Biomedical subjects
Publications and source records attributed to M Durand.
The case of a patient presenting with a gigantiform fibrous cementoma of the maxillary sinus is described. The diagnostic, the treatment and the histologic classification of the cementifying tumours is reviewed in light of the present literature.
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BACKGROUND: Because of the relative rarity of breast cancer in males, data have not been sufficient to support a definitive analysis of pertinent prognostic factors. Remarkably, no studies of male patients with breast cancer have presented survival information based on the number of histologically positive axillary nodes, the most sensitive single indicator of prognosis in women with breast cancer. METHODS: In this study, the clinical course of breast cancer was documented for 335 male patients registered from 1965 through 1986. For patients to be eligible, diagnoses had to be made within 3 months of registration and the patients had to have histologic confirmation and receive part or all of their initial treatment at 1 of 11 cancer centers participating in the International Patient Data Exchange System. RESULTS: The survival rate at 10 years was 84% for patients with histologically negative nodes, 44% for those with one to three positive nodes, and 14% for the group with four or more histologically positive nodes. The survival rates at 5 years were 90%, 73%, and 55%, respectively. In a multivariable analysis, the risk of death due to breast cancer for a patient with four or more histologically positive nodes was 6.75 times that of a patient with negative nodes. CONCLUSIONS: The findings of the authors indicate the following: (1) The number of histologically positive axillary nodes and, to a lesser degree, tumor diameter are significant prognostic factors for breast cancer in male patients. (2) The prognosis of breast cancer is the same in male and female patients when compared on the basis of the number of histologically positive nodes.
The optimal range of pulse oximeter oxygen saturation (SaO2) for infants with chronic lung disease (CLD) has not been well established. We quantified episodes of spontaneous desaturation, at two different ranges of SaO2. For 1 hr each, we alternatively administered inspired O2 concentrations (FiO2) necessary to maintain an SaO2 of 94-96% or 87-91% to 21 patients (mean birth weight, 865 g; gestational age, 27.3 weeks; postnatal age 40.6 days) with CLD (defined by FiO2 > 0.21 at > or = 28 days and radiographic evidence). SaO2 was monitored with the Nellcor N-200 oximeter and analyzed by a computer program (SatMaster). The percentage of time the infants desaturated to levels of SaO2 < 85 and < 80% revealed significantly fewer spontaneous episodes during the hour of higher baseline SaO2 (P < 0.0002). Comparison of episodes of spontaneous desaturation to SaO2 < 80 and < 85%, lasting 0-15, 16-30, 31-45 sec also showed significant differences between the two levels of SaO2. We conclude that when infants with CLD are maintained at a higher SaO2 they probably experience fewer episodes of spontaneous desaturations, because of less alveolar hypoxia. We believe that attempts at weaning the FiO2 should be tempered with the need of maintaining an adequate SaO2. Therefore, prolonged monitoring of oxygenation in infants with CLD at different levels of SaO2 could be helpful during the weaning process.
The purpose of the present paper was to study the effects of a dietary undigestible carbohydrate and intestinal microflora on mucin distribution (neutral, acid, sulphonated), glycolytic activities: beta-D-galactosidase (EC 3.2.1.23), N-acetyl-beta-D-galactosaminidase (EC 3.2.1.43), N-acetyl-beta-D-glucosaminidase (EC 3.2.1.30), alpha-L-fucosidase (EC 3.2.1.51) and bacterial metabolism (gas production, short-chain fatty acids (SCFA) and lactic acid caecal concentration) in germ-free (GF), conventional (CV) and heteroxenic (HE) rats (GF rats associated with a human flora). Rats were fed on either a control diet or a diet containing 40 g trans-galactosylated oligosaccharide (TOS)/kg. In GF rats fed on the control diet caecal pH was almost neutral and glycolytic activities negligible. The number of mucus-containing cells increased from the caecum to the colon for the three types of mucin. TOS had no effect in the caecum but it modified mucin cell repartition in the colon. In CV and HE rats fed on the control diet caecal pH was similar (6.8), but caecal SCFA and lactic acid concentrations (mumol/g) and gas production (ml/24 h) were higher in CV (70, 5.9 and 2.3 respectively) than in HE rats (32, 4.6 and 0.4 respectively). In CV, as in HE rats, acid-mucin-containing cells increased from the caecum to the colon and glycolytic activities were similar. TOS reduced acid-mucin-containing cells in the caecum of CV rats by twofold but had no effect in either the caecum or the colon of HE rats. TOS strongly increased beta-galactosidase activity and slightly modified the other glycolytic activities. Its effect on bacterial metabolites depended on bacterial status. However, comparison between CV and HE rats showed no evident relationship between the number of mucus-containing cells and measured bacterial metabolites. Differences between CV and HE rats might be due to bacterial microflora specificity. TOS had an intrinsic effect on mucus cell distribution in the colon of GF rats. In CV and HE rats the presence of the flora abolished this effect.
