[Physical and sports activities and aging: how to delay the state of dependence]. / Activités physiques et sportives et vieillissement: comment repousser la survenue de la dépendance.

The ageing is a daily physical activity's reduction and after 80 years can led to dependence. The physiological factors of this evolution are: reduction of striated muscular mass, reduction of cardiac output, reduction of VO2 max from 50 ml.min-1.kg-1 at 30 years to 20 ml.min-1.kg-1 at 80 years. On average the reduction of moving functional capacity in 10% by decade. The studies show in fact that the half of reduction is due to ageing, and the other half to sedentary life. The lower limit is 15 ml.min-1.kg-1, threshold of dependence; it is an expensive and irreversible stage. To slow down the dependent people's number, it is one alone way: physical and sports activity in endurance from 55 years. With these exercise and method, the dependence is put back 10 or 20 years for anyone. We prevent the fact that we do not know cure.

Combined chemical and enzymatic synthesis of the sialylated non reducing terminal sequence of GM1b glycolylated ganglioside, a potential human tumor marker.

N-Glycolylglucosamine 8 was synthesized in 4 steps from anisal glucosamine, via the new crystalline monochloracetyl derivatives 3, 4 and 7. N-Glycolylneuraminic acid 10 was prepared in 59% yield starting from pyruvate and a mixture of 8 and its manno epimer 9 in a 2:3 ratio, with immobilized sialic acid aldolase. Neu5Gc 10 was converted into CMP-NeuGc 11 in the presence of immobilized calf brain CMP-sialate synthetase. Finally 11 was used as a donor in the transfer to the acceptor beta-D-Gal-(1-3)-beta-D-GalNAc-OBn 12 catalyzed by a preparation of porcine liver (2-3)-alpha-sialyltransferase, roughly purified by a chromatography on Cibacron Blue-agarose. alpha-Neu5Gc-(2-3)-beta-D-Gal-(1-3)-beta-D-GalNac-OBn 13 isolated in 56% yield was deprotected to give the non-reducing terminal sequence of GM1b glycolylated ganglioside, which might be expressed in human tumors.

Effect of a protein-sparing diet on responses to exercise in obese subjects.

We have studied muscular work efficiency and VO2 peak in seven obese individuals (body mass index: 38.9 +/- 5.8 kg.m-2) before and after twelve days of a low-caloric diet (protein-sparing modified fast) providing about 2460 kJ/day. Respiratory gas exchanges were measured at rest and during an exercise protocol through a rubber mask connected to a pneumotachograph and a mass spectrometer. A significant reduction in body mass was observed with the diet therapy (109 +/- 12 vs 105 +/- 14 kg; p < 0.02). No significant differences were observed in VO2 peak (1.78 +/- 0.32 vs 1.88 +/- 0.43 l/min, p > 0.05) and work efficiency (26 +/- 5 vs 24 +/- 4%, p > 0.05), after the diet protocol. It is concluded that the low-caloric diet used had no effect on muscular work efficiency.

[Poor tolerance of exertion during sports and bronchial hyperreactivity]. / Mauvaise tolérance à l'effort chez le sportif et hyperréactivité bronchique.

135 sportsmen and women, 55 girls, 80 boys, aged from 7 to 30 years, from various sports, who complained of bad tolerance of exertion were examined with an exercise test and isocapnic spontaneous hyperventilation. 61, about 45%, during a hyperventilation test had a fall of V.E.M.S. greater than or equal to 20%, showing bronchial hyperreactivity. After three tests, this fall index was greater than or equal to 50%. 68% of the positive responses were seen in boys and 2/3 of the subjects with a positive response were atopics. No other argument could be maintained from the questioning or clinical history to predict the positive or negative character of the hyperventilation (age, sporting level, symptoms, previous asthma or asthmatic, allergy). H.S.V.I. of the chests of a sporting population that complains of exertion intolerance, therefore allows verification of an H.R.B. assessment of its severity and to follow evolution after treatment.

Captopril but not acebutolol, prazosin or indomethacin decreases postexercise proteinuria.

