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Biomedical subjects

R Gonthier

Publications and source records attributed to R Gonthier.

At least 55 records · Page 3Linked to original sources
PubMed1993

[Markers of hemostasis and myocardial infarction in persons under 40 years of age].

Coronary disease before the age of 40 has special clinical and pathogenic features. The authors sought evidence of the existence of abnormalities of hemostasis markers in 39 patients aged under 40, several weeks after a myocardial infarction (MI). Blood samples were drawn a mean of 8 months after the MI. These laboratory studies included assay of C and S proteins, fibrinogen, clotting factors VII and VIII and antithrombin III, as well as detection of any possible circulating anticoagulant. Plasma levels of platelet factor 4 (PT4) and of beta-thromboglobulin (BTG) were measured in the same sample, enabling determination of the BTG/PF4 ratio. Only fibrinogen and plasma levels of platelet proteins were abnormal, revealing a significant difference between patients with multi-vessel disease and those with single vessel disease or free of severe angiographic lesions. Platelet activation appeared to persist some time after the MI, chiefly in patients with multi-vessel disease, and showing no relation to either age or treatment. Conclusions require prudence in view of difficulties in interpreting plasma assays of PF4 and of BTG.

Adult↗
PubMed1988

Long-term prognosis in malignant or accelerated hypertension.

In 51 consecutive patients with malignant hypertension collected from 1976 to 1981 we have analysed patient and kidney survival at 5 years and at last follow-up. The patients were 41 men, 10 women, mean age 53 years, with a stage III (63%) or stage IV (27%) fundi and a diastolic blood pressure (BP) greater than 130 mmHg. The hypertension was primary in 26, renovascular in 17 and secondary to bilateral nephropathy in eight. At 5-years follow-up, the patient and kidney survival rates were respectively 72.5% and 47%. At last follow-up, 18 patients had died (35%) and 18 additional patients require dialysis (renal death = 70%). The principal causes of death related to terminal renal failure and/or dialysis. Initial involvement of heart (27%) and brain (35%) led to a few more deaths. Blood pressure control reduced consequences for the heart and brain but not for the kidney. Patients at higher risk are those with serum creatinine greater than 200 mumol/l on admission.

Adult↗
PubMed1984

[Comparative evaluation of the function of each kidney using Tc 99m DTPA].

To evaluate the clinical validity of 99m Tc DTPA renal investigation, we have studied 60 patients with different renal diseases: 1) Renovascular hypertension (22 patients); 2) Chronic pyelonephritis (11 patients); 3) Renal hypoplasia (12 patients); 4) Bilateral parenchymatous nephropathy with hypertension (15 patients). We observed a good correlation between the creatinine clearance and the total DTPA clearance (N = 51: r = 0.68; p less than 0.001); and also a good correlation between the respective renal surface extrapolated from renal X-Rays, and the respective renal function of each kidney (expressed in percentage) measured from DTPA data. This correlation is higher in group 1 and lower in group 2. From individual kidney function percentage and glomerular filtration rate measurement or estimation, we could calculate the GFR of each kidney, which serves as a guideline for surgical decisions.

Adult↗
PubMed1983

[Treatment of accelerated arterial or malignant hypertension with captopril. Value, efficacy and outcome of visceral complications].

We have investigated 36 patients with accelerated or malignant hypertension (diastolic greater than 130 mm Hg and fundi at stage III or IV). The acute administration of Captopril 50 mg per os decreases the mean arterial pressure (MAP) by 20 p. cent during the 3 following hours. 30 patients have been treated from 1 to 9 months with Captopril (mean daily dose during first month = 212 mg) associated with Furosemide (mean daily dose = 80 mg) +/- beta blockers (11/30). The mean blood pressure in supine position under heavy conventional treatment was 205/121 mm Hg just before starting Captopril and was reduced to 156/90 mm Hg at the end of the first month of treatment. We observed a clear cut regression of fundi stages (III-IV to I-II) and cardiac or cerebral involvement, and a clearcut stabilization of the rapidly progressive chronic renal failure.

