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Biomedical subjects

D Elkharrat

Publications and source records attributed to D Elkharrat.

At least 19 recordsLinked to original sources
PubMed1995

Orocecal transit time in humans assessed by sulfapyridine appearance in saliva after sulfasalazine intake.

PURPOSE: We propose a noninvasive method for the measurement of orocecal transit time assessed by the sulfapyridine appearance time in saliva after ingestion of sulfasalazine. METHOD: In 12 healthy volunteers, we studied the correlation between plasma and saliva sulfapyridine appearance times and then the sulfapyridine appearance times in saliva under various experimental conditions to assess the reproducibility, the effects of meals, and the role of the formulation, and the effects of gastrointestinal kinetic drugs. RESULTS: The correlation between saliva and plasma sulfapyridine appearance times was strong (r = 0.84; p = 0.0004). The sulfapyridine saliva appearance time was significantly delayed by the meal. Compared with placebo, the saliva sulfapyridine appearance time was reduced by cisapride (312 +/- 128 versus 551 +/- 97 minutes; p = 0.0001) and increased by loperamide (674 +/- 267 versus 501 +/- 131 minutes; p = 0.044). CONCLUSION: We propose the salivary sample method as a validated simplification of the plasma sulfasalazine-sulfapyridine test for the measurement of orocecal transit time.

Adult↗
PubMed1993

[Prospective study of the prescription of non-steroidal anti-inflammatory agents in a reception medical service of a university hospital. Influence of the prescriptor].

Non-steroidal anti-inflammatory drugs (NSAIDs) are estimated to be excessively prescribed. We have prospectively collected all drug prescriptions written by 50 doctors in an Outpatient Service, during a 5-day period. The purpose of this study was to draw the outline of NSAID prescriptors. Junior doctors (66%) wrote more controversial NSAID prescriptions (66%) than other doctors.

Ambulatory Care↗
PubMed1992

Evaluation of risk factors for laryngeal edema after tracheal extubation in adults and its prevention by dexamethasone. A placebo-controlled, double-blind, multicenter study.

Because laryngeal edema (LE) after tracheal extubation is likely to result from an exudative response, corticosteroids often are given routinely as a preventive treatment. No adequate controlled study supports this strategy, however. A prospective, randomized, placebo-controlled, double-blind, multicenter trial that included 700 consecutive patients requiring tracheal intubation and mechanical ventilation was conducted to determine risk factors for LE occurrence after tracheal extubation in adults and to evaluate the efficacy of corticosteroids in its prevention. One hour before extubation, patients were given either an intravenous bolus of 8 mg dexamethasone or a placebo. Patients were divided into two groups: 1) those in whom short-duration intubation (SDI, less than 36 h) was administered; and 2) those in whom long-duration intubation (LDI, more than 36 h) was administered. Minor LE was diagnosed when either stridor or laryngeal dyspnea, or both, occurred; major LE was diagnosed when reintubation due to LE was required, with LE evidenced during direct laryngoscopy. The overall incidence of LE was 4.2% and varied among the six participating centers from 2.3 to 6.9% (not significant). In only seven patients (1%), all with LDI, was tracheal reintubation required for LE. Laryngeal edema occurred more frequently after LDI than after SDI (7.2 vs. 0.9%; P less than 0.001). It also was more frequent in female than in male patients (20/284 vs. 8/379; P less than 0.05), irrespective of intubation duration and treatment. There was no association between LE and either difficulty/route of intubation or admission diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Acute carbon monoxide intoxication and hyperbaric oxygen in pregnancy.

Modalities of oxygen therapy for pregnant women intoxicated with carbon monoxide (CO) are ill defined. Hyperbaric oxygen (HBO) is presumed to be hazardous to the pregnancy. On the other hand CO entails anoxic injuries in the mother and fetus. We have entered 44 pregnant women who sustained an acute carbon monoxide poisoning at home, into a prospective study in order to assess HBO tolerance. They were treated within 5.3 +/- 3.7 h (range: 1-12) of the intoxication with a combination of 2 h of HBO at a pressure of 2 atmospheres absolute (ATA) and 4 h of normobaric oxygen, irrespective of the clinical severity of the intoxication and of the age of pregnancy. Six patients were lost to obstetric follow-up. Only 2 patients sustained a spontaneous abortion: 1 within 12 h and 1 within 15 days of the intoxication. Thirty-four women gave birth to normal newborns. Finally 1 elected to undergo abortion for reasons unrelated to the intoxication and 1 gave birth to a baby with Down's syndrome. There is no evidence that HBO was involved with either abortion of our study. We conclude that HBO may be carried out in pregnant women acutely intoxicated with carbon monoxide.

Acute Disease↗
PubMed1989

Trial of normobaric and hyperbaric oxygen for acute carbon monoxide intoxication.

The value of hyperbaric oxygen in the treatment of acute carbon monoxide intoxication was assessed in 629 adults who had been poisoned at home in the 12 h before admission to hospital. In patients without initial impairment of consciousness (group A) the effect of 6 h of normobaric oxygen (NBO) (group A0, n = 170) was compared with that of 2 h of hyperbaric oxygen (HBO) at 2 atmospheres absolute (ATA) plus 4 h NBO (group A1, n = 173). At the 1 month follow-up 66% of A0 and 68% of A1 patients had recovered. In patients with initial impairment of consciousness the effect of one session of HBO (group B1, n = 145) was compared with that of two sessions (group B2, n = 141); all group B patients also received 4 h of NBO. At 1 month of follow-up 54% group B1 and 52% group B2 patients had recovered. The 7 patients left with neuropsychiatric sequelae (3 B1, 4 B2) and the 4 who died (2 B1, 2 B2) had all presented with coma. HBO was not useful in patients who did not lose consciousness during carbon monoxide intoxication, irrespective of their carboxyhaemoglobin level, nor were two sessions of HBO in patients who sustained only a brief loss of consciousness. The prognosis is poorest for those presenting with coma; the trial needs to be pursued in this group of patients until the power of the study is sufficient to demonstrate the value or otherwise of HBO.

