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Biomedical subjects

J L Lambert

Publications and source records attributed to J L Lambert.

At least 19 recordsLinked to original sources
PubMed2006

A protocol of trauma care in the emergency service including MDCT imaging.

Trauma is the principal cause of young peo ple's death. Care should be appropriate to the severity of the injuries and involves a multidisciplinary team around the clock. In this article, we examine a protocol of care based on ATLS (Advanced Trauma Life Support) recom mendations, including advances in imaging technology, which have greatly increased quality care in our institu tion. The protocol is based on patient stability and on injury mechanisms. The challenge is to avoid wasting time in the definitive treatment of lesions. Multi-detector computed tomogra phy (MDCT) has brought complete and rapid imaging in stable traumas but it shouldn't delay immediate surgical operations. When patients are unstable despite reanima tion, three important x-rays are taken right on the stretch er (pelvis, neck, and chest) before going into surgery. The head of the trauma team makes a decision on the pertinence of such procedure.

Clinical Protocols↗
PubMed2005

Dynamical and cellular electrophysiological mechanisms of ECG changes during ischaemia.

The interpretation of normal and pathological electrocardiographic (ECG) patterns in terms of the underlying cellular and tissue electrophysiology is rudimentary, as the existing theories rely on geometrical aspects. We relate effects of sub-endocardial ischaemia on the ST-segment depression in ECG to patterns of transmural action potential propagation in a one-dimensional virtual ventricular wall. Our computational study exposes two electrophysiological mechanisms of ST depression: dynamic-predominantly positive spatial gradients in the membrane potential during abnormal repolarization of the wall, produced by action potential duration changes in the ischaemic region; and static-a negative spatial gradient of the resting membrane potential between the normal and ischaemic regions. Hyperkalaemia is the major contributor to both these mechanisms at the cellular level. These results complement simulations of the effects of cardiac geometry on the ECG, and dissect spatio-temporal and cellular electrophysiological mechanisms of ST depression seen in sub-endocardial ischaemia.

Action Potentials↗
PubMed2001

[Emergency medicine: general principles governing the hospital management of victims of multiple trauma].

The management of the trauma victim admitted to the emergency department must be rapid and efficient. Within the first hour, vital functions must be stabilised while a systematic survey of all injuries is carried out. This survey must be as complete as possible, and depends on the patient's status and response to initial resuscitative measures. The need for urgent surgical intervention, therapeutic radiology, or other treatment modalities must be quickly established. This systematic approach, which follows a seven step sequence, can only be carried out by a well-trained team. Because at this time emergency and SMUR are often staffed with general practitioners, and because the trauma centers do not yet exist in Belgium, the application of the treatment protocol presented in this paper is a pre-requisite to quality of care for these patients. It is the only means to end, once and for all, the improvised or intuitive, and often erroneous, approach to these patients.

Emergency Medicine↗
PubMed2001

[Emergency practice: specifics in the management of complex multiple trauma].

Almost twenty years ago, Trunkey showed that deaths due to trauma followed a trimodal distribution over time. Half of these deaths were delayed by at least one to two hours after the initiating insult. This interval (the "golden hour") can be exploited, especially in specialized trauma centers (where the most severely injured patients are cared for), to aggressively treat these patients, thereby reducing morbidity and mortality. In Belgium, this hierarchy of trauma care centers is non-existent; patients are distributed within the healthcare system randomly, depending on the localisation of the accident and the directives of the unified "100" call centre. Because this limits the number of cases any one centre treats, this type of arrangement acts to inhibit the acquisition of competency in the handling of these complex patients. The relative lack of experience of individual emergency departments leads to difficulties in establishing diagnostic and treatment priorities for the most severely injured trauma victims. The approach to these patients must follow very precise guidelines, established scientifically in order to minimize the impact of the injury on life and maximize chances of satisfactory functional recovery. In this paper, we describe the general principles of the initial approach to victims of complex multiple trauma.

Belgium↗
PubMed1999

A noninvasive glucose monitor: preliminary results in rabbits.

