[Stress without distress in baccalaureate nursing education if that were possible?].
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Adaptation, Psychological↗
Biomedical subjects
C Richard
Publications and source records attributed to C Richard.
Experimental studies of infant-parent co-sleeping: mutual physiological and behavioral influences and their relevance to SIDS (sudden infant death syndrome).
We hypothesize that maternal sensory exchanges, likely involving a combination of heat, sound, gas, smells, movement, and touch, induce important physiological changes, especially in the healthy infant's arousal patterns, body temperature, and sleep architecture as defined by standard physiological measures. We summarize the results of two preliminary physiological studies, and some early data from a third, in which mothers and infants are monitored using standard polysomnographic techniques as they sleep in the same bed, and then in adjacent rooms. Our data suggest that infant-parent co-sleeping alters the infant's sleep experience as, for example, the characteristics of arousals, the frequency and duration of nursing, infant sleep position and the number of maternal inspections. For example, while sleeping in the same bed, mothers nurse their infants three times more frequently than they do while their infants sleep in an adjacent room. These preliminary data demonstrate significant differences between routine co-sleeping and solitary sleeping environments. This work underscores the importance of studying infant sleep as it unfolds in the co-sleeping environment, the environment within which it evolved over at least 5 million years of human evolution. Should our preliminary findings be confirmed in future studies they will provide a beginning point for considering additional, possibly unconventional ways of helping to reduce SIDS risks.
Adult↗
[Chronic eosinophilic pneumonia in a patient treated with allogenic bone marrow transplantation].
A 39 year old patient diagnosed of severe aplastic anemia and treated with allogenic bone marrow transplantation and who presented chronic eosinophilic pneumonia eight months after the transplant is presented. The patient had no previous history of asthma or atopy. Conditioning was performed with cyclophosphamide and total body irradiation. Prophylaxis of the graft versus host disease was carried out with cyclosporin and short course of methotrexate. At day 30 mild graft versus host disease appeared which spontaneously resolved. A progressive increase in the number of eosinophils was observed from day +40 reaching 1.05 x 10(9)/l at day +180 coinciding with suspension of the cyclosporine. The patient remained asymptomatic with no evidence of chronic graft versus host disease. At 8 months following allogenic transplantation the patient developed three episodes of fever, cough, moderate dyspnea and pulmonary infiltrates. Respiratory tests showed a restrictive pattern. Bronchoalveolar lavage contained 20% of eosinophils. Upon lung biopsy alveolar infiltration by eosinophils, lymphocytes and mononuclear cells was observed. Diagnosis of chronic eosinophilic pneumonia was made with initiation of steroid treatment. A drastic response was observed. The patient remained asymptomatic without recurrence and without evidence of chronic graft versus host disease. This picture may have been caused by the donor eosinophils given that retrospective evaluation demonstrated a persistent moderate eosinophilia in the donor.
Adult↗
Left ventricular function during weaning of patients with chronic obstructive pulmonary disease.
OBJECTIVE: Determine the evolution of left ventricular ejection fraction during weaning. DESIGN: Prospective study. SETTING: Intensive care unit of a university teaching hospital. PATIENTS AND PARTICIPANTS: 12 consecutive mechanically ventilated patients, without documented coronary artery disease, suffering from acute exacerbation of chronic obstructive pulmonary disease and able to be weaned. MEASUREMENTS AND RESULTS: Left ventricular ejection fraction was determined during mechanical ventilation, inspiratory pressure support (10 cmH2O) and spontaneous ventilation with constant inspiratory oxygen fraction using technetium 99m radionuclide angiography. Spontaneous ventilation induced a significant decrease in left ventricular ejection fraction from 54.5 +/- 12.4 to 47.0 +/- 13% (p < 0.01). Inspiratory pressure support induced a slight but non-significant decrease in left ventricular ejection fraction from 55.0 +/- 12.1 to 50.3 +/- 12.4%. Left ventricular ejection fraction was homogeneously reduced by spontaneous ventilation without patent regional wall motion abnormalities of the left ventricle. Myocardial 201thallium imaging performed 15 min after weaning showed a normal perfusion in the left ventricle anterior and posterior free wall. CONCLUSION: Weaning of patients suffering from chronic obstructive pulmonary disease without coronary artery disease induced a significant reduction in left ventricular ejection fraction. The non significant decrease in left ventricular ejection fraction observed with inspiratory pressure support suggested that our results might be explained by a weaning induced increase in afterload.
Acute Disease↗
Scedosporium inflatum infection in immunocompromised haematological patients.
