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Biomedical subjects

J Messer

Publications and source records attributed to J Messer.

At least 73 records · Page 4Linked to original sources
PubMed1991

Lipase/amylase ratio. A new index that distinguishes acute episodes of alcoholic from nonalcoholic acute pancreatitis.

Because of observations that patients with acute episodes of alcoholic pancreatitis had high serum lipase levels whereas patients with gall stone pancreatitis had high serum amylase levels, a prospective study was undertaken to determine whether the ratio of serum lipase to serum amylase, a newly computed ratio, would discriminate between acute episodes of alcoholic and nonalcoholic pancreatitis. In phase one, 30 consecutive patients with acute pancreatitis were entered into the study and divided into groups A and B. Patients with renal failure were excluded from the study. Group A consisted of 20 patients in whom the etiology of pancreatitis was alcohol. Group B consisted of 10 patients whose pancreatitis was nonalcoholic in etiology (predominantly gallstones). Serum lipase values in group A ranged 492 to 25,706 U/L (median, 3433 U/L) and in group B from 711 to 31,153 U/L (median, 1260 U/L). These differences were not significant statistically. Serum amylase values in group A ranged from 104 to 2985 U/L (median, 331 U/L) and in group B from 423 to 13,000 (median, 1187 U/L). Although these figures were statistically different (P less than 0.005), there was a considerable degree of overlap in the values between the two groups. The lipase/amylase ratio calculated from the blood sample obtained at presentation appeared to be a promising discriminatory index. The lipase/amylase ratio was calculated by using the amylase and lipase levels expressed as multiples of the upper limit of normal in each case. The lipase/amylase ratios in the alcoholic group ranged from 2.2 to 14.8, whereas the lipase/amylase ratio in nonalcoholic pancreatitis ranged from 0.31 to 1.93. These differences were statistically significant (P less than 0.005). A lipase/amylase ratio of greater than 2 was indicative of an alcoholic etiology, and a ratio of less than 2 suggested that the pancreatitis was nonalcoholic in nature. In phase two, this lipase/amylase ratio of 2 was applied prospectively to an unselected population of 21 consecutive patients with acute pancreatitis. Thirteen patients had a lipase/amylase ratio of greater than 2; in 11 of them, the etiology of the pancreatitis was alcohol. Eight patients had a lipase/amylase ratio of less than 2; of them, only 1 patient had an alcoholic etiology for the pancreatitis. These differences were statistically significant (P less than 0.05).(ABSTRACT TRUNCATED AT 400 WORDS)

Acute Disease↗
PubMed1991

[Indications of magnetic resonance imaging in congenital cardiopathies in neonatal period. Apropos of 54 cases].

Between February 1988 and July 1989, the authors used magnetic resonance imaging (MRI) to study 54 newborn infants aged between 2 and 35 days and suspected of congenital heart disease. All children also underwent echocardiography and 7 angiography during the neonatal period (13% of children studied). MRI was well tolerated and there were no adverse events. MRI proved to be complementary to echocardiography in several lesions affecting the great vessels of the base and the left atrial region. Agreement between angiography and MRI results was very good, with MRI being more useful in one case. MRI enables full and non-invasive postoperative follow-up. In conclusion, despite the great heterogenicity of the cardiac malformations studied and which requires a degree of caution, the authors feel that MRI is a second line investigation after echocardiography. It may limit the indications of angiography. Its own indications are the retrocardiac region, the main arteriovenous vessels of the base and postoperative follow-up in congenital heart disease. The development of techniques such as angio RM will further modify data in the future.

Echocardiography↗
PubMed1990

Neonatal echovirus encephalitis with white matter necrosis.

The authors report a case of neonatal echovirus encephalitis associated with white matter necrosis. The pattern of illness in the neonatal period was diphasic, marked by hyperthermia and the occurrence of seizures. Echovirus was recovered from the cerebrospinal fluid. Cerebral magnetic resonance imaging (MRI) performed at one month of age showed right periventricular white matter necrosis. The infant exhibited mild left hemiparesis. Cerebral MRI at 6 months of age showed a delay in myelination in the right hemisphere. Echovirus encephalitis in the neonate can cause brain damage.

Cerebral Ventricles↗
PubMed1990

[Contribution of transcranial Doppler sonography to the diagnosis of brain death in children].

Brain death can be characterized by cessation of cerebral blood flow. We have measured blood flow velocity in cerebral arteries of 17 comatous children with a transcranial pulsed Doppler equipment. In 11 children who progressed to brain death, we have recorded a progressive decrease of Doppler signal with the following steps: decrease of diastolic velocity, no diastolic velocity, reverse diastolic flow, decrease of systolic signal, no signal at all. In the 6 surviving children (all except one with severe deficits), after an initial reduction but never to a retrograde flow, arterial cerebral blood flow velocity increased to high diastolic values before normalization. Transcranial Doppler technique is non invasive, reliable, can be used at the bedside and repeated; it allows evaluating the cerebral blood flow in comatous children and represents a useful adjunct to brain death diagnosis.

Brain Death↗
PubMed1990

[Magnetic resonance imaging of the brain of newborn infants].

The authors report their experience of cerebral magnetic résonance imaging (MRI) in the neonatal period. MRI offers many advantages compared to CT scan or ultrasonography in the study of malformations, tumors, infections and anoxic-ischemic brain injury. However, MRI is limited by the duration of the examination the need for total immobility which is achieved in the neonate via administration of chloral hydrate, and lack of accessibility. MRI is a non invasive method for following in vivo brain development during infancy.

Brain↗
PubMed1990

[Psychosocial factors and sudden infant death syndrome].

