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Biomedical subjects

G Aubert

Publications and source records attributed to G Aubert.

At least 55 records · Page 3Linked to original sources
PubMed2000

Obstructive sleep apnea syndrome after reconstructive laryngectomy for glottic carcinoma.

Obstructive sleep apnea syndrome (OSAS) is characterized by repetitive episodes of partial or complete obstruction of the upper airway during sleep. The obstruction predominantly occurs along the pharyngeal airway but other sites of obstruction have occasionally been described. We report our experience with three patients suffering from OSAS suspected to be of laryngeal origin. OSAS developed after reconstructive laryngectomy for glottic carcinoma and upper airway obstruction seemed to be located in the reconstructed laryngeal area. The three patients were given nCPAP (nasal-continuous positive airway pressure) treatment associated with peroral endoscopic CO2 laser vaporization of the laryngeal edema. After CO2 laser treatment, one patient was able to stop nCPAP treatment. The other two have remained on nCPAP therapy. OSAS may arise in the post-operative period of reconstructive laryngectomy for glottic carcinoma and can be managed by CO2 laser vaporization (laryngeal edema in the reconstructed area) in association with nCPAP treatment.

Aged↗
PubMed2000

Adenylosuccinase deficiency: an unusual cause of early-onset epilepsy associated with acquired microcephaly.

Adenylosuccinase deficiency, an autosomal recessive inborn error of purine synthesis, was first described in 1984 by Jaeken and Van den Berghe (reviewed in J Inher Metab Dis 20;1997:193). The cardinal features are variable psychomotor delay often accompanied by epilepsy and autistic features. Diagnosis is made by detection of abnormal purine metabolites in body fluids. We report a girl who presented with early onset epilepsy, associated with acquired microcephaly and severe psychomotor retardation, as the most prominent symptoms.

Adenylosuccinate Lyase↗
PubMed2000

Weight loss as a treatment for obstructive sleep apnoea.

Obesity is a major health problem in well-developed societies. It is frequently associated with metabolic, cardiovascular and psychological comorbid conditions. Besides, it is known that obesity constitutes a risk factor for obstructive sleep apnoea (OSA). Weight loss has been evaluated as a treatment for OSA. We reviewed the nature of the link between obesity and OSA as well as the conservative and surgical therapeutic approaches of obesity. We consider the effectiveness of weight loss alone or combined with other modalities of treatment in OSA. We conclude that although weight loss is important and can facilitate the treatment of OSA, it can rarely cure it without being associated to classical techniques, such as nasal continuous positive airway pressure (nCPAP).

Journal Article↗
PubMed2000

[Diagnosis of nocturnal respiratory disorders. Review of portable screening systems. Analysis and critique of different polysomnographic signals].

Polysomnography in an attended hospital laboratory setting is the gold standard for the diagnosis of sleep-related breathing disorders. However, this method is expensive and waiting lists are long. Portable recording devices that can be used at home have been recently developed to improve upon the problems of polysomnography. We review the recent portable devices validated by polysomnography and discuss their precise role in the assessment of sleep-related respiratory disorders.

Equipment Design↗
PubMed1999

Comparative evaluation of five chromogenic media for detection, enumeration and identification of urinary tract pathogens.

Five chromogenic agar plates--CPS ID2 medium (bioMérieux, France), CHROMagar Orientation medium (Becton Dickinson, France), UriSelect3 medium (Sanofi Diagnostics Pasteur, France), Rainbow Agar UTI medium (Biolog, USA) and Chromogenic UTI medium (Oxoid, Germany)--for the detection, enumeration and direct identification of urinary tract pathogens were compared using 443 urine specimens at two hospital laboratories. The enumeration of microorganisms was consistent on the five media for 403 of the 477 (84.5%) microorganisms. Chromogenic UTI, CPS ID2, UriSelect3, CHROMagar Orientation and Rainbow UTI gave detection rates of 98.3%, 97.9%, 97.3%, 96.9% and 94.1%, respectively, with some problems in yeast growth occurring on Rainbow UTI agar and problems in Staphylococcus spp. growth occurring on UriSelect3. For the direct identification of Escherichia coli, sensitivities were 93.8%, 88.5%, 86.1% and 82.2% for CHROMagar Orientation, CPS ID2, UriSelect3 and Rainbow UTI, respectively. Chromogenic UTI medium did not allow the accurate identification of Escherichia coli, since the indole reaction cannot be applied to this medium. Depending on the media, Enterococcus spp. could be identified at the genus or the species level. Slight differences were detected in the presumptive identification of the Proteus-Morganella-Providencia group and the Klebsiella-Enterobacter-Serratia group. Additionally, on Rainbow UTI agar, 12 of 20 Klebsiella pneumoniae strains and two of nine Pseudomonas aeruginosa strains were correctly identified. In conclusion, CPS ID2 medium and CHROMagar Orientation medium showed similar performance overall, while the UriSelect3, Rainbow UTI and Chromogenic UTI media require some improvement.

