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Biomedical subjects

A Lepape

Publications and source records attributed to A Lepape.

At least 37 records · Page 2Linked to original sources
PubMed1992

Study of pentoxifylline induced modulation of TNF alpha and interleukin-6 secretion in healthy and septic patients by the use of an ex-vivo model on whole blood.

The aim of this work is to reinvestigate the pentoxifylline (PTX) action on TNF alpha and IL-6 production using a whole blood ex-vivo model. 5 healthy controls, 2 septic patients (4 samples) and 3 patients in septic shock (7 samples) have been studied. Our data confirm the inhibitory action of PTX on TNF alpha production in healthy controls. This inhibition is nearly complete for a PTX concentration of 10(-3) M. More surprisingly a suppressive activity of PTX on IL-6 secretion has been found both in controls and septic patients. On the 7 samples of the 3 patients with septic shock no TNF alpha production has been detected. Taken altogether, these observations suggest a potential role for PTX as a modulator of the major cytokines involved in the pathogenesis of septic shock.

Blood↗
PubMed1991

[Acute intestinal ischemia after voluntary drug poisoning].

A case is reported of a patient who suffered from ischaemic enteritis after having taken an overdose of several drugs. The 42-year-old woman was found out no more than 7 h after she had taken a mixture of benzodiazepines, tricyclic antidepressants and barbiturates (4 mg.l-1 blood level on admission). She had been lying against a bedpost, resulting in compression of her anterior abdominal wall below the umbilicus, involving her right femoral nerve. There was a severe rhabdomyolysis. Despite clinical improvement, the patient being extubated the following day, her abdomen remained painful and swollen. A CT abdominal scan showed a peritoneal effusion and a distended small bowel. Laparatomy revealed severe ischaemia of the terminal 80 cm of ileum, with some gangrenous areas. This was resected, and a right-sided ileostomy performed. Histopathological examination demonstrated a mucosal necrosis without mesenteric arterial thrombosis. A bilateral pleural effusion occurred during postoperative course, requiring drainage. Thereafter, the clinical course was uneventful, with intestinal continuity being re-established three months later. The femoral paralysis receded spontaneously. It is likely that this unusual postural complication of coma may be attributed to a transient compression of mesenteric vessels.

Acute Disease↗
PubMed1990

Two cases of severe infection with beta-haemolytic group A streptococci associated with a toxic-shock-like syndrome.

Two cases of severe infection due to Streptococcus pyogenes associated with a toxic-shock-like syndrome (TSLS) and also with serious soft-tissue infection are described. Serotyping and detection of A, B and C exotoxins were carried out on strains isolated from blood cultures and skin samples. The strain of serotype M1 T1, which produced 10 ng/ml of exotoxin A and also synthesised exotoxins B and C, caused severe TSLS associated with major skin lesions. The second strain of serotype M12 T12, which produced only 1 ng/ml of exotoxin A and synthesised exotoxin B, was associated with clinical manifestations of adult respiratory distress syndrome. The relationship between the magnitude of exotoxin production and the severity of clinical manifestations cannot be established from these two cases.

Adult↗
PubMed1990

[Practical aspects of indirect calorimetry in post-anesthesia recovery].

The application of indirect calorimetry among intensive care patients is usually considered as a complicate technique, owing to the difficulties to interpret the bulk of obtained data. As a matter of fact, the variability of energy expenditure (EE) among these patients leads to prefer continuous measurements. This variability is related to interindividual variations as well as variations in the same patient (variations due to body temperature, activity state, diet-induced thermogenesis...). A computer program of data storage and calculations was developed. It allows: on-line storage as well as numerical and graphic display of VO2, VCO2, RQ and EE; menu-driven storage of all occurring events; automatic suppression of the recordings made after ventilator alarms; graphic printing and metabolic calculations. The two main indications for indirect calorimetry are the determination of actual EE and VO2 monitoring in acute states.

Adult↗
PubMed1988

Corynebacterium JK: surgical infections in non-immunosuppressed patients.

