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Biomedical subjects

M Durand

Publications and source records attributed to M Durand.

At least 181 records · Page 10Linked to original sources
PubMed1987

Pulse oximetry in very low birth weight infants with acute and chronic lung disease.

With improved survival of very low birth weight infants, the incidence of bronchopulmonary dysplasia has significantly increased. Pulse oximetry appears to be an adequate alternative to transcutaneous PO2, for continuous arterial oxygen saturation (SaO2) monitoring in neonates; however, its usefulness has not been very well documented in very low birth weight infants. We studied 68 patients with birth weight less than 1,250 g; 44 neonates had respiratory distress syndrome and 24 had bronchopulmonary dysplasia. Using a Nellcor N-100 pulse oximeter, we compared transcutaneous oxygen saturation with simultaneous arterial samples analyzed for SaO2 (range 78% to 100%) using an IL 282 co-oximeter. Fetal hemoglobin was measured in 66 patients. We also evaluated the accuracy of transcutaneous PO2 in reflecting arterial PO2 in patients with bronchopulmonary dysplasia. Over a wide range of PO2, PCO2, pH, heart rate, BP, hematocrit, and fetal hemoglobin, linear regression analysis revealed a close correlation between pulse oximeter values and co-oximeter measured SaO2 in patients with acute (r = .88, Y = 19.41 + 0.79X) and chronic (r = .90, Y = 9.72 + 0.92X) disease. Regression analysis of transcutaneous v arterial PO2 in infants with bronchopulmonary dysplasia showed an r value of .78. In addition, in these patients with chronic disease, the mean difference between pulse oximeter SaO2 and co-oximeter measured SaO2 was 2.7 +/- 1.9% (SD); whereas the mean difference between transcutaneous and arterial PO2 was -14 +/- 10.7 mm Hg. Our findings indicate that pulse oximetry can be used reliably in very low birth weight infants with acute and chronic lung disease, for SaO2 values greater than 78%.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1987

[Acute primary alveolar hemorrhage or Goodpasture's syndrome?].

We report a case of idiopathic diffuse alveolar haemorrhage with fatal outcome in a 23 year old man. In the absence of any renal abnormality of circulating antiglomerular basement antibody the diagnosis of Goodpasture's syndrome was made taking into account the history and the autopsy evidence of linear deposits of immunoglobulin on the glomerular basement membranes.

Acute Disease↗
PubMed1987

[Evaluation of the mid-term results of trident osteotomy using orthodontic goniometry].

The authors study a series of twenty patients who underwent a "trident" maxillary osteotomy for transversal deficiency. They try to have a good evaluation of the exact value of the inter-molar distance after one year, in comparison with the expected value on the plaster casts before operation. Furthermore, they measure the axial modifications of the first molar, which consists in vestibulo or linguo version. For this study, they use a simple method which is called "orthodontic goniometry" and give a great precision. The transversal augmentation seems to be quite stable, with only fifteen per cent lost in the measured intermolar distance. But there are dental axial changes in eighty per cent of the patients. The most common modification consist in vestibular inclination, without damage for the result. But in thirty per cent of the cases, a palatal inclination is observed, with deterioration of the results. This is a good reason for maintaining a palatal contention during at least six months after surgery.

Adolescent↗
PubMed1987

[From a clinical data base to the conception of treatment protocols. Example in operable cancers of the breast].

At Fondation Bergonié, a data base has been settled since ten years concerning all the patient who had been treated there for breast cancer. Collection of these data, compared with those reported in the medical literature, have allowed us to discuss orientations for clinical research, and to establish coherent treatment protocols fitting as much patients as possible. Eventually an interdisciplinary consensus was obtained on clinical trials to be performed, according to prognostic variables defined, and the foreseeable duration of patients inclusion and accrual.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1987

[Development of a knowledge-based system for aiding therapeutic decision in breast cancer].

