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Biomedical subjects

A Desachy

Publications and source records attributed to A Desachy.

15 recordsLinked to original sources
PubMed2006

[Standard perioperative management of patients treated with lithium can lead to hyperosmolar coma].

A 55-year-old woman with bipolar disorder who had been taking lithium for several years developed hyperosmolar coma following osteosynthesis of a hip fracture. The coma was attributed to decompensation of undiagnosed nephrogenic diabetes insipidus due to chronic lithium intake. The lengthy perioperative fasting and large fluid loading (necessitated by the anesthetic technique) led to acute hypernatremia. Closer monitoring and a different anesthetic strategy might have avoided this classical complication of chronic lithium therapy. The patient recovered after symptomatic treatment. We discuss the perioperative management of patients taking (or having taken) lithium, based on a review of the literature.

Anesthesia, Spinal↗
PubMed2006

[Lesional pulmonary oedema following laparoscopy for haemorrhage: aetiological assessment and possible gas embolism].

A 44-year-old woman had to undergo repeat laparoscopy, four hours after laparoscopic sigmoidectomy, because of persistent bleeding from the drain. The bleeding caused perioperative shock and necessitated transfusional support. The following day she developed dyspnea, revealing pulmonary oedema. As her respiratory status continued to deteriorate and the bleeding persisted, she was transferred to the intensive care unit on day 2, after corrective laparotomy. The echocardiogram ruled out cardiogenic pulmonary oedema. No inhalation had occurred during the three anaesthetic procedures, and onset several hours after transfusion argued against lesional pulmonary oedema secondary to packed red cell transfusion. Given the context of repeat surgery by laparoscopy because of active bleeding, a diagnosis of lesional pulmonary oedema complicating CO(2) embolism was made. She received symptomatic treatment and her respiratory status gradually improved. Four months later her clinical status was normal. The different causes of postoperative pulmonary oedema and the pathophysiologic mechanisms of pulmonary lesions induced by gas embolism are discussed.

Adult↗
PubMed2006

[Gas embolism during protective ventilation for acute respiratory distress syndrome].

A 34-year-old woman with toxic coma developed inhalation pneumonia complicated by the acute respiratory distress syndrome. Marked parenchymal destruction and recurrent pneumothorax occurred despite protective ventilation. Altered consciousness persisted after sedative withdrawal, and the patient subsequently died. Computed tomography revealed multiple cerebral, renal and splenic infarcts. The only identified cause of systemic embolism was multiple gas embolisms. We discuss the physiopathological mechanisms, and the diagnostic and therapeutic management of such patients.

Adult↗
PubMed2003

[Prospective assessment of information programme for blood transfusion in critical care patients].

OBJECTIVES: Assessment of oral and written information programme for blood transfusion in critical care patients and study of factors associated with the biological follow-up. STUDY DESIGN: Prospective study in one intensive care unit. PATIENTS AND METHODS: All blood recipients in 2000 were orally informed of transfusion process. In regard to the French haemovigilance regulation, written paper was given to the patient or passed on to the next hospital physician. Four months later, a questionnaire was proposed to the patients. RESULTS: In 2000, blood transfusion was performed for 102 patients and data were obtained for 59 patients (34 number of survivor patients, follow-up was impossible for eight and one refused the questionnaire). Quality assurance programme permit a global orally and written information of critical care patients. However, thirty-eight patients (64%) remembered oral information. Patients were younger (55 +/- 22 vs 68 +/- 13, OR = 1.04; p = 0.03). Biological follow-up was obtained for 22 patients (37%), particularly when written information was directly given to the patient (22/24 vs 2/35; OR = 335; p < 0.0001). CONCLUSION: Biological follow-up was obtained for only one third of blood recipients, because, in first, only 64% of critical care patients remembered oral information, particularly the younger patients. Perhaps, written information systematically given to the patient could permit a high biological follow-up. This study confirmed the lack of sensitivity of all hospital physician for haemovigilance.

