[Severe localized bronchial dyskinesis treated with an original plasty procedure. Apropos of a case].
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Biomedical subjects
Publications and source records attributed to D Herman.
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The authors have studied monthly the titres of specific IgE to Dermatophagoides pteronyssinus, by Phadebas RAST, in 8435 measurements, spread over 4 years. Significant seasonal and monthly variations were seen every year with a maximum level in the autumn or the beginning of winter, with a second peak at the end of winter in 3 years of the 4. There was no close superposition of pattern form one year to another. The domestic relative humidity had a significant effect on the seasonal variation with a mean shift of 2 months that could be explained by the length of the biological cycle of the mites. These data compare with those of the literature (sampling of mites in bedding, longitudinal studies...).
Few studies have been performed to assess the validity of clinic-based nutritional surveillance systems. We compared estimates of the prevalence of underweight (low weight-for-age) obtained from the clinic-based Swaziland surveillance system with estimates obtained from the 1983 National Nutrition Status Survey of Rural Swaziland. The age-adjusted prevalence of underweight among first-time clinic attenders (10.0%) was very similar to that estimated by the national survey (9.4%). However, the prevalence of underweight among children attending two or more times in a year was less than half that of first attenders (4.4%). The regional differences in the prevalence of underweight found in the national survey were not detected by the surveillance system. Surveillance data are useful in describing the nutritional status of children from clinics within the surveillance system. However, surveillance data, particularly from re-attenders, will not necessarily provide a valid estimate of nutritional status within the general population or of differences between regions.
Seven patients of Haitian and Central African origin were investigated for interstitial pneumonitis and unexplained chronic lymphadenopathy. A study of broncho-alveolar lavage fluid showed no opportunistic micro-organisms and disclosed a high alveolar lymphocyte count with more than 80% T8+ cells. In 3 patients, open lung biopsy showed lymphoid interstitial pneumonitis. Follicular hyperplasia was a constant finding in lymph nodes. Benign lymphocytic infiltration was found in other organs of all patients, associated with polyclonal hyperimmunoglobulinaemia, low peripheral T4+ cell count and LAV-Ig G antibodies.
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The value of computerized tomography (CT) was compared with that of conventional exploratory methods (standard radiology, bronchial tomography and endoscopy) in 60 patients with non-anaplastic bronchial cancer evaluated preoperatively. After CT examination thoracotomy was avoided in 14 (23%) patients with local or distal extension. CT proved more sensitive than conventional methods in the assessment of pleural and/or parietal extension, and of direct or lymph-node mediastinal invasion (67% vs 33%, 50% vs 33%, 64% vs 45% respectively). Similar results (75%) were obtained in cases with hilar lymph-node involvement. However, caution must be exerted before excluding thoracotomy, since CT may give false-positive results.
Between January 1981 and December 1983, a prospective therapeutic trial of detorubicin (14-diethoxyacetoxy-daunorubicin [DTR]) was conducted in 40 patients with histologically proven malignant mesothelioma (MM). DTR was given intravenously at 40 mg/m2 on days 1, 2, and 3 for five 21-day cycles, then 40 mg/m2 once every 21 days. Thirty-five patients (32 with pleural MM, 3 with peritoneal MM) were eligible. The overall median survival from onset of chemotherapy was 17 months. Complete relief from chest pain was observed in 8 of 15 cases (53%). Of 21 patients with measurable disease, there were 2 complete responses (10%) and 7 partial responses (33%). Median duration of response was 30 weeks. Congestive cardiac failure developed in two patients after 1100 and 1600 mg/m2 of DTR, respectively. Hematologic toxicity was moderate. This study demonstrates that DTR is effective against MM.
Intracellular recording techniques were used to test for cross-modality and topographic convergence among inputs to area 3a of cerebral cortex. Recordings were made within the projection area of group I afferent fibers of the deep radial nerve in barbiturate-anesthetized cats. Epsps were evoked in 90% of neurons (81/90) by electrical stimulation of more than one nerve of the contralateral forelimb. The deep radial nerve evoked the shortest latency epsps within this region of cortex and the only ones likely to be mediated by a monosynaptic thalamocortical pathway. However, the epsps evoked from other forelimb nerves (of deep or cutaneous origin) had mean latencies only a few milliseconds (1.3-3.0 ms) longer. Furthermore, there were a variety of interactions among inputs from separate afferent sources. The observed interactions included spatial facilitation, occlusion and afferent inhibition. The consequence of these interactions was that neuronal responses were shaped by combinations of effects from different topographic regions of the forelimb or of different modalities. The findings are interpreted as indicating a sharing of neurons among pathways to cortical neurons from separate afferent sources. Interactions between ascending pathways by way of such shared neurons may contribute to the modulation or plasticity of somatosensory responsiveness during behavior or after deafferentation.
