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Biomedical subjects

E Gautier

Publications and source records attributed to E Gautier.

At least 55 records · Page 3Linked to original sources
PubMed1997

Should cytomegalovirus be tested for in both blood and bronchoalveolar lavage fluid of patients at a high risk of CMV pneumonia after bone marrow transplantation?

To identify and treat patients at high risk of cytomegalovirus (CMV) pneumonia after bone marrow transplantation (BMT), we tested for CMV viraemia weekly, and performed broncho-alveolar lavage (BAL) on day 35 post-transplant in 63 recipients. 36 allogeneic BMT recipients were at a high risk of CMV pneumonia (25 CMV-seropositive recipients and 11 patients receiving marrow from a CMV-seropositive donor). Patients with a positive BAL or viraemia received a 14 d course of ganciclovir or foscarnet. CMV was detected in 29 (46%) of the 63 BMT recipients and excretion of CMV in blood and BAL was significantly linked. However, among the 29 patients who excreted the virus, only 10 (35%) shed CMV in blood and BAL at the same time: 19 patients (65%) had detectable CMV in blood (11 patients) or BAL (eight patients) only. Therefore, on the basis of viraemia or BAL alone, 21/29 patients (70%) and 18/29 patients (60%), respectively, would have received antiviral treatment. BAL increased the CMV detection rate by 13% (8/63 patients) relative to viraemia. With this strategy, the incidence of CMV pneumonia was reduced to 3% in allografted patients. Only two of the 19 autografted patients developed fatal CMV pneumonia. We avoided anti-CMV treatment in 54% of all the BMT recipients. In conclusion, CMV should be tested for in both blood and BAL fluid of BMT recipients at high risk of CMV pneumonia.

Bone Marrow Transplantation↗
PubMed1997

Hip fusion through an anterior approach with the use of a ventral plate.

A new technique to achieve a reliable fusion of the hip joint through an anterior approach with use of a ventral low contact dynamic compression plate and a lateral 6.5 mm lag screw is presented in detail. The advantages of this technique are that the approach does not jeopardize the vascularity of the femoral head, that the fixation on the pelvic side uses the strong bone stock of the sciatic buttress, and that the hip abductor muscles and greater trochanter are preserved. The authors also present the indications and the results of their experience with 12 patients. The followup period averaged 24.8 months (range, 10-42 months). Ten patients (83%) achieved a solid fusion by radiologic and clinical criteria. Although a moderately symptomatic nonunion developed in 1 patient, another patient went on to a painful nonunion to whom another attempt for fusion has been recommended. According to the hip score of Merle d'Aubigné and Postel, the average figures for pain and ambulation increased from 3.2 points to 5.0 points and from 2.7 points to 4.5 points, respectively, after surgery. Six of the 12 patients regained the ability to work in their former jobs or in new occupations. Eight patients felt no or minor restrictions in doing their former sports activities. Patient satisfaction was high with a majority reporting minor discomfort mainly around the fused hip.

Activities of Daily Living↗
PubMed1996

Phase I study of a recombinant adenovirus-mediated gene transfer in lung cancer patients.

