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Biomedical subjects

J F Payen

Publications and source records attributed to J F Payen.

32 records · Page 2Linked to original sources

Lactate accumulation during moderate hypoxic hypoxia in neocortical rat brain.

Neocortical metabolism was studied during moderate hypoxic hypoxia, reoxygenation, and postmortem periods in anesthetized normocapnic rats using 1H nuclear magnetic resonance (NMR) spectroscopic imaging. Rats were prepared with unilateral common carotid occlusion to determine the ipsilateral metabolic effects of inadequate cerebral blood flow (CBF) response to hypoxia. No difference in brain metabolism between the two hemispheres was found during the control period. Hypoxic hypoxia (PaO2 = 54.1 +/- 5.8 mm Hg) resulted in a significant rise in neocortical lactate peak in both hemispheres, with an additional marked rise in the clamped side compared to the unclamped side (53 +/- 27 vs. 22 +/- 13% of postmortem value, p < 0.001). These lactate changes were not reversible within 30 min of reoxygenation in the clamped hemisphere. No changes in neocortical lactate peak were observed while elevating arterial lactate via intravenous lactate infusion without hypoxia. In addition, hypoxic hypoxia resulted in an apparent decrease in neocortical water and N-acetyl aspartate (NAA) signals, which were related to a shortening in T2 relaxation times. It is concluded that neocortical lactate is an early metabolic indicator during moderate hypoxic hypoxia in normocapnic conditions.

Animals↗

Improved noninvasive diagnostic testing for malignant hyperthermia susceptibility from a combination of metabolites determined in vivo with 31P-magnetic resonance spectroscopy.

BACKGROUND: Phosphorus magnetic resonance spectroscopy (31P-MRS) in vivo has been suggested recently as a possible noninvasive diagnostic test in malignant hyperthermia (MH) susceptibility. However, differences between protocols and also within subjects may have led to inconsistent MRS abnormalities reported during and after exercise. The aim of the current study was to detect discriminant abnormalities in the leg muscles using in vivo 31P-MRS during the rest period. METHODS: Fourteen patients shown to be MH-susceptible and 22 patients MH-negative on the basis of in vitro caffeine/halothane contracture tests according to the European MH group protocol were compared to 36 control subjects using in vivo 31P-MRS during the rest period. A score of MRS combined abnormalities was calculated from a stepwise discriminant function analysis. RESULTS: The MH-susceptible group had a significantly (P < 0.01) higher inorganic phosphate (Pi) to phosphocreatine (PCr) (Pi/PCr) value (0.134 +/- 0.022) than either the MH-negative (0.097 +/- 0.016) or the control (0.101 +/- 0.017) group. The MH-susceptible group also exhibited a significantly (P < 0.01) higher phosphodiesters (PDE) to PCr (PDE/PCr) value (0.093 +/- 0.056) than either the MH-negative (0.034 +/- 0.021) or the control (0.029 +/- 0.019) group. Combining both MRS parameters, 13 of the 14 MH-susceptible patients demonstrated abnormal MRS test results (score value < 1.65). Conversely, 21 of the 22 MH-negative patients had normal MRS results (score value > or = 1.65). The sensitivity and specificity of this threshold value were 93 and 95%, respectively. CONCLUSIONS: This study confirms that 31P-MRS could be useful for distinguishing noninvasively between MH-susceptible and MH-negative patients if several MRS parameter are combined. Moreover, the present MRS approach appears to be more reliable and easier than that used during exercise.

Adolescent↗

Muscular metabolism during oxygen supplementation in patients with chronic hypoxemia.

