Thrombosis of angioaccess in haemodialysed patients treated with human recombinant erythropoietin.
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Biomedical subjects
Publications and source records attributed to C Michel.
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This paper presents two new rebinning algorithms for the reconstruction of three-dimensional (3-D) positron emission tomography (PET) data. A rebinning algorithm is one that first sorts the 3-D data into an ordinary two-dimensional (2-D) data set containing one sinogram for each transaxial slice to be reconstructed; the 3-D image is then recovered by applying to each slice a 2-D reconstruction method such as filtered-backprojection. This approach allows a significant speedup of 3-D reconstruction, which is particularly useful for applications involving dynamic acquisitions or whole-body imaging. The first new algorithm is obtained by discretizing an exact analytical inversion formula. The second algorithm, called the Fourier rebinning algorithm (FORE), is approximate but allows an efficient implementation based on taking 2-D Fourier transforms of the data. This second algorithm was implemented and applied to data acquired with the new generation of PET systems and also to simulated data for a scanner with an 18 degrees axial aperture. The reconstructed images were compared to those obtained with the 3-D reprojection algorithm (3DRP) which is the standard "exact" 3-D filtered-backprojection method. Results demonstrate that FORE provides a reliable alternative to 3DRP, while at the same time achieving an order of magnitude reduction in processing time.
The effects of tandospirone, enciprazine, gepirone, buspirone (5-HT1A agents) and carvotroline (5-HT2) on hypothalamic-pituitary-adrenocortical activity (HPA) activity were studied. These drugs increased the plasma corticosterone levels in a dose-dependent manner. Their ED50 values were 3.8, 31.8, 3.1, 3.4 and 7.0 mg/kg, respectively. Drug effects peaked between 30 min and 1 h, and plasma corticosterone levels returned to control levels after 2 h. When the drugs were given in conjunction with a rotatory stress, gepirone and enciprazine increased and carvotroline decreased plasma corticosterone levels. Dexamethasone (0.1 mg/kg) pretreatment reduced drug-activated HPA axis activity.
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Many nail abnormalities have traditionally been described in association with rheumatoid arthritis (RA), but their specificity has never been assessed in a controlled study. Our purpose was to evaluate the frequency and the specificity of nail changes associated with RA in a case-controlled study including 50 patients suffering from RA and 50 controls. For each patient, a general skin examination was performed and the 20 nails were examined. The nail features were noted and classified. A chi 2 test or a Fisher test was used to compare the two groups. The only nail abnormalities significantly associated with RA were longitudinal ridging on nine or 10 finger nails (29 patients in the RA group vs. three in the controls, chi 2: P < 0.001) and clubbing on at least one nail (24 patients vs. 10, chi 2: P < 0.01). Other nail changes were noticed but were not frequent enough to be significant. The presence of longitudinal ridging on the finger nails was significantly associated with RA.
INTRODUCTION: The usual treatments of rosacea (cyclines and metronidazole) are mainly effective on reducing the number of papules and pustules. Clonidine only was employed in order to treat flushes observed in rosacea. Rilmenidine is a central hypotensive drug which acts more specifically than clonidine on imidazoline receptors and which has no sedative side effects. The purpose of this study was to evaluate the efficacy of rilmenidine 1 mg/d in the treatment of rosacea. PATIENTS AND METHODS: A total of 41 patients suffering from typical rosacea were selected in this randomised double blind study rilmenidine versus placebo. The study comprised an 1-month observation period without treatment followed by 3 months of treatment. The major assessment criteria was the proportion of responders at the end of the treatment period. Responders were defined as patients showing a decrease of more than 50 p. 100 in the count of papules and pustules. Minor criterias were the variation of the number of flushes, self-evaluated by the patient and the variation of the redness of the face, noted by the investigator on a scale from 0 to 5. RESULTS: Fifteen patients treated by rilmenidine (R) and 19 patients receiving the placebo (P) were evaluated. The proportion of responders was 69.2 p. 100 in group R and 57.1 p. 100 in group P (p = 0.69). The variations of the number of papules and pustules and of the redness of the face were not significantly different in the two groups. The decrease in the number of flushes was higher in group R (around -13) than in group P (around -5), but the difference was not really significant (p = 0.076). Arterial pressure decreased in 3 patients in group R and in 2 patients in group P. Minor side effects were noted in a similar proportion of patients in the two groups. DISCUSSION: Rilmenidine is not efficient in reducing the number of papules and pustules but could decrease the number of flushes. Nevertheless, many patients were lost for follow-up and because of a major placebo effect, the conclusions of this study are not strong enough. Another study including more patients and using evaluation criteria based on the vascular components of rosacea could perhaps confirm this hypothesis.
