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Siami S, Polito A, Porcher R, Hissem T, Blanchard A, Boucly C, Carlier R, Annane D, Haymann JP, Sharshar T. Thirst perception and osmoregulation of vasopressin secretion are altered during recovery from septic shock. PLoS One 2013; 8:e80190. [PMID: 24223220 PMCID: PMC3819281 DOI: 10.1371/journal.pone.0080190] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 10/01/2013] [Indexed: 11/19/2022] Open
Abstract
Objective Vasopressin (AVP) secretion during an osmotic challenge is frequently altered in the immediate post-acute phase of septic shock. We sought to determine if this response is still altered in patients recovering from septic shock. Design Prospective interventional study Setting Intensive care unit (ICU) at Raymond Poincaré and Etampes Hospitals. Patients Normonatremic patients at least 5 days post discontinuation of catecholamines given for a septic shock. Intervention Osmotic challenge involved infusing 500 mL of hypertonic saline solution (with cumulative amount of sodium not exceeding 24 g) over 120 minutes. Measurements and main results Plasma AVP levels were measured 15 minutes before the infusion and then every 30 minutes for two hours. Non-responders were defined as those with a slope of the relation between AVP and plasma sodium levels less than < 0.5 ng/mEq. Among the 30 included patients, 18 (60%) were non-responders. Blood pressure and plasma sodium and brain natriuretic peptide levels were similar in both responders and non-responders during the course of the test. Critical illness severity, hemodynamic alteration, electrolyte disturbances, treatment and outcome did not differ between the two groups. Responders had more severe gas exchange abnormality. Thirst perception was significantly diminished in non-responders. The osmotic challenge was repeated in 4 non-responders several months after discharge and the abnormal response persisted. Conclusion More than half of patients recovering from septic shock have an alteration of osmoregulation characterised by a dramatic decrease in vasopressin secretion and thirst perception during osmotic challenge. The mechanisms of this alteration but also of the relationship between haematosis and normal response remain to be elucidated.
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Affiliation(s)
- Shidasp Siami
- Department of Intensive Care Medicine, Sud Essonne Hospital, Etampes, France
| | - Andrea Polito
- General Intensive Care Medicine, Assistance Publique Hôpitaux de Paris, Raymond Poincaré Hospital, University of Versailles Saint-Quentin en Yvelines, Garches, France
| | - Raphael Porcher
- Biostatistics and Medical Computer Science Department, Saint-Louis Teaching Hospital, Paris, France
| | - Tarik Hissem
- Department of Intensive Care Medicine, Sud Essonne Hospital, Etampes, France
| | - Anne Blanchard
- Clinical Investigation Centre, Assistance Publique Hôpitaux de Paris, European Georges Pompidou Teaching Hospital, University René Descartes and INSERM CIC9201, Paris, France
| | - Catherine Boucly
- Department of Biochemistry, Assistance Publique Hôpitaux de Paris, Raymond Poincaré Hospital, University of Versailles Saint-Quentin en Yvelines, Garches, France
| | - Robert Carlier
- Department of Radiology, Assistance Publique Hôpitaux de Paris, Raymond Poincaré Hospital, University of Versailles Saint-Quentin en Yvelines, Garches, France
| | - Djillali Annane
- General Intensive Care Medicine, Assistance Publique Hôpitaux de Paris, Raymond Poincaré Hospital, University of Versailles Saint-Quentin en Yvelines, Garches, France
| | - Jean-Philippe Haymann
- Department of Functional Investigations, Assistance Publique Hôpitaux de Paris, Tenon Teaching Hospital, University of Pierre et Marie Curie-Paris 6 and INSERM U702, Paris, France
| | - Tarek Sharshar
- General Intensive Care Medicine, Assistance Publique Hôpitaux de Paris, Raymond Poincaré Hospital, University of Versailles Saint-Quentin en Yvelines, Garches, France
- * E-mail:
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Hagège AA, Caudron E, Damy T, Roudaut R, Millaire A, Etchecopar-Chevreuil C, Tran TC, Jabbour F, Boucly C, Prognon P, Charron P, Germain DP. Screening patients with hypertrophic cardiomyopathy for Fabry disease using a filter-paper test: the FOCUS study. Heart 2010; 97:131-6. [PMID: 21062768 DOI: 10.1136/hrt.2010.200188] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Patients with Fabry disease (FD) show left ventricular hypertrophy (LVH) mimicking hypertrophic cardiomyopathy (HCM) of sarcomeric origin and might benefit, if detected early, from specific enzyme replacement therapy. The prevalence of FD in patients with LVH of 13 mm or greater, screened using the leucocyte alpha-galactosidase A (α-gal A) activity test, a technique that is difficult to apply routinely, ranged from 0% to 6%. OBJECTIVE To screen systematically for FD in patients with a diagnosis of HCM (LVH ≥15 mm) in primary cardiology practice, a validated, physician-friendly α-gal A assay was used on dried blood spots using a filter paper test. DESIGN AND PATIENTS A cohort of 392 adults (278 men) followed for HCM were screened for FD. A standard blood test was used for confirmation in nine men in whom the α-gal A result was 40% or less. RESULTS Four men (1.5%; 1.8% of men ≥40 years vs 0% <40 years; all with α-gal A <30%), but no women, were diagnosed with FD. Index cases presented with diffuse but asymmetric LVH, with severe obstruction in one case and frequent high-grade atrioventricular conduction block necessitating a pacemaker in three cases. Family screening identified eight additional cases. Genotyping was performed successfully on DNA extracted from the filter papers. CONCLUSION In male patients diagnosed as having HCM, pure FD cardiac variants are not exceptional and can be specifically identified using a simple filter-paper test. The sensitivity of this test is low in female patients.
