Biomedical subjects
Publications and source records attributed to F Gudinchet.
The case of a neonate who presented with symptoms of upper limb ischemia related to spontaneous multiple arterial and venous thromboses that were demonstrated by colour Doppler sonography and digital subtracted angiography is reported. The presentation of limb ischaemia at birth may be the warning sign of simultaneous cerebral infarction.
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The posterior lobe of the pituitary gland was studied by MR imaging in 30 children without pituitary gland disease and compared with studies from a group of 13 children with central diabetes insipidus, including eight cases of primary diabetes insipidus and five cases of diabetes insipidus secondary to suprasellar tumors (four proved germinomas, one still unknown tumor). Two components in the sella turcica were identified in all 30 children without pituitary gland disease, and the posterior lobe was identified as a high-intensity structure on T1-weighted images. In all 13 patients with diabetes insipidus, the normal hyperintense signal of the posterior hypophysis was absent on T1-weighted images. Three patients with suprasellar tumors presented with a progressively enlarging pituitary stalk on follow-up. Our findings show that absence of the normal hyperintense signal of the posterior lobe is closely related to a loss of function of the neurohypophysis. Size or signal modification of the pituitary stalk should suggest the development of a suprasellar tumor.
Pulmonary sequestration is a rare congenital disorder in which a portion of normal lung tissue lacks normal connections with the tracheo-bronchial tree and the pulmonary arteries. We report on three cases of left lower lobe extrapleural sequestrations that have been studied with ultrasound since 1980. In the two more recent cases demonstration of the feeding vessel originating directly in the abdominal aorta by real-time ultrasound permitted very rapid non-invasive diagnosis of the malformation. We recommend that a search should be made for such an aberrant vessel with real-time ultrasound whenever a pulmonary sequestration is suspected.
To examine the rates of whole body protein synthesis and energy expenditure during the rapid growing period, premature infants of very low birth weight (VLBW) (less than 1500 g), appropriate for gestational age were kept under standard thermoneutrality conditions and received a formula diet providing 110 kcal/kg.d metabolisable energy (ME) and 3.3 g protein/kg.d. Their energy expenditure was measured by open circuit indirect calorimetry. Nitrogen turnover and whole body protein synthesis and catabolism were determined using repeated oral administration of 15N-glycine for 60-72 h followed by the analysis of 15N-enrichment in urinary urea. These VLBW infants grew at an average rate of 15 g/kg.d. About half of the ME intake (i.e. 50 kcal/kg.d) was invested in weight gain while the remainder (i.e. 60 kcal/kg.d) was oxidised. The energy equivalent of the weight gain (i.e. the amount of energy stored per g weight gain) and the N balance indicated that lean tissue made up approximately 2/3 of the weight gained and fat tissue the remaining 1/3. The plateau value for 15N enrichment reached on the third day of administration allowed us to calculate a rate of protein synthesis of 14 g/kg.d and protein breakdown of 12 g/kg.d in five VLBW fed a formula diet. The elevated energy expenditure of the very low birth weight infant seems to be related to its rapid rate of weight gain which is accompanied by a high rate of body protein synthesis. More than 20% of the total energy expenditure of the VLBW infants was accounted for by whole body protein synthesis.
A test for determination of epinephrine sensitivity has been worked out using six healthy young women. Variables considered were metabolic rate, heart rate, respiratory frequency, blood pressure, blood glucose, plasma insulin, glycerol, free fatty acids, and lactate. After established basal conditions, epinephrine was infused at rates of 0.01, 0.03, and 0.1 microgram X kg fat-free mass-1 X min-1. Most variables responded to epinephrine in a dose-dependent manner. Physiological threshold plasma concentrations of epinephrine ranged from 95 to 250 pg/ml for different variables. Calculated maximal responses ranged from approximately -15% to +900% of basal values and infusion rates giving half-maximal responses from approximately 15 to 190 ng X kg fat-free mass-1 X min-1. On an average, metabolic rate increased by 8, 16, and 29%, respectively, at the three infusion rates, and the maximal metabolic response was calculated to be approximately 35%. The error in determining epinephrine-induced increments in metabolic rate was 7% of the response. As calculated from nonprotein RQ, carbohydrate oxidation increased and lipid oxidation decreased rapidly during the first 10 min of epinephrine infusion. Later, fat oxidation became more important. Results on epinephrine plasma metabolic clearance rate agreed with earlier results in the literature.
