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Biomedical subjects

D Perrotin

Publications and source records attributed to D Perrotin.

At least 37 records · Page 2Linked to original sources
PubMed1998

[Losing consciousness: role of the venous lactate levels in the diagnosis of convulsive crises].

OBJECTIVES: This prospective study was conducted to evaluate the usefulness of venous lactate assay in the diagnosis of generalized seizures. PATIENTS AND METHODS: Over a three month period, 78 consecutive adults admitted to the emergency unit for unconsciousness were included in the study. Three study groups were defined: patients with generalized seizures (n = 22), unconscious patients without seizure (n = 34) and known epileptic patients with unexplained malaises (n = 22). Patients with a disease susceptible of increasing lactate levels were excluded. Peripheral venous blood was drawn to determine lactates, bicarbonates and pH on a blood gas analyzer. All determinations were performed within 5 minutes of blood withdrawal. CPK level was also determined with an enzymatic method. RESULTS: In patients who had seizures, venous lactate levels were higher than those in patients who had no seizures: 4.3 +/- 0.5 mmol/l in generalized seizure patients versus 1.64 +/- 0.1 and 2.2 +/- 1.39 in unconscious patients without seizure and known epileptic patients with unexplained malaise respectively. The threshold lactate level of 2.5 mmol/l given by ROC curves gave a 0.97 specificity and a 0.73 sensitivity. DISCUSSION: The acidosis observed in patients with generalized seizures results from the combined effects of respiratory and metabolic acidosis. High lactate level would be a consequence of hypoxemia, per seizure rise in catecholamines, and aerobic and anaerobic metabolism in muscles during the tonic-clonic phase. In patients presenting in an unconscious state, increased lactate levels, even when determined up to 2 hours after venous blood withdrawal, could be a useful parameter for the diagnosis of epileptic seizure.

Adult↗
PubMed1998

Septicemia and meningitis due to Streptococcus zooepidemicus.

A case of septicemia and meningitis due to Streptococcus zooepidemicus in an immunocompetent patient is reported. This organism is an uncommon human pathogen that sometimes causes severe infection, usually in immunocompromised patients. In the reported case, the patient required to be mechanically ventilated for one week and was treated with intravenous ampicillin and gentamicin. He recovered and was discharged from hospital three weeks after the initial presentation. Streptococcus zooepidemicus sensitive to all penicillins, was isolated from all blood cultures and the cerebrospinal fluid.

Aged↗
PubMed1998

-Severe self-poisoning with formol-.

We report a case of voluntary poisoning with formalin in a 47-year-old man. The initial status included respiratory failure, metabolic acidosis and coagulopathy. Medical therapy consisted of mechanical ventilation, a single prolonged haemodialysis session, N-acetylcysteine, and folic acid administration. The corrosive damage to the gastrointestinal tract required an oesogastrectomy and three months later a colic transplant.

Acetylcysteine↗
PubMed1998

[Importance of other therapeutic medications administered parenterally in severe acute asthma].

Following definition of severity criteria for asthmatic crisis, the effects of various drugs are analyzed: inhaled isoproterenol, inhaled metaproterenol alone or in combination with theophylline, inhaled albuterol, intravenous salbutamol, theophylline in severe acute asthma, corticosteroids in very severe acute asthma. In conclusion, nebulized beta agonists often administered in combination with atropinic drugs represent the best therapy for moderate acute asthma.

Acute Disease↗
PubMed1996

[Non-hospitalization orders for subjects with presumed alcoholic intoxication].