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The aim of this study was to examine the value of systematic preoperative pulmonary function tests (PFTs) in order to reliably predict prolonged stay in I.C.U., prolonged mechanical ventilation and mortality in elective cardiac surgical patients. 149 consecutive adult patients (valvular replacement or coronary bypass graft) were studied retrospectively. We examined the preoperative respiratory data: vital capacity (VC), first second forced expired volume (FEV1), PaCO2 and PO2. Length of stay in I.C.U. (LICU), duration of mechanical ventilation (DMV), incidence of reintubation and survival rate were used as indices of respiratory morbidity. The results of the present study clearly indicate that patients with impaired airway flow rates had a prolonged postoperative recovery following cardiac surgery. Mortality, ICV and DMV increased when FEV1 was less than 1.5 L, VC was less than 2.5 L, or PaO2 was less than 8.5 kPa. Reintubation was associated with impaired flow rates. Pulmonary function tests appeared effective in predicting postoperative complications and the need for prolonged ventilatory support.
The interaction of netropsin, a minor groove binding drug, with T-A-T triple helix and A-T double helix was studied using circular dichroism spectroscopy and thermal denaturation. The triple helix was made by an oligonucleotide (dA)12-x-(dT)12-x-(dT)12, where x is a hexaethylene glycol chain bridged between the 3' phosphate of one strand and the 5' phosphate of the following strand. This oligonucleotide is able to fold back on itself to form a very stable triplex. Changing the conditions allows the same oligonucleotide in a duplex form with a (dT)12 dangling arm. Circular dichroism spectroscopy demonstrates that netropsin can bind to the triple helical structure. Spectral analysis shows that the bound drug exhibits a conformation and an environment similar in double-stranded and in triple-stranded structure. However, the binding constant to the triple-stranded structure is found smaller than the binding constant to the double-stranded one. Thermal denaturation experiments demonstrate that netropsin destabilizes the triplex whereas it stabilizes the duplex.
The triple-helix formation by the oligonucleotide (dA)12-x-(dT)12-x-(dT)12, where x is a hexaethylene glycol group, was investigated by thermal denaturation analysis and circular dichroism spectroscopy. Thermal denaturation analysis showed that this single-stranded oligonucleotide is able to fold back on itself twice to give a triple helix at low temperature. Upon an increase in the temperature, two cooperative transitions were observed: formation of a double-stranded structure with a dangling x-(dT)12 extremity, then formation of a single-stranded coil structure. Due to the intramolecular character of the transition, the triplex is much more stable than that formed by the reference mixture (dA)12 + 2(dT)12. In 0.1 M NaCl, the triplex-to-coil transition occurred at about 30 degrees C whereas the duplex-to-coil was at about 60 degrees C. Upon an increase in the salt, the increase of temperature corresponding to the triplex-to-duplex transition was larger than that of the duplex-to-coil transition. MgCl2 showed higher efficiency than NaCl to promote triplex or duplex formation. The thermodynamic parameters delta H and delta S were determined at various ionic strengths for both transitions. Both the enthalpy change and entropy change associated with triplex-to-duplex transition (Hoogsteen base pairing) were smaller than those associated to the duplex-to-coil transition (Watson-Crick base pairing). When the ionic strength increased, the parameters -delta H and -delta S showed a very small decrease for the duplex-to-coil transition whereas a strong increase was observed with the triplex-to-duplex transition.(ABSTRACT TRUNCATED AT 250 WORDS)
