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Biomedical subjects

D Robert

Publications and source records attributed to D Robert.

At least 145 records · Page 8Linked to original sources
PubMed1990

[Electrophoresis of cholinesterases of the cerebrospinal fluid in the Guillain-Barré syndrome].

Polyacrylamide gel electrophoresis of cholinesterase from cerebrospinal fluid was performed in 22 patients with Guillain-Barré syndrome. Fifteen of these patients had an abnormal cerebrospinal fluid with emergence of a second electrophoretic migration band corresponding to non-specific cholinesterase. Among 182 patients with a variety of diseases who served as controls, only one presented with this abnormality. From these data the sensitivity and specificity of cerebrospinal fluid cholinesterase electrophoresis were calculated at 68 and 99 percent respectively. The second migration band seems to appear early in the course of the disease and disappears when the patient is cured. Moreover, the occurrence of this band is correlated with the severity of the condition, as shown by a greater number of patients under artificial ventilation and by a longer stay in intensive care unit. Cerebrospinal fluid electrophoresis could be used as a prognosis factor.

Adolescent↗
PubMed1990

Continuous arteriovenous haemodialysis during emergency hepatic retransplantation: two case reports.

Two patients with severe hepatic and renal failure underwent emergency hepatic retransplantation (2nd and 6th day after transplantation). Continuous arteriovenous haemodialysis was begun before surgery and successfully performed, without any incident, during the retransplantation with a biospal (SCU/CAVH AN 69 S) device, without pump. Vascular access was obtained with femoral catheters. Such a continuous dialysis and ultrafiltration allowed us to infuse massive amounts of blood products before and during surgery and to maintain pH, potassium and lactate at levels compatible with survival in anuric patients. Standard haemodialysis replaced CAVHD when haemodynamic stability was restored.

Acute Kidney Injury↗
PubMed1990

Nosocomial maxillary sinusitis during mechanical ventilation: a prospective comparison of orotracheal versus the nasotracheal route for intubation.

Nosocomial maxillary sinusitis during mechanical ventilation may cause life-threatening complications in ICU patients. The aim of this prospective study was to compare the incidence of maxillary sinusitis according to the route of intubation. 111 consecutive adult patients (mean age: 53, mean SAPS: 12) were randomly assigned to receive either orotracheal (n = 53) or nasotracheal (n = 58) intubation. All had a nasogastric feeding tube. Patients with head trauma or mechanical ventilation for less than 48 h were excluded. Sinusitis diagnosis was made by radiography (waters' view) at the bedside. The two groups were similar in age, SAPS, duration of ventilation. Maxillary sinusitis occurred in 1/53 (1.8%) of the orotracheal group (on the nasogastric tube side), and in 25/58 (43.1%) of the nasotracheal group (7 on the nasogastric tube side, 11 on the endotracheal tube side, 7 bilateral; p less than 0.001). Nine of the 26 cases of sinusitis were initially treated by sinus drainage because of signs of infection (3 failures) and the 17 others were treated by tube removal. This procedure proved successful in 12 out of 17 cases but secondary drainage was performed in 5 cases (1 failure). Incidents related to the route for long-term intubation were significantly (p less than 0.001) more frequent in the orotracheal group (8/53 vs 2/58), however no patient died because of them. In this study, long-term orotracheal intubation reduced significantly the incidence of maxillary sinusitis in comparison with nasotracheal intubation.

Aged↗
PubMed1990

Early effects of nimodipine on intracranial and cerebral perfusion pressures in cerebral anoxia after out-of-hospital cardiac arrest.

Some calcium entry blockers seem to improve the neurological survival of anoxic comas. The early monitoring of intracranial pressure shows the frequency of intracranial hypertension. A calcium channel blocker has been shown to increase the cerebral blood flow which can potentially lead to deleterious increases of the intracranial pressure. This study presents 39 out-of-hospital cardiac arrests resuscitated with success. The intracranial pressures were registered by means of an extra dural screw set up as soon as possible. Nineteen patients received an early continuous 5 days nimodipine treatment (0.58 gamma/kg weight/min. after a 12.3 gamma/kg weight bolus). The other 20 patients did not receive any calcium entry blocker. The two groups were similar in terms of age, origin and electrical type of cardiac arrest, duration of cardiac arrest before BLS and before ACLS, principles of the treatment, initial neurological status and biological values. The maximum and mean intracranial pressures of the nimodipine group were always lower than the intracranial pressure of the control group. The cerebral perfusion pressure was never significantly different in both groups. If the nimodipine treatment proves to be efficient on neurological survival, it would be all the more interesting because it seems to limit the intracranial hypertension phenomenon which aggravates the neurological prognosis.

