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Biomedical subjects

G Etienne

Publications and source records attributed to G Etienne.

At least 73 records · Page 4Linked to original sources
PubMed1988

Goiter with severe respiratory compromise: evaluation and treatment.

Goiter with major respiratory compromise is uncommon but troublesome. Evaluation and treatment of this condition are controversial. Of a total of 2,908 goiters operated on over a 17-year period, 58 cases with this particular complication were studied retrospectively to define optimal management. Twenty-two patients had severe or acute dyspnea, and four of them required immediate tracheal intubation. Thirty-six patients had chronic dyspnea without cyanosis. Carcinoma was present in these two groups in 50% and 11% of patients, respectively. Results of our retrospective study are as follows: long-standing tolerance of goiter did not preclude the possibility of compressive respiratory distress or carcinoma. Optimal management of goiter with respiratory compression was obtained when surgery was delayed until satisfactory operating room conditions and adequate possibilities of interpretation of pathologic conditions were united. In case of respiratory distress, tracheal intubation allowed to abide without risks. In other patients preoperative investigations were kept to a minimum. Technical artifices facilitated the extraction of the goiter via cervicotomy without sternotomy in 92% of patients with minimal morbidity. Whenever necessary, endotracheal intubation obviated the need for tracheostomy. These data suggest preventive removal of all large or substernal goiters.

Adolescent↗
PubMed1987

[Diagnosis and localization of primary hyperparathyroidism].

The diagnostic value of pre-operative laboratory tests and current imaging methods was evaluated in a series of 65 patients operated upon for primary hyperparathyroidism. Among laboratory tests, nephrogenous cyclic AMP and PTH serum levels had sensitivities of 100% and 71.7% respectively. Total urinary cyclic AMP and bone biopsy were much less reliable. Imaging procedures were mainly real-time ultrasonography and thallium-technetium substraction scintigraphy with sensitivities of 50.8% and 46.7% and specificities of 86.3 and 76.3% respectively. Failure of cervical exploration occurred in only one case and was attributed to an incorrect diagnosis (1.5%). Thus the selective use of these preoperative investigations may be envisaged in the following cases: hypercalcemic crises, highly probable PHP, uncertain PHP and in secondary surgical exploration.

Adult↗
PubMed1986

A chromatin core particle obtained by selective cleavage of histones by clostripain.

Rat liver chromatin core particles digested with clostripain yield a structurally well-defined nucleoprotein particle with an octameric core made up of fragmented histone species (designated H'2A, H'2B, H'3 and H'4, respectively) after selective loss of a sequence segment located in the N-terminal region of each core histone. Sequential Edman degradation and carboxypeptidase digestion unambiguously establish that histones H2A, H2B, H3 and H4 are selectively cleaved at the carboxyl side of Arg 11, Lys 20, Arg 26 and Arg 19 respectively and that the C-terminal sequences remain unaffected. Despite the loss of the highly basic N-terminal regions, including approximately 17% of the total amino acids, the characteristic structural organization of the nucleosome core particle appears to be fully retained in the proteolyzed core particle, as judged by physicochemical and biochemical evidence. Binding of spermidine to native and proteolyzed core particles shows that DNA accessibility differs markedly in both structures. As expected the proteolyzed particle, which has lost all the in vivo acetylation sites, is not enzymatically acetylated, in contrast to the native particle. However, proteolyzed histones act as substrates of the acetyltransferase in the absence of DNA, as a consequence of the occurrence of potential acetylation sites in the core histones thus rendered accessible. The possible role of the histone N-terminal regions on chromatin structure and function is discussed in the light of the present observations with the new core particle obtained by clostripain proteolysis.

Amino Acid Sequence↗
PubMed1986

[Which antibiotics should one choose for prophylaxis in vascular surgery?].

Although the principle and duration of prophylactic antibiotic therapy in prosthetic vascular surgery are fairly widely accepted, the choice of antibiotic is still open to discussion. During two successive periods, identical groups of patients received peri-operative prophylaxis with, during period I (455 cases) oxacillin alone and during period II (537 cases) combined treatment with oxacillin and amikacin. The aim of the study was to evaluate efficacy of the association and to draw general conclusions on choice of antibiotic. The addition of amikacin reduced frequency of infection in elective operations, particularly aorto-ilio-femoral prostheses (0.5% as against 1.24%), but not in operations conducted as emergencies. In addition, frequency of infection due to BGN fell only slightly. Finally, combined therapy with oxacillin-amikacin had 2 disadvantages: impossibility of using these antibiotics for prophylaxis alone as provided for in the protocol, and its high cost. Factors of choice of antibiotic should be: efficacy against germs encountered, which can vary from year to year, rarity of toxic or side effects, good tissue diffusion, the rare need for therapeutic use and a low cost.

