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Biomedical subjects

E Moirot

Publications and source records attributed to E Moirot.

At least 19 recordsLinked to original sources
PubMed2006

[Extensive purpura and septic schock in two patients with Capnocytophaga canimorsus].

INTRODUCTION: Capnocytophaga canimorsus is a Gram negative bacillus present in oral flora and in saliva of dogs and cats. It can be responsible for septicaemia and meningitides in some patients after dog or cat bite two patient with a septic shock due to C. canimorsus, who presented with an extensive pupura are reported. CASE REPORT: A 50 year-old man with a past history of splenectomy was referred to an emergency department for a shock with vomiting, abdominal pain and generalized ecchymotic purpura culture samples isolated C. canimorsus in peritoneal fluid. Purpura occurred secondary to a disseminated intravascular coagulation. Despite intensive care and major antibiotherapy, the patient rapidly died. Four days previously, the patient administered pills in his dog mouth. The second patient was a 39 year old alcoholic man who was hospitalised for vomiting and septic shock witch occurred 24 hours after a dog bite. He presented with a livido and a diffuse purpura associated with necrotic lesions. Cultures of blood samples isolated C. canimorsus. CONCLUSION: These severe infections due to C. canimorsus should be avoided by the routine use of early antibiotherapy with amoxicilline and clavulanic acid in patients with dog or cat bite, particularly if patient with associated debilitating disorders.

Adult↗
PubMed2001

[How to manage very elderly patients in the emergency room? Evaluation of 150 very elderly patients at the Rouen university hospital center].

OBJECTIVES: There are few data in the literature concerning care provided to very elderly subjects referred to emergency care units. The emergency room setting would not be particularly adapted to management of this rising population. The purpose of our work was to assess the frequency of referral to emergency care units, the characteristics of the elderly population, and patient management. PATIENTS AND METHODS: One hundred fifty consecutive patients aged over 90 years addressed to the emergency unit of the Charles Nicolle hospital in Rouen France were studied. These patients were cared for by the medical and surgical teams. We recorded, type of referral, hour and reason for admission, degree of handicap and residence, gravity at admission using the clinical classification for emergency care patients (CCMU), complementary tests performed in the emergency unit, duration of stay in the unit and subsequent referral. The characteristics of these "very" elderly patients aged over 90 years were compared with those of "elderly" patients aged 75-90 years. RESULTS: Over a period of 33 days, the unit cared for 4888 patients, including 150 very elderly patients aged over 90 years (mean age 92.6 years). Daily, 4.4 patients were referred by a primary care physician (76.), mainly between 8 a.m. and 8 p.m. (81.3%). Forty-two percent of the patients had a surgical problem. Two-thirds were unable to walk, one-third had cognitive disorders, and one-third had urinary incontinence. However, half of these very elderly patients lived in a private home. According to the CCMU classification, 14.6% of the patients had a life-threatening disorder. Complementary tests were ordered for most patients (85%). Mean duration of stay in the emergency unit was 3.6 +/- 2.6 days. One quarter of the patients returned to their former residence, with a higher percentage among the surgery patients (37%) than among the medical patients (14.6%). There was no significant difference between the "very elderly" and "elderly" patients in terms of type of referral, duration of stay in the unit and subsequent referral. CONCLUSION: "Very elderly" patients are frequently addressed to emergency care units by their primary care physician. They have severe conditions with major handicaps that largely explain their hospitalization. Our results point out possible improvements for care in the emergency unit.

Activities of Daily Living↗
PubMed2001

Two cases of foodborne botulism type E and review of epidemiology in France.

In 1999, two new cases of type E botulism were observed in French hospitals. Since this type of botulism is uncommon in France, the cases prompted a national epidemiological study. Sixteen cases of type E botulism, including the two cases reported here, occurred between 1952 and 1999. The clinical and treatment characteristics of all cases were evaluated, and the results suggest that, despite its rarity, type E botulism should be considered by clinicians in France. Changes in the eating habits of people in France, as in the rest of Europe, with the increased consumption of vacuum-packed fish from endemic areas and decreased consumption of local foodstuffs, could explain the occurrence of the most recent cases.

Adult↗
PubMed1999

[Patients in a state of agitation at the admission service of a Rouen hospital emergency department].

OBJECTIVE: To determine the incidence and causes of agitation states in patients presenting at the Rouen University Hospital emergency room and to analyze the management scheme. PATIENTS AND METHOD: A prospective study was conducted over a 9 month period in 100 consecutive patients presenting a state of agitation assessed using the Overt Aggression Scale. A pre-planned management protocol was applied. RESULTS: The incidence of states of agitation was 0.56%. There were 43 women and 57 men, mean age 33 years. Most of the agitated patients were admitted between 6 p.m. and 4 a.m. (69%). Over the 9 month period, 2 patients were admitted twice for agitation and 2 absconded. Low glucose level was the cause of agitation in 4 cases. Alcohol and/or drug use concerned 73% of the agitated patients and was the most frequently observed triggering factor (17%). Only 6% of the patients had a regular employment. Physical restraining measures and sedation were required in 86% and 84% of the cases respectively. Among 67 patients given loxapine for sedation, 2 developed acute dyskinesia and 9 low blood pressure. One out of 4 patients were referred to a psychiatric unit. CONCLUSION: Patients in a state of agitation are young, often female, and in a difficult socio-economic situation. Hypoglycemia is the main differential diagnosis. A triggering factor can often be identified. A state of agitation is not a repetitive condition but occurs as a short-lived episode in the patientís history. Such patients need rapid care to avoid further aggravation and disruption of the emergency room activity, and to prevent the patient from fleeing. Loxapine provides effective sedation but requires regular monitoring of blood pressure and can provoke acute dyskinesia in young subjects.

