[The bed of Procrustes. How and when to institutionalize the elderly patient].
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Biomedical subjects
Publications and source records attributed to M Robert.
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An echographic study of the fetal normal kidney in 274 fetuses (548 kidneys measured) from 15 to 40 weeks of pregnancy is proposed by the authors. This work includes morphologic and biometric study with the growth curves of 4 parameters. It is shown that both kidneys are morphologically similar and their growth is continuous and there is a constant ratio between the different parameters. Ratios are established: Length/BPD = 0,45 +/- 10%, Width/BPD = 0,27 +/- 10%, Thickness/BPD = 0,26 +/- 10% which are very useful for the echographist. One hopes that with morphologic and biometric criteria of normality, the early detection of urinary tract malformations will be easier.
Reporting a clinical observation, the authors emphasize upon the scarceness of sacroiliac osteochondritis. Sacroiliac osteochondritis is difficult to recognize, it is rather frequently a case of diagnosis by elimination, which can be only confirmed by the course. Its prognosis is excellent. The best management is strict rest.
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A case of gastroschisis and double small bowel atresia is reported. Primary surgical treatment consisted in jejunostomy located at 28 cm from the ligament of Treits, reinstatement of excluded bowel loops encased in a thick matrix of fibrinous material, and abdominal wall closure. Seven weeks later, the lower part of small bowel was anastomosed to the medium part. Because of uneven bowel caliber, an ileostomy was associated to parenteral nutrition using permanent instillation of secretions recovered from ileostomy was associated to parenteral nutrition. At 4 1/2 month, small bowel continuity was restored with jejunal modeling. Authors stress the necessity to preserve as far as possible, intestinal segments in such a case and emphasize the advantage of the digestive instillation method in order to recover the function excluded intestinal segments.
Calcified intraluminal meconium is rarely observed in newborn. Only 27 cases are related in litterature; the authors report 4 new cases and point out the role of intestinal obstruction (principaly anorectal malformations, but also atresia, meconium ileus or Hirschsprung disease). Pathogenesis is unknown, while intestinal urinary fistula is frequently described.
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All cells that harbor the Epstein-Barr virus (EBV) genome contain a neoantigen in the nucleus (EBNA). By transfection we located a segment of the genome that encodes or induces an antigen serologically related to EBNA. The responsible genes are found in the 3.4-megaldalton BamHI fragment K of EBV DNA, specifically in the left 1.9 megadaltons represented by HindIII fragment I1. Mouse LTK- cells were cotransformed with recombinant plasmids, containing the herpes simplex virus thymidine kinase gene and either EcoRI fragment B or BamHI fragment of K of EBV DNA. The TK+ cells surviving in selective medium were cloned. About 50% of the clones expressed the neoantigen in every nucleus. These mouse cells were used as antigens in immunofluorescence tests. Antibody to the nuclear antigen was found in 30 human sera known to contain antibody to EBNA; it was not detected in 18 sera that did not have antibody to EBNA. Mouse cells expressing EBNA as the result of acquisition of cloned EBV DNA fragments should prove useful in the characterization of the structure of this antigen and as reagents for the diagnosis of EBV infections.
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In view of the fact that the inhomogeneity effects on pulmonary diffusing capacity (DL) estimates are quite different for O2 and for CO, simultaneous determinations of steady-state DLCO and DLO2 were attempted and compared. To this end, pulmonary gas exchange was measured in 17 anesthetized and artificially ventilated dogs, in hypoxia with and without carbon monoxide in inspired gas (FIO2 = 0.12, FICO = 0.0009 to 0.0016). The diffusing capacity estimates were computed by two conventional procedures, the first (Dapp) taking into account the mean alveolar partial pressures and the second (DVDA) the ideal alveolar partial pressures. It was found that the presence of COHb in blood, inevitable in the steady-state DLCO procedure, leads to a marked underestimation of DLO2; therefore DLCO values could only be adequately compared to DLO2 values obtained in the absence of CO from inspired gas. These DLO2 were 18.5 and 33.4 mumol . min-1 . Torr-1 . kg-1 for the mean DappO2 and DVDAO2, respectively, whereas the DLCO values obtained after 15 to 25 min CO inspiration were 30.0 and 83.4 mumol . min-1 . Torr-1 . kg-1 for the mean DappCO and the mean DVDACO, respectively. The salient feature is that with both procedures the mean value of DLCO estimate is higher than the corresponding DLO2 estimate. This finding suggests that in anesthetized, artificially ventilated dogs DappO2 and DVDACO estimates obtained by steady-state procedures in hypoxia are largely influenced by inhomogeneity effects and of limited value for assessment of the diffusing properties of the lung. DappCO and DVDAO2 are also affected by inhomogeneities but to a lesser degree.