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Biomedical subjects

F Marchal

Publications and source records attributed to F Marchal.

At least 91 records · Page 5Linked to original sources
PubMed1996

Separation of airway and tissue properties by transfer respiratory impedance and thoracic gas volume in reversible airway obstruction.

The aim of this study was to establish the ability to estimate separate airway and tissue properties from transfer respiratory impedance (Zrs,tr) data in the presence of airway obstruction. Zrs,tr, thoracic gas volume (TGV) and airway resistance (Raw,pleth) were measured in the presence of obstruction and after use of a bronchodilator (BD) in 13 normal or asymptomatic asthmatic adults and 28 children with symptomatic asthma. An analytical approach was used to solve the equations of a simplified variant of DuBois' model, including airway resistance (Raw*) and inertance (Iaw), tissue compliance (Ct) and resistance (Rt) and pulmonary gas compliance (Cg). The equations of the model could not be reliably solved in four children before BD. Mean Raw,pleth was not different from mean Raw* in adults before (mean +/- SEM) (3.4 +/- 0.5 vs 3.1 +/- 0.3 hPa.s.L-1) or after BD (1.4 +/- 0.2 vs 1.8 +/- 0.2 hPa.s.L-1), or in children after BD (2.9 +/- 0.3 vs 3.2 +/- 0.2 hPa.s.L-1, respectively). In children before BD, Raw* was significantly underestimated compared with Raw,pleth (3.8 +/- 0.4 vs 5.4 +/- 0.6 hPa.s.L-1). Overall, a significant positive correlation was found between the difference [Raw,pleth - Raw*] and Raw,pleth (r = 0.82). In adults, BD induced a decrease in Raw* and Rt, an increase in Ct, and no change in Iaw. In children after BD, there was no significant change in Raw* or Ct, whilst Rt decreased and Iaw increased. Taking Raw,pleth as the gold standard, it is concluded that coherent estimation of parameters of DuBois' model may be obtained from combined Zrs,tr and TGV measurements in normal subjects and moderately obstructed adults, but not in children with significant airway obstruction. This seems to be due to the systematic under-estimation of Raw*.

Adolescent↗
PubMed1996

Ex vivo cytokine production by whole blood cells from cancer patients.

It has been hypothesized that the development of cancer might partially result from a diminution of immunocompetence. Using ex vivo cytokine production by whole blood (WB) cells after polyclonal activation, we compared cytokine production levels of cancer patients to those of healthy controls. Seventeen patients without any prior treatment and attending the hospital for oncological surgery (for cancers of several origins) were enrolled in the study. WB was collected in heparinized tubes, diluted 1/10 in RPMI 1640 and incubated for 2, 4, 24, 48, and 72 h at 37 degrees C in the presence of 5 micrograms/ml PHA and 25 micrograms/ml LPS. Cytokine levels in the supernatant were measured by specific immunoassay kits. IL-10 levels after 24 h of culture, IFN-gamma and GM-CSF levels after 24 and 72 h of culture, and LIF levels after 72 h of culture were significantly lower in cancer patients than in healthy controls. No significant difference was observed for IL-1 beta, IL-2, IL-4, IL-8, and TNF-alpha production at any culture time. Our results suggest that the putative immunosuppression of cancer patients might be reflected by their reduced production of immunostimulated cytokines.

Adult↗
PubMed1995

Vascular distension in muscles contributes to respiratory control in sheep.

It has recently been proposed that afferent fibers from skeletal muscle could sense the state of the microvascular circulation, linking ventilation to the degree of peripheral perfusion or vascular distension (Huszczuk et al., Respir. Physiol., 91:207-226, 1993). Ventilatory and circulatory responses to manipulation of peripheral vascular pressures in the hind limbs of anaesthetized (sodium thiopental) sheep were examined. Inflatable balloons were placed at the caudal ends of the abdominal aorta and the vena cava (Vc). Aortic (Ao) occlusion induced a consistent normocapnic decrease in minute ventilation (VE). In contrast, VE increased significantly during vena cava obstruction, leading to hypocapnia. Small changes in systemic blood pressure were observed (+7 mmHg for Ao occlusion and -12 mmHg during Vc obstruction). Moreover, inflation of the caval balloon superimposed on a previously established Ao occlusion, preventing venous drainage of anastomotic inflow, resulted in a significant rise in distal vascular pressures with trivial changes in systolic blood pressure. This led to a gradual rise of VE, despite further reduction of the CO2 flux to the lungs. The subsequent deflation of the aortic balloon, exposing the hindlimb vasculature to aortic pressure, resulted in an even more profound hypocapnic hyperpnea. The concurrent arterial blood pressure changes were too small to possibly involve the ventilatory component of the arterial baroreflex. We therefore hypothesize, that perfusion-related afferent signals within the muscles could contribute to respiratory homeostasis by maintaining ventilation of the lungs commensurate with the circulatory state of the muscular apparatus.

