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Biomedical subjects

P Brun

Publications and source records attributed to P Brun.

At least 109 records · Page 6Linked to original sources
PubMed1990

[Myocardial mass index in the diagnosis of acute rejection of allogeneic heart transplants].

Changes in an index of left ventricular mass were evaluated in the diagnosis of acute cardiac transplant rejection in a prospective study involving 28 transplant patients by comparison with the histology of endomyocardial biopsy. The surface of a ring of left ventricular myocardium obtained from a 2D echocardiographic examination was used as an index of mass. Eighty-three pairs of results--biopsy and index of mass--recorded within a 12 hour interval were obtained between the first day and 10th month of transplantation over a period of 12 consecutive months. Echocardiographic diagnosis of acute rejection was made when the index of myocardial mass increased by over 7 per cent compared with baseline values recorded during the first 3 days of transplantation or during a new period of equilibrium after an episode of rejection. Two groups of patients were identified from the results of biopsy, taken as the reference: in 16 patients with mild or moderate histological signs of rejection the variation of the index of mass was 18.3 +/- 9.1%; endomyocardial biopsy was negative in the 12 other patients and the change in index of mass was -1.5 +/- 5.2% (p less than 0.001). The overall concordance in the 83 successive results was good with a Kappa coefficient of 0.71. The other parameters which have been reported to be useful in diagnosing rejection (relaxation, antegrade diastolic mitral flow, acoustic density of myocardium) present a number of problems in routine practice related either to difficulties with the recording of the data or to its interpretation.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1990

[Severe thrombocytopenia induced by heparin in an infant with acute myocarditis].

A severe heparin-induced thrombocytopenia is reported in a child suffering from acute myocarditis. Thrombocytopenia (80.10(9)/l) occurred on day 5 (D5) of heparin therapy which was thus discontinued during 8 hours but reintroduced on the view of a negative platelet aggregation test using standard heparin. On D10, while thrombocytopenia persisted the presence of two intra-cardiac thrombi led to replace standard heparin by low molecular weight heparin (Fraxiparin), associated with vitamin K antagonist (phenindione). On D12, a 3rd intra-cardiac thrombus required immediate discontinuation of Fraxiparin therapy. Platelet aggregation tests performed on D14 were positive in the presence of standard heparin and of low molecular weight heparin, thus demonstrating the existence of thrombocytopenia induced by standard heparin and secondly by low molecular weight heparin. This observation led the authors to discuss the diagnosis and the therapeutic management of heparin-induced thrombocytopenia.

Acute Disease↗
PubMed1990

[Polymyalgia induced by topical minoxidil].

Topical minoxidil, used in the treatment of baldness, has been commercially available since 1987. Its systemic side effects are rare. We observed an as yet unreported "polymyalgia syndrome" in four otherwise healthy males whose sole medication was topically applied minoxidil. They experienced fatigue, weight loss and severe pain in the shoulders and pelvic girdle, suggesting connective tissue disease. Three patients had a transient rise in liver enzymes, while other laboratory analyses remained normal. Tritanomaly was detected in two patients who underwent systematic color vision testing. All symptoms disappeared after withdrawal of minoxidil. Rechallenge was positive once in one patient and twice in another. The mechanism of this side effect remains to be determined.

Administration, Topical↗
PubMed1987

Transcriptional and post-transcriptional regulation of vitamin D-dependent calcium-binding protein gene expression in the rat duodenum by 1,25-dihydroxycholecalciferol.

