Biomedical subjects
Publications and source records attributed to A Blum.
A case of agenesis of the right lobe of the liver associated with portal hypertension is reported. This uncommon feature was diagnosed by computed tomography which excluded secondary liver atrophy due to cirrhosis or tumour. The main pathophysiological hypothesis for agenesis and portal hypertension, exceptionally associated, is arrest of hepatic development during foetal life.
AIM: To describe the US, CT and MRI pattern of the severe rectus sheath hematoma (RSH) complicating anticoagulant therapy. MATERIALS AND METHODS: CT scans were performed in thirteen patients (12 women, 1 man) aged from 53 to 90 (mean age, 74) with severe RSH. Five patients also underwent ultrasound examination and three MR examination. Nine patients (69%) were receiving subcutaneous injection of heparin, three (23%) oral anticoagulant therapy and one continuous IV infusion of heparin. Clinical diagnosis was reached in 6 cases. Excessive activity of anticoagulant therapy was noted in 4 cases. The location of the RSH, their densities and their signal were analysed. RESULTS: All the RSH were mostly developed in the lower third of the abdominal wall, had a large spreading into the Retzius space and compressed the bladder and/or the bowels. RSH were all hyperdense and in 8 cases (61%) a fluid-fluid level due to the hematocrit effect was noted. In one case, a retroperitoneal hematoma was discovered. The extension of the RSH was well delineated with MRI. The RSH showed itself with heterogeneous signal intensities with areas of high-signal-intensity on T1-weighted images. Fluid-fluid levels and a concentric ring sign were also noted. CONCLUSION: Older women with subcutaneous injection of heparin are especially prone to RSH even though there is no overall excessive activity of anticoagulant therapy. Clinical and biological diagnosis may be difficult. CT scan is the exam of choice to reach a precise and acute diagnosis of RSH.
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Acute pulmonary embolism is a medical emergency and diagnostic certitude must be obtained as early as possible. In clinically serious situations, spiral CT is a reliable diagnostic tool. It provides direct signs of embolism with visualisation of thrombi in the pulmonary arteries as far as the segmental branches and its diagnostic value does not change in cases of pulmonary parenchymal involvement. In emergencies, spiral CT should replace pulmonary angiography, which is more costly and associated with greater morbidity and mortality. Other methods, in particular MRI, which is totally innocuous, could play an important role in the diagnostic strategy of acute pulmonary embolism in the near future.
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OBJECTIVE: To assess three anti-stress ulcer prophylaxis regimens in mechanically ventilated patients for bacterial colonization, early- and late-onset nosocomial pneumonia, and gastrointestinal bleeding. DESIGN: Randomized controlled trial. PATIENTS: Consecutive eligible patients with mechanical ventilation and a nasogastric tube. Of 258 eligible patients, 244 were assessable. SETTING: Medical and surgical intensive care units. INTERVENTION: At intubation, patients were randomly assigned to receive one of the following: antacid (a suspension of aluminum hydroxide and magnesium hydroxide), 20 mL every 2 hours; ranitidine, 150 mg as a continuous intravenous infusion; or sucralfate, 1 g every 4 hours. MEASUREMENTS: Using predetermined criteria, the incidence of gastric bleeding, gastric colonization, early-onset pneumonia, and late-onset pneumonia was assessed in patients intubated for more than 24 hours. RESULTS: Of 244 assessable patients, macroscopic gastric bleeding was observed in 10%, 4%, and 6% of patients assigned to receive sucralfate, antacid, and ranitidine, respectively (P > 0.2). The incidence of early-onset pneumonia was not statistically different among the three treatment groups (P > 0.2). Among the 213 patients observed for more than 4 days, late-onset pneumonia was observed in 5% of the patients who received sucralfate compared with 16% and 21% of the patients who received antacid or ranitidine, respectively (P = 0.022). Mortality was not statistically different among the three treatment groups. Patients who received sucralfate had a lower median gastric pH (P < 0.001) and less frequent gastric colonization compared with the other groups (P = 0.015). Using molecular typing, 84% of the patients with late-onset gram-negative bacillary pneumonia were found to have gastric colonization with the same bacteria before pneumonia developed. CONCLUSION: Stress ulcer prophylaxis with sucralfate reduces the risk for late-onset pneumonia in ventilated patients compared with antacid or ranitidine.