OBJECTIVES: French law requires all persons in an apparent state of alcoholic intoxication taken into police custody to be examined at hospital to determine whether medical observation is necessary. A do-not-hospitalize order is required to return the person to police custody. We attempted to ascertain the number of orders delivered and the quality of medical management of these persons. METHODS: Over a one-month period, 140 persons in an apparent state of alcoholic intoxication and under police custody were seen at the University Hospital emergency ward at Tours, France. Do-not-hospitalize orders were delivered for 131 of them who were returned to police custody. Among the 66 other persons admitted for acute intoxication, 4 were also returned to police custody. Nurse and physician reports were assessed. RESULTS: The 135 persons, accounting for 12.7% of all emergency ward activity, were predominantly men (96%) and young (mean age 33 years). Many were aggressive (12.7%) and 80% arrived between 6 p.m. and 6 a.m. Nurse records revealed care was less rigorous at night and for the more aggressive subjects. Reasons for delivery of the do-not-hospitalize order were not sufficiently explicit in the physician records. CONCLUSION: The large volume of activity involved in caring for these persons and the difficulty encountered in correct medical management, together with legal implications, suggest that medical and paramedical teams need better training for the management of persons in an apparent state of alcoholic intoxication.

Adolescent↗
PubMed1996

[Legionnaires' disease with acute respiratory insufficiency. Clinical and biological characteristics, comparison with pneumococcal pneumonia].

OBJECTIVES: Legionnaires' disease is one of the main etiologies of bacterial pneumonias because of its frequency as well as its potential severity. The therapeutic choice implies the need to look for distinctive clinical, biological or radiological signs, due to the unreliability of rapid immunological criteria. Pneumococcus is the first cause of bacterial pneumopathy. Thus, identifying the distinctive signs between these two etiologies may be necessary. METHODS: In our restrospective study, nine Legionnaires' disease-related pneumonias were compared with nine pneumococcus-related pneumonias with acute respiratory failure and comparable level of severity. Patients were recruited over a two year period in a medical intensive care unit. RESULTS: Four criteria were found more frequently in pneumonia related to Legionnaires' disease: high-grade fever at the time of admission, elevated transminases, presence of Miller's criteria (converging clinical and biological signs) and increasing creatine kinase. CONCLUSION: In patients with severe pneumonia, both Pneumococcus and Legionella should be entertained as possible diagnoses before starting treatment. A prospective analysis of precise diagnostic criteria is needed to distinguish between these two bacterial diseases.

Acute Disease↗
PubMed1996

Buflomedil poisoning: five cases with cardiotoxicity.

OBJECTIVE: To report cardiotoxicity of buflomedil. SETTING: Medical intensive care unit of a university hospital. PATIENTS: Five patients admitted to the hospital since 1985 for buflomedil poisoning. The amount ingested was known for only three patients (3-10.8 g). RESULTS: The five young women were admitted to the hospital because of generalized seizures or myoclonic jerks. Cardiac arrest (asystole) occurred for two of them on admission, 1 and 3 h after ingestion. Electrocardiogram revealed atrio-ventricular and intraventricular conduction abnormalities, increased QT interval and flattened T wave, decreasing after sodium bicarbonate infusion in two cases. The patients received mechanical ventilation, gastric lavage, oral activated charcoal, and clonazepam or valproic acid for convulsions or myoclonic jerks. Epinephrine was administered for cardiac arrest. Sodium bicarbonate was infused in one patient on the basis of slightly prolonged QRS duration and in two patients due to cardiac arrest. Clinical outcome was good and without sequelae for all five patients after a few days in the intensive care unit. CONCLUSION: Clinical and electrocardiographic symptomatology of buflomedil poisoning suggests direct cardiotoxicity, which could be related to possible sodium antagonist properties.

Adolescent↗
PubMed1996

Herbicide: fatal ammonium thiocyanate and aminotriazole poisoning.

