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Biomedical subjects

P Gelas

Publications and source records attributed to P Gelas.

18 recordsLinked to original sources
PubMed1999

Waterborne outbreak of intestinal microsporidiosis in persons with and without human immunodeficiency virus infection.

Among 1454 persons whose stool samples (n=5692) were submitted to a reference laboratory for microsporidia assessment from 1993 to 1996, microsporidia were identified in 338 persons: 261 persons infected with human immunodeficiency virus (HIV), 16 transplant patients, and 61 others. Intestinal microsporidiosis appears to be an endemic disease in HIV-positive persons (prevalence, 0.1%) and a sporadic disease in HIV-negative persons (prevalence, <1/1 million). A waterborne outbreak in 200 persons (attack rate, 1% in HIV-positive patients/month) occurred in the 1995 summer, without evidence of fecal contamination of water. No explanation was found before the outbreak ended, several months before the antiprotease era. Factors associated with microsporidiosis diagnosis were HIV infection, male homosexuality, low CD4 cell counts, and diarrhea. The major factor associated with a diagnosis of microsporidiosis during the outbreak was living in an area corresponding to one of the three water distribution subsystems of the town. Lake contamination was suspected.

Adult↗
PubMed1996

Efficacy of 2-month total parenteral nutrition in AIDS patients: a controlled randomized prospective trial. The French Multicenter Total Parenteral Nutrition Cooperative Group Study.

OBJECTIVE: To evaluate the efficacy of total parenteral nutrition in AIDS patients. DESIGN: A prospective, randomized, controlled, multicentre trial. METHODS: Over a period of 2 months, 31 malnourished and severely immunodepressed AIDS patients were assigned to receive either dietary counselling (n = 15) or home total parenteral nutrition (TPN; n = 16) via a central venous access after an educational program. Results were analysed by intent-to-treat basis. RESULTS: Bodyweight change was +8 kg (+13 +/- 3%) in the TPN group and -3 kg (-6 +/- 2%) in the control group (P < 0.0006). Lean body mass increased in the TPN group (+9 +/- 3%) and decreased in the control group (-5 +/- 3%; P < 0.004) while body cell mass increased in the former (+15 +/- 4%) and decreased in the latter (-12 +/- 6%; P < 0.002). Nutritional subjective global assessment, subjective self-reported health feeling and Karnofsky index were also improved by TPN. Infection line sepsis incidence remained low (0.26 per 100 patient-days). However, no difference in survival rate was exhibited between the two groups by the log-rank test. CONCLUSION: We conclude that home TPN is an efficient treatment of malnutrition in severely immunodepressed AIDS patients.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Home parenteral nutrition and AIDS.

The evolution of AIDS in 25 patients enrolled in a home parenteral nutrition(HPN) programme was analysed retrospectively. All patients were grade 4C or 4D (CDC criteria). All suffered from major gastrointestinal symptoms, 13 had anorexia (< 700 kcal/day) and the overall mean weight loss was 21%. HPN involved administration of an all-in-one nutritional formula (caloric intake = 148% of MREE) which was infused at night through a Broviac type silastic catheter or a subcutaneous infusion port. It was continued until the patient's death or temporary recovery. 19 patients died during PN, 4 showed a temporary stabilisation. The average duration of PN was 180 days (54-358). Because of rehospitalizations for opportunistic infections or PN complications, the mean time spent at home was only 101 days (13-296), or 58.5% of the total duration of PN. 21 patients experienced weight gain and the Karnofsky activity index increased in half the patients. A temporary return to work was possible in only 3 patients. 15 PN related septicaemias were diagnosed for 4400 days of PN (0.34 for 100 days). On the whole, HPN seems to have been beneficial in 13 out of 25 patients, but the criteria for identifying patients who are likely to respond are not clearly established.

Journal Article↗
PubMed1994

Effects of intravenous medium-chain triglycerides on pulmonary gas exchanges in mechanically ventilated patients.

OBJECTIVE: In mechanically ventilated patients, pulmonary gas exchange was investigated during the administration of total parenteral nutrition containing medium-chain triglycerides or long-chain triglycerides as fat emulsions. DESIGN: Prospective, randomized, crossover trial (two lipid infusion periods of 8 hrs). SETTING: Intensive care unit in a university hospital. PATIENTS: Six mechanically ventilated patients, using the pressure-support mode. INTERVENTIONS: Total caloric intake was adapted according to measured energy expenditure. Fat emulsion provided 50% of the energy expenditure. Patients were infused with 50% medium-chain/50% long-chain triglycerides or 100% long-chain triglycerides in a random sequence. MEASUREMENTS AND MAIN RESULTS: Oxygen consumption, CO2 production, and minute ventilation were measured by indirect calorimetry. PaO2 and PaCO2 were determined in blood samples. Medium-chain triglycerides increased oxygen consumption by 27.8% and minute ventilation by 14.3% at the end of the protocol. CO2 production, PaO2, and PaCO2 were not different between groups. CONCLUSIONS: Medium-chain triglycerides cause an increase in metabolic demand in mechanically ventilated patients when they are infused over a short period. Postoperative or intensive care unit patients with a low pulmonary reserve should receive infusions of medium-chain triglycerides over a more prolonged period than long-chain triglycerides.

