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Biomedical subjects

P Mahieu

Publications and source records attributed to P Mahieu.

At least 37 records · Page 2Linked to original sources
PubMed1998

Ethylene glycol poisoning treated by intravenous 4-methylpyrazole.

A 19-year-old woman was admitted 45 min after ethylene glycol (EG) ingestion. The initial serum EG concentration was 1.34 g/l (21.6 mmol/l), the anion gap 14.5, and the osmolal gap 24. Renal function was preserved (serum creatinine 75.1 micromol/l). As the patient was seen soon after poisoning, before the development of metabolic acidosis, therapy with 4-methylpyrazole (4-MP) was proposed as an antidote. 4-MP was administered via the intravenous route (7 mg/kg as loading dose, followed by 3.6, 1.2, 0.6, and 0.6 mg/kg at intervals of 12 h). 4-MP alone was effective in preventing EG biotransformation to toxic metabolites (absence of metabolic acidosis and renal injury). Ethanol therapy, hemodialysis, and sodium bicarbonate administration were not required. The half-life of EG during 4-MP therapy was 11 h, with a mean EG renal clearance of 26.9 ml/min, and a total of 65.3 g EG was eliminated unchanged in the urine. 4-MP therapy was also well tolerated.

Acid-Base Equilibrium↗
PubMed1998

Effect of enteral versus parenteral feeding on hepatic blood flow and steady state propofol pharmacokinetics in ICU patients.

OBJECTIVE: The main objective of this study was to evaluate the effect of switching from parenteral to enteral feeding on liver blood flow and propofol steady-state blood concentrations in patients in the intensive care unit (ICU). DESIGN AND PATIENTS: Steady-state blood concentrations of propofol were measured in eight ICU patients before (on days D -3, D -2, and D -1) and after (on days D + 1, D + 2, and D + 3) switching from parenteral to enteral feeding (on day DO). All patients received a continuous intravenous infusion of propofol (4.5 mg x kg(-1) x h(-1)) from several days before the start of the study, continuing throughout the experimental period. Hepatic blood flow was estimated by measuring steady-state D-sorbitol hepatic clearance. RESULTS: Hepatic blood flow was high and was not affected by switching from parenteral to enteral feeding: 33 +/- 8 ml x min(-1) x kg(-1) (mean +/- SD) and 33 +/- 10 ml min(-1) x kg(-1) on D -3 and D -1, respectively, as compared to 37 +/- 11 ml x min(-1) kg(-1) and 34 +/- 8 ml x min(-1) x kg(-1) on days D + 1 and D + 3, respectively. Systemic clearance of propofol was much higher than liver blood flow with average values on the six observation days ranging from 74.0 to 81.2 ml x min(-1) x kg(-1) and was not affected by switching from parenteral to enteral feeding. CONCLUSIONS: Liver blood flow and systemic clearance of propofol were not affected by switching from parenteral to enteral feeding in the eight ICU patients studied. Extrahepatic clearance accounted for at least two thirds of the overall systemic clearance of propofol.

Adult↗
PubMed1998

Tumour necrosis factor (TNF) gene polymorphism influences TNF-alpha production in lipopolysaccharide (LPS)-stimulated whole blood cell culture in healthy humans.

TNF-alpha is involved in infectious and immuno-inflammatory diseases. Different individuals may have different capacities for TNF-alpha production. This might determine a predisposition to develop some complications or phenotypes of these diseases. The aims of our study were to assess the inter-individual variability of TNF-alpha production and to correlate this variability to a single base pair polymorphism located at position -308 in TNF gene. We studied 62 healthy individuals. TNF-alpha production after LPS stimulation was evaluated using a whole blood cell culture model. The TNF gene polymorphism was studied by an allele-specific polymerase chain reaction. Other cytokines produced in the culture, soluble CD14 concentrations and expression of CD14 on blood cells were also measured. Among the 62 individuals, 57 were successfully genotyped. There were 41 TNF1 homozygotes and 16 TNF1/TNF2 heterozygotes. TNF-alpha production after LPS stimulation of whole blood cell culture was higher among TNF2 carriers than among TNFI homozygotes (929pg/ml (480-1473pg/ml) versus 521 pg/ ml (178-1307 pg/ml); P<0.05). This difference was even more significant after correction of TNF-alpha production for CD14 expression on blood cells. In conclusion, the single base pair polymorphism at position -308 in the TNF gene may influence TNF-alpha production in healthy individuals.

Adult↗
PubMed1998

Immunological status of competitive football players during the training season.

