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Biomedical subjects

R Favre

Publications and source records attributed to R Favre.

At least 19 recordsLinked to original sources
PubMed1995

[Gastroschisis. Management. 50 cases].

OBJECTIVE: Demonstrate the need for a multidisciplinary antenatal approach to laparoschisis. MATERIAL AND METHODS: A retrospective series of 50 children who underwent surgery for laparoschisis between 1975 and 1994 in the Infant Surgery Department of the Strasbourg University Hospitals. Postoperative outcomes were evaluated as a function of the stage of laparoschisis and surgical technique. Follow-up was also examined. RESULTS: Depending on the periods evaluated, ultrasound diagnosis varied from 16 to 92% and was made at 21 weeks gestation on the average. Lesions observed were atresia of the bowel (10%), complete intestinal involution (2%), and perivisceritis (88%). Complete parietal closure was achieved after bowel emptying in 58% of the newborns. Postoperative mortality, usually in vere severe forms, fell from 46% to 15% over the 20-years study period. CONCLUSION: Antenatal echography can confirm the diagnosis of laparoschisis. It can be used to define risk factors (size, bowel dilatation(s), mesenteric blood flow) allowing planned extraction in an Infantile Surgery Unit. This multidisciplinary attitude should help to improve overall outcome.

Abdominal Muscles↗
PubMed1995

Immuno-gold-labelling of CUT-1, CUT-2 and cuticlin epitopes in Caenorhabditis elegans and Heterorhabditis sp. processed by high pressure freezing and freeze-substitution.

CUT-1 and CUT-2 are two distinct protein components of cuticlin, the insoluble residue of the cuticles of nematodes. In previous experiments of gold-immuno-labelling on sections of chemically fixed Caenorhabditis elegans, CUT-1 and CUT-2 epitopes were specifically lost. Cryo-immobilization of C. elegans under high pressure followed by freeze-substitution, however, resulted in a good preservation of these antigenic sites and of the ultrastructure of the worms. The entomopathogenic nematode Heterorhabditis sp. processed by the same cryopreparation protocol has shown a strong reactivity with anti-sera raised against CUT-1, CUT-2 and against the whole cuticlin residue of C. elegans. The localization of these epitopes was conserved across the two species.

Animals↗
PubMed1992

[Medical treatment of chylous effusions in newborn infants. Apropos of 3 cases].

BACKGROUND: Chylous effusions are the most frequent cause of non immunologic hydrops fetalis. They can be recognized antenatally by ultrasonography. Their evacuation is sometimes necessary and medical treatment often effective. CASE REPORTS: Case n. 1: fetal ascites was detected by ultrasonography at the 30th week of gestation. Paracentesis was performed at 36 weeks, followed 3 days later by spontaneous delivery. The newborn was fed milk formula. A second paracentesis showed a milky fluid, rich in cholesterol, triglycerides and chylomicrons. The child was fed formula rich in medium-chain triglycerides and the chylous ascites disappeared completely within 2 weeks. Case n. 2: a diagnosis of bilateral hydrothorax and hydramnios was made at the 27th week of gestation. An in utero evacuation of the hydrothorax performed at the 30th week was ineffective and a pleuro-amniotic drainage was performed 2 weeks later. The baby was born at the 35th week, and presented a moderate respiratory distress due to the hydrothorax and ascites. Aspiration of the thoracic fluid confirmed its chylous origin. The chylous effusions completely disappeared when the child was fed a high medium chain triglycerides diet. A lymphedema of legs appeared at the age of 1 month. Case n. 3: ascites, hydramnios, hydrothorax and peripheral edema were found at the 21st week of a third pregnancy (the 2 first pregnancies were complicated by lethal hydrops fetalis). Bilateral hydrothorax and peripheral edema were found again after birth at the 37th week. Diuresis and albumin-infusion led to recovery, but chylothorax and chylous ascites reaccumulated after introduction of milk formula, despite repeated evacuations and feeding medium-chain triglycerides formula. The thoracic fluid remains chylous at the age of 9 months. CONCLUSIONS: In utero, and sometimes post-natal, evacuation of fluid present in the thoracic and peritoneal cavities can be necessary, depending of the functional tolerance. Medical management including feeding a low fat and/or high medium-chain triglycerides diet, and sometimes temporary total parental nutrition, is necessary, together with salt restriction, diuresis and albumin infusion as required. Most cases recover spontaneously or as a result of therapy within a few weeks.

Chylothorax↗
PubMed1991

Pharmacokinetics of navelbine after oral administration in cancer patients.

