[Right heart insufficiency due to thiamine deficiency].
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Alcoholism↗
Biomedical subjects
A Boussuges
Publications and source records attributed to A Boussuges.
Operation Everest III (Comex '97): modifications of cardiac function secondary to altitude-induced hypoxia. An echocardiographic and Doppler study.
During Operation Everest III (Comex '97), to assess the consequences of altitude-induced hypoxia, eight volunteers were decompressed in a hypobaric chamber, with a decompression profile simulating the climb of Mount Everest. Cardiac function was assessed using a combination of M-mode and two-dimensional echocardiography, with continuous and pulsed Doppler at 5,000, 7,000, and 8,000 m as well as 2 d after return to sea level (RSL). On simulated ascent to altitude, aortic and left atrial diameters, left ventricular (LV) diameters, and right ventricular (RV) end-systolic diameter fell regularly. Heart rate (HR) increased at all altitudes accompanied by a decrease in stroke volume; in total, cardiac output (Q) remained unchanged. LV filling was assessed on transmitral and pulmonary venous flow profiles. Mitral peak E velocity decreased, peak A velocity increased, and E/A ratio decreased. Pulmonary venous flow velocities showed a decreased peak D velocity, a decreased peak S velocity, and a reduction of the D/S ratio. Systolic pulmonary arterial pressure (Ppa) showed a progressive and constant increase, as seen on the elevation of the right ventricular/right atrial (RV/RA) gradient pressure from 19.0 +/- 2.4 mm Hg at sea level up to 40.1 +/- 3.3 mm Hg at 8,000 m (p < 0.05), and remained elevated 2 d after recompression to sea level (SL) (not significant). In conclusion, this study confirmed the elevation of pulmonary pressures and the preservation of LV contractility secondary to altitude-induced hypoxia. It demonstrated a modification of the LV filling pattern, with a decreased early filling and a greater contribution of the atrial contraction, without elevation of LV end-diastolic pressure.
Adult↗
Left atrial and ventricular filling in chronic obstructive pulmonary disease. An echocardiographic and Doppler study.
Abnormal left ventricular (LV) diastolic function has frequently been reported in patients with chronic obstructive pulmonary disease (COPD). In the present work, diastolic function was studied by a combined analysis of pulmonary venous and mitral blood flow velocities in 34 patients with COPD clinically stable and without history of heart disease, and 20 control subjects. We confirmed the increased contribution of the atrial contraction to the LV filling in COPD patients in comparison with control subjects; furthermore, a decreased left atrial (LA) filling during the ventricular systole was observed. Changes in LV filling were not the consequence of a systolic dysfunction, because LV systolic function was normal. Doppler indices indicated that LA pressure was below 15 cm H(2)O in all the patients with COPD and control subjects. Several factors can be put forward to explain these changes; the first one is tachycardia. In addition to hypoxemia and medications, echocardiography suggested that a decreased LV preload participated in increased heart rate. Analysis of Doppler transmitral and pulmonary venous flows demonstrated the role of the ventricular interdependence because a correlation existed between LA and LV filling pattern and right ventricle pressure and diameter.
Atrial Function, Left↗
[Cardiac beriberi].
Interest has recently risen regarding thiamine deficiency (beriberi). In industrial countries, not only alcoholics, but also deprived people with malnutrition, elderly patients and patients with AIDS are at risk of thiamine deficiency. Moreover, long-term furosemide use may be associated with thiamine deficiency through urinary loss, contributing to cardiac insufficiency in patients with congestive heart failure. Cardiovascular (wet beriberi) manifestations of thiamine deficiency are characterized by peripheral vasodilatation with increased cardiac output, myocardial lesion, sodium and water retention and biventricular myocardial failure. Treatment consists of thiamine administration with rapid clinical improvement after supplementation.
Acquired Immunodeficiency Syndrome↗
[Severe air embolism after surgical irrigation with hydrogen peroxide].