Adult↗
PubMed2001

Reactivation of human herpesvirus type 6 in multiple organ failure syndrome.

Human herpesvirus type 6 (HHV-6) and cytomegalovirus (CMV) are known to interact with the production of cytokines. In this study, we sought to determine the incidence of HHV-6 and CMV reactivation during multiple organ failure syndrome (MOFS) and to evaluate the potential effects of viral replication on both the morbidity and mortality associated with MOFS. Viral reactivation was assessed by use of specific polymerase chain reaction (PCR) analysis of the serum samples obtained from 48 consecutive patients with MOFS (the MOFS group) and from 48 sex- and age-matched patients with <2 organ failures (the control group). In addition, HHV-6 replication was assessed in 106 blood donors (the normal group). The incidence of HHV-6 replication was higher in the MOFS group than in the control and normal groups (26 [54%] of 48 vs. 7 [15%] of 48 and 5 [5%] of 106, respectively; P<.0001), with apparently no influence on morbidity and mortality rates. In contrast, reactivation of CMV was found in a single patient. Further studies are needed to evaluate the pathogenesis of HHV-6 replication in critically ill patients.

Adolescent↗
PubMed2001

[Hemophagocytosis during multiple organ failure: M-CSF overproduction or viral reactivation?].

OBJECTIVE: This study was aimed to assess the potential role of M-CSF and viral reactivation in the genesis of haemophagocytosis during the multiple organ failure (MOF) syndrome. METHODS: Twenty-five patients (mean age: 60 +/- 16 years; Apache II: 23 +/- 5) sustaining MOF with an unexplained thrombocytopenia were studied. In each patient, a bone marrow aspirate, serum M-CSF concentration, and a virological examination (Herpes viruses) were obtained on admission. In addition, 20 patients (mean age: 57 +/- 15 years; Apache II: 24 +/- 7) with at least two organ failures but no thrombocytopenia constituted the control group. Circulating M-CSF levels and the frequency of virus reactivation were compared between groups. RESULTS: Haemophagocytosis was diagnosed in 11/25 patients (44%). No viral reactivation was found. Serum M-CSF concentrations were higher in the presence of haemophagocytosis (699 +/- 242 vs 438 +/- 157 IU.mL-1; p < 0.05). Ferritin levels were also increased in the presence of a macrophage activation (3,258 +/- 2,807 vs. 520 +/- 280 mg.L-1; p < 0.0001). In contrast, both circulating M-CSF and ferritin levels were similar between thrombocytopenic patients with no hemophagocytosis and controls. CONCLUSIONS: This study confirmed the high incidence of haemophagocytosis in critically ill patients sustaining MOF. In this setting, circulating M-CSF levels were markedly elevated, whereas no Herpes viruses reactivation was found.

Aged↗
PubMed2001

Extrapericardial cardiac tamponade caused by traumatic retrosternal hematoma.

Cardiac tamponade is an uncommon complication of blunt chest trauma, resulting typically from hemorrhage into the pericardial space. We report a case of hemodynamic compromise secondary to an extrapericardial compression caused by the acute formation of a retrosternal hematoma associated with a sternal fracture. The patient was involved in a violent deceleration accident. Initially, he only complained of an anterior thoracic pain, but subsequently became restless, pale, and dyspneic. A severe hypotension associated with sinus bradycardia (45 bpm) rapidly occurred. Both jugular veins became markedly turgescent, but no significant pulsus paradoxus was noted. Echocardiography disclosed a large hematoma, compressing anteriorly both the right ventricular cavity and outflow tract. Surgical evacuation of the retrosternal hematoma related to a bifocal fracture of the manubrium was followed by instantaneous hemodynamic improvement. Regional extrapericardial tamponade secondary to the acute formation of compressive retrosternal hematoma is an unusual cause of circulatory failure after severe blunt chest trauma. Since conventional clinical signs associated with typical tamponade physiology may be lacking in this setting, echocardiography is ideally suited for early recognition of this unusual condition.