T-lymphocyte levels may adversely affect the clinical course and outcome of patients with acute myocardial infarction (AMI). To characterize the T-lymphocyte profile during AMI and to explore whether these cells play a detrimental role in the extent of myocardial insult, levels of T-lymphocyte subpopulations, free soluble interleukin-2 receptor (sIL-2R), and interleukin-1 beta (IL-1 beta), were measured during the first week of AMI. Results were correlated with left ventricular ejection fraction (LVEF), age, sex, survival rate, thrombolytic therapy, and the occurrence of reinfarction. Thirty-nine patients, 20 men and 19 women aged 30 to 80 years, with first AMI were included. Patients were divided into two groups. Group A (13 patients) experienced reinfarction; group B (26 patients) did not. T-helper and-suppressor cells were measured by the indirect immunofluorescence method and sIL-2R and IL-1 serum levels by enzyme-linked immunosorbent assay (ELISA) methods on days 1, 4, and 7 after AMI. A low count of T-helper cells (CD4) was found on the first day after AMI in both AMI groups; however, the count returned to normal in group B but not in group A. A significant correlation (r = 0.63) was found between T-helper cell count on day 4 of AMI and LVEF assessed by radionuclide ventriculography, and between the CD4/CD8 ratio on day 1 and the creatine phosphokinase level (r = -0.6950). High sIL-2R levels were found in groups A and B of the AMI patients as compared with the control group (p < or = 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
The aim of this study was to investigate the pattern of body fat distribution and its association with metabolic and hormonal cardiovascular risk factors in women undergoing coronary angiography. Thirty of the 51 women exhibited significant coronary artery disease (CAD) (group A), whereas the remaining 21 subjects were free of major coronary stenoses (group B). Twenty-five healthy women without clinical signs of CAD served as a control group (group C). Despite comparable age and body mass index the women of group A had a significantly higher waist-to-hip ratio (WHR), a measure of the pattern of body fat distribution, than those of group C (0.88 +/- 0.07 vs. 0.78 +/- 0.06, P < 0.01). In an oral glucose tolerance test a high prevalence of impaired glucose tolerance or diabetes was found in groups A and B (53% and 63%, respectively) compared with group C (4%, each P < 0.01). The women of groups A and B showed significantly higher blood pressure and triglyceride levels as well as lower HDL-cholesterol than those of group C, whereas total and LDL-cholesterol were not different between the groups. The serum concentrations of testosterone, sex-hormone-binding globulin (SHBG) and cortisol were comparable between the three groups and correlation analysis revealed positive associations between androgens and WHR (r = 0.36, P < 0.01) and serum insulin (r = 0.34, P < 0.01) respectively. These findings indicate that women with angiographically confirmed CAD, and those with clinical signs of CAD but without significant stenosis, frequently exhibit a metabolic syndrome characterized by a cluster of metabolic abnormalities which may underlie the atherosclerotic process.
The extent of duodenal bacterial overgrowth during the pronounced inhibition of acid secretion that occurs with omeprazole treatment is unknown. The bacterial content of duodenal juice of patients treated with omeprazole was therefore examined in a controlled prospective study. Duodenal juice was obtained under sterile conditions during diagnostic upper endoscopy. Aspirates were plated quantitatively for anaerobic and aerobic organisms. Twenty five outpatients with peptic ulcer disease were investigated after a 5.7 (0.5) weeks (mean (SEM)) treatment course with 20 mg (nine patients) or 40 mg (16 patients). The control group consisted of 15 outpatients referred for diagnostic endoscopy without prior antisecretory treatment. No patient in the control group had duodenal bacterial overgrowth. In the omeprazole group bacterial overgrowth (> or = 10(5) cfu/ml) was found in 14 (56%) patients (p = 0.0003). The number of bacteria (log10) in duodenal juice in patients treated with omeprazole was distinctly higher (median 5.7; range < 2-8.7) when compared with the control group (median < 2; range < 2-5.0; p = 0.0004). As well as orally derived bacteria, faecal type bacteria were found in seven of 14 and anaerobic bacteria in three of 14 patients. Bacterial overgrowth was similar with the two doses of omeprazole. These results indicate that duodenal bacterial overgrowth of both oral and faecal type bacteria occurs often in ambulatory patients treated with omeprazole. Further studies are needed to determine the clinical significance of these findings, particularly in high risk groups during long term treatment with omeprazole.
The development of helicoidal CT acquisition allows 3D reconstruction of vessels, cavities or parenchyma of mobile organs such as the kidney. The value of this 3D surface reconstruction was investigated in various areas of urology: congenital malformations (horseshoe kidney, megaureter, ectopic organs), acquired malformations (diverticulum, trabeculated bladder), renal stones, particularly staghorn calculi, and renal transplantation. The fields of interest of 3D CT scans are still poorly defined, but are probably threefold: diagnostic, therapeutic and for teaching purposes. 3D representation completes classical axial scans and, in some cases, competes with other more invasive imaging techniques.