OBJECTIVE: To describe fatal herbicide poisoning with Radoxone TL composed of aminotriazole and ammonium thiocyanate. CASE REPORT: A 54-year-old man was hospitalized because of unexplained coma with myoclonic jerks and vascular collapse. Despite symptomatic treatment with mechanical ventilation and vascular filling, life-threatening shock occurred with oliguria, profound metabolic acidosis and cardiac arrest. Hyperchloremia (141 mmol/L) with reversed anion gap (-19) suggested interference with chloride measurement caused by halogens (Br,F,I) or other anions such as thiocyanate. Eventually a weed killer, Radoxone TL containing ammonium thiocyanate, was found at the patient's house. Thiocyanate and aminotriazole blood levels were 750 mg/L and 138 mg/L respectively more than 12 hours after ingestion. After prolonged cardiopulmonary resuscitation, continuous venovenous hemodiafiltration was performed. Despite hemodynamic recovery the patient died 48 hours later of postanoxic coma. CONCLUSION: Aminotriazole, a systemic nonselective herbicide, is often associated with ammonium thiocyanate which enhances its activity. Experimental studies and previous fatal cases suggest a predominant toxicity of thiocyanate. Early diagnosis is important.

Amitrole↗
PubMed1995

Outcome of elderly patients requiring ventilatory support in intensive care.

The objectives of the study were: 1) to evaluate mortality in elderly patients requiring ventilatory support in Intensive Care Unit (ICU) and at 6, 12 and 18 months after discharge from ICU; 2) (main objective) to determine predictors of mortality in ICU and after discharge; and 3) to assess the life-style of survivors. One hundred and ten consecutive hospitalized patients > or = 70 years were included in this retrospective study. Follow-up evaluation was conducted by telephone interview. Mortality in ICU and after discharge was the outcome variable. Fifteen parameters were recorded at admission and during hospitalization. Residence, health status, and self-sufficiency were evaluated after discharge. 1) Mortality in ICU and at 6, 12 and 18 months after discharge was 38%, 60%, 63% and 67% respectively. 2) The predictors of mortality in ICU were admission in shock, and use of major therapeutic interventions. Predictors of mortality at 6 months were admission in shock, previous impaired health status and marital status. 3) Eighteen months after discharge 92% of the surviving patients (N = 33) had the same residence, 75% had the same health status, and 78% had the same autonomy compared with pre-admission status. We concluded that shock and previous health status but not age are predictors of short- and long-term prognoses in elderly patients hospitalized in ICU for mechanical ventilation.

Aged↗
PubMed1994

[State of shock during acute meprobamate poisoning. 6 cases].

The prognosis of acute meprobamate poisoning is related to shock whose haemodynamic mechanism remains obscure. We report the results of a retrospective study of six patients with meprobamate poisoning associated with shock and explored by a right heart catheterization. The age of the patients, five women and one man, ranged from 36 to 57 years. Five patients had also ingested other psychotropic drugs. A haemodynamic investigation was performed at admission to the ICU and three hours later, under treatment. Vasoplegia was the predominant feature. A myocardial dysfunction was sometimes associated, which can be explained by a moderate hypothermia. According to these results, we suggest that prior to right heart catheterization, the treatment should include inotropic and alphamimetic agents and that vascular filling should be cautious.

Adult↗
PubMed1993

[Sub-coraco-clavicular approach of the axillary vein].

This prospective study aimed to assess the value of the infraclavicular route for axillary vein catheterization in intensive care patients. Forty-six patients, 26 to 90 years old, were assigned to one of two groups according to their body mass index: obese (W/H2 < 30) and non obese (W/H2 < 30). The three operators were not previously trained for this particular technique, but were familiar with others. There were 55 attempts. Overall success rate was 47%; 8% in obese and 58% in non obese patients respectively. Perceiving axillary artery beats beneath the coracoid process increased significantly the success rate in non obese patients (94%; p < 0.01). There was one major complication (pneumothorax), due to a non respect of the technique. In conclusion, this technique requires a previous training period, and is not to be recommended in the obese. However, it is a convenient technique for non obese patients, in whom axillary artery beats can be detected.

Adult↗
PubMed1993

Efficacy of epinephrine therapy in shock complicating pulmonary embolism.

A case of shock and pulmonary embolism in a 57-year-old woman is described in which hemodynamics were unresponsive both to usual therapy (volume loading, dobutamine, thrombolysis) and then to norepinephrine. Epinephrine proved to be effective, above all by strong beta 1-inotropic effect.

Cardiac Output, Low↗