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B Branger

Publications and source records attributed to B Branger.

At least 19 recordsLinked to original sources
PubMed2001

[The measurement of end-tidal carbon dioxide (PETCO2) is not a significant parameter to monitor in patients with severe traumatic brain injury].

PURPOSE: To evaluate the agreement between end-tidal carbon dioxide (PETCO2) and arterial CO2 (PaCO2) in patients with traumatic brain injury and to document the course of the (PaCO2-PETCO2) gradient over time. METHODS: Twenty one traumatic brain injury patients (Coma Glasgow Scale < or = 8) were included in this prospective observational study over a period of six months. Simultaneous determinations of PaCO2 and PETCO2 (by infrared capnometry) were recorded. Agreement between PaCO2 and PETCO2 was determined by the statistical method described by Bland and Altman. Changes in PETCO2 over time were compared with changes in PaCO2. Factors likely to explain a gradient superior to +/- 4 mmHg were explored. RESULTS: One hundred and eleven data pairs were obtained. The bias was 5.5 mmHg with a precision of 5.1 mmHg and limits of agreement ranged from -4.5 mmHg to 15.5 mmHg. The latter exceeded the predefined limits of agreement established to determine interchangeability between methods (+/- 4 mmHg). PETCO2 and PoCO2 changed in opposite directions in 20% of 90 consecutive measurements. Only the duration of ventilation was found to be significantly associated with a gradient superior to +/- 4 mmHg. CONCLUSIONS: In this selected population of patients with severe traumatic brain injury, measurements of PETCO2 and PaCO2 are not interchangeable. Further the PoCO2-PETCO2 gradient is not stable over time and cannot predict variations of PaCO2. The use of PETCO2 instead of PaCO2 could be deleterious in patients in whom strict control of PaCO2 values is required.

Adult↗
PubMed2001

[Neurologic toxicity caused by zelitrex (valaciclovir) in 3 patients with renal failure. Is overdose associated with improvement of product bioavailability improvement?].

INTRODUCTION: We report three cases of neurotoxicity in patients with renal failure, treated with Zelitrex (valacyclovir). EXEGESIS: The patients are two women and a man, aged 76 +/- 4.6 years, who presented acute mental confusion during a treatment with valacyclovir. In two cases, the patients previously had altered renal function and were under peritoneal dialysis. In the last case, the patient had simultaneous neurotoxicity and acute renal failure. After the discontinuation of the drug, the outcome was favourable in all cases. CONCLUSION: Our cases focus attention on the possible neurotoxicity of valacyclovir, which is an amino acid ester prodrug of acyclovir, rapidly and almost completely hydrolysed to acyclovir prior to systemic exposure. The bioavailability of valacyclovir is 54% compared to approximately 20% for oral acyclovir and may account for unexpected overdoses, which may lead to serious neurological toxicity.

Acyclovir↗
PubMed2001

Comparison of fentanyl and sufentanil in combination with bupivacaine for patient-controlled epidural analgesia during labor.

STUDY OBJECTIVES: To compare the efficacy of fentanyl plus bupivacaine with sufentanil plus bupivacaine for treatment of pain during labor and delivery using patient-controlled epidural analgesia (PCEA). DESIGN: Prospective, double-blind, clinical investigation. SETTINGS: University-affiliated hospital. PATIENTS: 226 ASA physical status I and II laboring patients. INTERVENTIONS: Patients were randomized to receive 0.125% bupivacaine with fentanyl (2 micro g.ml(-1)) or 0.125% bupivacaine with sufentanil (0.25 micro g.ml(-1)) through PCEA. MEASUREMENTS: Maternal analgesia assessed by visual analog scale was recorded before epidural block, 1 and 3 hours after epidural block, at full cervical dilation, and at delivery. Motor blockade assessed by Bromage scale was recorded at delivery. MAIN RESULTS: Nine patients in group fentanyl, and 11 in group sufentanil were excluded from the study. Overall analgesia was good and no difference was observed between the two groups. Total boluses of 4 mL bupivacaine-opioid administered and the number of supplementary top-up injections of 5 mL 0.25% bupivacaine were similar in both groups. In group sufentanil, motor blockade and pruritus were significantly lower than in group fentanyl. Nausea was not recorded in any patients. Mode of delivery was similar in both groups, i.e., cesarean section, vacuum or forceps, or spontaneous vaginal delivery. No difference was observed in Apgar scores. CONCLUSIONS: Sufentanil is preferable to fentanyl during bupivacaine PCEA as there is less incidence of motor blockade and pruritus.

