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Biomedical subjects

C Pommier

Publications and source records attributed to C Pommier.

11 recordsLinked to original sources
PubMed2002

[Amniotic fluid embolism: successful evolution course after uterine arteries embolization].

A 28-year-old woman, G3P3, who was otherwise healthy and had taken no medication and had no known allergy, was admitted to our hospital for delivery after a normal pregnancy. An epidural catheter was inserted for analgesia and labour was induced with oxytocin. Two hours later, she suffered a sudden cardiac arrest. She was immediately treated and, since a normal cardiac rhythm and a blood pressure of 90 mmHg has been obtained 30 minutes later, a 3750 g child was delivered by caesarean section. Soon after delivery, a life-threatening uterine haemorrhage appeared, due to DIC. Evolution was favourable, after bilateral uterine arteries embolization had been performed. The diagnosis of amniotic fluid embolism was established by the clinical course, the absence of local cause and the presence of a large number of amniotic cells in the mother's peripheral blood. Tryptase blood concentration was normal in the mother's blood.

Adult↗
PubMed2002

[Hemoperitoneum and pregnancy in a patient with von Willebrand's disease type 3].

A 24-year-old woman with type 3 (characterised by a blood level of von Willebrand factor less than 1%) was admitted to the surgical intensive care unit with an haemorrhagic shock. She was pregnant (Beta HCG = 115 Ul.L-1), the echography of the abdomen, soon after admission, revealed a haemoperitoeum. She underwent abdominal surgery after substitution treatment. The surgeon found an ovarian haemorrhagic cyst. Later the course of pregnancy was normal and she was delivered by caesarean section. We describe the therapeutic strategy of that care.

Adult↗
PubMed2001

[Percutaneous tracheostomy].

OBJECTIVES: The aim of this study was to evaluate the different techniques of percutaneous tracheostomies, their advantages, drawbacks, complications and to compare them to standard surgical tracheostomies. This study will consider only elective (non emergency) bedside procedures in intensive care units. DATA SOURCES: Extraction from Medline database of english and french articles on percutaneous tracheostomies and searching along with major review articles. STUDY SELECTION: The collected articles were selected according to their qualities regarding to their evidence level. In addition to several important or historic references, the literature of the five past years was studied. DATA EXTRACTION: The articles were reviewed according to their contribution for techniques, perioperative and postoperative complications, recent advances, advantages and drawbacks of all procedures. Publications addressing recent comparisons between surgical and percutaneous tracheostomies were specially studied. DATA SYNTHESIS: Four techniques of bedside percutaneous tracheostomies are available and marketed, in France: Ciaglia's dilation technique (with multiple or unique dilator), Griggs's technique (using a special designed forceps), and Fantoni's technique (Trans Laryngeal Tracheostomy). The most spred but also first described technique is the Ciaglia's (1985). The most recent articles comparing surgical and percutaneous tracheostomies techniques are not able to demonstrate a superiority of one of them in terms of feasibility or safety. In other words, there should be a slight advantage for the percutaneous tracheostomy regarding to the late post-operative complications, as there should be a slight advantage for the surgical techniques regarding to the perioperative complications. The literature analysis point out firstly the learning curve for percutaneous dilational tracheostomy, with a significant decrease of complication incidence with the operator's experience and secondly the continuous endoscopic guidance seems to increase the safety of the percutaneous procedure. CONCLUSION: Since there has been a great deal of percutaneous tracheostomy in the intensive care units, the incidence of tracheostomy have increased in those services. There is a trend to replace the surgical procedure by the percutaneous one. However, according to the potentially jeopardizing complications, percutaneous tracheostomy should be done by an experienced operator with the help of a continuous endoscopic guidance.

France↗
PubMed2000

[Tracheal gas insufflation associated with mechanical ventilation for CO2 removal].