BACKGROUND: Hydrogen peroxide is widely used for its antiseptic properties. In certain circumstances, however the risk of air embolism can create a life-threatening situation. CASE REPORT: A 16-year-old adolescent required surgical treatment for femorotibial trauma. During the surgical procedure, cardiac arrest suddenly occurred when hydrogen peroxide was being used to irrigate the wound. A central catheter was inserted and aspiration of air bubbles in the line led to the diagnosis of air embolism. Outcome was unfavorable despite successful resuscitation. A chronic neurovegatative state ensued and the patient died 8 months later. DISCUSSION: Several cases of air embolism have been described due to hydrogen peroxide in surgical, medical and accidental circumstances. Our case emphasizes the potential danger of using hydrogen peroxide in certain situations, including orthopedic surgery. Clinicians should be aware that hydrogen peroxide is not a perfectly safe product.
Adolescent↗
Economic impact of a rational use of antibiotics in intensive care.
OBJECTIVE: To evaluate the economic impact of a rational policy in antibiotic treatment. DESIGN: Comparative study with a retrospective and a prospective part. SETTING: An 11-bed intensive care unit (ICU) in a general hospital. PATIENTS: All patients admitted to the unit in 1994, 1995 and 1996. INTERVENTIONS: In 1995, a program of cost control was started and a contract of agreed objectives signed with the director of the hospital. This contract included a commitment to refund the eventual savings in order to improve the quality of care. Prescribing protocols were established by consensus as guidelines for a rational policy in antibiotic therapy. MEASUREMENTS AND RESULTS: The cost of antibiotic therapy, the patients' characteristics and the incidence of nosocomial infection were compared prior to and during the program. The expenses for antibiotic drugs decreased by 19% in 1995 and by 22% in 1996. Most of the savings were refunded to the ICU and contributed to the employment of an additional nurse and the purchase of new material. In number of patients, type of disease, mean age, Simplified Acute Physiology Score, occupancy rate, length of stay, omega score, artificial ventilation, readmission within 7 days, mortality and incidence of nosocomial infection, no significant difference was found. CONCLUSIONS: We proved a positive economic impact of a rational policy in antibiotic therapy realized with a contract of agreed objectives. The savings made while applying our program of cost control were used to improve the quality of care.
Anti-Bacterial Agents↗
Venous gas embolism: detection with pulsed Doppler guided by two-dimensional echocardiography.
BACKGROUND: Venous gas embolism is a rare but severe event in critically ill patients and the diagnosis should be obtained as soon as possible. Ultrasonography is a sensitive, non-invasive, and bedside means of detection. METHOD: We prospectively estimated the performance of two-dimensional (2D) echocardiography and pulsed Doppler guided by 2D echocardiography in the detection of venous embolism. We used, as a model of venous gas embolism, the decompression following a recreational dive. This activity is responsible for circulating bubbles related to nitrogen desaturation. RESULTS: Venous gas emboli were detected following 44 of 68 dives in 20 of 24 divers. Gas emboli in 36 cases (16 divers) was shown by 2D echocardiography. Parasternal short-axis and right-cavity longitudinal views were the best views for positive detection. Pulsed Doppler confirmed the existence of venous gas emboli in all of the 36 cases with positive detection by 2D echocardiography. In 8 other cases, pulsed Doppler detected circulating bubbles, which were not observed by using 2D echocardiography. Discrepancies were observed in 4 divers with an echographic image of medium or poor quality. CONCLUSION: Combined utilization of 2D echocardiography and pulsed Doppler provides a better method for the detection of venous gas embolism than 2D echocardiography alone. This protocol could be used for critically ill patients suspected of venous air embolism.
Adult↗
Circulating venous bubbles in recreational diving: relationships with age, weight, maximal oxygen uptake and body fat percentage.