Agar↗
PubMed1999

Expiratory flow limitation in awake sleep-disordered breathing subjects.

Increased upper airways (UA) collapsibility has been implicated in the pathogeny of sleep-disordered breathing (SDB). An increased UA instability during expiration has recently been shown in healthy subjects. The present study assessed UA collapsibility in SDB patients by applying negative pressure during expiration. Full-night polysomnography was performed in 16 subjects (all snorers) with a wide range of SDB, and in six healthy control subjects. Physical examination, spirometry, and maximal inspiratory and expiratory flow rates were within normal limits for all 22 subjects. Negative expiratory pressure (NEP) (-5 cmH2O) was applied during quiet breathing in seated and supine position. Flow limitation (FL) during NEP was expressed as the percentage of tidal volume during which expiratory flow was less than or equal to the flow recorded during quiet breathing (%FL). The mean desaturation index (DI) of the 16 subjects was 27.3+/-26.4 (+/-sD) and the average FL in supine position was 38.4+/-37.9%. A close correlation between %FL supine during wakefulness and DI during sleep (r=0.84, p<0.001) was found. All obstructive sleep apnoea subjects had >30%FL supine. There was no FL in the six control subjects. In conclusion, negative expiratory pressure application during expiration appears to be a useful, noninvasive method for the evaluation of subjects with sleep-disordered breathing. Present results suggest that upper airway collapsibility can be detected in these subjects during wakefulness.

Adult↗
PubMed1999

Characterization and nucleotide sequence of CARB-6, a new carbenicillin-hydrolyzing beta-lactamase from Vibrio cholerae.

A clinical strain of Vibrio cholerae non-O1 non-O139 isolated in France produced a new beta-lactamase with a pI of 5.35. The purified enzyme, with a molecular mass of 33,000 Da, was characterized. Its kinetic constants show it to be a carbenicillin-hydrolyzing enzyme comparable to the five previously reported CARB beta-lactamases and to SAR-1, another carbenicillin-hydrolyzing beta-lactamase that has a pI of 4.9 and that is produced by a V. cholerae strain from Tanzania. This beta-lactamase is designated CARB-6, and the gene for CARB-6 could not be transferred to Escherichia coli K-12 by conjugation. The nucleotide sequence of the structural gene was determined by direct sequencing of PCR-generated fragments from plasmid DNA with four pairs of primers covering the whole sequence of the reference CARB-3 gene. The gene encodes a 288-amino-acid protein that shares 94% homology with the CARB-1, CARB-2, and CARB-3 enzymes, 93% homology with the Proteus mirabilis N29 enzyme, and 86.5% homology with the CARB-4 enzyme. The sequence of CARB-6 differs from those of CARB-3, CARB-2, CARB-1, N29, and CARB-4 at 15, 16, 17, 19, and 37 amino acid positions, respectively. All these mutations are located in the C-terminal region of the sequence and at the surface of the molecule, according to the crystal structure of the Staphylococcus aureus PC-1 beta-lactamase.

Amino Acid Sequence↗
PubMed1999

[Pneumococcus observatory data in the Rhône-Alps region. Results from 1996].

