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Biomedical subjects

B Allaouchiche

Publications and source records attributed to B Allaouchiche.

At least 19 recordsLinked to original sources
PubMed2006

Diagnosis of early coagulation abnormalities in trauma patients by rotation thrombelastography.

BACKGROUND: Reagent-supported thromboelastometry with the rotation thrombelastography (e.g. ROTEM) is a whole blood assay that evaluates the visco-elastic properties during blood clot formation and clot lysis. A hemostatic monitor capable of rapid and accurate detection of clinical coagulopathy within the resuscitation room could improve management of bleeding after trauma. OBJECTIVES: The goals of this study were to establish whether ROTEM correlated with standard coagulation parameters to rapidly detect bleeding disorders and whether it can help to guide transfusion. METHODS: Ninety trauma patients were included in the study. At admission, standard coagulation assays were performed and ROTEM parameters such as clot formation time (CFT) and clot amplitude (CA) were obtained at 15 min (CA(15)) with two activated tests (INTEM, EXTEM) and at 10 min (CA(10)) with a test analyzing specifically the fibrin component of coagulation (FIBTEM). RESULTS: Trauma induced significant modifications of coagulation as assessed by standard assays and ROTEM. A significant correlation was found between prothrombin time (PT) and CA(15)-EXTEM (r = 0.66, P < 0.0001), between activated partial thromboplastin time and CFT-INTEM (r = 0.91, P < 0.0001), between fibrinogen level and CA(10)-FIBTEM (r = 0.85, P < 0.0001), and between platelet count and CA(15)-INTEM (r = 0.57, P < 0.0001). A cutoff value of CA(15)-EXTEM at 32 mm and CA(10)-FIBTEM at 5 mm presented a good sensitivity (87% and 91%) and specificity (100% and 85%) to detect a PT > 1.5 of control value and a fibrinogen less than 1 g L(-1), respectively. CONCLUSIONS: ROTEM is a point-of-care device that rapidly detects systemic changes of in vivo coagulation in trauma patients, and it might be a helpful device in guiding transfusion.

Blood Coagulation Disorders↗
PubMed2005

[Case report: a bacteremic pasteurellosis].

Bacteremic pasteurellosis is an uncommon form of Pasteurella multocida infection, usually involved in local infections. This systemic infection often occurs in immuno-compromised patient such as cirrhotic or alcoholic patients, with a high mortality rate (up to 60%). Septic shock may occur and neurological disorders or coma are frequent. We report such a case. Treatment associated local care, antibiotics (beta-lactam antibiotics plus fluoroquinolone) during 14 days and resuscitation of septic shock. Owing these therapies, septic shock was successfully treated without complications.

Aged↗
PubMed2005

Glucose-lipid ratio is a determinant of nitrogen balance during total parenteral nutrition in critically ill patients: a prospective, randomized, multicenter blind trial with an intention-to-treat analysis.

OBJECTIVE: Protein sparing, the major goal of nutritional support, may be affected by the glucose/lipid ratio. This study in critically ill patients compared the efficacy and tolerance of two isocaloric isonitrogenous total parenteral nutritions (TPN) having different glucose/lipid ratios. DESIGN: Multicentric prospective randomized study. PATIENTS: 47 patients with SAPS I score higher than 8 and requiring exclusive TPN. INTERVENTIONS: Patients received glucose/lipid ratios of 50/50 or 80/20. For 7 days all patients received 32 glucidolipidic kcal/kg and 0.27 g/kg nitrogen daily. All-in-one bags were prepared using industrial mixtures and a fat emulsion. MEASUREMENTS AND RESULTS: We determined TPN efficacy by nitrogen balance, urinary 3-methylhistidine/creatinine ratio, transthyretin and tolerance by glycemia, and liver enzymes. After controlling for five variables with significant effects, patients receiving the 50/50 ratio during TPN had significantly higher nitrogen balance than those receiving the 80/20 ratio. The daily difference in mean nitrogen sparing effect in favor of the latter group was 1.367 g (95% CI 0.0686-2.048). Glycemia on day 4 and gamma-glutamyltranspeptidase on day 8 were higher in group receiving the the 80/20 ratio. CONCLUSIONS: In critically ill patients TPN at a glucose/lipid ratio of 80/20 ratio induces a small nitrogen sparing effect compared to the ratio of 50/50, at the expense of poorer glycemic control. The clinical significance is unclear.