Cerebrovascular Circulation↗
PubMed1990

Polyneuropathy: potential cause of difficult weaning.

Severe critically ill polyneuropathy (CIP) is a neurologic syndrome with potential effects on ventilatory weaning. Fifteen CIP patients with the following clinical criteria were diagnosed: limb weakness, amyotrophy, and reduced deep tendon reflexes. Electromyogram (EMG) confirmed polyneuropathy by the following signs: denervation, normal nerve conduction velocities, normal distal latencies, and decreased compound action potential. It was observed that motor signs were more important than sensitivity. EMG performed during ICU hospitalization showed axonal abnormalities. Ventilation and mean duration of weaning were unusually long. Four patients had EMG a few years after discharge; the recovery was delayed and incomplete. The present study suggests that CIP is a multifactorial disease.

Action Potentials↗
PubMed1990

[Chronic and severe respiratory insufficiency and pregnancy. A new way of treating it].

Severe chronic respiratory distress accompanied by pregnancy is not rare. It means that the fetus is at risk of being born prematurely and with intra-uterine growth retardation and the mother, apart from the obstetric complications that she is likely to suffer, has the chance of becoming decompensated as far as her cardiac and respiratory systems are concerned. There is therefore a very real need for assisted respiration. The authors report a case of chronic severe restrictive respiratory function and pregnancy in which the outcome was successful for the mother and for the fetus but where the mother had to be ventilated by a new procedure. This consisted of intermittent positive pressure ventilation using a nasal mask at home. The efficiency of this method has been proven and it is a method that must be preferable to tracheotomy.

Adult↗
PubMed1990

[Subpleural air cysts. A complication of barotrauma during mechanical ventilation].

The presence of air in the interstitial pulmonary tissues is shown as interstitial emphysema and is often the first sign of barotrauma. It results from hyper-pressure in the airways occurring for the greater part of the time on some underlying pulmonary pathology. This extra alveolar air may diffuse into the interstitium and collect under the visceral pleura, appearing on radiographs as air cysts from 3 to 10 centimeters in diameter. We described 7 cases of air cysts occurring in adults on mechanical ventilation. The lesions seem to us to represent a radiological entity and evidence of barotrauma due to mechanical ventilation and possessing its own potential outcome, namely rupture leading to pneumothorax, infection, persistence, or disappearance. The early occurrence in its history of a particular disease should be noted, enabling one to minimise the factors contributing to the barotrauma.

Adolescent↗
PubMed1989

Human immunodeficiency virus reverse transcriptase expressed in transformed yeast cells. Biochemical properties and interactions with bovine tRNALys.

Human immunodeficiency virus (HIV) reverse transcriptase has been purified from yeast transformed by an autoreplicating plasmid containing the retroviral DNA polymerase gene. The previously described purification procedure for the yeast-expressed reverse transcriptase [Barr, P.J., Power, M.D., Chun Ting Lee-Ng, Gibson, H. & Luciw, P. (1987) Bio/Technology 5, 486-489] has been substantially modified, leading to an increased yield and a higher degree of purity. Several biochemical properties of the enzyme are described (template specificity, effect of DNA synthesis inhibitors); interestingly, HIV reverse transcriptase is highly resistant to N-ethylmaleimide. A complex between the human retroviral enzyme and the bovine tRNALys was shown, using a direct approach, by glycerol gradient centrifugation, as well as by the protective and specific effect of the tRNALys against enzyme inactivation by thermal denaturation and trypsin digestion. A competitive type of inhibition of HIV reverse transcriptase by tRNALys, but not by tRNAVal, is observed when viral RNA or activated DNA are used as templates.

Animals↗
PubMed1989

Comparison of nonbronchoscopic bronchoalveolar lavage to open lung biopsy for the bacteriologic diagnosis of pulmonary infections in mechanically ventilated patients.

We compared nonbronchoscopic bronchoalveolar lavage (NB-BAL) with open lung biopsy to determine the etiological diagnosis of lung infiltrates in patients requiring mechanical ventilation. NB-BAL was performed via a cuffed reusable 7F catheter generally used for right heart catheterization (BAL-C). In 13 patients, BAL-C and open lung biopsy were performed in the same lobe immediately after death when the ventilator was still functioning. No organism was cultured from BAL-C cultures when histopathologic examination of the lung showed no pneumonia and lung culture isolated no organism. Among the 10 positive BAL-C cultures, lung biopsy showed histologic pneumonia in 9 cases. Among these 9 pneumonia cases, 14 organisms were isolated in lung cultures and BAL-C correctly identified the causative agent in 13 cases. BAL-C appears to be an effective and safe procedure in the diagnosis of pulmonary infections in patients under mechanical ventilation who have previously received antibiotic therapy.

