Fortuitous discovery of the association of true and false left ventricular aneurysm in a patient in cardiogenic shock.
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Aged↗
Biomedical subjects
C Richard
Publications and source records attributed to C Richard.
An outbreak of pneumonia and meningitis caused by a previously undescribed gram-negative bacterium in a hot spring spa.
An outbreak of infection caused by a previously undescribed Gram-negative bacterium affected people attending a hot (37 degrees C) spring spa in France in 1987. Thirty-five case of pneumonia and two cases of meningitis occurred. None of these patients died. Attack rates were significantly higher for patients above 70 years old and for male patients. An epidemiological comparison of the 26 hospitalized cases with 52 matched controls suggests that spa treatment early on the first day (OR = 4.8) and attendance at the vapour baths (OR = 10.7) were significant risk factors for acquiring the infection. Person-to-person spread was not thought to have occurred. The same bacterium was isolated from the hot spring water. All strains studied shows a single rRNA gene restriction pattern. Epidemiological data indicated that the thermal water was the source of infection. This outbreak stresses the need for increased surveillance of infections in people attending hot spring spas.
Aged↗
Autologous bone marrow transplantation as consolidation therapy for non-Hodgkin's lymphoma patients with poor prognostic features.
Theoretical considerations and preliminary results of clinical trials support the earlier use of autologous bone marrow transplantation (ABMT) in poor prognosis non-Hodgkin's lymphoma (NHL). A prognostic analysis of 50 patients with intermediate or high grade NHL younger than 60 years, who achieved at least one complete remission and were not treated with BMT, was performed. Patients with bulky tumor at diagnosis and/or serum LDH greater than or equal to 600 U/l do poorly with conventional chemotherapy. Twelve patients with these high-risk initial characteristics in first complete remission (CR) and six patients in second or third CR were treated with cyclophosphamide (60 mg/kg x 2) and total body irradiation (1000-1200 cGy) followed by ABMT. Overall disease-free survival was 65% at a median follow-up of 35 months. No differences were found between the first and later CR patients. The rate of toxic death was 11%. Disease-free survival after first CR was better for 1st CR ABMT patients than for a historical chemotherapy control group with similar poor prognosis features (p = 0.008). These results support the use of ABMT in selected, high-risk NHL patients in first CR.
Adolescent↗
[Fortuitous discovery of the association of true and false aneurysm of the left ventricle after cardiogenic shock].
The authors report the fortuitous diagnosis of a true and a false left ventricular aneurysm in a 77 year old man with severe ischaemic heart disease and calcific aortic stenosis, admitted for cardiogenic shock. The association of these two forms of aneurysm is very rare. Clinical and paraclinical diagnosis is difficult. Conventional left ventriculography is the investigation of reference but the diagnosis has been facilitated by Technetium 99 cardiac scintigraphy and color Doppler echocardiography. Surgery may be considered in cases of true aneurysm especially in patients with left ventricular failure, but the indication is formal in cases of false aneurysm.
Aged↗
[Acute non-lymphoid leukemia with basophilic differentiation and t(6;9)].
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Bone Marrow↗
Angiotensin converting enzyme inhibition. Systemic and regional hemodynamics in rats and humans.
The systemic and regional hemodynamic effects of angiotensin I converting enzyme inhibitors (ACEIs) have been investigated using different experimental methods (pulsed Doppler, radioactive microspheres), either in rats (normotensive NT or genetically hypertensive SHRs) or in humans (healthy volunteers or patients with congestive heart failure CHF). All ACEIs decreased systemic vascular resistance but the profile of their peripheral vasodilating properties was heterogeneous. ACEI-induced vasodilation primarily affected the kidney in rats and in humans and this effect was accompanied by a strong and consistent increase in renal blood flow. This occurred even at non-hypotensive doses in SHRs and CHF patients and resulted in a favorable redistribution of cardiac output towards the kidney. In the muscular vascular bed, ACEIs also decreased local vascular resistance in rats and in humans, whether normotensive or hypertensive. In humans, this vasodilation affected both the arterioles and the large conductance vessels, more markedly in CHF patients than in normotensive subjects. Muscular blood flow was increased and a favorable redistribution of cardiac output towards the muscle occurred. Cerebral blood flow in SHRs and carotid blood flow in humans were augmented, whereas hepatosplanchnic blood flow was increased in rats but not modified in humans. There was no major difference between the regional vasodilating profiles of the different ACEIs, but captopril was somewhat less active at the muscular level. In conclusion, ACEI-induced regional vasodilation is heterogeneous, preferentially affecting the kidney and the muscle. In the latter, both arterioles and large conductance vessels are dilated.
