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Biomedical subjects

A Vandevenne

Publications and source records attributed to A Vandevenne.

At least 19 recordsLinked to original sources

[Community-acquired pneumonia in healthy adults: 188 patients treated with spiramycin in private practice].

One hundred and eighty eight outpatients with community acquired pneumonia have been treated by spiramycin in general practice. Community acquired pneumonia was defined by the association of fever > or = 38 degrees C, respiratory symptoms as cough, sputum production, dyspnea or thoracic pain, and pulmonary opacity on the chest X-Ray. The mean age of patients was 44.7 +/- 16.6 and few of them had concomitant chronic illness, as cardiovascular (9%) or bronchopulmonary disease (9%). Twenty one percent of patients have been included after a previous antibiotherapy failure. In 92% on these cases, prior antibiotherapy was a beta lactam. At inclusion, the fever was greater than 39 degrees C in 56% of patients, 58% had localized crepitations at the chest auscultation. The chest X-Ray was performed 1.4 +/- 2.1 days after inclusion and showed a lobar consolidation in 77%. One third of patients presented a clinical picture evoking acute bacterial pneumonia. One hundred and seventy one patients have been reviewed for a second evaluation 4 +/- 1.5 days after inclusion. One hundred and eighty seven patients have visited for the long term follow up 19 +/- 6.5 days after the onset of treatment. Ninety six per cent of them have consulted with a control chest X-ray. At this visit, the antibiotherapy was changed in 2 other patients with of failure. Overall, 83% of patients were clinically and radiologically cured by Spiramycin 3 MU twice a day for 13 +/- 3.5 days. Fourteen percent of patients were improved without necessity of changing the antibiotic regimen. This study confirms the efficacy of spiramycin in the management of community acquired pneumoniae in general practice, either in first line therapy of after the failure of beta lactam.

Adult

Magnetic resonance imaging in the diagnosis of pulmonary infarction.

We report for the first time, to our knowledge, MRI features which could differentiate noninvasively pulmonary infarction from pneumonia. Three subjects with angiographically proven pulmonary infarction showed high T1 weighted MRI signals located in the embolic territory. Three patients with pneumonia and one patient with emboli, but without infarction, did not have these T1 weighted images.

Diagnosis, Differential

[Cystic fibrosis and bronchial hyper-reactivity].

An increased airway responsiveness to inhaled nonspecific stimuli has been often observed in cystic fibrosis patients. But bronchial hyperreactivity in such patients is due, in most cases, to damaged bronchial mucosa rather than to coexistent asthma, and it remains under question whether or not bronchodilators are of help in cystic fibrosis. Indeed some authors reported adverse effects after inhalation of beta-mimetic drugs. This behavior seems to be due to an "instability" of the bronchial walls in cystic fibrosis. Nevertheless other studies showed that bronchodilators could be of help when administered in some cases and during definite periods in the evolution of the disease. Indeed, variability in responsiveness to bronchodilator drugs is one of the features of cystic fibrosis and therapy must be adjusted to this variability in every patient. In any way, pulmonary functional tests must be performed before and after administration of a bronchodilator drug and before beginning such therapy.

Asthma

[Prevention of pneumocystosis with pentamidine aerosols].

In patients with human immunodeficiency virus infection primary or secondary prevention of pulmonary pneumocystosis sometimes fails, resulting in atypical or extrarespiratory pneumocystosis. From the series found in the literature and from our own experience, it appears that such failures depend on the way aerosols are administered: they are usually due to low dosage, intervals of more than 2 weeks between aerosols, excessive particle size or poor patient's compliance. We suggest that pentamidine mesylate or isethionate should be administered forthnightly in doses of 4 mg/kg bodyweight, using an inhaler capable of delivering particles of less than 2 micrometers in diameter.

Acquired Immunodeficiency Syndrome

[Pleurisy in ovarian hyperstimulation syndrome. Apropos of a case].

The syndrome of ovarian hyperstimulation is a little known aetiology of pleural effusion. It should be thought of in young women who are under treatment to induce ovulation. Serous effusions which occur in these cases are a serious sign. The effusions are exudates and not transudates as occurs in Demons-Meigs syndrome. The treatment which will be undertaken ought to consider the possibility that a pregnancy is underway.

Adult

[Instrumentation support in respiratory kinesiotherapy].

The points of impact of instrumental support in respiratory physiotherapy are numerous; they concern primarily the pulmonary expansion, bronchial drainage and function of respiratory muscles. The pulmonary expansion may be helped by incitant spirometry and either intermittent or continuous positive pressure respiration, or indirectly by the utilisation of respiration against resistance (expiratory bottles, masks with uni-directional valves and expiratory resistances etc.). These different techniques may be used in the presence of instability of the respiratory units, secondary to an alteration of surfactant or to closure of the small airways induced by a transitory reduction (in the post-operative period) or permanent reduction (such as parietal wall disease of mechanical or neuro-muscular origin) of the functional residual capacity (CRF). If the continuous positive airway pressure (CPAP) seems particularly helpful for the CRF to recover to the pre-operative level it also appears on the contrary as the least efficacious technique to increase trans-pulmonary pressure. The instrumental support for bronchial drainage may theoretically affect the tension activity of the transport (instrumental help in the pulmonary expansion and in hyperventilation), muco-ciliary transport (external parietal vibration or internal vibrations applied to the upper airways), the biphasic flow (expiratory assistance by negative pressure and humidifiers). The function of the respiratory muscles may in certain cases be improved by the use of abdominal pneumatic cuirasses, by hyperventilation exercises in an isocapnoeic milieu or in breathing exercises against an additional inspiratory or expiratory resistance. If the physiological foundation of mechanical support in respiratory education may be frequently identified, the clinical results reported in the literature are often contradictory.