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The main characteristics and the relative interest of the different modalities of medical imaging digitalization are presented as well as their most appropriate clinical indications.
BACKGROUND: Previous work has documented that dysfunctional noninfarcted collateral-dependent myocardium, a condition typical of myocardial hibernation, exhibited almost normal resting perfusion. The present study was designed to test whether these observations could be extended to unselected patients with chronic dysfunction and a previous infarction. METHODS AND RESULTS: Dynamic positron emission tomographic imaging with [13N]ammonia and [18F]fluorodeoxyglucose (FDG) to assess myocardial perfusion and glucose uptake was performed in 39 patients with chronic anterior wall dysfunction undergoing coronary revascularization. Left ventricular function was evaluated by echocardiography before (at rest and during low-dose dobutamine infusion) and 5 months after revascularization. At follow-up, wall motion was improved in 24 patients and unchanged in 15 patients. Before revascularization, absolute myocardial blood flow was higher (84 +/- 27 versus 60 +/- 26 mL.min-1 x 100 g-1, P = .007) in reversibly compared with persistently dysfunctional segments. In segments with reversible dysfunction, values of myocardial blood flow were similar to those in the remote segments of the same patients or in anterior segments of normal volunteers. During glucose clamp, FDG uptake was higher (69 +/- 17% versus 49 +/- 18%, P < .01) but myocardial glucose uptake was not different (38 +/- 20 versus 29 +/- 19 mumol.min-1.100 g-1, P = NS) in reversibly compared with persistently dysfunctional segments. A flow-metabolism mismatch was present in 18 of 24 reversibly injured but absent in 10 of 15 persistently dysfunctional segments. With dobutamine, wall motion improved in 17 of 24 reversibly dysfunctional segments and did not change in 13 of 15 segments with persistent dysfunction. CONCLUSIONS: This study indicates that chronic but reversible ischemic dysfunction is associated with almost normal resting myocardial perfusion, with maintained FDG uptake, and with recruitable inotropic reserve. These data support the contention that chronic hibernation is not the consequence of a permanent reduction of transmural myocardial perfusion at rest.
An attempt to determine the consequences of prolonged ischemia on simultaneous regional changes in norepinephrine (NE) and neuropeptide Y (NPY) interstitial myocardial concentrations in a pig model in vivo was made. The aim of the authors was to investigate further the mechanism of the major NE release previously observed in perfused hearts preserved using a Langendorff technique. Regional myocardial ischemia was induced by ligation of the left anterior descending coronary artery (LAD) in ten anesthetized pigs. NE and NPY release was studied using interstitial microdialysis, a technique initially used to monitor neurotransmitter kinetics in brain dialysate samples. Four dialysis probes were implanted into the left ventricular wall of the beating heart. Two were implanted into the ischemic region (LAD) (for NE and NPY determinations, respectively) and the remaining two into the non-ischemic left circumflex coronary artery region (LCX). Dialysate NE and NPY concentrations, as indices of interstitial myocardial NE and NPY concentrations, were measured by HPLC and RLA, respectively. A slight but significant increase in NPY levels was observed in both territories (LAD: from 190 +/- 27 to 349 +/- 62 pmol/l, LCX: 146 +/- 30 to 257 +/- 52 pmol/l) suggesting moderate stimulation of cardiac sympathetic nerve activity following LAD occlusion. On the contrary, a marked but progressive increase in NE release was observed in the ischemic region (from 8.8 +/- 1.0 to 251.4 +/- 44.8 nmol/l), when NE levels in the non-ischemic region remained stable (from 10.3 +/- 2.1 to 11.0 +/- 1.9 nmol/l). These results demonstrate the utility of regional in-vivo myocardial NE and NPY monitoring using microdialysis. The strong and sustained NE accumulation occurring in the ischemic region is consistent with the hypothesis of a local non-exocytotic metabolic NE release in case of prolonged myocardial ischemia, when exocytotic release remain only minimal as attested by the slight increase in NPY observed.
