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J Goudemand

Publications and source records attributed to J Goudemand.

At least 55 records · Page 3Linked to original sources
PubMed1997

Effects of N omega-nitro-L-arginine methyl ester on the endotoxin-induced disseminated intravascular coagulation in porcine septic shock.

OBJECTIVES: Nitric oxide is known to prevent platelet aggregation and clot formation. Inhibitors of nitric oxide synthase might promote or enhance endotoxin disseminated intravascular coagulation. The present study was designed to evaluate the effects of the arginine analog, N omega-nitro-L-arginine methyl ester (L-NAME), on the endotoxin-induced disseminated intravascular coagulation in a porcine model of septic shock. DESIGN: Prospective, comparative, experimental study. SETTING: Laboratory at a large university hospital. SUBJECTS: Sixteen female piglets, weighing 20 to 28 kg. INTERVENTIONS: Three groups of animals were studied: a control group (n = 6); a lipopolysaccharide (LPS)-treated group (n = 5) receiving Escherichia coli endotoxin (5 micrograms/kg/min over 30 mins); and an LPS + L-NAME group (n = 5) receiving endotoxin and, 1 hr after, a bolus of L-NAME (25 mg/kg). MEASUREMENTS AND MAIN RESULTS: Hemodynamic changes, usual coagulation parameters, and plasma concentrations of thrombin-antithrombin complexes, antithrombin III activity (At III), tissue plasminogen activator, plasminogen activator inhibitor type 1, and von Willebrand factor were measured at baseline, and at 30, 60, 90, 120, 180, 240, and 300 mins. After euthanasia or death, lungs and kidneys were withdrawn for histologic study. The extent of microvascular thrombosis was assessed by a semiquantitative disseminated intravascular coagulation score. In both septic endotoxin group, administration of LPS resulted in hemodynamic changes typical of severe septic shock, with disseminated intravascular coagulation and histologic changes characterized by adult respiratory distress syndrome and kidney microthrombosis. L-NAME administration normalized mean arterial pressure with a dramatic increase in systemic vascular resistances and a marked decrease in cardiac index. The changes in usual coagulation parameters, AT III, tissue plasminogen activator, and plasminogen-activator inhibitor type 1 concentrations were not different between both septic groups. However, in the LPS + L-NAME group, thrombin-antithrombin complexes and von Willebrand factor were higher and associated with a higher histologic disseminated intravascular coagulation score. CONCLUSION: In this model of endotoxin septic shock, L-NAME administration resulted in histologic and coagulation changes consistent with an increased activation of intravascular coagulation.

Animals↗
PubMed1997

Effects of inter-alpha-inhibitor in experimental endotoxic shock and disseminated intravascular coagulation.

We investigated the effects of human inter-alpha-inhibitor (I alpha I) on hemodynamics, oxygenation, and coagulation parameters in a porcine model of endotoxic shock. Four groups of six animals were studied: (1) control, (2) I alpha I group receiving 30 mg/kg I alpha I over 30 min, (3) LPS group receiving 5 micrograms.kg/min Escherichia coli endotoxin over 30 min, and (4) LPS + I alpha I group receiving 30 min after endotoxin 30 mg/kg/30 min I alpha I. We measured hemodynamic and oxygenation parameters, usual coagulation markers and plasma levels of thrombin-antithrombin complexes, antithrombin III activity, plasminogen activator tissue type, plasminogen activator inhibitor type 1, von Willebrand factor, tumor necrosis factor-alpha, and I alpha I at baseline and at 30, 60, 90, 120, 180, 240, and 300 min. In the I alpha I group, plasma I alpha I levels reached 447 +/- 23 mg/L just after injection and 287 +/- 39 mg/L at 300 min. I alpha I half-life was 7.3 +/- 1.9 h. In the IPS + I alpha I group, I alpha I plasma levels decreased more rapidly, reaching 260 mg/L at 300 min. Compared with the LPS group, administration of I alpha I normalized the mean arterial pressure and cardiac index, improved the LPS-induced pulmonary hypertension, and resulted in the blunted increase in blood lactate and oxygen extraction ratio. A significant decrease in thrombin-antithrombin complexes and plasminogen activator inhibitor type 1 levels were observed. There was no significant difference in plasma tumor necrosis factor-alpha levels. We concluded that in this hypodynamic model of endotoxin shock, I alpha I administration resulted in a marked improvement in the hemodynamic, oxygenation, and coagulation parameters.

Alpha-Globulins↗
PubMed1997

Evaluation of sensitivity and specificity of a standardized procedure using different reagents for the detection of lupus anticoagulants. The Working Group on Hemostasis of the Société Française de Biologie Clinique and for the Groupe d'Etudes sur I'Hémostase et la Thrombose.