Infection caused by Corynebacterium JK (CJK) has been recently described in immunocompromised patients. To evaluate the frequency of CJK infection among surgical and trauma intensive care patients, all patients with CJK isolations at clinical sites were reviewed. The criteria used were the presence of bacterial infection symptoms, isolation from significant sites and the efficiency of a vancomycin treatment. Eight patients were studied; 3 of them were considered infected, while 5 were judged only colonized. It is concluded that CJK infections can be a clinical problem in surgical trauma patients.

Adult↗
PubMed1988

[Regional anticoagulation with citrate in hemodialysis in patients with a high risk for hemorrhage].

During haemodialysis in the patient at high risk for bleeding, heparin cannot be safely used to prevent clotting in the dialysis assembly. Among numerous procedures proposed to reduce the risk for bleeding, Pinnick et al. (N Engl J Med, 308: 258, 1983) proposed the use of citrate as the sole anticoagulant. Citrate toxicity and efficiency were studied during 44 haemodialyses carried out in thirteen patients with a high risk for bleeding or with active bleeding. Three patients had hepatic failure. Two types of citrate solution were used, the trisodium form of citrate (102 mmol.l-1 citrate) or the monosodium form (306 mmol.l-1 citrate). The solutions were infused with a calibrated, pressure insensitive pump, before the dialysis unit at a flow rate of 600 ml.h-1 and 200 ml.h-1 respectively. Sufficient citrate was infused to maintain a clotting time of the blood line and dialyser of more than 18 min. Standard 10% calcium chloride was infused at a constant rate of 7 mg.min-1 into the blood being returned to the patient. The patients were dialysed for 4 h for each haemodialysis with a single-pass system. The dialyses were uncomplicated; no active bleeding was noted. The patient's clotting time was significantly reduced during haemodialysis (18.1 +/- 8.9 min to 14.5 +/- 6.3 min; p less than 0.001). Two-hundred and twenty serum citrate levels were measured. Only nine were above the toxic value of 2 mmol.l-1. No clinical evidence of a decrease in ionized calcium was found: there was no change in the corrected QT intervals and blood pressure.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

[Serum amyloid protein A (SAA) and HDL. Clinical implication and surgical resuscitation].

The variation of Apo SAA has been studied in parallel with HDL disturbances in septic patients to try to define the role of SAA in these lipoproteins abnormalities. 14 septic patients hospitalized in a surgical intensive care unit have been studied. In these patients, the determination of cholesterol, HDL-cholesterol, Apo AI, Apo B, Apo SAA and CRP and lipoprotein electrophoresis have been made between the 4th and the 7th day after admission in the unit. A control group includes 10 patients undergoing an elective knee surgery. Our results show that SAA elevation (480 +/- 250 mg/l) are much greater than CRP ones (137 +/- 38 mg/l) with no correlation between the 2 proteins specially in patients with hepatic failure. As reported by others, we find a diminution of total cholesterol (3.0 +/- 1.2 mmol in our series) and HDL-cholesterol (0.39 +/- 0.18 mmol). Apo AI is dramatically decreased (0.50 +/- 0.29 g/l) such as a negative acute phase protein. The polyacrylamide gel electrophoresis of lipoproteins confirms the HDL decrease and reveals an abnormal migration of this class of lipoprotein in 8 cases/14 cases (4 accelerations and 4 double-bands). From the results, this HDL modification does not seem to correlate with SAA elevation; immunoblotting experiments lead to the same conclusion. The data are discussed and compared to other findings of the literature.

Adult↗
PubMed1987

[Evaluation of the Engstrom metabolic computer].

The Engstrom Metabolic Computer (EMC), in association with the Erica Ventilator, uses indirect calorimetry to carry out continuous on-line gas exchange measurements. A laboratory assessment of the different parts of this equipment is described. The variability of FIO2 was less than 0.05. The accuracy and stability of the inspiratory flowmeter were only slightly modified by changes in the I/E ratio and gas flow rates. The overestimation of flow on increasing FIO2 was taken into account by the computer. The hygrometry of inspiratory and expiratory air samples reached that of room air, with an absence of saturation during prolonged measurements. The CO2 analyser also showed a good stability. The accuracy of the oxygen cell needed to be checked periodically. A global evaluation was carried out using Damask's method: a lung model was used into which CO2 and N2 were insufflated at precise rates to simulate CO2 production and O2 consumption. The measured respiratory quotient was also compared with the known RQ of burning methanol. The difference between measured and real values was less than 5%. Therefore, it was concluded that the EMC was reliable for indirect calorimetry measurements.

