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Biomedical subjects

N Delorme

Publications and source records attributed to N Delorme.

At least 19 recordsLinked to original sources
PubMed1998

[Prevention of venous thromboembolism. Survey of in-hospital medical practice].

OBJECTIVES: In an effort to improve the prevention of venous thromboembolism, the Nancy University Hospitals conducted a survey of medical practice concerning indications for preventive therapy and surveillance of platelet counts and anti Xa activity. METHODS: The survey involved 163 medical files. Questionnaires were filled out in 6 units (3 medical wards and 3 intensive care units). RESULTS: Indications for preventive therapy were found to be quite variable with the exception of very low risk of thromboembolism where the treat/do not treat ratio was 0.1/1, indicating a clear tendency for abstention. This ratio was 0.77/1 and 0.38/1 respectively for low and moderate risk and 2/1 for high risk. There was undoubtedly a ward effect. The attitudes in practice tended toward non-prevention in patients without limited mobility. For platelet counts, an initial count was performed in 95% of the cases and during treatment in 38% although the specific rates were not the same for different types of units. Anti-Xa activity, which according to prevention recommendations need not to be determined, was not monitored in 88% of the cases. In accordance with prevention recommendations, anti-Xa activity was not determined in 88% of the cases. CONCLUSION: Further progress is needed in the prevention of venous thromboembolism and should be based on wider use of existing methods.

France↗
PubMed1996

[Fibrosing pneumopathy caused by labetalol].

A diffuse interstitial pulmonary fibrosis occurred in a 74-year-old woman treated for ten years with labetalol for systemic hypertension. Bronchoalveolar lavage (BAL) revealed lymphocytic and neutrophilic alveolitis. The lack of another etiologic factor and the spontaneously favorable course after withdrawal of the drug support the hypothesis of a labetalol induced pulmonary fibrosis.

Adrenergic beta-Antagonists↗
PubMed1995

Effect of acute hypercapnia on alpha atrial natriuretic peptide, renin, angiotensin II, aldosterone, and vasopressin plasma levels in patients with COPD.

Disturbances in hormonal systems involved in sodium and water homeostasis are common during respiratory insufficiency. To investigate the role of hypercapnia, we designed a study to examine the hormonal response to acute hypercapnia induced at constant cardiac filling pressures and without hypoxemia. Seven sedated patients with COPD receiving mechanical ventilation were studied during five successive periods. Hemodynamics, arterial blood gases, and plasma hormone levels (atrial natriuretic peptide, renin, angiotensin II, aldosterone, vasopressin) were measured three times during 60 min of acute hypercapnia (52 +/- 5 mm Hg) and at control periods, before (36 +/- 4 mm Hg) and after (42 +/- 3 mm Hg) acute hypercapnia. During acute hypercapnia, mean pulmonary arterial pressure and cardiac output were increased without variation of other measured cardiorespiratory data and hormonal levels when compared with control values. After acute hypercapnia, cardiorespiratory variables returned to control values without variations of hormonal levels. Our results show that moderate acute hypercapnia does not significantly influence the hormonal levels when cardiac filling pressures and sympathetic tone remain stable. We suggest that changes in those plasma hormones involved in salt and water homeostasis during acute hypercapnia are secondary to hemodynamic changes induced by acute respiratory failure and not to acute hypercapnia per se.

Aged↗
PubMed1995

[Methotrexate pneumonitis arising during the treatment of non-Hodgkin's lymphomas with the m-BACOD protocol].

We retrospectively studied 32 patients treated with the m-BACOD regimen in a single institution between January 1988 and December 1991. After four to seven courses, four patients presented severe acute pneumonitis (PaO2 < 55 mmHg in room air), with diffuse bilateral interstitial syndrome. Broncho-alveolar lavage displayed increased lymphocyte count (> 45%) with inversion of CD4/CD8 in two cases and no evidence of parasitic, bacterial or viral infection. All patients received methyl-prednisolone (0.5 to 1 mg/kg/d x 1 week) with both complete clinical and radiological recovery within a week. The m-BACOD regimen was continued without bleomycine for four patients and without bleomycine plus methotrexate for two patients, until the completion of eight courses, without recurrence of pneumonitis. Drug-exclusion decisions were made empirically because the exact nature of the pneumonitis was not recognized at the time of diagnostic. Because of the regular administration in the m-BACOD regimen, methotrexate leads to an increased risk of pneumonitis. We concluded that the use of the m-BACOD regimen should henceforth be discontinued.