This study was designed to test the sensitivity and specificity of a combination of 3 phospholipid-dependent assays performed with various reagents, for the detection of lupus anticoagulant (LA). Plasmas containing an LA (n = 56) or displaying various confounding pathologies [58 intrinsic pathway factor deficiencies, 9 factor VIII inhibitors, 28 plasmas from patients treated with an oral anticoagulant (OAC)] were selected. In a first step, the efficiency of each assay and reagent was assessed using the Receiving Operating Characteristic (ROC) method. Optimal cut-offs providing both sensitivity and specificity > or = 80% were determined. The APTT assay and most of the phospholipid neutralization assays failed to discriminate factor VIII inhibitors from LA. In a second step, using the optimal cut-offs determined above, the results of all the possible combinations of the 3 assays performed with 4 different reagents were analyzed. Thirteen combinations of reagents allowed > or = 80% of plasmas of each category (LA, factor deficiency or OAC) to be correctly classified (3/3 positive test results in LA-containing plasmas and 0/3 positive results in LA-negative samples).

Evaluation Studies as Topic↗
PubMed1997

Multicenter retrospective study on the utilization of FEIBA in France in patients with factor VIII and factor IX inhibitors. French FEIBA Study Group. Factor Eight Bypassing Activity.

Factor VIII or factor IX replacement is frequently impossible in inhibitor-developing hemophiliacs, because of the level of the inhibitor titer. Activated prothrombin complex concentrates are one of the available options to treat the bleeding episodes in such patients. However, the efficacy of these products and the associated thrombogenic risk, particularly in prolonged administration such as employed during surgeries, are important concerns for hemophilia care providers. We performed a multicenter retrospective study to evaluate the use of FEIBA (Factor Eight Bypassing Activity) in France, and data is presented on 433 bleeding episodes, including surgical procedures, concerning 60 patients from 15 hemophilia centers. The efficacy was judged as good or excellent in 352 episodes (81.3%), poor in 73 episodes (16.9%) and non-existent in 8 episodes (1.8%). Minor and major surgical procedures were successfully performed using FEIBA as a second-line therapy after human or porcine factor VIII, and in some occasions FEIBA was utilized as the only substitution product. The tolerance was assessed as good in 428 episodes (98.8%), but in 5 cases adverse effects were reported. Only 3 patients out of 52 regularly evaluated (5.8%) were HIV-seropositive, and for two of them the seroconversion occurred prior to the first use of FEIBA. In contrast, 80.4% of the patients were HCV-seropositive. An anamnestic response after the administration of FEIBA was noted in 31.5% of cases. This study points out the main features of the use of FEIBA in France, and particularly the low HIV seroprevalence in the patients treated. The good efficacy and the excellent tolerance still confer to this product a place to consider in the therapeutic options for the treatment of inhibitor-developing hemophiliacs or in acquired hemophilia.

Adolescent↗
PubMed1996

[Severe hemolysis related to an association of erythrocyte allo- and autoantibodies in a thalassemia patients].

Alloimmunization to red cell antigens and haemolytic transfusion reactions may occur after red blood cell transfusion. We describe a case of life threatening postransfusion hyperhaemolysis in a beta thalassaemia patient. For many years, transfusion therapy was stopped but the patient developed a profound anaemia which required splenectomy. At that time, the serum contained a red cell alloantibody with anti-KN3 specificity. In vivo red cell survival studies were performed trying to determine the capacity of this antibody to cause red cell destruction. Unfortunately, these studies triggered again an intense haemolytic process explained by the appearance of red cell auto- and alloantibodies. This case underlines a possible link between the development of alloimmunization and the induction of potentially serious autoimmune haemolytic anaemia.

Autoantibodies↗
PubMed1996

Laboratory evaluation of the Abbott Cell DYN 3500 5-part differential.

