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Biomedical subjects

B Leclercq

Publications and source records attributed to B Leclercq.

At least 37 records · Page 2Linked to original sources
PubMed1997

Prognostic factors for neutropenic patients in an intensive care unit: respective roles of underlying malignancies and acute organ failures.

The admission of neutropenic patients to an intensive care unit (ICU) is still controversial, especially if mechanical ventilation is required. To avoid useless stays in ICU, the evaluation of the respective role of the underlying malignancy and acute organ failures might be useful for better definition of the categories of patients who could benefit from aggressive ICU support. For this purpose, we carried out a retrospective study of the charts of 107 consecutive neutropenic patients admitted to an ICU in a comprehensive cancer centre over a four-year period. The following characteristics were recorded within 24 h of admission: patient data, characteristics of neutropenia and the underlying malignancy, the type and number of organ system failures (OSFs) and simplified acute physiological scores (SAPS and SAPS II). The impact of each variable on outcome in the ICU was studied by univariate and multivariate (logistic regression) analysis. 59 patients died in the ICU (mortality rate: 55%). Patients with a haematological malignancy (n = 57, 53%) were more likely to experience respiratory failure, an underlying malignancy deemed rapidly fatal, and to have longer lasting neutropenia than patients with a solid tumour (n = 50, 47%). However, the mortality rate did not differ in the two groups (haematological malignancy 61% versus solid tumour 48%, p = 0.16). Respiratory and cardiovascular organ failure (p < 0.001 for both) correlated with mortality in the ICU. In the multiple logistic regression model, only the number of organ system failures and respiratory failure remained predictive of ICU mortality. In conclusion, the characteristics of the underlying malignancy are not relevant when deciding whether or not neutropenic patients should be admitted to an ICU. The main risk factors for death in an ICU are the number of organ failures on admission, and among them the presence of respiratory failure.

Adult↗
PubMed1997

Effects of selection, over three and four generations, on meat yield and fatness in Muscovy ducks.

1. Two experiments were undertaken to analyse the effects of selection for lowering carcase fatness and improving meat yield of Muscovy ducks. The control generation N and the selected generations N + 3 and N + 4 of the same heavy line (Grimaud) were reared under similar conditions. 2. We compared growth, carcase characteristics, chemical composition of breasts and plasma concentrations of very low density lipoproteins (VLDL), triglycerides and phospholipids. 3. Selection induced an increase of body weight (+8% to 10% at slaughter age), a decrease of abdominal fat percentage (-10%) and an improvement of breast and thigh plus shank yields (+3% to 7% and +4% respectively). 4. The lipid content of breast meat decreased in the selected ducks (-14% to -20%), particularly phospholipids and triglycerides. Breasts appeared paler and less red which suggested modifications of muscular fibre composition. 5. We found no significant correlations between plasma VLDL, triglyceride and phospholipid concentrations and carcase fatness. It therefore seems difficult to use these variables as selection criteria for lowering carcase fatness of Muscovy ducklings.

Abdomen↗
PubMed1997

Effect of dietary protein and environmental temperature on growth performance and water consumption of male broiler chickens.

1. Male broilers were reared in individual cages from 23 to 44 d of age. The effect of 2 temperatures (22 degrees and 32 degrees C) and 2 crude protein (CP) levels (160 and 200 g/kg) were studied. The low protein diet was supplemented with lysine, methionine, arginine, threonine and valine in order to meet requirements. 2. At 22 degrees C, a reduced CP content did not affect growth rate and breast muscle but slightly increased adiposity and food to gain ratio (FCR). Water consumption was reduced. 3. High temperature reduced growth rate and absolute and proportional breast muscle weight, and increased adiposity and FCR. These effects were more pronounced with the low CP diet. Water consumption was also reduced. 4. It was concluded that reducing CP content did not seem a good way to help broilers to withstand hot conditions. This experiment suggests that amino acids other than lysine, methionine and cystine are probably involved in the detrimental effect of high temperature.

Analysis of Variance↗
PubMed1996

Effects of the naked neck (Na) gene on the sulfur-containing amino acid requirements of broilers.