Critical Care↗
PubMed2004

Pneumatocele formation in adult Escherichia coli pneumonia revealed by pneumothorax.

Pulmonary pneumatoceles are a rare complication of nosocomial pneumonia. They occur most often in staphylococcal infections and are hence more frequent in children. We report the case of an immunocompromised adult who shortly after digestive surgery developed Escherichia coli pneumonia which evolved rapidly towards pneumatocele formation revealed by pneumothorax.

Cross Infection↗
PubMed2004

Diffusion of levofloxacin into bone and synovial tissues.

OBJECTIVES: The degree of penetration of an antibiotic into the infected site is an important determinant of therapeutic success. Levofloxacin is widely used in the treatment of serious infections. However, there are only few studies concerning its diffusion into bone tissue and none concerning its diffusion into synovial tissue. Our objective was to quantify levofloxacin bone and synovial tissue penetration and to compare our data with the breakpoint for susceptible organisms. PATIENTS AND METHODS: In an open-label study, 12 subjects who were undergoing elective total hip replacement received a single, parenteral, 500 mg dose of levofloxacin. Plasma, cortical and cancellous bone, and synovial tissue samples were collected a mean of 1.2 h later and analysed by a validated HPLC method. RESULTS: The mean +/- S.D. plasma concentration of levofloxacin at the time of bone removal was 7.5 +/- 1.3 mg/L. The levofloxacin concentrations were 7.4 +/- 2.2 mg/kg in cancellous bone tissue and 3.9 +/- 1.2 mg/kg in cortical bone tissue. The levofloxacin concentration was 8.9 +/- 2.1 mg/kg in synovial tissue. The mean +/- S.D. ratios of levofloxacin concentration in bone and plasma (bone/plasma) were 1.0 +/- 0.4 for cancellous bone tissue and 0.5 +/- 0.1 for cortical bone tissue. The ratio of levofloxacin concentration in synovial tissue and plasma (synovial tissue/plasma) was 1.2 +/- 0.4. CONCLUSIONS: The concentrations of levofloxacin achieved in cancellous and cortical bone tissue and in synovial tissue are greater than the breakpoint for susceptible organisms, which is < or =2 mg/L.

Aged↗
PubMed2004

Determination of levofloxacin in plasma, bronchoalveolar lavage and bone tissues by high-performance liquid chromatography with ultraviolet detection using a fully automated extraction method.

The aim of this study was to develop a specific and sensitive high-performance liquid chromatographic (HPLC) assay for the determination of levofloxacin in human plasma, bronchoalveolar lavage and bone tissues. The sample extraction was based on a fully automated liquid-solid extraction with an OASIS cartridge. The method used ultraviolet detection set at a wavelength of 299 nm and a separation with a Supelcosil ABZ+ column. The assay has been found linear over the concentration range 0.25-25 microg/ml for levofloxacin in plasma, 1-6 microg/ml in bronchoalveolar lavage and 0.5-10 microg/g for bone tissues and it provided good validation data for accuracy and precision. The assay will be applied to determine the penetration of levofloxacin in human bronchoalveolar lavage (BAL) and bone tissues during pharmacokinetic steady state.

Anti-Infective Agents↗
PubMed2003

[Acute cupric sulfate intoxication: pathophysiology and therapy about a case report].

A case of acute copper sulfate intoxication is presented here, as an illustration of high toxic copper dose. A 38-years-old patient with a light mental deficit ingested half a glass of copper sulfate. This patient first suffered from nausea and vomiting, then an intravascular haemolysis occurred during the hospitalisation in our intensive care unit. The outcome was favourable under aetiologic and symptomatic treatment: administration of D-penicillamine as a copper antidote and packed red cell transfusion. The patient left the intensive care unit after 9 days. Acute copper intoxication is not an exceptional situation, with a potentially severe outcome.