Strenuous physical exercise causes transient proteinuria and renal hemodynamic changes: decrease of renal blood flow and to a lesser extent of the glomerular filtration rate, and an increase of the filtration fraction. However, the mechanisms of these modifications are still poorly understood. In order to elucidate them we performed maximal exercise tests on 8 untrained healthy volunteers after inhibition of the renin-angiotensin system (RAS) by captopril, the sympathetic nervous system by a beta-blocking drug (acebutolol) or an alpha-blocking drug (prazosin) and the prostaglandin system by indomethacin. Urinary albumin excretion was measured in every subject first at rest (AB) and then after exercise (AA) performed successively without and with blockade by each of theses drugs. AA-AB difference in the captopril test (12.04 +/- 6.11 micrograms/min) compared to that in the control test (68.91 +/- 25.18 micrograms/min) was significantly reduced (p less than 0.02). This difference remained unchanged after acebutolol (59.87 +/- 21.91 micrograms/min, p = 0.62), prazosin (35.23 +/- 27.80 micrograms/min, p = 0.21) and indomethacin (55.21 +/- 28.43 micrograms/min, p = 0.35). There was a negative correlation between the lowering of AA elevation and the rise in plasma renin activity in the captopril test (r = 0.64; p less than 0.03). Only acebutolol decreased systolic blood pressure significantly. These results suggest that the RAS plays a major role in postexercise proteinuria. We hypothesize that stimulation of this system induces an increase of efferent glomerular artery constriction and consequently of glomerular transcapillary pressure and the filtration fraction. Captopril seems able to prevent these hemodynamic changes.

[Reliability of the transcutaneous PO2 measurement in the adult by the TCM 1 radiometer electrode]. / Fiabilité de la mesure de la PO2 transcutanée chez l'adulte par l'électrode radiometer TCM 1.

The accuracy of transcutaneous PO2 measurements (PtcO2; Radiometer TCM 1) was evaluated by comparison with arterial PO2 (PaO2) on 115 recordings in 35 patients: 20 during exercise testing (group I) and 14 during assisted ventilation at different FIO2 values (group II). The correlation coefficient between PaO2 and PtcO2 was satisfactory (r = 0.977; n = 115). However PaO2 and PtcO2 mean values were significantly different in group I, and in group II at 45% FIO2. The analysis of variance showed that the difference between PaO2 and PtcO2 was significant among the patients but did not vary with exercise and FIO2 changes (group I: F19 = 6.28, p less than 0.001; group II: F19(19) = 2.54, p less than 0.025). In the adult, transcutaneous PO2 measurement by TCM 1 radiometer electrode seems to be interesting in the context of monitoring blood gases with exercise and assisted ventilation. The significant variation with arterial PO2 sometimes registered should make one cautious in the interpretation of accurate measurements.

[Measurement by mass spectrometry of oxygen consumption and carbon dioxide production in mechanically ventilated patients]. / Mesure par spectrométrie de masse de la consommation d'oxygène et de la production de gaz carbonique chez les patients ventilés artificiellement.

The authors present a technique of VO2 and VCO2 measurements by a non invasive method in mechanically ventilated patients. Inspirated and expirated gas are sampled respectively in the inspiratory limb of the patient's breathing circuit and in a mixing chamber. Gas samples are analysed by mass spectrometry in the laboratory. Expiratory flow rate is determined by the ventilator flowmeter. To evaluate this procedure the authors have studied the stability of the inspirated and expirated gas samples and the reproductibility of measurements. In a patient with respiratory and haemodynamic stable status this method measures VO2 within 8,2% and VCO2 within 7%.

[Contribution of nocturnal polygraphy to the diagnosis of Pickwickian syndrome. 10 cases]. / Apport de la polygraphie nocturne au diagnostic du syndrome de Pickwick. A propos de 10 observations.

The authors studied a series of 10 obese patients with respiratory failure referred for treatment because of sleep disorders and diurnal, sometimes uncontrollable, episodes of somnolence. 8 parameters were recorded in the polygraphic study performed during a night of hospitalization: electroencephalogram, electrocardiogram, electro-oculogram, chin electromyogram, thoracic movements, and nasal and buccal air flows. SaO2 and transcutaneous PO2 were recorded simultaneously. A sleep apnea syndrome was diagnosed in 6 of the 10 patients, whose apnea index was markedly above the limit of 5 apneas per hour. The apnea index was below 5 in the other 4 patients. Most patients with sleep apnea syndrome suffer from obstructive apneas of varying duration taking up as much as 48% of total sleep time. The cardiorespiratory effects of these events are apparent, with a drop in PO2 and SaO2 and a decrease in heart rate at the end of apnea. Polygraphic studies seem useful in the diagnosis of the pickwickian syndrome. They allow the type of apnea and its effects to be specified and thus guide treatment.

