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Biomedical subjects

B Dureuil

Publications and source records attributed to B Dureuil.

At least 37 records · Page 2Linked to original sources
PubMed2000

[An unusual cause of acute respiratory distress].

A 54-year-old patient was admitted to our ICU for ketoacidosis with acute respiratory distress (ARD). The main and unusual cause of ARD was hypophosphataemia. Patient-related risk factors for chronic hypophosphataemia were malnutrition, chronic alcoholism, and diabetes mellitus. Correction of the metabolic acidosis by insulin therapy resulted in intracellular penetration of phosphate and potassium, causing severe hypophosphataemia and hypokaliaemia responsible for ARD. This case provides an opportunity for reviewing the main causes and consequences of hypophosphataemia, and for emphasising the value of monitoring serum phosphate levels and providing supplemental phosphate in ICU patients at risk for phosphate depletion.

Alcoholism↗
PubMed2000

Comparison of direct examination of three types of bronchoscopy specimens used to diagnose nosocomial pneumonia.

OBJECTIVE: To compare direct examination of bronchial aspirate and plugged telescopic catheter specimens (PTC) with infected cell counts in bronchoalveolar lavage (BAL) specimens for the diagnosis of nosocomial pneumonia. DESIGN: Prospective study of critically ill patients. SETTING: Intensive care unit in a university hospital. PATIENTS: A total of 64 patients hospitalized for >48 hrs with suspected nosocomial pneumonia. INTERVENTIONS: Fiberoptic bronchoscopy with bronchial aspirate and quantitative protected specimen brush, PTC, and BAL cultures. PTC and bronchial aspirate specimens were Gram-stained. BAL specimens for infected cell counts were examined as described previously in the literature. MEASUREMENTS AND MAIN RESULTS: Nosocomial pneumonia was diagnosed by the medical staff based on all available clinical, radiologic, laboratory test, and microbiological data and on the course before and after appropriate therapy. A total of 71% of patients were ventilated, and 70.1% were receiving antibiotics. Nosocomial pneumonia was diagnosed in 54% of the cases. On direct examination, sensitivity (Se) and specificity (Sp) of bronchial aspirate specimens were Se, 82% and Sp, 60%; of BAL with 5% infected cells, Se, 56% and Sp, 100%; of BAL with 3% infected cells, Se, 74% and Sp, 96%; of PTC specimens, Se, 65% and Sp, 76%; and of PTC specimens plus BAL with 3% infected cells, Se, 83% and Sp, 78%. BAL with 3% infected cells was significantly better for predicting nosocomial pneumonia than direct examination of bronchial aspirate or PTC specimens (p = .0012). When the BAL showed 3% infected cells, neither direct examination of bronchial aspirate nor direct examination of PTC specimens was useful (p = .24 and p = .38, respectively). Combined use of direct examination of PTC specimens plus BAL with 3% infected cells markedly improved sensitivity. The total cost of each procedure was taken into account for the final evaluation. CONCLUSIONS: Our data suggest that BAL with 3% infected cells is currently the only test whose predictive value for nosocomial pneumonia is sufficiently high to be of use for guiding the initial choice of antimicrobial class while waiting for quantitative culture results.

Adult↗
PubMed2000

[Impact of the daily variations of the air pollution on the ambulatory emergency health services activity. Study in the urban area of Rouen (France)].

BACKGROUND: The aim of this study was to evaluate feasibility of using both the emergency phone calls (SAMU) and medical interventions (SMUR) related to ambulatory emergency services for local epidemiological surveillance of health impact of air pollution. METHODS: A temporal ecological study was performed at Rouen area (France) (380,000 inhabitants) for 1990-1997 (SAMU) and 1990-1996 (SMUR). The pollutants tested were: Sulphur dioxide (SO(2)), Particles (PM13), and Nitrogen dioxide (NO(2)), as collected routinely by a local automated network. For each phone call (SAMU) or emergency interventions (SMUR), the date, medical reason for calling (SAMU) or diagnosis after interventions (SMUR) (classified as respiratory, cardiovascular or other diseases) have been extracted from a specific information system. A statistical analysis based on time series analysis associated to a Poisson regression was conducted, taking into account temporal trend, seasonal variations, influenza, days of the week, holiday and meteorological data. RESULTS: An association was observed between ambulatory emergency services activity for cardiovascular diseases, and the daily variations of both SO(2) (relative risk=1.008 [1.001-1.016] for SAMU with an increase of 10 microg/m(3)) and NO(2) (relative risk=1.018 [1.008-1. 030] for SAMU, relative risk=1.016 [1.001-1.032] for SMUR with an increase of 10 microg/m(3)). No association could be observed with the respiratory diseases for these pollutants. CONCLUSION: The ambulatory emergency services activity data could contribute to an epidemiological surveillance of the health impact of the air pollution, but a better quality of data collected (concerning both procedures and codification) is requested. The interest of an epidemiological surveillance, rather than usual pollutant monitoring, remains to evaluate.