Calorimetry↗
PubMed1986

Fate and distribution of radioactive sodium diethyldithiocarbamate (Imuthiol) in the mouse.

The distribution of 35S in mouse tissues has been investigated by radioactivity counts and by autoradiography after the intravenous injection of 35S-labeled imuthiol (sodium diethyldithiocarbamate). Radioactive Imuthiol is selectively localized on liver, thymus and brain neocortex, most likely as the methyl ester, within minutes after dosing. Lung or white brain matter did not fix the labeled thiol. Blood, kidney and guts show rapid elimination patterns, and can be considered as passage organs which did not fix Imuthiol. The findings are consistent with the immunopharmacological data which demonstrate that Imuthiol exerts its T-cell recruiting and activating influence through a multi-step pathway involving the brain neocortex, the thymus and the liver.

Animals↗
PubMed1986

[A severe form of heat stroke in a long-distance runner].

A case of a severe heat stroke is reported in a 30 yr old white man while running a long-distance race. At the time of admission, moderate hyperthermia (40 degrees C) and coma were two major symptoms found at physical examination. Within 24 h, the clinical picture evolved to multiple organ failure with marked rhabdomyolysis, acute renal failure with hyperkalaemia and lactic acidosis. At this time, were also found a consumptive coagulopathy and acute hepatic failure. After numerous complications, most of them infectious, the patient was discharged after four months in ICU and admitted in a physical rehabilitation department. Muscle biopsy performed three years after the heat stroke showed an abnormal reactivity to caffeine, but a normal reaction to halothane. The relationship between malignant hyperthermia and heat stroke remains uncertain.

Acute Disease↗
PubMed1986

[Tracheal rupture in closed cervicothoracic injuries].

Two cases are reported of tracheal fracture occurring during blunt cervico-thoracic trauma. The first case emphasized the impossibility of passing a tracheal tube below the fracture preoperatively, without the fibreoptic or rigid tracheoscope which has the added advantage of making an accurate diagnosis of the fracture. The clinical and paraclinical signs could only lead to a suspicion of the diagnosis, but not its confirmation. The second case showed the use of different ventilatory means during and after surgery (separate lung ventilation, jet ventilation, high frequency ventilation) in case of proximal fractures. The monitoring of intratracheal pressure should be used so as to have the best ventilation for the lowest pressures in the suture zone.

Accidents, Traffic↗
PubMed1985

[Pseudomonas pickettii septicemia].

A case of bacteremia caused by Pseudomonas pickettii in an insulin dependent diabetic patient is reported, the portal of entry was unknown. After a failure of cefotaxime therapy whereas the strain was found susceptible by disk assay to this antibiotic, the patient became afebrile with doxycycline treatment. The bacteriological findings as well as the clinical problems are reported in the present paper.

Adult↗
PubMed1977

[Mendelson's syndrome].

Mendelson's syndrome is discussed with a review of the literature and presentation of 27 personal cases studies. Accidental aspiration of gastric fluid occurs primarily during anesthesia, in cranial trauma victims, and in toxic coma patients. Tissue damage is proportional to the acidity and the quantity of aspirated fluid. The initial clinical manifestations are often serious, sometimes leading to acute respiratory distress syndrom with pulmonary edema. Frequent infectious complications, often with anaerobic microbes, are deciding factors in the prognosis. Artificial ventilation with positive pressure (sometimes continuous) is often necessary. Administration of corticosteroids at high doses is likely favorable. Prophylactic administration of antibiotics is initially directed against anaerobic agents. The prevention of this serious syndrome should be a primary concern of anesthesiologists and physicians treating comatous patients.

Adrenal Cortex Hormones↗