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Biomedical subjects

B Dousset

Publications and source records attributed to B Dousset.

At least 91 records · Page 5Linked to original sources
PubMed1996

[Evaluation of the blood quality collected by cell-saver during cesarean section].

OBJECTIVE: To determine the quality of blood salvaged and processed during Caesarean section with a cell-saver. STUDY DESIGN: Laboratory study. PATIENTS: The study included 20 patients of ASA physical class 1 or 2 undergoing a scheduled Caesarean section. METHODS: A separate suction device was used from the beginning surgery until the delivery of the fetus, to remove most of the amniotic fluid coming from the surgical field. Thereafter using an Haemolite 2Plus (Haemonetics), the blood was separated and washed with 2 L of normal saline solution. Blood quality was assessed through detection of fetal cells and measuring out of alpha-fetal-protein, tissue factor. A Kleihauer test was also performed. RESULTS: Cell-saver processing removed most of alpha-fetal-protein and tissue factor while fetal cells were rarely seen. The Kleihauer test could not be performed because of haemolized blood samples. However, the results were very heterogeneous and after washing some salvaged units contained very high concentrations of alpha-fetal-protein or tissue factor. CONCLUSIONS: These preliminary results show that intra-operative autologous transfusion is not fully safe during Caesarean sections. In addition, there is an immunological risk if a significant part of fetal red blood cells are reinfused into maternal circulation. Therefore, additional studies are needed to better assess this risk.

Adult↗
PubMed1996

[Complications of two types of pancreatic anastomosis after pancreaticoduodenectomy].

The operative mortality rate after pancreaticoduodenectomy (PD) is 5% or less at major surgical centers and is generally related to pancreatic anastomosis complications. Recently, several authors have reported a low incidence of complications after PD using pancreaticogastrostomy. The aim of our work was to retrospectively study the operative complications of pancreaticogastrostomy (PG) and pancreaticojejeunostomy (PJ) after PD. Since 1989 we have performed 59 consecutive DP, in 33 male patients and 22 female patients, with a mean age of 56 +/- 12 years. We performed 43 PG and 16 PJ. In 42/59 cases, PD was performed for malignant disease. Pancreaticoduodenal resection was identical in both groups, with classical pancreatic transection performed at the level of the mesentericoportal axis. The overall mortality rate in this study was 5.08% (n = 3). It was 4.65% (n = 2) in the PG group and 6.25% (n = 1) in the PJ group. Operative complications were absent in 36 patients (24 PG, 12 PJ). The mean postoperative hospital stay was 17 +/- 6 days; 23 patients (19 PG, 4 PJ) presented one or several complications. 12 patients required re-exploration (10 PG, 2 PJ). Pancreatic fistula occurred in 8 patients (13.55%), 14% (n = 6) in the PG group and 12.5% (n = 2) in the PJ group. In each group, only one pancreatic fistula was re-explored. Seven patients (16%) in the PG group presented postoperative pancreatitis. Pancreatic fistula and postoperative pancreatitis occurred in a pancreas with a normal texture and non-dilated pancreatic duct in every case, with one exception (PJ). During long term follow-up, 18 patients died from cancer (12 PG, 6 PJ). In conclusion, this study suggests that PG does not decrease the pancreatic fistula or postoperative pancreatitis rates and that these complications are essentially related to pancreatic texture and pancreatic duct.

Adult↗
PubMed1995

Enhanced risk of steroid-resistant acute rejection following pretransplant steroid therapy in liver graft recipients.

Most episodes of acute rejection will resolve after steroid therapy without detrimental consequences on the liver allograft. However, steroid-resistant acute rejection may induce irreversible lesions of the graft and is associated with an increased risk of chronic rejection. The aim of this study was to determine whether there were predictive factors for steroid-resistant acute rejection after liver transplantation. A total of 108 adult liver recipients with a follow-up of at least 2 years have been analyzed; sixty-two (57%) patients had at least one episode of acute rejection. The rates of steroid resistance were 35%, 52% and 83% after a first (n = 62), second (n = 25), or third (n = 7) episode of acute rejection, respectively. Steroid resistance of acute rejection was significantly associated with a past history of pretransplant steroid therapy (P = 0.004). High levels of ALT (P = 0.03) and serum bilirubin (P = 0.002) were also predictive of steroid-resistant acute rejection. Eight (7%) patients eventually developed chronic rejection. Predictive factors for chronic rejection included steroid-resistant acute rejection (P = 0.01), recurrent acute rejection (P = 0.03), and CMV infection (P = 0.01). In conclusion, this study suggests that pretransplant steroid administration or high levels of ALT and bilirubin in rejecting patients are risk factors for steroid resistance and should lead to aggressive antirejection therapy without delay.

