Does computed tomography modify management of traumatic haemothorax?
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Accidents, Traffic↗
Biomedical subjects
F Brunet
Publications and source records attributed to F Brunet.
[Hospitalization for acute community-acquired rotavirus gastroenteritis: a 4-year survey].
OBJECTIVE: To evaluate the number of hospitalizations due to community-acquired rotavirus acute gastroenteritis in a general pediatric unit during a four-year survey. RESULTS: From January 1997 to December 2000, 725 patients were admitted for acute gastro-enteritis to the general paediatric unit of a Parisian children hospital (nosocomial diarrhoea excluded) and 706 (97.5%) of these patients had had a stool microbiologic examination. Diarrhoea was caused by rotavirus in 359 patients (50.89%) and Salmonella sp in 61 (8.6%). Children and infants hospitalized for rotavirus acute gastroenteritis were younger (26% had three months or less, and 50.03% had six months or less) than in other European studies. CONCLUSION: This study is the first in France reporting a systematic survey of hospitalized gastroenteritis during four years. More than half of hospitalized community-acquired gastroenteritis were due to rotavirus in this Parisian area. The young age of patients should be investigated in other French areas, searching for risk factors and rotavirus strains.
Acute Disease↗
[Procalcitonin and viral meningitis: reduction of unnecessary antibiotics by measurement during an outbreak].
OBJECTIVE: Viral meningitis are often treated with antibiotics in emergency because routine analysis of CSF is not always efficient for distinguishing between viral and bacterial infection. The aim of the study was to evaluate the usefulness of procalcitonin (PCT) to reduce antibiotic treatments. METHODS AND RESULTS: A blood PCT level < 0.5 ng/mL was prospectively used for the diagnosis of viral origin of meningitis in 58 patients (two months-14 years), in which enterovirus was isolated by culture or PCR during an outbreak (May-June 2000). CSF cells range was 10 to 2800/mL (m: 244), PMN 5 to 2464/mL and CSF proteins range was 0.19 to 0.92 mg/dL (m: 0.37). Seventeen patients received antibiotic therapy in admission. In nine patients, PCT (dosage was routinely measured 3/week) result < 0.5 ng/mL was obtained in 24 h and in 48 h in six: treatment was then stopped and children led hospital. In two patients, PCT was > 1 ng/mL because of bacterial coinfection. CSF and PCT values were similar to those of an already published control group. CONCLUSION: PCT dosage allowed to shorten hospitalization of 4.47 (controls) to 2.06 (patients) days in patients receiving unnecessary antibiotic treatments. During this outbreak, PCT dosage allowed to reduce 40 days of hospitalization.
Adolescent↗
[Sudden unexpected death in an infant due to a ruptured coronary aneurysm revealing Kawasaki disease].
UNLABELLED: The early mortality of Kawasaki disease is low, resulting from coronary complications, mainly aneurismal thrombosis with myocardial infarction. The aneurysmal rupture is an exceptional cause of death. CASE REPORT: We report on a six-month-old girl who died suddenly and unexpectedly. The autopsy showed a cardiac tamponade caused by an important ruptured aneurysm of the left coronary artery. Multiple aneurysms, with or without thrombosis, on the right coronary were also present. There was no ischaemic lesion. Three weeks before death, this infant demonstrated several clinical signs of Kawasaki disease whose diagnosis had not been done. CONCLUSION: Even if the rupture of coronary aneurysm is an exceptional initial complication of Kawasaki disease, a better knowledge of the atypical or incomplete forms, particularly below the age of one year, should allow an early diagnosis and treatment, decreasing the risks of coronary complications. This observation furthermore illustrates the interest of post-mortem examination in all sudden or unexpected infant deaths.
Coronary Aneurysm↗
Decorated Ag19 on Pt(111) or the "rare gas necklace".
Ag19 cluster ions are mass selected and deposited on a Pt(111) surface covered by five monolayers of Kr. Almost monodispersed hexagonal shaped Ag islands are observed after Kr evaporation at 125 K. The identification of the island shape and the exact number of atoms has been successful by decorating the clusters with Kr atoms which can be counted by high resolution scanning tunneling microscopy.
