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Biomedical subjects

J Kienlen

Publications and source records attributed to J Kienlen.

At least 37 records · Page 2Linked to original sources
PubMed1980

[Improvement in nitrogen sparing by branched amino acids during parenteral nutrition].

Two groups of ten patients each, staying in a Intensive Care Unit, received exclusive parenteral alimentation with different concentrations of branched chain amino acids (BCAA). Group A received studied solution containing 12 g N (852 mmol) with 41,1 p. 100 BCAA. Group B received control solution containing 18 g N (1278 mmol) with 21,1 p. 100 BCAA. Every patient received 60 nonprotein Kcal x kg-1 body weight/24 hr. The study was performed on five days. Measured parameters were: daily (D0 to D5) N balance, blood urea N and total protein and urinary alpha amine N, and after therapy (D6) amino acid levels. Results have shown no statistical significant difference between both groups. N balance became less negative during the therapy. Amino acid levels were in the normal range and alpha amine urinary elimination remained low in patients with parenteral nutrition. These results indicate that 12 g (852 mmol) N in BCAA rich solution are as efficient as 18 g (1278 mmol) N in standard solution, allowing a N sparing.

Amino Acids↗
PubMed1980

[Effects of almitrine on the pulmonary circulation].

Almitrine was injected intravenously at a dose of 1 mg.kg-1 over a period of sixty minutes in eight men aged from 49 to 69 years suffering from chronic bronchitis and obstructive airway disease, with signs of chronic cor pulmonale. During the study, patients on artificial respirator were in stable ventilation. Measurements gave the following results: arterial pO2 rose at all the times of study (P < 0.02). Arterial pCO2 decreased, the difference being significant 20 minutes after the end of the infusion. Q tended to increase accompanied by a slowing in heart rate, an increase in cardiac index and in systolic ejection work (P < 0.01 at T60). Pw increased (with P < 0.05 at the 20th minute) and subsequently varied in the same direction in parallel with pulmonary resistance. The authors concluded that almitrine, apart from its well known effects on ventilatory mechanics, results in blood gas changes with are not directly correlated with variations in VE by direct action on pulmonary vascular flow with any notable improvement in the upper zones of the lung.

Aged↗
PubMed1979

[Blood and urinary cyanide concentrations during long-term sodium nitroprusside perfusion].

Five deeply comatose neurological patients were administered a continuous perfusion of sodium nitroprusside (SNP) at the rate of 3 microgram.kg-1.min-1. The levels of blood cyanide (CN-) were measured two hours after the start, then every 12 hours during, and 12 and 24 hours after the end of perfusion. The urinary output of CN- was also studied. The results show that total blood CN- stabilized after 36 hours to a mean value of 0.11 mg/l. When perfusion was stopped, CN- blood levels dropped but did not reach pre-perfusion values at the 24th hour. Urinary excretion of CN- which reached a maximum value of 0.050 mg/24 h represents a negligible amount and does not explain the fall of blood CN- and the occurrence of a concentration plateau. The results showing lower values obtained on non-anesthetized patients during the first hours of perfusion compared to those of a previous study done under neuroleptanaesthesia are discussed. These results suggest that prolonged perfusions at SNP at the rate of 0.177 mg.kg-1.h-1 do not produce toxic blood level of CN-.

Adult↗
PubMed1979

[Nature and antibiotic resistance of bacteria encountered in an intensive care unit. Computerized study based on 422 antibiograms].

A computer analysis of 422 sheets of data from antibiograms performed on 146 patients in a resuscitation unit of multipurpose type, was performed. The study comprises the investigation of the nature of the isolated bacteria and the resistance of the organisms to antibiotics alone or in combinations. The results obtained show on the one hand, that there is a development over time of resistance to antibiotics and a change in the nature of the bacteria, and on the other, that a precise knowledge of the bacteriological data concerning a given department enables the intiation of treatment before having the antibiogram results with an increased chance of efficacy. The importance of such a study is controversial.

Anti-Bacterial Agents↗
PubMed1978

[Osmotic colloidal pressure: measurement and clinical importance].

Knowledge of osmotic pressure has long existed and its practical use in the treatment of patients under intensive care has been widely developed over the past few years following the introduction of simple electronic osmometers. It is related more to plasma albumin than to globulins. It varies in relation with a certain number of physiological factors and in different pathological circumstances. The value of OP and above all of the difference OP--PCP in the prevention, diagnosis, treatment and prognosis of pulmonary oedema has been clearly demonstrated in several recent studies. Its value in relation to total serum proteins is that it takes into account any possible dysproteinaemia and that it is directly expressed in units of pressure which makes possible the calculation of the OP--PCP difference which represents the difference between the only OP--PCP difference which represents the difference between the only two intravascular forces which participate in fluid exchanges at the level of the pulmonary capillary.