Accidents, Traffic↗
PubMed2000

[Refractory shock after converting enzyme inhibitor administration. Usefulness of angiotensin II].

BACKGROUND: Angiotensin-converting enzyme (ACE) inhibitors are commonly used during the early phase after myocardial infarction but severe hypotension and shock have been described. CASE REPORT: A 42-year old woman underwent a conservative management for an anterior acute myocardial infarction, initially associated with a pulmonary edema. Two hours after the initiation of a treatment with ACE inhibitor administered orally (lisinopril, Zestril), a circulatory failure in conjunction with an acute renal insufficiency occurred. Right heart catheterization disclosed markedly decreased systemic vascular resistance in the presence of a preserved cardiac index. Repeated fluid challenges and intravenous administration of norepinephrine failed to improve the hemodynamic status. The refractoriness of shock raised the hypothesis of a dysregulation of the renin-angiotensin system, secondary to the treatment by ACE inhibitor. Accordingly, the patient was given angiotensin II intravenously (Hypertension) which markedly raised systemic vascular resistance, and result in subsequent regression of shock. The patient was discharged after an otherwise uneventful course. DISCUSSION: We reported a refractory shock to fluid challenges and norepinephrine after the first dose of ACE inhibitor during acute myocardial infarction. Regression of shock was possible only with angiotensin II.

Adult↗
PubMed2000

Platelet-activating factor acetylhydrolase and haemophagocytosis in the sepsis syndrome.

Sepsis syndrome (SS) is associated with depressed PAF acetylhydrolase, the enzyme responsible for the degradation of platelet activating factor. PAF acetylhydrolase is in a large part produced by macrophages, whose inadequate activation with haemophagocytosis is frequent in patients with SS. The aim of this study was to test the hypothesis that PAF acetylhydrolase levels could be affected in these critically ill patients, because of the large amounts produced by activated macrophages in vitro and in vivo in animal models. The levels of serum PAF acetylhydrolase were assessed in 90 SS patients, who were divided into three groups: patients with (n = 34) or without haemophagocytosis (n = 31), and patients without thrombocytopenia (n = 25) who were used as a control group. The number of organ dysfunctions was matched between patients with haemophagocytosis and controls. Normal reference values were obtained in 59 randomly selected blood donors. Circulating levels of PAF acetylhydrolase were significantly (p = 0.0001) decreased in patients with SS (57+/-3 nmol/ml/min, n = 90) when compared with healthy subjects (69+/-3 nmol/ml/min, n = 59). PAF acetylhydrolase levels were greater in the presence of a haemophagocytosis but without statistical significance (64.2+/-6.5 vs. 50.1+/-2.8:p = 0.25). Despite the fact that macrophagic activation stimulates the in vitro release of PAF acetylhydrolase, no difference was found between patients with or without haemophagocytosis. The mechanism and the role of the PAF acetylhydrolase reduction in SS patients remain to be determined.

1-Alkyl-2-acetylglycerophosphocholine Esterase↗
PubMed1999

[A rare cause of sudden death in young adults with "normal" heart: the Brugada syndrome].

BACKGROUND: Brugada syndrome is a rare condition causing sudden death in young adults due to unexpected sudden-onset ventricular fibrillation. Diagnosis is based on the presence of an ST depression in the anteroseptal territory and a right branch block. No underlying dysrhythmic condition or arrhythmogenic heart disease can be detected. CASE REPORT: A 15-year old boy with an uneventful past history experienced cardiocirculatory failure due to ventricular fibrillation during a sports competition. Cardiac arrest developed and resuscitation was initially successful but death ensued due to cerebral anoxia. Characteristic electrocardiographic signs and the presence of similar anomalies in a brother and an aunt led to the diagnosis of Brugada syndrome. DISCUSSION: Brugada syndrome is a recently discovered hereditary condition with a probably underestimated prevalence. Systematic family studies have demonstrated autosomal dominant inheritance. The characteristic electrocardiographic anomalies can be transitory and may be unmasked by sensitivization tests. The only currently effective treatment is the implantable defibrillator programmed to prevent sudden death by ventricular fibrillation.