Journal Article↗
Evaluation of the offer of physical activity for the elderly in a region of France.
The aim of this study was an evaluation of the possibilities of physical activity for the elderly in a region of France where 24% of the population is over 65 years old. It stressed the very poor level of physical activity in the community as well as in nursing homes. This situation is linked to a combination of factors: lack of interest, insufficient information and financial constraints. The 5-year plan we are developing in this region aims at the development of the practice of physical activity, to maintain as long as possible the autonomy and the quality of life of this growing elderly population.
Journal Article↗
Inducibility of the 70 kD heat shock protein in peripheral blood monocytes is decreased in human acute respiratory distress syndrome and recovers over time.
The heat shock/stress proteins (HSP), and, in particular, the inducible, cytosolic Hsp70, represent an extremely conserved response to many different cellular injuries, including reactive oxygen species (ROS). Hsp70 has been shown to confer to cells and tissues protection against the deleterious effects of ROS or cytokines, both in vitro and in animal models of acute respiratory distress syndrome (ARDS). We hypothesized that Hsp70 expression levels in peripheral blood monocytes (PBM) of patients with ARDS, would correlate with disease severity. We prospectively included 13 patients with previous ARDS (50 +/- 17 yr; range, 20 to 76 yr), nine ventilated patients with non-ARDS/ALI disease (45 +/- 20 yr; range, 19 to 76 yr), and 14 healthy volunteers (45 +/- 20 yr; range, 22 to 77 yr). PBM activation state was evaluated according to their membrane expression of CD16, and oxidative status according to plasma lipid peroxidation products. Both baseline expression and Hsp70 inducibility (after in vitro heat shock) were examined in PBM, using flow cytometric analysis. We found that basal expression of Hsp70 in PBM was similar for patients and control subjects, whereas Hsp70 inducibility- a reflection of the ability to mount a stress response-was significantly reduced in the patients with ARDS (p = 0. 02). Among all correlation analyses we considered between Hsp70 inducibility on the one hand, clinical and laboratory biomarkers for disease severity and outcome in the patients with ARDS on the other, only the duration of ventilatory support was significant (p < 0.003). As an approach to distinguish between disease and ventilation, we also analyzed a group of, ventilated patients without ARDS. Our results indicate that in patients with ARDS, Hsp70 inducibility in PBM is decreased, but it recovers over time with duration of ventilatory support.
Adult↗
[The emergency department: a new concept for a reform].
Emergency care are now restructuring in France. The role of emergency departments is defined by new regulations. They include the closure of small emergency rooms and definition of three levels for the others. The most advanced units, i.e. level 1 or S.A.U., will be equipped and staffed to respond to any kinds of medical problems. However, such a restructuration requires high investments from the hospitals and changes in patient's habits. This document describes the organization of a level 1 emergency department in a large teaching hospital in Paris. Principles and tools used to design this model have been drawn from a previous analysis of different emergency care in North America and Europe. The role of triage nurse, observation units, information system, continuous quality improvement approaches are described. Team work training has been used to put these new concepts in. Academics and research activities from this department are also reported.
Emergency Service, Hospital↗
A mariner-like transposable element in the insect parasite nematode Heterorhabditis bacteriophora.
For the first time, mariner elements were found in insect parasitic nematodes. Full-length elements were isolated from the rhabditid Heterorhabditis bacteriophora. They were 1279 bp long, flanked by two 30-bp inverted repeats, and were able to encode a putative 358-amino acid transposase. These elements were present in about 30 copies in the H. bacteriophora genome, but their distribution among closely related Heterorhabditis and Steinernema genera was patchy. DNA and encoded peptide sequences of H. bacteriophora mariners showed greater similarity to the mariner of the coleopteran Carpelimus sp. than to the mariners of the rhabditid Caenorhabditis elegans. The possibility of horizontal transfer was investigated by examination of a host for Heterorhabditis nematodes, a beetle of the Phyllophaga sp. Mariner elements were found in this insect, but they were not very similar to the H. bacteriophora elements. Finally, the H. bacteriophora mariners formed a group with those of invertebrates, suggesting vertical transmission from a common ancestor.