Regulation of the expression of vitamin D-dependent calcium-binding protein (Mr 9000 CaBP) gene by 1,25-dihydroxycholecalciferol (1,25-(OH)2D3) was studied in the rat duodenum. In vivo stimulation of Mr 9000 CaBP synthesis was analyzed using a complementary DNA probe and by measuring the rate of Mr 9000 CaBP gene transcription in isolated nuclei (run-on assay). A single 1,25-(OH)2D3 injection (650 pmol/100 g of body weight) induced a 2-fold increase in Mr 9000 CaBP gene transcription within 15 min in the duodenum of vitamin D-deficient rats. RNA synthesis was maximal at 1 h, then decreased until 16 h of postinjection. There was an initial transient accumulation of Mr 9000 CaBP mRNA (from 7 to 15 min), which was followed by a second, significant increase, by 3 h which remained elevated until 16 h. The magnitude and time course of the Mr 9000 CaBP increase was similar to that of its mRNA as early as 1 h after 1,25-(OH)2D3 administration. Mr 9000 CaBP gene transcription was not significantly induced by 1,25-(OH)2D3 in vitamin D-replete rats and no transient accumulation of Mr 9000 CaBP mRNA was observed. Thus, 1,25-(OH)2D3 modulates Mr 9000 CaBP gene expression in at least two ways, a rapid transcriptional stimulation and a post-transcriptional effect preventing degradation of Mr 9000 CaBP transcripts and accounting for their accumulation several hours after the hormone treatment.

Animals↗
PubMed1987

Pulmonary oedema during pulmonary embolism.

Pulmonary oedema during angiographically proved massive pulmonary embolism without left ventricular failure is unusual. A few previous reports have used haemodynamic data obtained during the acute phase to rule out left ventricular failure. The following case, which we were able to observe for a period of 4 years has given further evidence of uninvolved left ventricular function.

Female↗
PubMed1987

Epidemiological survey of a major outbreak of nosocomial legionellosis.

Forty-seven nosocomial cases of legionellosis due to Legionella pneumophila serogroup 1 were diagnosed in one major outbreak from November 1982 to March 1983 in a 960-bed teaching hospital. Contaminated water was considered to be a possible source of infection because, during that period, monthly samples were found to be positive with averages of 10(4) CFU/l. After chlorination of hot water associated with flushing of outlets, nearly all samples taken in the next two years were found to be negative. A case-control study was performed to examine potential risk factors. Three groups of controls were randomly selected among eligible patients. In a multivariate analysis, only three clinical factors were found to be associated with legionellosis patients: malignant illness (relative risk, RR = 3.5), presence of an ultimately fatal disease (RR = 2.6), and exposure to corticosteroids prior to admission (RR = 7.9). Investigations of in-hospital exposures suggest that during this nosocomial outbreak diagnostic or therapeutic respiratory procedures had not increased the risk of illness. Although the epidemiological association between water contamination and disease remains unclear, the eradication of L. pneumophila from the identified supply seems to have been effective in preventing disease in this hospital.

Adolescent↗
PubMed1987

Pulmonary disposition of roxithromycin (RU 28965), a new macrolide antibiotic.

The penetration of roxithromycin (RU 28965), an ether oxime derivative of erythromycin, into the cells and fluid lining the epithelial surface of the lower respiratory tract was studied by performing fiber-optic bronchoscopy with bronchoalveolar lavage on eight patients who had received roxithromycin at 300 mg perorally every 12 h for 5 days. The apparent volume of epithelial lining fluid recovered by bronchoalveolar lavage was determined by using urea as an endogenous marker. There was a significant relationship (r = 0.75; P less than 0.02) between roxithromycin levels in plasma and epithelial lining fluid, with a correlation whose slope suggested that the level of drug penetration into the lining fluid was 0.2. Concentrations of the antibiotic in cells recovered by bronchoalveolar lavage (21 +/- 10 micrograms/ml) were 2 and 10 times higher than in plasma (11.4 +/- 5.7 micrograms/ml) and epithelial lining fluid (2.0 +/- 1.7 micrograms/ml), respectively. Thus, when administered perorally in humans, roxithromycin is markedly accumulated by resident alveolar macrophages in concentrations largely exceeding the MBCs of the drug for most facultative intracellular pathogens including Legionella pneumophila, despite low concentrations in the epithelial lining fluid.

Bronchitis↗
PubMed1987

Acute and latent pneumonitis after subcutaneous injections of silicone in transsexual men.