Patients with chronic lung disease (CLD) have frequent episodes of spontaneous desaturations. Utilizing computerized pulse oximetry (CPO) we quantified the frequency and severity of spontaneous desaturations in very low birth weight (VLBW) infants with CLD. Thirty-four studies by CPO were performed in intubated infants for 4 hours; 17 patients (birth weight, 550-980 g; postnatal age 28-85 days) had CLD, and 17 (birth weight, 520-980 g; postnatal age, 1-7 days) had acute lung disease. Oxygen saturation (SaO2) was measured with the Nellcor N-200 oximeter, its serial output (updated once a second) captured by a computer. Pulse rate, pulse amplitude, and heart rate were also monitored continuously. We measured respiratory system mechanics in 23 patients. Tidal volume (VT), respiratory system compliance (Crs), and resistance (Rrs) were obtained by the PeDS system. Spontaneous desaturation to SaO2 less than 90% occurred for 4.5% of the time in acute patients vs. 27.1% of the time in chronic patients (P less than 0.0001); to SaO2 less than 85%, 0.7% vs. 7.6% of the time in acute vs. chronic patients (P less than 0.002); and to SaO2 less than 80%, 0.4% vs. 2.6% of the time in acute vs. CLD patients (P less than 0.05). Rrs was significantly higher in the ventilated patients with CLD (174 cmH2O/L/s) than in the ventilated patients with acute lung disease (94 cmH2O/L/s, P less than 0.0001). The mean Crs values of the two groups were comparable. Our preliminary data indicate that VLBW infants with CLD receiving assisted ventilation have a greater number of spontaneous desaturation episodes, as compared to patients with acute lung disease.
OBJECTIVE: Our purpose was to determine the relationship of umbilical acid-base status and Apgar score to neonatal asphyxial sequelae in infants with severe acidemia (pH < 7.00). STUDY DESIGN: The obstetric and neonatal course of 129 term, nonanomalous singleton infants with umbilical pH < 7.00 was reviewed. RESULTS: There were three stillbirths (failed resuscitation). Seventy-two of 126 (57%) were admitted to the neonatal intensive care unit. Thirty-eight percent had pulmonary dysfunction, 26% renal dysfunction, 31% cardiac dysfunction, and 31% hypoxic ischemic encephalopathy (seizures and hypotonia, n = 29; seizures only, n = 3; hypotonia only, n = 10). There were five neonatal deaths. In 109 cases umbilical arterial values were available, and among these infants there was a significant increase in the incidence of seizures with declining pH from 9% (5/57), with a pH of 6.90 to 6.99, to 80% (8/10), with a pH of 6.61 to 6.70. Respiratory acidemia (PCO2 > 65, base deficit < 10) was identified in 28 of 109 (26%), all but six occurring in the pH range above 6.90. Compared with infants with comparable umbilical artery pH, infants with respiratory acidemia did not differ significantly with respect to asphyxial end-organ injury in general (8/35 vs 6/22), but there was a trend toward a lower incidence of hypoxic ischemic encephalopathy (6/35 vs 1/22, p = 0.06). All infants with definite abnormal outcome (five neonatal deaths and 10 severe neurologic deficit) had seizures, hypotonia, and at least one other organ system dysfunction. Twenty-four of 29 infants (83%) who developed seizures had a 5-minute Apgar score < 7, but only 12 of 29 (41%) had a 5-minute Apgar score of < or = 3. Two infants with Apgar scores of 6 and 7 at 5 minutes and no evidence of nonasphyxial comorbidity subsequently manifested profound neurologic deficit. CONCLUSIONS: Infants with severe umbilical acidemia can be separated with regard to risk of hypoxic ischemic encephalopathy and abnormal neurologic outcome by consideration of the severity and composition of the acidemia and evidence of other end-organ dysfunction. Even in this pH range the Apgar score is not highly predictive of asphyxial complications.
Nine of nineteen infants in this study exhibited two or more central apnea greater than or equal to 20 seconds when they were older than one week and between 32-36 weeks postconceptional age (PCA). We focused on the sequelae of these apneas. Apnea was separated from other morbidity associated with immaturity by the selection of consistently healthy infants. Following discharge, polygraphic tracings were obtained at 40, 44 and 52 weeks PCA in these non-apneic and previously apneic infants. Sleep states, minute by minute values for heart and respiratory rate, skin temperature and transcutaneous O2 (PtcO2) and CO2 (PtcCO2), apnea and transient decreases in PtcO2 were determined. Polygraphic measurements did not differentiate preterm infants with late apnea in the nursery from non-apneic ones. However, the apneic group exhibited a transient decrease in awakenings at 44 weeks PCA.