Angiotensin-Converting Enzyme Inhibitors↗
[Tissue oxygenation during recovery from anesthesia. Value and measurement].
The measurement of tissue oxygen concentrations in the intensive care unit is important for the management of patients, especially those in shock. In daily practice, right heart catheterization with continuous monitoring of the oxygen saturation of mixed venous blood provided means of evaluating the principal parameters of oxygenation (transport, consumption and extraction), and of analyzing therapeutic interventions. The finding of an oxygen debt implies an appropriate therapeutic response designed to balance oxygen supplies with peripheral oxygen demand.
Blood Gas Monitoring, Transcutaneous↗
[Bone marrow autotransplantation in patients with acute myeloblastic leukemia in primary remission].
Fifteen bone marrow autotransplants (BMAT) in patients with acute myeloblastic leukemia (AML) were performed after the first remission. The mean age was 37 years (range 12 to 60 years). According to the morphological classification FAB, 8 patients had monocytic leukemia (M4, M5) and 7 myeloid leukemia (M1, M2, M3). The mean interval elapsed between the date of complete remission and the BMAT was 3.9 months (range 1 to 5-9 months). In 8 patients this interval was longer than 6 months and in 7 cases it was shorter than 6 months. After achievement of the complete remission all patients underwent certain cycles of intensification before the BMAT. Eight patients received only a cycle whereas 7 patients received more than one cycle (between 2 and 4). The conditioning protocol consisted of cyclophosphamide (CP) (60 mg/kg x 2) and total body radiotherapy (TBR) (10 Gy) in 9 patients; CP and busulfan in five; and CP, cytarabine at high doses and melphalan in one case. Marrow extraction was performed after completion of chemotherapy of intensification. In 5 cases the bone marrow was depleted of leukemic cells by previous in vitro treatment with ASTA-Z. There are at present 8 alive patients. The survival free of illness was 51.8%. Seven patients died: 3 cases because relapse of the leukemia, 3 due to attachment failure of the transplantation, and one patient suffered a viral myocarditis. The survival free of illness was significantly longer in those patients transplanted after 6 months of the complete remission.
Adolescent↗
Acquired von Willebrand disease in multiple myeloma secondary to absorption of von Willebrand factor by plasma cells.
A case of acquired von Willebrand disease (AvWD) associated with an IgA lambda multiple myeloma is reported. No form of inhibitor could be detected. SDS-agarose gel electrophoresis patterns of von Willebrand factor (vWF) both in plasma and platelet lysates were normal but a decrease in all-sized multimers with a type IA pattern was seen. After 1-deamino-8-D arginine vasopressin (DDAVP) infusion, vWF multimers larger than those seen in the resting state appeared in patient plasma, which were progressively cleared. Indirect immunofluorescence studies with a monoclonal antibody to vWF showed that vWF was selectively absorbed into myelomatous cells. This is the first case of AvWD associated with multiple myeloma resulting from the selective absorption of vWF into abnormal plasma cells. This feature established a new pathophysiological mechanism of AvWD in multiple myeloma and probably in other lymphoproliferative diseases.
Absorption↗
Severe rhabdomyolysis related to heroin sniffing.
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Acute Kidney Injury↗
Susceptibility of Alcaligenes denitrificans subspecies xylosoxydans to beta-lactam antibiotics.
The susceptibility of 56 clinical isolates and two reference strains of Alcaligenes denitrificans subsp. xylosoxydans to beta-lactam agents was tested and related to beta-lactamase activity of the strains. The MICs of 12 beta-lactams determined by an agar dilution method showed that all the strains were sensitive to imipenem and moxalactam. Forty-one cloxacillin-sensitive beta-lactamase producing strains were highly susceptible to azlocillin, piperacillin and ticarcillin, and less susceptible to several cephalosporins (cefamandole, cefoperazone, ceftazidime). The 17 remaining beta-lactamase-producing strains, which were sensitive to clavulanic acid and to a lesser extent cloxacillin, had variable resistance to the penicillins tested and synergy was obtained when these penicillins were combined with clavulanic acid or tazobactam. The choice of agents for treatment of infections with this organism must take into account the susceptibility phenotype of clinical isolates.
Alcaligenes↗
Steroid receptor exchange assay in the presence of acetonitrile: application to the study of glucocorticoid- and anti-glucocorticoid-receptor complexes.
