Biomedical subjects

M Carlier

Publications and source records attributed to M Carlier.

At least 37 records · Page 2Linked to original sources

PubMed1998

Hepatopulmonary syndrome and liver transplantation: a review of the peroperative management of seven paediatric cases.

Until recently, hypoxaemia was considered as a relative contraindication for liver transplantation. The hepatopulmonary syndrome associated with a right to left shunt of blood through the lungs is reversible in adults and children after correction of the cirrhosis by liver transplantation. However, concerns have been raised regarding the risks of anaesthesia in such hypoxaemic patients. Since the peroperative management of children undergoing liver transplantation and suffering from hepatopulmonary syndrome and severe hypoxemia has never been described, we report here our experience in seven children. Despite the fact that severe arterial desaturation was recorded throughout the procedure, no major complications were recorded peroperatively. The postoperative intubation time was 58 +/- 21 h, five children being extubated while still hypoxaemic. All seven patients reversed their hepatopulmonary syndrome after a mean postoperative period of 24 +/- 10 weeks. This shows that liver transplantation can be successfully achieved in severely hypoxaemic children and that postoperative correction of the right to left shunt is then obtained.

Adolescent↗

PubMed1998

The effects of intraoperative intravenous clonidine on fluid requirements, hemodynamic variables, and support during liver transplantation: a prospective, randomized study.

UNLABELLED: In this prospective, nonblind study, we report the use of clonidine during orthotopic liver transplantation (OLT). Twenty adult patients in a stable medical condition were studied. General anesthesia consisted of isoflurane in air/oxygen and sufentanil. Patients in the clonidine group received a slow i.v. infusion (15 min) of 4 microg/kg clonidine during induction. The other patients were used as controls. I.v. fluid requirements were determined as follows: albumin (4% solution) was administered to maintain filling pressures to a pulmonary capillary wedge pressure (PCWP) of more than 12 mm Hg. Packed red blood cells were transfused to maintain a hemoglobin level of 8-9 g/dL. Circulatory stability was evaluated using: systolic and diastolic arterial blood pressure and heart rate recorded at 2-min intervals; and the vasopressor/inotropic support required to maintain adequate hemodynamic variables after reperfusion. Intraoperative albumin and packed red blood cell requirements were significantly reduced in patients in the clonidine group (1644 +/- 140 and 50 +/- 50 mL vs 2867 +/- 226 mL and 1350 +/- 443 mL; P < 0.05). Heart rate was significantly slower in patients of the clonidine group. There were no differences in systolic arterial blood pressure. After reperfusion, patients in the control group showed significantly lower diastolic arterial blood pressure, required more vasopressor/inotropic support, and were more acidotic than patients in the clonidine group. We conclude that the administration of 4 microg/kg clonidine during induction of OLT significantly reduced the intraoperative requirements of i.v. fluids and blood products without compromising circulatory stability. Improvement in immediate reperfusion-induced disturbances was observed. IMPLICATIONS: The administration of 4 microg/kg clonidine during induction of liver transplantation significantly reduced the intraoperative requirements for i.v. fluids and blood products without compromising the circulatory stability. Improvement in immediate reperfusion-induced disturbances was also observed.

Blood Volume↗

PubMed1997

Brachial, radial, or femoral approach for elective Palmaz-Schatz stent implantation: a randomized comparison.

UNLABELLED: From October 1994 to November 1995, 150 male eligible patients were randomly assigned to Palmaz-Schatz stent implantation through 6 French catheters using the femoral (puncture) (n = 56), radial (puncture) (n = 56), or brachial (cutdown) (n = 38) approach at 6 participating Belgian centers. Acenocoumarol was given for 1 month after stenting. END POINTS: Primary-entry site complications (bleeding, haematoma, transfusion, occlusion, surgery) poststent implantation. Secondary-success rate, stent thrombosis, Q or non Q wave MI, repeat PTCA, CABG, CVA, haemorrage, death. There were no statistically significant differences between the three groups for base line and angiographic patient characteristics, procedural characteristics, in hospital outcome, average hospitalisation time after stenting, events during the month after stenting, or local complications at 1 month follow-up. The only statistically significant difference was the arterial time of the procedure: mean +/- SD (minutes) brachial 31.0 +/- 10.02 *P < 0.001, femoral 42.2 +/- 21.8, radial 55.8 +/- 31.3 **P < 0.0001 (*brachial vs. femoral, **brachial vs. radial). There was a clear trend toward more technical difficulties and more problems with the radial approach. In each group: vascular surgery at entry site: 0%, blood transfusion: 0%. In our study, local complications and length of hospital stay were similar with the three possible approaches, and brachial approach was associated with a shorter arterial time.

Adult↗

PubMed1996

Manual performance and laterality in twins of known chorion type.