The SENEX project has been initiated at the fondation Bergonié in 1985 and is intended for providing physicians in general hospitals with knowledge based systems for the management of cancer treatment protocols. The design and building of a knowledge-based system for the management of breast cancer protocols (SENEX) was the first goal of this project. SENEX has been developed using a commercially available development tool (Personal Consultant Plus, Texas-instruments) derived from EMYCIN. It runs on IBM and compatible microcomputers. The knowledge base embeds the formal knowledge contained in the breast cancer protocols currently in use at the fondation Bergonié, and some judgmental knowledge acquired form breast cancer experts. Production rules and frames allowed us to adequately represent and structure this knowledge and the problem solving processes related to the management of breast cancer. A preliminary informal evaluation of the system has shown that it performs at the expert-level in giving advice for patients included in formal protocols. Its use and acceptability are good. However, we have to add judgmental knowledge into the knowledge base and to interface the system with a temporal data base management system to improve the overall performances of SENEX. Moreover the effectiveness of the system remains to be demonstrated before one can anticipate is routine use in clinical practice.

Breast Neoplasms↗
PubMed1986

Monoamine oxidase activity in chick cerebral microvessels.

In chick brain microvessels, monoamine oxidase activity using catecholamines (dopamine and noradrenaline) and indoleamines (serotonin and tryptamine) as substrates was higher than that measured in synaptosomes and free mitochondria. In contrast, phenylalkyamines such as tyramine and 2-phenylethylamine were more deaminated in free mitochondria and synaptosomes than in microvessels. These results suggest that the activity of monoamine oxidase towards neurotransmitter amines in microvessels should be considered as a site of inactivation of these neurotransmitters in the chick brain parenchyma.

Animals↗
PubMed1986

Maitotoxin stimulates the formation of inositol phosphates in rat aortic myocytes.

Maitotoxin is the most potent of the known marine toxins. The effect of maitotoxin on muscle contraction or hormone release was consistent with its action on the voltage-sensitive channel. Indeed, calcium antagonists such as nifedipine or diltiazem were able to reverse the maitotoxin effects. Using smooth muscle cells, we have analysed the effects of maitotoxin on the inositol phosphate metabolism. Maitotoxin stimulates the inositol phosphate formation (5 +/- 1.8-fold in the presence of 10 mM LiCl). Moreover, this effect is not reversed, even partially by calcium antagonists, by alpha 1 antagonists and is not mimicked by Ca2+ ionophores such as A23187 or calcium agonists such as Bay-K 8644. The action of maitotoxin is further discussed in this paper.

Animals↗
PubMed1986

Pulse oximetry for continuous oxygen monitoring in sick newborn infants.

We studied 54 neonates with acute cardiorespiratory illness and 21 infants with bronchopulmonary dysplasia, to evaluate the accuracy of a nonheated pulse oximeter in predicting arterial oxygen saturation (SaO2). We also studied the accuracy of transcutaneous oxygen tension (tcPO2) in estimating arterial oxygen tension (PaO2) in infants with bronchopulmonary dysplasia. We compared pulse oximeter SaO2 with simultaneously measured SaO2 (range 78% to 100%) using a co-oximeter. Over a wide range of values for heart rate, blood pressure, hematocrit, PO2, PCO2, and pH, linear regression analysis revealed a close correlation between in vivo pulse oximeter readings and in vitro SaO2 measurements in patients with acute (r = 0.86, Y = 29.64 + 0.68X) and chronic (r = 0.91, Y = 6.29 + 0.96X) disease. Regression analysis of tcPO2 versus PaO2 showed an r value of 0.76 in infants with bronchopulmonary dysplasia. In these patients the mean difference between pulse oximeter SaO2 and in vitro SaO2 was 2.9% +/- 1.8% (SD), whereas the mean difference between tcPO2 and PaO2 was -14.5 +/- 11.1 mm Hg. Fetal hemoglobin ranged from 4.3% to 95%. We conclude that pulse oximetry is an appropriate alternative to tcPO2 for continuous oxygen monitoring in newborn infants with acute cardiorespiratory illnesses and chronic lung disease.

Acute Disease↗
PubMed1986

[Peridural anesthesia with procaine and fentanyl in a parturient with acute intermittent porphyria].