Decompression sickness (DCS) is recognized as a multifactorial phenomenon depending on several individual factors, such as age, adiposity, and level of fitness. The detection of circulating venous bubbles is considered as a useful index for the safety of a decompression, because of the relationship between bubbles and DCS probability. The aim of this work was to study the effects of individual variables which can be assessed non invasively, on the grades of bubbles detected 60 min, after diving by means of Doppler monitoring, in a sample of 40 male recreational scuba divers. The variables investigated were: age, weight, maximal oxygen uptake (VO2max) and percentage of body fat (%BF). Bubble signals were graded according to the code of Spencer. The relationships between the bubble grades (BG) and the variables investigated were studied using two methods: the differences between the average values of each variable at each BG were analyzed by the Scheffe test. Then we performed the non-parametric Spearman correlation analysis. Significant differences (P < 0.05) were found (Scheffe test) between average values of the variables at grade 0 and 3 (age: P = 0.0323; weight: P = 0.0420; VO2max: P = 0.0484), except for %BF (P = 0.1697). Relationships with P < 0.01 were found (Spearman correlation) between BG and the variables: age: p = 0.486, P = 0.0024; weight: p = 0.463, P = 0.0039; VO2max: p = -0.481, P = 0.0027; except for %BF: p = 0.362, P = 0.0237. This work showed that bubble production after hyperbaric exposures depends on several individual factors. The effects of age, weight and VO2max are more significant than the effect of %BF. We concluded that to take into account such variables in decompression tables and diving computer programs should allow to adapt the decompression procedures to individual risk factors and reduce the DCS probability.
Adult↗
Haemoptysis after breath-hold diving.
Pulmonary oedema has been described in swimmers and self-contained underwater breathing apparatus (Scuba) divers. This study reports three cases of haemoptysis secondary to alveolar haemorrhage in breath-hold divers. Contributory factors, such as haemodynamic modifications secondary to immersion, cold exposure, exercise and exposure to an increase in ambient pressure, could explain this type of accident. Furthermore, these divers had taken aspirin, which may have aggravated the bleeding.
Adult↗
[Acute pleurisy revealing post-myocardial infarction syndrome].
We report a case of Dressler's syndrome in which the diagnosis was made following an investigation of pleurisy which the laboratory data revealed as inflammatory. A myocardial infarction which had occurred two months earlier had passed unnoticed. The principal value of this case was to draw attention to the syndrome which may initially be a pleurisy but also clinically the picture may mimic pneumonia, both alone or together may be associated with classical pericarditis. Pleurisy occurs in Dressler's syndrome but it is rarely the presenting diagnosis as the cardiac picture tends to predominate.
Acute Disease↗
Heliox in the treatment of obstructive hypoventilation.
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Acidosis, Respiratory↗
Decompression induced venous gas emboli in sport diving: detection with 2D echocardiography and pulsed Doppler.
The aim of this study was to determine the utility of pulsed Doppler and 2D echocardiography for the detection and the quantification of circulating bubbles after decompression. Twenty-three sport divers performed 60 SCUBA dives (mean 32 msw). An evaluation of circulating bubbles was performed using 2D images one hour after diving. Circulating bubbles were also detected with pulsed Doppler. The sample volume was placed in the outflow area of the right ventricle 1-2 cm below the pulmonary valve. 2D echocardiography showed circulating bubbles in right cavities of the heart in 32 cases. Short axis parasternal view and right cavities long axis view were the best incidences. Pulsed Doppler confirmed the results in these 32 cases and detected circulating bubbles in seven other cases. Isometric contraction of muscle limb must be performed to increase the sensitivity of detection. The count of the bubbles may be evaluated when using a combination of Spencer's and Powell's grading. We conclude that 2D echocardiography is less accurate than pulsed Doppler in the detection of circulating bubbles after decompression. Further studies are needed to compare pulsed Doppler guided by 2D echocardiography to continuous Doppler for the detection of circulating bubbles.
Adult↗
Diagnosis of nosocomial pneumonia in mechanically ventilated patients: repeatability of the bronchoalveolar lavage.
The repeatability of the bronchoalveolar lavage (BAL) was assessed prospectively in 44 mechanically ventilated patients with suspected nosocomial pneumonia. Two BAL were performed in the same lung area (contiguous segment) during two fibroscopic procedures performed with a thirty minute interval. All the bronchoscopies were performed by the same operator. The statistical analysis looked out for bias (MacNemar test), agreement, and repeatability (kappa test). In the 44 patients studied, the qualitative repeatability (i.e., presence or absence of bacteria) was excellent (95.4%). However, in the 16 patients having at least one positive culture, these results were more controversial. The quantitative repeatability for bacteria (same log10 for both BAL of the same patient) was the lowest of all the results (26.7%). The distinction between presence and absence of bacterial pneumonia (based on the 10[4] cfu/ml threshold) showed a repeatability of 75% with no bias, an agreement of 47% and a just-significant kappa test (test = 1.97; p = 1.96 for a 5% risk error). BAL seems to have excellent repeatability when sterile. Its repeatability when positive needs further studies to be assessed.
