PubMed Health⌕ Search

Biomedical subjects

E Chailleux

Publications and source records attributed to E Chailleux.

At least 37 records · Page 2Linked to original sources
PubMed1995

[Secondary neuromuscular deficiencies in critical care patients].

The authors report three cases of neuromuscular deficits occurring after a variable time of mechanical ventilation in ICU patients suffering from acute respiratory failure requiring sedation and neuromuscular blockade by pancuronium bromide. The clinical features of these deficits were similar : flaccid quadriparesia slowly reversible without sensory loss and difficult weaning from ventilation for two patients. The paraclinical investigations (measurements of creatine kinase, electrophysiological examination) permitted to distinguish two diseases: critical illness polyneuropathy (in patient with ARDS) and acute myopathy (in other patients with severe asthma) caused by corticosteroids and potentiated by neuromuscular blocking agents. This myopathy differs from the chronic myopathy caused by long term corticotherapy. After a status asthmaticus treated with corticosteroids and mechanical ventilation under muscle relaxants, creatine kinases should be measured in plasma and a neurological examination be performed. The value of neuromuscular blockade monitoring for the prevention of this myopathy should be assessed.

Adult↗
PubMed1995

[Horton disease of pulmonary localization].

A case of Horton's disease with interstitial pulmonary involvement is reported. Transbronchial biopsy of the lung and biopsy of the temporal artery provided evidence of giant cell lesions. Outcome was favourable with general corticosteroid therapy with regression of the pulmonary disease.

Aged↗
PubMed1994

[Acute eosinophilic pneumopathy induced by minocycline].

A 22-year-old patient was hospitalized for severe acute eosinophil pneumonia imputable to treatment with minocyclin chlorhydrate (Mynocine). Clinical manifestations began one week after onset of drug intake. The clinical picture included fever at 38 degrees C, polypnoea at 44/min, pulmonary crepitation and severe hypoxia at 4.5 kPa. Eosinophil blood counts were high (3.02 x 10(9)/l) Standard chest X-ray led to the diagnosis of eosinophil pneumonia. Approximately 50% of the polynuclears were eosinophils. The clinical course was rapidly favourable after withdrawal of minocyclin and administration of corticosteroids. This case was analysed and compared with other reports of minocylin induced pneumonia.

Acute Disease↗
PubMed1994

[Prognostic factors in the survival of patients with neuromuscular diseases after an episode of acute respiratory insufficiency].

We have studied the survival of 49 patients suffering from neuromuscular disease, who were hospitalised in the Respiratory Intensive Care Unit between 1981 and 1990 (29 males and 20 females with a mean age of 49.3 +/- 17 years with a range of 15 to 79). The neuromuscular diseases consisted of 8 with multiple sclerosis, 9 with amyotrophic lateral sclerosis, 8 with Steinert's disease, 11 myopathies, and 10 suffering from miscellaneous neurological diseases. Initially 27 of the 49 patients had been intubated and ventilated. During the hospital stay long-term ventilation was undertaken in 27 patients (21 by tracheotomy and 6 by nasal mask). The principal prognostic factor was the aetiology. Three groups of varying degrees of severity could be individualized: progressive neuromuscular disease (amyotrophic lateral sclerosis and multiple sclerosis), primary muscle disorders (myopathies and Steinert's disease), and neuromuscular disease with little or no evolution (survival at two years was 15%, 45% and 71% respectively for three groups. p = 0.001 by log-rank testing). The other factors which influence survival are age (p < 0.01), the presence of false route (p < 0.01), and the reason for hospitalisation (acute as opposed to chronic progressive deterioration, p < 0.05). In a multivariate analysis the most significant factors associated with the diagnosis were age, the reason for hospitalisation, and the existence of false routes. The initial treatment (intubation) and the prescription of long-term ventilation did not bring with it any significant further information as to prognosis, compared to the model which included these four factors.

Acute Disease↗
PubMed1994

[Sleep apnea syndrome in intensive care].