We report four cases of Scedosporium inflatum (S. inflatum) infection in severely immunocompromised haematological patients. Six well-documented cases of S. inflatum disseminated infection in haematological patients have been reported: four in Australia and two in Spain. Their clinical and pathological characteristics are heterogenous, particularly in the Australian cases. However, the clinical and pathological profile emerging from our and other Spanish cases is homogenous and very similar to the clinico-pathological spectrum of other disseminated mycoses, including Aspergillus and S. apiospermum. The optimal treatment of S. inflatum infection is unknown and the outcome in haematological patients is very poor. Eight patients died despite systemic antifungal treatment.
Amphotericin B↗
HIV infection among women in prison: an assessment of risk factors using a nonnominal methodology.
The relative contributions of needle use practices and sexual behaviors to human immunodeficiency virus (HIV) antibody seropositivity among 394 women incarcerated in Quebec were determined by risk factor assessment and serology with a nonnominal methodology. HIV positivity was found in 6.9% (95% confidence interval [CI] = 4.6, 9.9) of all participants and in 13% (95% CI = 8.6, 18.6) of women with a history of injection drug use. HIV seropositivity among women with a history of injection drug use was predicted by sexual or needle contact with a seropositive person, self-reported genital herpes, and having had a regular sexual partner who injected drugs, but it was not predicted by prostitution. Nonnominal testing is an ethical alternative to mandatory and anonymous unlinked testing among correctional populations.
Adolescent↗
[Results of anal sphincteroplasty for post-traumatic incontinence: with or without colostomy].
Surgical repair of the anal sphincters after previous trauma is generally successful. In earlier publications, a protective colostomy was recommended but in most recent series colostomy is omitted. We have been through both phases and this is the first comparative study done on 82 consecutive repairs: 45 with colostomy from 1977 to 1986 (Group I) and 37 without colostomy from 1986 to 1992 (Group II). Causes of trauma were obstetrical: 50, surgical: 24 and violence: 5. Apart from colostomy related morbidity, postoperative complication rates were similar in the two groups. Results were graded excellent, good, fair or poor according to continence to solids, to liquids and soiling. Good and excellent results were obtained in 82% (Group I) and 87% (Group II) after a mean follow-up duration of 42 and 23 months respectively. Furthermore there was no difference between Group I and II in the rate of good/excellent results for cases who had undergone prior repairs (98% v. 100%) and also when the duration of incontinence was more than 10 years (71% v. 83%). We conclude that colostomy is not a determinant factor in the outcome and is therefore not required, avoiding all colostomy related morbidity and disability.
Anal Canal↗
[Against preventive antibiotic therapy in neutropenia].
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Anti-Bacterial Agents↗
Cytomegalovirus interstitial pneumonia in autologous bone marrow transplant recipients. Infectious Disease Working Party of the European Group for Bone Marrow Transplantation.
CMV pneumonia is rare following ABMT. No information has been presented concerning risk factors or outcome of antiviral therapy. Information concerning CMV pneumonia after ABMT was collected from bone marrow transplant centers in Europe. Twenty-one patients who fulfilled the diagnostic criteria of CMV pneumonia were reported. Eighteen of these patients were reported from centers who also reported the total number of ABMT performed. The CMV pneumonia frequency among 2252 reported ABMT patients was 0.8%, and this varied from 0% to 8.6% between different centers. Survival for > 30 days from diagnosis of pneumonia was 43%. Three patients suffered relapses, which were fatal, giving a total survival of 28%. Patients treated with or without TBI had a survival of 18% and 50%, respectively. Among patients given ganciclovir or foscarnet with or without intravenous immune globulin, survival at 30 days was 50% and total survival 28%. There was no difference in survival with or without the addition of intravenous immune globulin. CMV pneumonia is an infrequent but serious complication of ABMT.
Adolescent↗
Purification and characterization of the alpha-agarase from Alteromonas agarlyticus (Cataldi) comb. nov., strain GJ1B.
The phenotypic features of strain GJ1B, an unidentified marine bacterium that degrades agar [Young, K. S. Bhattacharjee, S. S. & Yaphe, W. (1978) Carbohydr. Res. 66, 207-212], were investigated and its agarolytic system was characterized using 13C-NMR spectroscopy to analyse the agarose degradation products. The bacterium was assigned to the genus Alteromonas and the new combination A. agarlyticus (Cataldi) is proposed. An alpha-agarase, i.e. specific for the alpha(1-->3) linkages present in agarose, was purified to homogeneity from the culture supernatant by affinity chromatography on cross-linked agarose (Sepharose CL-6B) and by anion-exchange chromatography (Mono Q column). The major end product of agarose hydrolysis using the purified enzyme was agarotetraose. Using SDS/PAGE, the purified alpha-agarase was detected as a single band with a molecular mass of 180 kDa. After the affinity-chromatography step, however, the native molecular mass was approximately 360 kDa, suggesting that the native enzyme is a dimer which is dissociated to active subunits by anion-exchange chromatography. The isolectric point was estimated to be 5.3. Enzyme activity was observed using agar as the substrate over the pH range 6.0-9.0 with a maximum value at pH 7.2 in Mops or Tris buffer. The enzyme was inactivated by prolonged treatment at a pH below 6.5, or by temperatures over 45 degrees C or by removing calcium. In addition, a beta-galactosidase specific for the end products of the alpha-agarase was present in the alpha-agarase affinity-chromatography fraction, probably as part of a complex with this enzyme. The degradation of agarose by this agarase complex yielded a mixture of oligosaccharides in the agarotetraose series and the agarotriose series, the latter consisting of oligosaccharides with an odd number of galactose residues.