OBJECTIVE: Tracheal gas insufflation (TGI) either continuously, or at inspiration, or at expiration, is a technique associated with mechanical ventilation aimed to enhance CO2 elimination in favouring washout of anatomical dead space. This article analyses the mechanism of action, the techniques and the effects of TGI in presence of hypercapnia, especially in the fame of ARDS in adults. DATA SOURCES: In addition to some historical or major references, the articles on TGI published over the past five years have been searched in the Medline data base. STUDY SELECTION: Articles with data on TGI associated with mechanical ventilation were selected. DATA EXTRACTION: Data on mechanisms of action, technical and practical aspects of TGI were extracted. DATA SYNTHESIS: CO2 elimination is increased when the TGI catheter tip is close to the carina, when the gas jet is directed towards the latter, by a continuous gas jet, by a high washing gas volume. The effect on oxygenation is minor. The work of breathing is decreased. An increased intracranial pressure is decreased. Circulatory effects are minor. The major risk is dynamic pulmonary over distension. Local complications include dessiccation and lesion of bronchial mucosa by the gas jet. CONCLUSION: In mechanically ventilated patients, additional TGI is a valuable technique for decreasing anatomical dead space. TGI decreases hypercapnia during mechanical ventilation with limited tidal volumes in permissive hypercapnia. Further clinical studies with large series of patients are required to assess the benefits and the effect of TGI on outcome.

Animals↗
PubMed1997

[Treatment of pain in children burns].

Burn injury is considered by children as one of the most painful traumas (just after bone factures). Burn pain in children can and must be controlled as well as for adult patients, with almost identical techniques. Continuous pain from injury and intermittent pain caused by therapeutic procedures must be evaluated and treated separately. Due to very high levels of nociception, satisfactory management of procedural pain requires the use of opioid therapy. Non pharmacological methods are meaningless if pharmacological treatment is not optimal.

Burns↗
PubMed1994

[Surgery for epidermolysis bullosa in children: value of the association of inhalation anesthesia and locoregional anesthesia].

Due to the cutaneous and mucosal fragility associated with epidermolysis bullosa, this disease is a source of various practical problems for the anaesthesiologist concerning the surgical posture, the monitoring of vital functions, the airways control and the vascular access, as all these procedures may worsen, sometimes dramatically, the lesions in these young patients, still in a precarious health state. Basing on published studies and their own experience, the authors have used in these patients a combined locoregional and general anaesthesia. The latter was obtained with isoflurane, administered in the non intubated and spontaneously breathing patient through a closed surgical isolation container (Vi-Drape), including the patient's head and ventilated with a ventilator generating a PEEP for long procedures. The results obtained during 9 procedures in 3 children are reported and discussed. For several shorter procedures (for example wound dressing), intramuscular ketamine was used.

Anesthesia, Conduction↗
PubMed1990

[Aneurysm of iliac arteries. Is it anatomo-clinical entity? Report of 18 cases].

338 patients with aorto iliac aneurysms were operated in the Department of vascular surgery (Hosp. E.-Herriot-University A.-Carrel Lyon). Retrospective evaluation found 20 solitary iliac artery aneurysms (AAIS) in 18 patients (2 bilateral AAIS). 77% of aneurysms were on the common iliac artery, 17% on the internal iliac artery, and one case of mycotic aneurysm on the external iliac artery. 8 patients (44.4%) were asymptomatic, 5 (27.8%) had non specific complaints. Rupture or acute ischemia occurred in 5 cases (27.8%). The incidence of non atherosclerotic cause (dysplasia 33.3%, infection 16.7%) in this series shows a real difference with AAA (atherosclerotic dominant etiologic factor). The value of C.T. scanning and sonographic evaluation and their extensive use in vascular and non vascular diagnostic problems are an obvious explanation for increasing AAIS reports. The risk of rupture is probably higher than in AAA because of the incidence of arterial dysplasias (1/3 in this study) and mycotic origin. This occurrence suggests an aggressive surgical management. Aneurysmorrhaphy with graft interposition by intraperitoneal approach is the routine technique for most of surgeons. An alternative procedure (retroperitoneal approach) was performed on ten of our patients (55.5%). No perioperative mortality and low morbidity rate (one case of phlebitis) in our cases support this surgical management. The survival rate based on actuarial method is estimated 64% at five years (all grafts patent).

Adult↗