Adult↗
PubMed1983

[Prognostic significance of electrocardiographic changes observed in the immediate postoperative period of isolated aortic valve replacements].

The predictive value of early postoperative ECG changes was studied in 144 patients: 106 men (mean age 50.6 +/- 12.9 years) and 38 women (mean age 49.7 +/- 15.3 years), undergoing isolated aortic valve replacement (AVR) with a Björk-Shiley prosthesis between January 1973 and December 1976, using an identical protocol of myocardial protection. Eighty four patients had pure or predominant aortic stenosis, 60 had pure or predominant aortic regurgitation. The early postoperative ECGs (first 30 days) were compared with the preoperative recordings to determine the significance of the changes observed in the immediate postoperative period. Changes of ventricular repolarisation (0.2 mV ST depression and/or 0.5 mV or more T wave inversion) were observed in 44% of cases. Isolated T wave inversion--more common in aortic incompetence than in aortic stenosis--had a good prognosis. On the other hand, ST depression was associated with a worse prognosis (mortality rate three times higher). Conduction defects, either atrioventricular or intra-ventricular, were observed in 30% of cases. They had no effects on mortality or long-term outcome. Atrial fibrillation was observed in 16% of cases and had a good prognosis. In conclusion, the only change in the early postoperative ECG of patients undergoing isolated AVR associated with a poor medium or long-term prognosis, was significant ST depression.

Adult↗
PubMed1982

[Circulating immune complexes, detection in human glomerulonephritis by the PEG-EDTA technique (author's transl)].

In a prospective study, we screened sera samples of 128 patients with glomerulonephritis (GN) for the presence of circulating immune-complexes (CIC) fixing C1q by precipitation of native C1q with 2% polyethylene glycol (PEG) in the presence of 10 mM EDTA. The amount of precipitated C1q, as measured by Mancini, is less than 27% (m +/- 2 SD) of the original value in control sera. We found 35/128 (27%) positives samples, distributed as follows: 4/17 (24%) in acute GN, 10/15 (67%) in SLE, 2/16 (13%) in membraneous GN, 13/24 (54%) in membranoproliferative GN, 3/16 (19%) in segmental focal hyalinosis, 2/10 (20%) in minimal lesions nephrotic syndrome, and 1/30 (3%) in mesangial IgA GN. We then correlated these results with clinical, serological and pathological data. Whatever the type of GN, the presence of CIC fixing C1q correlated significantly, well with : the presence of chronic renal failure (serum creatinine greater than or equal to 2 mg/dl) (X2 = 5.48, p less than 0.02), the presence of hypocomplementemia (X2 = 12.30, p less than 0.001), the presence of low serum C3 (X2 = 8.25, p less than 0.01), the activation of C3 through normal pathway (low serum C4 and/or C1q) (X2 - 18.12, p less than 0.001) and the presence of glomerular deposits of C3 (X2 = 8.52, p less than 0.01), of C4 (X2 = 7.10, p less than 0.01), and of C1q (X2 = 4.11, p less than 0.05). The technique is simple, does not require labeled C1q, and allows the further study of antigen or antibody determinants of the complexes. Its sensitivity is near that of the 125 I-C1q binding assay technique. Such routine screening is a major immunopathologic step in the investigation of human GN.

Adult↗
PubMed1981

[Distal complications of therapeutic arteriovenous fistulae (author's transl)].

Having observed 4 personal cases, the authors review the distal complications of therapeutic arteriovenous fistulaes. Ischaemic complications are of arterial origin and may be severe: strong pain increasing during dialysis, soft tissue trophic disorders and ulcerations, and functional sequelae. Venous stasis disappear without permanent damage. The carpal tunnel syndrome is of uncertain and probably mixed aetiology and can easily be cured by surgical decompression. The use of small calibre, termino-terminal or latero-terminal distal anastomoses should help to prevent these complications.