Animals↗
Phylogenetic analysis of Mos1-like transposable elements in the Drosophilidae.
We have performed a phylogenetic analysis of 59 mariner elements in 14 Drosophilidae species that are related to the active Drosophila mauritiana Mos1 element. This includes 38 previously described sequences and 21 new sequences amplified by PCR from 10 species. Most of the elements detected are nonfunctional due to several frameshifts and deletions. They have been subdivided into four groups according to specific signatures in the nucleotidic and amino acid sequences. The mean nucleotide diversity is 4.8 +/- 0.1% and reflects mainly the divergence of inactive elements over different periods. Although this probably gives rise to occasional homoplasies between distantly related taxa, the elements of each species remain grouped together. Horizontal transfer, reported previously between D. mauritiana and Zaprionus tuberculatus, can be extended to Z. verruca, while the Mos1-like element of Z. indianus belongs to another group. Interpretation of the phylogeny leads to a comparison of the influence of common ancestral sequences and putative horizontal transfers.
Animals↗
Effects of dobutamine on gastric mucosal perfusion and hepatic metabolism in patients with septic shock.
We prospectively evaluated the effects of dobutamine on gastric mucosal perfusion and hepatocytic clearance in patients with septic shock. After resuscitation with volume expansion and norepinephrine (12 patients) as needed, 14 hemodynamically stable patients (median age: 60 yr, median SAPS II score: 47) were given an infusion of 7.5 microg/kg/min dobutamine for 1 h. Gastric mucosal perfusion and hepatocytic clearance were assessed with tonometry and indocyanine green (ICG) elimination, respectively. All measurements were made before dobutamine infusion, after 1 h of dobutamine infusion, and 1 h after the infusion ended. Cardiac output (thermodilution technique) increased with dobutamine from a baseline median level of 4.0 L/min/m(2) (range: 1.7 to 7.4 L/min/m(2)) to 5.0 L/min/m(2) (range: 3.5 to 8.9 L/min/m(2)) (p = 0.004) and returned to baseline levels after dobutamine infusion ended. The gastric-arterial PCO(2) difference decreased from a baseline median level of 13 mm Hg (range: 5 to 54 mm Hg) to 7 mm Hg (range: 5 to 48 mm Hg) (p = 0.005). ICG elimination was low in all patients at baseline (median plasma disappearance rate: 12.2%; range: 7.6 to 16.2%) and did not change significantly during or after dobutamine infusion. In summary, dobutamine increases gastric mucosal perfusion but does not alter hepatocytic clearance in patients with septic shock. The absence of a beneficial effect of dobutamine on hepatocytic clearance may be related to profound alterations in hepatocellular metabolism during septic shock.
Adult↗
Is the evolution of transposable elements modular?
The evolution of transposable element structures can be analyzed in populations and species and by comparing the functional domains in the main classes of elements. We begin with a synthesis of what we know about the evolution of the mariner elements in the Drosophilidae family in terms of populations and species. We suggest that internal deletion does not occur at random, but appears to frequently occur between short internal repeats. We compared the functional domains of the DNA and/or amino acid sequences to detect similarities between the main classes of elements. This included the gag, reverse transcriptase, and envelope genes of retrotransposons and retroviruses, and the integrases of retrotransposons and retroviruses, and transposases of class II elements. We find that each domain can have its own evolutionary history. Thus, the evolution of transposable elements can be seen to be modular.
Amino Acid Sequence↗
Protective ventilation for the acute respiratory distress syndrome.
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Barotrauma↗
Clinical evaluation of the Abbott Qvue-OptiQ continuous cardiac output system in critically ill medical patients.