Manual performance, direction, and degree of laterality were tested in monozygotic (MZ) twins (8-12 years old) of known chorion type and dizygotic (DZ) twins. Three manual tasks rarely employed in twin studies were used; dot-filling, tapping, and peg-moving tasks. No chorion effect was observed: the monochorionic and dichorionic MZs differed neither for frequency of discordant pairs nor for handedness, laterality measurements, and manual performance. The pooled MZs and DZs were then compared in a classic twin design. The within-pair resemblance was not higher in MZs than in DZs for variables measuring level of manual performance. For laterality scores intraclass correlations were close to zero in MZ and DZ twin groups.

Child↗

PubMed1996

Vocalizations in newborn mice: genetic analysis.

Two kinds of vocalizations are produced by newborn mice: whistles (between 50 and 150 ms in length), having a narrow bandwidth in each strain that ranges from 30 to 90 kHz; and clicks, which are shorter (about 1 ms) and have a larger bandwidth. These vocalizations were individually recorded in 1-day-old pups from seven inbred strains of laboratory mice, at two temperatures (23 +/- 0.5 and 15 +/- 0.5 degrees C). The numbers of clicks and whistles were counted under these two conditions. Moreover, the length and frequencies at the beginning, apex, and end of the whistles were measured during the 15 degrees C condition. Correlations, including several components-additivity, epistasis (between homozygous loci), and maternal environment-were calculated between the characteristics of the whistles during the 15 degrees C condition. Clicks and whistles were also counted from 1 to 8 days of age during the 15 degrees C condition. The numbers of clicks and whistles were age dependent, with a decrease from day 1 to day 8 for the clicks and a consistent production of whistles. A quantitative genetic analysis was also performed on the 1-day-old pups from the Mendelian generations produced by the inbred strains most contrasting for the number of whistles produced in the cold condition: NZB/BINJ and CBA/H. The heterozygous genotype of the mother induced an increment of the number of whistles. Moreover, a significant part of the additive variance was suspected from the first design, and found with the second one, for this variable. Quantitative genetic analysis showed significant dominance and epistasis between homozygous loci and homozygous and heterozygous loci. This points to multigenic correlates for the number of whistles in this population. The significant additive values for all the variables recorded during the 15 +/- 0.5 degrees C condition and for the number of whistles produced during the 23 +/- 0.5 degrees C condition are compatible with an effect that indicates neither directional nor stabilizing selection. This result is examined in the light of the multichannel sensorial process implicated in maternal behavior in mice.

Animals↗

PubMed1996

Comparative diagnoses of twin zygosity by SSLP variant analysis, questionnaire, and dermatoglyphic analysis.

Zygosity diagnosis has been performed in 79 pairs of twins using three methods. Simple sequence repeat length polymorphism (SSLP) analysis allows an efficient classification (MZ or DZ) with only a few markers following a simplified technique of extraction and amplification. A method based on a full questionnaire completed by parents about twin similarity correctly classifies 97.46% of the pairs; 92.41% are correctly classified using only four questions as suggested by logistic regression analysis. The third method, using dermatoglyphic analyses, correctly classifies 86.76% of pairs. To lower the cost of DNA diagnosis we stress the possibility of limiting its use to pairs with scores in the overlap area between MZ and DZ twins with a validated questionnaire.

Child↗

PubMed1996

[Venous thrombosis on central catheters in oncology].

Central venous catheters have considerably improved the comfort and safety of chemotherapy in cancer patients. However complications as thrombosis could occur and their incidence vary from 3.7 to 42% in oncology. Catheter placement induces modifications of vascular system with formation of a fibrin sleeve and/or a mural thrombus. Thrombosis origin is linked with catheter itself, its position and the biomaterial used. Hypercoagulable state in cancer results from the perturbation of blood flow, the composition of blood itself and the vessel wall, and increases the iatrogenic effects of indwelling catheters. Finally chemotherapy used in the treatment of cancer has been associated with an increased incidence of thromboembolic events, suggesting the proposal of an antithrombotic prophylaxis in cancer patients receiving chemotherapeutic agents through indwelling catheter.

Antineoplastic Agents↗

PubMed1995

Long-term effects of embryo freezing in mice.

Embryo cryopreservation does not induce clear-cut anomalies at detectable rates, but several mechanisms exist for nonlethal damage during the freeze-thaw process, and the risk of moderate or delayed consequences has not been extensively investigated. In a long-term study including senescence, we compared cryopreserved and control mice for several quantitative traits. Significant differences were seen in morphophysiological and behavioral features, some of them appearing in elderly subjects. Thus, apart from its immediate toxicity, embryo cryopreservation, without being severely detrimental, may have delayed effects. These results, consistent with other findings, question the neutrality of artificial reproductive technologies and draw attention to the preimplantation stages in developmental toxicology.