We investigated possible immunological changes in 15 professional football players before, during and after the sports season. We studied the leucocyte count as well as different functions such as T-lymphocyte proliferation, NK activity, chemotaxis and phagocytosis of neutrophils. Training and competitions did not produce any change in the total number of leucocytes but increased neutrophil counts and decreased T4 lymphocyte counts. We also observed a slight decrease of T-lymphocyte proliferation and a significant decrease of neutrophil functions. On the other hand, training and competitions did not induce significant changes in the number of NK cells nor in the total NK cytotoxic activity. The different change observed tended to normalize after the sports season. Our results suggest a predominant neutrophil function depression in football players during a training season which could partly explain the susceptibility of elite athletes to infections.

Analysis of Variance↗
PubMed1998

[Clinical case of the month. Hepatoportal sclerosis in a patient treated with azathioprine].

We report a case of hepatoportal sclerosis in a renal transplant patient treated with azathioprine. The initial symptom was ascites. On the biochemical level, there were cholestasis without cytolysis or hepatocellular insufficiency. A presinusoidal portal hypertension was found on haemodynamic studies, without portal thrombosis at CT-scan. A diagnosis of hepatoportal sclerosis was evoked on histology and attributed to azathioprine. This case gives an illustration of a classical albeit rare complication of azathioprine. The indolent pattern of the disease and the risk of variceal bleeding point out the need for a hepatic follow-up during the treatment.

Adult↗
PubMed1997

Cytogenetic observations following thallium poisoning.

Observations have been performed on peripheral blood lymphocytes from a patient having ingested 200 mg thallium sulfate, in order to evaluate the ability of the compound to produce cytogenetic damage in vivo in humans. Our results demonstrate that neither the yield of structural chromosome aberrations nor sister chromatid exchanges were significantly modified. The drastic increase of binucleated cells with micronuclei indicates that thallium sulfate has in common with many metallic compounds the ability to interfere with chromosome distribution.

Cell Nucleus↗
PubMed1997

Community-acquired Serratia marcescens meningitis.

Serratia marcescens is an unusual cause of community-acquired meningitis in adults. We report a case of S. marcescens meningitis occurring 29 years after a head injury and preceded by 3 years of intermittent nasal discharge of cerebrospinal fluid (CSF). One month before admission, the patient had received treatment with cefadroxil. This case illustrates the risk of Gram-negative bacillary meningitis in patients with a CSF leak when they are treated with antibiotics. When patients have a chronic clear nasal discharge, one should look for a past medical history of head injury before prescribing antibiotics. In the presence of a fistula, any antibiotherapy may lead to the selection of resistant organisms which may be difficult to treat. Due to the high risk of meningitis and the fact that spontaneous closure in delayed CSF rhinorrhoea is unlikely, surgical repair of any associated fistulae is mandatory.

Anti-Bacterial Agents↗
PubMed1997

A rapid high-performance liquid chromatographic method for the measurement of midazolam plasma concentrations during long-term infusion in ICU patients.

A new high-performance liquid chromatographic method was developed for quantification of midazolam in plasma samples from intensive care unit patients on long-term intravenous infusion of this benzodiazepine. Plasma samples (0.5 ml) were mixed with 1 microgram flurazepam (internal standard), alkalinized with 2.5 N NaOH, and extracted with toluene. The organic phase was evaporated to dryness, and the residue was dissolved in the mobile phase (acetonitrile/0.05 M phosphate buffer pH 4.5) and injected into the analytical column (C18 Nova-Pak 3.9 x 150 mm, 4 microns, maintained at room temperature; mobile phase flow rate: 1.2 ml/minute). The eluate was monitored at 207 nm, which reduced the risk of interferences from concurrent medications. Retention times of flurazepam, 1'-hydroxymidazolam (an active metabolite) and midazolam were approximately 4.5, 6.1 and 13.5 minutes, respectively. The assay was linear over the range 100 to 3000 ng/ml. The coefficients of variation of the within-day and between-day assay for the 100 to 3000 ng/ml range were < 5% and < 7%, respectively. The developed method is fast, reproducible, and well suited to monitor steady state midazolam plasma concentrations in clinical samples.

Anesthetics, Intravenous↗
PubMed1997

Neurotoxicity to the basal ganglia shown by magnetic resonance imaging (MRI) following poisoning by methanol and other substances.

