Biomedical subjects
Publications and source records attributed to A Louis.
We studied a kindred in which 8 members had the neuroretinopathy of Leber's disease; 14 had a progressive, generalized dystonia attributed to striatal degeneration; and 1 had both disorders. The mode of inheritance was compatible with maternal transmission. This neurologic disorder may be a mitochondrial disease.
As the clinical significance of hemodynamic parameters remains controversial, the portohepatic gradient has been measured in 89 patients with cirrhosis by a transjugular approach. Relationships between portohepatic gradient and clinical, roentgenologic and prognostic patterns were studied with a maximum follow-up period of 36 months. Portohepatic gradient was not related to the rate of occurrence or rate of recurrence of digestive tract bleeding. Portohepatic gradient was related to the size of esophageal varices, p less than 0.01. Observation of large varices at endoscopy was associated with a higher risk of digestive tract bleeding. Portohepatic gradient was related to the number of portosystemic shunts opacified at portography, p less than 0.01. Portohepatic gradient was found to be related to these aspects of prognosis: the mean portohepatic gradient was higher in patients who died than it was in survivors, p less than 0.05. When patients were separated into two groups according to portohepatic gradient values--greater than or equal to 20.8, less than 20.8 millimeters of mercury--the actuarial survival rate was inversely related to portohepatic gradient at one, p less than 0.02, and at 12, p less than 0.02, months of follow-up study. This relationship could be demonstrated in the entire group of patients with cirrhosis and in the group of patients with digestive tract bleeding. This pattern seemed to be related to the risk of hemorrhage. In groups of patients and within a 24 month observation period, the survival rate was significantly related to the range of portohepatic gradient in each group.
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The main haemostasis changes observed in a screening study performed in 40 patients who underwent an open heart surgery with extracorporeal circulation (ECC) are: a significant drop in platelet count from the onset of the ECC to the third postoperative day, a decrease of platelet retention and aggregation during ECC with an 8-day persistently increased heparin-neutralizing activity in plasma but not in serum, a moderate decrease of plasma factors I, II, VII-X, X and XIII and a more important drop in factor V which disappears 24 h after ECC, a transitory increase of fibrinolysis during ECC and the lack of FDP elevation in the serum. These disorders require a very good neutralization of the heparin used during ECC. The ratio protamine/heparin can be established by a titration clotting time test. Protamine chloride seems to be more efficacious and to act more quickly than protamine sulfate for the neutralization. An overload in protamine can enhance the hemostatic, biological and clinical disorders. The preventive administration of platelet concentrate immediately after the heparin neutralization contributes to reduce the bleeding disorders related to the quantitative and qualitative platelet defects.
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A theoretical framework is presented for optimized heating of deep-seated tumours by phase and amplitude steering. The optimization problem for a specific tumour and perfusion case results in a functional dependency between power-level and maximum obtainable therapeutic efficiency. Different optimization criteria and strategies are outlined, which cause an increase of power or thermal dose in the tumour. Three tumour models (central pelvic tumour, eccentric abdominal tumour with or without necrosis) are analysed in detail. The simulation studies predict that appreciable parts of these tumours (50-100%) can be heated efficiently (42.5-43 degrees C) within the range of available and clinically tolerated power levels (1-5 kW/m), if tumour perfusion is less than 20-25 ml/100 g min. Some improvements are obtained by increasing the number of independent channels (from four to eight) and by the application of time-dependent (complementary) power-deposition patterns.