[Value of gastric fluid to start antibiotics in premature babies suspected of having early neonatal bacterial infection]. / Intérêt du liquide gastrique dans la décision d'antibiothérapie du nouveau-né prématuré suspect d'infection bactérienne précoce.

The objective of this study was to evaluate the value of direct examination and culture of gastric fluid in the treatment of early neonatal bacterial infections (INBP) in pre-term infants. MATERIALS AND METHODS: Observational study conducted over 6 months in a Type III center. All hospitalized premature babies who had routine gastric fluid sampling at birth during the period of the study were included. They were classified into two groups: premature infants with probable or suspected infection and treated as such (Group 1) and premature infants with no infection or only having colonization (Group 2). RESULTS AND DISCUSSION: In total, 255 pre-term infants were included in the study. Group 1 consisted of 127 newborns and group 2 consisted of 128 newborns. The direct gastric fluid examination was positive in 51 newborns in Group 1 and in 46 newborns in group 2. The culture was positive in 25 newborns in group 1 and eight newborns in group 2. Direct examination of gastric fluid of the 255 children studied had low sensitivity (40.1%) and low specificity (64%) of INBP, with 52.6% positive predictive value (PPV) and 51.8% negative predictive value (NPV). The gastric fluid culture was specific (93.7%) of the INBP, sensitivity was low (19.6%), with PPV at 75.7% and NPV at 54%. CONCLUSION: These results undermine the relevance of the direct examination of gastric fluid in the delicate diagnosis of INBP. This direct examination has a low PPV and NPV. It is advisable not to start or stop antibiotic therapy solely on this argument; however, it can guide the choice of antibiotic therapy and remains useful for this reason. The culture of gastric fluid has very good specificity (93.7%).

[Monitoring of adipocyte responsiveness by in situ microdialysis in lipodystrophy tissue: adjustment of a glycerol quantification method in small samples]. / [In Process Citation]

In situ microdialysis allows monitoring of metabolic cellular processes at the tissue level in vivo. In the assessment of physiopathologic alterations seen in lipodystrophy, monitoring of glycerol release is pivotal. Indeed, it allows to quantify the pharmacological responsiveness of subcutaneous adipose tissue in humans. Until now, the small volume of microdialysate collected (5-15 microL/sample) restricted the assessment of glycerol level to the use of the radio-enzymatic method or the reference spectrophotometric microanalysis technique. The aim of this study was to adapt the method of glycerol measurement by iminequinone spectrophotometry colorimetric assay (520 nm) using the following reagent: 0.5 IU Glycerokinase, 1.23 IU glycerophosphate oxidase, 0.98 IU peroxidase, 4.6 mM Mg, 5.4 mM 4-chlorophenol, 0.25 mM 4-aminoantipyrine and 1.4 mM ATP. The assay was setup to run on Olympus AU 2700 automate (15 pL sample volume). The sensitivity of the method was improved by adding a 0.2 mmol triglyceride (TG) solution and 1.5 IU lipase to samples, reducing the limit of free glycerol quantification to 0.020 mmol/L. The analytical repeatability was 2.0% and the reproducibility was 7.9%. The present method thus demonstrated the feasibility of pharmacodynamic exploration of local cutaneous responsiveness in vivo in clinical trials.

Monte Carlo simulation of electron beams from an accelerator head using PENELOPE.

The Monte Carlo code PENELOPE has been used to simulate electron beams from a Siemens Mevatron KDS linac with nominal energies of 6, 12 and 18 MeV. Owing to its accuracy, which stems from that of the underlying physical interaction models, PENELOPE is suitable for simulating problems of interest to the medical physics community. It includes a geometry package that allows the definition of complex quadric geometries, such as those of irradiation instruments, in a straightforward manner. Dose distributions in water simulated with PENELOPE agree well with experimental measurements using a silicon detector and a monitoring ionization chamber. Insertion of a lead slab in the incident beam at the surface of the water phantom produces sharp variations in the dose distributions, which are correctly reproduced by the simulation code. Results from PENELOPE are also compared with those of equivalent simulations with the EGS4-based user codes BEAM and DOSXYZ. Angular and energy distributions of electrons and photons in the phase-space plane (at the downstream end of the applicator) obtained from both simulation codes are similar, although significant differences do appear in some cases. These differences, however, are shown to have a negligible effect on the calculated dose distributions. Various practical aspects of the simulations, such as the calculation of statistical uncertainties and the effect of the 'latent' variance in the phase-space file, are discussed in detail.