From January 1985 to December 1987, 228 women with breast cancer smaller than 3 cm were treated by surgery +/- radiotherapy. All of them had axillary node involvement (N+) and/or lacked estrogen and progesterone steroid receptors (EPR-). They were randomized in an adjuvant chemotherapy trial comparing 9 intravenous CMF courses (cyclophosphamide, methotrexate, 5FU)--113 patients--to a polychemotherapy consisting of 3 courses of MTV (mitomycin C, thiotepa, vindesine) plus 3 courses of EVM (epirubicin, vincristine, methotrexate)--115 patients. Prognostic factors were well balanced between the two treatment groups. With a 59-month median follow-up, local breast relapses are more frequent in the CMF group, but regional and metastatic recurrences are the same in the two groups. Overall survival is identical. Toxicity is different: alopecia and neurotoxicity are more frequent in the MTV+EVM group, but general and digestive toxicities are equivalent. Haematologic toxicity is greater in the CMF group, requiring more frequent dosage reductions.
Repetitive polysomnograms were recorded from a total of 33 infants, 19 healthy preterm infants, and 14 term controls between 40 wk postconceptional age and 6 mo of age. These nighttime recordings lasted 2-4 h, except at 52 wk in preterm infants and at 3 mo of age in term infants when an overnight 12-h recording was performed. Minute by minute values of transcutaneous PO2 (PtCO2) and transcutaneous PCO2 (PtcCO2) levels and variability during the awake state, active sleep, and quiet sleep were obtained through computer analyses of the polygraphic data. The results from preterm infants at corrected postconceptional age could not be differentiated from those of control infants. PtCO2 levels rose between 40 wk and 3 mo, and PtcCO2 levels declined. Sleep states modulated only the variability of PtcO2, not the level; in contrast, state modulation was seen in both variability and level of PtcCO2 throughout the age span studied. During sleep the number of transient declines in PtCO2 greater than 2.03 kPa (15 mm Hg) decreased with advancing age. Hypercapnic PtcCO2 values decreased with age as well, but their prevalence in healthy, young infants suggests the need for reevaluation of criteria for hypercapnia based on transcutaneous measurements. The data demonstrate that ventilatory regulation continues to undergo changes between 1 and 3 mo, the age of highest risk for sudden infant death syndrome.
Thymidine kinase (TK) was assayed in the cytosol of 210 primary breast cancers to assess its predictive value for response to first line chemotherapy and hormonotherapy. We performed correlations between TK and the other prognosis factors of breast cancer. TK activity is correlated with SBR grading and estrogen receptors. It has a low predictive value for response to chemotherapy and is not useful for hormonotherapy.
Four cases of tracheo-oesophageal fistulae following mechanical ventilation are reported. The determining factors, revealing signs, and palliative and curative treatment are discussed based on a review of the literature. In this series, the tracheotomy cannula provided good protection of the upper airways in three cases of upper fistulae. In the other case, the fistula was too close to the carena, requiring the use of high frequency jet ventilation. The management of low, large fistulae is more problematic concerning the choice of technique and timing of the operation.
Sodium nitroprusside is widely used in the treatment of hypertension after coronary artery bypass surgery despite its toxicity and its deleterious effect on the coronary circulation. The aim of this study was to compare the safety and effectiveness of nicardipine with sodium nitroprusside in a randomized study. Nicardipine and sodium nitroprusside are effective for controlling hypertension after coronary artery surgery. Oxygen myocardial balance was more often improved by nicardipine than by sodium nitroprusside. Hemodynamic stability was better with nicardipine which was also devoid of toxicity and might therefore have advantages over sodium nitroprusside in the management of hypertension after coronary artery surgery.
The binding of the lac repressor and the lac repressor N-terminal headpiece to a mini-operator with a hairpin loop made of a hexaethylene glycol chain was investigated using circular dichroism spectroscopy. The lac repressor's headpiece binds to the modified mini-operator with the same affinity as to a mini-operator of the same sequence without the hexaethylene glycol loop. The conformational effect due to the binding is not affected by the presence of the hexaethylene loop. It is also shown that the entire lac repressor binds to this modified mini-operator inducing a conformational change.