The aim of this work was to study the existence of special characteristics in the sleep apnoea syndrome (SAS) discovered following a stay on the Intensive Care Unit. This retrospective study of 25 casenotes of SAS patients who were resuscitated has enabled a comparison with 182 SAS patients who have never had acute respiratory failure. The intensive care consisted of controlled ventilation, following intubation, in a clinical context of acute respiratory failure with major problems of conscious level. The diagnosis of SAS was made using conventional or computerised polysomnography, or a computerised study of transcutaneous SaO2 (SaO2TC) which had been validated before. The results show that patients with SAS in an Intensive Care Unit, differs significantly from other patients with SAS by the permanent presence of alveolar hypoventilation in a stable state, associated with a significant decrease in the FEV1 (VEMS) in relation to the group that had not been in intensive care. However, the FEV1/VC ratio did not differ between the two groups which were expressed in absolute values or as a percentage of the theoretical value defined on the basis of their age. There was no difference on the data from the sleep studies and notably the hypoapnoeic indices, nor on age, the index of body mass or the sex ratio. We conclude that there is a need to look for SAS in the presence of acute respiratory failure in the obese without a recognised cause.

Acute Disease↗
PubMed1993

Primary pulmonary lymphomas. A clinical study of 70 cases in nonimmunocompromised patients.

We studied 70 patients with biopsy-proven pulmonary non-Hodgkin's lymphomas without extrathoracic involvement or mediastinal adenopathy to determine the clinical, imaging, and endoscopic features of this condition in a homogeneous series. In low-grade (LG) lymphomas, symptoms were cough, dyspnea, chest pain, hemoptysis. Imaging features consisted of localized alveolar opacities, infiltrative diffuse opacities, atelectasis, and pleural effusions. Inflammatory changes of the mucosa were present in some patients, leading to bronchial stenosis in 7; biopsies showed lymphomatous infiltration in 12. Prognosis of LG lymphomas was excellent, with 93.6 percent survival at five years. High-grade lymphomas differed from LG lymphomas principally by a more aggressive course and a worse survival. Inflammatory changes occurred in seven of nine cases leading to stenosis in two, and biopsies showed lymphomatous involvement in five. The profile of primary pulmonary lymphomas in this study could help clinicians consider this condition and prompt them to evaluate new diagnostic tools.

Adult↗
PubMed1993

[Predictive factors in maintaining nocturnal continuous positive pressure in patients with sleep apnea syndrome].

A retrospective study was carried out on 347 case notes involving 303 men and 44 women who were suffering from a sleep apnea syndrome (SAS). The mean age was 57 plus or minus 10 years, and the diagnosis was made between 1982 and 1992. We have carried out the research to examine if there were clinical factors or factors related to respiratory function which would predict the acceptance in the short or long term and the correct observation in a daily time-table of nocturnal continuous positive pressure (PPC). The diagnosis of SAS was made using conventional polygraphy (35%), computerised cardiorespiratory recording 38%, or limited to transcutaneous saturation 27%. The mean number of respiratory nocturnal events in the three groups were respectively 48 plus or minus 25 per hour during sleep, and 45 plus or minus 23 and 51 plus or minus 20 per hour by the recording techniques. We have suggested a treatment by PPC in 235 patients: 86 patients refused at the outset (37%), 26 stopped secondarily (11%), and 108 (46%) continued until the end point 1992 with a mean duration of treatment of 24 (plus or minus 17), months and a mean duration of nocturnal usage of 6.2 (plus or minus 2.5) hours a mean level of positive pressure of 11 (plus or minus) 2) centimetres. The primary acceptance of PPC is significantly linked to the understanding of the patient of the functional signs (p less than 0.001) and of the severity of diurnal hypersomnolence (p less than 0.001). The acceptance in the long-term is linked in a weakly significant manner to the recognition by the patient of functional signs (p less than 0.04). None of the other 68 criteria used for assessing the severity of the patient and the SAS had any influence on the acceptance of PPC in short or long term. The compliance with a daily time-table is a weakly significant factor to the severity of the SAS judged by the number of nocturnal respiratory events (p less than 0.03).

Aged↗
PubMed1992

[A rare and curable cause of acute respiratory insufficiency after a pneumonectomy. The platypnea-orthodeoxia syndrome by the reopening of the foramen ovale].

We describe a case of a 54 year old patient who had developed a right to left shunt due to a patent foramen ovale as a late consequence of a pneumonectomy; this was responsible for acute respiratory insufficiency and respiratory failure. This is a rare complication, but its clinical presentation as platypnea-orthodeoxia should lead to the correct diagnosis. The diagnosis can be rapidly confirmed by a non-invasive examination, namely contrast echocardiography, coupled with color doppler. The treatment is surgical with excellent results. The pathophysiological mechanism is also discussed.