Acetonitrile was used to modify the binding parameters of glucocorticoid-receptor complexes. Acetonitrile (8%) caused a striking increase of the rate constant of dissociation of non-transformed [3H]triamcinolone and [3H]RU 486 receptor complexes. The latter complexes appeared significantly less sensitive to acetonitrile than the former. Similar data were obtained for heat-transformed [3H]triamcinolone and RU 486-receptor complexes purified at a 90% relative homogeneity by DEAE-Trisacryl (diethylaminoethyl) chromatography. The rate constant of dissociation of both steroid-receptor complexes decreased after transformation. The dissociation of non-transformed receptor complexes by acetonitrile was reversible, and an exchange assay allowing 75% to 85% steroid exchange is described. However, the dissociation of transformed receptor complexes appeared completely irreversible and precluded the design of any exchange assay.
Acetonitriles↗
Free radical scavenging and cytotoxic properties in the ellipticine series.
In the series of cytotoxic intercalating compounds derived from ellipticine, we tried to correlate free radical scavenging properties with cytotoxic activities. Scavenging properties were determined in vitro on two experimental models: a) antioxidant activity of the drugs during the autoxidation of methyl linolenate induced by azo-bis-isobutyronitrile; this activity was measured either by the initial rate ratios in the presence and in the absence of the drug or by the length of the inhibition period of the reaction in the presence of the drug and b) ability to reduce DPPH free radicals. Cytotoxic properties were expressed by ID50 the dose which reduces by 50% the L 1210 cell growth rate as compared to controls after 48 h. It appears that antioxidant activity and reduction of DPPH both require the presence of a free OH group on the ellipticine ring. A good correlation is observed between cytotoxicity and antioxidant activity of the hydroxylated derivatives; minor structural modifications which result in a loss of cytotoxic activity also result in a loss of antioxidant properties. No such correlation is observed with DPPH reducing properties of ellipticine derivatives.
Alkaloids↗
Vitamin E deficiency and lipoperoxidation during adult respiratory distress syndrome.
Vitamin E (Vit E) is an important component of the lung's defense against oxidant injury. The aim of this study was to determine a) if adult respiratory distress syndrome (ARDS) was associated with a decrease in Vit E plasma level linked to an enhancement of plasma lipoperoxidation, and b) if this Vit E deficiency might be explained by malnutrition and/or a consumption defect. Vit E, lipoperoxides (LP), total lipids, and fatty acid plasma levels were measured in 12 patients with ARDS (PaO2 less than or equal to 60 Torr with FIO2 0.6 on mechanical ventilation). At the onset of ARDS (T0), the decrease in Vit E plasma level was significant (p less than .001) 7.73 +/- 0.54 (n = 12) vs. 11.46 +/- 0.55 mg/L (n = 7) in the control group (healthy subjects breathing room air). A significant (p less than .05) increase in LP was simultaneously observed (4.12 +/- 0.35 [n = 12] vs. 2.94 +/- 0.30 nmol/ml [n = 17]) in the control group. At T0, LP were inversely correlated with Vit E plasma levels (r = .78, p less than .01). Vit E deficiency was associated with low levels of total plasma lipids (3.68 +/- 0.25 g/L) and plasma cholesterol (0.97 +/- 0.07 g/L). Thus, the Vit E/total lipids ratio (2.18 +/- 0.17 mg/g) was always above the accepted normal limit value for this ratio (0.8 mg/g).(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Systemic and regional hemodynamic effects of perindopril in congestive heart failure.
The acute systemic and regional hemodynamic responses to a single oral dose (4 mg) of the angiotensin converting enzyme inhibitor perindopril were investigated in 10 patients with severe congestive heart failure. Perindopril produced significant and long-lasting decreases in systemic vascular resistance (-18%), right atrial pressure (-60%), and mean pulmonary capillary wedge pressure (-28%), whereas it significantly increased cardiac index (+ 12%). Brachial (+ 130%, pulsed Doppler technique) and renal (+ 34%) blood flows were also significantly increased whereas hepatic blood flow remained unchanged. Brachial flow/cardiac output and renal flow/cardiac output ratios increased significantly from 0.8 to 1.6 and from 13.2 to 16.5, respectively. The maximal decreases in forearm and renal (but not in systemic) vascular resistances were correlated with the basal plasma norepinephrine concentrations but not plasma epinephrine concentrations or plasma renin activity. We conclude that in severe heart failure (a) perindopril considerably improves systemic hemodynamics and exerts an inhomogeneous vasodilating effect, resulting in a redistribution of flows toward the forearm and renal territories, (b) norepinephrine is a major determinant of the arteriolar tone in these two vascular beds, and (c) the pulsed Doppler is a particularly suitable method to non-invasively detect and assess hemodynamic improvements in heart failure patients.
Administration, Oral↗
The effect of respiratory disorders on clinical pharmacokinetic variables.