Adolescent↗
PubMed1998

Traumatic pulmonary hernia: surgical versus conservative management.

The therapeutic management of lung herniation, an uncommon complication of severe blunt chest trauma, remains controversial. We report here on two cases of traumatic lung herniation with different, yet successful, methods of therapeutic management according to the particular anatomic types. Because of the threat of tension pneumothorax, incarceration, or strangulation of the lung parenchyma in mechanically ventilated patients, surgical reduction of intercostal pulmonary hernias with narrow necks is usually recommended. In contrast, supraclavicular pulmonary hernias secondary to clavicle-sternal dislocation may be treated conservatively with serial clinical and thoracic imaging follow-up including chest computed tomographic scan. In this anatomical type of lung herniation, favorable spontaneous evolution is frequently observed, presumably because of the presence of a larger thoracic wall defect together with the absence of associated perforating bone trauma. The efficacy of the therapeutic approach proposed herein remains to be confirmed by further experience.

Adult↗
PubMed1998

[Pancytopenia and pulmonary tuberculosis. Significance of a hemophagocytic syndrome].

Haemophagocytic syndromes or syndromes involving macrophage activation are rare complications of tuberculosis, whether they be pulmonary or polyvisceral. They are characterised by an anomalous increase in the phagocytic power of macrophages with phagocytosis of the formed elements of blood. The clinical biological picture associates a change in the general physical state accompanied by organomegaly, hyperferritinaemia and pancytopenia. Their occurrence is a poor prognostic factor and few treatment seem to check this mechanism. The authors report a rare case of marked macrophage activation syndrome complicating pulmonary tuberculosis in a patient who was HIV negative without an underlying blood disturbance and a favourable outcome.

Aged↗
PubMed1997

[Continuous intrathecal injection of baclofen in generalized tetanus. A therapeutic alternative].

BACKGROUND: In France, tetanus is diagnosed predominantly in the elderly due to the absence of vaccination in this population. Mortality remains high and is mainly related to complications secondary to prolonged hospitalization, intravenous administration of benzodiazepines, and at times curares. Baclofen, a selective agonist of GABAB receptors, directly counteracts the effects of the tetanic toxin. CASE REPORT: We report the case of a 92-year-old man suffering from tetanus, who fully recovered after a myorelaxant treatment based solely on intrathecal baclofen administration. Continuous intrathecal administration of baclofen resulted in a marked muscular relaxation with minor side effects (bradycardia, sleepiness), which rapidly stopped after the cessation of the treatment. Initial careful titration is required in order to determine the optimal dose of baclofen which provides a substantial myorelaxation together with minor central effects. Low concentration of baclofen may facilitate its diffusion. DISCUSSION: Continuous intrathecal administration of barclofen appears to be a valuable alternative therapy in tetanus. This new therapeutic modality promises to improve the prognosis of this condition, especially in the elderly.

Aged↗
PubMed1997

Serotonin syndrome due to an overdose of moclobemide and clomipramine. A potentially life-threatening association.

The serotonin syndrome is frequently characterized by minor neurologic manifestations that regress rapidly (such as confusion, tremor, ...). Many medications including tricyclic antidepressants, serotonin reuptake inhibitors, tryptophan and the association of monoamine oxidase inhibitors together with a serotoninergic agent have been implicated in this syndrome. In certain cases, and for poorly understood reasons, clinical manifestations can include circulatory collapse, malignant hyperthermia, convulsions and rhabdomyolysis. These forms are often fatal. Treatment, other than the withdrawal of the offending drug, is symptomatic. Dialysis may be of value in withdrawing the drug from the circulatory system. We report a patient with the serotonin syndrome of favorable outcome due to an overdose of moclobemide and clomipramine.

Antidepressive Agents↗