OBJECTIVE: To define specific brain magnetic resonance features in methanol intoxicated patients and to evaluate the clinical relevance of monitoring these features. BACKGROUND: During the past decade magnetic resonance imaging has proven to be an exquisitely sensitive modality in depicting subtle water changes in diseased areas of the brain, allowing the definition of high-risk structures in numerous pathological conditions. METHOD: Four patients admitted to our institution for acute methanol intoxication were repeatedly evaluated by brain magnetic resonance imaging or a combination of computed tomography and magnetic resonance imaging. Common features of initial brain status were shown in all four cases and compared to those of patients presenting with other intoxications or critical deprivation states. RESULTS: Preferential localization of methanol-induced lesions within the putamina was observed in all four cases. This finding is specific compared to intoxication by other substances like carbon monoxide, or in the critical phase of metabolic disorders. The striking regression of the putaminal lesions on follow-up magnetic resonance examinations correlated with complete neurological recovery and the absence of extrapyramidal disturbance. Two patients exhibited discrete symmetric additional lesions in the medial areas of the parieto-occipital lobes. In a third one, the occipital lesions were severe. All three suffered from permanent visual impairment. The fourth patient, in whom magnetic resonance examinations failed to reveal any occipital lesion, never complained of visual disturbance though signs of optic neuropathy were detected in the visual evoked potentials. CONCLUSION: Magnetic resonance imaging appeared as a well suited neuroimaging modality in methanol intoxicated patients both in revealing a specific pattern of brain lesions and in demonstrating valuable correlation between evolution of brain changes on magnetic resonance images and clinical outcome.

Adult↗
PubMed1997

Methanol poisoning during late pregnancy.

CASE REPORT: A 26-year-old woman ingested 250 to 500 mL methanol during the 38th week of pregnancy. The initial serum methanol concentration was 230 mg/dL and formate was 33.6 mg/dL. A mild metabolic acidosis was present. As gynecologic examination and fetal monitoring failed to detect fetal distress, it was decided to give tocolytic therapy until the treatment of methanol poisoning could be achieved in the mother. Therapy included ethanol infusion, bicarbonate administration and three courses of hemodialysis. Delivery occurred six days after methanol exposure, when methanol was no longer detected in maternal blood. No further complications were noted in the mother and her newborn. To our knowledge, there is no other case of methanol poisoning during pregnancy in the literature.

Adult↗
PubMed1997

Carvedilol overdose.

Carvedilol is a non selective beta-adrenoceptor antagonist which also causes peripheral vasodilation primarily via alpha 1-adrenergic blockade (Strein et al., 1987, McTavish et al., 1993). It has been shown effective in the treatment of mild-to-moderate hypertension and angina, and is currently under investigation in patients with congestive heart failure.

Adrenergic beta-Antagonists↗
PubMed1996

Evaluation of the ability of paracetamol to produce chromosome aberrations in man.

The ability of paracetamol to induce structural chromosome aberrations in human peripheral blood lymphocytes in vivo was evaluated in volunteers who had been administered a single oral dose of 3 g paracetamol, in patients who had received 2 g of propacetamol by intravenous infusion every 6 h for at least 7 days, and in self-poisoned patients who, for suicidal reasons, had ingested more than 15 g paracetamol. In addition to the in vivo observations, the effectiveness of paracetamol to interfere with fusorial microtubule polymerisation was assayed in vitro in order to detect a possible effect of paracetamol on the distribution of chromosomes during cell division. The negative results obtained in all those assays strongly suggest that paracetamol has no mutagenic properties in human. There was, indeed, no significant difference in the percentage of abnormal cells before and after application of paracetamol in volunteers (0.2% before ingestion of 3 g paracetamol, 0.12% after 24 h, 0.04% after 72 h and 0.04% after 168 h) and in patients (0.5% of abnormal cells before treatment versus 0.44% after intravenous infusion of a total of 28 g paracetamol). Moreover, the yield of abnormal cells was not modified in self-poisoned persons (0.24%), in spite of an important decrease in the mitotic index of the PHA stimulated lymphocytes. In the in vitro assay, no inhibition of microtubule polymerisation was detected with concentrations of 2.5, 5 and 10 mM paracetamol.

Acetaminophen↗
PubMed1996

Sister chromatid exchanges in human peripheral blood lymphocytes after ingestion of high doses of arsenicals.

OBJECTIVE: To evaluate the cytogenetic effects following the ingestion of high doses of arsenicals. METHODS: Determination of the mean sister chromatid exchange (SCE) frequency and the population of high-frequency cells (HFC, cells with a high SCE frequency) in the peripheral blood lymphocytes in four patients who ingested 150 mg KAsO2, 1 g, 10 g and 20 g As2O3 respectively. RESULTS: Doses of 10 g and 20 g significantly increased the HFC frequency and produced a shift in the distribution of the cells in accordance with the number of SCEs. The mean frequency of SCEs/cell was affected only after the highest dose (20 g). CONCLUSION: These results strongly suggest that cytogenetic methods are inappropriate for biomonitoring people occupationally exposed to arsenicals.

Adolescent↗