[Hyperglycemic coma without ketosis, with dehydration, chlorosodic and potassic deficiency, after treatment with salidiuretics, in nondiabetic patients].
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Biomedical subjects
Publications and source records attributed to B Caillard.
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Isoflurane and halothane, two anaesthetics agents have been compared. Forty young and healthy patients were divided into two randomly selected group. Each of them was anaesthetized either with isoflurane or with halothane. Anaesthesia was maintained with nitrous-oxide and dextromoramide. During induction, the ventilation was spontaneous. Blood-gas, ventilation rate and tidal-volume were studied before induction, during anaesthesia and at the end of the surgery. Statistical data show a higher PaCO2 and a lower pH with isoflurane. This was increased by dextromoramide. During induction, complications occurred more after than with halothane but the emergence was better.
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It is difficult to apprehend certain precarious hemodynamic states with classical parameters alone; the help of a flow-directed pulmonary artery catheter is necessary in order to define the disease accurately and reach a rational therapy. The problem is easily solved by the use of a Swan-Ganz catheter. The authors have selected 50 observations to help them make clear the indications of this method in surgery and traumatology: it appears necessary to use this method not only in specialized surgery such as valvulary surgery under CEC, but also in the treatment and prevention of non-cardiogenic pulmonary oedema and in emergency or bleeding surgery on patients suffering from cardiac disease or renal failure.
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After having studied nine observations about patients referred to them for embolectomy under CEC on suspicion of massive pulmonary embolism, the authors describe five differential diagnosis and how they can be reached. A low central venous pressure, an hypoxaemia sensitive to oxygenotherapy, a high pulmonary wedge pressure or the lack of diastolocapillary gradient, and, last of all, a real hypocoagulability attained by the use of low and daily doses of heparin must make one cautious. Yet, if a doubt should persist, an angiography and/or a scintigraphy will be asked for.
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