Throughout 1996, 22 hospital-based laboratories in the Rhône-Alpes region of France collected pneumococcal strains and used a standardized protocol to record the following data; patient age and sex; type of specimen; and determination of susceptibility to at least the following antibiotics: oxacillin 1 microgram and 5 micrograms, erythromycin (Ery), tetracycline (Tet), chloramphenicol (Chl), rifampin (Rmp), and loracarbef. For penicillin-nonsusceptible strains (PNSSs), which were identified based on results with oxacillin, MICs for penicillin G, amoxicillin (Amx), and cefotaxime (Ctx) were determined using the E Test, at the study site and agar dilution at the coordinating center. Of the 1153 strains, 65.5% were from adults and 31.8% from children; patient age was unknown in 2.7% of cases. PNSPs (MIC > 0.06 mg/l) contributed 32.9% of strains (I: 23.3%; R: 9.6%) and were more common in children (41.1%) than in adults (28.1%). The frequency of PNSSs varied across specimen types: 27.9% in blood cultures (305 strains), 15.6% in cerebrospinal fluid (32), 38.7% in protected bronchopulmonary specimens (31), 31.5% in unprotected bronchopulmonary specimens (434), 50.8% in acute otitis media (118), and 34.4% in other specimens (221). Among PNSSs, nonsusceptibility (I + R) to other antibiotics was variable: Ery, 62.1%; Tet, 41.5%; Chl, 40.4%; Rmp, 1.1%. Corresponding figures for the overall strain population were Ery, 33.3%; Tet, 22.7%; Chl, 22.8%; Rmp, 0.9%. In addition, 56.5% of PNSSs exhibited multiple drug resistance. Resistance to amoxicillin (MIC > 2 mg/l) was demonstrated for only 5 strains. No strains were resistant to loracarbef or cefotaxime. Serotypes of the 379 PNSSs were as follows: 23F, 26.6%; 14 (25.6%); 9V (18.2%), 6 (8.7%), 15 (5%), 19 (4.5%).

Adult↗
PubMed1998

Effects of Breathe Right on snoring: a polysomnographic study.

The nasal vestibule is a major site of resistance to airflow in healthy subjects. A high nasal resistance may increase snoring. Activation of the alae nasi and alar retraction reduce resistance to airflow and improve ventilation. The Breathe Right (BR) device has been proposed to reduce or eliminate snoring by improving nasal breathing. We assessed the efficacy of BR on sleep quality and snoring during 2 full-night polysomnographies, the first without and the second with BR. Ten non-apnoeic snorers were studied. Snoring was present during 22-98% of total sleep time during the control night. Ear-nose-throat examination disclosed a nasal valve anomaly in five subjects, objectivated by anterior and posterior rhinomanometry. Quality of sleep and snoring were not influenced by BR, even when different sleep stages were analysed separately. No difference in snoring index was found between snorers with or without nasal valve anomaly. We conclude that BR is ineffective in relieving snoring in non-apnoeic snorers.

Adult↗
PubMed1998

[Comparison of the results of the Etest and the method for determining minimum inhibitory concentrations in solid media for penicillin G, amoxicillin, and cefotaxime for S. pneumoniae. A multicenter study].

In 1996-1997 a multicentre study was carried out on 450 Streptococcus pneumoniae strains to compare the MICs and susceptibility categories obtained with the Etest (AB Biodisk) used under routine conditions in 22 hospital laboratories in the Rhône-Alpes region, France, with those obtained by the reference technique of agar dilution performed in a single coordinating centre. Each laboratory detected penicillin resistant pneumococci (PRP) by the oxacillin disk method (1 microgram and 5 micrograms) and determined the MICs of penicillin G (PG), amoxycillin (AMX) and cefotaxime (CTX) by the Etest. All the PRP strains were collected in the coordinating centre where MICs were carried out. The strains were classified as susceptible (S), intermediate (I) and resistant (R) according to the CASFM criteria (Comité de l'Antibiogramme de la Société Française de Microbiologie). The concordance results based on susceptibility categories are as follows: PG = 67.6%, AMX = 63.6%, CTX = 71.5%. Minor errors are as follows: PG = 31.2%, AMX = 36%, CTX = 28.5%. Major and very major errors are rare (0% to 0.6%). Agreement within 1 log2 dilution was obtained for about 80% of the strains. The minor errors results from strains clustering near the breakpoints 1 mg/l (PG) and 0.5 mg/l (AMX, CTX), and from practical difficulties in routine use of the Etest. These discrepancies may result in severe therapeutic problems. This study confirms the limits of the Etest. The authors insist on standardization and rigorous use of the Etest under routine conditions.

Amoxicillin↗
PubMed1998

[Diagnosis of nocturnal respiratory disorders. Review of portable monitoring devices. Analysis and evaluation of different polysomnography signals].

Polysomnography in an attended hospital laboratory setting is the gold standard for the diagnosis of sleep-related breathing disorders. However, this method is expensive and waiting lists are long. Portable recording devices that can be used at home have been recently developed to improve upon the problems of polysomnography. We review the recent portable devices validated by polysomnography and discuss their precise role in the assessment of sleep-related respiratory disorders.

Equipment Design↗
PubMed1997

Effectiveness of controlled and spontaneous modes in nasal two-level positive pressure ventilation in awake and asleep normal subjects.