The effects of supplemental oxygen (O2) versus air on working calf muscle metabolism were studied in seven patients with stable chronic obstructive pulmonary disease (COPD) and chronic hypoxemia (PaO2 = 57 +/- 3 SE mm Hg) and seven age-matched control subjects. Oxygen and air were randomly administrated at 24-h intervals, and O2 flow rate was adjusted to correct hypoxemia (PaO2 = 87 +/- 4 mm Hg) in the COPD group. The relative concentrations of ATP, phosphocreatine (PCr), inorganic phosphate (Pi), phosphomonoesters (PME), and the intracellular pH (pHi) were determined with 31P magnetic resonance spectroscopy at rest, during a graded standardized and localized exercise protocol (360 active plantar flexions), and during recovery. In resting muscle no significant effect of added O2 was demonstrable in each group with regard to pHi, Pi/PCr, and ATP/(PCr+Pi+PME) ratios. Mechanical data were similar between the two groups and between the two tests during the whole exercise. The indices of muscular oxidative metabolism (Pi/PCr and pHi at the end of exercise and recovering PCr resynthesis rate) were impaired in the COPD group compared with that in the control group during air (all p < 0.05). All these parameters were significantly improved with added O2 in the COPD group (p < 0.05), whereas no similar effects were observed in the control group. However, these beneficial effects were incomplete since the exercising Pi/PCr ratio remained higher in the COPD group than in the control group during added O2. This energetic muscular impairment could correspond to tissular damage related to chronic hypoxemia.

Aged↗

Discrimination between cross-country and downhill skiers by pulmonary and local 31PNMR evaluations.

The purpose of the present study was to correlate data on calf muscle metabolism using 31P nuclear magnetic resonance spectroscopy with measurements of whole body maximal oxygen consumption and maximal power output, and to determine whether the combination of these data could be used to predict athletic ability. Experiments were performed in a 2.35 Tesla, 35 cm diameter electromagnet on the leg muscle of sedentary human subjects (N = 6) and groups of athletes trained for endurance (cross-country skiers, N = 7) or strength performance (downhill skiers, N = 5). The exercise protocol consisted of successive plantar flexions performed at graded fractions of the maximal voluntary contraction (MVC). The results obtained from NMR investigation (changes in content of inorganic phosphate: Pi, phosphocreatine: PC and muscle ATP, and intracellular pH) were then compared with those of maximal O2 consumption (VO2max) and maximal power (MP). When the data on athletes were compared with those obtained on sedentary subjects, the curves illustrating the relationship between the imposed load and the Pi/PC ratio were significantly shifted toward high output power for a given Pi/PC value. It also appeared from this study that specific training in force development (downhill skiing) induced a slighter decrease in PC level than for endurance (cross-country skiers) despite improvement in physical performance. A slight but significant intracellular acidification was observed in the muscles of sedentary subjects and downhill skiers for contraction at, respectively, 50% and 80% of MVC, but not in the skeletal muscles of cross-country skiers.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

[Pharmacokinetics of methohexital given by constant rate intravenous infusion].

The pharmacokinetic characteristics of a constant rate methohexitone infusion were studied in young ASA 1 patients undergoing maxillofacial surgery. They were randomly assigned to two groups; group M patients (n = 7) were given 9 mg.kg-1.h-1 of methohexitone for one hour, and group MF patients (n = 7) 9 mg.kg-1.h-1 of methohexitone with 7 micrograms.kg-1.h-1 of fentanyl, also for one hour. Blood samples for determining methohexitone concentrations were obtained at various times, from before the start of the methohexitone infusion up to 19 h afterwards. In twelve patients, a two-compartment model was appropriate to characterize the decrease of methohexitone concentration; for the other two (one in each group), a three-compartment model was applied. There were no statistically significant differences between the two groups. Elimination half-life in group M was 3.22 +/- 1.96 h, and total plasma clearance 8.54 +/- 2.8 ml.kg-1.min-1. The wide variations in pharmacokinetic parameters between subjects may explain some unpredictable variations in duration of action of methohexitone. Fentanyl did not modify methohexitone pharmacokinetics, which remained of the first order. However, it potentiated the barbiturate's action: extubation was only possible after stopping the infusion for 39.4 min +/- 22 min in group MF, and 15.4 min +/- 6 min in group M (p less than 0.01). At that time, plasma concentrations were respectively 3.12 +/- 0.99 mg.l-1 (group MF) and 5.71 +/- 2.09 mg.l-1 (group M), (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Muscle bioenergetics in skiers: studies using NMR spectroscopy.