BACKGROUND: Despite vigorous efforts at curbing tobacco consumption and aggressive combined-modality treatment programs, both the incidence of and the mortality from lung cancer have remained virtually unchanged in the last 10 years. More effective innovative therapies are clearly needed. The direct transfer into tumor cells of tumor suppressor genes or toxic gene products that specifically promote tumor cell death and spare nonmalignant cells is a potentially novel anticancer treatment approach that should be investigated. PURPOSE: On the basis of compelling preclinical data, we initiated a phase I study involving six patients with inoperable lung cancer and an endobronchial lesion accessible by bronchoscopy. Our purpose was to evaluate the feasibility, tolerance, and clinical, biologic, and immunologic effects of the intratumoral administration of a recombinant, replication-deficient adenovirus (rAd.RSV beta-gal), using the Rous sarcoma virus promoter to drive transcription of the Escherichia coli lacZ marker gene that encodes for the bacterial enzyme beta-galactosidase (beta-gal). METHODS: From June 1994 through April 1995, six patients (five males and one female) were enrolled in the trial. A single dose of recombinant virus suspension containing 10(7) or 10(8) plaque-forming units (PFU) was injected intratumorally into two successive cohorts of three patients. Eligible patients received concomitant chemotherapy. Patients were kept under isolation conditions from 3 days before the injection was given until virus excretion was undetectable. Biopsy specimens of the tumor and surrounding mucosa were collected on the 8th day and at 1, 2, and 3 months after injection. They were analyzed by cell culture, polymerase chain reaction (PCR), and beta-gal expression for the presence of recombinant adenovirus. So that the risk of virus recombination or complementation could be minimized, wildtype adenovirus carriers among the hospital staff (identified by PCR) were excluded from contact with patients who were potentially excreting recombinant virus. RESULTS: beta-gal was expressed in tumor biopsy specimens of three patients (one who received the 10(7) PFU dose level and two who received 10(8)). Bronchoalveolar lavage specimens collected immediately after injection were positive for recombinant adenovirus when analyzed in culture and by PCR. All biologic fluids were negative for recombinant virus as judged by PCR after day 12, with the exception of bronchoalveolar lavage specimens (positive PCR up to 90 days in two of three patients treated with 10(8) PFU). The blood samples obtained from the three patients treated with 10(8) PFU showed positive PCR results immediately after virus injection. Patients were kept in isolation for a median of 17 days. The most common toxic effects were moderate bleeding (occurring in two patients) during bronchoscopy and fever (seen in four patients). Endoscopic and clinically objective antitumor responses were seen in four patients, including one patient who showed a complete response by pathologic evaluation. The median survival for the patients was 12.5 months (range, 3-16+ months). Throughout the study, hospital staff remained negative for recombinant adenovirus infection. CONCLUSIONS: This ongoing phase I study has demonstrated that a recombinant adenovirus-mediated marker gene, such as rAd.RSV beta-gal, can be safely introduced into humans and that the gene product is expressed by lung tumor cells of the host.

Adenoviridae↗
PubMed1996

Intracytoplasmic sperm injection in infertile patients with structural chromosome abnormalities.

In the present study we investigated the results of cytogenetic analysis in male and female patients included in an intracytoplasmic sperm injection (ICSI) programme for severe male infertility as well as in conceptuses resulting from these ICSI treatments. In the 261 couples treated, 11 male (4.2%) and three female (1.2%) abnormal karyotypes were found, all consisting of structural chromosome anomalies. Chromosomal translocation exhibited the highest frequency (eight males and two females), and there were also three cases of chromosomal inversion (two males and one female) and one male with one additional marker chromosome. There was no difference in fertilization rates among couples with abnormal (n = 14) and normal (n = 147) cytogenetic results, and the rates of clinical pregnancy per ICSI attempt were 25.0% (5/20) and 20.6% (78/ 378) respectively. In pregnancies obtained in couples with normal karyotypes, all of the 108 fetuses were free of chromosomal abnormalities. Among the eight fetuses from couples with chromosome structural anomalies, three out of five and two out of three inherited from the cytogenetic defects found in their father or mother respectively. In this series of 83ICSI pregnancies there were no chromosomal abnormalities other than those inherited from the parents. These findings suggest that normal pregnancy rates can be obtained by ICSI in cases of chromosomal translocation in couples with severe male infertility. However, until further evaluations of available data can be performed, cytogenetic analysis must be conducted prior to ICSI in men with low sperm counts, and genetic counselling must include prenatal diagnosis for all growing conceptuses.

Chromosome Aberrations↗
PubMed1996

[New technique for a hip arthrodesis using an anterior approach and a ventral plate].