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Affiliation(s)
- Albert A Hagège
- Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Department of Cardiology, University Paris Descartes, INSERM U 633, Paris, France.
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Ravard-Goulvestre C, Boucly C, Mathieu B, Van Amerongen G, Viollet L, Estournet B, Barois A, de Mazancourt P. Allele-specific amplification for the diagnosis of autosomal recessive spinal muscular atrophy. Clin Chem Lab Med 1999; 37:133-5. [PMID: 10219501 DOI: 10.1515/cclm.1999.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The SMN1 gene is homozygously deleted for at least exon 7, interrupted or converted to a non-functional telomeric copy in most cases of proximal spinal muscular atrophies. The presence of a pseudogene hampers direct detection of the exon 7 deletion. We describe a method for the detection of the of exon 7 deletion, based on the amplification refractory mutation system (ARMS), in a multiplex PCR with fluorescent-labelled primers. The gene and pseudogene amplification products differ in the dye bound and in their size, which allows distinction of both products on electrophoresis. The pseudogene is used as an internal control, and this method gives a clear and specific pattern for the patients. Amplification is achieved with 30 cycles, and specificity is retained up to 40 cycles.
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Affiliation(s)
- C Ravard-Goulvestre
- Laboratoire de biochimie et biologie moléculaire, Hôpital R. Poincaré, Garches, France
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Van Amerongen G, Mathonnet F, Boucly C, Mathieu B, Vinatier I, Peltier JY, Catherine N, Collet C, de Mazancourt P. An improved method for the detection of the thermolabile variant of methylenetetrahydrofolate reductase. Clin Chem 1998. [DOI: 10.1093/clinchem/44.5.1045] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Geneviève Van Amerongen
- Laboratoire de biochimie et biologie moléculaire, Hôpital R. Poincaré, F92380 Garches, France; Laboratoires d’hématologie du centre hospitalier de Poissy-Saint Germain en Laye, F78303 Poissy, France; Service de Médecine Interne, centre hospitalier de Poissy-Saint Germain en Laye, F78303 Poissy, France; Faculté de Médecine Paris Ouest, CJF 9402, Université Paris, V, F92380 Garches, France
| | - Florence Mathonnet
- Laboratoire de biochimie et biologie moléculaire, Hôpital R. Poincaré, F92380 Garches, France; Laboratoires d’hématologie du centre hospitalier de Poissy-Saint Germain en Laye, F78303 Poissy, France; Service de Médecine Interne, centre hospitalier de Poissy-Saint Germain en Laye, F78303 Poissy, France; Faculté de Médecine Paris Ouest, CJF 9402, Université Paris, V, F92380 Garches, France
- Laboratoire de biochimie et biologie moléculaire, Hôpital R. Poincaré, F92380 Garches, France; Laboratoires d’hématologie du centre hospitalier de Poissy-Saint Germain en Laye, F78303 Poissy, France; Service de Médecine Interne, centre hospitalier de Poissy-Saint Germain en Laye, F78303 Poissy, France; Faculté de Médecine Paris Ouest, CJF 9402, Université Paris, V, F92380 Garches, France
| | - Catherine Boucly
- Laboratoire de biochimie et biologie moléculaire, Hôpital R. Poincaré, F92380 Garches, France; Laboratoires d’hématologie du centre hospitalier de Poissy-Saint Germain en Laye, F78303 Poissy, France; Service de Médecine Interne, centre hospitalier de Poissy-Saint Germain en Laye, F78303 Poissy, France; Faculté de Médecine Paris Ouest, CJF 9402, Université Paris, V, F92380 Garches, France
| | - Bertille Mathieu
- Laboratoire de biochimie et biologie moléculaire, Hôpital R. Poincaré, F92380 Garches, France; Laboratoires d’hématologie du centre hospitalier de Poissy-Saint Germain en Laye, F78303 Poissy, France; Service de Médecine Interne, centre hospitalier de Poissy-Saint Germain en Laye, F78303 Poissy, France; Faculté de Médecine Paris Ouest, CJF 9402, Université Paris, V, F92380 Garches, France
| | - Isabelle Vinatier
- Laboratoire de biochimie et biologie moléculaire, Hôpital R. Poincaré, F92380 Garches, France; Laboratoires d’hématologie du centre hospitalier de Poissy-Saint Germain en Laye, F78303 Poissy, France; Service de Médecine Interne, centre hospitalier de Poissy-Saint Germain en Laye, F78303 Poissy, France; Faculté de Médecine Paris Ouest, CJF 9402, Université Paris, V, F92380 Garches, France
