age (< 26 WA = 52% vs. > or = 26 WA = 21.1%, p < 0.01) and the birth weight (< 1,000 g = 41.5% vs. > 1,000 g = 20%, p < 0.05). Two other factors with a harmful impact were identified: retarded growth (neonatal mortality doubled) and fetal multiplicity (increased fourfold). Investigation of the neonatal morbidity highlights the importance of respiratory, neurological and digestive problems. Assessment of the longer-term outcome has shown an 11.3 p. cent incidence of handicap. An estimation of the prognosis on the basis of gestational age is proposed.

Apgar Score↗
PubMed1992

[Medical behaviors and cancer of the exocrine pancreas].

A French national enquiry examined 4,530 cases of cancer of the exocrine pancreas treated from 1982 to 1989. Ultrasonography was performed in 98% of cases. Other radiological or biological investigations varied from one department to another (P < 0.001). Of 769 patients seen in Gastroenterology departments, 47% (range: 0 to 72%) were operated on. Of 3,761 patients undergoing operation, surgical techniques differed significantly from one department to another (P < 0.001). Resections were performed in 21% (range: 2 to 45%) of cases. Causes of unresectability, choice of biliary bypass, indications for gastrojejunostomy, and use of splanchnicectomy varied from one surgical department to another (P < 0.01). Wide variance in therapeutic policies may be explained by differences in local indications or surgical expertise, giving support to the need for a consensus conference to discern the indications of the available therapeutic alternatives for cancer of the exocrine pancreas.

Biliopancreatic Diversion↗
PubMed1992

Mitotic responsiveness of cultured adult human hepatocytes to epidermal growth factor, transforming growth factor alpha, and human serum.

The present study was undertaken to evaluate the ability of human hepatocytes to respond in culture to various mitotic agents including epidermal growth factor (EGF), transforming growth factor alpha (TGF-alpha), or serum from patients with fulminant hepatitis. Human hepatocytes were maintained in culture on collagen-coated plates in a chemically and hormonally defined serum-free medium at low cell density. Twelve hours after plating, cultures were treated with increasing amounts of EGF (1-100 ng/mL), TGF-alpha (1-100 ng/mL), or human serum (1%-10%) for 0-96 hours. Proliferative response was assessed by determining against time the rate of DNA synthesis by [3H]thymidine incorporation in DNA, the labeling index, the expression of cyclin A, the amount of DNA, and the number of cells. The rate of DNA synthesis reached a maximum after 48 hours of treatment with 20 ng/mL EGF, 40 ng/mL TGF-alpha, or 5%-10% of human serum (fulminant hepatitis); the average increase with respect to untreated cells was 4.35 times with EGF, 5.4 times with TGF-alpha, and 4-6 times with serum from patients with fulminant hepatitis. The maximum expression of cyclin A coincided with the maximum of DNA synthesis. After 72 hours of treatment with EGF or human serum (fulminant hepatitis), the amount of DNA increased by 75%-100% (P less than 0.001) and the number of cells by 50% (P less than 0.001). These results show that adult human hepatocytes respond to mitogens, as expected from previous studies on animal hepatocytes, and provide experimental basis for future investigations in the field of human liver regeneration.

Adult↗