[Severe water intoxication in a healthy subject following acute polydypsia].
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Biomedical subjects
Publications and source records attributed to G Potel.
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Haemodynamic parameters and their variations after the loss of 250 and 500 ml of blood under anaesthesia were studied in nine, 11 to 12 week-old, domestic swine weighing 37.4 +/- 2.6 kg. Premedication consisted of 2 ml azaperone i.m. Anaesthesia was induced with thiopentone, followed by suxamethonium to allow the easy placement of a cuffed endotracheal tube. Anaesthesia was maintained with phenoperidine and pancuronium. The animals were mechanically ventilated with a 50/50 nitrous oxide-oxygen mixture. A catheter was inserted in each of the femoral artery, upper hepatic vein, vena cava and portal vein. Right atrial, pulmonary and wedge pressures were measured; stroke volume, systemic and pulmonary resistances were calculated (fC 90 c X min-1, Pa 82 mmHg, Pra 4.7 mmHg, Ppa 24 mmHg, Ppw 11.6 mmHg, Q 4.45 l X min-1 and Rsa 1460 dyn X s X cm-5). The swine were then bled. After a bleed of 250 ml (t1), the haemodynamic parameters were significantly modified. After another bleed of 250 ml (t2), the heart rate only was significantly higher than at t1; but the blood transfusing could not re-establish a normal haemodynamic state. Blood samples were obtained to measure pH and total CO2 in a systemic artery, and the upper hepatic veins, vena cava and portal vein: the results suggested that the liver took part in the removal of acid metabolites.
The authors present a technique of VO2 and VCO2 measurements by a non invasive method in mechanically ventilated patients. Inspirated and expirated gas are sampled respectively in the inspiratory limb of the patient's breathing circuit and in a mixing chamber. Gas samples are analysed by mass spectrometry in the laboratory. Expiratory flow rate is determined by the ventilator flowmeter. To evaluate this procedure the authors have studied the stability of the inspirated and expirated gas samples and the reproductibility of measurements. In a patient with respiratory and haemodynamic stable status this method measures VO2 within 8,2% and VCO2 within 7%.
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Precise information was obtained by a computerized analysis of the treatment, prognosis and clinical outcome of 108 representative cases selected from a series of 160 patients with Horton's disease (HD) diagnosed between 1970 and 1981. At the end of the study, 18 patients had died (16,6 p. 100), the commonest cause of death being a cerebrovascular accident. Death occurred during the first two years of the illness in half these cases. Despite these early complications of the disease, from a statistical point of view, the patients did not die of HD or the complications of its treatment. The 5 years survival rate 80,1 p. 100 (actuarial analysis). Most deaths were from natural causes; an intercurrent disease was often implicated; the lower probability of survival for men (69,9 p. cent at 5 years, compared to 85,4 p. cent for women) is compatible with the lower life expectancy which is well established. The roles of intercurrent disease and sex were statistically significant. On the other hand, there was no difference in the probability of 5 year survival when the different presenting of the disease, the terrain (HLA-DR4) and choice of corticosteroid therapy were compared. The initial dose of prednisone or prednisolone should exceed 0,5 mg/kg/day, if relapse is to be avoided. No additional benefits were observed with doses in excess of 1 mg/kg/day except in cases with complications from the onset (ocular, coronary insufficiency, stenosis of the main large arteries, without being able to prejudge their mechanism).(ABSTRACT TRUNCATED AT 250 WORDS)
Sixty patients, for whom a diagnosis of giant cell arteritis (GCA) was clinically suspected, underwent Doppler study as a method of guiding temporal artery biopsy. In group A (23 patients with normal Doppler results), only one had a positive histological lesion. In group B (14 patients with discrete Doppler abnormalities), none had inflammatory lesions. Twelve of the 23 patients in group C (stenosis or thrombosis) had a biopsy result corresponding to GCA. Forty-three percent of the patients in group C had degenerative arterial lesions leading to a decrease in blood flow. There is a small probability, according to this preliminary study, of diagnosing GCA by artery biopsy even when findings from the ultrasonic examination are normal or only slightly irregular. However, a negative Doppler result should in no case exclude a biopsy if the clinical picture is suggestive.
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