Biomedical subjects
Publications and source records attributed to D Perrotin.
A severe chloroquine poisoning, featuring indicators of bad prognosis, has been treated by a diazepam-type therapy. The outcome was favourable in a dramatic way. A toxicokinetic study showed very high chloroquine plasmatic levels, consistent with the severity of the poisoning.
Explore the source record for details and available documents.
An outbreak of nosocomial staphylococcal infections occurred over a six months period in an intensive care unit. This outbreak was caused by a single phage type of oxacillin resistant Staphylococcus aureus (SA) which infected ten patients. Six patients had bacteremia with infected catheter, two with urinary tract infection and two patients had a pneumonia. The median SAPS was 13. Four patients died. An epidemiologic study was performed to know SA nasal carriage prevalence of patients and hospital staff. There were seven isolates of SA from 83 hospital staff and three from 20 patients, all with the same phage type 77. Hospital staff and patients colonisation with a same SA strain is a potential reservoir for epidemic nosocomial infections. Prophylactic measures are hygienic measures like handwashing, but perhaps also patients and staff selective decontamination with topical antimicrobial substances.
In this retrospective study, 100 cases of primary staphylococcal septicaemia collected in 5 hospitals over a 2-year period were reviewed. Out of 91 strains of Staphylococcus aureus isolated, 6 were methicillin-resistant, but all 6 came from the same hospital. The mortality rate was 36 per cent. The only prognostic factors elicited were chronic renal failure and septic shock. The 64 patients who survived stayed in hospital for a mean period of 42 days, and 42 recovered without sequelae. Staphylococcal infections remain serious and are not all hospital-acquired.
We present two case histories. The first is a case of congenital malaria in a newborn whose Laotian mother immigrated into France 2 years ago. The other is a case of very severe malaria with fetal death in a 28 year old woman who was 8 months pregnant and who had come back to France from Gabon where she had lived for 2 years. The authors wish to draw attention to malaria brought into the country and how serious it can be, and suggest prophylactic measures to be applied for pregnant women and their newborn babies.
Six patients treated with theophylline, including five with advanced chronic obstructive pulmonary disease, developed generalized seizures with serum theophylline concentrations ranging from 7 to 21 mg/l. Cerebral computed tomographic scans showed a small sylvian infarction in one patient. In the other five patients nothing, except theophylline, could account for the seizures. There were no clinical signs of theophylline toxicity prior to the failures, all of which had a favourable outcome. Patients with acute exacerbations of chronic obstructive pulmonary disease seem to be prone to develop generalized seizures when treated with theophylline.
Explore the source record for details and available documents.
Central pontine myelinolysis is a rare, but probably underreported, complication of the treatment of severe hyponatraemia. The typical presentation, with pseudobulbar palsy, quadriplegia and locked-in syndrome, made the diagnosis clinically possible in the two new cases reported. It was confirmed by computed tomography (CT). Serial CT scans in one case showed the chronological dissociation, as there was complete resolution of the pontine lucency several months after complete clinical recovery. Osmotic demyelination is suspected, but it remains unproven. Although recent evidence has suggested that too rapid a correction of severe hyponatraemia may be a possible factor, the two cases described occurred after slow correction. It would seem that rapid correction to a level of mild hyponatraemia (128-132 mmol.l-1) may be safe, reducing the morbidity of severe hyponatraemia without having central pontine myelinolysis.
Explore the source record for details and available documents.
Digital arterial circulation before and after administration of a vasodilator orally was explored by mercury gauge pulsed plethysmography and photoplethysmography in 12 patients with primary Raynaud's phenomenon and results compared with those of 10 healthy volunteers. The amplification factor F, ratio of amplitude in reactive hyperemia over amplitude at rest was determined in the index before and after 8 mg daily of dihydroergokryptine over 4 weeks. Before treatment, for each of the two plethysmographic technics, a significant increase in mean factor F values was noted in the patients with Raynaud's phenomenon when compared with healthy controls. This is due to a decline in digital arterial flow at rest. Using the mercury gauge plethysmograph, a significant reduction in factor F was observed after vasodilator treatment corresponding to an increase in digital flow at rest without increase in flow during hyperemia. Using photoplethysmography, no significant variation in factor F was noted after treatment. Mercury gauge plethysmography, which measures global digital blood flow appears to be a more sensitive method than photoplethysmography, which measures dermal and hypodermal blood flow, for follow-up of effects of vasodilator treatment on Raynaud's phenomenon.
Fifty-four episodes of hypercapnic status asthmaticus (Pa CO2 50 mmHg or more) were treated with intravenous theophylline (6 mg/kg over 30 minutes, then 1 mg/kg/hour), intravenous hydrocortisone hemisuccinate (1 g then 500 mg 4-hourly) rehydration and oxygen therapy at a sufficient rate to obtain a Pa O2 of 80 mmHg or more. As a rule, improvement was rapid with a significant decrease of mean Pa CO2 values from 61 +/- 14 to 44.5 +/- 11.5 mmHg (P less than 0.001) over 2 hours. In only 3 cases was mechanical ventilation necessary. An initially high Pa CO2 value is not an absolute indication of mechanical ventilation. This method remains exceptional and can be avoided in most patients by the emergency medical treatment outlined above.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The authors report a case of "spontaneous" rupture of the liver in a woman of 35 years of age. This occurred immediately after post-partum eclampsia. It was not possible to obtain complete haemostasis using absorbable haemostatic compresses along the convexity of the liver. Complete cessation of bleeding only occurred after the operation when posterior pituitary abstracts had been transfused. The patient died 53 days after the initial procedure from a high gastro-intestinal haemorrhage. A study of the literature shows that this rare condition is most probably a complication of toxaemia of pregnancy but the physio-pathology of these liver lesions is ill-understood. The clinical picture is in two phases--the first corresponds to the formation of a sub-capsular haematoma and the second to the intra-peritoneal rupture of this haematoma. The prognosis for this condition is poor, the maternal mortality ranging from 56%-75%. The prognosis is linked to the speed with which the diagnosis is made and surgical intervention is carried out. This should be done before the capsule of the liver ruptures. Haemostasis is nearly always best obtained by using haemostatic compression with packs but haemostasis is not always adequate, particularly if there are several lesions in both lobes of the liver. This case history shows that using posterior pituitary abstracts in transfusion can be helpful.
Explore the source record for details and available documents.
Beta-blocking agents may induce vascular syndromes related to environmental temperature, accentuation of arterial diseases, gangrene of the extremities. Incidence and severity are variable with beta-blocking agent's properties: cardioselectivity, intrinsic sympathomimetic activity, cardiac depression, and with the patient's disease. The risk of complication is greater with hypertension disease because of the reduction of arterial compliance and quantitative and qualitative alterations of adrenergic receptors.
Explore the source record for details and available documents.