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Biomedical subjects

J Clerc

Publications and source records attributed to J Clerc.

At least 37 records · Page 2Linked to original sources
PubMed1992

Single lung transplantation for primary pulmonary hypertension without cardiopulmonary bypass.

We report the first case, to our knowledge, of single lung transplantation for primary pulmonary hypertension carried out without cardiopulmonary bypass. This operation seems to be possible even if the right ventricular ejection fraction is low (0.17) and the pulmonary vascular resistance very high (1,096 dynes.s.cm5). Since 1981, heart-lung transplantation has been successfully performed in patients with primary pulmonary hypertension. If heart-lung transplantation results in resolution of pulmonary hypertension, the incidence of obliterative bronchiolitis is significant in heart-lung transplantation recipients. Single lung transplantation has been performed for end-stage interstitial and obstructive lung disease but has not been considered a good option for primary pulmonary hypertension due to concerns that a single transplanted lung would be unable to cope with the entire blood flow. However, recently single lung transplantation has been performed for primary pulmonary hypertension, the risk of obliterative bronchiolitis remaining unknown. The purpose of this communication is to report one case of single lung transplantation for primary pulmonary hypertension and the feasibility of this operation without the use of cardiopulmonary bypass, if cardiopulmonary bypass is thought to be dangerous.

Adult↗
PubMed1992

Significance of secondary ion mass spectrometry microscopy for technetium-99m mapping in leukocytes.

Secondary ion mass spectrometry (SIMS) microscopy is the only method potentially capable of mapping all the elements in the periodic table including stable and radioactive isotopes. We used this method to study 99mTc distribution by detecting and localizing of 99Tc, a daughter product which has the same mass and the same chemical properties. It was combined with albumin macroaggregates or with Hexamethylpropylene-amine oxime (HMPAO) in leukocytes. The efficiency of 99Tc ionization under Cs+ bombardment was higher than with an O2+ beam. By using high mass resolution we succeeded in detecting and localizing 99Tc in cell sections by eliminating polyatomic ions that arise from this biological matrix. The 99Tc specific signal was obtained with a mass resolution of 2000 for labeled albumin macroaggregates, and 5000 for HMPAO-labeled leukocytes. In the latter, the labeling varied from one cell to another and 99Tc was present in both the nucleus and the cytoplasm. The results indicate that SIMS microscopy can provide new insights into 99mTc dosimetry.

Humans↗
PubMed1991

[Bilateral Leydig cell tumor of the ovary in a woman with congenital adrenal hyperplasia. The first reported case].

A 26-year-old woman with congenital adrenal hyperplasia (CAH) due to 11 hydroxylase deficiency complained of infertility. Clinical examination disclosed no evolutive virilizing features. Basal serum levels of delta 4 androstenedione and testosterone, under hydrocortisone suppressive therapy, where elevated at 4.72 and 2.84 ng/ml respectively (N: 1.2 to 2.2 and 0.2 to 0.6) leading to the discovery of a right ovarian tumor. Post-operative evaluation (8 months later) revealed dexamethasone-sensitive hyperandrogenism and a coincidental large left ovarian tumor. Three months after the second surgical procedure, the patient became pregnant and gave birth to a non-virilized girl. At microscopic examination both tumors were typical Leydig cell tumors of the ovary containing crystals of Reinke. This is the first case of bilateral and macroscopic Leydig cell tumor ot the ovary in a woman with congenital adrenal hyperplasia. Relationships between hilus cell tumors and steroid cell tumors of the adrenocortical type are discussed.

Adrenal Hyperplasia, Congenital↗
PubMed1991

Superoxide production by peripheral blood monocytes during sustained endotoxaemia in sheep.

1. We have studied the time course of the numbers of arterial monocytes and their superoxide anion (O2-) production in a chronically instrumented sheep model of subacute endotoxaemia induced by a continuous intravenous infusion of Escherichia coli lipopolysaccharide (20 ng min-1 kg-1). 2. Four out of 11 animals died from irreversible respiratory and cardiovascular failure within 21 h of the start of lipopolysaccharide administration ('non-survivors'), whereas in the seven surviving sheep ('survivors') there was a persistence of decreased systemic vascular resistance, systemic hypotension, pulmonary hypertension, anorexia and lethargy. 3. O2- generation by isolated monocytes was measured by the O2- dismutase-inhibitable reduction of ferricytochrome c after stimulation with phorbol myristate acetate (100 ng/ml) or opsonized zymosan (3 mg/ml). Basal mean value of phorbol myristate acetate-stimulated O2- production was significantly (P = 0.008) higher for non-survivors (31.3 +/- 8.8 nmol 30 min-1 10(-6) cells; n = 4) than for survivors (6.2 +/- 2.3 nmol 30 min-1 10(-6) cells; n = 7). 4. For both survivors and non-survivors, monocyte counts and phorbol myristate acetate-stimulated O2- production increased over time to reach in survivors a plateau after 2 days of continuous lipopolysaccharide infusion. Similar results were obtained when monocytes were stimulated for O2- production with opsonized zymosan. 5. These results suggest that (1) increased O2- production by monocytes and monocytosis appear with a precise, delayed time course during the development of subacute endotoxaemia in sheep; and (2) a high stimulated O2- production by monocytes before lipopolysaccharide administration may represent a predictive factor for the subsequent respiratory failure and outcome of endotoxaemia.

