[Balint Prize 1998: Growing together. Sarah's story].
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Biomedical subjects
Publications and source records attributed to J Husson.
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Postoperative sore throat occurs in up to 90% of intubated patients and is the most common complaint of patients after endotracheal intubation. A recent study suggested that the use of lidocaine to inflate the endotracheal tube cuff would decrease the incidence of postoperative sore throat. The purpose of this prospective randomized study was to compare the incidence and severity of sore throat after using lidocaine, saline, or air to inflate the endotracheal tube cuff. Variables typically associated with postoperative sore throat, including endotracheal cuff design, endotracheal tube size, intubation technique, laryngoscopy blade, airway placement, suctioning technique, and anesthetic technique, were controlled. The participants were all ASA physical status I, II, or III, female, adult patients undergoing general endotracheal anesthesia for gynecological procedures. The researcher administered the verbal analogue scale, Melzack's Present Pain Intensity Scale of the McGill Pain Questionnaire, to the 75 participants at two intervals, 1 to 3 hours postoperatively and 22 to 25 hours postoperatively, to assess postoperative sore throat. Analysis using the Kruskal-Wallis test suggested that there was no statistical difference in postoperative sore throat among the 3 groups. Lidocaine, saline, and air had similar effects on postoperative sore throat.
The recent withdrawal of the HP41C* calculator from the market necessitated a translation of the HP41C* 'MLE2' program published earlier (Roussel and Husson, 1991) into a version for its successor, the HP48SX. The existence of the HP41CV emulator module for the HP48SX offers no solution for continued support of the 'MLE2' program, because it does not accept synthetic HP41C instructions (cf. 'Warning' paragraph in (Roussel and Husson, 1991)). Moreover, the built-in HP48SX upper-tail probability functions (UTPC UTPF UTPN) are more accurate than the corresponding HP41C subprograms. The easy interfacing capabilities of the HP48SX with PC or Macintosh make transfer of the program itself, and its output (e.g. for reporting) straight-forward. This calls for a specific HP48SX implementation with ASCII text output of the algorithm presented by Roberts and Coote (1965), and extended by Roussel and Husson (1991). Finally, the probability distribution of the particle concentration lambda as a function of a given set of counts is shown to be chi 2, so that exact confidence bounds for lambda can be computed using the HP48SX UTPC and ROOT commands.
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An observation of an inter-auricular conduction disorder is reported. This disorder concerned the median part of the left atrium as shown by evidence provided by stepped oesophageal recordings, which suggest an auricular depolarisation normally descending in the upper part of the left atrium but abnormally retrograded into the lower part. This suggests that interauricular conduction is blocked at the median inter-auricular passage but that it occurs by the tract of Bachmann at the upper part of the left atrium and by retrograde passage to the lower part. On the surface electrocardiogram, the wave P is diphasic + - in D2, D3 and aVF, of normal duration with a normal PR space.
The authors report the case of partial interatrial block arising in the mid zone of the left atrium as demonstrated by oesophageal recordings. These showed that atrial depolarisation descending normally in the superior part of the left atrium was abnormally retrograde in the inferior part; this suggests a block of the mid-interatrial pathway and conduction via Bachmann's pathway in the upper part of the left atrium and via a retrograde pathway in the inferior region. The surface ECG showed a P wave of normal duration which was diphasic in Leads III and aVF with a normal PR interval. In addition, endocavitary recordings in the inferior part of the right atrium showed the presence of preatrial potentials potentials during three ectopic complexes, the significance of which is uncertain.
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A case of interatrial block is reported, involving the upper part of left atrium, demonstrated by oesophageal recordings at different levels. Abnormally retrograde atrial depolarisation in the upper part of the left atrium was observed, but normal descending depolarisation in the lower part of the left atrium suggested that interatrial conduction was blocked on the Bachmann bundle but was normal on the middle interatrial pathway. The surface ECG showed a P wave of normal duration; it was inverted in Lead III and a VF, and flat in Lead II with a normal PR interval. The author suggests a method of classification of interatrial block into three types.
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The authors report the clinical, biochemical, histological and etiologic characteristics of 24 patients with the syndrome of benign intra-hepatic post-operative cholestasis. Jaundice appeared early in the post-operative period, from the first to the 12th post-operative day. All patients had received blood transfusions. In 23 patients, the post-operative course was complicated, chiefly by local infection or septicemia. Hyperbilirubinemia ranged from 2 to 28 mg per 100 ml and was mainly conjugated; serum alkaline phosphatase activity was normal or moderately elevated; in 3 patients, it was markedly elevated; serum glutamic-pyruvic transaminase activity was normal on 7 patients, moderatly increased in 15, and markedly increased in one. Liver histology was normal in 6 patients, and showed minimal lesions (cholestasis and slight portal inflammatory changes) in 3. Jaundice did not appear to modify the final outcome. It appears to be due both to increased production of bilirubin (as a result of blood transfusions) and to decreased excretion of bilirubin by the liver (as a result of the surgical operation and of infection).
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A program for a Hewlett-Packard 41C calculator is described, applying the maximum likelihood method for the estimation of the density of a suspension of infective particles when counts are available for a number of independent dilutions of the original suspension. An unbiased estimate for the variance of the density, a suitable confidence interval and its corresponding confidence level are also given by the program. Moreover, after testing for the presence of overcrowding and/or clumping, the selection of suitable dilutions is fully automated so as to avoid recourse to statistical tables.
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The authors report a case with typical bepridil-induced electrocardiographic changes. Although the serum potassium was normal, an infusion of potassium chloride caused the electrical abnormalities induced by bepridil to disappear.
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