Adult↗
PubMed1994

SETH: an expert system for the management on acute drug poisoning in adults.

The aim of SETH is to give end-users specific advice concerning treatment and monitoring of adult drug poisoning. SETH is developed with an off the shelf expert system shell (KBMS) and runs on a microcomputer. Technical choices were done according to this analysis, financial considerations and portability. Currently, the database contains 1000 French drugs from 75 different toxicological classes. The SETH expert system simulates the expert reasoning, taking into account for each toxicological class delay, signs and dose. Two phases of evaluation were performed. The experimental implementation of Seth began in April 1992 in our Poison Control Centre. Since then, 1100 cases inputted by residents were analysed by SETH. The extension of the knowledge base to child poisoning began in March 1993.

Acute Disease↗
PubMed1986

Complete atrio-ventricular block after furosemide.

We report a case of nonfatal complete atrio-ventricular (A-V) block after injection of 125 mg of furosemide by a central vena cava catheter. Accidents with this diuretic are very rare but this observation shows that it could induce A-V conduction disturbances. When large quantities of this diuretic must be used, we would recommend a slow injection rate to avoid such accidents.

Aged↗
PubMed1984

Metronidazole kinetics in patients with acute renal failure on dialysis: a cumulative study.

Nine patients with acute renal failure who were undergoing dialysis at intervals depending on clinical state were injected with metronidazole, 7.5 mg . kg-1 iv every 8 hr. Plasma samples were drawn during the 8 hr after the first infusion, during the first dialysis session, and during the course of the fourth infusion after the first three dialysis sessions. Metronidazole and its two main metabolites (alcohol [M1] and acid [M2]) were assayed by HPLC. The plasma t 1/2 of metronidazole (6.8 hr) is of the same order as that in healthy subjects. M1 and M2 plasma levels increased continuously until the next infusion. Dialysis clearances of metronidazole and its metabolites were about 60 ml . min-1; 25% of metronidazole in the body at the beginning of hemodialysis was eliminated. The corresponding apparent t 1/2 s are 3.3 hr (metronidazole), 8.0 hr (M1), and 7.9 hr (M2). In patients with acute renal disease under hemodialysis, there was no cumulation of metronidazole and its metabolites; hence there is no need for change in dosage regimen.

Acute Kidney Injury↗
PubMed1983

[Massive digestive hemorrhage in typhoid fever. A case report].

In a case of massive intestinal haemorrhage during typhoid fever the bleeding area was located by angiography to the superior mesenteric artery, and excision of the ileo-colonic junction was performed. Pathological study of the lesions showed necrosis of Peyer's plaques resulting in section of small submucosal arterioles. The necrosis itself was caused by initially endothelial lesions, later completed by thrombosis. The complication is exceptional. This case is reported in order to draw attention to the usefulness of mesenteric arteriography and the effectiveness of surgery in massive intestinal haemorrhages.

Colonic Diseases↗
PubMed1983

[Splenectomy and pneumococcal septicemia].

A literature review, following the observation of 4 cases of pneumococcal septicemia in splenectomized patients, demonstrated that infection was frequent in subjects with functional or anatomical asplenia, usually in the form of a pneumococcal septicemia. Infection occurs one hundred times more frequently in splenectomized patients than in the general population. The risk of developing an infection varies from one patient to another, and is related to the motive for splenectomy, the period since operation, and the age of the patient at the time of surgery. Pneumococcal septicemia in such cases is distinguished by its insidious nature and its very poor prognosis, the outcome being fatal in 50 to 70 p. cent of cases. This justifies intensive prophylactic measures: partial splenectomy, heterotopic transplantation, anti-pneumococcal vaccination, and long-term antibiotic therapy. None of these methods offers absolute protection, and indications for splenectomy should therefore be limited to the strict minimum.

Adult↗
PubMed1983

[Treatment of rheumatoid arthritis by plasma exchange].

The authors treated 9 patients with rheumatoid arthritis by plasma exchange. In the 5 cases with purely joint involvement, the treatment was not effective, with one exception. In the 4 other cases, with polyneuropathy and vasculitis, plasma exchange resulted in a rapid regression of the symptoms. Thus cases of polyneuropathy and vasculitis due to rheumatoid arthritis are good indications for treatment by plasma exchange.

Adult↗