Sedentary human subjects (n = 6) and two homogeneous groups of athletes, trained for down-hill skiing (n = 5) and cross-country skiing (n = 7), were subjected to cardiorespiratory testing and to evaluation of the bioenergetics of calf muscles by means of Phosphorus Nuclear Magnetic Resonance Spectroscopy. The exercise consisted of successive plantar flexions performed at graded fractions of the maximal voluntary contraction force. It appears from this study that the decrease in phosphocreatine level induced by exercise at 80% of maximal voluntary contraction, was smaller in the muscles of athletes who trained for cross-country skiing, than in the muscles of down-hill skiers and control subjects. Intracellular acidosis was virtually absent in cross-country athletes. The rate of restitution of phosphocreatine, after the exercise, was higher in both groups of skiers, compared to sedentary subjects. The maximal oxygen consumption and the maximal alactic power were higher in athletes than in sedentary subjects. NMR data and mechanical measurements are used in consideration with functional systemic indexes to characterize the capabilities of skiers.

Adult↗

Metabolism and aerobic capacity of skeletal muscle in chronic respiratory failure related to chronic obstructive pulmonary disease.

The calf muscle energy metabolism of 8 stable chronic obstructive pulmonary disease (COPD) patients with chronic respiratory failure (arterial oxygen tension (Pao2) 7.7 +/- 0.4 kPa or 58 +/- 3 mmHg) was studied, using 31-phosphorus magnetic resonance spectroscopy (31P MRS). MRS spectra were acquired at rest and during the course of 360 pedal movements at 20, 35 and 50% of the maximal voluntary contraction (MVC) and during recovery. Eight healthy age-matched subjects served as the control group. No significant differences between groups were observed in resting muscle, as regards intracellular pH, Pi/PCr ratio (Pi: inorganic phosphate; PCr: phosphocreatine) and the relative ATP expressed as the ratio beta ATP/PCr + Pi + PME (PME: phosphomonoester). Although effective power outputs were similar for both groups at each work level, COPD patients exhibited a higher Pi/PCr ratio than health controls (3.34 +/- 0.89 vs 0.49 +/- 0.05 at 50% MVC; p less than 0.01) and a lower pHi (6.65 +/- 0.11 vs 7.06 +/- 0.02 at 50% MVC; p less than 0.01). PCr resynthesis during recovery was slower in patients than in control subjects (t1/2 PCr 1.27 +/- 0.26 min vs 0.47 +/- 0.05 min; p less than 0.05). These results suggest impairment of aerobic capacity in a non-ventilatory working muscle, which may be due to hypoxaemia in patients with chronic respiratory failure.

Aged↗

Exertional heatstroke and muscle metabolism: an in vivo 31P-MRS study.

An impairment of muscle energy metabolism has been suggested as a predisposing factor for, as well as a consequence of exertional heatstroke (EHS). Thirteen young men were investigated 6 months after a well-documented EHS using 31Phosphorus Magnetic Resonance Spectroscopy (31P-MRS). The relative concentrations of ATP, phosphocreatine (PCr), inorganic phosphate (Pi), phosphomonoesters (PME), and the intracellular pH (pHi) were determined at rest, during a graded standardized exercise protocol (360 active plantar flexions) and during recovery. Also the leg tissue blood flow was determined by venous occlusion plethysmography during the MRS procedure. Sixteen age-matched healthy male volunteers served as control group. In resting muscle, there were no significant differences between the groups as regards pHi, Pi/PCr, and ATP/PCr+Pi+PME ratios. During steady state exercise conditions, effective power outputs were similar for both groups at each level of exercise: 20, 35, and 50% of maximal voluntary contraction (MVC) of the calf muscle. No significant differences were shown between the two groups in Pi/PCr, pHi, or changes of leg blood flow at each level of exercise. At 50% MVC, Pi/PCr was 0.48 +/- 0.08 vs 0.47 +/- 0.05 (P = 0.96), pHi was 6.94 +/- 0.03 vs 6.99 +/- 0.02, respectively (P = 0.13). Finally, the rate of PCr resynthesis during recovery was not significantly different between the two groups: t1/2 PCr = 0.58 +/- 0.07 vs 0.50 +/- 0.05 min, respectively (P = 0.35). Therefore, no evidence of an impairment of muscle energy metabolism was shown in the EHS group during a standardized submaximal exercise using 31P-MRS performed 6 months after an EHS.

Adenosine Triphosphate↗

Impairment of muscular metabolism in chronic respiratory failure. A human 31P MRS study.