Age Factors↗

PubMed1995

Linkage between brain serotonin concentration and the sex-specific part of the Y-chromosome in mice.

The implication of the sex-specific part of the Y-chromosome (YS-SP) on brain serotonin (5-HT) level was investigated using congenic strains for this chromosomal region. The 5-HT level, which was higher in the NZB than in the CBA/H strain of mice, was depleted by the transfer of the YS-SP from NZB on CBA/H whereas the transfer of the YS-SP from CBA/H on NZB had no effect. The variations of 5-HT levels were not correlated with plasma testosterone concentration which is also dependent of the YS-SP.

Animals↗

PubMed1995

Intermale aggression tested in two procedures, using four inbred strains of mice and their reciprocal congenics: Y chromosomal implications.

Indications of a role for the nonpseudoautosomal region of the Y chromosome (YNPAR) in intermale attack behavior have been demonstrated by Maxson's group using C57BL/10 (B10) and DBA/1 (D1) inbred mouse strains and their reciprocal congenics. Carlier and Roubertoux' group, using CBA/H (H) and NZB/B1NJ (N) mice, did not find such a YNPAR effect. For the two research groups, however, not only were the parental strains different, but also the rearing conditions and testing methods. The divergent conclusions drawn may therefore have been due either to genetic variation or to environment-related variables. We carried out two experiments to investigate these alternatives. The N and H strains were raised and tested according to the experimental design used by Maxson's group (homogeneous set test) and the D1 and B10 strains were raised and tested according to the experimental design of Carlier and Roubertoux' group (standard opponent test). Considering all studies together, the YNPAR effect appeared in both sets of mice only when using the homogeneous set test. This raises the question of what environmentally related variables are involved in the YNPAR effect on intermale attack. One strong hypothesis is that the different types of opponents in each experimental design send differing olfactory signals, which, in turn, differentially affect the capacity to elicit intermale attack behavior.

Aggression↗

PubMed1995

Effect of 1-28 alpha-h atrial natriuretic peptide on acute renal failure in cadaveric renal transplantation.

The efficacy and safety of (1-28) alpha-human ANP in preventing acute tubular necrosis (ATN) in cadaveric renal transplantation was tested by comparing ANP infusion with a maximal hydration (MH) regimen which we previously reported as effective in lowering the incidence of ATN (1, 2). Since the production of endogenous ANP increases with volume overloading (3), we hypothesized that increased endogenous ANP production may contribute to the beneficial effects of MH in renal transplant recipients. We thus conducted an open randomized study comparing the effect on early renal allograft function of MH (control group) versus moderate hydration plus ANP infusion (ANP group). Forty patients were blindly paired in two groups of 20 according to the duration of cold ischemia time (mean +/- 2 h). The demographic characteristics of donors and recipients were similar. Using a Swan-Ganz catheter, hemodynamic parameters were monitored for 4 h after transplantation. The group receiving ANP and moderate hydration was perfused to a mean pulmonary arterial pressure (PAP) of < or = 20 mmHg. The PAP in patients receiving MH was driven to > or = 25 mmHg. In the ANP group, a bolus of 100 micrograms of ANP was infused into the graft's renal artery at the time of unclamping, followed by 24 h of continuous intravenous infusion at 0.03 microgram/kg/min. Thereafter, the patients received ANP at a rate of 0.01 microgram/kg/min until the serum creatinine reached < 2 mg/dl. As a consequence of the hydration regimen, the PAP at unclamping was lower in the ANP group than in the control group; 20 +/- 3 and 26 +/- 4 mmHg, respectively (p < 0.05). The ANP plasma levels were significantly higher during the first 3 d in the ANP group (p < 0.001). The median recovery rate of renal function was similar in both groups. No patients in the ANP group experienced ATN while 4 patients (20%) in the control group did (p = 0.125). The need for hemodialysis was markedly reduced in the ANP group compared to the control group (1 ANP-treated patient required dialysis once whereas 5 patients from the control group underwent dialysis a total of 26 times; p = 0.068). ANP administration was well-tolerated and no hypotensive episodes were reported. This preliminary study suggests that ANP infusion is at least as effective as maximal hydration in preventing ATN and represents an efficient alternative for transplantation centers which do not use maximal hydration as a standard regimen in managing kidney allograft recipients.

Acute Kidney Injury↗

PubMed1994

Sibling resemblance in two manual laterality tasks.

Two tests of manual performance were adapted for French children: a dot-filling test and a tapping test. Sibling resemblance was assessed in a sample of 46 pairs of sibs. The power of intra-class correlation was estimated by a procedure of Approximate Randomization Tests. In both tests sibling resemblance was significant for overall level of motor skill (i.e. when the two hands were considered separately). Sibling resemblance was significant for degree of laterality in the dot-filling test (the closest task to writing) but not in the tapping test. The usefulness of including degree of laterality measures, in future genetic research is discussed.