Aged↗
PubMed1981

[Progression and severity of arterial hypertension in aged subjects (12 cases].

We analyzed retrospectively 12 patients, aged from 63 to 73 years, with renovascular hypertension due to unilateral or bilateral atheromatous lesions (4 out of 12). Malignant or accelerated hypertension with multiple visceral involvement was frequent (8 out of 12). The proximal lesions (stenosis) of the renal arteries were rapidly progressive, leading to complete thrombosis in 8 cases. Five patients received medical treatment only, but 2 worsened their GFR and 2 had a poor blood pressure control. Of the 5 patients who underwent renal surgery 2 had nephrectomy, 2 had an aorto-renal bypass and 1 a bypass plus nephrectomy; 2 of them recovered a normal GFR, but 2 died in the post-operative period. Three patients had selective embolization of a renal artery, but only one was definitely improved. So far, the treatment of such cases still is very difficult.

Aged↗
PubMed1980

Human glomerulonephritis and persistent non-polio enterovirus infection.

In a prospective work, we have studied the non-polio enterovirus (NPEV) excretion in spot urine and stools by four appropriate cell cultures, in four different groups: 20 exposed controls (GI), 88 patients with renal biopsy 'proven GN' (GII), 38 cases with 'proven nonGN' (GIII), and 9 with 'probable nonGN' (GIV). The positive excretion in stools and/or urine is respectively 0 and 5% in Group I, 14 and 33% in Group II, 6 and 19% in Group III, and 13 and 22% in Group IV. Viruria, the consequence of a viraemia, is therefore associated with 'proven GN' (p less than 0.05). In the majority of patients with positive NPEV excretion, we have made an additional but similar study, 3-12 months later. Persistent excretion was confirmed in 22/30 cases in Group II (73%) versus 0/8 in Group III-IV (p less than 0.001). These data concerned patients with membranoproliferative GN [5], membranous GN [6], mesangial IgA GN [6], endocapillary GN [2] or minimal lesions [3]. Thus we have demonstrated a significant relation between persistent NPEV urine/stools excretion and the occurrence of active GN in humans. Such persistent viral infections may represent the cause of some GN, probably mediated by an immune complex mechanism with viral antigens.

Enterovirus↗
PubMed1978

[Comparison of serum levels of beta2-microglobulin and carcino-embryonic antigen in the follow-up of lung cancer (author's transl)].

Serum levels of carcino-embryonic antigen (CEA) and beta2-microglobulin (beta2m) were assayed on 133 sera during follow-up of 31 patients with lung carcinoma (squamous cell ca. without recurrence : 2, squamous cell ca. with recurrence : 11, anaplastic cell ca. : 4, adenocarcinoma : 2, unclassifiable : 5). Normal creatinine (less than or equal to 12 mg/l) levels were found in all sera. CEA and beta2m levels showed no correlation nor in these groups, nor in the whole. The squamous cell carcinomas with recurrence showed the largest dispersion for CEA as for beta2m levels. However, the trends of serial beta2m values did not correlate with clinical features. Increasing or decreasing levels of CEA and beta2m levels showed no correlation in the whole nor in patients undergoing radiotherapy. In our experience, beta2m levels failed to correlate with clinical findings during the follow-up of lung cancer patients.

Adenocarcinoma↗
PubMedDate not supplied

Using algorithms in rehabilitation nursing: an educational strategy.

The purpose of this article is to describe the use of algorithms in the specialty practice of rehabilitation nursing. Algorithms are particularly useful for the nurse who is new to rehabilitation because they can offer guidance in some important aspects of clinical decision making. In this article, the authors include information on the historical uses of algorithms, the benefits of using algorithms, and the ways in which algorithms are developed. Examples are also included, and suggestions for further development of algorithms in rehabilitation nursing are proposed.

