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Biomedical subjects

A Larcan

Publications and source records attributed to A Larcan.

At least 19 recordsLinked to original sources
PubMed1992

Transient non-cardiogenic pulmonary edema following massive ingestion of ethylene glycol butyl ether.

A case of acute poisoning with ethylene glycol butyl ether (EGBE) is reported in a chronic alcohol abuser. On admission the 53-year-old patient was comatose with metabolic acidosis, shock, and noncardiogenic pulmonary edema confirmed by haemodynamic study. Following supportive treatment and haemodialysis the outcome was favorable. The relationship between respiratory failure and EGBE is examined.

Alcoholism↗
PubMed1992

Respective effects of malnutrition and phosphate depletion on endurance swimming and muscle metabolism in rats.

To examine the respective roles of malnutrition and phosphate depletion on muscle exercise capacity and bioenergetics, phosphate-depleted, either underfed or partly refed rats; phosphate-supplemented, either underfed or partly refed rats; and well-nourished control animals were studied, using swim time to exhaustion and 31P NMR spectroscopy measurements of muscle phosphocreatine, inorganic phosphate, adenosine triphosphate and intracellular pH. Only partly refed rats displayed hypophosphataemia. Swim time to exhaustion was lower in non-refed rats than in controls. Among the four groups, both refeeding and phosphate depletion positively affected swim time to exhaustion (both with P less than 0.02), and swim time to exhaustion was negatively correlated with phosphataemia (P less than 0.05). At rest, the ratio of muscle phosphocreatine/inorganic phosphate was lower in the phosphate-supplemented rats than in controls, whereas muscle phosphocreatine/adenosine triphosphate and intracellular pH were comparable. After non-tetanic stimulation, the muscle phosphocreatine recovery was slower in the four groups than in controls and closely correlated with exhaustion (P less than 0.01). These findings suggest that malnutrition alters the capacity of muscular work, mainly because of a reduced cell oxidative energy availability. These patterns are improved by partial refeeding and clearly influenced by the level of phosphorus intake, whether depletion is capable of improving metabolic alterations or uncontrolled supplementation is deleterious in malnourished animals.

Animals↗
PubMed1992

[Organization of psychiatric emergencies in the general hospital].

The authors try to define the notion of psychiatric emergency "pathology covering a whole line of situations characterized by their particularly acute and dramatic behaviors, their constant dealing with human relations, the high frequency of acting out and their usually rapid resolutions" (translated from Védrinne). They make a brief overview of french psychiatric emergencies departments organization in France either in psychiatric hospitals or in general hospitals. They report the Nancy psychiatric emergencies room's experience, which was born in 1987 and is based on an agreement between the psychiatric "secteurs" and the general hospital. This agreement provides psychiatrists and psychiatric nurses 24h/24, working in a psychiatric room within the medical emergencies department. This experience agrees with the recent french law about psychiatric emergencies.

Emergency Services, Psychiatric↗
PubMed1992

[Current status of poisoning by ingestion of caustics: apropos of a series of 49 cases].

The authors report the history of 49 patients, admitted to an intensive care unit after a caustic or corrosive ingestion. This series follows a similar one, related in 1979. An update is made for early evaluation and management, based on patients classification in three groups: severe cases, moderate cases, mild cases. Clinical and biological data, treatment and outcome for the three groups are related. The frequency and gravity of these poisonings appear to be the same as in the first series, with poor prognosis for extreme emergencies and high risk of oesophageal or gastric stricture for important forms. In this population, 20% of extreme emergencies have favorable outcome with early major surgical procedure.

Adolescent↗
PubMed1991

Full recovery after a chloroquine suicide attempt.

The nonfatal case of a 20 year-old woman who ingested 6 grams of chloroquine in a suicide attempt is reported. After initial ventricular fibrillation, she rapidly developed a pulmonary edema with cardiogenic shock. She was successfully treated with diazepam, epinephrine, dobutamine and mechanical ventilation. Plasma chloroquine levels showed an initial peak of 36 micrograms/mL. The patient was discharged fully recovered after 19 days. The interaction between chloroquine and diazepam is discussed, as is the need for careful management of epinephrine therapy.

Adult↗
PubMed1991

[Emergency care at the hospital].

Emergencies are very diversified: clinical setting, age, sex, circumstances, medicine, surgery, psychiatry, specialties. The admission into the specific departments depends on geographical, demographical features (distances to be covered...). They are theoretically unscheduled but sometimes out-hospital messages can be sent to improve the reception or to decide a very short circuit. Emergency rooms exist in most hospitals and are not so often appropriate. Emergency reception requires a place and a technical assistance where to get in touch with and to perform as quick as possible the formalities, first diagnosis and first aid procedures and orientation to the appropriate department. As a main frame in the network of assistance and care, emergency department ought to be a unique place with multiple disciplines (medicine, surgery, psychiatry), where universal first aid technical assistance and unified working would open to al hospital departments or a piece of hospitals. This structure relies on well dispatched areas, with easy ways, many examinations, simultaneous actions, urgent complementary tests and families reception. A hospital, practitioner must be in charge, whom speciality deals with emergency. Staff must include on-call doctors who can be helped by at-home physicians and many competent paramedics: nurses, health workers, stretcher-bearers, X-ray handlers, drivers, operators, secretaries, social workers, hostesses... Specific arrangements must be taken for special X-rays, biology and hospital reception of medico-surgical, obstetrical, psychiatric, social, medico-legal and medico-judicial emergencies. Running of that structure, mainly facing severe emergencies, must go together with out-hospital medical advises, patients admission for some time or a brief relief (control and social cases). In all cases, connection between out-hospital set-ups, various medical sittings and hospitals in the main goal which must be achieved with the S.A.M.U. Emergency medicine is universal, sequential, discontinuous with a social aspect open to a town or a district. If someone wants to be technically irreproachable, he needs to get together most of the existent structures to have a performant material and as much and efficient staff as possible.