Coronary Angiography↗
PubMed1992

[Prognostic factors in survival of patients with obstructive respiratory insufficiency treated by long-term oxygen therapy. Data from the ANTADIR registry].

Prognostic survival factors in COPD patients obtaining long-term oxygen therapy (LTO) through 25 french associations were studied using data from the ANTADIR register. Selection criteria included age (50 to 79 yr), FEV1/VC < 60%, PaO2 < 60 mmHg and start of therapy between beginning 1984 and end 1988. A total of 1,775 patients were selected (1,462 men, 313 women, mean age 66.1 yr). PaO2 was 50.9 +/- 5.8 mmHg, PaCO2 47.1 +/- 5.8 mmHg, FEV1 8.81 +/- 0.31 l (30.4 +/- 11.1% of predicted values) and FEV1/VC 37.7 +/- 10.1%. Overall survival was 81.6% at 1 yr, 68.6% at 2 yrs, 55.7% at 3 yr, 44.9% at 4 yr and 37.3% at 5 yr (survival median 3.5 yr). Age was the most predictive survival factor (5 yr survival 48.8% for 50-59 yr-old patients vs 27.3% for 70-79). Survival was longer in women (49% at 5 yr vs 34.9% for men). After stratification by age, FEV1, FEV1/VC, PaO2, PaCO2 and Body Mass Index (BMI) were all significant predictive factors for men. FEV1/VC was the only prognostic factor for women. For all the population multivariate analysis showed that age, sex and BMI were the most significant variables. A prognostic score determined from the final Cox model and based on sex, age, BMI, FEV1, PaO2 will be validated in an independent patient series. Our data confirm the influence of age, airways obstruction and hypoxemia on survival of COPD patients under LTO. Furthermore they demonstrate a poorer survival in men, in underweight patients and in non hypercapnic patients.

Age Factors↗
PubMed1990

[Asthma and air pollution. A study of admissions to the Hospital of Saint-Nazaire].

To test the possible influence of atmospheric pollution on the frequency of asthmatic exacerbations we have looked to see whether there is a link between the number of daily admissions for asthma in hospitals in Saint-Nazaire and data from pollution sensors in the network of the Association for the Measurement of Atmospheric Pollution in the Loire estuary. The pollutions studied were sulphur dioxide, oxide of nitrogen (NOx) and non sedimenting dust (black smoke). The meteorological data (speed and direction of the wind and temperature) were also recorded. The study was carried out for 18 months in a retrospective fashion. During this period 372 hospital admissions were recorded in 229 subjects. The number of daily admissions correlated in a significant fashion with the level of black smoke (r = 0.149, p less than 0.001) and this result was particularly due to subjects who were less than 15 years old. In this group the frequency of hospital admission was doubled on those days when the level of smoke was at its most elevated. There was a weak link between the peaks of SO2 (r = 0.116, p less than 0.05). An analysis of the place of residence in those hospitals and the dominant direction of the wind did not enable us to confirm the role of the principal sources of industrial pollution, which were all situated to the east of Saint-Nazaire.

Adolescent↗
PubMed1989

[Phrenic stimulation in C1-C2 tetraplegia. Apropos of a case].

The authors report a case of post traumatic tetraplegia at the C1-C2 level in a young man of 16 with total respiratory paralysis treated with mechanical ventilation and a tracheotomy. Thirty months after the accident, an Avery S 232(1) diaphragmatic pacemaker was surgically implanted by the mediastinal approach. The technique was rapidly successful and enabled satisfactory ventilation and phonation two months after the implantation. The patient is currently treated at home with no signs of diaphragmatic fatigue 20 months after the implantation of the stimulator.

Adolescent↗
PubMed1989

[Reliability of transcutaneous PO2 measurements and ear oximetry at different levels of exercise].