The pharmacokinetic behavior of navelbine was investigated in 19 patients presenting with advanced cancers (mainly women with breast cancer). Navelbine was given orally at seven dose levels of up to 200 mg/week. For a given dose, patients received four successive weekly treatments. Five subjects also received two different doses. After drug administration, plasma was collected for 48 or 72 h and monitored for navelbine concentration by radioimmunoassay. Absorption of navelbine was very rapid after oral administration: maximal drug concentrations were reached within the first 1 or 2 h (Tmax, 0.9-1.75 h; cmax, 70.9-832.6 ng/ml), with absorption constants ranging from 0.85 to 2.42 l/h. A comparison of dose-normalised plasma concentration profiles revealed significant time dependence in six evaluable patients (P less than 0.001). Only four subjects who received low doses (less than or equal to 100 mg/week) exhibited time-independent kinetics. All of the five patients who were treated at different doses displayed apparent dose dependence (P less than 0.001). No individual profile was characterised by both time- and dose-independent pharmacokinetics. In all, 18 patients presented biphasic plasma concentration-decay patterns, and only 1 subject exhibited monophasic decay kinetics. The navelbine pharmacokinetic parameters obtained following oral administration were similar to those observed after i.v. bolus injection and were characterised by high oral clearance (0.43-1.45 1 h-1 kg-1), a large apparent volume of distribution (27.4-45.9 1/kg), and a long terminal half-life (24.2-56.5 h). Large intra- and inter-individual variations in pharmacokinetic parameters were observed. Moreover, after a high dose of 200 mg, an enterohepatic cycle and/or a delay in navelbine's absorption at a distal intestinal site as evidenced by a marked plasma level rebound was observed.

Administration, Oral↗
PubMed1991

Standard curves of cerebral Doppler flow velocity waveforms and predictive values for intrauterine growth retardation and fetal acidosis.

Cerebral Doppler measurements seem to be a future method to evaluate the degree of fetal hypoxemia. The aim of this study was (1) to elaborate standard curves for the different cerebral vessels in our own population, and (2) to describe the predictive value of Doppler measurements for intrauterine growth retardation (IUGR) and fetal acidosis. We recorded cerebral flow velocity waveforms from 71 normal pregnancies to establish standard curves for the following vessels: proximal middle cerebral artery, distal middle cerebral artery and posterior cerebral artery. Finally, we calculated the cerebroplacentar index (CPI) for each case. The predictive values from the different vessels were determined in 24 patients with IUGR and 17 cases with fetal acidosis. The poor sensitivity and the low positive predictive value of each cerebral vessel is probably explained by the rather long interval between the last Doppler assessment and delivery (22 +/- 23 days). Reducing the interval to less than 7 days, the distal middle cerebral artery and the CPI were pathological in 4 cases out of 5 fetuses that underwent cesarean section for fetal distress. These latter results have encouraged us to use cerebral Doppler flow velocity to detect fetal hypoxemia. In conclusion, the middle cerebral artery blood flow in its distal part seems to be the finest parameter to predict fetal acidosis, and this vessel should be used to optimize obstetrical management of high-risk pregnancies.

Acidosis↗
PubMed1991

[First clinical evaluation of the CHUV ballistic lithoclast].

The authors present the first clinical evaluation of the ballistic lithoclast CHUV based upon results of 55 treated patients. Their conclusion is that the lithoclast CHUV is a simple, reliable, easy to use, efficient and patient-friendly machine.

Equipment Design↗
PubMed1991

[Middle cerebral artery fetal velocimetry: criteria for extraction in severe growth retardation].

Traditional fetal extraction criteria based on the cardiotocogram (group 1) probably occur too late to serve as extraction criteria in cases of severe growth retardation. We suggest that Doppler ultrasound of the middle cerebral artery (M.C.A.) (group 2) would be used to assess the optimal moment for fetal extraction. This method has enabled us to modify perinatal mortality from 37% to 0% (p less than 0.01). The percentage rate of cerebral hemorrhage and/or neurological sequelae was 41% (9/22) in the first group whereas no infant in group 2 or 3 (control group) had these complications. The percentage rate of neonatal complication was 67% in group 1 versus 28% in group 2 (p less than 0.01). Group 1 spent 53 days (+/- 35) in intensive neonatal care unit versus 43 days (+/- 22) for group 2. Neonatal outcome was quite similar between group 2 and the control group. Cerebral Doppler could allowed us to extract severe IUGR fetuses just before cerebral ischemia and irreversible tissue damage.

Cardiotocography↗
PubMed1991

[Value of Doppler velocimetry of the umbilical artery, aorta, cerebral artery, and uterine artery in pathological pregnancies].