Drainage

[Gastroesophageal reflux in asthmatic and chronic bronchitis patients].

To determine the relationship between gastroesophageal (GE) reflux and pulmonary disease, we studied 21 asthmatics, 30 chronic bronchitics, 6 patients with GE reflux and no pulmonary symptoms, and 10 control subjects; GE reflux was diagnosed by pH monitoring and GE scintiscanning. Frequency of GE reflux in the asthmatics was 57%; in chronic bronchitis it was 56%. Pulmonary function tests did not show any differences between patients with or without reflux. The GE reflux episodes were more numerous but shorter in asthmatics than in chronic bronchitis. Patients with digestive symptoms alone were no different from chronic bronchitis with respect to reflux. The mechanism whereby reflux triggers pulmonary problems was investigated using the following 2 tests: scintiscan for pulmonary aspiration, and esophageal acid infusion (0.1N HCI). Six pulmonary aspirations were detected. Only asthmatics, with or without reflux, showed any significant variations in maximal expiratory flow at 50% and 25% of VC after HCI infusion. Thus, our results show that asthmatics differ from bronchitis patients by the characteristics of their reflux.

Adult

[Tolerance test to an inspiratory resistive load and resistive training of respiratory muscles. Preliminary critical study in kyphoscoliotic patients].

Is increased tolerance to an additional inspiratory load after resistive training always due to respiratory muscle endurance? To answer this question, 5 kyphoscoliotic subjects were subjected to ventilation through a Y-shaped tube 3.2 cm in diameter during 10 minutes three times a day for 3 months. The subjects were divided into 3 groups. Group 1 (n = 3) trained with a non-linear resistance placed in the inspiratory branch of the tube during the first and third months and without additional load during the second month. Group 2 (n = 2) trained without inspiratory resistance during the first and third months and with an additional load during the second month. The load selected for the initial tolerance test (R1) was an inspiratory orifice with a diameter 0.5 mm wider than that of the orifice not tolerated during 3 min (R2). In each subject, ventilatory mode and time of tolerance on R1 were determined. This time was 10.8 +/- 6.8 min for the whole group. The tolerance test was repeated after each month of resistive or placebo training on R1 and R2. By grouping together the results of tolerance tests at 2 months after placebo training (4 measurements) and after resistive training (5 measurements), we found that the gain in endurance was similar without concomitant changes in volumes, air flows, VO2 max and time of endurance at 70% of VO2 max.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Physiological

Gastroesophageal reflux in patients with asthma and chronic bronchitis.

To determine the relationship between gastroesophageal (GE) reflux and pulmonary disease, we studied 21 asthmatics, 30 chronic bronchitics, 6 patients with GE reflux and no pulmonary symptoms, and 10 control subjects; GE reflux was diagnosed by pH monitoring and GE scintiscanning. Frequency of GE reflux in the asthmatics was 57%; in the chronic bronchitics it was 56%. Pulmonary function tests did not show any differences between patients with or without reflux. The GE reflux episodes were more numerous but shorter in asthmatics than in chronic bronchitics. Patients with digestive symptoms alone were no different from chronic bronchitics with respect to reflux. The mechanism whereby reflux triggers pulmonary problems was investigated using the following 2 tests: scintiscan for pulmonary aspiration, and esophageal acid infusion (0.1N HCl). Six pulmonary aspirations were detected. Only asthmatics, with or without reflux, showed any significant variations in maximal expiratory flow at 50% and 25% of VC after HCl infusion. Thus, our results show that asthmatics differ from chronic bronchitics by the characteristics of their reflux.

Adult

[Hypoxia in cirrhotic patients. Apropos of a case].

The authors report a case of hypoxia in a non-smoking cirrhotic patient. The pathophysiological hypotheses proposed to date to explain this hypoxia without pulmonary artery hypertension, but accompanied by disturbances of carbon monoxide transport, reveal a common element which is difficult to diagnose and quantify: intra-pulmonary shunts. The authors consider gamma-angiocardiography to be a simple diagnostic procedure.

Dilatation, Pathologic

[Characteristics and evolutive data of chronic respiratory diseases after respiratory intensive care. Evaluation of the Pneumology Department of the Pavillon Saint-François in Strasbourg between 1980 and 1985].

Between 1980 and 1985, 66 patients with chronic obstructive lung disease (respiratory deficit of the restrictive type) were admitted to our department after an episode of acute respiratory failure treated with assisted ventilation in an intensive care unit. These patients were in a particularly poor clinical condition, due to their previous long stay in the intensive care unit (mean 43 days), the high percentage of tracheotomies (mean 44%), the loss of autonomy of movement in 30% of the cases and the presence of an associated pathology in 45% of the patients. These data explain the high mortality observed in this group: 40% of the patients died within one year of the acute respiratory failure episode. Other prognostic factors, notably the patients' nutritional status, must also be taken into account.

Aged

[Pulmonary tuberculosis and cutaneous anergy to tuberculin].

A negative tuberculin test in a bacilliferous subject is an apparently paradoxical situation, since the first penetration of tubercle bacilli into the human body is known to induce hypersensitivity to tuberculin and to enhance cellular immunity. These two facets of cutaneous reaction are most probably related to lymphocyte populations of two different phenotypes. The authors found that 21% of skin tests were negative in patients carrying tubercle bacilli, with a higher frequency in elderly people and in subjects with low serum albumin levels and/or biochemical hepatic alterations. Helped by the literature, they are wondering about the significance and possible mechanisms of this situation.

Adult