Aged↗
PubMed1992

Catheter fracture and embolisation in a totally implanted venous access catheter (TIVAC) following shoulder trauma.

A totally implanted intravenous catheter (TIVAC) was placed via the subclavian vein in a 32-year-old male patient with HIV infection for intermittent drug therapy. 8 months after insertion, a catheter fracture was noted with embolisation of the distal part into the heart. This accident was related to shoulder trauma with a downward movement of the clavicle. In active patients alternatives to the subclavian approach for TIVAC need to be considered.

Journal Article↗
PubMed1992

[Acute respiratory insufficiency caused by diffuse pulmonary hemorrhage].

Two cases of adult respiratory distress syndrome due to diffuse pulmonary haemorrhage are reported. The first patient was treated with azathioprine, prednisolone, cyclosporine and ranitidine for haemorrhagic rectocolitis; the second has untreated primary biliary cirrhosis. Haemoptysis only occurred in the latter. Both had severe isolated hypoxaemia. Chest X-rays revealed bilateral alveolar infiltrates. Bronchoscopies showed a diffusely bleeding bronchial tree. Both patients recovered after having been mechanically ventilated with positive end-expiratory pressure for six and eight days respectively. The cause of the diffuse pulmonary haemorrhage was, in the first case, severe thrombocytopaenia (17,000 G.1-1) of central origin, and, in the other patient, an unspecified vasculitis. Diffuse pulmonary haemorrhage should be added to the list of possible causes of the adult respiratory distress syndrome.

Adult↗
PubMed1991

[Biological and clinical surveillance techniques: problems and complications of enteral feeding].

The present high degree of safety of enteral nutrition is due to improvements in commercial nutritional products and, chiefly, to the respect of well-established rules of administration. Monitoring the equipment consists of making sure, by means of repeated rinsing, that the fine digestive tract prosthesis remains patent. Nutrients are now sterile and easy to use, and their compositions varied and well-balanced. They are very well tolerated in most cases. Monitoring the speed of gastrointestinal (GI) transit is crucial. One must watch for the occurrence of multiple daily stools, due to the speed of administration or to malabsorption, proliferation of exogenous or endogenous pathogens or patient's underlying pathology, and for a gastric fluid residual volume exceeding 150 ml. Regular controls of gastric emptying and of GI prosthesis position prevent the very rare complications that are aspiration pneumonia and unexplained chronic dyspnoea. Possible interference between enteral nutrition and patient's pathology or treatment must be detected and prevented.

Enteral Nutrition↗
PubMed1991

Subcellular localization of enzymes related to PAF metabolism in Krebs-II ascites cells: evidence for the lack of intracellular PAF transfer activity.

We have investigated various steps in the metabolism of Platelet-Activating Factor (PAF-acether or PAF) at the subcellular level in Krebs-II ascites cells. Microsomes contained an active acetyltransferase located on a heavy-rough domain of the endoplasmic reticulum quite rich in ribosomes, as monitored by [3H]uridine labelling, and which displayed a very high density across the Percoll gradient. This membrane domain, which was separated from all other cellular organelles including peroxisomes, also contained a membrane-bound acetylhydrolase with similar activity as the acetyltransferase. However most part of the cellular acetylhydrolase was located in the cytosol, which was actually devoid of PAF transfer activity, normally involved in transport of the mediator within the cell.

Acetyltransferases↗
PubMed1990

[Sleep and psychological disorders in intensive care units].

The evaluation of sleeping and psychical disorders for 24 patients hospitalized during at least 5 days in an intensive care unit was realized through a semi-guiding talk with a psychiatrist. All patients were faced to a very disordered sleep and a high number of psychopathological phenomenons: amnesia, disorientation, hallucinations, anxiety, depression. Different factors are concerned in the genesis of those troubles. Some means could prevent it.

Critical Care↗
PubMed1989

Differential activation by fMet-Leu-Phe and phorbol ester of a plasma membrane phosphatidylcholine-specific phospholipase D in human neutrophil.