Forty-eight measurements of energy expenditure were performed in 15 very low-birth-weight infants during the first 6 wk of life. Their mean birth weight and gestation age was 1223 g and 31 wk respectively. Their mean weight gain was 11.2 g/kg . d (range: -6.6 to +15.9 g/kg . d.). The mean energy expenditure increased from 170 kJ/kg . d (wk 1) to 252 kJ/kg . d (wk 6). There was a significant relationship between weight gain and energy expenditure (r = 0.58, P less than 0.001) and also between the net increase in body weight gain and the net increase in energy expenditure (r = 0.80, P less than 0.001). From the slopes of these regression lines, the metabolic cost of growth was found to be approximately 2.3 kJ/g of weight gain. Carbohydrate oxidation represented 80% of energy expenditure at the second wk and decreased to 65% the 6th wk, whereas lipid oxidation during the same period increased from 14 to 30% and the relative protein oxidation remained unchanged, covering 5-6% of the energy expended.
The Ring-Sling Complex is an uncommon, congenital vascular and tracheobronchial malformation with a persistent high death rate. We report three patients in whom computed tomography (CT) and magnetic resonance imaging (MRI) were used for the preoperative diagnosis and for staging of the morphologic tracheal and vascular anomalies.
Rupture of a congenital aneurysm of the sinus of Valsalva is a rare congenital cardiac malformation. This case report describes a congenital aneurysm of the sinus of Valsalva which ruptured into the right ventricle in a 3-year-old girl. The exact route of the fistula through the cardiac walls and the localization of the rupture into the right ventricle was not completely defined by two-dimensional and color Doppler echocardiography and could be determined only by magnetic resonance imaging (MRI).
Pulmonary edema may be classified as increased hydrostatic pressure edema, permeability edema with diffuse alveolar damage (DAD), permeability edema without DAD, or mixed edema. Pulmonary edema has variable manifestations. Postobstructive pulmonary edema typically manifests radiologically as septal lines, peribronchial cuffing, and, in more severe cases, central alveolar edema. Pulmonary edema with chronic pulmonary embolism manifests as sharply demarcated areas of increased ground-glass attenuation. Pulmonary edema with veno-occlusive disease manifests as large pulmonary arteries, diffuse interstitial edema with numerous Kerley lines, peribronchial cuffing, and a dilated right ventricle. Stage 1 near drowning pulmonary edema manifests as Kerley lines, peribronchial cuffing, and patchy, perihilar alveolar areas of airspace consolidation; stage 2 and 3 lesions are radiologically nonspecific. Pulmonary edema following administration of cytokines demonstrates bilateral, symmetric interstitial edema with thickened septal lines. High-altitude pulmonary edema usually manifests as central interstitial edema associated with peribronchial cuffing, ill-defined vessels, and patchy airspace consolidation. Neurogenic pulmonary edema manifests as bilateral, rather homogeneous airspace consolidations that predominate at the apices in about 50% of cases. Reperfusion pulmonary edema usually demonstrates heterogeneous airspace consolidations that predominate in the areas distal to the recanalized vessels. Postreduction pulmonary edema manifests as mild airspace consolidation involving the ipsilateral lung, whereas pulmonary edema due to air embolism initially demonstrates interstitial edema followed by bilateral, peripheral alveolar areas of increased opacity that predominate at the lung bases. Familiarity with the spectrum of radiologic findings in pulmonary edema from various causes will often help narrow the differential diagnosis.
Mesenteric panniculitis is an inflammatory condition of mesenteric fat which may result in peritoneal space occupying lesions. Only two previously reported cases in the English literature have been evaluated by computed tomography (CT). We present 2 additional cases and emphasize that CT patterns are not specific, but suggest the diagnosis in the presence of a well-defined fibrous wall circumscribing a fatty mass containing regions with attenuation near that of water. Lymphoma and mesenteric metastases should be considered the most frequent radiologic, clinical and surgical differential diagnosis.
We report the appearance of a cavernous malformation associated with a developmental venous anomaly in a young boy 3 years after radiation therapy for a posterior fossa medulloblastoma. The presence of a stenosis of the venous drainage of the anomaly led us to postulate that venous restrictive disease, induced by radiation therapy, resulted in increased venous pressure and caused the formation of the cavernous malformation.