Two cases of splenic arteriovenous fistula (SAVF) are reported and the literature pertaining to this disease is discussed. SAVF is a rare but curable cause of portal hypertension. Until recently, diagnosis was based and angiographic findings. However, it can now be reached with duplex-Doppler sonography, CT or MRI. Duplex-Doppler sonography highlights an enlarged splenic vein with a turbulent flow. CT scan detects the arterial aneurysms and shows the early opacification of the enlarged splenic vein. MRI depicts all the morphological abnormalities and flow-void due to time-of-flight losses may indicate the location of the fistula. Intra-arterial obliteration of the fistula is a good alternative to surgical procedure for treating SAVF in avoiding the potentially serious threat of gastrointestinal hemorrhage.
The collections encountered around the renal transplant are mainly lymphoceles, more rarely hematomas, abscesses and urinomas, the frequency of which constituting 12% of cases. Their diagnosis is usually made by sonography; the percutaneous puncture is guided by US or CT in order to define its nature and drain the cavity. Urinary obstruction (6% of the cases) may be detected by sonography or scintigraphy, but percutaneous pyelography is often required to confirm the obstruction, to precise its level and nature, and to guide the percutaneous procedure. In the case of urinoma (3% of the cases), ultrasound may be unclear and the urinary extravasation must be then confirmed by scintigraphy, postinjection delayed plain or CT scan films.
Retrocaval ureter is a rare malformation occasionally associated with other urological or nonurological abnormalities. We report an exceptional case of retrocaval ureter associated with contralateral pelvic ectopic kidney in a 22 year old man. The anomalies associated with the retrocaval ureter and the embryological mechanisms are described. Abdominal computed tomography with 3D reconstruction provided a new perspective of this malformation, but its clinical value remains unclear.
Th cells within the granulomas of murine schistosomiasis mansoni produce IL-5, which is essential for granuloma eosinophil growth and development. The mechanisms regulating granuloma IL-5 production are unknown. The granulomas also make IL-2 in small quantities. rIL-2 therapy stimulates eosinophilia and IL-5 synthesis. Therefore, we studied the effect of IL-2 on IL-5 production within the liver granulomas of murine Schistosoma mansoni. Dispersed granuloma cells and intact granulomas cultured in vitro released IL-5. Adding anti-IL-2 or anti-IL-2R to the cultures, to block IL-2 activity, significantly inhibited IL-5 production. However, supplementing the cultures with small quantities of rIL-2 markedly stimulated IL-5 release in a dose-dependent fashion. Blocking anti-IL-4 mAb had no effect. Also, granuloma T cells were isolated by FACS. These highly purified T cells produced IL-5 both in the presence and absence of plate-bound anti-CD3. Once again, the IL-5 production was dependent on IL-2. The requirement of IL-2 for normal IL-5 production was not dependent on an IL-2-induced expansion of the IL-5-producing, T lymphocyte population. Thus, IL-2 mediates T cell interactions within the granuloma that regulate granuloma IL-5 secretion.
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Mice infected with Schistosoma mansoni mount focal granulomatous responses around each ovum that deposits in the liver and intestinal wall. The granulomas ultimately destroy the ova while absorbing the released toxic, injurious agents. The granulomas contain T cells and other cell types, all of which are under control. For example, T lymphocyte proliferation in situ within the granulomas is probably restrained by various regulatory mechanisms. Granuloma eosinophils make VIP, and granuloma T cells have VIP receptors. Yet, the function of VIP within the granulomatous response is unknown. We studied the effect of VIP on granuloma and splenic T cell proliferation in response to Con A or soluble egg antigens (SEA). [3H]Thymidine incorporation was used to assess the rate of proliferation. VIP decreased Con A- or SEA-induced, T lymphocyte proliferation. Suppression of proliferation was most evident for T cells stimulated submaximally with mitogen or antigen. Since T lymphocyte proliferation in response to antigen or mitogen requires soluble lymphokines, we investigated the capacity of VIP to alter the expression of several lymphokines as a possible mechanism for mediating suppression of T cell proliferation. VIP decreased IL-2 production, but did not effect IL-5 or IFN-gamma release. The effect of VIP on IL-2 production was dependent on the presence of a CD4+ T lymphocyte subset. VIP could no longer modulate lymphocyte proliferation if exogenous rIL-2 was added to the cultures. The addition of neutralizing anti-IL-2 mAb, but not anti-IL-4 mAb, substantially decreased granuloma lymphocyte proliferation in response to antigen or mitogen. This suggested that granuloma T cell proliferation required endogenously produced IL-2. These findings suggest that VIP may help modulate granuloma T cell proliferation through regulation of IL-2 production.