We evaluated 13 transsexual men who were hospitalized for symptoms resulting from illicit subcutaneous injections of silicone. Patients with acute silicone pneumonitis were admitted because of fever, bilateral pulmonary infiltrates, and hypoxemia (mean PaO2, 58 +/- 14 mm Hg). Most patients in this group had received new silicone injections within hours of admission, but one presented with the same clinical syndrome a few hours after a brawl. The alveolitis of acute silicone pneumonitis was characterized by increased numbers of alveolar macrophages, neutrophils, and eosinophils (p less than 0.05 compared with those in normal persons with a similar smoking history). Evidence of alveolar hemorrhage was also present in some cases. Alveolar macrophages contained large, pleomorphic, cytoplasmic inclusions, which were identified as silicone by atomic absorption and infrared spectrometry. Patients with latent silicone pneumonitis underwent clinical study at much longer times after the silicone fluid injections because they developed local inflammatory phenomena at the sites of previous injections. Pulmonary function studies usually showed slight restrictive changes, and bronchoalveolar lavage disclosed abnormalities similar to those found in patients with acute silicone pneumonitis, although to a lesser degree. Thus, illicit silicone fluid injection carries a serious respiratory risk since it can induce pneumonitis, followed in some patients by respiratory failure.

Acute Disease↗
PubMed1987

Vitamin D-dependent calcium-binding proteins (CaBPs) in human fetuses: comparative distribution of 9K CaBP mRNA and 28K CaBP during development.

The vitamin D-dependent calcium-binding protein (CaBP) cholecalcin or calbindin, has been used as a molecular marker of 1,25-dihydroxyvitamin D3 action. Mammals possess two CaBPs: a 9,000 mol wt (9K CaBP) and a 28,000 mol wt (28K CaBP). The distinct localization of each protein in the rat has been previously described with the aid of specific radioimmunoassays developed for each CaBP. Antibodies raised against the rat 28K CaBP can be used to detect this protein in a number of mammalian species including humans. In contrast, antibodies against rat 9K CaBP do not cross react with human 9K CaBP, but human 9K CaBP mRNA can be analyzed using a cDNA probe for rat 9K CaBP mRNA. Such a cross-hybridization between the rat cDNA probe and human CaBP mRNA was demonstrated by Northern analysis. We have documented the distribution and evolution of 28K CaBP and 9K CaBP mRNA in human tissues during fetal development from 14 to 32 wk of gestation. 28K CaBP was only present in kidney and cerebellum, and not detectable in duodenum. There was a 2-fold increase of 28K CaBP in the cerebellum between 14 and 24 wk of gestation. The 9K CaBP mRNA was unevenly distributed in human fetal tissues. 9K CaBP mRNA was present in classical vitamin D target tissues such as duodenum and placenta; high levels of 9K CaBP mRNA also were found in thymus and lung.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1987

Pulmonary fibrosis following pneumonia due to acute Legionnaires' disease. Clinical, ultrastructural, and immunofluorescent study.

During a recent nosocomial outbreak, 20 critically ill patients with acute Legionnaires' disease were admitted to the intensive care unit of Hopital Bichat, Paris. Pulmonary specimens were obtained at surgery or immediately after death in 12 patients and were examined by light, immunofluorescent, and electron microscopy. Five of these 12 patients showed evidence of pulmonary fibrosis. In all of these five patients, infection with Legionella pneumophila was evidenced by bacteriologic methods, and other diseases known to cause fibrosis were excluded. The condition of four patients deteriorated rapidly with respiratory failure, and they died with pulmonary fibrosis. Only one patient finally recovered but was left with pulmonary sequelae. Two distinctive morphologic patterns were observed, one in which interstitial fibrosis was predominant and one in which intra-alveolar organization and fibrosis were also present. The alveolar epithelial lining and the basement membranes were disrupted in all patients, as evidenced by ultrastructural observations and by immunofluorescent studies showing gaps in the distribution of type 4 collagen and laminin. Types 1 and 3 collagen accumulated in areas corresponding to thickened interstitium and intra-alveolar fibrosis. Thus, some patients who survive the acute pneumonia of Legionnaires' disease may develop pulmonary fibrosis, and this process may lead to functional impairment or death despite prompt and appropriate treatment.

Adult↗
PubMed1986

In vivo effects of transcriptional and translational inhibitors on duodenal vitamin D-dependent calcium-binding protein messenger ribonucleic acid stimulation by 1,25-dihydroxycholecalciferol.

