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Biomedical subjects

J de Lattre

Publications and source records attributed to J de Lattre.

At least 19 recordsLinked to original sources
PubMed1997

Relationship between maximal oxygen uptake on different ergometers, lean arm volume and strength in paraplegic subjects.

The present experiment was designed to study the importance of strength and muscle mass as factors limiting maximal oxygen uptake (VO2max) in wheelchair subjects. Thirteen paraplegic subjects [mean age 29.8 (8.7) years] were studied during continuous incremental exercises until exhaustion on an arm-cranking ergometer (AC), a wheelchair ergometer (WE) and motor-driven treadmill (TM). Lean arm volume (LAV) was estimated using an anthropometric method based upon the measurement of various circumferences of the arm and forearm. Maximal strength (MVF) was measured while pushing on the rim of the wheelchair for three positions of the hand on the rim (-30 degrees, 0 degrees and +30 degrees). The results indicate that paraplegic subjects reached a similar VO2max [1.23 (0.34) 1 x min(-1), 1.25 (0.38) 1 x min(-1), 1.22 (0.18) 1 x min(-1) for AC, TM and WE, respectively] and VO2max/body mass [19.7 (5.2) ml x min(-1) x kg(-1), 19.5 (6.14) ml x min(-1) x kg(-1), 19.18 (4.27) ml x min(-1) x kg(-1) for AC, TM and WE, respectively on the three ergometers. Maximal heart rate f((c) (max)) during the last minute of AC (173 (17) beats x min(-1)], TM [168 (14) beats x min(-1)], and WE [165 (16) beats x min(-1)], were correlated, but f((c) (max)) was significantly higher for AC than for TM (P < 0.03). There were significant correlations between MVF and LAV (P < 0.001) and between the MVF data obtained at different angles of the hand on the rim [311.9 (90.1) N, 313.2 (81.2) N, 257.1 (71) N, at -30 degrees, 0 degrees and +30 degrees, respectively]. There was no correlation between VO2max and LAV or MVF. The relatively low values of f((c) (max)) suggest that VO2max was, at least in part, limited by local aerobic factors instead of central cardiovascular factors. On the other hand, the lack of a significant correlation between VO2max and MVF or muscle mass was not in favour of muscle strength being the main factor limiting VO2max in our subjects.

Adult↗
PubMed1997

[Visual, auditory and somatosensory potentials in the diagnosis of vitamin B12 deficiency].

We describe visual, brain stem auditory, and somatosensory evoked (VEP, BAEP, SEP) in a 49-year old male patient presenting with subacute degeneration of the spinal cord due to vitamin B12 deficiency. Neurological signs included tetraplegia with a C4-C5 spinal cord compression that was unchanged after surgical decompression. Before treatment, the duration of the bilateral VEP was slightly increased, though their amplitude and morphology were not modified. BAEP were normal. However, abnormalities of SEP with loss of cortical potentials were noticed. Two months after initiation of the treatment, both VEP and SEP recorded in response to median nerve stimulation had improved, but there was still no cortical response to tibial nerve stimulation. Eighteen months later, VEP were normal and recovery of SEP in response to tibial nerve stimulation was observed; however, alterations of peripheral sensory and motor action potentials were still present. These findings are in good agreement with previously reported pathological changes in patients presenting with subacute combined degeneration. Similar abnormalities have been described in patients with multiple sclerosis. Evoked potentials in this case proved to be useful for the diagnosis and the evaluation of the efficacy of the treatment. These findings also suggest that demyelination of the posterior part of the spinal cord and peripheral axonal degeneration might be the main pathological changes related to vitamin B12 deficiency. The former, but not like the latter, were clearly responsive to the treatment.

Evoked Potentials, Auditory↗
PubMed1996

Long-term effects of nasal intermittent positive-pressure ventilation on pulmonary function and sleep architecture in patients with neuromuscular diseases.