[Electroencephalographic changes in patients with cardiopathies, subsequently operated under extracorporeal circulation. Significance and outcome. Evaluation of 679 cases]. / Altérations électroencéphalographiques chez des patients atteints de cardiopathies, opérés ultérieurement sous circulation extracorporelle. Signification et devenir. Bilan de 679 dossiers.

This study analysed the pre-operative electroencephalographic recordings of 679 patients with heart disease, later undergoing surgery under extra-corporeal circulation. The type and the severity of the abnormalities are listed for each heart disease. These results are compared to those already published in the literature on this subject and are discussed in terms of a number of possible aetiological factors: the age of the patients, data provided by the pre-operative cardio-pulmonary assessment. This analysis does not enable us to demonstrate, with any statistical significance, the aetiological factor(s) of these electroencephalographic alterations. Finally, comparison of the pre-, intra- and postoperative EEG in the same patients enables us to evaluate the prognostic value of these electrical abnormalities.

[Blood pressure profile in effort and recuperation in the sportsman]. / Profil tensionnel d'effort et de récupération chez le sportif.

105 male sportsmen, children, adolescents, adults and veterans, performed a standardized stress test, seated on an ergometric bicycle. The HR/BP ratio was studied during effort and during 6 minutes of recuperation. The level of effort achieved was excellent in each age group, reflecting the value of regular physical training: 187 W in the 13--15 year olds, 274 W in the 16--18 year olds and 20--30 years olds and an excellent level of 206 W in the 60 year old veterans. The stress blood pressure profile in children and adolescent sportsmen is identical for superior performance to that seen in the young sedentary subject. Starting in the 16--18 year old group, we find a blood pressure profile comparable to that seen in other sportsmen. Adult and veteran sportsmen have a blood pressure profile similar to sedentary adults, for superior performance. The 6 minute recovery period allows us to examine: the change in the HR which remains higher than rest values (= 100) independent of age, and the maximal HR attained, as well as the return to normal of the blood pressure figures, which always returned to their initial value, whatever value was obtained on maximal effort. A pathological blood pressure profile is defined as an abnormal elevation during effort and an absence of normalization during the 6 minute recovery period.

[Electroclinical aspects of intramuscular methohexital anesthesia in children]. / Aspects éléctrocliniques de l'anesthésie au méthohexital intramusculaire chez l'enfant.

Intramuscular methohexital is used in children for short-term anaesthesia. As a seizure was observed in two of our cases after administration of this barbiturate, an EEG study was performed. The EEG pattern was characterized by a particularly slow, sharp, high voltage stage with a decrease of fast rhythms (stage 3a), then fast and sharp rhythms becoming more and more frequent (stage 3b). These stages were particularly pronounced and prolonged in children over 3 years of age, with myoclonic jerks observed in 6 cases, beginning about 3 min after methohexital injection and at the same time as the clinical seizures. These results are discussed in terms of previously reported descriptions of barbiturate anaesthesia, and especially of i.m. or i.v. methohexital anaesthesia. This anaesthetic, although reliable and easy to use, should in our opinion be avoided in epileptic children.

[Study of the effects of isaxonine on retrograde axon degeneration induced by vincristine in man (author's transl)]. / Etude des effets de l'isaxonine sur les lésions de dégénérescence axonale rétrograde induites chez l'homme par la vincristine.

Fifteen patients with Hodgkin's disease were examined before and after each administration of vincristine sulfate (2 intravenous injections of 1.4 mg/m2 of body surface, during the first week of each month for 3 months). Moreover, each patient received daily, according to a double blind protocol, either 4 capsules of 375 mg of isaxonine, either 4 capsules filled with lactose used as placebo. At the end of treatment, analysis revealed that 8 subjects were given isaxonine and 7 the placebo. Motor, sensory and reflex conduction velocities, amplitudes of potentials evoked by stimulating motor, cutaneous sensory, or primary afferent fibres, were determined in each electrophysiological examination session. The data and pecularly those obtained from reflex studies, show a significant lesser degree of distal axonal degeneration, in patients receiving a placebo. These results support evidence for a protective effect of the drug against vincristine induced peripheral nerve lesions.