PURPOSE: The aim of this study was to evaluate the reliability of a new continuous cardiac output (CCO) monitoring device (Qvue/OptiQ system; Abbott Critical Care Systems, Mountain View, CA) based on the pulsed warm thermodilution technique in critically ill medical patients. METHODS: Nineteen patients with cardiogenic or septic shock were included in the study. Pairs of CCO and intermittent bolus cardiac output (ICO) were noted at least every 6 hours for determination of bias, precision, and limits of agreement. Simultaneously, blood samples were collected, and arterial-venous oxygen content difference (C[a-v]O2) was determined. A multiple stepwise logistic regression was used to identify situations associated with a CCO-ICO difference exceeded 20%. A multiple linear regression was performed to analyze the respective accuracy of CCO and ICO to predict the variations of C[a-v]O2. RESULTS: A total of 203 pairs of cardiac output measurements was obtained. The bias was 0.12 L/min (1.2% of pairs mean) and the precision 1.0 L/min (13%). The 95% limits of agreement were between -1.7 L/min (-25%) and 1.9 L/min (+26%). Low blood temperatures and heart rates above 120 beats/min were significantly associated with a ICO-CCO difference higher than 20%. In a multiple linear regression, CCO was significantly correlated with C[a-v]O2, an independent reflection of the patient's cardiac output; by contrast, ICO did not. CONCLUSION: These results suggest that ICO and CCO measurement by the Qvue/OptiQ system are interchangeable, except for temperature or heart rate extreme values.
Cardiac Output↗
Noninvasive cardiac output monitoring by aortic blood flow determination: evaluation of the Sometec Dynemo-3000 system.
OBJECTIVE: The Sometec Dynemo-3000 system allows the permanent measurement of descending aorta diameter by an echographic (A-scan) device and the blood flow velocity by a pulse Doppler velocimeter. The Dynemo-3000 then furnishes a new hemodynamic parameter, i.e., descending aortic blood flow (ABF), which is a fraction of the cardiac output (CO). We evaluate the ability of this system to measure the aortic diameter and to accurately detect ABF changes. DESIGN: A case study prospective trial. SETTING: A 24-bed medical intensive care unit of a 1,100-bed university hospital. PATIENTS: Twenty critically ill patients fully sedated, mechanically ventilated, and monitored by a pulmonary artery catheter. INTERVENTIONS: CO values determined by conventional thermodilution method (TD-CO) and ABF were recorded during the study, which included two initial baseline periods, a dobutamine infusion (5 microg/kg/min) interval of 30 mins, and a third baseline period. To assess the accuracy of A-scan, aortic diameter was measured by transesophageal echocardiography. The difference between echocardiography and A-scan was used to determine bias and precision for aortic diameter measurements. TD-CO and ABF variations were analyzed using Kruskal-Wallis and Wilcoxon tests. Association between TD-CO and ABF values was determined by calculating the linear correlation coefficient. The ability of ABF to detect a TD-CO >6.0 L/min and its variations >13% was analyzed by determination of sensitivity, specificity, and positive (PPV) and negative (NPV) predictive values. MEASUREMENTS AND MAIN RESULTS: Aortic diameter measurements by A-scan and bidimensional methods were 23.0+/-2.8 mm (SD) and 24.2+/-2.7 mm, respectively. Bias and precision were 1.1 mm and 1.4 mm (95% confidence interval: -1.9 to 3.7), respectively. During the course of dobutamine infusion, we observed a significant increase of TD-CO mean value from 6.65+/-1.53 L/min to 9.30+/-2.5 L/min (p=.0008), and a parallel and significant increase in ABF mean value from 4.34+/-1.18 L/min to 5.70+/-1.63 L/min (p= .0029). Absolute TD-CO and ABF values had a correlation coefficient of 0.80. For detection of an increased TD-CO, PPV and NPV were 87% and 86%, respectively. For detection of TD-CO changes >13%, PPV and NPV were 80% and 94%, respectively. CONCLUSIONS: The Dynemo-3000 system is able to display the real aortic diameter, which is one of the most important components of this noninvasive ultrasonic technique. When compared with TD-CO, the ABF determination provided by this ultrasonic device constitutes a reliable noninvasive tool for estimating CO and tracking its changes.