STUDY OBJECTIVE: This article evaluates the long-term clinical and physiologic effects of nocturnal nasal intermittent positive-pressure ventilation (NIPPV) in patients with neuromuscular disease. METHODS: Before and after 18 +/- 2 months of NIPPV, we measured during the daytime arterial blood gases, lung mechanics, and respiratory muscle strength in 8 patients (51 +/- 5 years; mean +/- SEM). Sleep parameters were also evaluated at 10 +/- 2 months. RESULTS: All patients tolerated NIPPV and none required hospitalization during follow-up. After NIPPV, daytime arterial PO2 increased (71 +/- 4 to 81 +/- 2 mm Hg; p < 0.05) and arterial PCO2 decreased (46 +/- 3 to 41 +/- 1 mm Hg; p < 0.05). The change of PaO2 after NIPPV was related to its baseline value (r2 = 0.78, p < 0.05). Vital capacity (50 +/- 6% predicted), total lung capacity (63 +/- 4% predicted), alveolar-arterial oxygen gradient (20 +/- 3 mm Hg), and maximal inspiratory (39 +/- 9% predicted) or expiratory (32 +/- 5% predicted) pressures did not change after NIPPV. The apnea-hypopnea index fell from 22 +/- 6 to 1 +/- 1 (p < 0.05), and both sleep architecture and sleep efficiency (from 59 +/- 8% to 83 +/- 5%; p < 0.05) were enhanced. The time spent with an arterial oxygen saturation (SaO2) value below 90% decreased from 160 +/- 53 min to 8 +/- 4 min (p < 0.05). Mean (88 +/- 3 to 95 +/- 1%; p < 0.05) and minimal nocturnal SaO2 (67 +/- 5 to 89 +/- 1%; p < 0.001) improved after NIPPV. CONCLUSIONS: In patients with neuromuscular disease, long-term NIPPV is well tolerated and easy to implement clinically. In these patients, long-term NIPPV improves daytime arterial blood gas values and sleep-disordered breathing. However, it does not modify lung mechanics or respiratory muscle strength.

Adult↗
PubMed1994

Sleep-related respiratory disturbances in patients with Duchenne muscular dystrophy.

Sleep-related respiratory disturbances (SRD) in patients with muscle diseases may have significant clinical implications, because the patients frequently die at night. The aims of the study were to :1) assess the presence and severity of sleep-related respiratory disturbances in patients with Duchenne muscular distrophy (DMD); and 2) investigate the relationship of sleep-related respiratory disturbances to daytime symptoms and pulmonary function. We studied six clinically stable patients with Duchenne muscular dystrophy, mean age (+/- SD) 18 +/- 2 yrs. Vital capacity was 27 +/- 19% of predicted and daytime arterial oxygen tension (PaO2) was 10.9 +/- 1 kPa (range 8.9-12.4 kPa). The presence of daytime somnolence, insomnia, headache, nightmares and/or snoring was recorded. Four patients (67%) showed symptoms that suggest sleep-related respiratory disturbances. At night, the apnoea-hypopnoea index (AHI) was 11 +/- 6. The patients with more symptoms during the daytime had the highest AHI scores. Most of the apnoeas (85%) were central, particularly during rapid eye movement (REM) sleep. Sleep architecture was well-preserved. Arterial desaturation (> 5% below baseline) occurred during 25 +/- 23% of total time. AHI correlated with daytime PaO2, and AHI in REM sleep correlated with age. A stepwise multivariate analysis showed that PaO2 and, to some extent, the degree of airflow obstruction were significantly correlated with AHI. We conclude that sleep-related respiratory disturbance are frequently present in patients with Duchenne muscular dystrophy. Therefore, physicians should look for symptoms related to sleep-related respiratory disturbances in these patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

[Value of somatosensory evoked potentials in spinal surgery monitoring in children and adolescents: 110 cases].

This study shows the results obtained in 110 patients, children and adolescents by monitoring somatosensory evoked potentials during spinal surgery: Cotrel-Dubousset instrumention, surgical anterior correction by plating, spondylolisthesis and hemivertebra surgery. The recordings were made in preoperative, peroperative and postoperative period; the anaesthetic and electrophysiological conditions allowed us to obtain reliable recordings. In the peroperative period, the recordings were made: after induction of anesthesia and exposure of the spine, after instrumentation, after maximum traction and at the end of the operation. Analysis of the peroperative somatosensory evoked potentials (PESEP) showed significant differences in latencies, but also in amplitudes and morphology during distraction in scoliosis or spondylolisthesis. These impairments gradually improved and recovered their normal values at the end of the operation. The impairments were, with equal correction, 4 times more important in Cotrel-Dubousset instrumentation than in surgical anterior correction by plating. During instrumentation and in two cases, the impairments observed led the surgeon to change his operative behavior, certainly avoiding a postoperative neurological disorder, the "wake-up test" was made in one case. The correlation between the neurological problems, and the impairments of the potentials allowed us to define alarm criteria, and if they persist the "wake-up test" becomes necessary.