The study reports the performance of the Abbott CD3500 automated hematology analyzer for the enumeration and delineation of leukocyte populations for both adult and pediatric samples, and the ability of this instrument to detect the presence of abnormal cells. Samples from 542 individual patients either attending medical practitioners or during hospitalization were examined and then subdivided for the purposes of this study into 106 samples from newborn infants (< days), 145 samples from older children (15 days to 14 years) with non-oncologic disorders, 100 samples from normal adults, and 191 samples from oncology patient (97 adults and 94 children). The leukocyte differentials provided by both the Abbott CD3500 and the Coulter STKS were compared with those obtained from conventional morphology (two observers, total of 400 leukocytes). The sensitivities and specificities of the blast, immature granulocyte (IG) and NRBC "flags" were also determined. For the non-oncology adult (n=100) and pediatric (n=145) cohorts, automated differentials were given in all samples with the CD3500, whereas the STKS did not provide a differential analysis for 20 of the 145 (14%) pediatric samples, 11 of these were absent for no obvious reason. However, for the evaluable cases, the performances of the CD3500 and the STKS were broadly similar and generally correlated well with the manual reference procedure. The results for the newborn samples were less consistent with wider 95% confidence intervals (CI) noted. For example, the CD3500 (which reported a differential for all 106 samples studied) gave CI values of +/-14.4% for neutrophils, +/-14.6% for lymphocytes and +/-8.1% for monocytes. For comparison, the STKS (which did not provide a differential in 15% of 79 samples analyzed; insufficient material being available from the remaining 27 of 106 newborn samples) gave CI values of +/-21.9% for neutrophils, +/-23.5% for lymphocytes and +/-8.2% for monocytes. For all samples, the sensitivity of the blast flag on the CD3500 was 85% with a specificity of 91% (STKS: sensitivity, 75%; specificity, 85%); the sensitivity of the CD3500 IG flag was 72% with a specificity of 76% (STKS: sensitivity, 75%: specificity, 73%); and the sensitivity of the NRBC flag was 43% with a specificity of 94%(STKS sensitivity, 37%; specificity, 88%). This study confirms competitive performance levels for the CD3500 in the analysis of normal adult samples and suggests positive performance advantages in the study of neonatal, pediatric, and leukopenic samples.

Adolescent↗
PubMed1996

[Willebrand's disease and pregnancy. Fifteen cases].

Willebrand's disease, the most frequent inborn coagulopathy, is defined as a deficiency in Willebrand's factor required for normal hemostasis as a mediator in platelet adhesion to the subendothelium and which also contributes to plasma coagulation pathway (by preserving the coagulating activity of factor VIII). Classically, Willebrand's disease improves somewhat during pregnancy. We followed 15 pregnancies in 12 patients with Willebrand's disease in an attempt to determine the best management strategy to reduce the risk of bleeding during delivery. This risk can be assessed on the basis of prior history of bleeding and the laboratory tests and reduced by administration of concentrated Willebrand's factor at 8 months gestation. In patients with type I disease, desmopressin is proposed as curative treatment during the post partum period. Antenatal diagnosis is possible in the most severe forms. Programmed delivery is recommended. Spinal analgesia is contraindicated.

Decision Trees↗
PubMed1996

[May-Heggelin anomaly and pregnancy. A case report, review of the literature].

The May-Hegglin anomaly is a rare autosomal dominant platelet disorder characterized by thrombocytopenia, giant platelets and existence of crescent-shaped inclusions within the cytoplasm of granulocytes, eosinophils and monocytes (Döhle body). We report a case of May-Hegglin anomaly associated with a pregnancy. The pregnancy and delivery were uneventful. The child is not a carrier of this hematologic anomaly. Nine cases of complicated pregnancies with this anomaly have been reported in the literature. The risks of maternal hemorrhagic accident during pregnancy and during delivery are weak due to the fact that platelets functions are preserved. The same applies to the fetus. Nevertheless, as in the case of maternal autoimmune thrombocytopenic purpura, most reports advice performing a fetal platelet count on fetal blood sampling before birth to decide upon the mode of delivery. The risk of the cordonal approach to perform fetal blood sampling must be balanced against the small fetal hemorrhagic risk and most authors propose to allow normal delivery whilst avoiding all traumatic instrumental extraction, especially the use of vacuum extractor.

Adult↗
PubMed1995

Coagulation inhibitor substitution during sepsis.

This review presents the rationale for and main results of coagulation inhibitor substitution during experimental and human sepsis. Activation of the contact system induces activation of the classical complement pathway with generation of anaphylatoxins, of the kinins pathway and of fibrinolysis. Physiologic inhibition depends on the C1-inhibitor (C1-Inh.). Septic patients exhibit a relative deficiency of biologically active C1-Inh. Substitution with concentrations of C1-Inh has been safely performed and preliminary results are consistent with a possible beneficial effect on hypotension and vasopressor requirement in septic shock. The extrinsic pathway is the main initial coagulation process involved in sepsis-induced DIC. Endothelial and monocyte generation of tissue factor (TF) is activated by bacterial products and endotoxin. Activation of TF is counteracted by a specific tissue factor pathway inhibitor (TFPI). The potential for TFPI substitution to inhibit the activation of the coagulation cascade in sepsis requires further study. Thrombin generation is inhibited by antithrombin III (AT III) and the protein C-protein S system. During sepsis, AT III is consumed and degraded by elastase. Animal studies have shown that DIC and death were prevented by high doses of AT III concentrates. Although a significant reduction in the duration of biological symptoms of DIC has been reported in most human studies, the usefulness of AT III substitution in human sepsis is still debated. None of the studies was able to document a statistically significant reduction in mortality. Protein C is activated by thrombomodulin and, with its cofactor protein S, inhibits factors Va and VIIIa. The free level of protein S depends on the level of the C4b binding protein (C4bBP), an acute-phase complement regulatory protein. During sepsis, protein C activity is significantly reduced, either by acute consumption or by thrombomodulin down-regulation, and increased levels of plasma C4bBP inhibit protein S. Infusion of activated protein C and protein S substitution both protect animals from the lethal effects of bacteria. Combining these different coagulation inhibitors should be carefully studied before its use in septic patients is recommended.