Age Factors↗
PubMed1978

[Plasma concentration of fentanyl during and after its administration at constant flow].

Using the technique of the radio-immunological estimation with fentanyl-H3, a study was made in sixteen adults anaesthetised by the administration at a constant rate of alfadione and fentanyl, of plasma concentrations of fentanyl during and after anaesthesia. Anaesthesia was induced by the administration of 4.2ml of alfadione and 0.084mg of fentanyl. The maintenance dose was 0.147 ml/kg/hour of alfadione and 2.95 microgram/hg/hour of fentanyl. Five minutes after induction, the concentration of fentanyl was 2.7 microgram/l. The level fell significantly to 2.56 microgram/l at the 45th minute. From this point onwards, it increased regularly up to the 120th minute, when it reached a level of 3.7 microgram/l. When the infusion was stopped, the level first decreased rapidly, the excretion curve then becoming flattened out. At the 120th minute, a level of 1 microgram/l persisted. This study indicates that the administration of fentanyl at a constant rate is not accompanied by a constant blood concentration up to the 120th minute, the point at which the study was terminated. The residual level found after administration and in the absence of any clinical effect implies the need for a reduction in dose at the time of any complementary administration of fentanyl during the postoperative period.

Adult↗
PubMed1977

[Atypical pulmonary embolism associated with inter-auricular communication].

A case of massive pulmonary embolism at a patient with undetected atrial defect is reported. The authors discuss the difficulties of establishing a proper diagnosis when the right heart pressure is not raised and when a large emboliser is well tolerated. Angiography confirmed the diagnosis and the patient was successfully treated with embolectomy followed by ligation of the inferior vena cava.

Heart Septal Defects, Atrial↗
PubMed1977

[Admission and treatment of 592 patients over 70 years in an intensive care unit].

Using an IBM 3741 computer, the authors analysed 592 case records of patients aged over 70 years, admitted to hospital on an intensive care unit, age appears to be an important factor in determining the prognosis of numerous diseases without, however, being a criteria for rejection of admission of these patients to an intensive care unit. The fragility of these patients leads one to consider the following parameters: 1--the degree of resuscitation is assessed by quantification of the therapeutic means. As for other patients, survival varies inversely in relation to the important of the therapeutic means, but in the case of the elderly patient, there is a definite difference in the correlation mortality-therapeutic index towards aggravation, so one may determine a ceiling above which survival is not possible; 2--duration of the intensive care is very important. In most cases, the decisive point is situated on the 3rd or 4th day of care, at which time the decision to continue or stop treatment may be considered in the light of the patient's progress.

Aged↗
PubMed1977

[Deficiencies in trace elements during parenteral alimentation].

During recent years, techniques of parenteral alimentation have seen the development of complications due to deficiencies in trace elements. The main deficiency states described involve iron, copper and zinc. In addition to these three trace elements, manganèse and cobalt are included in this study. The metabolism, physiological role, needs in parenteral alimentation and clinical and metabolic effects of possible deficiency are described for each of these elements.

Biological Transport↗
PubMed1977

[Routine comparison of trace element deficiencies during parenteral alimentation].

In 50 patients aged between 3 and 84 years treated in a multidisciplinary Intensive Care Unit and receiving parenteral alimentation, deficiency in certain trace elements or electrolytes (Cu++, Zn++, Mn++, Co++, PO-4, Mg++) was prevented or treated by the administration of a glucose solution (MB 147 G) enriched in trace elements. The aim of the present study was to demonstrate, on the basis of assay of serum levels of the trace elements involved, with the exception of Mn and Co, the effectiveness of treatment. Reference values were determined on the one hand in healthy individuals for normal figures and secondly on subjects included in the study, already on parenteral alimentation for several days, before treatment with MB 147 G, in order to demonstrate the existence of a deficiency (patient control values). In the case of PO--4, however, the patient control values concerned at one and the same time subjects in the study before treatment with MB 147 G and other patients receiving parenteral alimentation who were not part of the trial. MB 147 G solution was presented in units of 500 ml associated with glucose of varying concentrations (15 p. 100, 30 p. 100, 50 p. 100). The average daily amount administered, over a period of 236 days, was 3 unites per 24 hours, corresponding to an intake of copper of 3.78 mg, 3.90 mg of zinc, 0.20 mg of manganese, 0.24 mg of cobalt, 363 mg of magnesium, 240 mg of calcium and 15 mEz of phosphates. The results show that levels of copper, zinc, magnesium and phosphates were low during parenteral alimentation. The administration of MB 147 G resulted in a significant increase in these values, without there being any evidence of accumulation.

Adolescent↗
PubMed1977

[Functional sequelae of Mendelson's syndrome. Myth or reality?].