STUDY OBJECTIVES: The purpose of the present study was to compare in awake and asleep healthy subjects, under nasal intermittent positive pressure ventilation (nIPPV) with a two-level intermittent positive pressure device (two-level nIPPV), the efficacy of the controlled and spontaneous modes, and of different ventilator settings in increasing effective minute ventilation (VE). PARTICIPANTS: Eight healthy subjects were studied. SETTING: In the controlled mode, inspiratory positive airway pressure (IPAP) was kept at 15 cm H2O, expiratory positive airway pressure (EPAP) at 4 cm H2O, and the inspiratory/expiratory (I/E) time ratio at 1. The respirator frequencies were 17 and 25/min. In the spontaneous mode experiment, IPAP was started at 10 cm H2O and progressively increased to 15 and 20 cm H2O; EPAP was kept at 4 cm H2O. MEASUREMENTS AND RESULTS: We measured breath by breath the effective tidal volume (VT with respiratory inductive plethysmography), actual respiratory frequency (f), and effective VE. Using the controlled mode, effective VE was significantly higher on nIPPV than during spontaneous unassisted breathing, except in stage 2 nonrapid eye movement sleep at 17/min of frequency; increases in f from 17 to 25/min led to a significant decrease in VT reaching the lungs, during wakefulness and sleep; effective VE was higher at 25 than at 17/min of frequency only during sleep; periodic breathing was scarce and apneas were never observed. Using the spontaneous mode, with respect to awake spontaneous unassisted breathing, two-level nIPPV at 10 and 15 cm H2O of IPAP did not result in any significant increase in effective VE either in wakefulness or in sleep; only IPAP levels of 20 cm H2O resulted in a significant increase in effective VE; during sleep, effective VE was significantly lower than during wakefulness; respiratory rhythm instability (ie, periodic breathing and central apneas) were exceedingly common, and in some subjects extremely frequent, leading to surprisingly large falls in arterial oxygen saturation. CONCLUSIONS: It appears that two-level nIPPV should be used in the controlled mode rather than in the spontaneous mode, since it seems easier to increase effective VE with a lower IPAP at a high frequency than at a high pressure using the spontaneous mode. We suggest that the initial respirator settings in the controlled mode should be an f around 20/min, an I/E ratio of 1, 15 cm H2O of IPAP, and EPAP as low as possible.

Adult↗
PubMed1997

[Catheter infection in intensive care: influence of systematic replacement of central venous catheters on a guide wire every 4 days].

OBJECTIVES: Determine whether systematic replacement of central venous catheters on a guide wire every 4 days leads to a lower rate of catheter infection. METHODS: We conducted a prospective randomized study comparing systematic catheter replacement with the standard procedure where one-way catheters are left in situ as needed. RESULTS: The study included 150 patients and 170 catheters. Catheter replacement on a guide wire was performed 169 times. The rate of infection was not significantly different between the group of patients with replacement (3.7 for 1000 catheter days) and the group with systematic replacement (5.4 for 1000 catheter days). No mechanical complications occurred during the replacement procedures on guide wires. CONCLUSION: We do not recommend systematically replacing catheters on a guide wire for the prevention of catheter infection. This procedure may however be indicated in case of suspected catheter infection as no mechanical of infectious complications occurred.

Adult↗
PubMed1997

Compliance with nasal CPAP in obstructive sleep apnea patients.

Continuous positive airway pressure (CPAP) is currently the treatment of choice for the majority of patients with obstructive sleep apnea (OSA). After a CPAP trial, the initial acceptance rate is 70-80%. Patients who derive no subjective benefit from such a trial are poor candidates for home treatment with CPAP because they are likely to exhibit lower adherence and compliance rates. About 90% of OSA patients provided with CPAP apparatus will adhere to long-term CPAP treatment. Patients abandoning CPAP do so during the first few months of home therapy, a period during which close monitoring and support is warranted. Because of the strong correlation between the machine run time and effective pressure delivered at the nasal mask (90-95%), the time-counter of the CPAP device is sufficient to monitor compliance in clinical practice, allowing for early intervention in cases of suboptimal use. Longterm acceptors of CPAP display a satisfactory compliance (5-6.5 h of average daily use) which compares favourably with compliance with treatment in other chronic diseases. Lower acceptance and compliance rates have been reported in North America as compared to Europe. This could be related to cultural differences or different routines of prescription and follow-up.

Journal Article↗