The calf muscle metabolism of 7 patients with stable chronic respiratory failure (PaO2 below 65 Torr) was studied using 31P NMR spectroscopy. NMR spectra were acquired at rest, during the course of 360 pedal movements at 20, 35 and 50% of the maximal voluntary contraction (MVC) and during recovery. Eight normal aged-matched subjects served as a control group. In resting muscle, no significant differences were observed between both groups as regards intracellular pH, inorganic phosphate/phosphocreatine (Pi/PCr) and beta-ATP/PCr + Pi + phosphomonoester (PME) ratios. Although effective power outputs were similar for both groups at each work level, patients exhibited a higher Pi/PCr ratio than healthy controls (3.19 +/- 1.01 vs 0.49 +/- 0.05 at 50% MVC; p less than 0.01) and a lower pHi (6.65 +/- 0.11 vs 7.06 +/- 0.02 at 50% MVC; p less than 0.01). Moreover, PCr resynthesis during recovery was slower in patients than in control subjects (t1/2 PCr = 1.26 +/- 0.30 vs 0.47 +/- 0.05 min; p = 0.01). These results suggest impairment of aerobic capacity in a non-ventilatory working muscle, probably due to hypoxemia in patients with chronic respiratory failure.

Adenosine Triphosphate↗

[Abnormalities of the skeletal muscle in hypertrophic cardiomyopathy. Spectroscopy using phosphorus-31 nuclear magnetic resonance].

There have been several reports of electromyographic and histological changes of striated skeletal muscle, especially of the type I oxidative fibres, in hypertrophic cardiomyopathy. In order to determine whether these anomalies also cause metabolic changes, a P-31 magnetic resonance spectroscopic study was undertaken at rest and on exercise in 5 pauci-symptomatic patients and 10 control subjects. The 5 patients had primary hypertrophic cardiomyopathy without alteration of systolic function or signs of congestive cardiac failure (Stages I or II). There were no clinical signs of myopathy. None of the patients were receiving betablocker therapy at the time of investigation. No significant difference was observed at rest. Intracellular acidosis was particularly pronounced in 2 of the 5 patients at the peak of exercise. In addition, the phosphocreatine recovery time (T1/2) was longer in the patient group (3.4 +/- 1.7 vs 1.6 +/- 0.9 mn; p less than 0.01) suggesting a mitochondrial metabolic oxidation abnormality. These results suggest that some patients with primary hypertrophic cardiomyopathy have abnormalities of mitochondrial oxidation in their striated skeletal muscle which can be demonstrated by P-31 magnetic resonance spectroscopy. This would suggest a global abnormality of striated muscle which, at a more advanced stage of the disease, could account for decreased effort tolerance in these patients.

Adult↗

[Intraoperative nitroglycerin: value of determining individual doses: (surgery of the abdominal aorta)].

Thirteen patients requiring infrarenal aortic clamping were studied during flunitrazepam, fentanyl, pancuronium and nitrous oxide anaesthesia. Each awake patient was submitted to a volume loading test to determine the haemodynamic status and his optimal left pre-load. Anesthetic induction was well tolerated. Nitroglycerin was administered by continuous infusion before aortic clamping and we determined the dose necessary to decrease the systemic vascular resistance by 20 per cent. This dose was very variable and needed to be increased in five of 13 patients at the time of clamping. With nitroglycerin, we noticed no significant alteration of MVO2 at clamping. Volume loading allowed good stability at declamping.

Aged↗

[Comparison of the clinical effects of propofol and methohexital in induced abortion].

The clinical effects of propofol and methohexitone were compared in a group of 59 women undergoing abortion under general anaesthesia. At induction, the premedicated patients were given 2.5 mg . kg-1 propofol or methohexitone, followed by 1 mg . kg-1 fentanyl; if necessary, extra bolus doses of hypnotic were given. Hiccups and other movements were more frequent with methohexitone. There was no difference between the two groups as for injection pain and apnoea. The quicker recovery with propofol, with a mean of 2 min less, even when extra doses were given, could be explained by the pharmacokinetics of the drug. However, the quality of recovery in either group was satisfactory for short-length anaesthesia.

Abortion, Induced↗