Afferent Pathways↗
PubMed1995

Persistent increased lung response to methacholine after normobaric hyperoxia in rabbits.

This study was performed to determine the occurrence and time course of airway hyperreactivity following exposure to normobaric hyperoxia. Twenty-six rabbits were studied. Twelve served as control (group 1), and 14 were exposed to normobaric hyperoxia (FiO2 > or = 95%) for 48 h: 9 rabbits (group 2) were studied after 1 day of recovery in room air and 5 (group 3) after 7 days. The rabbits were anesthetized, curarized and artificially ventilated. Respiratory resistance (Rrs) and elastance (Ers) and their respective changes induced by cumulative doses of aerosolized methacholine were assessed by the multiple linear regression analysis of airway pressure, tidal flow and volume. Weight-specific Rrs and Ers were significantly higher in group 2 (respectively, 87.7 +/- 6.5 cmH2O.L-1.sec.kg and 1100.2 +/- 87.1 cmH2O.L-1.kg, mean +/- SEM) than in group 1 (respectively, 65.2 +/- 3.2 cmH2O.L-1.sec.kg and 904.4 +/- 49.7 cmH2O.L-1.kg (P < 0.05)), but were not different from group 3 (79.4 +/- 7.9 cmH2O.L-1.sec.kg and 952.3 +/- 125.0 cmH2O.L-1.kg, respectively). The dose of methacholine required to increase Rrs by 50% (PDRrs50) was significantly lower in both treated groups: 0.37 +/- 0.11 mg in group 2 and 0.51 +/- 0.19 mg in group 3 vs 2.07 +/- 0.51 mg in group 1 (P < 0.05)). PDErs50 was significantly lower in group 2 (0.45 +/- 0.15 mg) and 3 (0.75 +/- 0.43 mg) compared with controls (1.11 +/- 0.26 mg (P < 0.05)). These results show that hyperoxia induces an increase in Rrs and Ers, and airway hyperreactivity in the rabbit. The latter is prolonged beyond the immediate post-exposure period.

Analysis of Variance↗
PubMed1995

Gastroesophageal reflux and acute life-threatening episodes: role of a central respiratory depression.

The aim of this study was to evaluate plasma levels of beta-endorphins in babies with gastroesophageal reflux (GOR) admitted for acute life-threatening episodes (ALTE). In case of ALTE (n = 15), beta-endorphin levels were significantly increased compared to sudden infant deaths syndrome siblings with GOR of a similar gravity evaluated for risk factors (n = 13). beta-Endorphin levels are decreased following successful treatment of GOR. Studies of ventilation suggest that changes in the central respiratory drive are associated with a reduction in plasma beta-endorphin levels.

Acute Disease↗
PubMed1995

Specificity and sensitivity of respiratory impedance in assessing reversibility of airway obstruction in children.

Flow in the upper airway wall induces significant error in estimating respiratory impedance by the standard forced oscillation technique in subjects with airway obstruction and may be minimized by oscillating pressure around the subject's head (head generator technique). The aim of this study was to determine whether the latter improves the power of forced oscillations in detecting airway response to bronchodilators in children. Seventy-five children with airway obstruction were studied (ages 5.5 to 15 years old). Fifty-three had asthma and 22, cystic fibrosis. A bronchodilator was administered, and the percent changes in respiratory resistance at 10 Hz (Rrs10), 20 Hz (Rrs20), respiratory compliance (Crs), and resonant frequency (fn) with standard and head generator were compared with the corresponding change in FEV1. The response was positive in 38 (delta % FEV1 > or = 15%) and negative in 37 patients. Data on Rrs10, Crs, and fn could not be obtained in 7, 8, and 4 subjects, respectively, for technical reasons. The delta % Rrs20 was not different between head and standard generator in nonresponders (mean +/- SEM: -19.0 +/- 4.5, vs -11.8 +/- 3.1%), but significantly larger with head than standard generator in responders (-54.1 +/- 3.0 vs -26.5 +/- 2.4%; p < 0.001). The optimal decision level determined by Receiver Operation Characteristic analysis showed that, compared with the standard method, the head generator improved the specificity of Rrs20 (78 vs 65%) with no change in sensitivity (76% for both). Resonant frequency had larger sensitivity with standard than with head generator (91 vs 53%) but slightly lower specificity (70 vs 78%). Finally, delta %Crs was more specific (72 vs 67%) and more sensitive (68 vs 52%) with standard than with head generator. The overall incidence of false results was lower with the head generator than with the standard generator for resistance and lower with the standard generator than with the head generator for fn and compliance. Thus, the head generator improves the diagnostic power of the forced oscillation resistance in establishing the reversibility of airway obstruction, but parameters derived from the reactance may have better diagnostic value with the standard method.