Air Pollutants↗
PubMed1999

[Tracheal rupture initially masked by accidental bronchial intubation].

We report a case of tracheal rupture complicating a blunt chest trauma. As the endotracheal tube had been inadvertently inserted into the right bronchus, tracheal rupture was only suspected when increasingly severe subcutaneous emphysema occurred after mobilization of the tube. Bronchoscopy confirmed the diagnosis. After surgical repair of the lesion the outcome was uneventful. Tracheal rupture is an uncommon lesion. All physical and radiological symptoms provide useful diagnostic orientation. In the patient of our case report, inadvertent bronchial intubation made artificial ventilation possible and probably prevented lethal outcome.

Adult↗
PubMed1999

[Interpretation of standard chest x-rays in thoracic trauma: influence of the experience of the interpreter].

OBJECTIVE: To compare the quality of interpretation of chest radiographs (CRs) by physicians of different levels of experience, with reference to data obtained from helicoidal computed tomography (HCT). STUDY DESIGN: Prospective observational study. MATERIAL: CRs of 50 thorax trauma patients as recent to HCTs as possible obtained within the 48 h following admission to the intensive therapy unit. METHOD: CRs were analyzed according to a grid by observers included in one of the four groups: residents in anaesthesiology (n = 6), residents in radiology (n = 3), senior anaesthesiologists (n = 5), and senior radiologists (n = 3). The inter-observer agreements, the specificity and sensibility of each group with reference to HCT, and their global performances were assessed. RESULTS: Inter-observer agreements were poor and sensitivities low in comparison to specificities. No group of observers performed better than another one. These data substantiate the low sensitivity of CRs in comparison to HCT and show that the quality of interpretation of CRs of thorax trauma patients is not influenced by physicians' experience.

Adult↗
PubMed1999

Differential effects of isoflurane and i.v. anaesthetic agents on metabolism of alveolar type II cells.

Alveolar type II (ATII) cells perform many important functions within the lung, including surfactant metabolism. We have investigated the effects of isoflurane and different i.v. anaesthetics on cell metabolism in primary cultures of rat ATII cells. Biosynthesis of phosphatidylcholine, the main phospholipid component of surfactant, was decreased in cells exposed to isoflurane in a dose- and time-related manner. This effect was fully reversible within 2 h after isoflurane removal. Lactate dehydrogenase (LDH) release, an index of cell damage, was increased with isoflurane exposure (1%) over a long incubation period (8-12 h). Enhanced lactate production, reflecting an increase in glycolytic metabolism, was also observed in isoflurane exposed cells. In contrast, metabolism of ATII cells was moderately affected by i.v. anaesthetics. Our data suggest differential metabolism of alveolar homeostasis depending on the anaesthetic agent used.

Anesthetics, Inhalation↗
PubMed1999

Alteration in diaphragmatic function induced by acute necrotizing pancreatitis in a rodent model.

Some of the common complications of acute necrotizing pancreatitis also involve pulmonary complications. These manifestations are often associated with a cephalad diaphragmatic shift. We hypothized that diaphragmatic function might be directly compromised by the acute abdominal process. This hypothesis was tested on an acute necrotizing pancreatitis (ANP) rat model. We assessed the diaphragm and peripheral (Extensor Digitorum Longus and Soleus) muscle properties in vitro using strips in control (C) and ANP animals. Contractile parameters included single twitch and a force-frequency curve (10 to 100 Hz), and an endurance capacity index (T50%) was calculated after a repetitive stimulation (30 Hz). Breathing pattern was not different between control and ANP animals, and muscular histologic examination was normal. However, ANP was associated with a marked decrease in diaphragmatic strength for all frequencies of stimulation when compared with C. Endurance capacity was also reduced in ANP animals as assessed by a lower T50% (ANP: 31 +/- 10.5 s; C: 49 +/- 10.3 s; p < 0.05). By contrast, no significant change in peripheral muscle function was observed in both groups. We conclude that ANP causes impairment in diaphragmatic strength and endurance capacity, whereas peripheral muscles are spared. These findings suggest that alterations in the respiratory pump may be involved in the genesis of acute respiratory failure in ANP.

Animals↗
PubMed1998

[Kidney procurement from a heart-arrest donor].

Brain death occurred in a 47-year-old head trauma patient following 5 days of intensive care. The procedure for multiple organ procurement was initiated. Irreversible cardiac arrest had occurred during the period in the surgical intensive therapy unit. External cardiac massage and mechanical ventilation were maintained until in situ cooling of the kidneys was achieved. The patient was taken to the operating room for nephrectomy. Both kidneys were transplanted with a favorable outcome. Procurement of kidneys from non-heart-beating donors could increase the number of available grafts for transplantation.

