Biomedical subjects
Publications and source records attributed to C Bricard.
We report the case of splenic subcapsular haematoma, that happens to a woman after three months. Breaking and fistulation of the splenic haematoma into the gastric cavity and its subsequent evacuation made it first identify as digestive haemorrhage.
A case of severe cardiac failure during generalized Yersinia enterocolitica infection, in a previously healthy woman is described. It was possible to demonstrate the important role of coronary hypoperfusion in the late stages of septic shock. When beta stimulant drugs became ineffective, IABP improved cardiac function.
The effects of incremental increases in PEEP during mechanical ventilation on left ventricular (LV) contractility before and after intravascular volume expansion (IVE) were studied in 10 patients treated for ARDS. A pulmonary artery (PA) catheter, a LV catheter-tip micromanometer, and an esophageal balloon catheter were inserted in these patients. We measured transmural right atrial and PA pressures, transmural LV end-diastolic and systemic arterial pressures, the first derivative of LV pressure (LV dP/dt), the ratio of LV dP/dt at transmural developed LV pressure (dP/dt/DPt) with DPt = 5, 10, 40 mm Hg, cardiac index (CI) at every level of PEEP and after IVE at the highest PEEP. Stepwise increases in PEEP (from 0-20 cm H2O) were associated with progressive fall in CI whereas heart rate remained unchanged. Transmural right atrial and PA pressures did not change; transmural LV end-diastolic and systemic arterial pressures and peak dP/dt decreased significantly with PEEP, except for dT/dt/dPt. IVE reversed this fall in CI and peak dP/dt. Whereas transmural LV end-diastolic pressure rose markedly. We conclude that the observed fall in LV performance during PEEP is not the result of a depressed LV contractility because PEEP does not induce a decrease in dP/dt/DPt, the least sensitive to change in preload isovolumic phase indices of contractility.
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Attention Deficit Hyperactivity Disorder (ADHD) is a relatively frequent affection that can generate severe problems (school, social, professional) if no take in charge is done. Treatment of ADHD is generally multifactorial; it can associate medical treatment, comportemental and analytical psychotherapies, reeducation of associated disorders (orthophony, psychomotor reeducation) and educative approach. Methylphenidate, considered as therapeutic reference, is a central nervous system stimulant. It produces a stimulation of vigilance and superior mental activities, a diminution of fatigue sensation and sleep need, an anorexigen power and sympathomimetic effect. Its mechanism of action is abundantly studied and is not completely known. Principal hypothesis are: increase of chemical mediators biodisponsibility and change in cerebral blood flow delivery. In France, it is agreed since 1995 for treatment of ADHD in over 6 years-old child. Ritaline 10 mg is registered on the narcotic list and an initial hospital prescription is needed, reserved to specialists and/or to neurologic, psychiatric and pediatric services. Mid-1995, 2.8% (namely 1.5 millions) of 5 to 18 years-old american children have taken this drug. Methylphenidate is effective on each three principal symptoms of ADHD: it decreases the level of activity, it improves apprentice capacity, just as school performances and it eases social interactions. The therapeutic schedule at short and middle term is reassuring, with substantial profits on school, familiar and social plans, but unknowns subsist and opinions diverge about long term efficacity. Methylphenidate is not the only one used in ADHD treatment. Other products, like dextroamphetamine and pemoline have been used in the USA and are for those who can't tolerate methylphenidate or badly respond to it. Those other drugs are not commercialized in France. The limits of stimulating drugs (fear to favour toxicomania, undesirable effects that need to stop treatment or non-responsive hyperactive children), just as positives experiences with antidepressants (especially on enuresis) led to use tricyclic antidepressants as second-line agents in ADHD treatment. Their efficiency is less and their well known side-effects are sometimes constraining. Antidepressants that inhibit serotonin recapture, MAOI and bupropion, central antihypertensive, such as clonidine and guanfacine have been tried in ADHD treatment as third-line agents. They should be useful on non-responsive or patients who can't tolerate stimulants or tricyclic antidepressants. Analytical and comportemental psychotherapies are used in addition to medicamental treatment. Reeducation of troubles such as dyslexia, language delay, corporal scheme troubles or fine coordination trouble is obtained by orthophony and psychomotricity. It's very important to instaurate an educative strategy in order to contend inattention and hyperactivity. Regular conservations with parents and child are necessary. The whole american literature shows better efficiency of multimodal treatment of ADHD in child, as opposed to single stimulant treatment.