Algorithms↗
PubMedDate not supplied

[Contribution of 99mTc MAG3 in hypertension in an elderly subject with renal artery thrombosis].

To ascertain the responsibility of renal artery thrombosis for the genesis of arterial hypertension, the methods available are not sufficiently sensitive and reproducible, and the residual revascularization maintained by a vicarious arterial network is not easy to demonstrate. Renal scintigraphy with technetium 99m-labelled mercaptoacetyltriglycine (MAG3) was performed in 4 old and severely hypertensive male patients with chronic thrombosis of one renal artery. With this tracer the thrombotic kidney was detected lately and weakly at the vascular and nephrographic stages. When the functions of both kidneys were compared, that of the affected kidney was always estimated at less than 5%. At the excretory stage a residual activity could be detected in the kidney with renal artery thrombosis. Owing to the specific biophysical behaviour of the tracer, MAG3 scintigraphy coupled with arteriography and assays of plasma renin activity in the veins contribute to the decision concerning nephrectomy.

Aged↗
PubMedDate not supplied

[Pheochromocytoma disclosed by isolated inflammatory syndrome].

Among the atypical forms of phaeochromocytoma the isolated inflammatory form is rare and difficult to diagnose clinically. The authors report such a case, where computerized tomography and magnetic resonance imaging contributed enormously to the diagnosis.

Adrenal Gland Neoplasms↗
PubMedDate not supplied

Nutritional markers, acute phase reactants and tissue inhibitor of matrix metalloproteinase 1 in elderly patients with pressure sores.

BACKGROUND: Loss of collagen and elastin is observed in the elderly. In geriatric inpatients, chronic protein malnutrition could induce susceptibility to additional morbidity such as pressure sores. OBJECTIVE: The purpose of this study was to explore the relationship between nutritional and inflammatory status and the production of tissue inhibitor of matrix metalloproteinase 1 (TIMP-1). METHODS: Chronically ill elderly inpatients, without or with pressure sores, were enrolled. Nutritional protein markers, acute phase reactants, and TIMP-1 were determined, and changes in these biological parameters were compared. RESULTS: Chronic inflammatory process and protein malnutrition were observed in all enrolled patients. The severity of these two pathophysiological processes was independent of the occurrence of pressure sores. The serum prealbumin and albumin levels were lower in patients with pressure sores than in those without. In addition, the general increase in the TIMP-1 level was independent of the occurrence of pressure sores. The TIMP-1 level was mainly related to the prognostic inflammatory and nutritional index. CONCLUSIONS: The general increase in acute-phase reactants observed in the elderly could be related to the intercurrent diseases. The generally low serum albumin level, lowest in patients with pressure sores, may be considered evidence of protein malnutrition and hypercatabolism. Regarding the morbidity, the increase in TIMP-1 levels could be explained as an adaptive process to prevent intrinsic protein expenditure of extracellular matrices.

Acute-Phase Proteins↗
PubMedDate not supplied

Natural history of vascular dementia.

Knowledge about the natural history of vascular dementia (VaD) provides one context for assessing efficacy in pharmacological drug trials. We reviewed the literature for original studies reporting either (a) duration of survival or (b) cognitive status following a diagnosis of multi-infarct dementia (MID). Among 13 papers (combined sample size = 470; mean duration of follow-up = 4.3 years), survival was significantly shorter following a clinical diagnosis of MID compared with Alzheimer disease (AD). Nine studies (combined sample size = 175; mean duration of follow-up = 2.9 years) reported at least two mental status scores separated by at least 1 year. Among four studies using the Mini-Mental State Examination, no consistent differences in annualized rate of decline could be observed for MID compared with AD. Also, no factors were identified that predict rate of decline. This review reveals many limitations in our current knowledge about the natural history of VaD. Understanding would be enhanced by multinational harmonization of definitions for study entry point, diagnosis of VaD, classification of subtypes, as well as cognitive, functional, and behavioral endpoints.

Cognition Disorders↗