Craniocerebral Trauma↗
PubMed1998

Effects of etomidate, propofol and thiopental anaesthesia on arteriolar tone in the rat diaphragm.

We have assessed, by intravital microscopy in rats, the effects of different anaesthetics on diaphragmatic arteriolar diameter. Rats were anaesthetized with etomidate, propofol or thiopental (groups E, P and T, respectively) and the diameters of the arterioles were measured sequentially at baseline and after topical application of either mefenamic acid (MA, 20 mumol litre-1) or N omega-nitro-L-arginine (NNA, 300 mumol litre-1), inhibitors of prostaglandins and nitric oxide, respectively. In group E, baseline arteriolar diameters were significantly higher than those in the two other groups (P < 0.01). MA and NNA induced significant constriction in the three groups (P < 0.001). However, whereas constriction induced by NNA was similar in the three groups, constriction induced by MA was significantly higher in group E compared with groups P and T (P < 0.05). We conclude that diaphragmatic arteriolar diameters in rats were greater during etomidate than during thiopental or propofol anaesthesia. This phenomenon may be mediated by prostaglandins.

Anesthetics, Intravenous↗
PubMed1998

Halogenated anesthetics inhibit Pseudomonas aeruginosa growth in culture conditions reproducing the alveolar environment.

UNLABELLED: We assessed the effects of halogenated anesthetics on Pseudomonas aeruginosa growth in a liquid nutrient broth. Sterile Petri dishes (3.5-cm diameter) were filled with a 1-mL suspension of a Pseudomonas aeruginosa strain and incubated at 37 degrees C. Exposure of bacterial plates to halothane, isoflurane, and enflurane administered at 1 and 2 minimum alveolar anesthetic concentration (MAC) were studied for different exposure times (1, 2, 3, and 4 h) using an airtight chamber. For each time, a control point was obtained. Serial dilutions and agar plates were made, and developed colonies were counted. A significant decrease in bacterial growth was observed from the second hour of exposure to every halogenated anesthetic. For long periods of exposure (3 and 4 h), bacterial growth was significantly reduced in the plates exposed to 2 MAC compared with 1 MAC. The maximal inhibition was observed after a 4-h exposure at 2 MAC and reached 60%, 49%, and 42% for halothane, isoflurane, and enflurane, respectively. We conclude that a decrease in Pseudomonas aeruginosa growth is observed after exposure to halogenated anesthetics, but whether this inhibition is clinically important remains to be demonstrated. IMPLICATIONS: Bacterial pneumonia is a major source of morbidity after general anesthesia. We measured the effects of volatile anesthetics on the growth of Pseudomonas aeruginosa, one of the pathogens most often isolated in hospital-acquired pneumonia. The experiments were performed in vitro in culture conditions reproducing those observed in the alveolar space. Volatile anesthetics inhibited the growth of these bacteria, but the clinical significance of this fact remains to be determined.

Anesthetics, Inhalation↗
PubMed1998

Halothane decreases Na,K-ATPase, and Na channel activity in alveolar type II cells.

BACKGROUND: Halothane alters surfactant biosynthesis and metabolism of alveolar type II cells. In addition to synthesizing surfactant, alveolar type II cells actively transport sodium (Na) from the alveolar space to the interstitium. Na enters the cells through amiloride-sensitive Na channels or Na cotransporters and is extruded by a Na pump. The purpose of this study was to examine the effects of halothane on Na transport activities. METHODS: Epithelial type II cells from adult rat lungs were exposed to halothane concentrations of 1, 2, and 4% from 0.5-4 h. In some experiments, cells that were exposed to 1% halothane for 1 h were allowed to recover after replacement of the medium for 15 and 30 min. Na transport was then evaluated by direct measurement of radiolabeled ions uptake. In addition, the effects of halothane were assessed in the absence of extracellular calcium (Ca) with or without 1,2-bis(2-aminophenoxy)ethane-N,N,N',N'-tetraacetic acid, an intracellular Ca chelating agent. RESULTS: Exposure of epithelial type II cells to halothane reduced the activity of sodium, potassium-adenosine triphosphatase, and amiloride-sensitive Na channels, whereas Na cotransporters were unchanged. The decrease in sodium, potassium-adenosine triphosphatase activity was maximal for 30 min of exposure and reached 50, 42, and 56% for halothane concentrations of 1, 2, and 4%, respectively, and did not change for longer exposure times. This effect was not prevented by either the absence of extracellular Ca or 1,2-bis(2-aminophenoxy)ethane-N,N,N',N'-tetraacetic acid pretreatment. Exposure for 45 min to 1% halothane also decreased Na channel activity by 46%. These effects were completely reversible after 30 min of recovery. CONCLUSIONS: Sodium, potassium-adenosine triphosphatase, and amiloride-sensitive Na channel activities are impaired by halothane in alveolar type II cells in vitro. This inhibition could reduce transepithelial Na transport.

