Presse Med
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The pathogenesis of premature atherosclerosis in diabetic patients has not yet been fully elucidated, but it seems to be related to changes in circulating lipoproteins and to a poor metabolic balance. In this study plasma levels of triglycerides (TG), total cholesterol (TC), HDL- and LDL-cholesterols, apolipoproteins (Apo) A1 and B were measured in 120 young patients aged from 4 to 32 years (mean +/- 1 SD: 17 +/- 6 years) whose diabetes had been present for a mean period of 10 +/- 6 years (range: less than one year to 25 years). The results obtained were analysed in relation to glycosylated haemoglobin (N: 6.8 +/- 0.6 per cent) and plasma fructosamine (N: 1.9 +/- 0.2 mmol/l) levels. ⋯ These parameters were significantly correlated with HbA1 (p less than 0.01) and even more significantly with fructosamine (p less than 0.001). No significant difference in HDL-C and ApoA1 levels was found in the 3 groups of patients. Thus, TG, TC, LDL-C and ApoB are increased in young diabetics whose HbA1 and fructosamine levels exceed reference values by more than 5 standard deviations.
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In a longitudinal study, 53 renal allograft recipients were investigated for changes in serum creatinine and neopterin levels and in the neopterin/creatinine (N/C) ratio which makes it possible to disregard the glomerular filtration level. The patients were divided into 5 groups according to their clinical situation: stability, acute renal failure due to acute tubular necrosis, acute graft rejection, bacterial or viral infection and cyclosporin overdosage. ⋯ The highest N/C value was observed in patients with primary cytomegalovirus infection. It is concluded that the N/C ratio is a good biochemical parameter to be used in the follow-up of renal allograft recipients.
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Eight-five carotid endarterectomies were performed in 77 patients, under regional anaesthesia using 2 different techniques: cervical epidural anaesthesia (35 cases) and cervical plexus block (50 cases). The patients' mean age was 71 years; 80 per cent had arterial hypertension and 41 per cent coronary disease. Transoperative cerebral ischaemia was detected by a 5-minute carotid clamping test, the occurrence of a neurological event indicating that shunting was required. ⋯ The analgesia obtained was equally good with both anaesthetic techniques, but cervical plexus block anaesthesia is easier to perform, had less haemodynamic repercussions and therefore tends to be preferred to cervical epidural anaesthesia. The lack of mortality, low morbidity and absence of systemic complications in this series despite the high number of patients at risk are in favour of this type of anaesthesia, notably for such patients. Moreover, because vigilance is preserved attention can be paid to the quality rather than the rapidity of endarterectomy, which is the best way of preventing embolism.
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Measuring respiratory mechanics is reputed to be difficult and therefore is seldom done in intensive care units although simple techniques are available. Air flow interruption after constant rate inflation enables the total respiratory system resistance (Rrs) to be divided into airway resistance (Raw) and additional resistance (delta R), the latter being associated with the viscosity and elasticity of the respiratory system and with the inhomogeneity of the lung. Thus, in patients with chronic obstructive lung disease this end-inspiratory air flow interruption provides physiopathological data (increase of Rrs to the detriment of Raw and delta R, due to major disparities of time constants in the lung) and therapeutic data (optimum ventilation mode reducing the patient's breathing work during assisted ventilation). ⋯ Combining the end-inspiratory and end-expiratory techniques enables a realistic and complete pressure-volume curve to be drawn easily. It is therefore possible during mechanical ventilation to evaluate the characteristics of respiratory mechanics very precisely and very simply. This should improve both our understanding of some diseases and our management of ventilated patients.
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Biography Historical Article
[The tragic and marvelous history of anesthesia].