Adult↗
PubMed2000

[Shock? Stop!].

Explore the source record for details and available documents.

Adrenal Gland Neoplasms↗
PubMed2000

[Does neonatal screening of cystic fibrosis affect outcome? Comparative study of two cohorts in Britanny and Loire-Atlantique with follow-up after ten years].

UNLABELLED: Neonatal screening for cystic fibrosis was started in Brittany in 1989 but not in the adjacent department of Loire-Atlantique. This study compares the outcome from the children of both populations nine years after the beginning of the screening. Those children were seen in different centers but with the same following guidelines. POPULATION AND METHODS: All children with cystic fibrosis born between 01/01/89 and 31/12/97 in Brittany and the Loire-Atlantique, excluding the meconium ileus, were compared for their initial characteristics and their outcome after nine years of follow-up. RESULTS: There was no significant difference between both populations for sex ratio, gestational age, birth biometry, percentage of homozygotes delta F508, and mean age of children. Age at diagnosis was lower in Brittany (37 vs 372 days, P < 10(-7)), as was the delay for starting pancreatic supplementation (1.5 vs 14.3 months, P < 10(-7)). Percentage of children hospitalized at least once was higher in Loire-Atlantique (84.4 vs 40.3%, P < 10(-4)). There was no significant difference for colonization with Pseudomonas aeruginosa. Z-scores for weight and height were better in Brittany, as were Shwachman's and Brasfield's scores. CONCLUSION: The homogeneity of both populations and their follow-up points out that even if the numbers of children are small and the study is retrospective, some benefits of neonatal screening appear, which are already found in other countries where it is partly practiced. This leads us recommend its general use in our populations, which should be associated with the follow-up of the screened children in cystic fibrosis centers to achieve the most of its benefits.

Adolescent↗
PubMed2000

[Gravely ill newborns (excluding greatly premature) in 1986 and 1995 in three deparments of Pays de la Loire].

AIM: Evaluation of the progress in the treatment of seriously ill newborn infants under hospital care over the nine-year period from 1986 to 1995 in three departments of the Pays de la Loire region in France. POPULATION AND METHODS: The category of seriously ill newborn infants included only infants born after at least 32 weeks of gestation and having a Cullen severity score higher than 2. The two groups of seriously ill newborn infants at risk in 1986 and 1995 were first compared to a control group of healthy newborn babies delivered during the same years. The two groups were then compared with each other. RESULTS: In 1986 and 1995, the numbers of births were respectively 32,876 and 29,446, and the numbers of seriously ill newborn infants under hospital care were respectively 307 and 245. However, between 1986 and 1995 the risk factors as well as the causes of morbidity had changed. The average period of hospitalization decreased by five days. The mortality rate dropped from 0.16% to 0.09% (P < 0.05) and the number of serious complications decreased from 0.07% to 0.03% (P < 0.05). CONCLUSION: The improvement in the care of seriously ill newborn infants between the two reference periods, 1986 and 1995, may be attributed not only to technical progress but also to a better organization of the perinatal care in our region.

Female↗
PubMed2000

[Voluntary lithium salt poisoning; risks of slow release forms].

Lithium carbonate has been an invaluable drug in the treatment of manic-depressive illness. At the present time slow-release forms are available for better stability of circulating drug level with one daily take. However the better stability of lithiemia with these forms has to be balanced with a higher toxic risk in cases of lithium carbonate overdose because of continuous release. We report three cases of overdose with sustained-release lithium salts reaching life threatening complications. Two hemodialysis sessions were necessary to control plasma lithium levels. In two cases, lithiemia rebond was observed after the first hemodialysis session, and was associated with severe neurological disorders. This publication pointed out the therapeutic rule of at least two hemodialysis sessions in cases of severe slow release lithium carbonate salts intoxication.

