Biomedical subjects

F Verra

Publications and source records attributed to F Verra.

22 records · Page 2Linked to original sources

PubMed1991

Diagnosis of nosocomial pneumonia in mechanically ventilated patients. Comparison of a plugged telescoping catheter with the protected specimen brush.

Protected samples of lower respiratory tract secretions processed by quantitative culture techniques are recommended to diagnose nosocomial bacterial pneumonia in intubated, mechanically ventilated patients. To evaluate the accuracy of a simple and inexpensive sampling device in this setting, we compared quantitative cultures of paired single-sheathed plugged telescoping catheter (PTC) and protected specimen brush (PSB) samples in 55 patients during 78 suspected episodes of nosocomial pneumonia. PTC and PSB samples were taken in randomized order, and patients were also randomized to have PTC samples taken "blindly" or via a fiberoptic bronchoscope. Fifteen PSB and 27 PTC samples were culture positive (greater than or equal to 10(3) cfu/ml). The two sampling procedures gave similar results in 58 (74%) episodes. A major discrepancy occurred in 20 episodes, including six false negatives of PSB in episodes of proved pneumonia, four possible false positives of PSB, and 10 possible false positives of PTC (three of which rapidly evolved towards overt pneumonia). The sensitivity and specificity of PTC were 100 and 82.2%, and those of PSB were 64.7 and 93.5%, respectively. Blinded or directed PTC samples had similar concordance with PSB samples taken via bronchoscopy. We conclude that PTC is at least as accurate as PSB in the bacteriologic diagnosis of nosocomial pneumonia in intubated patients, and that its use can result in substantial cost savings, especially when fiberoptic bronchoscopy is not otherwise indicated.

Bacterial Infections↗

PubMed1991

Inherited factors in diffuse bronchiectasis in the adult: a prospective study.

To evaluate the prevalence of inherited respiratory ciliary structure and underlying mucus abnormalities in the diffuse bronchiectasis syndrome, we investigated 53 subjects comprising 38 patients with diffuse bronchiectasis confirmed by high-resolution thoracic computed tomography, ten with chronic bronchitis and no diffuse bronchiectasis and five healthy nonsmoking control subjects. The clinical history was determined by means of a standardized questionnaire. Axonemal abnormalities of respiratory cilia were evaluated on bronchial or nasal mucosa samples by transmission electron microscopy (structure) and stroboscopic observation (function). Cystic fibrosis (CF) and Young's syndrome were detected by means of the sweat test and semen analysis when male infertility was suspected. Among the 38 patients with diffuse bronchiectasis, a primary ciliary dyskinesia (PCD) was detected in five (13%) with a high proportion (range: 55-100%) of cilia showing axonemal ultrastructural abnormalities always involving the dynein arms. The prevalence of this inherited condition was higher in North African (36%) than in European patients (4%) (p less than 0.01). After exclusion of the five patients with PCD, the patients with diffuse bronchiectasis showed axonemal ultrastructural abnormalities similar to those with chronic bronchitis. The diagnosis of underlying mucus disorders was based on two types of criterion, i.e. for CF, sweat chloride levels greater than 80 mmol.l-1, or the combination of diagnostic criteria proposed by Stern et al. Respectively, five (three Young's syndrome and two CF) and seven (one Young's syndrome and six CF) cases of inherited mucus disorders were suspected. Our results showed that PCD was highly prevalent among the adult North African patients with diffuse bronchiectasis but relatively rare in the Europeans.

Adult↗

PubMed1990

Effects of local anaesthetics (lidocaine) on the structure and function of ciliated respiratory epithelial cells.

Sampling for nasal or bronchial ciliated cells requires the use of anaesthetic agents, but such drugs may interfere with the morphological or functional results. Lidocaine is the most frequently used local anaesthetic. In order to study the morphological and functional effects of lidocaine hydrochloride, we designed an experimental study on ciliated cells from guinea pig and bovine trachea. On guinea pig tracheal specimens, different lidocaine concentrations (0.05, 0.25 and 1%) were tested. Tracheal rings were immersed in either culture medium alone (control) or in different lidocaine concentrations. Measurements of ciliary beat frequency (CBF) were performed by the stroboscopic method. Tracheal rings were consecutively incubated in culture medium alone and a second set of measurements was performed. Tracheal rings were studied by light microscopy after incubation in either 1% lidocaine or in culture medium alone. On bovine tracheal specimens, a cotton wool swab impregnated with different lidocaine concentrations (0, 0.25, 1, 2.5 and 5%) was placed in contact with the tracheal mucosa. Three different kinds of samples were collected: the first one was used to study CBF, the second one (0.1 and 5%) was studied by scanning electron microscope (SEM) and the third (0.1 and 5%) by transmission electron microscopy (TEM). The results on guinea pig specimens show a significant but reversible CBF diminution for concentrations of 0.25 and 1% lidocaine and cellular lesions for the concentration of 1%.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMed1990

[Value of the LDH level in pneumocystis carinii pneumonia in patients infected with human immunodeficiency virus].

LDH levels were measured in 30 AIDS patients with P. carinii pneumonia (PCP), evidenced by bronchoalveolar lavage, and 12 HIV 1-infected patients with P. carinii-negative bronchial or pulmonary manifestations, constituting the control group. Extrapulmonary causes of elevated LDH levels were eliminated. In the case of bronchopneumopathy, the sensitivity and the specificity of an abnormal LDH level for suggesting PCP were both 83%. For an interstitial pneumopathy, the sensitivity was the same but the specificity was 100%. During a one year period, the prevalence of PCP in our department was 69%. The positive and negative predictive values of increased LDH levels in HIV-infected patients were, respectively: 92 and 63% for bronchopneumopathy, and 100 and 73% for interstitial pneumopathy. Furthermore, the lowering and then the normalization of the LDH value were observed in all PCP cases with a favorable outcome. This simple yet highly sensitive laboratory analysis should be used for the diagnosis and monitoring of all bronchopneumopathies in HIV-infected patients.

Acquired Immunodeficiency Syndrome↗