Animals↗
PubMed1991

[Retrospective study of 412 aortic valve replacements by Bjork-Shiley prosthesis implanted between January 1972 and October 1984. Actuarial survival, mortality, complications].

Between January 1972 and October 1984, 412 aortic valve replacements by Bjork-Shiley disk prosthesis were performed. 183 patients suffered from aortic incompetence, 132 from an aortic disease and 97 from aortic stenosis. 116 associated procedures (28%) were performed = 36 myocardial revascularizations, 61 Bentall operations, 12 patch grafts to the ascending aorta and 7 Wheat operations. The mean age was 53.6 years and 25% of the patients were over the age of 65 years. Fifty percent of the patients had stage III or IV disease according to the NYHA classification. The cardiac index was less than 2.3 l/min/m2 in 44.26% of cases. The early postoperative mortality was 4.85% and 20% of these deaths were related to the prosthesis. The late mortality was 17.25%, with 20% of deaths related to the valve. The mean follow-up 59.75 +/- 2 months (range: 1 to 166 months) with a cumulative survival of 2.092 patients-years. It was significantly influence by the existence of preoperative angina, another operation associated with AVR and a cardiac index less than 2.3 l/min/m2. Seventy-one complications were related to the prosthesis including dysfunction (0.05% patient-year), 3 valve thromboses (0.15% patient-year), 6 infected valves (0.31% patient-year), 12 cases of peri-prosthetic dehiscence (0.61% patient-year), 10 embolic complications (0.61% patient-year) and 37 complications related to anticoagulants, including 26 major complications (1.48% patient-year). The valve failure rate was 1.19% patient-year. The results of our series are comparable to those reported in the literature, which confirm the reliability of the Bjork-Shiley Valve.

Actuarial Analysis↗
PubMed1990

[Right ventricular assistance using a centrifugal pump after heart transplantation].

A case of right ventricular assistance required after emergency heart transplantation is reported. The patient was a 62 year-old man with terminal congestive heart failure due to ischaemic cardiomyopathy. Preoperatively, this patient had a cardiac index of 1.93 1.min-1.m-2, moderate pulmonary hypertension (mean Ppa: 34 mmHg) and pulmonary arteriolar resistances at 440 dyn.s.cm-5; clinical examination revealed pulmonary oedema, cardiac liver and oliguria with renal failure. Cardio-pulmonary bypass lasted 145 min, including 50 min of assistance after graft reperfusion. Despite postoperative dopamine and dobutamine treatment, oliguria and central venous pressure increased, and higher doses of catecholamines (adrenaline, noradrenaline) and pulmonary intraarterial prostaglandin E1 infusions were required. Despite these agents and haemofiltration, mechanical assistance was needed and a centrifugal pump set up. Diuresis and haemodynamic parameters improved. The patient was weaned from this assistance after 102 h. A satisfactory haemodynamic status was then maintained, but still required 1.4 micrograms.kg-1.min-1 noradrenaline and 0.02 microgram.kg-1.min-1 prostaglandin E1. Six days later, the patient was weaned from the ventilator, but he rapidly developed fatal aspergillus septicaemia. This case demonstrates that temporary mechanical assistance can be useful for treating right ventricular failure occurring after transplantation.

Heart Failure↗
PubMed1990

[Ovarian tumors located in the hilus. Analysis of 126 publications of the literature].

One hundred and twenty six reported cases of ovarian tumors located in the hilus (OTLH) are analyzed. They represent a special sub group of ovarian steroid cell tumors (former "lipid cell tumors"). A number of these neoplasms are Leydig-Berger cell tumors (LBCT), which are characterized by the presence of the crystal of Reinke, a specific proteinaceous inclusion, whose detection may be improved by new available methods. Crystal-free steroid cell tumors located in the hilus are in most cases true leydigoma of the ovary whose features are indiscernible from LBCT's. They are revealed after years of evolution by signs of hyperandrogeny or post menopausal bleeding. Plasma testosterone levels are always elevated while urinary 17 keto steroid cytoplasmic values are normal in 50% of cases. Three main features distinguish ovarian tumors located in the hilus from others ovarian steroid cell tumors: the occurrence in aged women, the small size of the tumors, and the excellent prognosis.