Twenty patients having previously had a Mendelson's syndrome were subjected to a respiratory functional test. A syndrome of diffuse interstitial pulmonary fibrosis (DIPF) was found only in 3 cases examined shortly after the pneumopathy. In one of these cases, another examination done later showed signs of regressing fibrosis. The authors concluded that if a functional syndrome of DIPF occurred immediately after a Mendelson's pneumopathy, it eventually disappeared in the long term in most cases.

Adolescent↗
PubMed1976

[2 cases of anaphylactic-type reaction to alphadione (Alfatesine, Althesin, CT 13.41)].

Two cases of anaphylactic-type reaction to alfadione were referred to our Department for immuno-allergic enquiry. From the clinical standpoint, the pictures obtained were rather similar, dominated by dramatic collapse of abrupt onset associated with an erythemato-oedematous cervico-facial rash, however with a favourable course under respiratory and circulatory emergency resuscitation. The immunological enquiry carried out in both cases did not enable one to attribute the responsibility for the accident to alfadione or to cremophor EL nor to be able to put it down to a direct pharmacological histamine-liberation, or to a specific histamine-liberation due to an antigen-antibody reaction.

Adult↗
PubMed1976

[In tolerance reactions to Rheomacrodes. Apropos of 3 cases].

Three cases of reactions of intolerance to Rheomacrodex were observed during these last four years in our Department, and this led us to attempt to sum up their exact nature and in particular the possibility of an immuno-allergic orgin. From the clinical standpoint, the symptomatology is dominated by the combination of abrupt collapse associated with Quincke's edema in two cases, and with bronchospasm in the third. The course was rapidly favourable under respiratory and circulatory emergency resuscitation. The immuno-allergic enquiry carried out in one case, did not enable one to demonstrate the responsibility of an antigen-antibody reaction. Analysis of the different works appeared on this subject, in particular those of the Swedish school, of W. RICHTER et col., did not enable one to pick out with any certainty the responsibility of an antigen-antibody conflict in the genesis of these reactions.

Adult↗
PubMed1976

[Hemodynamic effects of Etomidate].

Hemodynamic variations due to Etomidate administration were studies in 10 patients submitted to artificial ventilation. Etomidate was given at a 0.37 mg/kg B.W. dosage. Cardiac rate, mean arterial B.P., C.V.P., mean arteial pulmonary pressure, mean pulmonary capillary pressure and cardiac output were investigated. From values found, systolic output, systemic vascular resistance, and pulmonary arteriolar resistance were calculated. Results show that Etomidate has little effect on hemodynamics. There is only a 5 p. 100 increase in cardiac rate, a 16p. 100 decrease in cardiac output, 1 18 p. 100 decrease in systolic output and a 12p. 100 decrease in mean arterial B.P. Variations of mean capillary pressure, of systemic vascular resistance and of pulmonary arteriolar resistance are not significant.

Adult↗
PubMed1976

[Hemodynamic effects of high-dosage corticoids. Their justification in the treatment of shock].

In 61 patients in whom high doses of corticoids had been administered owing to various indications, the hemodynamic modifications caused by this injection were studied. The corticoids administered were : hydrocortisone hemisucccinate (150 mg/kg), methyl prednisolone sulfate (30 mg/kg), prednisone sodium m sulfobenzoate (50 mg/kg), prednisolone sodium m sulfobenzoate (35 mg/kg) and dexamethasone phosphate (2 mg and 6 mg/kg). The results study the modifications caused by each drug on heart rate, arterial blood pressure, cardiac output, systolic stroke volume and peripheral vascular resistance. The expression of the results is given as a percentage of the variation with statistical study. Methyl-prednisolone sulfobenzoate only leads to slightly marked hemodynamic effects : the four other compounds studied have definite hemodynamic effects, of variable intensity and duration. The most important variations are noted with dexametasone phosphate. From these results, the indications and results of the use of corticoids in states of shock are discussed.

Adrenal Cortex Hormones↗
PubMed1975

[Anesthesia in reoperations in abdominal surgery].

Fifty one patients from different surgical units, hence anesthetized by different anaesthesists, underwent reinterventions in abdominal surgery. The indications for the first intervention essentially involved the supra-mesocolic region of the abdomen (62 out of 100 cases). The operative risk during the first intervention was on the average 18 pour cent. The protocol of the first anaesthesia which was known in 42 cases, was of the narco-ataralgestic type. The date of the return to the operation table varied from 1 to 60 days. The state of the patients was in general catastrophic (organic renal failure, acute respiratory failure). Here again the anaesthesia was of the narco-ataralgesic type but the choice of drugs varied depending on the patients' state. However non significant difference was noted in the average hourly drug consumption between the two interventions. Apart from one circulatory arrest during induction, in one patient with hemorrhagic shock, no death was attributable to the anesthetic technique. The authors, using these findings, attempt to pick out a practical line of behaviour.

Abdomen↗