Alanine↗
PubMed1998

Diaphragmatic function is markedly altered in cerulein-induced pancreatitis.

OBJECTIVE: To assess diaphragmatic function in vitro during experimental cerulein-induced acute pancreatitis. DESIGN: Prospective, randomized, controlled animal trial. SETTING: Research laboratory at a large university medical center. SUBJECTS: Twenty male Sprague-Dawley rats, weighing 180 to 200 g. INTERVENTIONS: Sodium chloride 0.9% or cerulein (5 microg/kg/hr) was infused for 6 hrs. MEASUREMENTS AND MAIN RESULTS: Isometric force generated during electrical stimulation of costal diaphragmatic strips was measured 6 hrs after the end of infusion. Diaphragmatic strength was assessed at different frequencies (10, 20, 30, 50, and 100 Hz). Endurance index was the time until the force generated during the 30 Hz repetitive stimulation decreased to 50% of the initial value (T50%). Histologic examination of the diaphragm was performed. A decrease averaging 40% in diaphragmatic strength generation was observed for all frequencies of stimulation in the pancreatitis group. Compared with the control group, this decrease was associated with a reduction in T50% (30.9 +/- 12.5 [SD] and 46.4 +/- 10.8 secs in pancreatitis and control, respectively; p< .05). No histologic alteration of the diaphragm was observed. CONCLUSIONS: Acute pancreatitis induced marked diaphragmatic dysfunction. Although the precise mechanisms responsible for this alteration are not precisely determined, diaphragmatic dysfunction may play a role in pancreatitis-associated respiratory failure.

Acute Disease↗
PubMed1998

Effects of tracheal suctioning on respiratory resistances in mechanically ventilated patients.

OBJECTIVE: To evaluate the effects of tracheal suctioning (TS) on respiratory resistances in sedated critical care patients receiving mechanical ventilation (MV). SETTING: Surgical ICU of Bichat Hospital, Paris. PATIENTS AND PARTICIPANTS: Thirteen sedated critical care patients receiving MV for various conditions. MEASUREMENTS AND RESULTS: Airway resistances (R1), airway and pulmonary resistances (R2), and intrinsic positive end-expiratory pressure (PEEPint) were measured according to the end-inspiratory and end-expiratory occlusion methods before and after TS. R1 and R2 increased by 49.1% and 46.3%, respectively, 0.5 min after TS (p<0.01) but returned to baseline values at 1 min without any change thereafter. PEEPint decreased progressively following TS to reach a significant level (-13.3%) at 10 min (p<0.05) and was persistently reduced at 30 min (p<0.01). Nine patients received 500 microg of inhaled albuterol before another suctioning procedure. R1 and R2 decreased by 11.5% and 9.9%, respectively, 20 min after inhalation (p<0.05), but the R1 and R2 initial increase following TS did not differ between the two suctioning procedures. CONCLUSIONS: TS evokes only a transient bronchoconstrictor response, but thereafter, does not reduce respiratory resistances below presuctioning values. However, the decrease of PEEPint following TS suggests an increase of expiratory flow. Effective beta2-adrenergic receptor blockade fails to suppress the TS-induced bronchoconstrictor response.

Administration, Inhalation↗
PubMed1998

[Respiratory impact of new anesthetic agents].

Respiratory depression is induced by the great majority of anaesthetic agents and is responsible for the morbidity and mortality and is the prime complication of anaesthesia. However, for several years newer agents are available which are characterised by equal or superior power although the duration of their residual effects, in particular their respiratory effects are considerably reduced. This development leads to the possibility that the newer agents will enable a reduction in the respiratory morbidity associated with anaesthesia.

Analgesics, Opioid↗
PubMed1997

[Hemolysis can conceal another hemolysis].

We report a delayed haemolytic reaction during the course of a severe HELLP syndrome, which required red blood cell transfusions. Haemolysis was mainly ascribed to the erythrocyte alloantibody anti-Fy a. The fact that this antibody was undetectable before transfusions (despite cross-matching and anti-erythrocyte antibody screening test) emphasizes the limits of these tests for low antibody concentrations. Moreover, this patient, who had a remarkable obstetrical history, received red blood cell transfusions matched for Rhesus and Kell antigens. The opportunity to perform a more extended phenotype screening for patients at high-risk to develop multiple alloantibodies is discussed.

Adult↗