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I Jouannic

Publications and source records attributed to I Jouannic.

6 recordsLinked to original sources
PubMed1997

Effects of epinephrine on right ventricular function in patients with severe septic shock and right ventricular failure: a preliminary descriptive study.

OBJECTIVE: To recognize patients with unresponsive septic shock and right ventricular (RV) failure and to evaluate the effects of epinephrine on RV performance in these patients. DESIGN: Prospective descriptive study. SETTING: Medical intensive care unit. SUBJECTS: 14 consecutive patients in septic shock unresponsive to fluid loading, dopamine, and dobutamine. INTERVENTIONS: Evaluation of RV function by thermodilution with a pulmonary artery catheter equipped with a rapid-response thermistor. Measurements were obtained before and during epinephrine infusion to achieve a systolic arterial pressure > or = 90 mmHg or a mean arterial pressure (MAP) > or = 70 mmHg. RESULTS: At the time of inclusion in the study the hemodynamic pattern in the 14 patients was as follows: (MAP) 58 +/- 14 mmHg, systemic vascular resistance (SVR) 1046 +/- 437 dyne.s.cm-5.m-2, pulmonary artery occlusion pressure (PAOP) 14 +/- 4 mmHg, mean pulmonary artery pressure (MPAP) 24 +/- 4 mmHg, right arterial pressure (RAP) 11 +/- 4 mmHg, cardiac index (CI) 4 +/- 1.7 l/min per m2. During epinephrine infusion, MAP, CI and stroke volume index (SVI) were increased (27%, p < 0.01; 20%, p < 0.01; 15%, p < 0.05, respectively). There was no change in PAOP, SVR or heart rate. Seven patients (group A) had marked RV failure defined by both RV dilation [RV end-diastolic volume index (RVEDVI) > 92 ml/m2] and low RV ejection factor (RVEF) (< 52%) and 7 did not (group B). Group A had a lower baseline RVEF than group B (24 +/- 7 vs 45 +/- 9%, p < 0.05), a higher RVEDVI (134 +/- 28 vs 79 +/- 17 ml/ m2, p < 0.01), and a higher RVES (systolic) VI (103 +/- 30 vs 43 +/- 11 ml/ m2, p < 0.01). The other hemodynamics, especially RAP and RV stroke work index (RVSWI) were no different in the two groups and did not predict RV dysfunction. In group A, epinephrine infusion improved RVEF (25%, p < 0.05) by a reduction in RVESVI (-8%, p < 0.05) without any change in RVEDVI or in RAP, in spite of a rise in MPAP (11%, p < 0.05). A rise in RVSWI (76%, p < 0.05), SVI (23%, p < 0.05), and CI (24%, p < 0.05) was also achieved. An upward vertical shift of the Frank-Starling relationship RVSWI/ RVEDVI and an upward shift to the left of the pressure volume relationship pulmonary artery peak pressure/RVESVI was observed only in the group with RV failure following treatment with epinephrine. In group B (without RV failure), RV parameters were not modified by epinephrine. CONCLUSION: In patients with severe septic shock, RV dysfunction was identified by the use of an RVEF pulmonary artery catheter and was improved by epinephrine by means of an improvement in RV contractility.

Adult↗
PubMed1996

Exogenous lipoid pneumonia complicated by Mycobacterium fortuitum and Aspergillus fumigatus infections.

We report the case of a nonimmunocompromised female patient, who developed exogenous lipoid pneumonia with Mycobacterium fortuitum infection at diagnosis, later followed by Aspergillus fumigatus infection. The association of exogenous lipoid pneumonia with atypical mycobacterial infection is uncommon but well-recognized, but, to our knowledge, association with A. fumigatus infection has not previously been reported.

Aspergillosis↗
PubMed1995

[Cardiac tuberculoma; value of echocardiography and therapeutic management apropos of a case].

The authors report the case of a patient with a large mass in the right ventricle which was a tuberculoma without pulmonary disease. The severity of the right ventricular obstruction required surgical intervention with quadri-antitubercular therapy. Myocardial tuberculomas are very rare and usually reported as post-mortem findings. Only four cases resulting in cure have been previously reported. Current means of investigation such as echocardiography and endomyocardial biopsy allow rapid diagnosis of these tumours and should lead to better medical management with possible surgical intervention and a higher therapeutic success rate.

Adult↗
PubMed1995

[Extrapulmonary mycobacterial infection with multiple cold abscesses].

We report one case of extrapulmonary mycobacterial infection, in the absence of HIV infection, singular by a clinical presentation simulating a tumor, associating a bulky intrahepatic mass, an abscess of the psoas, multiple intracerebral lesions, and an obstructive intracardiac mass of the right ventricle, which required a surgical resection. We comment the type of the mycobacterium involved and the hepatic and cardiac localisations, since macronodular hepatic abscesses are rare, and cardiac abcesses, exceptional.

Adult↗
PubMedDate not supplied

A microcomputer teaching and decision-support system for emergency medicine: use of hypermedia and artificial intelligence in combination.

Hospital emergency units are submitted to a continuous intensive and polyvalent practice of medicine. In addition to the few experienced physicians, the medical staff is often made up of young and unskilled students and residents. The ability to reach at any time a wide and flexible knowledge is of the utmost importance to improve the quality of care given to patients and to perfect bedside teaching. The purpose of this work was to present a computerized system, a kind of shell, using, in combination, artificial intelligence and hypertext/hypermedia tools. A modular architecture is presented integrating two entities: an illustrated encyclopedic hypertext network and several expert modules based on production rules concerning well-limited fields of medicine (basic clinical problem-solving, metabolic and acid-base disorders). An interface using the World Wide Web (WWW) will soon be proposed.

Artificial Intelligence↗