Adult↗
PubMed1999

Left ventricle output and mean arterial blood pressure in preterm infants during the 1st day of life.

UNLABELLED: The objective was to assess the contribution of left ventricular output (LVO) in determining low mean arterial blood pressure (MABP) in preterm infants admitted to the neonatal intensive care unit. Doppler echocardiography was prospectively performed on a cohort of 17 consecutive infants with low MABP (<30 mmHg) and on 17 consecutive control subjects (range: 600-1520 g; 27-30.7 weeks gestation). The median haematocrit was 42.5% in the low MABP group versus 49.4% in the control group (P < 0.01). The index of resistance to the LVO (RILV = MABP:LVO ratio) was lower in the low MABP group (98 vs 156 mmHg x l(-1) x kg(-1) x min(-1); P < 0.05). An analysis of the low MABP group regarding LVO revealed that a subgroup of four infants had LVO <10th percentile (185 ml x kg(-1) x min(-1)) with a high RILV (>90th percentile: 226 mmHg x l(-1) x kg(-1) x min(-1)) for three of the infants. The remaining 13 infants had LVO >10th percentile and a shortening fraction >25th percentile. In this subgroup, a high proportion of infants (9/13 vs 2/17, P < 0.01) had low RILV (<10th percentile: 96 mmHg x l(-1) x kg(-1) x min(-1) and the incidence of haemodynamically significant patent ductus arteriosus was higher than in the control group (10/13 vs 4/17, P < 0.01). CONCLUSION: Left ventricular output, index of resistance to left ventricular output and patent ductus arteriosus status are important to consider in evaluating mean arterial blood pressure during early postnatal life in preterm infants. Low mean arterial blood pressure is frequently associated with normal or high left ventricular output, low index of resistance to left ventricular output and significant patent ductus arteriosus.

Blood Pressure↗
PubMed1999

Long-term follow-up of allogeneic bone marrow transplantation in patients with poor prognosis non-Hodgkin's lymphoma.

Relapsed or very aggressive high-grade NHL and refractory low-grade NHL have a poor clinical outcome. Autologous BMT may be used but is of limited efficacy in these cases. Allogeneic BMT offers the advantage of tumour-free bone marrow and a possible GVL effect. Between 1987 and 1996, 13 patients (median age 31 years) suffering from lymphoid malignancies underwent allo-BMT. Four patients had low-grade NHL, three intermediate-grade and six high-grade NHL. Three patients were grafted with evolutive disease, four were in partial remission after several courses of chemotherapy, two were in CR2 and four were in CR1 after initial therapy. The mean number of prior treatments was 2.7 (1-6). Median time from diagnosis to BMT was 25 months (4-90). The conditioning regimen consisted of cyclophosphamide (120 mg/kg/day for all, plus VP16 in one case) and total body irradiation. Five out of the seven patients who were not in CR at the time of transplantation entered CR after BMT. Eight patients developed acute GVHD grade > or = II and four had chronic GVHD. Nine patients are alive, eight in CR with a median follow-up of 49.8 months post BMT (2-125). Overall survival is 67.3% and the median time for EFS is 102 months. Two patients with low-grade NHL relapsed 61 and 102 months post BMT and were treated with DLI. One patient with a stage IV SLL had a partial remission and one with multiple cutaneous localisation of FL entered CR after grade IV acute GVHD. Allo-BMT is a highly effective treatment for advanced poor prognosis lymphoid malignancies with acceptable toxicity. Moreover, DLI can be effective in relapsing patients.

Adult↗
PubMed1999

Analysis of time management in stroke patients in three French emergency departments: from stroke onset to computed tomography scan.

