Biomedical subjects
A Harari
Publications and source records attributed to A Harari.
[Severe drug complications: current prevalence amongst patients admitted to adult intensive care units (author's transl)].
A retrospective study involving nine teaching hospital mixed intensive units provided information concerning severe drug complications amongst patients admitted to these departments over the past ten years. Amongst a total of 63717 patients admitted, there were 1132 drug complications (1.8%) without any predominance in terms of sex. Mortality was high (252 patients, i.e. 22.2%), being all the greater in older patients. Details concerning the various drug complications are given, the most common being anaphylactic shock and haemorrhage due to anticoagulants. These statistics are compared withthose already published by hospital departments of internal medicine.
[Cardiovascular disorders induced by hypophosphoremia].
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[Normal pulmonary capillary pressure in hemodynamic pulmonary edema].
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[A complication of permanent positive-pressure respiration to be well aware of: pneumoperitoneum].
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Haemodynamic effects of dopamine in septic shock.
The Haemodynamic response to dopamine infusion has been assessed in 30 patients in septic shock with myocardial dysfunction. Dopamine infusion resulted in a haemodynamic improvement as indicated by significant increases in cardiac output of 38.4% (p less than .001), stroke volume 18.7% (p less than .001), and mean arterial pressure of 33% (p less than .001). Despite the inotropic effect, left ventricular filling pressure did not change in 20 cases and increased in 10 cases. Mean peripheral resistance remained unchanged with a scatter of individual responses depending upon factors such as dopamine dose and initial vascular resistance. Dopamine increased intrapulmonary shunting by 48% (p less than .001), insignificantly decreased PaO2, increased mixed venous oxygen saturation by 16% (p less than .02) and decreased pulmonary vascular resistance by 15% (p less than .02). Both isoprenaline and dopamine improve stroke volume by an inotropic action, with an increase in venous return in the case of the latter and a reduction in afterload in the former. It is concluded that the usefulness of dopamine in septic shock may be limited in patients with previous myocardial disease because of the risk of increasing preload and in hypoxaemic patients because of the risk of increasing intrapulmonary shunting.
Intradural rupture of lumbar intervertebral disk: report of two cases with review of the literature.
Two cases of intradural rupture of lumbar intervertebral disks are described, in addition to 22 cases reported in the literature. Our case occurred among 753 herniated disks surgically treated in this department, an incidence similar to that in the literature. Clinically most cases presented as an acute cauda equina syndrome, and a myelographic block was almost always present. Prognosis is not made worse by the perforation. Various factors that might contribute to this relatively rate complication of disk disease are mentioned.
[Dopamine and isoprenaline: pharmacology and therapeutic indications].
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Letter: Normal pulmonary-capillary pressures in the late phase of neurogenic pulmonary oedema.
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[Hemodynamic study of gas exchange in pulmonary edema caused by bacterial lung diseases].
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Acute gastroduodenal lesions related to severe sepsis.
To determine the incidence of acute gastroduodenal lesions during severe sepsis, prospective endoscopies were performed in two groups of critically ill patients. The criteria of selection ruled out the incidence of other factors, such as shock, acute renal or respiratory failure. Evaluation of sepsis by clinical and bacteriologic criteria and endoscopic examination were performed in a double blind study. In the group of 14 patients with sepsis, 19 fibroscopies showed abnormalities of mucosa in all of them. In the group of 16 patients with sepsis, 23 fibroscopies showed either superficial lesions or normal mucosa. The difference between the incidence and the severity of acute lesions in the two groups studied was highly significative, p less than 0.001. Besides, gastroduodenal lesions became worse when sepsis prolonged, while they improved dramatically when focal infection and septicemia were eradicated. These data strongly suggest that severe sepsis per se can provoke acute digestive damage.
[Hemodynamic study of pulmonary edemas due to the increase of alveolo-capillary permeability].
