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Biomedical subjects

J Conard

Publications and source records attributed to J Conard.

At least 19 recordsLinked to original sources
PubMed1979

[Haemorrhagic complications using streptokinase during 98 treatments. Place of the biological surveillance (author's transl)].

Streptokinase was administered to 98 patients, 75 of them with arterial occlusion of the limbs, in accordance with the classical protocol of high and continuous doses (150,000 international units per hour for 48 to 78 hours after an initial standard dose of 500,000 units). There were a total of 15 haemorrhagic complications: --related to a non-respected contraindication (1 case) --traumatic (4 cases) --spontaneous (10 cases), responsible for or contributing to a fatal outcome in 4 instances. In addition, there were 13 spontaneous or provoked haemorrhagic side effects. Retrospective analysis of laboratory results shows that it is difficult to predict haemorrhage: the degree of fibrinopaenia and fibrin breackdown product levels are not closely related to the onset of bleeding. Nevertheless, the combination of a residual fibrin level of less than 1.50 g/l approximately with an amount of fibrinogen broken down (difference between fibrinogen levels before treatment and during treatment) of more than 3 grams was present in the great majority of patients in whom complications developed. The absence of bleeding seen when plasma thrombolytic activity, assessed by the Blix test, is inadequate, suggests the existence of a relationship between biological effectiveness and the risk of haemorrhage. In practice, apart from strict observation of contraindications, the risk of haemorrhage must be born in mind when the therapeutic decision is made. Careful clinical surveillance is today more important than laboratory studies in the prevention of haemorrhagic complications, the price which must be paid for the thrombolytic activity of streptokinase. The latter is capable of acting not only upon the vascular obstruction but also upon haemostatic clots.

Adolescent↗
PubMed1978

[Congenital dysfibrinogenaemia. Two new cases (author's transl)].

Congenital dysfibrinogenaemia is a rare disorder related to an abnormality in the behaviour of the fibrinogen molecule. The diagnosis may be made with the aid of simple tests, including prothrombin'time, even though this examination may be normal in a small number of cases. Two new cases are reported here. Neither of the two women involved had a past history of severe haemorrhage, the diagnosis being made at the time of routine coagulation studies. According to the international nomenclature, we suggest the names fibrinogen Paris IV and fibrinogen Buenos-Aires II. In order to avoid missing the diagnosis, fibrinogen should be estimated by different methods in the presence of hypofibrinaemia. There is disagreement between fibrinogen levels estimated by the thrombin chronometric method, in general low, and levels obtained by gravimetric and immunological methods, usually normal.

Adolescent↗
PubMed1978

[Trial of an automatic apparatus for coagulation : Auto-Fi Dade (author's transl)].

Auto-Fi Dade has been used for thromboplastin time, activated partial thromboplastin time, fibrinogen determination and a few determinations of factors V, VII + X, II and VIII. The results of the thromboplastin time, using Dade Tromboplastin or thromboplastins from two other commerical firms, show a coefficient of variation (CV) ranging from 1.11 to 3.43% for short times and 1.97 to 2.64% for longer times.

Afibrinogenemia↗
PubMed1978

Tolerance of the human liver to prolonged normothermic ischemia. A biological study of 20 patients submitted to extensive hepatectomy.

To evaluate the biological tolerance of the human liver to prolonged warm ischemia, two groups of extensive hepatic resection for tumor were compared. Group 1 (11 patients) performed with short hepatic inflow occlusion (7 [mean] +/- 2 [SEM] minutes), and group 2 (nine patients) operated with use of complete hepatic vascular exclusion and prolonged warm liver ischemia (38 [mean] +/- 5 [SEM] minutes). Comparison of biological values, such as transaminase, bilirubin, total protein, albumin, and fibrinogen levels, the platelet count, prothrombin complex, and proaccelerin level, did not show statistically significant differences between the two groups. Therefore, the hepatic warm ischemia period may be, if needed, safely extended beyond the classical 15 minutes. It lasted 65 minutes in one case without adverse effect. These clinical observations parallel recent experimental work and should destroy the myth of the high sensitivity of the liver to warm ischemia.

Adolescent↗
PubMed1978

[Thrombolytic treatment (theoretical basis, therapeutic protocols, monitoring)].

Thrombolytic therapy is aimed at dissolving thrombi. Streptokinase (SK) and urokinase (UK) are currently used in France but their mode of action has not been completely elucidated, which renders the establishment of therapeutic protocols and the choice of doses difficult. This treatment has a certain number of contraindications which must be strictly respected. The effectiveness of SK and UK in high doses has been demonstrated, in particular in pulmonary embolism and acute arterial obstruction of the limbs, but there is a risk of haemorrhage, whilst UK in moderate doses is usually well tolerated but has yet to prove its effectiveness in randomised double blind trials. Laboratory control has been simplified but it is essential not to forget the importance of clinical monytoring. Finally, drugs have recently been used in association with thrombolytics and more particularly the administration of plasminogen or defibrinating agents before or after thrombolytics.

Arterial Occlusive Diseases↗
PubMed1976

[Disorders of hemostasis during partial hepatectomies. Study of 20 cases].

Changes in blood coagulation have been studied during and after 20 elective hepatic lobectomies, most of them for tumors necessitating extensive resection (17 right lobectomies, 10 of which were extended to the medial segment of the left lobe). In addition, 9 unresectable tumors, as proved by exploratory laparotomy, were taken for controls. Before operation, hemostasis in essentially normal except a hyperfibrinogenemia and a slight increase of fibrinogen split products in half the cases. Factor VIII antigen levels are consistently increased. During mobilization of the liver an increased fibrinolytic activity and soluble complexes are frequently observed. Fibrinolysic activity spontaneously returns to normal at the end of the operation, except in cirrhotic patients. No bleeding disthesis is observed and haemorrhage appears to be related to technical problems. On the other hand, there is no clinical evidence of thromboembolism after operation. Therefore any specific therapy either pro or anti-coagulant, appears unjustified, apart from the eventual and transient administration of antifibrinolytic drugs in cirrhotic patients. In the post operative period, blood clotting factors synthetized by the liver (prothrombin complex and antithrombin III) slowly return to normal. Rapid correction of hypo-accelerinaemia reflects the onset of liver regeneration. A simplified method for surveying hemostasis during and after liver resection is proposed.

Adolescent↗
PubMed1975

Increased sensitivity of platelets to adrenaline in human myotonic dystrophy.

Platelets from patients with myotonic dystrophy showed a normal pattern of aggregation in response to adenosine diphosphate (A.D.P.) and collagen but were unusually sensitive to adrenaline, aggregation being detectable with adrenaline concentrations as low as 0.041 mumol per litre. In other diseases in which such sensitivity has been reported this has been accompanied by a similarly altered response to A.D.P. The increased platelet aggregation could be due to increased uptake of Ca++ by platelets or to a decrease in phosphorylation of the platelet membrane.

Adenosine Diphosphate↗