Adolescent↗
PubMed1995

[Celioscopic treatment of acute obstructions caused by adhesions of the small intestine. Experience of 35 cases].

Postoperative adhesions are the primary cause of occlusion of the small bowel. We evaluated the feasibility and the immediate postoperative results of laparoscopic procedures for acute adhesions on the small bowel. Between September 1992 and March 1995, we performed laparoscopic procedures in 35 patients with acute occlusion of the small bowel. The preoperative work-up highly suggestive of adhesion. There were 17 males and 18 females, mean age 48.2 years. In 30 patients, the operation confirmed the preoperative diagnosis of occlusion by adhesions. Lysis was performed entirely via the laparoscopic route in 21 of the 30 patients (70%). Immediate postoperative complications were 3 bowel lesions. Intestinal mobility was re-established in 1.8 days after operation and the mean duration of hospitalization was 5 days for patients with laparoscopic procedure alone compared with 3.4 days for intestinal mobility and 10.4 days hospitalization for the 9 patients who were converted to laparotomy. An eventration of the trocar orifice occurred late in one patient and ischaemic stenosis of the bowel required laparotomy in another. There were no deaths. Laparoscopic treatment of adhesion occlusions is a feasible operation. Morbidity is low in experienced hands. The immediate benefit is rapid intestinal mobility and shorter hospital stay. The effect on long-term risk to be evaluated.

Acute Disease↗
PubMed1995

[Peritonsillar abscess. Emergency tonsillectomy?].

The treatment of peritonsillar abcess is still controversial: quincy tonsillectomy, also called tonsillectomy "à chaud" (TC) or interval tonsillectomy, also known as tonsillectomy "à froid" (TF), several weeks after incision and drainage. Of 105 patients presenting with peritonsilar abscess, 53 had tonsillectomy: 27 TC and 26 TF. For each group the following variables were analyzed: age, location of abscess, bacteriology, duration of surgery, amount of per-operative bleeding, post-operative hemorrhage and complications, and length of hospital stay. The location of the abscess was posterior in 33%, and therefore difficult to drain without tonsillectomy. Significant differences in favor of TC were found for: 1) the amount of per-operative bleeding; 2) the occurrence of post-operative hemorrhage; and 3) the duration of hospital stay. We conclude that TC is a safe procedure without increased risks, with less complications, and with a reduced cost. When surgery is indicated in the treatment of peritonsillar abcess, we advocate TC. From our results and the litterature a decision tree for the management of peritonsillar abcess is presented.

Abscess↗
PubMed1994

Effects of haemorrhagic hypotension on carotid chemosensory discharge in the kitten.

Hypotension is known to affect the rate of carotid chemosensory activity in the adult cat, but the relationship between arterial blood pressure and carotid sinus nerve discharge has not been established in the kitten. The purpose of this study was to determine the response of carotid chemosensory afferents to hypotension induced in normoxia and in hyperoxia in eight kittens aged 1 to 25 days. Hypotension was obtained by a gradual decrease in blood volume. The activity of a few chemosensory fibres was recorded from one carotid sinus nerve. Baseline steady-state mean arterial blood pressure and carotid chemosensory activity were, respectively, 70.0 +/- 4.3 mmHg and 7.6 +/- 1.9 impulse/s (mean +/- SEM) in normoxia and 56.3 +/- 6.7 mmHg and 0.58 +/- 0.2 impulse/s in hyperoxia. Lowering arterial blood pressure below 37.5 +/- 3.5 mmHg in normoxia and 26.8 +/- 2.3 mmHg in hyperoxia was associated with a consistent increase in the rate of chemosensory discharge. Above this threshold, blood pressure variations had little effect on carotid chemoreceptor activity. These data are qualitatively similar to those of adult cats and provide evidence that, in newborn kittens, changes in arterial blood pressure will not influence carotid chemosensory discharge unless these changes are out of the physiological range.

Action Potentials↗
PubMed1994

Effect of dopamine on carotid chemoreceptor activity in newborn kittens.