Carbohydrate Conformation↗
Rapidly progressive interstitial renal fibrosis in young women: association with slimming regimen including Chinese herbs.
Two similar cases of rapidly progressive fibrosing interstitial nephritis in young women who followed the same slimming regimen prompted us to conduct an epidemiological survey of the nephrology centres of Brussels and to further investigate the exact nature of this slimming treatment. Seven other women under the age of 50 in terminal or preterminal renal failure were admitted for dialysis in 1991 and 1992. They had all followed a slimming regimen in the same medical clinic. Renal biopsy samples in eight of the nine cases showed extensive interstitial fibrosis without glomerular lesions. Two of the patients were seen for the first time in terminal renal failure and were started immediately on dialysis. For the seven other women, the nephropathy was characterised by a rapid deterioration in renal function, with initial serum creatinine doubling within about 3 months. The clinic had specialised in slimming treatments for the previous 15 years without any problems. In May, 1990, therapy was changed, with the introduction of two Chinese herbs (Stephania tetrandra and Magnolia officinalis). In June, 1992, three of twenty-five randomly selected women who had followed the same regimen during at least 3 months from 1990 had impaired renal function. Chemical analysis of some brands of these Chinese herbs did not show nephrotoxic contaminants of fungal or plant origin (ochratoxin or aristolochic acid) or adulteration by diuretics or antiinflammatory drugs. However, the medicinal preparation of the capsules taken by patients had different alkaloid profiles from those expected in Chinese plants. The striking relation between a specific type of fibrosing interstitial nephritis in young women and a slimming treatment involving Chinese herbs adds support to the arguments against uncontrolled therapy with herbal preparations.
Adult↗
Interferon gamma inhibits apoptotic cell death in B cell chronic lymphocytic leukemia.
The malignant, CD5+ B lymphocytes of B cell chronic lymphocytic leukemia (B-CLL) die by apoptosis in vitro. This is in contrast to the prolonged life span of the leukemic cells in vivo and likely reflects the lack of essential growth factors in the tissue culture medium. We found that interferon gamma (IFN-gamma) inhibits programmed cell death and promotes survival of B-CLL cells in culture. This effect may also be important in vivo: increased serum levels of IFN-gamma, ranging from 60 to > 2,200 pg/ml, were found in 7 of 10 B-CLL samples tested, whereas the sera of 10 healthy individuals did not contain detectable levels of this cytokine (< 20 pg/ml). High levels of IFN-gamma message were detected in RNA from T cell-depleted B-CLL peripheral blood samples by Northern blot analysis. Synthesis of IFN-gamma by B-CLL lymphocytes was confirmed by in situ hybridization and flow cytometry. The majority of B-CLL cells (74-82%) expressed detectable levels of IFN-gamma mRNA, and CD19+ B-CLL cells were labeled with anti-IFN-gamma monoclonal antibodies. These results show that IFN-gamma inhibits programmed cell death in B-CLL cells and suggest that the malignant cells are able to synthesize this cytokine. By delaying apoptosis, IFN-gamma may extend the life span of the malignant cells and thereby contribute to their clonal accumulation.
Antigens, CD↗
[Symptomatic treatment of septic shock].
Septic shock is characterized by an important vasoplegia associated with an oxygen extraction abnormality probably linked to the presence of a biochemical alteration at the microcirculatory level. Hemodynamic intervention requires aggressive fluid resuscitation complemented if necessary by the use of sympathomimetic amines (dopamine and often epinephrine, norepinephrine). Dobutamine is indicated when left ventricular dysfunction was obviously demonstrated. Swan Ganz catheter is required when hemodynamic intervention -ie fluid resuscitation and dopamine-remains unefficacious. However the earlier indication of Swan Ganz catheter use might be justified by the necessity of a precise preload evaluation and the possibility of the determination of the best oxygen transport.
Colloids↗
Heterogeneity of ANCA sera showing atypical, peripheral and classical cytoplasmic immunofluorescence patterns.