Full-sibling normal (na/na) and naked neck (Na/na) chickens were fed from 28 to 42 d of age on one of five diets with different SAA contents (from 5.4 to 7.0 g/kg). The experimental diets were made by adding DL-methionine to a well-balanced corn, soybean, and cornstarch diet containing 5.4 g SAA/kg and 161 g crude protein/kg. Dietary SAA influenced the growth rate of both genotypes similarly. There were no significant differences (P > 0.125) in body weight gain due to genetics or a diet by genetics interaction. Body weight gains were maximized at 6.24 +/- 0.45 (R2 = 0.171) and 5.96 +/- 0.52 g/kg SAA (R2 = 0.107) for the na/na and Na/na stocks, respectively. There was a significant SAA by genotype interaction for feed efficiency: the na/na birds were more efficient at low SAA levels, but the Na/na birds were more efficient at high SAA levels. Feather weight gain increased in a linear manner with increasing dietary SAA and was greater in na/na than Na/na birds with high dietary SAA concentrations. Abdominal fat decreased with increasing dietary SAA; and although the Na/na birds had significantly more abdominal fat than their na/na siblings (P = 0.049), on average the difference was small and complicated by differences in body weight. Analysis of covariance showed (a significant interaction) that the relationship between abdominal fat and body weight was different for the na/na and Na/na chickens. Although the shape of the response curves of na/na and Na/na chickens to dietary SAA are different, the quantitative requirements are very similar during the growing period.

Adipose Tissue↗
PubMed1995

Intermittent vascular exclusion of the liver (without vena cava clamping) during major hepatectomy.

Intermittent vascular exclusion of the liver (IVEL) combines clamping of the hepatic pedicle with clamping of the main hepatic veins without interruption of caval flow. In this retrospective study, eight cases of total IVEL and eight of partial IVEL were analysed (involving only the middle and left hepatic veins) during major hepatectomy for malignant tumours. Liver parenchyma was pathological in nine cases. IVEL was feasible in 16 of the 18 attempts and was efficient in reducing bleeding during hepatectomy in 15 cases. Mean duration of IVEL was 60.2 (range 37-140) min, mean blood loss was 1230 (range 300-2800) ml and there were no postoperative complications related to the procedure. The major advantages of this technique of liver vascular exclusion (good tolerance and possibility of long duration) merit its inclusion in the list of different clamping techniques available for use during hepatectomy.

Adult↗
PubMed1995

Early tracheotomy in neutropenic, mechanically ventilated patients: rationale and results of a pilot study.

Despite substantial advances in the management of such patients, the prognosis of ventilated neutropenic patients remains grim. The objective of our study was to evaluate the benefit of tracheotomy in this category of patients, in terms of mortality while they were in the intensive-care unit and nosocomial pneumonias. The charts of 53 consecutive, ventilated, neutropenic patients, or those destined to be imminently neutropenic, admitted to our intensive-care unit during a 4-year period, have been retrospectively reviewed. Tracheotomy was performed at the bedside or in the operating room: 20 patients underwent tracheotomy within 48 h of mechanical ventilation (ET group), while 33 were tracheotomized later or remained intubated (INT group). The two groups were comparable with regard to the underlying disease, respiratory failure, mechanical ventilation patterns and severity scores, but neutropenia was more profound in the ET group. Mortality while in the intensive-care unit was similar (ET: 70%; INT: 78.8%). However, the survival curves showed a trend towards longer survival in the ET group, even after adjustment for the degree of neutropenia (log-rank test: P = 0.07). The incidence of pneumonias was similar in both groups. No major complications of tracheotomy were reported. These findings suggest that a tracheotomy could be proposed for neutropenic patients requiring mechanical ventilation, in order to prolong their survival beyond the end of the neutropenic period. A prospective study is underway to confirm these preliminary results.

Adolescent↗
PubMed1995

Totally implanted catheters to reduce catheter-related infections in patients receiving interleukin-2: a 2-year experience.