Animals↗
PubMed1995

[Postoperative disorders of hemostasis caused by antifactor V circulating anticoagulant].

The case of a 34-year-old woman who experienced a biological haemostasis disorder, without clinical manifestations, is reported. The disorder was caused by a factor V inhibitor induced by a prolonged administration of antibiotics required by a postoperative biliary peritonitis. Therapeutic strategies in patients with an acquired factor V inhibitor are reviewed.

Adult↗
PubMed1994

Evaluation of desmopressin for dental extractions in patients with hemostatic disorders.

We evaluated the effectiveness of desmopressin to control bleeding of patients with coagulation defects during dental surgery. Thirty-five patients, mainly with moderate and mild hemophilia and Willebrand disease, were undergoing dental extractions (over 80 extractions in total). Bleeding was successfully prevented in 28 patients with the use of a combined treatment incorporating IV desmopressin, an antifibrinolytic agent (tranexamic acid), and local methods (surgical glue and compression techniques). Seven patients had a bleeding episode after dental extraction, which was controlled in two cases by repeated injection of desmopressin and in another two by local methods; Factor VIII substitutive treatment was needed in only three patients. Desmopressin offers an alternative to blood products to control bleeding risk in patients with moderate and mild coagulation defects. Our experience tends to specify the mode of administration of both desmopressin and the associated treatments. Our findings suggest that desmopressin can be used in conjunction with other treatments to prevent bleeding in patients with coagulation defects who undergo dental surgery. This work highlights the concept of multifactorial medical care of these patients in which desmopressin plays a major role.

Adolescent↗
PubMed1994

[Immunohematologic surveillance of patients treated with ABO incompatible bone marrow allografts].

Direct antiglobulin test (DAT), ABO typing and isoagglutinins titers were regularly performed in 26 patients who received a marrow transplant from a major ABO incompatible donor (M = 10 cases), from a minor ABO incompatible donor (m = 10 cases) or both (B = 6 cases). Erythrocyte or plasma depletion of bone marrow infusate was used in all major or certain minor ABO incompatibilities respectively. A positive DAT was recorded in 19/26 patients at various times, but only a few of them, belonging to groups M or B, exhibited a significant hemolysis. No serious complication was observed after bone marrow infusion. Five patients showed evidence of hemolysis after transplantation, 1 patient died with a graft rejection and 3 patients had a delayed erythropoietic engraftment. In all cases of major ABO incompatibility, the erythrocyte recovery was preceeded by a decrease of antibodies against the donor's blood group. These antibodies finally disappeared in all patients except one who had a persistence of isoagglutinins beyond day + 650. A transient appearance of isoagglutinins against the recipient blood group was sometimes detected in minor ABO incompatibility without any clinical complications.

ABO Blood-Group System↗
PubMed1994

Evaluation and use of the white blood cell differential provided by the Coulter STKS in a children's hospital.

The Coulter STKS was evaluated in a children's hospital, in order to (a) compare the WBC differential given by the instrument to a 400 cell visual differential (reference method); (b) evaluate the sensitivity and specificity of the alarm system, and (c) provide data concerning the use and interpretation of results in children. 653 blood samples were collected. The Coulter STKS results were studied in 523 patients having no morphological abnormalities in the blood smears, separated into subgroups according to the presence of STKS alarms and according to age. The results were found accurate both in STKS negative and STKS positive patients (i.e., those with alarms: 'Blasts', Imm Gran 2, Variant Lymph, NRBC, review slide). Negative STKS results had the same accuracy in all age groups, except in neonates where slide review must be systematically performed. The instrument exhibited a good sensitivity of the suspect flags studied (91.4%), with a lower specificity (72%) reflecting the number of false positive results found in our group, probably due to the cytological features particular to children. However, it was shown that the numerical results given by the Coulter STKS in positive patients could be taken into account, provided that a scan of the blood smear was negative for morphological WBC abnormalities.