Sudden infant death (SID) is a multifactorial syndrome in which the role of psychosocial factors should be taken into consideration. Deep changes in mores and in the way infants are cared for occurred in the second half of the XXth century. Fragmentation of the traditional family has led to increased isolation of the infant. Significant changes have also occurred in the status of women and have translated into increasingly early separation of the mother from her baby. These factors, together with economic difficulties that carry a risk of preterm birth and intrauterine growth retardation, may be involved in the genesis of SIDS. Difficulties experienced by the mother in relating with her child during the first few months of life, a critical period for interaction, may also play a role. Prevention of SIDS should take psychosocial factors into account and attempt to minimize their effect.

Cultural Characteristics↗
PubMed1989

Neonatal renal dysfunction and intrauterine exposure to prostaglandin synthesis inhibitors.

Three cases of renal dysfunction at birth were observed in premature babies exposed in utero to prostaglandin synthetase inhibitors (PSI) and corticosteroids. Transient water and sodium retention with uraemia occurred in one patient, and severe acute renal failure with marked hyperkalaemia in twins. These findings may be due to impairment of prostaglandin (PG)-mediated renal adaptation to stress conditions after transplacental passage of PSI. Corticosteroids may also have affected PG synthesis inhibition.

Acute Kidney Injury↗
PubMed1989

Influence of anesthetics on cerebral blood flow velocity in infancy. Effects of halothane versus thiopental-fentanyl.

We studied the effects of 2 anesthetic protocols on blood flow velocity of the middle cerebral artery, measured with a pulsed Doppler sonograph in infants. A first group of 10 infants (mean age 64 days) was anesthetized with halothane and nitrous oxide. A second group of 10 infants (mean age 88 days) was anesthetized with thiopental-fentanyl i.v. and nitrous oxide. Heart rate, mean arterial blood pressure (MABP) and mean velocity (MV) decreased during both types of anesthesia. Decrease of MV was of the same magnitude in the 2 groups but MABP decreased more under halothane. After skin incision MABP and MV increased in both groups but MV followed MABP more closely under halothane than under thiopental. These results suggest cerebral blood flow (CBF) reduction after both inductions but by a different mechanism. In spite of cerebral arteriolar dilation with halothane, CBF decreases by means of severe reduction of MABP: CBF is pressure-passive and autoregulation seems to be impaired. In contrast, thiopental induces cerebral arteriolar constriction but CBF is less dependent of MABP changes.

Anesthetics↗
PubMed1989

[Acyclovir and pregnancy: current aspects].

Acyclovir (ACV), an antiviral nucleoside analog, is active against Herpes simplex viruses (HSV1, HSV2) and varicella virus (VZV). These viruses seems to be prejudicial to the pregnant woman and to the fetus. Yet, ACV is not recommended for use in pregnancy. However in certain cases, this drug has been used. We review in this paper, the pharmacokinetics and transplacental passage of ACV, indications, and whether the benefits of the administration of ACV in pregnancy outweigh the theoretical risks. Peak and trough plasma concentrations of ACV in pregnant women seem to be lower as compared to those of non-pregnant adults but effective. This drug crosses the placenta. Levels of ACV in cord blood ranged from 0.5 to 3 mumol/l. In as much as in vitro inhibitory doses 50 (ID 50) for HSV1, HSV2 and VZV ranged from 0.1 to 3 mumol/l, it is quite likely that levels noted above may be effective for in utero inhibition of viral replication. No adverse effects were noted in newborn exposed in utero to ACV. But one must be careful about the direct effects of this drug on nucleic acid metabolism despite encouraging results on animal fetuses. Based on these findings and from our experience, ACV can be administered in pregnancy in two particular situations: in cases of maternal severe viral infections and in order to inhibit in utero VZV replication. Doses required for pregnant women range from 5 to 15 mg/kg/8 hours given intravenously, and 200 mg of oral Acyclovir 5 times daily.

Acyclovir↗
PubMed1987

[The transfer of newborn infants. Experience of a department of neonatology].

The results of 6 years of neonatal transport to the neonatology unit of the Hautepierre hospital (January, 1980 to December, 1985) are reported. During that period 1866 neonates were transferred from maternities of Strasbourg and its region to the neonatology unit, representing 23.77% of total admissions. The 350 premature babies born before or at 32 weeks of pregnancy amount to 55% of babies born at the same gestational age. Mortality in that group (46.52%) was associated mainly with hyaline membrane disease and intraventricular haemorrhage. Neonatal infections and congenital malformations were seen in children born after 32 weeks. To improve the quality of transport and reduce morbidity and mortality, the biological and haemodynamic parameters of the neonates should be stabilized prior to their transfer, and all the necessary precautions (i.e. ventilation, oxygenation, temperature, glycaemia, asepsis) should be observed at every stage of their journey. In high-risk pregnancies, "transfer in utero" to a neonatal intensive care unit undoubtedly is the best solution.

Evaluation Studies as Topic↗
PubMed1987

[Persistent hyperbilirubinemia after intrauterine intraperitoneal transfusions in 4 newborn infants. Role of intraperitoneal red cells present at birth].

Four neonates who had undergone intra-uterine peritoneal blood transfusions for Rhesus disease and hydrops fetalis presented, during the first days of life, with intractable hyperbilirubinemia in spite of multiple exchange transfusions. The hyperbilirubinemia was due to delayed absorption and hemolysis of peritoneal red cells. This unusual complication can be successfully managed with peritoneal lavage which should be performed when the antenatal history is contributive for low absorption of transfused blood.

Blood Transfusion, Intrauterine↗