Adolescent↗
PubMed1995

Methods for reducing the ammonia in hybridoma cell cultures.

The factors which limit the proliferation of eukaryotic cells in vitro are still not well known. Ammonia is believed to be toxic for mammalian cell proliferation and secretion. We have tried two approaches to reducing the ammonia in the medium. We first limited the ammonia produced by the cells by replacing glutamine by glutamate. Then, we used two chemical engineering methods to eliminate accumulated ammonia. In one the used medium was passed through a natural cation exchanger: the clinoptilolite. In the other, the culture medium was passed through a hydrophobic microporous hollow fiber module. Replacing the glutamine by glutamate reduced the medium ammonia concentration. The physicochemical removal of ammonia induced a better cell growth, but not a better specific antibody secretion.

Ammonia↗
PubMed1995

Measurement of plasma testosterone by gas chromatography-negative-ion mass spectrometry using pentafluoropropionic derivatives.

Plasma testosterone was measured by gas chromatography-negative-ion chemical ionisation mass spectrometry (GC-MS). The testosterone was extracted from plasma using home-made Extrelut columns and diethyl ether elution. It was quantified as the pentafluoropropionate (PFP) derivative by selected-ion monitoring at m/z 560 (testosterone) and 563 (d3-testosterone), accounting for about 34% of the total ion. The characteristics of the method were: extraction recovery about 95%; linearity over the range 1.7-71.5 nmol l-1 with linear regression equation y = 1.41x + 0.0217, r = 0.999; detection limit 3.5 fmol injected with a signal-to-noise ratio of 7.4; within-day variation, 3% for GC-MS, and 5.8% for the whole process; day-to-day coefficient of variation, 6.6-11%, depending on the concentrations. There was a good correlation between the results obtained by GC-MS and RIA (r = 0.994), but the GC-MS values were significantly lower (p < 0.05) than those obtained by RIA.

Adult↗
PubMed1995

Metastatic endocrine tumors: is there a place for liver transplantation?

The authors describe their experience with liver transplantation (OLT) for metastatic endocrine tumors (MET) in order to determine reasonable indications for OLT in patients with this disease. Removal of the primary lesion and subsequent liver transplantation were performed in two separate procedures in all patients except one. Only those patients suffering from objective tumor progression and symptoms with no evidence of extrahepatic spread after complete work-up (including endoscopic ultrasonography (US) and 123I-labeled Tyr3-octreotide body scanning) underwent liver transplantation. Fifteen patients were referred for liver transplantation. Seven patients were excluded either because of stability of liver metastases (n = 3), extrahepatic spread, general contraindication (n = 2), or feasibility of aggressive surgical resection (n = 2). Liver transplantation was undertaken in eight patients with carcinoid tumor (n = 4), gastrinoma (n = 3) and glucagonoma (n = 1). Three patients did not survive the surgical procedure itself, whereas two additional patients died from chronic rejection or from recurrent disease. Three patients who received transplants for metastatic carcinoid tumor are alive without biochemical or imaging evidence of disease recurrence at 6, 15, and 52 months. The best indication for transplantation seems to be patients with metastases restricted to the liver and unresponsive to adjuvant therapy after aggressive surgical resection including excision of the primary lesion and reduction of hepatic metastases. In such highly-selected patients, liver transplantation remains a high-risk operation, but it can yield long-term survival.

Adult↗
PubMed1995

Evidence for the detrimental role of proteolysis during liver preservation in humans.

BACKGROUND/AIMS: Proteolysis may persist in the liver allograft during cold storage. The aim of this study was to determine the significance of proteolysis within liver allografts stored at 4 degrees C in University of Wisconsin preservation fluid. METHODS: Thirty recipients of 32 liver allografts were studied prospectively. Amino acid content of the preservation fluid was analyzed at the end of cold storage and was correlated to graft and patient outcome after transplantation. RESULTS: Analysis of the preservation fluid showed the presence of free amino acids, the profile of which was different from that of stored liver parenchyma. Concentrations of amino acids (alanine, cysteine, leucine, isoleucine, methionine, lysine, ornithine, and threonine) and transaminases (alanine aminotransferase and aspartate aminotransferase) in the preservation fluid correlated with the duration of cold ischemia. Indexes of graft dysfunction (serum alanine aminotransferase and aspartate aminotransferase peaks and prothrombin rate) correlated with concentrations of cysteine, alanine, isoleucine, leucine, methionine, lysine, ornithine, and threonine, whereas enzyme concentrations in the fluid were not predictive of graft dysfunction. CONCLUSIONS: These data suggest that liver proteolysis occurs during cold storage and may have a detrimental effect on the outcome after transplantation. The measurement of the amino acids in the preservation fluid at the end of the cold storage period could help to identify the most severely damaged organs.

