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Biomedical subjects

C Gibert

Publications and source records attributed to C Gibert.

At least 19 recordsLinked to original sources

Subpopulation of hyperresponsive polymorphonuclear neutrophils in patients with adult respiratory distress syndrome. Role of cytokine production.

To gain further insight into the pathogenesis of the adult respiratory distress syndrome (ARDS), we studied possible relationships among the activation status of circulating polymorphonuclear neutrophils (PMN), cytokine levels, and the severity of lung injury in 31 patients: 15 with ARDS, nine with severe pneumonia uncomplicated by ARDS, and seven mechanically ventilated with neither ARDS nor pneumonia. Nine healthy subjects served as controls. Using flow cytometry, we identified a subpopulation of PMN with an increased capacity to generate hydrogen peroxide after stimulation ex vivo in all three patient groups; significantly higher values were found in those with ARDS. The PMN stimulation index, a reflection of the degree of hyperresponsiveness, correlated with elevated levels of tumor necrosis factor-alpha (TNF alpha) in plasma, and both spontaneous and lipopolysaccharide-induced TNF alpha production by cultured monocytes. These biologic expressions of PMN activation and cytokine generation both correlated with indices of the severity of lung injury, but not with the overall clinical severity. In contrast, IL-6 and IL-1 beta showed little or no relationship with either the degree of lung injury or PMN hyperresponsiveness. We conclude that TNF-alpha-primed PMN may play a major role in the pathogenesis of ARDS-associated lung injury.

Flow Cytometry

Pancuronium blood level monitoring in patients with tetanus.

Overdosage of muscle relaxant has been given as a possible explanation for the hypotensive episodes occurring during the management of tetanus. The aim of the present work was to study the pharmacokinetics of pancuronium during long term infusion. Pancuronium was administered to eight patients with severe tetanus for a period varying from 8 to 24 days. The concentration of pancuronium was measured daily in plasma and urine using a fluorimetric method. The plasma concentration varied from 0.27 to 0.48 microgram/ml. No tendency to accumulation was observed. The plasma concentration fell rapidly below the level associated with muscle relaxation when pancuronium was discontinued. This absence of accumulation can be explained by a rapid elimination of pancuronium through the kidney according to a process of ultrafiltration.

Adolescent

[Echocardiographic diagnosis of 4 cases of tricuspid valve endocarditis].

Four tricuspid endocarditis cases are reported. Echocardiography found, four times, large vegetations on the tricuspid leaflets leading to the diagnosis. The degree of tricuspid insuffisancy was appreciated by the RV/LV ratio. Successive echos have permitted to survey the evolution and specially to establish a clear decrease of abnormal tricuspid echoes succeeding to pulmonary embolisms. In the four cases, surgery confirmed the diagnosis.

Adolescent

[Traumatic rupture of the aortic valve. Echocardiographic aspects. Apropos of a case].

The appearance of a diastolic murmur in a pyrexial patient 15 days after trauma was suggestive of infectious endocarditis. This diagnosis was excluded, especially by echocardiography, and the aortic incompetence was attributed to the trauma. The value of echocardiography and the features of other reported cases are discussed with referrence to this case.

Accidents, Traffic

[Severe pneumococcal infections of adults. 100 cases collected in three years (Claude Bernard Hospital, Paris) (author's transl)].

After retrospective in intensive care unit of 100 severe cases of pneumococcal infection in three years, the authors analyse the circumstances of onset (occurring in autumn of winter), the general status (without evident high risk population), the symptomatology (84% of meningitis, 30% of pneumonia), the origin of infection (essentialy otitis media in meningitis). The case fatality rate is 39%. Frequency of multiple visceral localisations and of bacteremias is emphasized.

Adolescent

IgM and IgG antibody responses in rabies encephalitis.

Immunological survey of 3 patients with proved rabies encephalitis shows three interesting facts. 1) An IgM local synthesis, sometimes proportionally higher than IgG local synthesis, is observed in 8 CSF (among 13 investigated) and detected early, during the first week of the disease for 2 patients. 2) A relative poor IgG response is noted; this response is absent in one and decreasing in the 2 others patients despite their progressive aggravation. 3) A very little elevation of blood nucleic antibodies is detected in 5 CSF only. This very poor synthesis of antinucleic IgG contrast with their common increase in viral encephalitis. Thus, a viral immunosuppression may be discussed in rabies encephalitis, which may contribute to the lethal prognosis.

Encephalitis

Rapid immunoenzymatic technique for titration of rabies antibodies IgG and IgM results.

Techniques usually employed for the detection of rabies' antibodies are costly, time consuming, and sometimes fail to detect early antibodies. The introduction of immunoenzymatic techniques in the serology of viral disease represents a new and important advance. We therefore adapted this technique to the detection of rabies antibodies. We have found that the sera from rabies patients who had not received antirabies treatment do not show seroneutralizing antibodies until several days after the onset of symptoms. However, antibodies can be detected some days earlier by the immunoenzymatic method in the same samples. Furthermore, the immunoenzymatic test was applied to the detection of both the IgM or the IgG class of antirabies antibodies using an antihuman Ig-or antihuman IgG-peroxydase conjugate.

Antibodies, Viral

Acute mitral valve obstruction during infective endocarditis.

Five patients were found during surgery or at necropsy to have the mitral valve orifice obstructed by vegetations. They had had unexplained severe and recurrent episodes of acute febrile pulmonary oedema, and four had few cardiac ausculatory findings. Three patients died suddenly and unexpectedly; the other two were operated on and survived. In view of its ominous prognosis, acute mitral valve obstruction should be considered in patients whose pulmonary symptoms are compatible with endocarditis and are not adequately explained by the findings on examination of the heart. The condition, which should be confirmed by echocardiography, requires emergency surgery.

Adolescent