Adult↗
PubMed2003

Diffusion of cefepime into cancellous and cortical bone tissue.

The degree of penetration of an antibiotic into the infection site is an important factor in its therapeutic efficacy, particularly in bone and joint infections. In the present study, we examined the bone tissue penetration of cefepime at a dose of 2 g, and the results were correlated to microbiological data to estimate the clinical efficacy of cefepime in bone infections. In this open-label, single-arm, noncomparative study, subjects of similar age, body weight, height and creatinine clearance who were undergoing elective total hip replacement received a single, parenteral 2 g dose of cefepime. Plasma samples were collected simultaneously with bone tissue samples 1.5 hours later, on average, and analyzed by a validated high performance liquid chromatography assay. Ten patients (7 women and 3 men; mean age, 78 years; mean body weight, 57 Kg; mean creatinine clearance, 56 mL/min) were enrolled. The mean +/- SD plasma concentration of cefepime at the time of bone removal was 72.9 +/- 24.4 microg/mL. The mean +/- SD cefepime concentrations were 73.5 +/- 16.2 microg/mL in cancellous bone tissue and 67.7 +/- 17.0 microg/mL in cortical bone tissue. The mean +/- SD ratios of cefepime concentration in bone and plasma (bone/plasma) were 1.06 +/- 0.23 for cancellous bone tissue and 0.87 +/- 0.37 for cortical bone tissue. Cefepime exhibits an excellent diffusion into bone tissue, with concentrations achieved in both cancellous and cortical bone tissue greater than the minimum concentrations required to inhibit the growth of 90% of strains (MIC90) of most of the susceptible pathogens commonly involved in bone infections.

Aged↗
PubMed2002

[Surgical treatment of acute pancreatitic with infected necrosis by necrosectomy-pancreatostomy].

UNLABELLED: Technical modalities of surgical treatment of infected pancreatic necrosis remains controversial. The aim of this retrospective study was to assess the results of necrosectomy associated by pancreatostomy using active drainage according Mikulicz, which is currently an unusual technique. PATIENTS AND METHODS: From 1985 to 1997, 18 consecutive patients (median age = 63; range = 35-88 years) were operated on through laparotomy for infected necrosis and treated by necrosectomy combined with Mikulicz drainage. Fourteen patients were referred from another center, including 9 who had previous surgery. Necrosectomy was performed after a median delay of 22 days (1-45) after onset of pancreatitis, in all patients because of severe sepsis (including 12 patients with persisting shock) and presence at CT scan of necrotic collections containing gas bubbles (n = 15) and/or infection proven by percutaneous aspiration (n = 3). RESULTS: After the first procedure, patients underwent between 2 and 25 (median: 5) additional necrosectomies through the pancreatostomy tract. Thirteen surgical complications were observed in 8 patients: digestive fistula (n = 7), intraabdominal bleeding (n = 3), gastrointestinal haemorrhage (n = 1), colic stenosis with colectasy (n = 1). Five patients, all referred from another center, died (28%) between the 47th and the 140th day from multiorgan failure (n = 4) or gastrointestinal haemorrhage (n = 1). The median hospital stay was 109 days (26-265) including 51 in intensive care unit (1-134). The 13 surviving patients were followed during an average of 2 years (4 months-7 years). All developed an incisional hernia of the pancreatostomy tract, which was surgically treated in 6 cases. CONCLUSIONS: Necrosectomy-pancreatostomy is an appropriate treatment of acute pancreatitis with infected necrosis, despite the usual need of additional but easy necrosectomies, and the frequent occurrence of incisional hernia. Results observed in patients referred to our center suggest that earlier diagnosis of necrosis infection using percutaneous aspiration could improve the prognosis.

Adult↗