Adult↗
PubMed1995

[Contribution of bronchoalveolar lavage and transbronchial biopsy to diagnosis and prognosis of drug-induced pneumopathies].

This survey reports on 10 case-studies of drug-induced pneumonitis. The drugs under consideration are amiodarone, methotrexate, chlorambucil, sulindac, nilutamide-leuproreline, cyclothiazide, with the possible addition of bleomycin. In each case, one or more bronchoalveolar lavage were carried out and in most cases it was also possible to perform a transbronchoscopic lung biopsy. The results of these tests are analysed in order to ascertain their contribution to diagnosis and prognosis. Regarding diagnosis, bronchoalveolar lavage does not evidence a typical cellular configuration characterizing drug-induced alveolitis. Moreover, transbronchoscopic lung biopsy plays no part in diagnosing this pathology. Both these tests, however, help to eliminate other hypotheses. Regarding prognosis, transbronchoscopic lung biopsy provides no information, unlike bronchoalveolar lavage in which a high rate of neutrophils in the lavage fluid is sometimes associated with the development of pulmonary fibrosis.

Acute Disease↗
PubMed1992

[Drug-induced pulmonary diseases: diagnostic, therapeutic and prognostic aspects. Apropos of 10 personal case reports].

The authors report ten cases of drug induced lung diseases, complicated by respiratory failure of whom five were attributed to cytotoxic drugs and five to non cytotoxic drugs. The drug induced lung disease presented as acute respiratory distress syndrome in two cases, alveolar interstitial lung disease in three cases, purely interstitial in five cases. There was acute respiratory failure (ARF) in eight cases and chronic respiratory failure (CRF) in two cases. Among the five patients admitted for cytotoxic drug induced lung disease and ARF, four recovered and one died of diffuse destructive pulmonary fibrosis. Among the five patients having non cytotoxic drug induced lung disease, three were in ARF and recovered. The other two had CRF and died of diffuse pulmonary fibrosis. The diagnostic of drug induced lung disease was established in each case with the chronology of the clinical events, the exclusion of other possible causes of the lung disease and the evolution after removal of the incriminated drug. Broncho-alveolar lavage (BAL) had a major diagnostic value. It was contraindicated by respiratory failure in five cases. The predominant alveolar cell type was lymphocyte (four cases), eosinophil (three cases) and neutrophil (one case), BAL was realized with a provocation test and demonstrated the pathogenic role of cyclothiazide in one case. No specific information was given by histology. The prognosis did not seem to be linked to the severity of the initial clinical picture, or to the nature of the underlying neoplastic disorder, but to the degree and evolution of the pulmonary fibrosis.

Adrenal Cortex Hormones↗
PubMed1992

[Fibrosing pneumopathy induced by cyclothiazide. Apropos of a case].

A diffuse interstitial pulmonary fibrosis associated with an idiopathic hepatic cirrhosis occurred in a 79 years old man treated during five years with cyclothiazide and triamterene for a mild systemic hypertension. The outcome was fatal. A provocation test was positive with BAL lymphocytic reaction. Cyclothiazide induced fibrosis is likely.

Aged↗
PubMed1991

Reliability of six pulse oximeters in chronic obstructive pulmonary disease.

