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Biomedical subjects

F Coste

Publications and source records attributed to F Coste.

At least 37 records · Page 2Linked to original sources

[Hyponatremia of acute pulmonary infections].

The mechanism of hyponatremia associated with pneumonia has been debated. In particular, the responsibility of inappropriate antidiuretic hormone secretion has been questioned. We have shown that inappropriate antidiuretic hormone secretion is a nearly constant finding during pneumonia and is roughly proportional to the extent of pneumonia. Nevertheless, it must be emphasized that extracellular fluid volume may be increased, diminished or normal during pneumonia, depending on the underlying condition (congestive heart failure, cirrhosis) or on the importance of extrarenal losses (sweats, fever). Careful clinical and laboratory assessment of extracellular fluid volume should enable adequate therapy.

Acute Disease

Does the stress of admission to an intensive care unit influence arginine vasopressin secretion and renal diluting ability?

The pathogenesis of excessive arginine vasopressin (AVP) release and hyponatraemia in euvolaemic intensive care unit (ICU) patients is poorly understood. Stress has frequently been proposed as a possible determinant, but its actual responsibility has not been adequately assessed. Therefore, water-load tests were prospectively performed in 11 patients admitted to the ICU for severe or potentially severe diseases, but who had no other condition which could result in excessive AVP release or impairment of renal diluting ability. Renal diluting ability was normal in 9 patients. Two patients exhibited very slight defects, which might be the consequence of subclinical haemodynamic alterations, since one had a pulmonary embolism and the other manifested a gastrointestinal haemorrhage just after the completion of the water load. Nevertheless, plasma AVP levels decreased in response to the water load in all the patients, resulting in a significant decrease in mean values. Plasma norepinephrine values were found to be elevated both before and after water loading. A highly significant correlation existed between the levels of norepinephrine and those of AVP measured before the load, but was lost after it. In addition, norepinephrine values were markedly elevated in two patients who exhibited strictly normal renal diluting abilities, and no correlation was found between plasma norepinephrine values and any parameter of renal water excretion. Our study shows that the stress of a serious illness and of admission to an ICU does not seem to interfere, by itself, with osmotic regulation of AVP secretion and renal diluting ability, and that sympathetic activation is not, under such circumstances, a predominant stimulus for AVP release.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult

Tall T waves during metabolic acidosis without hyperkalemia: a prospective study.

The specific ECG characteristics of metabolic acidosis have not been satisfactorily defined in man. We addressed this question by prospectively studying 14 consecutive patients admitted with metabolic acidosis and without hyperkalemia. Arterial blood gas analysis and serum potassium determinations were performed during acidosis and after its correction. ECGs were recorded at the same times. Mean pHa increased from 7.11 +/- 0.05 to 7.40 +/- 0.01 (p less than .001) in response to an increase in total CO2 content from 6.8 +/- 1.4 to 21.2 +/- 0.7 mmol/L (p less than .001). Serum potassium concentration decreased only slightly after correction of the acidosis from 4.2 +/- 0.1 to 3.9 +/- 0.14 mmol/L (p less than .05). T waves were taller during acidosis than after correction (0.68 +/- 0.1 vs. 0.28 +/- 0.04 mV, p less than .001 and 0.64 +/- 0.08 vs. 0.38 +/- 0.04, p less than .005, in precordial leads V2 and V3, respectively). Moreover, the amplitude of T waves in V2 was correlated positively with the arterial concentration of H+ (r = .786, p less than .001) and negatively with the arterial total CO2 content (r = -.71, p less than .005). In addition to their augmented amplitude, T waves were peaked and symmetrical with a narrow base ("tent-shaped"). Thus, metabolic acidosis may be accompanied by an increase in the amplitude of T waves, even in the absence of hyperkalemia.

Acid-Base Equilibrium

Acute infectious pneumonia is accompanied by a latent vasopressin-dependent impairment of renal water excretion.

The mechanism of hyponatremia associated with pneumonia has not been definitely established. Moreover, renal water excretion was never systematically investigated in cases of pneumonia without hyponatremia. We therefore studied nine consecutive patients breathing spontaneously (nasal oxygen in five), with acute infectious pneumonia and normal plasma sodium concentration. All the patients were previously healthy. Water loads were administered during illness and after recovery. Extracellular fluid volume, arterial blood pressure, PaO2, and PaCO2 were identical during and after pneumonia. By contrast, renal water excretion was markedly impaired during pneumonia and returned to normal values after recovery. This was attested to by a significant decrease in minimum urine osmolality together with significant increases in the percentage of the excreted water load and the maximum free water clearance, after resolution of the pneumonia. Plasma arginine vasopressin values were significantly higher during pneumonia than after recovery despite similar plasma sodium concentrations, both before and after water load. A positive correlation between plasma arginine vasopressin and minimum urine osmolality was found during pneumonia. Thus, impairment in renal water excretion appeared to be due to resetting of the vasopressin osmostat and could not be attributed to any recognized nonosmotic stimulus for vasopressin secretion. On the other hand, these defects varied in severity depending on the extent of the pneumonia and persisted until clearing of alveolar opacities, accounting for their protracted course in some patients. We conclude that water excretion is impaired in most if not in all patients with acute infectious pneumonia (especially if extended), and that the administration of hypotonic solutions should be avoided in these patients.

Acute Disease

[Fatal massive intravascular coagulation during phlebography. Responsibility of epsilon-aminocaproic acid?].

The occurrence during phlebography of massive intravascular coagulation involving the inferior vena cava, the right cardiac cavities and the entire pulmonary arterial network suggested that epsilon-aminocaproic acid administered before phlebography was responsible for this complication. The mechanisms of reactions to contrast media are still poorly understood, but these reactions are known to include, in some cases, disseminated intravascular coagulation. This phenomenon was histologically demonstrated in our patient, and it may be suggested that its strong enhancement by the antifibrinolytic agent had resulted in the fatal accident. In view of the possibility of such lethal reactions, the advisability of administering epsilon-aminocaproic acid--a drug widely used in France for the prevention and treatment of contrast media reactions--should be reconsidered.

Adult

[Life cycle of Leranthropus kroyeri Van Beneden 1851, hematophagous branchial copepod of the sea bass Dicentrarchus labrax (Linné, 1758) in wild and experimental populations].

The life cycle of Lernanthropus kroyeri Van Beneden, 1851, copepod (Siphonostomatoida) parasite of Dicentrarchus labrax is described. The cycle comprises two nauplii, one infective copepodid, four fixed copepodids and one preadult. All the attached stages are caracterised by the lack of the frontal filament. This is the first description of a life cycle lacking a chalimus for Siphonostomatoida Copepods parasitic on fish.

Animals

[Reproduction and sexuality of parasitic copepods of fishes. I. The reproductive apparatus of Chondracanthus angustatus Heller, 1865: anatomy, histology, and spermiogenesis (author's transl)].

The pygmy males of Chondracanthus angustatus are fixed on the genital segment of the female on two anterior-ventral tubercules. The genital system is formed by two dorsal testes, two broad vas deferens and two seminal vesicles each one containing a spermatophore. Two types of cells can be seen in the interstitial tram: the sexual (normal and abortive) and the somatic ones. The plasmic and nuclear membranes joined together on one end of the spermatid; on the opposite pole, the mitochondria penetrate into the cytoplasmic expansions. The non-motile starfish spermatozoa present neither di-ferentiated acrosome nor centrioles. The male gametes are stocked in the spermatophore and enveloped by many kinds of secretions. Spermatozoa are discharged into the female integument folds and they reach the seminal receptacle with the help of the villosities movement; they stay there till fertilization occurs.

Animals