| | - Jean-Yves Peltier
- Laboratoire de biochimie et biologie moléculaire, Hôpital R. Poincaré, F92380 Garches, France; Laboratoires d’hématologie du centre hospitalier de Poissy-Saint Germain en Laye, F78303 Poissy, France; Service de Médecine Interne, centre hospitalier de Poissy-Saint Germain en Laye, F78303 Poissy, France; Faculté de Médecine Paris Ouest, CJF 9402, Université Paris, V, F92380 Garches, France
| | - Nicole Catherine
- Laboratoire de biochimie et biologie moléculaire, Hôpital R. Poincaré, F92380 Garches, France; Laboratoires d’hématologie du centre hospitalier de Poissy-Saint Germain en Laye, F78303 Poissy, France; Service de Médecine Interne, centre hospitalier de Poissy-Saint Germain en Laye, F78303 Poissy, France; Faculté de Médecine Paris Ouest, CJF 9402, Université Paris, V, F92380 Garches, France
| | - Catherine Collet
- Laboratoire de biochimie et biologie moléculaire, Hôpital R. Poincaré, F92380 Garches, France; Laboratoires d’hématologie du centre hospitalier de Poissy-Saint Germain en Laye, F78303 Poissy, France; Service de Médecine Interne, centre hospitalier de Poissy-Saint Germain en Laye, F78303 Poissy, France; Faculté de Médecine Paris Ouest, CJF 9402, Université Paris, V, F92380 Garches, France
| | - Philippe de Mazancourt
- Laboratoire de biochimie et biologie moléculaire, Hôpital R. Poincaré, F92380 Garches, France; Laboratoires d’hématologie du centre hospitalier de Poissy-Saint Germain en Laye, F78303 Poissy, France; Service de Médecine Interne, centre hospitalier de Poissy-Saint Germain en Laye, F78303 Poissy, France; Faculté de Médecine Paris Ouest, CJF 9402, Université Paris, V, F92380 Garches, France
- Laboratoire de biochimie et biologie moléculaire, Hôpital R. Poincaré, F92380 Garches, France; Laboratoires d’hématologie du centre hospitalier de Poissy-Saint Germain en Laye, F78303 Poissy, France; Service de Médecine Interne, centre hospitalier de Poissy-Saint Germain en Laye, F78303 Poissy, France; Faculté de Médecine Paris Ouest, CJF 9402, Université Paris, V, F92380 Garches, France
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Annane D, Clair B, Mathieu B, Boucly C, Lesieur O, Donetti L, Gatey M, Raphael JC, Gajdos P. Immunoglobulin A levels in bronchial samples during mechanical ventilation and onset of nosocomial pneumonia in critically ill patients. Am J Respir Crit Care Med 1996; 153:1585-90. [PMID: 8630606 DOI: 10.1164/ajrccm.153.5.8630606] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Local immunoglobulins play a key role in host defense against lung infection. We investigated the pattern of evolution of bronchial albumin, IgA, and IgG levels in ventilated ICU patients in relation to nosocomial pneumonia. Immunocompetent, critically ill patients underwent serial blood and bronchial protein determinations on Day 1 (intubation day), and on Days 3, 7, 10, and 14. The variations in proteins levels were compared with corresponding Day 1 values in the whole population, and between patients who developed lung infections (Group A) and the remaining population (Group B). Forty-four patients were included into the study. In the whole population, when compared with the baseline value, bronchial IgA/albumin ratio increased significantly (Day 3, +58%, p = 0.04); Day 14, +171%, p < 0.01), but serum IgA/albumin and serum and bronchial IgG/albumin ratios did not change significantly. In Group A, the increase in the IgA/albumin ratio was less than in Group B (Day 3, +15% versus +87%, p = 0.04; Day 14, +29% versus +210%, p < 0.01). No significant differences were observed between the two groups for bronchial and plasma albumin and IgG levels and for bronchial polymorphonuclear elastase levels. Bronchial IgA production was enhanced in ventilated patients. A reduction in this enhanced bronchial IgA production might account for the development of nosocomial pneumonia.
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Affiliation(s)
- D Annane
- Service de Réanimation Médicale, Hôpital Raymond Poincaré, Garches, Université Paris V., France
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