Six pulse oximeters with finger probes were studied in three groups of 17 hypoxemic patients with COPD aged 50 to 75 years. Transcutaneous arterial oxygen saturation (SpO2) was measured with the Nellcor N101 (oximeter 1a), the Ohmeda Biox III (oximeter lb), the Nellcor N200 (oximeter 2a), the Critikon Oxyshuttle (oximeter 2b), the Radiometer Oxi100 (oximeter 3a), and the Ohmeda Biox 3700 (oximeter 3b). The SpO2 was compared with SaO2 measured in simultaneously withdrawn samples of arterial blood (Radiometer OSM2) at three 20-minute steady-state levels of FIO2 ranging from 0.21 to 0.40 (SaO2, 62 to 100 percent). The bias (mean SpO2-SaO2 difference) and the error in precision (SD of the differences) were both below 4 percent for instruments 1a and 1b and remained below 1.2 and 3 percent, respectively, for the others. A good agreement between SpO2 and SaO2, as reflected by the Bartko intraclass correlation coefficient, was observed in instruments 2a, 3a, and 3b. The individual relationships between SpO2-SaO2 differences and SaO2 appeared to be linear and parallel. With four instruments (1a, 1b, 2a, and 2b), the mean slope of this relationship was negative, showing a systematic instrumental error: the lower the SaO2, the larger the overestimation of SaO2. The scattering of the data (precision) principally reflects a subject source of error. In most instruments a technical adjustment could greatly improve instrumental errors and accuracy. The correction of the errors due to between-subject variation would require a system of calibration adjustable by the users to each individual.

Aged↗
PubMed1991

[Respiratory pasteurellosis. Apropos of 32 cases].

The authors present the main characteristics of respiratory pasteurellosis on the basis of 32 personal cases. The predominant background is chronic obstructive lung disease consecutive, in most cases, to chronic bronchitis. In patients without chronic lung disease the infection occurs when the terrain is deficient. The most common clinical form is bronchitis; pneumonia, pleurisy and lung abscess are rare. The existence of asymptomatic carriers has been recognized. Clinical manifestations are devoid of pathognomonic signs and symptoms. Diagnosis rests on isolation of the micro-organism and can be completed by serodiagnosis and intradermal reaction to pasteurelline. The severity of respiratory pasteurellosis depends on the clinical form and the background. The curative treatment is simple and effective as a rule, but prevention is possible and recommended since pasteurellosis is a potentially severe infection.

Aged↗
PubMed1990

[Cystic fibrosis in adults].

While fifty years ago 20 p. 100 of cystic fibrosis patients only reached the age of one year, more than 50 p. 100 of the patients now live more than twenty years. The clinical manifestations of cystic fibrosis are more diverse in adults than in children, so that the diagnosis might concern several specialties. In actual fact, only 3 to 7 p. 100 of cystic fibroses are diagnosed after thirteen to sixteen years, and in half the cases the symptoms had been present before the age of one year. In adults, the respiratory manifestations of cystic fibrosis are predominant, whereas the gastrointestinal manifestations tend to be blurred. Radiography of the chest shows interstitial lesions (opacities, cystic images, disorders of ventilation), principally located in the right side and the apex. The most common functional defect is an obstructive syndrome corresponding to a gradual involvement of the peripheral airways. A number of complications may develop, including recurrent Pseudomonas infection of the lung, pneumothorax, heart failure, malnutrition, liver cirrhosis, episodes of intestinal occlusion, etc. The longer life span of these patients raises the problems of diabetes with its vascular complications, infertility or pregnancy, social and professional insertion, and so forth. The prognosis of cystic fibrosis in adults depends on the date the diagnosis was made, on the therapeutic follow-up and on the creation of specialized centres. The control of Pseudomonas infections and the development of lung transplantation are the main advances to be expected.

Adult↗
PubMed1990

Computed tomography in the etiologic assessment of idiopathic spontaneous pneumothorax.

In an attempt to elucidate the origin of the so-called idiopathic spontaneous pneumothorax (ISP), clinical examination, pulmonary function tests, and computed tomography (CT) with visual quantification and density analysis were performed in 20 young patients two months after an ISP episode. Twenty controls were recruited for CT. The chest roentgenograms were normal in the two groups. The results indicated the presence of various types of emphysematous lesions (EL) in the ISP group located predominantly in the apical fields with subpleural location in 16 patients. Interestingly, diffuse but moderate centrilobular emphysema was noted in 12 of 20 patients. The EL visual quantification was always less than 5 percent of the CT slices' total areas. The lung mean density shifted significantly toward the air density in the patient group (patients: -743 +/- 57.5 HU vs controls -713 +/- 59.5 HU, p less than 0.01). These findings suggest that CT may be useful for early assessment of EL in patients with ISP.