Acute intermittent porphyria is one of three severe hepatic porphyrias. Clinical manifestations include intermittent acute attacks of abdominal pain and neuropathy with an occasionally outcome. These attacks are often precipitated by endogenous (menstrual cycle and pregnancy in women) or exogenous factors (porphyrinogenic drugs). An epidural analgesia was performed during the labour of a pregnant woman with acute intermittent porphyria just after an acute attack of abdominal pain. Analgesia was obtained using procaine and fentanyl. The choice of drugs was based on available clinical reports and experimental studies of the porphyrinogenicity of drugs in animal models (rat in vivo and chick embryo in ovo).

Acute Disease↗
PubMed1986

[Hormonotherapy of metastatic breast cancer with tamoxifen and medroxyprogesterone acetate. Randomized trial comparing alternating sequences with successive applications].

Sixty-eight women with metastatic breast cancer occurring less than five years positives after the treatment of the primary tumour, with estrogens and/or progesterone receptors (EPR), were randomized. Sixty-four patients were available for evaluation of efficacy and toxicity. Thirty patients received treatment A: tamoxifen 30 mg per day alternating every two weeks with medroxyprogesterone acetate (MPA) 1 000 mg per day orally. Thirty-four received treatment B: tamoxifen 30 mg per day and after relapse, high dosage of MPA alone. The distribution of the evaluable metastasis and the value of the ER are the same in the two groups. The total responses or the responses by metastatic site were as follows: complete response, one case in each treatment group, partial response, 6 and 10 cases, no change, 14 and 17 cases and progressive disease, 9 and 6 cases respectively. The duration of the response was the same in the two groups with a median of 6 months (extremes of 30 and 19 months). Among the patients under protocol B, 19 received MPA after failure of tamoxifen: eight responded (3 partial responses and 5 no change). Toxicity was slight but 2 treatments in group A were discontinued. Alternated sequential hormonal treatment is theoretically attractive for these patients with known and positive EPR but it is not more efficient than the two hormonotherapies applied successively.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1986

[Chemotherapy of breast cancers. Coordinated evolution of therapeutic schemes from 1975 to 1985].

In 10 years the schemes of medical treatment of breast cancer have progressed in the direction of greater efficacy (balanced multiple associations), improved articulation with other therapeutic tests, increased ease of application (single perfusion) and lower toxicity (especially from the cardiac point of view), which make it possible to extend the indications to less advanced forms.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1986

Prospective evaluation of percutaneous central venous silastic catheters in newborn infants with birth weights of 510 to 3,920 grams.

With improved neonatal survival, especially of very low birth weight infants, our efforts should be directed toward reduction of morbidity. Sick preterm infants require total parenteral nutrition for prolonged periods of time due to extreme prematurity and feeding intolerance. However, the use of surgically placed Broviac catheters has been associated with a high complication rate. A prospective study of 53 percutaneous central venous Silastic catheterizations for administration of total parenteral nutrition was performed in 45 newborn infants. At the time of catheter insertion, 37 babies weighted less than 1,500 g and 19 weighed less than 1,000 g. Percutaneous central venous catheters were placed successfully the first time in 50 of 55 attempts. In three babies, insertion was successful on second attempt. The catheters remained in place for 25.4 +/- 16.7 days ([mean +/- SD] range two to 80 days). In babies weighing less than 1,000 g, the catheters remained in place for a longer period of time (34.0 +/- 18.0; range 12 to 80 days). Sixty-six percent of the catheters were removed electively. There were four cases of bacteremia (7.5%), and the overall incidence of mechanical complications was 26.4%. We conclude that percutaneous central venous catheters can be used safely and effectively in newborn infants for prolonged administration of total parenteral nutrition, especially in neonates weighing less than 1,000 g.

Birth Weight↗
PubMed1986

[Influence of dietary factors on microbial protein synthesis in the rumen].

The effect of dietary factors (usually controlled in practice) on microbial protein synthesis is reviewed using in vivo experiments. Attention is drawn on the necessity to clearly distinguish variations in microbial growth efficiency from those of intestinal flow of microbial protein and to consider simultaneously variations in feed protein degradation. In practice, the relationship between microbial protein synthesis and energy intake depends mainly on diet composition and the nature of the forage. Microbial protein flow to the intestine, relative to energy intake, is lower with high concentrate diets (when given in restricted amounts), with silages and with antibiotic supplements. This flow is increased by some forage processing (such as dehydration and alkali treatments), by natural or induced defaunation, and occasionally by increased feeding frequency (when intake is restricted) and buffer and vitamin supplements. However, with some factors such as feeding frequency and antibiotics supplementation, these variations are partly counterbalanced by reverse effects on feed protein degradation.