In newborn kittens, intravenous bolus injections of dopamine may be inhibitory or excitatory to the carotid chemosensory activity. In order to further identify the role of dopaminergic mechanisms on the chemosensory activity in the kitten, 10 anesthetized, paralyzed and artificially ventilated kittens aged from 1 to 21 days were studied. The activity of a few chemoafferent fibers from one carotid sinus nerve was recorded at three levels of FiO2 in N2, 21, 8 and 100%, before and during a continuous dopamine infusion at a dose of 10 micrograms/kg/min. The immediate effect of dopamine usually was a transient inhibition of carotid chemosensory discharge. After 2 min of infusion, the activity had consistently increased from 4.5 +/- 0.8 to 8.8 +/- 1.4 impulses/s (mean +/- SEM, p < 0.05) in normoxia. Dopamine also significantly increased the steady state chemosensory response to hypoxia from 24.6 +/- 3.7 to 33.4 +/- 5.3 impulses/s. Hence, continuous infusion of dopamine has a dual effect on carotid chemoreceptor activity: early inhibition followed by excitation. The excitatory effect enhances the response to hypoxia. These data suggest that the dual effect of dopamine on carotid chemosensory discharge may be related to dopamine concentration in the carotid body.

Action Potentials↗
PubMed1994

Input respiratory impedance to estimate airway hyperreactivity in children: standard method versus head generator.

We previously found that a significant underestimation of respiratory mechanical impedance (Zrs) at high frequency may result from the upper airway artefact in children, when pressure is directly varied at the mouth. To determine the importance of this artefact in estimating lung response to bronchomotor agents with the forced oscillation technique, input respiratory mechanical impedance was measured using 6-32 Hz pseudorandom pressure oscillations applied directly to the mouth (standard generator (SG)) and around the subject's head (head generator (HG)) in 35 children aged 2.5-13 yrs. Changes in resistance were generally larger with HG than SG. The mean +/- SEM changes in resistance of the respiratory system (Rrs) at 20 Hz induced by acetylcholine or allergen challenge were 15 +/- 4% for SG and 67 +/- 12% for HG, and changes induced by bronchodilators were -25 +/- 2% for SG, and -46 +/- 4% for HG (p < 0.01). Challenge induced negative frequency dependence of Rrs with SG and positive frequency dependence with HG. There was significant increase in inertance after salbutamol with SG, but no significant change occurred with HG. With both methods, respiratory compliance decreased significantly after challenge. Computer simulations showed that the difference in change in Rrs induced by airway challenge with HG and SG could be explained by the effect of the upper airway wall impedance (Zuaw). Zuaw could also account for the change in inertance and compliance observed with SG, but not for the change in compliance with HG. The latter could be reproduced by simulating unequal distribution of mechanical time constants within the lung, increased peripheral lung resistance with compliant central airways.(ABSTRACT TRUNCATED AT 250 WORDS)

Airway Resistance↗
PubMed1993

Low-frequency vs. high-frequency respiratory mechanics after methacholine challenge in artificially ventilated rabbits.

Respiratory system resistance (Rrs) and elastance (Ers) were estimated by two methods, before and after methacholine in six anesthetized, paralyzed, and artificially ventilated rabbits. Rrs and Ers were obtained (1) by multiple linear regression analysis of the relationship between tracheal pressure and tidal volume and flow [Rrs(mlr)], Ers(mlr), and (2) by analysis of the Fourier transforms of tracheal pressure and flow resulting from 4 to 30 Hz pseudorandom pressure oscillations delivered by an Infant Star respirator [Rrs(os), Ers(os)]. Rrs(os) was significantly lower than Rrs(mlr). For instance, Rrs(os) at 20 Hz [Rrs(os)20] was (mean +/- SD) 17.3 +/- 3.5 vs 21.4 +/- 3.6 cm H2O x L-1 x s (P < 0.01) for Rrs(mlr). Ers(os) was significantly higher than the respective value obtained by multiple linear regression (718.2 +/- 81.0 vs 403.7 +/- 43.0 cm H2O L-1; P < 0.01). After methacholine, the changes of respiratory mechanics were similar with both methods. Rrs(mlr) and Rrs(os)20 increased respectively by 131 +/- 45 and 134 +/- 76%, and Ers(mlr) and Ers(os) increased respectively by 63 +/- 7 and 54 +/- 13%. A significant correlation was observed between Rrs(mlr) and Rrs(os)20 (r = 0.97) and between Ers(mlr) and Ers(os) (r = 0.96). We conclude that positive response to methacholine may be detected by forced oscillation as well as by multiple linear regression. However, the identified physiological components of the lung response (alteration in lung viscoelastic properties, increased lung inhomogeneity or increased intrathoracic airway shunt) are likely to be different with each method.

Airway Resistance↗