Adult↗
PubMed1989

Pulmonary vascular resistance rises with lung volume on exercise in obstructed airflow disease.

There has been experimental evidence that lung distension produces an increase in pulmonary vascular resistance (PVR). To study this effect in patients, we measured functional residual capacity (FRC) by helium dilution at rest and during low-load supine exercise in 30 patients with chronic obstructive pulmonary disease. Pulmonary haemodynamics were studied in these patients under the same conditions. FRC increased from rest (4.32 +/- 0.21 l) to exercise (4.71 +/- 0.20, P less than 0.001) but the change was smaller in the patients with the highest FRC at rest: there was a significant negative correlation between FRC change and FRC at rest (r = -0.38, P less than 0.01). There were seven patients with a small FRC change (less than 0.2 l) with exercise and 10 patients with a marked increase (greater than 0.5 l). Exercise was of the same load on average. FRC at rest was 5.1 l in the first group and 4 l in the second (P less than 0.05). Blood gases were almost identical at rest, and almost unchanged during exercise. PVR decreased from rest to exercise by 33 dyn.s.cm-5 in the first group and increased by 24 in the second (P less than 0.01). There was a significant correlation (P less than 0.05) between PVR and FRC changes from rest to exercise. These results suggest that lung distension may play a role in the PVR increase seen in some COPD patients with exercise.

Exercise↗
PubMed1989

Theophylline disposition in patients with COLD with and without hypoxemia.

This study aimed to assess the effect of hypoxemia on theophylline disposition. Ten patients with a mean (+/- SEM) of 58 +/- 3 years with COLD (PaO2 55 +/- 1 mm Hg, PaCO2 46 +/- 2 mm Hg, and pH of 7.39 +/- 0.01) were hospitalized to have oxygen therapy. Before starting O2, they received intravenously, 4 mg/kg of theophylline over a 20-minute period; blood samples and urine were collected for six hours. The results suggested that hypoxia does not influence the disposition of theophylline or its metabolites.

Biotransformation↗
PubMed1989

[Anomalies of mucus and bronchial pathology in adults].

Recent studies have shown that normal bronchial secretion composed of proteoglycans, atypical glycoproteins and neutral lipids neither includes mucins nor glycolipids, nor phospholipids. The rheological characteristics of bronchial mucus thus depend on mucociliary clearance and clearance of bronchial secretions by cough, which in turn depend on the properties of the glycoprotein acids secreted and on the degree of their entanglement which is linked to their water content and on the chemical bonds with other protein or lipid components which are present in the secretions. Chronic bronchitis, asthma and bronchorrhoea allow for changes in the biochemical composition and the physical and rheological characteristics of the bronchial mucus which alter the clearance. In certain conditions mucus plugs can form. An understanding of the pathology of bronchial mucus in the adult enables one to choose the best therapeutic prescriptions but the efficacy of measurements available remains imperfect.

Bronchi↗
PubMed1988

Local variations of pulmonary arterial wedge pressure and wedge angiograms in patients with chronic lung disease.

This study was undertaken in 23 patients with chronic lung disease to determine whether local wedge pressure variability is related to the state of the local perfusion as observed in distal wedge angiograms. We also compared the variability of the pressures obtained after distal (mechanical) and proximal (balloon inflation) wedging of a catheter in three to six different sites in each patient. When the wedge pressure measurements were repeated in the same site (n = 7), the mean of the absolute differences was below 1 mm Hg. In individual patients, the maximal pressure difference between sites ranged from 0 to 6 mm Hg for Ppw and from 1 to 12 mm Hg for Pdw. The range in Pdw increased from normal to abnormal angiograms. These results suggest that when Pdw is high in one region, it may correspond to local perfusion abnormalities. When the wedge pressure is measured repeatedly or under different conditions, it should be determined after wedging the catheter in the same location for all of the periods of observation.

Bronchiectasis↗