Emergency Service, Hospital↗
PubMed1991

[Hemorheology in clinical practice. Introduction to the notion of hemorheologic profile].

Although the non-Newtonian characteristics of blood have now been accurately defined, the influence and effect of a hyperviscosity syndrome at the onset of ischemia and in oxygen transport to the tissues remains within the realm of assumptions. Using a simple theoretical approach it can be shown that oxygen transport capacity to the tissues is proportional to the radio H/eta s (where H = hematocrit, eta s = blood viscosity), as long as vascular bed geometry remains constant (with no sign of compensatory vasodilation). With the help of examples, the authors show the changes in oxygen transport as a function of various rheological parameters (red cell aggregation ans deformability). Further, the authors introduce the concept of a hemorheological profile for taking all the hemorheological parameters into consideration and for standardising the presentation of the results for hyperviscosity syndromes.

Blood Viscosity↗
PubMed1990

Effects of epinephrine on hemodynamics and oxygen metabolism in dopamine-resistant septic shock.

The hemodynamic effects of epinephrine were prospectively studied in 13 patients with septic shock who remained hypotensive after both fluid loading and dopamine. Hemodynamic measurements were performed before and one hour after the start of epinephrine infusion. Systolic, diastolic, and mean arterial pressure increased in all patients (p less than 0.01). Cardiac index and systemic vascular resistance increased by 34 and 32 percent, respectively (p less than 0.05), but heart rate and pulmonary vascular resistance remained unchanged. There was a concomitant increase in oxygen delivery (p less than 0.01) and oxygen consumption (p less than 0.05), the magnitude of the latter being related to baseline lactacidemia (p less than 0.01). In view of the generally recognized physiologic goals of septic shock management, we conclude that epinephrine could be an appropriate alternative where fluid loading and dopamine have failed.

Adolescent↗
PubMed1990

[Polytraumatized patient. First aid care, transport and resuscitation].

The initial management of multiple trauma must achieve a triple aim: performing the actions required by a vital emergency, preventing as well as possible the complications associated with the initial lesions, and, most importantly, bringing the injured person into hospital in the best possible conditions for emergency surgery. Achieving these aims requires a perfect coordination of medical and nonmedical rescue. A rough initial categorization is important to decide whether additional medical staff is desirable, choose the type of transport planned (by ambulance, helicopter...) as well as the department or hospital due to receive the patient. Four actions must be accomplished, most often jointly, all of them contributing to the quality of treatment: 1. picking up/freeing/immobilizing the injured person, 2. controlling the hypovolemic collapse and the traumatic shock, 3. dealing with the associated distresses, 4. suppressing pain. The techniques used to pick up, free and immobilize the injured person require a close co-operation with the rescuing staff (stretcher bearers, fire department, first-aid workers). The hypovolemic shock is treated by volume replacement, mainly with colloids. Local hemostasis may sometimes be necessary. Anti-shock trousers should be widely used in cases of multiple trauma. Dealing with the associated distresses gives priority to ventilation. The indications of ventilatory support must be very wide whenever coma or signs of respiratory distress are noted, more so with an associated shock. The indications of aspiration of a gaseous or fluid pleural effusion must also be discussed. Maximal suppression of pain must be kept in mind throughout all these operations.(ABSTRACT TRUNCATED AT 250 WORDS)

Analgesia↗
PubMed1989

[Clinical examination of the comatose patient].

The clinical examination of a comatose patient may be divided into neurological ang general. The neurological examination aims at determining all that is proper to the state of coma, its complication, whatever they origin (mostly cerebral oedema and herniation) and its focal signs. As for the coma itself, one may distinguish between disorders of consciousness or perceptivity and disorders of wakefulness. Specific reactivity and reactivity to pain. This must be combined with a study of muscle tone (reactions in flexion and extension, reflexes). Reflexes of the brain stem, nowadays better known, provide for a better assessment of severity and a better evaluation of tiered suffering. Vegetative symptoms, including respiration, cardiovascular system, temperature, trophicity, sphincteral function, must be studies in all comas. The classification of comas into stages of severety and the relevant scores (Glasgow, Liège) must be known with their advantages and limitations. The general clinical evaluation, including past history and associated signs, may suggest an aetiological diagnosis and point to the necessary paraclinical explorations.

Coma↗
PubMed1989

[Treatment of severe hyponatremia by restricted water intake].

The outcomes of 23 patients admitted to a medical intensive care unit for severe hyponatraemia (less than 120 mEq/l) associated with neurological disorders were reviewed. All patients had restricted water intake combined with a sodium intake adjusted to the natriuresis, and some received a loop diuretic. The mean correction rate during the first 48 hours was slow (greater than 12 mmol/l.24 h) in 16 cases and fast (less than or equal to 12 mmol/l.24 h) in 7 cases. Following biochemical cure, 2 patients in the fast correction group had an unfavourable outcome: one died for an unknown reason, the other developed pontine myelinosis. A review of the literature did not provide evidence that a certain rate of correction was better than the other, but it showed that an excessive rise in natraemia or an overcorrection of hyponatraemia was dangerous. Slow correction of hyponatraemia, usually obtained with water intake restriction, may be recommended.

Adult↗