The authors present a new technique for fusion of the hip joint through an anterior approach (Smith-Petersen) with the use of a ventral plate and a lateral compression screw. The indications for fusion of the hip joint are discussed and some cases are presented. The advantages of this technique are that strong bone stock for fixation is used on the pelvic side, that the abductor muscles and vascularization of the femoral head are left intact, and that no external fixation (cast) is routinely used for after-treatment.

Adult↗
PubMed1996

Late reconstruction after pelvic ring injuries.

Pelvic malunions or nonunions are the result of inappropriate treatment of rotationally or linearly unstable injuries of the pelvic ring. Long-term sequelae such as chronic pain in the posterior pelvic ring, gait abnormalities, leg length discrepancy, sitting discomfort, neurological problems or impingement on the visceral organs may be secondary to the disturbed integrity of the pelvic ring. The late correction of the deformity is technically much more demanding than the treatment of acute pelvic ring injuries. Depending on the specific problem, osteotomies at the site of the deformity, excision of scar tissue and callus, release of ligaments, bone grafting, and an adapted technique of reduction and fixation may be required. Possible complications include nerve or vascular injuries, incomplete reduction of the deformity, failure to unite, incomplete pain relief, and infection. Prior to surgery, a careful clinical and radiological examination is mandatory to assess the relationship between the presenting anatomical deformity and the complaints of the patient. The final decision for surgery has to be made by the patient taking into account reasonable expectation and the potential complications associated with the corrective procedure.

Fracture Fixation↗
PubMed1996

[The value of corrective osteotomies--indications, technique, results].

Corrective osteotomies around the knee joint gained wide acceptance in the treatment of unicompartmental osteoarthritis of the knee joint despite the improvements in total and partial knee arthroplasty. The combination of axial malalignment of the lower limb with degenerative changes of one femorotibial compartment accentuates the stress onto the damaged cartilage with subsequent increase in the magnitude of axial deformity. The reduction of stress can be achieved by realignment of the leg, which in turn redistributes the forces to more normal areas of the joint. The main goals of the osteotomy include relief of pain and improvement of function. Careful patient selection and assessment as well as a precise surgical technique enable the surgeon to more predictive and improved clinical longterm results. The ideal candidate for a corrective osteotomy is in the sixth or seventh decade of life with a clearly localized, activity-related knee pain, axial malalignment of the leg and radiologically unicompartmental degenerative arthritis. Nevertheless, the patient's activity level and his personal expectations after the procedure are worth to be discussed in context with other treatment possibilities. As with prosthetic replacement, the patient has to understand that the surgical procedure will not provide a normal joint: but "buying time" with an osteotomy may be a viable concept.

Aged↗
PubMed1996

[Pelvic fracture with shock-inducing retroperitoneal bleeding and concomitant lower extremity ischemia syndrome: discussion of management exemplified by a case report].

BACKGROUND: Initial treatment of severe pelvic fracture consists of appropriate resuscitation and early pelvic reposition and stabilization. Concomitant retroperitoneal arterial bleeding in a hemodynamically unstable patient in combination with lower extremity ischemia make early management decisions very difficult and the mortality rate of this entity of injuries is extremely high. CASE REPORT: We report on a successful treatment of a 36 year old skier, referred in hemorrhagic shock, who had sustained a severely displaced both column fracture of the right acetabulum, an unstable pelvic ring injury on the left and a retroperitoneal bladder rupture. He developed complete ischemia of the right lower extremity. Angiography revealed an obliteration without extravasation of the external iliac artery and allowed treatment of a right superior gluteal artery disruption by embolization. The right lower extremity ischemia was revascularized with a subcutaneous femoro-femoral bypass graft. Delayed internal fixation of the right acetabulum and exploration of the iliac vasculature was done through an ilio-inguinal approach. Simultaneously, the cross-over bypass could be removed. After 18 months, the patient recovered without any ischemic symptoms, but continues with a mixed sciatic nerve lesion. DISCUSSION AND CONCLUSIONS: The combination of severe retroperitoneal arterial bleeding and total ischemia of the lower extremity requires immediate surgical therapy. Direct exploration of the retroperitoneum, however, can be fatal and should be avoided if the iliac vessels are angiographically intact or if a hemorrhage is controllable by an embolization procedure. Extraanatomic temporary revascularization of the lower extremity should be envisaged when a lower leg ischemia due to obliteration or compression of major intrapelvic vessels cannot be directly and immediately treated.