Atypical (A) ANCA immunofluorescence (IF) patterns have been described in several disease groups. We have previously reported a distinct cytoplasmic A-ANCA in 7-10% of patients with SLE and/or RA. Here, we show that these rheumatic disease associated A-ANCAs are best identified using U937 cells as substrate and that they do not target either a serine proteinase or a peroxidase. Furthermore, these sera immunoprecipitate a 40 kDa or a 42 kDa band using in vivo 35S-amino acid labelled HL60 or U937 cell extracts, respectively. Although these bands are the only one seen with pure A-ANCA sera, they can also be found in addition to the expected bands of PR3 or MPO in up to 30% of bona fide C- or P-ANCA sera. These data confirm and extend our previous observations. They also suggest that target heterogeneity of ANCA antibodies is frequent. Care should thus be taken in interpreting in a cause and effect relationship, an IF pattern or a biological effect produced by a serum with ill documented monospecificity. The exact nature and significance of this (these) new antigen(s) have yet to be clarified.
Antibodies, Antineutrophil Cytoplasmic↗
Arterial hemodynamics and cardiac effects of enoximone, dobutamine, and their combination in severe heart failure.
The acute systemic and regional hemodynamic effects of dobutamine (5, 10, and 15 micrograms/kg/min intravenously), of enoximone (1, 1.5, and 2 mg/kg intravenously), and of the dobutamine-enoximone combination were compared in eight patients with severe congestive heart failure. Dobutamine and enoximone similarly and dose-dependently increased cardiac index and decreased systemic vascular resistance, right atrial pressure, and mean capillary wedge pressure. Dobutamine, but not enoximone, increased heart rate after 10 and 15 micrograms/kg/min. The combination of the two drugs caused a greater increase in cardiac index and a greater decrease in total peripheral resistance than did each drug alone. In the forearm vascular bed, brachial blood flow and brachial artery diameter were increased by enoximone significantly and dose-dependently and by dobutamine only at 5 micrograms/kg/min. Finally, the combination of the two drugs increased brachial blood flow but not brachial artery diameter to a larger extent than enoximone alone. Hepatosplanchnic and renal blood flows were not altered by any of the treatments. These results indicate that (1) enoximone exerts a significantly greater muscular vasodilator action than dobutamine; (2) the dobutamine-enoximone combination potentiates the systemic and brachial vasodilator effects of each drug; and (3) high doses of dobutamine (10 and 15 micrograms/kg/min) improve hemodynamics through their positive inotropic and chronotropic effects, whereas at low doses (5 micrograms/kg/min) a peripheral vasodilation also contributes.
Adult↗
Regional hemodynamic effects of perindopril in congestive heart failure.
The onset of heart failure is associated with complex neurohumoral, cardiac, and vascular changes. These disorders partly explain that, in this situation, regional distribution of blood flows is hardly modified with stability or increase in heart and brain flows and impairement of limb, renal, and splanchnic blood flows. Using the bidimensional Doppler technique to measure brachial blood flow and diameter and standard clearance techniques to determine renal and hepatic blood flows, we studied the effects of perindopril, a long-lasting angiotensin-converting enzyme inhibitor, on regional hemodynamics. We demonstrated that perindopril produces a very marked increase in forearm and kidney flows but a very minor increase in the hepatosplanchnic territory, resulting in a regional distribution of cardiac output that favors the renal and musculocutaneous territories. This mechanism of action might be an important contribution to clinical improvement observed with perindopril.
Angiotensin-Converting Enzyme Inhibitors↗
Induction of apolipoprotein E expression during erythroid differentiation of human K562 leukemia cells.
Apolipoprotein E (ApoE) is the only apolipoprotein that is expressed in extrahepatic tissues. ApoE expression was studied in leukemia K562 cells differentiated towards erythroid or myelomonocytic lineages. When K562 cells were differentiated into the erythroid lineage by addition either of 1-beta-D-arabinofuranosylcytosine or hydroxyurea, an increase in ApoE mRNA and protein was detected. A weaker ApoE induction was also observed during phorbol ester-induced myelomonocytic differentiation. Previous work has associated ApoE expression to monocytic differentiation. The findings reported here indicate that ApoE overexpression is not associated with a specific lineage in myeloid differentiation and that may play a role in erythroid differentiation.
Apolipoproteins E↗
[Acquired corticotropin insufficiency in adults. 2 new cases].
We report two new cases of isolated corticotropin deficiency, associated with TSH deficiency in one of the two patient. The diagnostic was made difficult because the symptoms were mainly psychiatric. Low plasmatic cortisol and ACTH level were found, with low T3, T4 and TSH in the second patient. The TSH did not respond to the stimulation by TRH. The cerebral tomodensitometry and magnetic resonance imaging focused on the sella turcica were normal, eliminated a tumor and showed an empty sella turcica. The patients have to be followed-up because an isolated deficiency may further complete to panhypopituitarism.
Adrenocorticotropic Hormone↗