The standardized bilateral fronto-orbital advanced method of osteotomy established at the University of Wuerzburg is applied in all forms of craniosynostosis except scaphocephalus. The intention behind early operation is to halt progression of the disorder and to institute the physiological direction that growth should take. The preoperative severity of the disorder, the particular symptoms of the various malformations concerned, and the postoperative course of growth were analyzed and assessed both clinically and cephalometrically using the retrospective evaluations of the file data of 131 children with various forms of craniosynostosis. In contrast to linear craniectomy and so-called lateral canthal advancement, which have sometimes been thought to lead to undesirable postoperative growth development, only 11 relapses requiring renewed operation were found postoperatively in our own study of 131 children. It became evident that the greater the severity of the malformation, the more probable it was that a relapse would occur. Fronto-orbital advancement can only affect the pathological growth pattern to a limited degree, especially when craniosynostosis is related to a syndrome. Cephalometric evaluation confirmed the limited potential for growth in the area of the anterior skull base and in the mid-face in the presence of syndrome-related brachycephaly and severe facio-craniosynostoses. In such clinical cases, compensatory growth of maxillary hypoplasia cannot be expected after fronto-orbital advancement.
This report describes techniques and protocols implemented at the Geneva Canton University Hospitals (HUG) for the combination of various biomedical imaging modalities and sensors including electromagnetic tomography, to study, assess, and localize neurological (dys) function. The interest for this combination stems from the broad variety of information brought out by (functional) magnetic resonance imaging, magnetic resonance spectroscopy, computed tomography, single-photon emission tomography, positron emission tomography, and electromagnetic tomography. Combining these data allows morphology, metabolism, and function to be studied simultaneously, the complementary nature of the information from these modalities becoming evident when studying pathologies reflected by metabolic or electrophysiologic dysfunctions. Compared with other current multimodality approaches, the one at the HUG is totally compatible with both clinical and research protocols, and efficiently addresses the multidimensional registration and visualization issues. It also smoothly integrates electrophysiology and related data as fully featured modalities.
Structurally unique macrocyclic phenols from liverwort, i.e., marchantins and related substances, were studied for their antioxidative potential using pulse-radiolytic and EPR-spectroscopic techniques. The generally diffusion-controlled rate constants for scavenging of azide radicals as a model electrophilic species and the sufficiently slow bimolecular decay confirm their antioxidative potential. Transient spectra after pulse radiolysis and the EPR spectra both demonstrate the internal strain of the macrocyclic ring. One compound, Perrottetin D, furthermore gave proof to the hitherto only kinetically verifyable superior radical-scavenging capability of the aroxyl radical derived from a phenolic antioxidant.