Amikacin↗
PubMed1986

[Acute ischemia of the extremities and drug addiction].

It is not unusual to find ischemia of limbs in drug addicts and two new cases are reported, together with a literature review, allowing analysis of physiopathologic mechanisms and therapeutic modalities. The first case was a 20 year old man who presented with sensory-motor ischemia of the right hand after injection of heroin into the radial artery. Arteriography showed partial occlusion of the deep palmar arch and all collateral arteries of fingers. Regression of ischemia followed administration of thrombolytics, heparin and vasodilators, arteriography showing restoration of palmar arch and digital arteries flow apart from that of the 4th finger. The latter developed distal necrosis which required, in spite of thoracic sympathectomy, amputation of the 3rd phalanx. Histology of amputation piece showed presence of intra-arterial foreign bodies. The second case was a 30 year old man who presented with an acute sensory-motor ischemia of left calf and foot after injection of heroin into the retromalleolar groove. Arteriography showed absence of opacification of vascular axes in the middle third of leg and an atheromatous plaque in left main iliac artery. Heparin therapy plus lumbar sympathectomy resulted in reheating of the foot, but ischemia recurred one month later. A repeat arteriography with oblique images demonstrated that the plaque in the main iliac artery was larger than it appeared in frontal images and that an embolus had developed in the deep femoral artery. Final treatment in this patient involved an inter-femoral saphenous vein bypass and amputation of 4th toe. Histology of amputation piece showed only a banal arterial thrombosis without foreign body.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

[Complications of surgery of the thoraco-cervico-brachial outlets].

Surgery of the thoraco-cervico-brachial outlet can be associated with a number of serious complications. This study is divided into two parts: the description of 2 cases of recurrent arterial thrombosis following operations performed in other centres, an analysis of the results of a series of 70 operations associated with transient neurological sequelae, one respiratory complication secondary to a haemothorax and 9% of cases with moderate or poor results, some of which were due to errors in indications or to incomplete excision. The literature shows that 5 types of complication can be observed: arterial, neurological, complications of the surgical approach, failures due to incomplete procedures, arterial or nervous recurrences. For these reasons, the patients submitted to these operations should be very carefully selected. This type of surgery should not be presented to patients as being free of risks and always effective. The operator should be very careful before and during the operation. If complications occur, they should be treated early and completely.

Adult↗
PubMed1985

[Are there indications for sympatholysis using phenol?].

A phenol injection of the lumbar sympathetic chain has been performed 45 times on 40 patients whose mean age was 78 years and whose poor general condition was a contra-indication to any kind of anesthesia. The results have been evaluated at one month and one year in 33 patients. Among these patients, 21 had an available distal artery seen on the arteriography and 12 no distal artery. Our results suggest that: the injection is not always easy, the rate of complications is important: 2 deaths (4.5%) and 4 serious complications (9%) mainly nervous irritations, the rate of good results is poor: 42% at one month and 27% at one year. When there is a toe gangrene without any distal artery, a good result should not be expected. The diabetes mellitus had no incidence on our results. The indications to a phenol lumbar sympathectomy have to be selected: the best results have been obtained on patients with rest pain or ischemic ulcers when at least a distal artery could be visualized on arteriography. On the other hand no good result should be expected when there is a toe gangrene or when there is no distal flow either on the arteriography or on Doppler examination.

Aged↗
PubMed1979

[Development of human resources for working in environmental health].

This paper was presented as a reference document in the First Meeting of the PAHO/WHO Textbook Program Committee for the Teaching of Sanitary Engineering and Environmental Sciences, held in Santo Domingo, Dominican Republic, from 24 to 26 November 1977. It analyzes the human resource development process in terms of the basic components: planning, development itself, and utilization. Its principal objectives are: to encourage the performance of studies and research on human resources in environmental health as sources of information for taking decisions, making policy, and drawing up training plans; to suggest ways of improving the quality of education and training services; to encourage the development of suitable techniques and methods for determining human resource needs; and to highlight some recent studies and publications on human resources in relation to environmental problems.

Allied Health Personnel↗