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Biomedical subjects

G Bleichner

Publications and source records attributed to G Bleichner.

At least 37 records · Page 2Linked to original sources

[Postpartum myocardial infarction with normal coronary arteries. Apropos of a case].

A case of painless anteroseptal and high lateral wall infarction presenting as cardiogenic shock with pulmonary oedema 24 hours after childbirth complicated by severe post partum haemorrhage with a coagulation defect, is reported. Coronary angiography performed one month later was normal, with a negative ergometrine provocation test. The authors review five previous reports in the medical literature, and discuss the possible physiopathological mechanisms which, alone or in association could have operated in the reported case.

Adult↗

[Hypophosphoremia during mechanical ventilation for chronic obstructive bronchopathies].

Hypophosphoremia may interfere with respiratory function in chronic obstructive pulmonary diseases (COPD) through different mechanisms: muscular exhaustion and weakness. Accordingly, the frequency and magnitude of hypophosphoremia was studied in 36 consecutive patients with acute respiratory failure and mechanical ventilation. Initial phosphoremia was normal (1,32 +/- 0,12 mmol/l) but often and rapidly decreased in all patients after mechanical ventilation had been started (0,54 +/- 0,14 mmol/l after 24 h). After this, phosphoremia remained low, slowly increasing with continued enteral nutrition (2000 Kcal, 276 g of glucides, 33 mmol/l of phosphorus). Four patients had severe hypophosphoremia after 24 h of mechanical ventilation (less than 0,30 mmol/l). Phosphoremia returned to a normal level 36 h after extubation. Hypophosphoremia was closely linked to pH improvement (r = + 0,67, P less than 0,001) and was paralleled by a drop in phosphaturia, suggesting intra-cellular penetration of phosphorus.

Acidosis↗

[Bacteriologic, clinical and kinetic evaluation of cefmenoxime (SCE 1365) in the treatment of 68 cases of septicemia. A multicenter trial].

Cefmenoxime (SCE 1365), a new broad-spectrum, third generation cephalosporin was used in the treatment of 68 patients with bacteremia. Cefmenoxime was given as monotherapy to 63 patients in a mean daily dosage of 3 g (range: 1 to 6 g). 63 successes were recorded. Results were inconclusive in the remaining five cases. General and biological tolerance of cefmenoxime was excellent.

Adult↗

[Acute neutropenia in adult severe bacterial infections. Six cases (author's transl)].

A transient neutropenia (duration : less than 48 hours) occurred in 6 patients with severe bacterial infections. The bone marrow myeloïd cellularity was high or normal; a maturation arrest of the myeloïd cells - at a variable stage - was present in each case, as well as circulating granulocyte precursors. Other causes of neutropenia were excluded. A general survey of the literature is made and the mechanisms of this bacterial neutropenia are considered : bone marrow failure seems mostly improbable ; the few previously reported cases, the experimental bacterial neutropenias, the peculiar, transient, evolution we observed, all favor a peripheral mechanism ; the bacterial infection seems to act by; two ways : in septicemia (especially during septic shock) by enhancing leucocyte margination along vascular walls ; in large septic foci (mostly pulmonary) by an important destruction of polymorphonuclear neutrophils. Such bacterial infections share a bad prognosis but the neutropenia itself needs no specific treatment.

Acute Disease↗

Inhibited response to isoproterenol and altered action potential of beating rat heart cells by human serum in septic shock.

Human serum, obtained within 24 hours after the onset of septic shock, was evaluated for its effects on the chronotropic response of cultured rat myocardial cells to isoproterenol. Transmembrane action potential (AP) was measured in some experiments. Sera obtained after the first four to five hours, when central venous pressure (CVP) was normal or high, inhibited increased cell beats, while this property was not evidenced for samples taken soon after septic shock when CVP was low. Sera were also found to alter AP in much the same way as Sotalol, an adrenergic beta-blocking drug. These two effects were never observed with control sera obtained from healthy male adults at rest. These findings demonstrate that sera from patients in septic shock depress the beta-adrenergic response of rat myocardial cells, after the early phase of septic shock characterized by sympathoadrenergic activity. They strongly suggest the mediation of unidentified humoral factors, which might interfere in the pathogenesis of myocardial dysfunction during the intermediate phase of septic shock.

Action Potentials↗

[Total parenteral nutrition in the adult. Theoretical aspects (author's transl)].

When oral or enteral feeding becomes impossible or inadequate, total parenteral nutrition makes it possible to reduce the occurrence of malnutrition states as complications of medicosurgical disorders. From a practical point of view it should provide a minimum fluid intake of 30 ml/kg with a nitrogen intake of the order of 150 to 300 mg/kg/day with sufficient quantities of all essential amino acids in a balanced ration. In most instances the calorie intake should be 40 to 60 Kcal/kg/day. Non-protein calories are obtained from carbohydrates or fats but the ideal percentage of each of these two nutrients is not known. In order to be effective and well tolerated, intravenous nutrition of this sort must be adapted to each patient and should be administered by a qualified medical and nursing team in order to minimise the metabolic and septic risks secondary to the techniques used.

Amino Acids↗

[Parenteral feeding. Prevention of complications in adults during exclusive mid-term parenteral feeding].

The benefits of parenteral feeding need no longer be emphasised. However, qualitative and quantitative food supplements raise a certain number of difficulties which should be better known. Infection is the most frequent complication. It may be avoided by strict aseptic precautions throughout parenteral feeding. Hypoglycemia is a major risk owing to the possible consequence. Hyperglycemia and its consequence of osmotic polyuria is more frequent and should be controlled to avoid loss of water and salt. Complications due to the use of lipid emulsions are exceptional when soya oil is used. Hypophosphoremia should be corrected by increasing phosphate intake. Hypocalcemia is common; it is often associated with hypoproteinemia and sometime a low calcium intake, vitamin D deficiency or a sudden increase in phosphate intake. Vitamin deficiencies, hypomagnesemia, and oligo-element deficiencies should be correcty by appropriate supplements.

Acid-Base Imbalance↗

Inhibitory action of human serum on the isoprenaline-induced chronotropic effect in cultured rat heart cells. Influence of sex and pregnancy.

Cultures of beating rat myocardial cells brought into contact with various human sera during 24 hours were infused with isoprenaline. The isoprenaline-induced positive chronotropic effect (IIPCE) was not found with all sera. IIPCE was present in all the male sera, but was absent in the cases of clinically beta-blocked pindolol treated men. IIPCE was present only in about 50% of the female sera, menopaused or not. IIPCE was absent in 95% of the sera of pregnant women in the late phase of pregnancy. This suggests the presence in female sera, especially during pregnancy, of a circulating factor capable of "in vitro" inhibition of isoprenaline-induced positive chronotropic effect.

Adult↗