Abdominal Injuries↗
PubMed1995

Hyperechogenic fetal bowel: an ultrasonographic marker for adverse fetal and neonatal outcome.

OBJECTIVE: Fetal hyperchogenic bowel is associated with a variety of conditions, the incidence of which has yet to be studied. STUDY DESIGN: The outcomes of 182 cases of fetal hyperechogenic bowel were reviewed. Screening for maternal toxoplasmosis, fetal karyotyping, and amniotic fluid digestive enzyme assays were performed in all cases. Eight mutations associated with cystic fibrosis were analyzed in 116 cases. RESULTS: Of 135 newborns, 121 were normal, but nine underwent surgery for gastrointestinal obstruction, three had cytomegalovirus or parvovirus infection, one had a triple X chromosome, and one died from sudden infant death syndrome. In utero fetal death was observed in 24 cases. Elective termination of pregnancy was performed in 23 cases for associated anomalies. CONCLUSIONS: Hyperechogenic fetal bowel was associated with increased risk for adverse outcome. Prenatal management should include ultrasonographic surveillance, fetal karyotyping, amniotic digestive enzyme assays, and screening for cystic fibrosis and infectious disease.

Amniocentesis↗
PubMed1994

Combination of the small external fixator and standard tubular system.

A modification of the standard setup of the small external fixator is presented for use mainly on the wrist. The setup used since 1988 offers further possibilities as compared with conventional application: Completely free positioning of the wrist joint for all possible six degrees of freedom, therefore: Better possibility to postpone manual reduction until the frame is applied ("modular" fixator frame, comparable to the tube-to-tube configuration of the standard external fixator), Easy correction of axial, flexural and rotational malalignment during surgery with the external fixator in situ and without changing the pin position, Easy relaxation of overdistraction postoperatively, Temporary postoperative mobilization of the wrist joint possible. Better preoperative distraction due to higher force and longer distance of the compression/distraction device. Rigid construction by using comparably short threaded K-wires and large diameter connecting bar. Less interference with peri- and postoperative imaging techniques.

Equipment Design↗
PubMed1994

[The biological plate osteosynthesis].

The continually evolving understanding of bone biology and the analysis of clinical complications have led to a modified approach in internal fixation using plates. Anatomical reduction of the fragments in comminuted diaphyseal and metaphyseal fractures itself is no longer a goal. Important reduction aims are the correct length of the bone, and axial and torsional alignment. The preservation of the viability of the bone fragments is the key to unimpaired fracture healing. The primary stability of an osteosynthesis seems to be of minor importance for bone healing. More important is the rapid integration of unreduced but vital fragments into the fracture callus which buttresses the fracture area opposite the plate reducing the risk for overload and fatigue failure of the implant. Additional primary bone grafting leeds to local vascular disturbance of the bone and is rarely indicated. Indirect reduction technique with the aid of the fracture table or the distractor and a minimal but optimal use of implant material is the new concept to achieve undisturbed fracture repair in metaphyseal and diaphyseal fractures. In articular fractures the anatomic restoration of the articular surface can be obtained by the combination of indirect reduction technique (ligamentotaxis, soft tissue taxis) and accurate direct reduction of certain strategic fragments. Modifications of the plate design (limited contact, point contact) which minimize additional vascular damage to the bone help to accomplish this new concept.

Ankle Injuries↗
PubMed1993

Alfuzosin, a selective alpha 1-adrenoceptor antagonist in the lower urinary tract.