This prospective study try to evaluate the predictive value of Doppler umbilical artery in the diagnosis of intra-uterine retardation (IUGR) and fetal distress requiring operative delivery. We use the blood flow class (BFC) to characterize the blood velocity waveform. Like others, we found a strong negative correlation between the blood flow class and fetal weight at delivery. When the umbilical BFC is abnormal in case of suspicion of IUGR, the diagnosis is confirmed at delivery in 100%, but in case of umbilical BFC 0, we found only 53% of IUGR. If we consider the mode of delivery, we found 7% of cesarean section for fetal distress in BFC 0, 38% in BFC1 and 78% in BFC 2-3. We had 5 fetal death, two cases with malformations, non-immunologic hydrops and trisomy 18. The others three were severe IUGR, in all cases the umbilical Doppler BFC was abnormal. Another parameter was significantly modified in case of fetal distress: the cerebro-placental index. This confirm the brain sparing phenomenon. We found a prevalence of IUGR of 43% in the high risk pregnancies group. The positive predictive value of umbilical Doppler is 82%, but the sensitivity is low, 44%. The efficacy of umbilical Doppler to predict the occurrence of operative delivery for fetal distress is better, because the prevalence is lower, 18%, the positive predictive value is 60% and the sensibility 70%. There is non doubt that, fetal blood flow is a secondary test of great value in identifying fetuses at risk of perinatal hypoxia.

Adult↗
PubMed1991

[Value of Doppler of the uterine arteries and the association of uterine and umbilical velocimetry in pregnancies at risk].

This study was designed to evaluate the role of Doppler velocimetry of uterine artery and of the association of uterine and umbilical artery. We use the index of Stuart S/D to characterize the uterine waveform. A value greater than or equal to 3 and/or the persistence of a notch is considered abnormal. When the uterine artery is pathological, we find more proteinuric hypertension, the incidence of intrauterine growth retardation (IURG) twice (p less than 0.001), the birthweight is significantly lower; the caesarean section rate for fetal distress is 35% for 11% in the other group (p less than 0.005), but the caesarean section rate for maternal indication is the same in the two groups. If we test the efficiency of the uterine Doppler study in prediction IUGR, we obtain a sensitivity of 42.5% and a positive predictive value of 74%. The population of high risk pregnancies is divided into four groups according to the Doppler findings. The first group contain normal values in the uteroplacental circulation and in the umbilical vessels, this association predict a normal outcome. The second group contain normal umbilical artery flow velocity waveform (FVW) and abnormal uteroplacental FVW, this pattern is associated with more severe hypertension and a rate of caesarean section of 16%. The final two groups contain patients with abnormal umbilical FVW and either normal or abnormal uteroplacental FVW. We find in these two groups the more complicated neonatal evolution, the incidence of caesarean section for fetal distress is more than 50%, the rate of IUGR is between 82% and 100%. The examination of the uteroplacental vessels permit the selection of patients with high risk of chronic fetal distress, therefore these pregnancies will have intensive surveillance with biophysical profile, umbilical and cerebral Doppler.

Adult↗
PubMed1990

[Arthritis of the hip associated with infantile toxocariasis].

A parasitic origin of rheumatological manifestations is only suspected if the patient returns from an endemic area of the world. We report a young girl who developed without travelling, an isolated hip arthropathy simultaneously with a Toxocara infestation. Pathogenesis is discussed.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed1990

Nucleotide sequence and control of transcription of the bacteriophage T4 motA regulatory gene.

A 2116bp segment of the bacteriophage T4 genome encompassing the motA regulatory gene has been sequenced. In addition to motA, five open reading frames were identified in the direction of early transcription. The motA gene encodes a basic protein of 211 amino acids with a predicted molecular weight of 23,559. Measurements of the rate of transcription of motA showed that the promoter of this gene is turned off after only 2 min of T4 development. This early promoter presents a structure which is richer in information than that of a classical constitutive Escherichia coli promoter. In addition to containing conserved sequences centred at -10 and -35, this promoter shares extensive homologies with other subgroups of early promoters in regions centred at +3 and at -55. We discuss the possible role of these different sequence determinants.

Amino Acid Sequence↗
PubMed1990

[Feto-placental non-immunological anasarca].

Two clinical cases of fetal hydrops are discussed: one of them was caused by diffuse lymphangiectasis and the other was idiopathic. A review of recent literature regarding the management of non-immunological hydrops is presented and gives hope for a new therapeutic approach to fetal hydrops especially in cases of chylothorax. However the mortality remains extremely high because of lung hypoplasia.

Adult↗
PubMed1990

[Value of clinical tests in the diagnosis of breast cancer: report of 2,626 cases].