Adenosine↗
PubMed1995

Gastroesophageal reflux and acute life-threatening episodes: role of a central respiratory depression.

The aim of this study was to evaluate plasma levels of beta-endorphins in babies with gastroesophageal reflux (GOR) admitted for acute life-threatening episodes (ALTE). In case of ALTE (n = 15), beta-endorphin levels were significantly increased compared to sudden infant deaths syndrome siblings with GOR of a similar gravity evaluated for risk factors (n = 13). beta-Endorphin levels are decreased following successful treatment of GOR. Studies of ventilation suggest that changes in the central respiratory drive are associated with a reduction in plasma beta-endorphin levels.

Acute Disease↗
PubMed1995

Role of the kidney in the production of a low molecular weight growth factor (MW < 1000 Da): experimental study in the pig.

Small peptide molecules known as low molecular weight growth factor (LMW-GF) have been identified in human serum. They enhance the effect of IGF-1 (insulin-like growth factor) on proteoglycan synthesis. In the present work we investigated the role played by the kidney in the production of LMW-GF, using the pig as an experimental model. Six pigs underwent bilateral nephrectomy followed 24 h later by orthotopic autotransplantation of the kidney. Renal and liver functions were evaluated by measurement of serum creatinine, urea, electrolytes, amino transferases (ASAT, ALAT), proteins, and bilirubin. LMW-GF was measured by bioassay using 11-day-old pelvic chick embryo cartilages. We observed that LMW-GF quickly disappeared from pig serum after nephrectomy and only reappeared when transplantation was successful. Reappearance of LMW-GF can precede improvement of renal function evaluated by plasma creatinine levels. These data appear to demonstrate that the kidney is involved in LMW-GF production.

Acute Kidney Injury↗
PubMed1995

[Physiological role of PTHrP].

Parathyroid hormone related protein (PTHrP) is the aetiological factor for the syndrome of humoral hypercalcemia of malignancy. The PTHrP gene encodes three isoforms of respectively 139, 141 and 173 amino acids with N-terminal homology to parathormone (PTH). PTHrP, which has a wide tissue distribution, appears to be a polyhormone with different physiologic functions that depend on the particular fragment secreted. PTHrP may act in an autocrine, a paracrine or an endocrine fashion. There is evidence for a role in the growth and development of both embryonic and mature tissues, in cellular differentiation, in smooth muscle relaxation, lactation and calcium and magnesium transport. The best known PTHrP functions are those mediated by the N-terminal domain fixation on the classical PTH/PTHrP receptor. Nevertheless, several other functions are mediated by different fragments of PTHrP such as midregion fragments or carboxy-terminal forms. Each of these functional forms of PTHrP has one or several physiological function(s) which is (are) mediated by his own specific receptors and signal transduction pathways, some of which may be tissue specific.

Animals↗
PubMed1995

[Surgical treatment of severe ulcerous hemorrhages: predictive factors of operative mortality].

OBJECTIVES: Multivariate analysis of operative mortality in patients with bleeding peptic ulcer. METHODS: Seventy-eight consecutive patients, who underwent emergency surgical treatment for bleeding peptic ulcer were reviewed retrospectively. There were 49 males and 29 females, with a mean age of 64.3 years, 2/3 of whom had associated medical disease. Surgical treatment was conservative in 63 cases: oversewing or ulcer excision, alone (n = 29) or associated with vagotomy (n = 34); and was radical in 15 cases: antrectomy+vagotomy (n = 10) or partial gastric resection (n = 5). RESULTS: There were 17 (21.8%) postoperative deaths and 19 (24.3%) bleeding recurrences. The causes of death included 9 bleeding recurrences, 7 organ failures and one duodenal leakage. On multivariate analysis, previous medical illness (cirrhosis or cardiac insufficiency (P < 0.001), shock at admission (P < 0.001), prolonged delay until surgery (P < 0.001), and bleeding recurrence (P < 0.001) were independently associated with increased mortality. In contrast, the type of surgical procedure did not influence postoperative mortality, whereas bleeding recurrence was more frequent in case of conservative surgery (P < 0.03) and anticoagulation therapy (P < 0.01). CONCLUSION: These results suggest that surgical treatment of bleeding peptic ulcer should be proposed early in high-risk patients. A radical procedure should be favoured since it reduces bleeding recurrence rate without increasing operative mortality.

Adult↗