Adolescent↗
PubMed1994

Protein kinase C-dependent desensitization of HDL3-activated phospholipase C in human platelets.

In isolated human platelets, exposure of subfraction 3 high-density lipoprotein (HDL3) binding sites to high concentrations of HDL3 (1 mg/mL) causes rapid desensitization of HDL3 (50 micrograms/mL)-stimulated breakdown of phosphatidylcholine, as shown in approximately a 70% depression of the maximal 1,2-diacylglycerol release activity by phospholipase C. This desensitization is HDL3 dose dependent (IC50, 150 +/- 20 micrograms/mL, n = 6) and time dependent (t1/2, < 30 seconds). It requires the binding of HDL3, as pretreatment of HDL3 by tetranitromethane does not cause the desensitization of HDL3-induced phospholipase C activity. Permeabilization of human platelets with 10 micrograms/mL digitonin, used to permit access of charged inhibitors to the cytosol, does not interfere with the pattern of HDL3 (1 mg/mL)-induced desensitization of HDL3 (50 micrograms/mL)-stimulated phospholipase C. Inhibitors of protein kinase C (100 mumol/L H-7 and 10 mumol/L staurosporine) markedly inhibit desensitization of HDL3-induced phospholipase C activity, whereas cAMP-dependent protein kinase inhibitor (1 mumol/L), heparin (100 nmol/L), or concanavalin A (0.25 mg/mL) were ineffective. HDL3-induced desensitization is accompanied at least by the phosphorylation of the 94- and 110-kD proteins. Inhibition of HDL3-induced desensitization by 100 mumol/L H-7 or 10 mumol/L staurosporine is characterized by a marked reduction of the phosphorylation state of these proteins in permeabilized platelets. Whereas protein kinase C inhibitors fully inhibited the phosphorylation of the 94- and 110-kD proteins, inhibitors of protein kinase A were less effective. These data establish that phosphorylation by protein kinase C represent a step in the desensitization of HDL3 binding sites in human platelets.

Binding Sites↗
PubMed1994

[Evaluation of Abbott CD 3500 in severe leukopenia].

Leucopenia patient follow-up remains, in terms of laboratory turnaround, a heavy workload due to the leucoconcentrations necessary for evaluating leucocytic formulas. We tested the CD 3500 with the objective of defining its' analytical performances and routine practice. 101 leucopenia samples (< 2.10(9)/l) procured from the onco-hematology department (adults and children) were studied during a 1 month period. The leucocytic formula obtained after leuconcentrations was our reference. The alarm sensitivity, as a whole, was of 97% for a 15.5% specificity. The correlation coefficients (Cell-Dyn/microscope) for polynuclears, lymphocytes and monocytes were respectively 0.889, 0.925 and 0.926. The correlation coefficients observed in both following subgroups: < or = 0.5.10(9)/l and > 0.5.10(9)/l were superposable. In 95% of the cases, the numeric value difference between the two methods attained a maximum of 21% for all neutrophils and lymphocytes and 13% for the monocytes. There was an excellent concordance between both methods for eosinophilia and basophils with confidence intervals of +/-8.8% and +/-2.2%. In practice, we feel that the use of a CD 3500 in post chemotherapy leucopenia, is perfectly adaptable and appreciated for leucocytic formulas, as well as a good exit for aplasia.

Autoanalysis↗
PubMed1994

Hepatitis A in French hemophiliacs.

The prevalence of serum antibodies to hepatitis A virus (HAV) in 793 hemophilia A (HA) and 89 hemophilia B (HB) patients coming from 10 French Hemophilia Centers and treated since 1986-1987 with solvent/detergent (SD)-treated products is reported. The results indicated seropositivity to HAV of 29.9% in HA and 40.4% in HB patients. There was no difference among the patients according to severity of the disease, HIV serology or administration of factor VIII during the last 12 months. Seropositivity increased with age from 5.2% in HA children to 42.4% in adults (in HB the respective prevalences in the same groups were 7.7% and 56.1%). When compared to normal controls (n = 585), the prevalence of HAV seropositivity was not excessive in HA patients (n = 206). 19/20 children exclusively treated with a very-high-purity SD-factor VIII concentrate (Centre régional de transfusion sanguine, Lille) remained HAV seronegative. Six cases of HAV contamination were reported in patients with severe HA, probably reflecting the level of HAV endemy in the normal population in France. No special risk of HAV transmission linked to the SD products used in France since 1986 had thus been identified.

Adolescent↗