1. Phenylephrine-induced contractions of rabbit isolated trigone and urethra were antagonized in a competitive manner by alfuzosin (pA2 7.44 and 7.30, respectively) and prazosin. 2. The characteristics of [3H]-prazosin binding to human prostatic adenoma tissue were evaluated. [3H]-prazosin was potently displaced by alpha 1-adrenoceptor specific agents including alfuzosin, its (+)- and (-)-enantiomers and prazosin (IC50 0.035, 0.023, 0.019 and 0.004 microM, respectively), but only weakly by alpha 2-adrenoceptor selective agents, for example, yohimbine (IC50 = 6.0 microM). 3. In the pithed rat, alfuzosin (0.03-0.3 mg kg-1, i.v.) markedly inhibited pressor responses produced by the alpha 1-selective agonist, cirazoline but inhibited only slightly responses to the alpha 2-selective agonist, UK 14,304. Alfuzosin (1 mg kg-1, i.v.) had minimal effects against responses mediated by stimulation of prejunctional alpha 2-receptors (UK 14,304-induced inhibition of sympathetic tachycardia). 4. In the anaesthetized cat, alfuzosin (0.001-1 mg kg-1, i.v.) and prazosin (0.001-0.3 mg kg-1, i.v.) produced dose-related inhibition of the increases in urethral pressure caused by stimulation of sympathetic hypogastric nerves. Prazosin was approximately 5 fold more potent than alfuzosin. When phenylephrine was employed to induce urethral and vascular alpha 1-mediated tone simultaneously, prazosin inhibited both stimuli with similar potency whereas alfusozin was 3-5 fold more potent against elevated urethral pressure. This functional uroselectivity of alfuzosin was more evident by the intraduodenal route, since doses of 0.03 and 0.1 mg kg-1 alfuzosin inhibited urethral pressure with minimal effects on arterial blood pressure. 5. Alfuzosin is a potent selective alpha1-adrenoceptor antagonist in tissues of the lower urinary tract including the human prostate. This provides a pharmacological basis for its use in the treatment of benign prostatic hypertrophy.

Adenofibroma↗
PubMed1992

[Treatment of subcapital humerus fracture with the Prévot nail].

Displaced subcapital fractures of the humerus are difficult to manage due to the specific anatomical and biological conditions in the proximal humerus. With respect to the fracture type and extent of displacement of the humeral head and the tuberosities the concepts for treatment remain controversial. A large spectrum of recommendations for the treatment of unstable subcapital fractures are known ranging from conservative treatment, open reduction and internal fixation using different implants to the primary prosthetic replacement of the humeral head. Recent results from basic research emphasize the importance of sound tissue viability for undisturbed fracture healing and influence today's strategies in fracture management. Minimal exposure of the fracture area, indirect reduction techniques and a minimal but optimal biomechanical use of implants can help to avoid some of the possible (and partially iatrogenic) complications. Fixation of subcapital humeral fractures by intramedullary pinning seems to provide sufficient stability without damaging the vascularity of the fracture fragments leaving intact in addition the soft tissues around the shoulder. The treatment of proximal humeral fractures by the use of Prévotnails is presented in this paper and some possible problems of the method are discussed.

Aged↗
PubMed1992

[Limited Contact Dynamic Compression Plate (LC-DCP)--biomechanical research as basis to new plate design].

Our continuously evolving understanding of bone biology has led to a new approach to plate fixation. In comminuted fractures, anatomical reduction of all fragments is no longer a goal in itself. Preservation of the viability of the bone fragments seems to be the key to unimpaired fracture healing in internal fixation. The rapid integration of unreduced but vital fragments into the fracture callus functions as a bio-buttress system and prevents fatigue fracture of the implant. To realize the new concept of biological internal fixation, the limited contact dynamic compression plate, which minimizes vascular damage to the plated bone segment, has been developed.

Animals↗