Signal transduction involving phosphatidylcholine hydrolysis has been investigated in human neutrophils (PMN) after in situ generation of [3H]alkylacyl-sn-glycero-3-phosphocholine ([3H]alkylacyl-GPC) by cell incubation with [3H]alkylacetyl-GPC. When PMN were stimulated with the chemotactic peptide N-formyl-Met-Leu-Phe(fMLP) or phorbol myristate acetate (PMA) in the presence of cytochalasin B, both 1-O-alkyl-2-acyl-sn-glycero-3-phosphate (PA) and 1-O-alkyl-2-acyl-sn-glycerol (AAG) were generated. On addition of the agonists in the presence of ethanol, phosphatidylethanol (PEt) [corrected] was formed with a concomitant decrease in PA and AAG. These results indicate the presence of a phospholipase D (PLD) acting on phosphatidylcholine in human PMN. The kinetics of hydrolysis were quite different according to the stimulus. Whereas fMLP induced a maximum rise in PA and AAG at 30-45 s, these products began to appear only after 1 min upon cell incubation with PMA. Similar amounts of products were formed at 1 min with fMLP and only at 5 min with PMA. Although similar time courses of PA generation were obtained in the absence of cytochalasin B, AAG were no longer involved and therefore cannot account for intracellular second messenger under physiological conditions. Subcellular distribution studies demonstrated the exclusive location of PA and PEt [corrected] in the plasma membrane. The possible involvement of PA in respiratory burst activation is discussed.

Cell Membrane↗
PubMed1988

[Trace elements in artificial nutrition. Art and practice].

The trace elements known to be necessary for man are iron, zinc, copper, selenium, chromium, manganese, molybdenum, cobalt and iodine. This review article, which excludes iron, deals with the need for supplemental trace elements during artificial feeding, and the way they should be administered. The biological importance of these trace elements is argued on the basis of their biochemical involvement and the clinical pictures seen in accidental or experimental deficiency states. Assessing a patient's trace element status is rather difficult. The relative merits of different laboratory investigations is discussed: plasma, erythrocyte, capillary and urinary levels, specific enzyme activities, loading tests. The different situations when trace elements are required, assessing the amount needed and the possible toxic risks, are presented from a literature survey.

Alcoholism↗
PubMed1980

[Gangrenous cholecystitis without lithiasis. A report on a case diagnosed by simple radiography of the abdomen (author's transl)].

The authors report a case of gangrenous cholecystitis without lithiasis but with secondary infection of the gallbladder by anaerobic germs. Pre-operative diagnosis was possible from simple x-rays of the abdomen which demonstrated an obvious fluid level in the gallbladder, and by parietography. An immediate cholecystectomy was performed. Bacteriological examination of the bile confirmed the presence of Clostridium perfringens. The main bile duct appeared normal and the bile in the common bile duct was sterile. Convalescence was uneventful with antibiotic cover, in spite of the age and condition of the patient. Gangrenous cholecystitis occurs more frequently without gallbladder stones in humans. Clinical signs are not specific but simple x-rays of the abdomen are pathognomonic and enable pre-operative diagnosis to be made. Urgent cholecystectomy appears to be the ideal treatment. This affection has a high mortality and early operation is therefore justified.

Aged↗
PubMedDate not supplied

Effect of parenteral medium- and long-chain triglycerides on lymphocytes subpopulations and functions in patients with acquired immunodeficiency syndrome: a prospective study.

BACKGROUND: Total parenteral nutrition (TPN) may offer significant clinical benefit in malnourished patients with acquired immunodeficiency syndrome (AIDS). However, the immunologic effect of parenteral lipids remains unknown in these severely immunodepressed patients. METHODS: We undertook a prospective randomized double-blind multicenter study comparing the effects of two i.v. lipid emulsions used during TPN: long-chain triglycerides (LCT) or balanced emulsion of long-and medium-chain triglycerides (LCT/MCT). Thirty-three AIDS patients requiring TPN for wasting and reduced oral intake were allocated randomly to receive a ternary TPN mixture consisting of 1.5 g/kg/d proteins, 18 kcal/kg/d lipids, and 12 Kcal/kg/d carbohydrates for 6 days. The following tests were performed at days 0 and 7: immunoglobulins, complement fractions, lymphocyte subpopulations count, and lymphocyte proliferation with mitogens. RESULTS: Patients were all severely malnourished (weight loss: -14.0 +/- 1.3 kg). No clinical or biological differences were observed between the groups at baseline. At day 7, both groups reported a significant increase in weight. Patients in the LCT group exhibited a significant decrease in phytohemagglutinin A response (p = .04) compared with baseline. Patients in the LCT/MCT group exhibited a lower level of IgM (p = .03) and significant increase in C3 fraction (p = .03) compared with baseline. They also showed a tendency to have a higher CD4/CD8 lymphocyte ratio (p = .07), whereas other immunological parameters remained unchanged CONCLUSIONS: Parenteral ternary mixture containing LCT or LCT/MCT are clinically well tolerated in AIDS patients over 6 days. With 2 g/kg/d of lipids, LCT seems to induce significant abnormalities in lymphocyte function. Such abnormalities are not observed with LCT/MCT.

Acquired Immunodeficiency Syndrome↗