Adolescent↗
PubMed1992

Breathing disorders during sleep in myasthenia gravis.

Twenty consecutive patients (16 women and 4 men), with a mean age of 40 years, who were diagnosed and treated for myasthenia gravis were enrolled in a prospective investigation aimed at determining the amount of respiratory disturbance occurring during sleep while they received treatment. Patients were clinically evaluated to determine body mass index, presence of upper airway anatomical abnormalities, level of functional capacity and activity scored from 1 to 5, and presence of sleep-related complaints. They underwent daytime pulmonary function tests, determination of maximal static inspiratory pressure, measurement of transdiaphragmatic pressure, and measurement of arterial blood gas levels. Polygraphic monitoring during sleep, evaluating respiration and oxygen saturation, was also performed. Results indicated that in the studied population, all subjects had evidence of daytime diaphragmatic weakness as demonstrated by transdiaphragmatic pressure measurements, independent of the degree of autonomy and functional capacity and activity level reached. Older patients with moderately increased body mass index, abnormal total lung capacity, and abnormal daytime blood gas concentrations were the primary candidates for development of diaphragmatic sleep apneas and hypopneas, and oxygen desaturation of less than 90% during sleep. However, these clear indicators were not found in all subjects with sleep-related disordered breathing. Rapid-eye-movement sleep was the time of highest breathing vulnerability during sleep. Sleep-related complaints may also help identify subjects at risk for abnormal breathing during sleep, even when daytime functional activity is judged normal.

Adult↗
PubMed1988

Adult maltase acid deficiency myopathy: treatment with long-term home mechanical ventilation.

We report a study of an adult with a maltase acid deficiency myopathy. A restrictive respiratory syndrome due to respiratory muscle weakness is associated with paralysis of other muscular groups. In 1982 the patient presented with an alveolar hypoventilation, and mechanical ventilation was required after acute respiratory failure. The patient has received nocturnal mechanical ventilation by tracheostomy at home for 5 years. His clinical status gradually improved in parallel to amelioration of his respiratory condition. Functional respiratory tests improved: initial hypoxia-hypercapnia disappeared, vital capacity increased. The possible mechanisms underlying the improvement are discussed. Increase in pulmonary compliance is an argument to explain the functional improvement observed. Ventilatory response to carbon dioxide was abnormal whereas the ventilatory response to exercise and maxima minute ventilation test were normal. Results are consistent with a respiratory control impairment. The role of mechanical ventilation is difficult to assess in the improvement we observed.

Adult↗
PubMed1979

[Study upon oxygen conveyance in severe anaemia. About a very serious case of hemolytic anaemia which led to a myocardial infarct (author's transl].

To understand the orientation the metabolism of a sick person whose arterial content in oxygen had collapsed (CaO2 reaching 1,9 vol/100 ml) the cardiac output and the rate myocardic extraction of the lactates have been measured. The cardiac index was very high 7,4 l/m/m2 and in spite of a low D (a-v) (2,5 vol/ml) the consumption of oxygen was normal. Three days after a first measure the steep (or brutal) fall of the cardiac and the reversal of the rate of myocardic extraction of lactate led up to diagnose an acute coronary insufficiency. The electrocardiogramm only cortoborated the myocardic necrosis in a second time. This result invites (or calls for) a constant electrographic watching of sick persons who suffer from severe anaemia, even with sane coronary vessels, to avoid diagnosing coronary insufficiency through so circuitous means.

Anemia, Hemolytic↗
PubMedDate not supplied

[Study of pulmonary leucostasis by measurement of the alveolo-arterial CO2 difference (author's transl)].

In order to study pulmonary leucostasis in 18 leukemic subjects, the ventilatory flow from ventilated nonperfused zones (VFVNZ) was measured using alveolo-arterial CO2 difference (28 times). This method proved to be simple and accurate in the follow-up of the patients. The number of white cells necessary to increase the VFVNZ by 1% is very different from one histologic type to another. These results are in agreement with in vitro observations.

Arteries↗