[Food allergy in the chronic alcoholic and alcohol in food allergy: apropos of 38 cases]. / L'allergie alimentaire chez l'alcoolique chronique et l'alcool dans l'allergie alimentaire: à propos de 38 cas.

Exacerbation or appearance of hypersensitivity of food origin in chronic alcoholics appears to be linked to a basis of catabolism of histamine, a facilitation of penetration of allergens under the impetus of the mucosa-irritating power of alcohol and its potential as a histamine-liberator; it results frequently in an elevated total IgE that predisposes to conflictual sub-cutaneous mechanisms, so explaining the easy appearance or exacerbation of food allergies. We have used skin tests of the principal food allergens to evaluate the influence of alcohol in the development of allergies, by determining the allergy profile of each patient and consequently, the titres of total IgE. Our results show the potentiating role in the physiopathology of allergy and food intolerance without which it helps as much by an evident inducing role in the appearance of true food allergy.

[The physician-pharmacist team in the education of patients concerning inhalant therapy]. / Duo medecin-pharmacien dans l'education du malade face aux therapeutiques inhalees.

The value of educational measures in consideration of the asthmatic patient appeared at first twenty years ago to the eyes of clinical physicians, generalists or specialists. Round about the year 76 the first associations for asthmatic patients were born, under pressure from pneumologists, with the aim of clarifying their illness to asthmatics, to counsel them and especially to enable them to associate their symptoms with their treatment, to assure them of a ready availability of materials more or less onerous to test, aerosolizers, nebulizers, ionizers of the environment, peak flow meters, inhalation chambers, acaricides.... Twenty years after these pioneers of this education of the patient to these responsibilities, the associations devoted to asthma as well as schools of asthma have recently been instigated in order to complete the venture on the ground, often with only feeble means. It is hardly necessary to make an illusion: asthmatic patients, children or adults within these associations are always the same: it is those who are prepared to stir themselves to take part in meetings. There remains the great majority of asthmatics who necessarily need a particular treatment that is adapted to their personal case: it is the duo of physician-pharmacist which is and which constitutes always the best point of impact to devote the time necessary at the best appropriate moment. Such is the aim of this presentation which should not be considered as a return to the past, but an advance towards the individualized formulation of patients by benefitting from the former experiences of corporative formations.

[Value of esophageal scintigraphy in exploration of a gastro-esophageal reflux in a respiratory patient]. / Intérêt de la scintigraphie oesophagienne dans l'exploration d'un reflux gastro-oesophagien chez le patient respiratoire.

Patients with respiratory pathologies in the forms of tracheitis, rhino-sinusitis, and asthma sometimes have symptoms of gastro-oesophageal reflux, that should be taken into consideration in order to treat the co-factors associated with the etiopathology. However, these patients, because of their respiratory handicaps, are frequently unwilling to submit themselves to traumatic investigations. Oesophageal scintigraphy, because of its perfect tolerance and reliability, seems to be an examination that is adapted to the situation to resolve this dilemma.

[Value of specific IgE and IgG4 measurements in the follow-up of a hymenoptera venom immunotherapy treatment: apropos of 82 cases]. / Intérêt du dosage des IgE et IgG4 spécifiques dans le suivi d'un traitement d'immunothérapie aux venins d'hyménoptères: à propos de 82 cas.

The work is devoted to the study of 82 dossiers of patients who were treated by immunotherapy (IT) to hymenoptera venoms, following various manifestations. The study has permitted analysis of the value of measurement of specific immunoglobulins, both IgE and IgG4 (1), in following IT in patients who were treated for at least three years. It especially emphasized the usefulness of adopting management that is appropriate to the clinical and biological characteristics of each patient.

Conceptualisation of diagnostic agents: from empirical in vivo screening to rational in vitro predictive parameters.

