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Biomedical subjects

F Fraisse

Publications and source records attributed to F Fraisse.

At least 19 recordsLinked to original sources

[Rearrangement of an emergency department. Reflections on a structure].

Since 1986, a new conception of the emergency department in the hospital of Saint-Denis comes out. It would adapt with a greater efficiency plan to the needs and has entailed a sudden awareness, reflections and critical analysis of the situation. The disposition of the emergency ward, the formal procedures that prevailed over the act of care and the deficiency of the first global relationship with the patient were impediments to the mission of emergency department. A new department that gathers both reception and emergency duties was inaugurated in May 1987. It puts three aims in concrete form: to make the emergency ward more functional, to improve quality and capacities of reception and to improve the medical act.

Emergency Service, Hospital

[Staphylococcus aureus endocarditis].

Among 409 cases of bacterial endocarditis (BE) observed from 1972 to 1985, 142 were caused by Staphylococcus aureus. Of these 142 cases, 59 affected native valves of the left heart (left BE), 47 affected native valves of the right heart (right BE) (including 36 drug-addicts), and 36 involved prosthetic valves (BEP) and were associated with mediastinitis in 11 cases. Symptoms were acute in 122 cases and subacute in 2 cases. 91 of the BE on native valves were primary (86%). Cutaneous manifestations were present in 38 cases (27%). Of the 67 patients who died (47%), 28/59 had left BE (47%), 7/47 had right BE (15%) (including 2 drug addicts) and 32/36 had BEP (86%); all differences were statistically significant. Complications consisted of: heart failure in 78 cases (55%), including 40 cases of left BE, 8 cases of right BE and 30 cases of BEP; systemic peripheral embolism in 29 cases (left BE 17, BEP 12) and neurological accidents in 58 cases (left BE 34, right BE 24). Thirty of these accidents occurred before the 4th day (left BE 13, BEP 17). Documented neurological accidents included cerebral haemorrhage (13 cases), cerebral infarction (14 cases) and cerebral abscess (4 cases); 4 of the 12 patients who underwent arteriography were found to have one or several aneurysms. Thirty-nine of these 58 patients died, death being directly due to a neurological cause in 20 cases (left BE 10, right BE 10).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent

[Chronic endocarditis on valve prosthesis. 6 cases].

Six cases of chronic endocarditis (more than 1 year duration) have been extracted from a series of 72 cases of endocarditis (delayed in 49) associated with intracardiac prosthesis observed over a 15-year period. In these 6 cases endocarditis developed 6 months to 2 years after valve replacement. The prosthetic material included 3 Starr-Edward's valves, 2 Hancock's valves and 1 intracardiac patch. The micro-organism isolated were Streptococcus in 3 cases, Serratia and Corynebacterium in 1 case each. The 18-month to 5-year course of the disease was marked by 2 to 5 relapses separated by long periods of apyrexia. The most significant complications were dysimmune syndrome (5 cases), embolic accidents (2 cases) and prosthesis disinsertion (4 cases). Five patients benefited from antibiotic therapy; 4 were operated upon with recurrent disinsertion in 2 cases. Two patients died, one of repeated disinsertion, the other of myocardial dysfunction. Bacteriostatic antibiotics were administered continuously to 3 patients whose endocarditis persisted or relapsed, with satisfactory results in two cases followed-up for more than 2 years.

Adult

[Acute rhabdomyolysis in alcoholic patients].

Six episodes of acute rhabdomyolysis were observed within a two-year period in 5 male adult alcoholic patients hospitalised in a hepatology intensive care unit. Painful muscle swelling was discrete of absent in 4 of the 5 patients. Acute rhabdomyolysis was preceded by grand mal seizures in 4 patients, delirium tremens in 1 and high fever with shivers in 3. All cases were rapidly diagnosed on the finding of very high serum creatinine phosphokinase levels. One patient developed acute respiratory failure and recovered after prolonged mechanical ventilation. Three patients had acute renal failure with severe hyperkalemia in one but none required dialysis. Three patients died within 2 to 6 days of the diagnosis, but the deaths were not directly related to rhabdomyolysis. It would appear that in alcoholic patients: the prevalence of rhabdomyolysis is probably underestimated; any muscular hyperactivity as seen in seizures, delirium tremens and prolonged shivers may be a precipitating factor; the condition is easily diagnosed by measuring serum creatinine kinase activity; some cases of acute renal failure in patients with alcoholic cirrhosis might be explained by acute rhabdomyolysis with minimal symptoms.

Acute Disease

[Normal values of the main stool constituents from age 1 year to puberty (author's transl)].

The daily excretions of the main stool constituents have been measured during 97 balance periods performed in 73 children aged 1 to 17 years and whose digestive functions could be considered as normal. From 1 to 2, 2 to 6, and 6 to 17 years of age, the following values (mean and range) have been obtained: expressed in g/day, for stool wet weight: 61 (33-112), 79 (19-157), 76 (22-166); for nitrogen: 0.49 (0.26-1.06), 0.74 (0.3-2.13), 0.83 (0.3-1.52); for fat: 2 (1-3.6), 1.9 (0.9-3.2), 1.8 (0.6-4.5); expressed in mmol/day for volatile acids: 10.1 (5.2-18), 13.7 (1.8-23.7), 10.1 (3.5-27.5); for Na+ : 0.7 (0.3-1.2), 1 (0.1-3.2), 1.1 (0.1-4); for K+ : 4.4 (3-6.7), 5.1 (1.7-10.4), 5.9 (1.6-11). Only wet weight and nitrogen vary significantly from the first to the second period of age (p less than 0.05 and less 0.01 respectively). Wet weight is highly correlated with volatile acid excretion (p less than 0.001) but weakly linked to fecal fat which implies that the measurement of the percentage of fat in fresh stools is not a correct estimate of their absorption.

Adolescent