Aged↗
PubMed1989

Changes in lipoproteins induced by the remnant kidney tissue or binephrectomy in chronic uremic patients treated by hemodialysis.

The role of the remmant kidney tissue in uremic patients undergoing hemodialysis treatment has rarely been considered to influence the changes in lipoprotein and lipid metabolism. Twenty hemodialyzed patients with remnant kidneys and 11 anephric patients were studied to examine whether the presence or the absence of remnant kidney leads to qualitative or quantitative changes of the lipids and lipoproteins. Anephric patients showed a significantly higher triglyceride level, 3.66 +/- 0.49 (SEM) mmol/L v 2.34 +/- 0.09 mmol/L in patients with remnant kidneys (P less than .01), higher very-low-density lipoprotein (VLDL) triglycerides, 1.24 +/- 0.30 mmol/L v 0.69 +/- 0.09 (P less than .04), and higher HDL-triglycerides, 1.22 +/- 0.29 mmol/L v 0.66 +/- 0.09 mmol/L (P less than .04). APO-AI was significantly decreased in anephric patients, 95.2 +/- 13.3 mg/dL v 129.7 +/- 6.02 mg/dL in patients with remnant kidneys (P less than .01). APO-B was similar in both groups. All APO-C and APO-E were significantly lower in anephric patients, APO-CI 6.13 +/- 0.87 mg/dL v 8.47 +/- 0.42 mg/dL in patients with remnant kidneys (P less than .01), APO CII 1.00 +/- 0.01 mg/dL v 10.0 +/- 0.01 mg/dL (P less than .0001), APO-CIII 10.12 +/- 1.43 mg/dL v 26.0 +/- 2.86 mg/dL (P less than .0005), and APO-E 8.0 +/- 0.02 mg/dL v 12.0 +/- 0.01 mg/dL (P less than .03). These results point out important differences between women and men. In women binephrectomy promotes a decreased concentration of all APO-C but has no influence on APO-AI concentration.(ABSTRACT TRUNCATED AT 250 WORDS)

Apolipoprotein A-I↗
PubMed1989

[Diagnosis of post-traumatic pleural effusion].

A rare case of post-traumatic pleural effusion is reported. A 19 year old male patient was admitted after a road traffic accident with a scalp wound, femoral shaft fracture and haematuria related to a ruptured bladder. Shortly after extubation following bladder surgical repair, the patient had to be reintubated because of acute respiratory failure. A large left-sided pleural effusion was then diagnosed. The liquid was sero-haematic and contained a high concentration of creatinine (839 mumol.l-1). Thoracic CT scan and intravenous urography displayed a left epirenal collection and a dilatation of the upper urinary tract with rupture of the renal pelvis. The surgical treatment of this urinothorax consisted of the rupture repair of the posterior diaphragm and of the urinary tract.

Adult↗
PubMed1989

Evaluation of the mammographic lesion.

Radiologists have all too often been vague about mammographic problems presenting on films. Their reports are often too equivocal. However, with a thorough mammographic evaluation, most lesions can be classified as benign, malignant or spurious. We have listed thirteen positions, apart from the routine craniocaudal and oblique views, that may help decide the malignant potential of a mammographic problem.

Breast Neoplasms↗
PubMed1989

Fathers' occupation and pregnancy outcome.

Findings from a survey of 56,067 women in Montreal on maternal occupation and pregnancy outcome have been reported. Paternal occupation recorded in the same survey was analysed for spontaneous abortion in 24 occupational groups retaining the six main sectors of maternal occupation and allowing, by means of logistic regression, for seven potentially confounding variables. In only one of the 24 fathers' occupational groups was there a statistically significant excess of spontaneous abortions--mechanics, repairers, and certain assemblers (O/E = 1.10, 90% CI = 1.02-1.20); subdivision of this group suggested that this excess was mainly attributable to the large group of motor vehicle mechanics (O/E = 1.17). No significant excess of known chromosomally determined defects was found in any of the 24 occupational groups. An association of developmental defects was found with food and beverage processing (18 defects observed compared with 8.02 expected; p less than 0.05); however, there was no specificity in type of food, beverage, or congenital defect, and no obvious explanatory mechanism.

Abortion, Spontaneous↗