Intracellular techniques were used to investigate a cortico-cortical path from sensory cortex to motor cortex of cats. Cortico-cortical epsps were evoked in motor cortex neurons by microstimulation of area 3a. Epsps with latencies between 1.2 and 2.4 ms were identified as monosynaptic. These short latency cortico-cortical effects were recorded in layers II through VI of the motor cortex. Neurons with monosynaptic cortico-cortical epsps also received excitatory inputs from forelimb nerves, usually from both muscle and cutaneous afferent fibers. The epsps evoked from forelimb nerves in motor cortex neurons were preceded by neural activity in somatosensory cortex. Time delays between arrival of inputs in sensory cortex and in motor cortex were compared to the latencies of cortico-cortical epsps in the same motor cortex neurons. It was apparent that the timing was appropriate for the identified cortico-cortical path to have relayed some sensory inputs to motor cortex.
Three patients had a typical clinical, functional, and histologic pattern of lymphoid interstitial pneumonitis (LIP). All 3 also had a marked follicular and interfollicular hyperplasia of peripheral lymph nodes. A benign lymphocytic infiltration was seen in the kidneys in 2 patients, in the liver of 1 of these, and in the nasopharynx and the bone marrow in another. This LIP, associated with other diffuse benign lymphocytic infiltrates, could be part of AIDS-related manifestations. The patients originated from central Africa (2 patients) and Haiti (1 patient) where AIDS is endemic. They had several immune abnormalities frequently observed in AIDS such as a polyclonal hyperimmunoglobulinemia and, in the 2 patients studied, a decreased number of T4 lymphocytes and an inverted T4/T8 blood lymphocyte ratio. All 3 patients had serum antibodies to human T-cell leukemia viruses.
Out of a total of 350 referrals for allergy to hymenoptera venom over four years, 250 patients who had one or more severe systemic reactions were selected for a "rush course" of immunotherapy after confirmation of the responsible reagin (skin tests, specific IgE). The method used in the 245 patients who accepted the protocol enabled us to arrive at a maintenance dose of 100 micrograms of venom in three days. Tolerance was excellent; no serious side effects were observed; the course of immunotherapy did not have to be stopped in any of the patients. Clinical efficacy appeared to be satisfactory as no systemic reaction occurred in a fifth (50) of the patients treated who were bitten again, either spontaneously (24 cases), sometimes successfully and repeatedly (11 cases), or intentionally (26 cases). The IgG antivenom antibody was constantly raised from the first month and remained at a stable value. This harmless and effective method should be offered to patients allergic to hymenoptera venom.
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In a series of 102 patients consulting for allergic reactions following hymenoptera sting, fifty-two of them, who had experienced one or more severe systemic adverse reactions were selected for rush immunotherapy. The method employed made it possible to attain the maintenance dose of 100 micrograms of venom in 3 days. Patient tolerance was excellent, no serious side-effect was observed; immunotherapy never had to be stopped. Clinical effectiveness seems to be very satisfactory, since no abnormal reaction was reported in seven patients who later were spontaneously stung, and in fourteen patients who received an induced insect sting. The level of IgG antivenom antibodies rose regularly from the first month onwards to remain at a stable level. Because of its safety and effectiveness, it appears that this method should be recommended for immunotherapy in patients who are allergic to hymenoptera stings.
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Postsynaptic potentials (psps) produced by electrical stimulation of 4 forelimb nerves were recorded intracellularly from neurons in the primary somatosensory cortex of sodium pentobarbital anesthetized cats. Convergent inputs were found from nerves subserving different modalities and different regions of the forelimb. Psps from separate afferent sources usually did not sum linearly but rather interacted with one another. These interactions could have occurred at the cortical level or earlier in the ascending pathways and are interpreted with regards to the control of somatosensory responsiveness by multiple converging inputs.
Cortico-cortical neurons and pyramidal tract (PT) neurons of the cat cerebral cortex were tested for convergent inputs from electrically stimulated vestibular, neck, head and forelimb nerves. Neurons were recorded within forelimb and vestibular projection regions of cortical area 3a. Consideration was given to both suprathreshold and subthreshold inputs. Neither vestibular, neck nor head inputs were detected in the forelimb region of area 3a. In contrast, within the vestibular projection region of area 3a, 43% (6/14) of the cortico-cortical neurons and 63% (24/38) of the PT neurons received excitatory vestibular input. Inputs from the skin of the pinna (greater auricular nerve) were detected only for PT neurons (66%, 25/38). No inputs were detected from afferent nerves supplying the dorsal neck muscles biventer cervicis and complexus. Cortico-cortical and PT neurons receiving vestibular input also received convergent inputs originating from forelimb group I deep and low threshold cutaneous afferent fibers. Further, one half of the PT neurons with vestibular input (12/24) received input from three somatic sources: forelimb group I deep, forelimb low threshold cutaneous and greater auricular (head) nerves. The input connectivities suggest a role for these projection neurons of somatosensory cortex in the coordination of head and forelimb movements. The convergence of vestibular information with somatic input from the forelimb implies that vestibular-influenced neurons of area 3a projecting to the motor cortex or through the pyramidal tract would signal head position or movement with respect to proprioceptive feedback from the limbs.
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