Measurement of transcutaneous PO2 (PtcO2) and of the saturation of hemoglobin by ear oximetry (StcO2) are two non-invasive methods which can be used when performing exercise tests in patients with respiratory failure. To evaluate their reliability, we have compared 18 patients recording the PtcO2 (Radiometer electrode TCM1) and of StcO2 (Biox II A) with arterial samples using a radial artery catheter at rest and at a level corresponding to 50% of the maximal predicted effort and at maximal power (Wmax) obtained at the time of a triangular exercise (increasing the charge at 15 watts/min). The PtcO2 was significantly lower than the PaO2 at rest and on exercise: the variation between PaO2 and PtcO2 was 1.85 kPa at rest (confidence interval -0.25 to 3.96 kPa) but decreased with exercise reaching 1.22 kPa at the last level of exercise (confidence interval -1.2 to 3.65 kPa). The relative raising of PtcO2 in relation to the PaO2 masks a fall in the observed PaO2 on average for the entire group (the PaO2 falls from 9.49 kPa to 8.62 kPa whereas the PtcO2 only falls from 7.64 kPa to 7.39 kPa). The mean StcO2 does not differ from th SaO2 at rest as on exercise. However, the confidence interval of the scatters between SaO2 and StcO2 increase considerably at maximal power: whereas it ranges between -5.5 and 3.5% at rest and in the middle range effort, and is between -13.4 and 11.1% at the last stage.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Prognostic factors in diffuse malignant pleural mesothelioma. A study of 167 patients.

The existence of large shipyards accounts for the particular frequency of pleural mesothelioma in the Nantes-St. Nazaire region of France. From 1955 to 1985, 167 cases were diagnosed. Occupational exposure to asbestos was involved in 131 cases (88 percent). There was a great predominance of epithelial types (135) over mixed (25) and fibrosarcomatous (7) types. Survival, estimated by the actuarial method, was 54 percent at one year from first symptoms and 39 percent from histologic diagnosis. No subject was alive four years after diagnosis. Histologic type and asbestos exposure had no predictive value in our series. Survival was longer in patients under 60 years of age and when mesothelioma originated on the left side. Overall, treated patients had significantly longer survival than untreated patients. However, there was no significant difference in survival with respect to the type of treatment given: surgery, chemotherapy, talc poudrage or their combination.

Adult↗
PubMed1988

[Benign pleural pathology of asbestos].

The most frequent benign lesions of the pleura created by asbestos are fibro-hyaline plaques, i.e. thick areas of collagen located on the parietal pleura and gradually becoming calcified. Less common is benign pleural effusion the cause of which is not always easy to determine. To these must be added an extensive pleural fibrosis with functional repercussions that are not negligible, and round pseudotumoral atelectasias. These pleural asbestos-induced lesions are often observed after a low intensity exposure, but they appear as a rule after more than 20 years of latency. While they betray a previous exposure to asbestos, they also raise the problem of possible asbestos-induced lung cancer and mesothelioma.

Asbestosis↗
PubMed1987

[Disseminated invasive aspergillosis associated with Mycoplasma pneumoniae infection].

Disseminated aspergillosis is rare in patients not suffering from haematological disorders and myelo-suppression. We report a case of pulmonary cardiac and renal aspergillosis diagnosed at autopsy in a patient with chronic respiratory failure dying in the intensive care unit during an acute exacerbation. The role of risk factors associated with invasive aspergillosis in patients not suffering from myelosuppression is discussed (steroid therapy, chronic respiratory disease, concomitant viral or bacterial infection). The discovery in this patient of a pulmonary infection associated with mycoplasma pneumonia (the micro-organisms were found in necropsy specimens of pulmonary tissue) does not seem to have been reported before in the literature.

Aspergillosis↗
PubMed1987

[Bacteriological aspects of 64 cases of severe pneumonia seen in a respiratory intensive care unit].

We report on the bacterial aspects of 64 cases of severe pneumonia in an intensive care over a two year period, excluding cases occurring during artificial ventilation. In all the cases, the grave respiratory and haemodynamic signs, the blood gas and radiological findings justified admission of these patients to an intensive care unit. Specimens for bacteriology, virology and parasitology enabled a precise microbiological diagnosis 43 times (63%); in 44% of these diagnosis the possibility of the protected specimens (trans-tracheal, protected brushing) were confirmed by another specimen (pleural or blood). The germs identified were: Streptococcus pneumoniae (13), Staphylococcus aureus (9), Haemophilus influenzae (6), other gram negatives (12), Mycoplasma pneumoniae (1), Koch's bacillus (1), Aspergillus fumigatus, Cytomegalovirus, Myxovirus, Pneumocystis carinii (5). Twenty eight patients died of whom eight had marrow failure following chemotherapy; amongst the non-leukopenic patients an analysis of the records allowed certain presumptions as to the causative organism according to the patients mode of referral and immune state. The prognosis of these pneumonias remains serious in spite of improved bacteriological diagnosis, above all in the elderly, poorly nourished or with marrow aplasia.

Adolescent↗