The aim of this study was to determine and identify the factors associated with shortening or lengthening time interval from stroke onset to performance of computed tomography (CT) scan in stroke patients admitted to three French emergency departments. All suspected stroke patients were eligible (n = 317). The time intervals between stroke onset and presentation to the emergency department and between CT scan request and CT scan performance were determined. Twelve variables likely to influence time interval before presentation to the emergency department, and five variables likely to influence time interval before CT scan performance were evaluated using stepwise regression analysis. Of the 317 patients included in the study, the mean time interval from stroke onset to CT scan performance for 180 patients was 7 hours 46 minutes (466 minutes). The mean time interval between stroke onset and presentation to the emergency department was 4 hours 36 minutes (276 minutes), varying according to the study site, level of initial severity, medical contact before admission, witnesses at stroke onset, and mode of transportation. The mean time interval between request and CT scan performance was 2 hours 14 minutes (134 minutes), varying upon the site, hour of CT scan request, type of stroke and level of severity at admission. It is concluded that current delays in stroke management are often incompatible with early treatment. The public needs to be informed and admission procedures reorganized. Improved response to the urgency of ischaemic stroke is required as well as direct access to the scanner during periods of scheduled use.

Aged↗
PubMed1999

[Apheresis for Byler syndrome in pregnancy: tolerance and effectiveness].

We report the first known case of a successful pregnancy in a 22-year-old white woman suffering from hepatic Byler's syndrome, a familial fibrogenic cholestasis observed in children and usually leading to death during adolescence or to liver transplantation. A first pregnancy was unsuccessful with intrauterine death. Medical surveillance of the second pregnancy was reinforced due to major cholestasis and itching sensation. Plasmapheresis was employed weekly from the 19th week of gestation. Within 2 weeks of treatment onset, plasma alkaline phosphatase levels returned to normal; pruritus completely disappeared after the second session. Delivery was decided at 33 weeks gestation with uterine section. The female baby weighed 2,090 g and outcome was excellent. This is the first reported case of Byler's syndrome with successful pregnancy. We underline the efficacy and safety of apheresis in this very particular disease.

Adult↗
PubMed1999

[Fetal and neonatal mortality from 22 weeks of amenorrhea in the Loire area].

BACKGROUND: The Pays de Loire has a low perinatal mortality indicators among French regions but this could be due to under-notification. OBJECTS: To explore this hypothesis we undertook a survey in order to identify all fetal and neonatal deaths occurring at a gestionnal age of 22 weeks or more. We also tried to examine and analyze the causes of death. METHODS: All maternity (26) and neonatal wards (5) in the region took part in the survey in 1995. Clinicians were asked to fill out a questionnaire for all deaths occurring from gestational age (GA) 22 weeks and/or concerning a birthweight of a least 500 g. Only perinatal deaths related to parents living in the Pays de Loire were included in the study. RESULTS: Two hundred and sixty seven perinatal deaths were identified out of a total 29,440 births (9.1 /1000). Eighty three (2.8 /1000) were termination of pregnancy for medical reasons, of which 82% were motivated by chromosomic illness. Ninety-nine stillbirths fell (3.4 /1000) into two GA periods: 24 to 27 weeks (20%) and 38 to 41 weeks (2%). The cause of stillbirths remained unknown in 50% of cases despite a post-mortem examination rate of 87%. There were 29 deaths (1 /1000) in the immediate per and post-partum, 40% of which occurred at GA 22 to 25 weeks. Another 38% occurred at GA 36 to 40 weeks and these were related to undectected malformations or infections. Neonatal and intensive care units reported 56 neonatal deaths (1.9 /1000). GA was under 33 weeks for 44% of them. Deaths were caused by usual complications of severe prematurity, neurologic diseases and malformations. Thirty-two percent of total deaths were not notified to the French Authority: 25% of deaths for termination of pregnancy for medical reasons and 7% for stillbirths and per and post partum deaths. CONCLUSION: This survey suggests that the Pays de Loire perinatal mortality indicators remained low compared with other French regions, even after adjustment for this under notification. This casts doubts on the validity of perinatal mortality monitoring based on official notifications. The cause may lie in the inadequacy of legislation of the particular circumstances of perinatal deaths.

Abortion, Induced↗
PubMed1998

[Factors influencing the duration of breast feeding. A study of 150 women].