Adult↗
Activation of coagulation in decompression illness.
In animal studies, many authors have observed coagulation activation in decompression illness (DCI). These hemostasis modifications have been attributed to circulating bubbles. We have studied molecular hemostasis markers in 25 consecutive divers, victims of DCI admitted to our hyperbaric center, and in 15 control divers. There was no significant difference in parameters studied in the patients and the control group (platelet, fibrinogen, antithrombin III, Thrombin Antithrombin III complexes, and D-Dimers). An activation of coagulation (D-Dimer > 500 ng.ml-1) was noted in three divers with neurologic troubles. However, such signs of coagulation activation were not correlated with the risk of sequeals. No control or study patient with an osteoarticular or vestibular accident presented signs of coagulation activation. Thus, there does not seem to be a correlation between the severity of the accident and the level of coagulation activation. Further studies will be necessary to evaluate the responsibility of hemostasis modifications in the physiopathology of decompression accidents in sports divers.
Adolescent↗
[Fat embolism after intrapenile injection of sweet almond oil].
We report a case of fat embolism following self injection of vegetable oil in the penis, to treat an impotence. The patient developed respiratory failure and neurological disorders as confusion. A chest roentgenogram revealed diffuse alveolar infiltrate. Initially, he presented an hemoconcentration, and fat globules in his urine. The outcome was favourable in 72 hours, with oxygen and hydration. The diagnosis of fat embolism was made after neurological improvement: the patient admitted to injection his penis with vegetable oil, in his corpus cavernosum.
Adult↗
Left-sided superior vena cava: diagnosis by magnetic resonance imaging.
We describe a case of left-sided superior vena cava. The diagnosis was suggested by chest radiograph after central venous catheter placement. This was subsequently confirmed by magnetic resonance imaging.
Aged↗
Echocardiography on HIV patients admitted to the ICU.
A prospective echocardiographic study was conducted in 68 patients with the human immunodeficiency virus (HIV) admitted to the intensive care unit (ICU) (C3 stage 78%, i.v. drug abuse 71%) in order, firstly to, assess the prevalence of cardiac abnormalities, and, secondly, to make an early therapeutic decision. Only five patients presented clinical evidence of cardiac disease. Echocardiographic abnormalities were identified in 35 patients (51%): pericardial effusion: 20 cases (29%), with tamponade in 2 cases that led to an immediate pericardiocentesis. Left ventricular dysfunction: 15 cases (22%) requiring treatment of cardiac failure. Mitral bioprosthesis rupture in 1 patient that led to a surgical procedure. Vegetations of the tricuspid value in 3 drug addicts (4%) requiring early antibiotic treatment. Echocardiography proved to be very helpful in detecting hidden cardiac dysfunctions. It is immensely valuable in ICU management of HIV patients, since prompt initiation of appropriate treatment is essential.
Adult↗
[Economic impact of a prescription protocol in an intensive care unit].
OBJECTIVE: To assess the economic impact of a prescribing protocol for i.v. fluid therapy and artificial nutrition. STUDY DESIGN: Comparative study, before and during use of the protocol. PATIENTS: The study included 555 ICU patients allocated into two groups, before and after starting with the protocol. The groups were comparable for number, pathologies, age, severity score, duration of ICU stay, incidence of nosocomial infections, mortality rate. METHOD: In February 1995, a written literature-based prescribing protocol for fluid therapy (hydroxyethylstarch and albumin), and artificial nutrition (enteral nutrition as first-line therapy) was devised. A cost analysis was made for two 6-month periods: before (August 1994 to January 1995) and after start of protocol (February to July 1995). RESULTS: The prescription of albumin and hydroxyethylstarch decreased (by 33 and 58% respectively), whereas administration of Ringer lactate and gelatine solutes increased simultaneously. This induced a cost saving of 15,000 FF (a 20% decrease in cost). The reduction of parenteral nutrition in favour of early enteral nutrition induced a cost saving of 56,000 FF (31% decrease in cost). CONCLUSION: Our prescribing protocol generated a cost saving of 9% of the pharmaceutical budget and decreased the cost-benefit ratio of our ICU.
Adult↗