A high incidence of bacterial infections has been previously reported during interleukin-2 (IL-2) treatment, mainly due to catheter-related infections. Antibiotic prophylaxis has been successfully used to decrease such infections. The goal of this study was to evaluate an alternative way to reduce catheter-related infections in IL-2-treated patients by the use of totally implanted catheters. A total of 74 patients with metastatic renal cell carcinoma, referred to our institution to receive IL-2 from March 1989 to July 1991, were included in this prospective study. IL-2 was given on a 2-days-a-week schedule (24 x 10(6) IU m-2 day-1) either alone (41 patients) or in association with interferon gamma (33 patients). All these patients were prospectively evaluated for fever, bacteremia and line-site infection. Seven patients (9.5%) had one (2 patients) or more (5 patients) positive blood cultures with Staphylococcus aureus. Antibiotics were used only in 5 patients, and the catheter had to be removed in only 2 of these patients. In the other patients, no further infection developed despite the lack of antibiotics. Moreover, 9 patients had positive blood cultures with Staphylococcus epidermidis (1.9% of total number of blood cultures). In conclusion, a totally implanted catheter appears to reduce the incidence of infections in IL-2-treated patients, at least on a 2-days-a-week schedule.

Antineoplastic Agents↗
PubMed1995

Safety of tracheotomy in neutropenic patients: a retrospective study of 26 consecutive cases.

OBJECTIVE: To evaluate the safety of tracheotomy in neutropenic ventilated cancer patients, in terms of infectious and haemorrhagic complications. DESIGN: Retrospective study. SETTING: A medical-surgical intensive care unit in a Cancer-hospital. PATIENTS AND PARTICIPANTS: 26 consecutive patients undergoing a tracheotomy in neutropenic period, from 1987 to 1990. INTERVENTIONS: Tracheotomy, performed at the bedside or in operating room. MEASUREMENTS AND RESULTS: In all neutropenic patients undergoing a tracheotomy, the characteristics and duration of both neutropenia and mechanical ventilation have been recorded. Stomal bleeding and infection, and infectious pneumonias and alveolar haemorrhage have been carefully reviewed. Platelets were transfused in 23 of the 26 patients at the time of the procedure; no local haemorrhage was observed. Neither stomal nor pulmonary infections secondary to tracheotomy were noted. No respiratory worsening was attributable to the tracheotomy. Nineteen patients (73%) died in ICU, without direct link between tracheotomy and death. CONCLUSIONS: These findings suggest that a tracheotomy can be safely performed in neutropenic patients requiring mechanical ventilation.

Decision Making↗
PubMed1995

Cerebral vasculitis after interleukin-2 therapy for renal cell carcinoma.

We report one patient with paralysis of the right upper extremity, bilateral cerebellar syndrome, and cognitive changes after treatment with interleukin-2 for metastatic renal cell carcinoma. Focal neurologic disturbances were associated with multiple images of cerebral infarcts but also with extraneurologic signs and autoantibodies. We suggest that this is a case of cerebral vasculitis with an autoimmune mechanism triggered by interleukin-2 therapy.

Adult↗
PubMed1994

Super-high-risk germ-cell tumors: a clinical entity. Report of eleven cases.

Among patients suffering from nonseminomatous germ-cell tumor, with a poor prognosis, a subset underwent respiratory failure and died very early in the course of their treatment. Between 1982 and 1989, 11 out of 56 such patients (20%) died within the first 5 weeks of chemotherapy. The clinical, radiological, biological and infectious characteristics of these patients were analyzed. Nine patients had extensive pulmonary metastases and the 2 others presented a bulky mediastinal mass with pleural effusion. All patients experienced acute respiratory distress during chemotherapy and underwent mechanical ventilation. All patients were febrile, and septicemia was documented in 7 cases. WHO grade 4 and grade 1-2 renal toxicities occurred in 3 and 4 patients respectively. There was no tumor lysis syndrome. All patients died within 35 days from the start of therapy; 4 were autopsied. These 11 patients represent a clinical entity, having what we called super-high-risk germ cell tumors. Early death is related to pulmonary distress within the first 5 weeks of therapy. The origin of the pulmonary distress is multifactorial: bulky disease of the chest, infection, and interstitial fibrosis. Immediate full-dose standard chemotherapy in association with intensive supportive care is recommended in the management of these patients.

Adult↗