The present study has assessed the value of clinical examination of breast cancers in a retrospective study of 2,626 cases of operated mammary lesions. Anatomopathology is used as basic reference. The fiability of the cancer diagnosis is 94%, its sensitivity is 90% and specificity 96%. The total error only amounts to 6%, with 2/3 false negatives and 1/3 false positives. The errors are for the most part due to the anatomopathologic nature of the tumor, its size, the area of the body it is situated in and also to the examiner and to the of the patient. Nevertheless clinical examination still remains the first diagnostic step, and is indispensable in all breast pathology.

Breast Neoplasms↗
PubMed1990

[Clinical pharmacokinetics of navelbine after oral administration, in vitro metabolism and interindividual variability].

Navelbine (NVB) (5'-noranhydrovinblastine) is a new semi-synthetic vincaalkaloid (VA) exhibiting a high affinity for tubulin and considerable anticancer activity in patients. A better hematologic tolerance and a weak neurotoxicity have been reported for this drug as compared to other VA. Moreover, NVB presents a relatively high bioavailability and a good digestive tolerance, thus offering original perspectives for the treatment of ambulatory cancer patients. A clinical pharmacokinetic study of NVB was carried out on 12 patients after oral administration of the drug. The pharmacokinetic parameters were similar to those of intravenous administration and also showed a high interindividual variability. Studies on the in vitro metabolism of NVB using hepatic microsomal fractions from 22 different donors demonstrated the formation of 3 metabolites. The biotransformation rate quantitatively varies from one human liver specimen to another, a fact which could be, in part, at the origin of the interindividual variability of the therapeutic response.

Administration, Oral↗
PubMed1989

[Atrioventricular block, a complication of radiotherapy of the mediastinum].

Cardiac complications of mediastinal irradiation usually concern the pericardium, the ventricular myocardium and the coronary arteries. We report the case of a 42-year old woman who experienced a syncopal atrioventricular (AV) block 12 years after irradiation of a mediastinal Hodgkin's lymphoma. Electrophysiological recordings showed infranodal conduction disturbances. A review of the literature yielded only 12 cases of syncopal radiation-induced AV block. This case highlights the risk of syncopal AV blocks occurring a long time after mediastinal irradiation and leading to severe damage of the His bundle and its branches. The presence, as in our patient, of an associated right ventricular outflow tract stenosis confirms the importance and severity of radiation-induced cardiac lesions.

Adult↗
PubMed1989

[Urokinase recanalization of extensive thrombosis of the superior vena cava secondary to an implantable perfusion device].

A superior vena cava syndrome developed suddenly in a 36 year old man who had been undergoing chemotherapy via an implanted venous access catheter for 18 months. Venography showed superior vena cava thrombosis extending bilaterally to the subclavian veins. Direct local thrombolysis with low-dose Urokinase resulted in partial recanalisation with an excellent clinical result despite the persistence of an endovenous sequestrum situated at the catheter tip, a sequela of previous thrombosis. This case underlines the importance of direct local thrombolysis in patients with a Port-a-Cath system complicated by a thrombosis.

Adult↗
PubMed1989

[Modification of the relative plasma concentrations of methyl and methylene groups in cancer: a study using proton NMR spectroscopy].

Fossel et al. have recently proposed the proton NMR examination of plasmatic lipoproteins--and more precisely the determination of an index obtained from the averaged linewidth of the CH2 and CH3 resonances--as a possible tool for detection of cancer. Many evaluations conducted on an international basis have demonstrated that initial expectations were not met and that the test lacked sensitivity, specificity, and predictive value to be accepted as a screening and diagnostic tool. In our evaluation we have collected plasma from healthy subjects, from patients with various kinds of cancer at different stages of evolution and therapy, and from patients suffering from a variety of pathologies, including benign tumors. In accordance with Chmurny et al., we observed that the linewidth index (LWI) is precise and reproducible when care is taken in the handling and storage of samples and in the fasting of subjects. After finding no predictive value to the test, we have reanalyzed the spectra and studied the variations of the ratio defined by the methylene signal area over the methyl signal area. This ratio is significantly increased in cancer. Furthermore, it offers a better separation of statistical populations permitting a more precise discrimination between cancer, other pathologies and controls. We have also found that malignant tumors arising from mesenchyma (sarcoma, leukemia, lymphoma) induce less important variations in the CH2/CH3 ratio than adenocarcinoma or glioma, when such differences cannot be documented using the LWI. These observations are particularly interesting since they might bring new information on the metabolic modifications of the LWI and the CH2/CH3 ratio might reflect the embryologic origin of the tumors and raise the issue of the heterogeneity of cancer disease.

Humans↗