OBJECTIVES: To examine whether the variability of CYP2D6 activity in patients with chronic renal failure can be assessed, particularly among subjects with the extensive metabolizer phenotype, by use of standard in vivo indexes of CYP2D6 activity derived from oral administration of dextromethorphan and sparteine. METHODS: A single 100 mg oral dose of sparteine and a single 40 mg oral dose of dextromethorphan were administered on two occasions to 12 patients with chronic renal failure (creatinine clearance ranging from 20 to 70 ml/min) and 12 age- and sex-matched healthy subjects. Sparteine clearances, sparteine metabolic ratio, and urinary recovery of dextrorphan were calculated. Patients and healthy control subjects were not selected on the basis of their CYP2D6 phenotypes. RESULTS: Chronic renal failure was associated with a decrease in sparteine partial metabolic clearance to dehydrosparteine (median of 322 ml/min and range of 62 to 670 ml/min in patients with renal failure versus median of 635 ml/min and range of 77 to 1276 ml/min in normal subjects; p < 0.02). Sparteine apparent oral clearance (p < 0.03) and renal clearance (p < 0.001) decreased in patients with renal failure. However, sparteine metabolic ratio was not significantly altered in patients with renal failure and showed that all patients were extensive metabolizers of sparteine. Although fractional urinary excretion of dextrorphan decreased in patients with renal failure (median, 24.4%; range, 9.7% to 55.9%) compared with control (median, 47.5%; range, 24.1% to 72.1%) (p = 0.02), it also showed that all subjects were extensive metabolizers of dextromethorphan. The amount of dextromethorphan excreted in urine correlated with creatinine clearance independently from CYP2D6 activity measured as sparteine partial metabolic clearance. However, it did not correlate with sparteine metabolic ratio or with fractional urinary excretion of dehydrosparteine. CONCLUSION: Assessment of CYP2D6 activity by use of dextromethorphan and sparteine is possible in extensive metabolizer patients with chronic renal failure. However, in these subjects, dextromethorphan and sparteine do not reflect CYP2D6 activity in the same way.
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Native GABAA receptors containing different gamma-subunit variants were distinguished immunobiochemically with antisera selectively recognizing the gamma 1-, gamma 2- and gamma 3-subunits. While GABAA receptors containing the gamma 2-subunits were confirmed to be rather ubiquitous in the adult brain, receptors characterized by the gamma 1- or gamma 3-subunit were of low abundance, as shown by immunoprecipitation. The three receptor populations differed strikingly in their benzodiazepine (BZ) site ligand binding profiles. The gamma 3-receptor population displayed reduced affinity for the full agonists clonazepam flunitrazepam and virtually lacked sensitivity to zolpidem. The gamma 1-receptor population displayed low affinity for all benzodiazepine site ligands tested, except for flunitrazepam, and could be differentiated from the gamma 2- and gamma 3-receptors by its low affinity for the inverse agonist beta CCM and its lack of affinity for the partial inverse agonist Ro 15-4513 and the antagonist flumazenil. Since flumazenil antagonizes all major effects of BZ agonists, gamma 1-receptors are not involved in mediating these actions in vivo. In immunopurified receptors, the gamma-subunit variants were found to be assembled with different variants of alpha- and beta-subunits, indicating that not only the gamma 2-subunit gamma 1- and gamma 3-subunits are part of various receptor subtypes. In addition, the gamma 2- and gamma 3-subunits can be co-assembled in native receptors, consistent with the subunit stoichiometry of two alpha-, one beta- and two gamma-subunits proposed previously for recombinant receptors.
The in vitro degradation of dietary fibre from three brown seaweeds (Himanthalia elongata, Laminaria digitata and Undaria pinnatifida) was studied, using human faecal flora. Two sets of fibre were tested: (1) total algal fibres extracted from the whole algae, mainly composed of alginates, and (2) purified fibres (sulphated fucans, Na-alginates and laminarans) representative of those contained in the whole brown algae. Mannuronate, one algal component, was also investigated. Substrate disappearance and short-chain fatty acid (SCFA) production were monitored after 6, 12 and 24 h fermentation. Gas production was followed hourly during the first 9 h and then at 12 and 24 h. Sugarbeet fibre was used as a fermentation reference substrate. According to the fermentative indices used, most of each of the total algal fibres disappeared after 24 h (range 60-76%) but, unlike the reference substrate, they were not completely metabolized to SCFA (range 47-62%). Among the purified algal fibres, disappearance of laminarans was approximately 90% and metabolism to SCFA was approximately 85% in close agreement with the fermentation pattern of reference fibres. Sulphated fucans were not degraded. Na-alginates exhibited a fermentation pattern quite similar to those of the whole algal fibres with a more pronounced discrepancy between disappearance and production of SCFA: disappearance was approximately 83% but metabolism was only approximately 57%. Mannuronate was slowly fermented but its metabolism corresponded to its disappearance from the fermentative medium. Thus, the characteristic fermentation pattern of the total fibres from the three brown algae investigated was attributed to the peculiar fermentation of alginates, and mannuronate was shown not to be directly involved.
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