BACKGROUND: The duration of breast feeding has not yet been thoroughly described in France. A prospective survey has been performed on 150 breast feeding mothers to determine its duration. The objective of this study was to analyse predicting factors of this duration. METHODS: A questionnaire including sociological, psychological and medical variables was completed by the mothers and fathers. After discharge, the mothers were contacted every month by a physician until the completion of weaning. RESULTS: The median duration was 10 weeks. By univariate analysis, several variables were associated with a longer duration: decision to breast feed before pregnancy (12 weeks vs 9 weeks; P < 0.01), multiparity (17 weeks vs 12 weeks, P < 0.05), high paternal social level (14 weeks vs 9 weeks, P < 0.001), high maternal education level (12 weeks vs 9 weeks; P < 0.05), mother's idea of "bad" milk (9 weeks vs 30 weeks; P < 10(-6), satisfied mothers (11 weeks vs 2 weeks; P < 0.001), motivation to breast feed (P < 0.05), baby and mother in the same room during the night (13 weeks vs 10 weeks; P < 0.05), and formula supplementation (6 weeks vs 13 weeks; P < 0.01). The mother's return to work was related to a decline in the breast feeding rate at 12 weeks, yet working women generally breast fed the most frequently before returning to work, and many women breast fed and worked concomitantly. A Cox multivariate analysis took into account six significant variables: "bad" milk (lower duration), mother who had been fed, mother satisfied with breast feeding, multiparity, high maternal education, closer proximity of baby to mother (longer duration). DISCUSSION: The duration in our study is longer than in other studies in France. Predictive factors are sociological, linked to maternal education, and psychological, with antecedent of mother breast feeding and decision before pregnancy. The role of the mother's occupation was not very important because working women are generally at a higher social level. The role of the father was analysed, as well as the role of professional workers, family and breast feeding women's associations. CONCLUSION: Factors of breast feeding duration can be somewhat modified, but it is necessary to respect the plans of both the mother and the father. However, early assistance in the hospital and after discharge can help parents realize their plans for prolonged breast feeding and helps obviating the cessation of 20% of mothers during the 1st month.

Adult↗
PubMed1998

Analysis of cost and of non-medical care load of patients seen in an accident and emergency department--the importance of clinical classification of emergency patients.

The aim of this study was to propose a method for calculating the costs incurred by the passage of a patient through an emergency department and to show that the scheme for clinical classification of emergency patients known as CCMU (Classification Clinique des Malades des Urgences) can identify groups of patients with different costs and non-medical care loads. All cases seen in the emergency department of a French hospital over an 8-week period were prospectively included. All non-medical and medical procedures, CCMU and GEMSA (Groupe d'Etude Multicentrique des Services d'Accueil) categories were recorded. Accounts for the same period were analysed in order to determine the true cost of each patient's passage through the emergency department. Qualitative data were analysed by ANOVA and logarithmic regression. The median cost of a patient's passage through the emergency department was 322 FF. CCMU identified groups of patients, including those with psychiatric problems, with very different non-medical care loads and costs, the latter varying from 158 FF (CCMU I) up to 1823 FF (CCMU V). This classification could be used as one of the elements defining homogenous groups of emergency department patients in future.

Analysis of Variance↗
PubMed1998

[Smoking in professional soccer players in France].

An enquiry was conducted to determine the smoking habits of coaches and professional soccer players in the first and second division of the French championship in 1993 and 1994. The rate of response was 31% for coaches (36 responded) and 54% for players (257 responded). Among the coaches, 19% were smokers, 14% were ex-smokers and 67% were non-smokers; for players, the rates were 36%, 3% and 71% respectively. The percentage of smokers was higher in second division players (31%) than in first division players (20%). Forty percent smoked less than 6 cigarettes a day. Fifty-eight percent of the coaches and 39% of the players thought that smoking and sports were compatible. This study shows that even the highest level sports are not spared from the effect of smoking. Other reports of similar smoking habits have been reported in other sports in France. The image of athletes who smoke given by the media is in contradiction with the national French policy forbidding tobacco advertising in stadiums.

Adult↗
PubMed1997

Continuous administration of intravenous iron during haemodialysis.

A simple, safe and potentially cost effective method of giving intravenous iron to patients receiving regular haemodialysis therapy is described. The heparin and iron are mixed in normal saline and given as a continuous infusion via the syringe pump present on the modern dialysis machine. No pharmacological incompatibility was observed between iron polymaltose and Heparin Choay or Heparin Roche. No adverse reactions attributable to i.v. iron were observed in over 400 patients and more than 30,000 dialyses.

Anaphylaxis↗