[Asbestos exposure and pleural calcification : functional effects in 34 patients]. / Exposition asbestosique et calcifications pleurales : appréciation du retentissement fonctionnel chez 34 sujets.

Respiratory function disturbances were evaluated in 34 patients, mostly retired naval shipyard workers, with asbestos-related pleural calcifications. All patients had spirography tests, while 20 of them were studied by CO transfer in steady-state and measurements of arterial gases. Results were correlated with previous clinical history (chronic bronchopathy and/or pleural effusions), smoking habits, and the duration of exposure to asbestos dust. Patients with no previous history had mean spirographic values close to the normal (VC: 96% of lower limits; TC: 113%, mean VEMS/CV: 72.5%). Previous clinical history had a very much more marked effect on spirographic results than on gas exchanges: whereas CO transfer and blood gases were usually fairly normal (97% of normal for TCO and DuCO, mean PaO2 at 78 mmHg, mean PaCO2 at 34,5 mmHg), many patients had markedly altered altered values. A clear correlation was found for TCO, DuCO, Du a and PaCO2 with the duration of exposure. This suggests that in some cases there is a certain degree of pulmonary fibrosis associated with the pleural thickening.

[Oxygen enrichers and different ways of using them]. / Enrichisseurs d'oxygène et différents modes d'utilisation.

Different ways of using oxygen enrichers have been studied. First, the performances of two different devices were tested: the results were very similar to the constructors' previsions. Second, oxygen concentrations in venturi masks connected to enrichers were measured with a mass spectrometer. The authors suggest to adjust the flow delivered by enrichers at 3 liters/min for any type of venturi mask. Pharyngeal oxygen concentration curves show the reliability of masks connected to enrichers compared to other modes of administration (nasal cannulae, nasal catheter).

Early phase of vincristine neuropathy in man. Electrophysiological evidence for a dying-back phenomenon, with transitory enhancement of spinal transmission of the monosynaptic reflex.

Ten patients with Hodgkin's disease were examined before and after each administration of vincristine sulfate (2 intravenous injections of 1.4 mg/m2 of body surface during the first week of each month for 3 months). The motor conduction velocity of the peroneal nerve, the conduction velocity in palmar sensory fibres of the median nerve, and the conduction velocity in the H reflex pathway remained unchanged. The amplitude of distal muscle (extensor digitorum brevis) and sensory nerve (median) potentials decreased, while the maximal response of more proximal muscles (soleus) was not significantly modified. The soleus T response quickly decreased, although at the same time the H response was increased in the days following administration of vincristine. Thus the T/H ratio seems to be the only convenient electrophysiological method of evaluating the functional impairment of primary afferent distal segments. These results show that vincristine induces a transitory excitability enhancement of the monosynaptic reflex. It is suggested that the drug may cause an increase in the firing rate in proximal segments of injured Ia fibres. Apart from this phenomenon the electrophysiological results lead to the conclusion that vincristine induces distal axonal degeneration, similar to that in other toxic neuropathies (e.g. acrylamide or n-hexane) where a dying-back process has been clearly demonstrated.

[Correlations between effort tolerance and the severity of coronary disease. Influence of myocardial lesions]. / Corrélations entre la performance physique des coronariens à l'effort et la sévérité de la maladie coronarienne. Influence des lésions myocardiques.

The influence of coronary and myocardial lesions, defining the severity of the coronary artery disease on effort tolerance was studied in 51 patients. The appearances of the coronary arteriography and ventriculography were compared with the parameters of exercise tolerance: electrocardiographic changes, maximal charge (Cw), total work (TW), maximal systolic arterial pressure (SAP), maximal heart rate, percentage of the theoretical maximal heart rate, double product, exercise capacity index (CEI). The results showed that exercise tolerance (Cw, TW, ECI) and the exercise SAP are mainly affected by the myocardial lesions: patients with very reduced left ventricular ejection fractions and double or triple artery disease have very low indices: average Cw of 60 watts, TW less than 20,000 joules, ECI approximately 50. The SAP only rises slightly. On the other hand, patients with normal or subnormal ejection fractions have much higher indices whatever the state of their coronary arteries; Cw over 80 watts, TW over 30,000 joules, ECI over 80. In addition, major left ventricular dysfunction is associated with ST segment elevation during exercise.