Adult↗
Early predictive factors of survival in the acute respiratory distress syndrome. A multivariate analysis.
To identify the potential impact of novel therapeutic approaches, we studied the early predictive factors of survival at the onset of acute respiratory distress syndrome (ARDS) in a 24-bed medical ICU of an academic tertiary care hospital. Over a 48-mo period, a total of 3,511 adult patients were admitted and 259 mechanically ventilated patients met ARDS criteria, as defined by American-European consensus conference, i.e., bilateral pulmonary infiltrates and PaO2/FIO2 lower than 200 without left atrial hypertension. These patients were randomly included in a developmental sample (177 patients) and a validation sample (82 patients). Demographic variables, hemodynamic and respiratory parameters, underlying diseases, as well as several severity scores (SAPS, SAPS-II, OSF) and Lung Injury Score (LIS) were collected. These variables were compared between survivors and nonsurvivors and entered into a stepwise logistic regression model to evaluate their independent prognostic roles. The overall mortality rate was 65%. SAPS-II, the severity of the underlying medical conditions, the oxygenation index (mean airway pressure x FIO2 x 100/PaO2), the length of mechanical ventilation prior to ARDS, the mechanism of lung injury, cirrhosis, and occurrence of right ventricular dysfunction were independently associated with an elevated risk of death. Model calibration was very good in the developmental and validation samples (p = 0.84 and p = 0.72, respectively), as was model discrimination (area under the ROC curves of 0.95 and 0.92, respectively). Thus, the prognosis of ARDS seems to be related to the triggering risk factor, the severity of the respiratory illness, and the occurrence of a right ventricle dysfunction, after adjustment for a general severity score.
Academic Medical Centers↗
The use, and misuse, of exogenous endothelial-derived vasodilators in acute respiratory failure.
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Acute Disease↗
Right ventricular function in human sepsis: a thermodilution study.
STUDY OBJECTIVE: To assess the relations among right ventricular (RV) pressures and volumes in sepsis. DESIGN: Prospective study. SETTING: ICU. PATIENTS: Eighteen patients with sepsis who were in hemodynamically stable condition. INTERVENTION: Stepwise increases and decreases in RV end-diastolic volume (EDV) as induced by military antishock trousers (MAST) inflation of 0, 15, 30, 50 and then 0 mm Hg over 15-min intervals. MEASUREMENTS AND RESULTS: RV volumes and pressures were measured using a rapid response thermistor pulmonary arterial catheter based on RV ejection fraction (RVEF) calculations. RV EDV was estimated as stroke volume (SV)/RVEF, while RV end-systolic volume (ESV) was estimated as EDV-SV. Right atrial pressure (Pra) was taken as end-diastolic pressure, and pulmonary artery pressures (Ppa), both mean and end-systolic, were used as RV ejection pressures. MAST inflation to 15 mm Hg had no measurable effects on the measured variables. However, inflation to 30 and 50 mm Hg increased Pra, both mean and end-systolic Ppa, EDV, and ESV, whereas SV and RVEF remained unchanged. The relation between either Pra and EDV (r=0.33) or the change in Pra and EDV, mean or end-systolic Ppa and ESV (r=0.5 and 0.28, respectively), or the change in mean or end-systolic Ppa and ESV for both the group and individual subjects was poor. Furthermore, SV correlated poorly with EDV (r=0.32), while RVEF correlated better with both EDV and ESV (r=-0.41 and -0.69, respectively), although it showed no definable relation to mean or end-systolic Ppa. However, both absolute and relative changes in EDV corresponded closely with respective ESV values (r=0.93). CONCLUSIONS: During sepsis, RV EDV and ESV vary independently of changes in Pra and ejection pressure. These data can be explained by assuming that the RV is a highly compliant chamber during filling, such that changes in RV EDV do not alter RV wall stress (preload) or ejection efficiency (RVEF). Thus, changes in RV EDV should proportionally alter RV ESV. Furthermore, the slope of the ESV/EDV relation should be inversely proportional to ejection efficiency.
Adult↗