A new rational conceptualisation protocol in new isotopic diagnostic agents has been designed to avoid systematic empirical in vivo screening. This protocol is based on multiple regression analysis, in order to determine the pharmacokinetic model capable of explaining in the best possible way the in vivo behaviour of molecules injected into an organism. Nine technetium complexes (99mTc-L) were synthesised from aminothiol ligand vectors. These complexes were characterised in terms of their physical, chemical and biological in vitro properties, i.e. lipophilicity (P), free fraction unbound to plasmatic proteins (Fup), the fraction unbound to blood cells (FuCb), and membrane adsorption fraction (Fad), an original factor assessed in vitro. Thus, two pharmacokinetic models were tested. The first takes into account the parameters classically used in pharmacokinetics (P, Fup, FuCb), and the second, in parallel with the first, includes the membrane adsorption rate (polar/apolar/polar membrane model). According to the phenomenon of tissular distribution, the explanatory power of the second model, including the Fad, is radically greater than that of the classical model. The comparative adjusted coefficient of determination (R2) of the model, including the Fad versus R2 of the first model, are heart (91%/6%), liver (89%/47%), spleen (64%/44%), lung (78%/26%), kidney (70%/33%) and brain (73%/8%), respectively. In addition, as for the myocardium, the membrane adsorption factor seems to be the only predictive factor of the affinity between the myocardium and neutral or cationic molecules. This refutes the generally held view that only cationic molecules could have an affinity with the heart.

[History-taking of the allergic patient]. / L'interrogatoire du malade allergique.

Etiological diagnosis of an allergic condition is assured mostly clinically and in particular by the data from a specific and minute interrogation. Complementary investigations only confirm the diagnostic suspicion produced by this interrogation, which includes several essential steps: The history of the patient from the first symptom to the day of consultation. The common criteria of unity of time, place or action on the different manifestations of hypersensitivity. The provocation factors and improvement of critical episodes. The mode of life of the subject and the factors of environmental imbalance.

Synthesis and biodistribution of new oxo and nitrido 99mTc complexes with asymmetrical potentially dianionic or trianionic tetradentate SNNO ligands derived from methyl-2-aminocyclopentene-1-dithiocarboxylic acid.

In this work, 10 new asymmetrical tetradentate SNNO ligands were prepared by reaction of the amine function of methyl 2-[(beta-aminoethyl)amino]cyclopentene-1-dithiocarboxylate with various bifunctional substituents bearing hydroxyl/ketone and hydroxyl/aldehyde functional groups and with diethyl oxalate. 99mTc labeling efficiency was optimized by adjusting temperature and pH conditions. Seven nitrido and two oxo 99mTc complexes were isolated. Six of them proved to be stable near physiological conditions. Biodistribution studies in the rat showed a significant heart uptake for four of them and strong kidney and liver uptake for the other two.

Technetium labeling of bi, tri and tetradentate ligands derived from 2-aminocyclopentene-1-dithiocarboxylic acid: characterization and biodistribution of their oxo and nitrido 99mtechnetium complexes.

We have synthesized and characterized seven ligands derived from 2-aminocyclopentene-1-dithiocarboxylic acid with different donor sets (SN2-, SNO2-, SNN2-, SNNO3- and SNNN3-) and different substituents on the sulfur moieties-SR (with R = H, CH3 or C2H5O(CH3)CH). With five of these ligands technetium nitrido complexes have been obtained with high yields (over 95%) using rather harsh conditions (pH = 1, temperature > or = 80 degrees C), whereas for technetium oxo complexes similar high yields were only obtained with two ligands but with mild conditions (pH = 7-8, temperature approximately equal to 50 degrees C). Changing an OH group for an NH2 has a drastic effect upon labeling yields. The possibility of complexing ligands as either oxo (TcO)3+ or nitrido (TcN)2+ derivatives increases the number of available labeled agents with different overall change and consequently with different biological behavior.

Synthesis, characterization and biodistribution of new 99mTc oxo and nitrido complexes with bi- and tetradendate unsaturated NS and N2S2 Schiff bases derived from 2-aminocyclopentene-1-dithiocarboxylic acid as potential heart imaging agents.

The synthesis, characterization and 99mTc labelling of unsaturated diamino dithiol ligands with methyl dithiocarboxylate functions: 2-aminocyclopentene-1-dithiocarboxylic methyl ester (H2L1), N,N'-ethylene bis(methyl 2-aminocyclopentene-1-dithiocarboxylate) (H2L2) and N,N'-propylene bis (methyl 2-aminocyclopentene-1-dithiocarboxylate) (H2L3) are described. Cationic oxo (Tc = O) and neutral nitrido (Tc = N) complexes were obtained. Biodistribution studies in rat showed a good heart uptake of 99mTcN-L2 (2% ID at 5 min) with a high heart-to-blood ratio (5.8 at 5 min), but this complex also exhibited high lung and liver uptake.