The in vivo stimulation of vitamin D-dependent calcium-binding protein (9 K CaBP) synthesis by 1,25-dihydroxycholecalciferol [1,25(OH)2D3] in the rat duodenum has been analyzed using a specific [32P]complementary DNA probe for rat 9 K CaBP and inhibitors of RNA transcription (actinomycin D, alpha-amanitin) or protein synthesis (cycloheximide). The relative amounts of 9 K CaBP messenger RNA (mRNA) were assayed by dot-blot hybridization and the relative amounts of 9 K CaBP by RIA. Both inhibitors were injected at doses which significantly inhibited by 80-95% [35S]methionine or [3H]uridine incorporation into protein and RNA, respectively. In vitamin D-deficient rats, a single 1,25(OH)2D3 injection (650 pmol/100 g BW) resulted in a rapid production of 9 K CaBP mRNA which was significantly detectable as early as 3 h, and was followed by an increase of 9 K CaBP levels. Injection of actinomycin D (25 micrograms/100 g BW) 1 h before 1,25(OH)2D3 treatment and repeated every 4 h did not prevent the hormone-induced elevation of duodenal CaBP mRNA, even when the actinomycin dose was doubled and given 2 h before hormonal treatment. alpha-Amanitin (2 micrograms/100 g BW) also failed to block the hormonal stimulation. The protein synthesis inhibitor cycloheximide (25 micrograms/100 g BW) did not cause any change in the 1,25(OH)2D3-induced CaBP mRNA but blocked the CaBP increase after hormone injection. Thus, transcription inhibitors did not prevent the in vivo hormone-induced elevation of 9 K CaBP mRNA, which suggests that 1,25(OH)2D3 increases 9 K CaBP synthesis by increasing 9 K CaBP gene expression at one or more posttranscriptional steps. More precise data will be obtained by measuring the rate of 9 K CaBP gene transcription on isolated nuclei from rat duodenum.

Amanitins↗
PubMed1985

Langerhans' cells in patients with psoriasis: effect of treatment with PUVA, PUVA bath, etretinate and anthralin.

Suction blisters were raised in lesions and normal appearing skin of patients with psoriasis. The blister roof which contains the epidermis separated at the dermal-epidermal junction was stained with ATPase, OKT-6 and anti-HLA-DR monoclonal antibodies. The technique permits the counting of the Langerhans' cells per mm2. Their mean number varied between 888-987 cells per mm2 in control subjects with the three staining procedures. In patients with psoriasis, the number of cells before treatment was between 1110-1179 in uninvolved skin and 521-1001 per mm2 in the lesions as measured using both monoclonal antibodies and ATPase. However, the latter technique seemed to be inappropriate for lesional skin. After treatment with PUVA bath or oral PUVA with or without etretinate, fewer Langerhans' cells were seen in both lesions and normal appearing skin with the appearance of giant Langerhans' cells with long dendrites. In patients healed with anthralin + UV-B the Langerhans' cells appeared normal in number and size.

Adenosine Triphosphatases↗
PubMed1985

[Normalization of the dimensions of the left ventricle as measured by echocardiography].

An M mode echocardiographic study was performed, of left ventricular dimensions and wall thickness in two series of normal (N1, N2) and pathological (P1, P2) subjects. In the more recent series (N2 = 40, P2 = 17) data acquisition was facilitated by tests deduced from the technique of ultrasound transit time. The parameters compared were based on: 1) the proportionality between fractional shortening and fractional thickening (N1: not significant; N2: p less than 0.001), 2) the relationship between systolic radius and wall thickness (linear correlation, r = 0.95, between N2 and P2). The slope seemed to be related to the initial condition of contraction, the ratio of end diastolic wall thickness/radius (N1: p less than 0.01). There are several ways of normalising myocardial surface of section in adults and children; the normal surface is related to body surface area (r = 0.87; p less than 0.001 between calculated and predicted values for a N2 mean of 9.3 +/- 0.06 cm2/m2). The end diastolic diameters and wall thicknesses correlated with body surface area but the coefficients were not as statistically significant due to physiological variations in chamber filling. The indexed myocardial surface was increased (p less than 0.001) in the pathological series. The introduction of these tests improves the reliability of echocardiographic data. The use of several measurements simultaneously allows normalisation of body surface area and increases the diagnostic efficacy.

Echocardiography↗