Animal Feed↗
PubMed1986

[Prognostic significance of isolated local recurrences in breast cancer following mastectomy and axillary node excision. Apropos of 77 recurrences in 2362 patients].

During the years 1958-1984, 2 362 patients presenting with breast carcinoma were treated at the Fondation Bergonié by modified radical mastectomy and followed or not by radiotherapy or adjuvant chemotherapy. A retrospective analysis of this series showed that 77 patients (3.3%) presented an isolated locoregional recurrence as the first sign of treatment failure. A chest wall recurrence alone was noted in 47 patients, while 30 presented an involvement of the lymph nodes, sometimes associated with chest wall disease. The prognosis' factors of isolated locoregional recurrence, studied by multidimensional analysis by Cox's model are by decreasing order the disease free interval and the Scarf and Bloom's histologic grade. The median survival is 29 months after isolated locoregional recurrence and the survival curve is very similar to that of patients with isolated bone metastatic recurrences (median survival of 26 months) and slightly better than the median survival of patients with non osseous metastasis (median survival of 16 months).

Axilla↗
PubMed1985

The incidence of herpes zoster in patients with Hodgkin's disease. An analysis of prognostic factors.

The incidence of zoster in 717 patients with Hodgkin's disease was determined by a retrospective chart review. All patients had been treated and followed in one of six cancer centers. Prognostic factors that might predict the subsequent incidence of zoster were examined by univariate and multivariate analytic techniques. Intensity of treatment was a key factor in the incidence of zoster. Thirty-six months after initiation of treatment, patients receiving chemotherapy-radiation-chemotherapy had twice the attack rate (27.3%) of those receiving radiation alone (11.5%). The pediatric age group had a significantly higher attack rate (26.6%) than did adults (18.7%). Stage, histology, and laparotomy did not influence the incidence of zoster.

Adolescent↗
PubMed1985

Ventilatory control and carbon dioxide response in preterm infants with idiopathic apnea.

Idiopathic apnea in preterm infants, more than 30 weeks of gestation, after the first week of life is uncommon and poorly understood. To study ventilatory control in these infants we measured minute ventilation, respiratory frequency, tidal volume, end-tidal oxygen pressure and carbon dioxide pressure, and transcutaneous oxygen pressure before and during the fifth minute of breathing 4% carbon dioxide in air. Nine healthy preterm infants and eight infants with three or more episodes of apnea (greater than or equal to 20 s) in 24 hours were studied during active sleep. We found that infants with apnea had a significantly increased alveolar carbon dioxide pressure while respiratory frequency, minute ventilation, and slope were significantly decreased. Alveolar-transcutaneous oxygen gradients were essentially unchanged. These preterm infants with apnea have a decreased carbon dioxide sensitivity. They have a decreased minute ventilation primarily as a result of decreased respiratory frequency and their alveolar-transcutaneous oxygen gradient is normal. Our findings suggest that the major deficit in these infants is a central disturbance in the regulation of breathing.

Apnea↗
PubMed1985

Analysis of a series of sixty soft tissue sarcomas in adults treated with a cyclophosphamide-vincristine-adriamycin-dacarbazine (CYVADIC) combination.

From 1976 to 1983, a group of 60 adult patients presenting with metastatic and/or locally advanced soft tissue sarcomas was treated with combination chemotherapy consisting in cyclophosphamide, vincristine, adriamycin, and DTIC (CYVADIC). A tumor response was obtained for 29 patients (48.3%), with 4 (6.7%) cases of complete regression. The median duration of the response was 10 months. Responses were noted in 14/22 patients receiving induction chemotherapy for advanced, and previously nonirradiated, primary tumors; among the patients with metastatic disease tumor regression was recorded in 17/32 patients with pulmonary metastases, but in none of the patients with metastases at other sites. Moreover, the attainment of a response was found to correlated with the patient's general condition, while response duration depended on the histoprognostic grade of the tumors.

Adolescent↗