Accidents, Home↗
PubMed1989

[Gas gangrene after aseptic orthopedic surgery].

Gas gangrene following scheduled orthopedic surgery is not uncommon. In order to assess its frequency and prognosis, identify possible predisposing factors and suggest preventive measures, we reviewed the records of 22 patients (14 males and 8 females, mean age 40 +/- 20 years) admitted between 1969 and 1987 who developed gas gangrene in the wake of orthopedic surgery. In all cases the lower limbs were the site of operation: the knee in 9, the hip in 4, the femur in 4 and the leg in 5 cases. Surgical procedures included on-site foreign material in 19 cases, pneumatic tourniquet in 6 and prolonged vascular stretch in 9. Infection was diagnosed within 1.4 +/- 1.1 days of surgery; local signs, especially crepitants and pain, were prominent for the diagnosis. Pathologic findings consisted of myonecrosis in 18 patients and cellulitis in 4. Local bacteriological studies, carried out in 19 patients, yielded organisms in 14, including 12 with Clostridia perfringens. Four patients (one despite surgical treatment) died within 24 hours of admission. The remainder were treated with a combination of surgery, antimicrobial therapy (18) and hyperbaric oxygen (17). Subsequently, 13 patients had severe functional disability, while 5 recovered without sequelae. In view of the poor prognosis of gas gangrene, several preventive measures are suggested during aseptic surgery of the lower limbs. Careful skin preparation, cleaning of the anal region and short-term prophylactic antibiotic therapy with cefamandole or amoxycillin-clavulanic acid, are among them.

Adult↗
PubMed1989

[Treatment of severe myasthenia gravis with cyclosporin. A 12-month open trial].

Cyclosporine A, an immunosuppressor and immunomodulator, has been proposed as an alternative in patients with autoimmune disease not responding to the usual immunosuppressants. We treated with cyclosporine 19 patients with severe myasthenia gravis in a 12-month open uncontrolled trial. There were 14 women and 5 men aged 51.5 +/- 18.5 years (range 20 to 81 years) who had had the disease for 50.8 +/- 43.6 months. Myasthenia gravis was generalized in 18 and ocular in 1. Previously, 4 patients had been unsuccessfully treated with azathioprine, 1 with cyclophosphamide, 12 with steroids; 5 had undergone thymomectomy and 5 thymectomy. Anti-acetylcholine receptor antibodies (AChR-ab) were detected in the sera of 15. The severity of the disease was assessed by a myasthenic muscle score (MMS) ranging from 0 to 100 and a 5-grade functional scale (FS) from 1 = severe disability to 5 = complete remission. Depending on changes in MMS and FS, the effectiveness of cyclosporine was deemed very good, good or nil. Cyclosporine was administered orally 3 times daily in doses of 5.6 +/- 1.6 mg/kg/day over 11.6 +/- 1.6 months. The final dosage was targeted to achieve a peak serum level and a trough level respectively below 200 and 100 mg/ml, and was adapted if side effects occurred. No other cytotoxic drug was allowed. Seventeen patients completed the treatment (M12); 1 died of uterine cancer at M6 and 1 was lost to follow-up at M5. At M12 clinical results were considered very good in 6 patients, good in 8, nil in 3. The MMS increased significantly from 56.1 +/- 17.2 (n = 19) at D0 to 83 +/- 15 (n = 17) (P less than 0.0005), as did the FS, from 2 +/- 1 to 3.7 +/- 0.85 (P less than 0.0005). Subsequently, cyclosporine was discontinued in 7 of the 14 patients who responded well and maintained in 7 at a reduced dosage (3.4 +/- 0.8 mg/kg/day). In the former group 3 patients relapsed 1, 1 and 5 months respectively after the drug was withdrawn; the remainder had, at the last follow-up (29.6 +/- 8.5 months from D0), MMS 62.9 +/- 34.1 and FS 3 +/- 2. In the latter group, at the last follow-up (17.6 +/- 3.6 months), MMS was 86.7 +/- 16.6 and FS 4.2 +/- 0.8, differing significantly from D0 values. AChR-ab titers and CD4/CD8 were unaltered at M12.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Serum demyelinating activity and Guillain-Barre syndrome: favorable effect of plasma exchange].

The present study was designed to determine whether plasma exchange has a beneficial effect on the activity of the demyelinating factor present in the serum of patients with the Guillain-Barre syndrome. The demyelinating activity was assessed electrophysiologically after subperineurial injection of 20 to 30 microliters of serum into the rat sciatic nerves Serum was obtained from 26 patients from the French Cooperative Trial, among whom 12 had plasma exchange. Sera were drawn at hospital admission (DO) and at D15, D30 and D60. They consistently produced conduction block in a large proportion of motor axons, measured by the ratio of amplitudes of the motor action potential elicited by stimulation at both proximal and distal sites of injection. The serum activity diminished during the time course of the illness earlier in patients receiving plasma exchange and even more in patients with the less severe clinical score at the plateau phase. Serum from patients without motor sequelae after one year evolution did not produce conduction block prior to D30, as compared to sera from patients with sequelae which were still very active. This work add biological data to the positive results of plasma exchange in Guillain-Barre syndrome obtained by the North American and French Cooperative Trials.

Adult↗