Adolescent↗
PubMed1988

Heat shock inhibits NADPH oxidase in human neutrophils.

The heat shock response is a conserved, physiological, transient cellular response to injury. Several studies have suggested a link between the heat shock response and oxidative injury. We have investigated the effects of heat shock on superoxide anion generation by human neutrophils stimulated with opsonized zymosan or phorbol myristate acetate. Human neutrophils exposed to elevated temperatures or to the heavy metal cadmium synthetized a variety of heat shock proteins. In parallel to this protein synthesis, we observed a selective, reversible and temperature-dependent inhibition of NADPH oxidase activation, which was independent from variations of cytosolic pH or thiol group oxidation. Inhibition of NADPH oxidase by heat shock appeared related to the synthesis of heat shock proteins and may represent an intrinsic cellular mechanism to down regulate superoxide production.

Cadmium↗
PubMed1986

Enoxaparine low molecular weight heparin: its use in the prevention of deep venous thrombosis following total hip replacement.

UNLABELLED: The effect of Enoxaparin in the prevention of thromboembolism after total hip prosthesis has been controlled by phlebography. 228 consecutives patients were studied with 4 dose regimens: 60 mg once a day, 40 mg once a day, and 30 and 20 mg twice a day. CONCLUSIONS: a total dose of 40 mg once a day or twice a day gives a rate of postoperative thrombosis of 8%.

Aged↗
PubMed1985

The legal obligation to learning-disabled and handicapped allied health students.

Recent legislation and judicial decisions regarding the legal responsibilities of postsecondary institutions to handicapped and learning-disabled students is discussed. The relevance of these decisions to administrators of allied health programs in the selection and retention of students becomes apparent as one reviews the increased number of litigations in the past few years. In summary, administrators must make reasonable accommodations to "otherwise qualified" handicapped individuals. They need not, however, accept students that could not benefit from the principal education given or would not likely pass certification exams in their field of study.

Allied Health Personnel↗
PubMedDate not supplied

Prognostic value of suppressed thyrotropin level and positive thyrotropin-receptor antibody activity in Graves' disease with long-lasting clinical remission.

OBJECTIVE: To determine the prognostic value of suppressed thyrotropin (TSH) level and positive TSH-receptor antibodies (TSH-R Ab) in patients with Graves' disease who have long-lasting clinical remission. METHODS: We retrospectively studied patients with Graves' disease who underwent follow-up for a mean of 55 months after the withdrawal of antithyroid drug treatment. Study patients were 84 consecutive subjects in clinical remission, with normal serum free thyroxine (FT(4)) and free triiodothyronine (FT(3)) levels, regardless of serum TSH levels, a mean of 35 months (range, 6 to 135) after discontinuation of carbimazole therapy. Eighty-seven euthyroid subjects were used as control study participants. All subjects had serum determinations of FT(4) and FT(3) (radioimmunoassay), TSH (highly sensitive immunoradiometric method), TSH-R Ab (radioreceptor assay), and microsomal antibodies (M Ab, passive hemagglutination method). RESULTS: In the study patients, serum TSH was suppressed (</=0.10 mU/L) in 13 cases (15%), TSH-R Ab were positive (>/=15%) in 11 cases (13%), and M Ab were positive (>/=1:100) in 54 cases (64%). Simultaneous suppressed TSH and positive TSH-R Ab levels were present in six patients. During the follow-up, 11 patients had a relapse, demonstrated by above-normal values for serum FT(4) and FT(3) in association with clinical symptoms of hyperthyroidism. Five of them had a previously suppressed TSH level, three had a positive TSH-R Ab level, and six had a positive M Ab titer. Relapse was significantly more likely in patients with a previously suppressed TSH level (P<0.02) but not in patients with a previously positive TSH-R Ab level or positive M Ab titer. CONCLUSION: Patients with Graves' disease and long-lasting clinical remission after discontinuation of carbimazole therapy may have a suppressed TSH level, a positive TSH-R Ab level, or a positive M Ab titer (or some combination of these findings). Although positive TSH-R Ab and M Ab have no significant prognostic value, a suppressed TSH level is indicative of subclinical hyperthyroidism and higher risk of relapse.

Journal Article↗