Adolescent↗

PubMed1994

Co-segregation of intermale aggression with the pseudoautosomal region of the Y chromosome in mice.

The sexual dimorphism of aggression has led to a search for its Y chromosomal correlates. We have previously confirmed that initiation of attack behavior against a conspecific male is Y-dependent in two strains of laboratory mice (NZB and CBA/H). We provide evidence that the non-pseudoautosomal region of the Y is not involved and that only the pseudoautosomal region of the Y is correlated with initiation of attack behavior. The autosomal correlates also contribute to this behavior in an additive or interactive manner with the pseudoautosomal correlates.

Aggression↗

PubMed1993

Is a dot-filling group test a good tool for assessing manual performance in children?

A dot-filling test was used to assess hand performance in two populations of French children. In the first experiment, the effect of sex, age and handedness on hand performance was examined (1742 children). Age was related to the degree of laterality, but girls were less lateralized than boys. The second experiment (200 children) showed that the surprising sex differences cannot be explained by the group testing procedure. Underlying processes leading to performance in the dot-filling task are probably different from those involved in other tests generally used for children.

Adolescent↗

PubMed1993

Hemostasis in children undergoing liver transplantation.

We reviewed the records of 200 children who underwent 238 orthotopic liver transplantations in order to determine which preoperative factors could predict intraoperative blood loss. A coagulation abnormality score (CAS) was calculated by allowing one point for each abnormality in six preoperative coagulation tests. The mean CAS values were significantly greater in children suffering from fulminant hepatic failure (Fulm) or post-necrotic cirrhosis (PNC) and those having retransplantation (ReTx) than in those with disease of other etiologies. No correlation was found between the CAS and the mean blood requirements in the different etiology groups. According to the amount of blood transfused, children could be divided in two groups. Group 1 were those with biliary atresia and ReTx, who received more than 200 ml/kg. Group 2 included those with PNC, Fulm, metabolic diseases, and Alagille syndrome and Byler disease, who received less than 140 ml/kg. The mean CAS was significantly lower and the PT significantly better in Group 1. We conclude that preoperative coagulation tests were weak predictors of intraoperative bleeding. The etiology of the underlying liver disease and previous abdominal surgery play an important role in the occurrence of severe bleeding. Intraoperatively, children presented the same hemostatic changes as adults.

Biliary Atresia↗

PubMed1993

Early stress tests after successful coronary angioplasty.

The aim of this study was to determine feasibility, safety and yield of early stress tests after successful coronary angioplasty. In 351 consecutive patients with an early stress test performed within 3 days after successful coronary angioplasty, no cardiac or puncture site complications occurred. Seventeen percent of the stress tests remained positive after successful coronary angioplasty. An angiographic explanation, based on the data collected at the time of the angioplasty procedure, was present in 82% of the cases. Positive early stress tests typically only prompted modifications of the drug regimen.

Angioplasty, Balloon, Coronary↗

PubMed1993

Liver transplantation and pulmonary gas exchanges in hypoxemic children.

Hypoxemia in cirrhotic patients is well documented. One of the possible causes of this association seems to be the presence of functional intrapulmonary shunts. The extent of the ventilation/perfusion ratio (VA/Q) abnormalities and their regression after orthotopic liver transplantation has been previously studied in adults by the multiple inert gas elimination technique. We report here a similar study in three children where the hypoxemia was the main indication for early liver grafting, although the liver function was still preserved at that time. Their hypoxemia was almost exclusively caused by a right to left shunt (VA/Q = 0) with a minimal amount of poorly ventilated but well perfused areas (Low VA/Q). This association may explain the poor response of the arterial oxygen pressure to an increased inspired oxygen concentration. Despite these very large VA/Q mismatches, the children underwent successful liver transplantations, resulting in a regression of the intrapulmonary shunt, as demonstrated by multiple inert gas elimination technique, and compatible with a normal life.

Child↗

PubMed1993

Hand performance of French children on a finger-tapping test in relation to handedness, sex, and age.

Hand performance and laterality scores on a unimanual tapping test were studied in relation to age, sex, and handedness in a sample of 209 French children. Each child performed three trials with each hand. Older children were faster, but differences between hands were not related to age. Right-handed girls were more lateralized than right-handed boys. Left- and right-handers could be differentiated more clearly by tapping speed than by variability of tapping. A subsample of 36 right-handers were retested to estimate reliability. The coefficients were high, especially when using the mean of trials as the dependent variable. Correlations between performance on the tapping task and another test of hand-efficiency (dot-filling task) were low.

Child↗