Hemodynamic data were collected in 42 patients with pulmonary edema (P.E.) due to altered permeability of various causes. Pulmonary artery wedge pressure (PWP) was normal, whatever the time of the study and the severity of the P.E. Pulmonary artery hypertension was present in the cases with severe hypoxemia, but disappeared with hypoxemia correction. In some cases, a hyperkinetic or a hypovolemic syndrome was found, being induced by the cause of P.E. Although within normal limits, PWP was significantly higher at the first hours of P.E. than after the 6th hour. Perfusion of colloid solutes worsened P.E., although increasing PWP by only a few mmHg. Dehydration using diuretics markedly improved the venous admixture, although PWP was previously normal. These data document the production of P.E. in many causes-such as severe sepsis, drowning, fat embolism, barbiturate overdose-by impaired alveolo-capillary permeability, PWP and blood protein content remaining within normal limits. They also demonstrate the noxious effects of overperfusion and the efficiency of dehydration in such pulmonary edemas.
[Letter: Influence of the pulmonary capillary pressure on non hemodynamic pulmonary edemas].
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[Septicemias of superinfection in resucitation. Their prevention by restriction of antibiotics].
Nosocomial septicemias supervened during the 15 trimesters following the opening of a new built critical care unit were reviewed. During the five first trimesters the incidence of nosocomial septicemias was 5.9 p.cent. It increases to 10.7 p.cent (p smaller than 0.001) during the five following trimesters. Then a drastic restriction in antibiotic administration was performed, including withdrawal of any prophylactic antibiotherapy, preferential use of penicilline G to prevent infection by Clostridium and cocci Gram positive species surinfection, and, in case of bacterial proved infection, use of a narrow spectrum adapted antibiotic for a time as short as possible. During the 5 trimesters following the application of this antibiotic restriction, the incidence of nosocomial septicemias dropped to 5.7 p.cent (p smaller than 0.001). This phenomenon was related to the lowered incidence of the Gram negative bacilli septicemias from 11.1 p.cent to 4.8 p.cent (p smaller than 0.001) while the incidence of Gram positive cocci septicemias remained unchanged. These results strongly suggest the responsibility of the overuse of antibiotics in the determination of nosocomial septicemias and the efficiency of a drastic antibiotic restriction upon the surinfection of patients hospitalized in a critical care unit.
[Hypovolemic shocks simulating severe pulmonary embolism. 20 cases].
Twenty cases of hypovolemic shock of various etiologies in which initial diagnosis was massive pulmonary embolism are analyzed. The error was due to intensity of respiratory failure symptoms and electrocardiographic changes suggesting acute cor pulmonale. However, although constant, hypoxemia was mild and easily corrected by oxygen administration. Hypovolemia was confirmed by low central venous pressure (CPV EQUALS 1, 3 cm H20); in 7 patients, right heart catheterism showed lowered cardiac output associated to low ventricular filling pressures (VFP). Rapid blood volume expansion simultaneously corrected in all cases both shock and clinical signs of "respiratory failure", while CVP increased only slightly. These findings suggest that CVP must be carefully checked when faced with a clinical picture of massive pulmonary embolism and if low, rapid blood volume expansion must be performed under CVP monitoring, in order to rule out hypovolemic shock.
Haemodynamic study of prolonged deep accidental hypothermia.
Right heart catheterisation was undertaken in six patients with accidental deep hypothermia. Studies were carried out before and after rapid blood volume expansion, with and without Isoproterenol infusion, and were repeated at normal body temperatures. The initial haemodynamic pattern indicated a marked hypovolemia with a simultaneous decrease of both cardiac output and ventricular filling pressures, and a decreased measured total blood volume. Rapid correction of the hypovolemia revealed cardiac insufficiency, in part due to the persisting bradycardia. Left ventricular function was depressed in patients with prolonged cold exposure and normal in patients with short exposure. These abnormalities disappeared after Isoproterenol infusion during hypothermia, and spontaneously after return to normothermia. No imbalance existed between the decreased cardiac output and oxygen uptake in hypothermia, arterio-venous oxygen difference being within normal limits.