Respiratory disorders induce several pathophysiological changes involving gas exchange and acid-base balance, regional haemodynamics, and alterations of the alveolocapillary membrane. The consequences for the absorption, distribution and elimination of drugs are evaluated. Drug absorption after inhalation is not significantly impaired in patients. With drugs administered by this route, an average of 10% of the dose reaches the lungs. It is not completely clear whether changes in pulmonary endothelium in respiratory failure enhance lung absorption. The effects of changes in blood pH on plasma protein binding and volume of distribution are discussed, but relevant data are not available to explain the distribution changes observed in acutely ill patients. Lung diffusion of some antimicrobial agents is enhanced in patients with pulmonary infections. Decreased cardiac output and hepatic blood flow in patients under mechanical ventilation cause an increase in the plasma concentration of drugs with a high hepatic extraction ratio, such as lidocaine (lignocaine). On a theoretical basis, hypoxia should lead to decreased biotransformation of drugs with a low hepatic extraction ratio, but in vivo data with phenazone (antipyrine) or theophylline are conflicting. The effects of disease on the lung clearance of drugs are discussed but clinically relevant data are lacking. The pharmacokinetics of drugs in patients with asthma or chronic obstructive pulmonary disease are reviewed. Stable asthma and chronic obstructive pulmonary disease do not appear to affect the disposition of theophylline or beta 2-agonists such as salbutamol (albuterol) or terbutaline. Important variations in theophylline pharmacokinetics have been reported in critically ill patients, the causes of which are more likely to be linked to the poor condition of the patients than to a direct effect of hypoxia or hypercapnia. Little is known regarding the pharmacokinetics of cromoglycate, ipratropium, corticoids or antimicrobial agents in pulmonary disease. In patients under mechanical ventilation, the half-life of midazolam, a new benzodiazepine used as a sedative, has been found to be lengthened but the underlying mechanism is not well understood. Pulmonary absorption of pentamidine was found to be increased in patients under mechanical ventilation. Pharmacokinetic impairment does occur in patients with severe pulmonary disease but more work is needed to understand the exact mechanisms and to propose proper dosage regimens.
Humans↗
[Acute respiratory distress caused by distal neoplastic pulmonary emboli].
In contrast to pulmonary parenchyma metastases or lymphangitic carcinomatosis, neoplastic emboli of small pulmonary arteries and capillaries frequently go unrecognized and are only discovered at autopsy. Five patients (48 +/- 12 years old) were admitted to 3 intensive care units for severe acute respiratory failure and died between the first and the tenth day following hospitalization. Each patient had a history of rapidly progressive dyspnea, and physical examination showed clinical evidence of right ventricular failure. The lungs were clear on chest X-rays and the ECG revealed sinus tachycardia with a right QRS axis. The mean partial pressures of oxygen (PaO2) and carbon dioxide (PaCO2) were, respectively, 50.8 +/- 9.1 mm Hg and 22.2 +/- 2.4 mm Hg. A swan-Ganz catheter, inserted into 4 patients, revealed pulmonary arterial hypertension (55, 43, 37, 28) with capillary wedge pressure within the normal limits and cardiac output normal or low (3.0, 3.8, 4.4, 5.0 l/min). Pulmonary angiograms from each patient showed decreased distal lung perfusion without any proximal defects suggestive of pulmonary embolism. The inferior vena cava always appeared clear. Malignant cells were found upon autopsy (4 cases) in the lumina of the pulmonary arterioles and the primary site of the cancer was determined in 3 patients (2 hepatomas and 1 pancreatic carcinoma). The last patient had a known breast cancer with bone marrow metastases and clinical, hemodynamic and angiographic evidence of neoplastic emboli. The clinical course of neoplastic emboli can suggest acute pulmonary embolism, but the diagnosis can only be advanced after pulmonary angiography, especially if the patient is to have a cancer.(ABSTRACT TRUNCATED AT 250 WORDS)
Acute Disease↗
[Empirical treatment of febrile episodes in patients with neutropenia in bone marrow transplantation].
The results of therapy of febrile episodes during the pregraft phase in bone marrow transplant was retrospectively evaluated in 84 granulocytopenic patients. Most patients received co-trimoxazole and i.v. ticarcillin as antibacterial prophylaxis. 47 episodes were treated with a third generation cephalosporin plus an aminoglycoside, with a 55% favorable response rate. 37 episodes were treated with a wide spectrum penicillin plus an aminoglycoside, with a 41% response rate (p greater than 0.05). Among the 23 infections caused by gram-negative bacilli the response rate was 89% (8 of 9) with the first regimen, and 21% (3 of 14) with the second one (p = 0.003). The investigation of in vitro sensitivity suggested that prophylactic ticarcillin favors the infections due to bacilli with cross-resistance to wide spectrum penicillins. The antibiotic regimen did not influence the final resolution or the mortality rate of the febrile episode.
Adult↗