BACKGROUND: Glucose in the aqueous humor appears to correlate with plasma glucose in humans. It is therefore a potential substrate for noninvasive optical glucose monitoring techniques. We wished to determine the potential for using rabbit aqueous humor as a model to develop a noninvasive method of measuring glucose with Raman spectroscopy. METHODS: Aqueous humor from 32 rabbit eyes was removed immediately after sacrifice by rapid exsanguination under anesthesia. Raman spectroscopy was performed on the aqueous humor using near infrared (NIR) excitation wavelengths. The Raman spectra from 785 nm and 787.2 nm were subtracted one from the other to eliminate broadband fluorescence. The spectra were then analyzed with linear and nonlinear multivariate analysis and assessed for ability to predict actual aqueous humor glucose concentration. Nine other rabbits were anesthetized with xylazine in order to cause elevation of blood glucose by blocking release of insulin. Blood and aqueous humor glucose were measured at various times after injection of xylazine. Correlation of aqueous humor glucose with simultaneous plasma glucose was assessed. RESULTS: Partial least squares analysis of raw Raman spectra of aqueous humor showed fair correlation with actual glucose concentration (r2 = 0.76). When the fluorescence spectrum was subtracted prior to linear multivariate analysis correlation was good (r2 = 0.90). When back-propagation with an artificial neural network was added to the analysis, correlation was further improved (r2 = 0.98). Aqueous humor glucose concentration exceeded blood glucose concentration at normoglycemic levels. When blood glucose rose above 200 mg/dL, aqueous humor glucose correlated linearly with plasma glucose. CONCLUSIONS: Raman spectroscopy can accurately predict glucose concentration in rabbit aqueous humor in vitro. Although rabbit aqueous humor is probably not a good model of human aqueous humor glucose physiology, its reliable correlation with plasma glucose makes it a good model on which to test noninvasive optical sensing techniques.

Animals↗
PubMed1998

[Coronary spasm and heart arrest caused by ventricular fibrillation].

We report the cases of three young men, heavy smokers, without previous heart disease and who were resuscitated after cardiac arrest due to ventricular fibrillation attributed to coronary spasm. All of them complained of atypical chest pain and the exercise testing, echocardiogram and coronary angiography were normal. The first case was diagnosed by Holter monitoring and by provocative testing with intracoronary ergonovine; the second by provocative testing with intracoronary acetylcholine and the third by Holter monitoring. The patients were treated with a calcium antagonist and/or nitrates and in the follow up they remained asymptomatic.

Adult↗
PubMed1993

Didanosine (ddI) and zidovudine (ZDV) susceptibilities of human immunodeficiency virus (HIV) isolates from long-term recipients of ddI.

Thirty HIV isolates, obtained from 15 patients before and after receiving single drug therapy with didanosine (ddI), were examined for sensitivity to ddI and zidovudine (ZDV) using a peripheral blood mononuclear leukocyte (PBML)-based assay. Fourteen of the patients had ARC, one had AIDS and 12 had received previous therapy with ZDV. After a median of 1 year of ddI therapy, isolates were significantly less sensitive to ddI than were isolates obtained prior to therapy (P = 0.03). A decrease in ddI sensitivity was observed in ten of the 15 isolate pairs. In contrast to ddI susceptibilities, sensitivity to ZDV increased over the same period of time (P = 0.03). Additional isolates were obtained from four patients who received ddI monotherapy for 2 years. Three of these isolates demonstrated no change in ddI sensitivity compared to baseline. No correlation could be made in this study between development of decreased ddI sensitivity and serum p24 levels, CD4 counts, or clinical outcome. Decreased ddI sensitivity occurs frequently among HIV isolates obtained from long-term recipients of ddI. This decreased sensitivity is modest in degree and is of unknown clinical significance.

AIDS-Related Complex↗
PubMed1992

[Spontaneous calcific embolization in calcified aortic valve stenosis. A case report].

Calcific embolism from an aortic stenosis is an uncommon event that can be seen after cardiac surgery or left heart catheterization but extremely rare in a spontaneous way. We report a case of a patient with calcified aortic stenosis presenting a spontaneous calcareous embolism in the retinal artery. We review the literature about this problem as well.

Adult↗
PubMed1989

An assessment of health care supervisory training needs.

Managerial and supervisory skills are seldom included as part of health care workers' education. This article explores activities performed by supervisors and managers, past training, perceived needs for additional training, and factors influencing attendance at training programs.

Adult↗
PubMed1983

Effect of resin disinfectants-I3 and -I5 on Giardia muris and Giardia lamblia.

The resin-I5 column developed in our laboratories rendered aqueous suspensions containing up to 5 X 10(4) cysts of Giardia muris or Giardia lamblia per ml incapable of excystation. The inhibition of excystation was effective at both 4 and 25 degrees C. The addition of Na2S2O3 to column eluates containing cysts appeared to partially reverse the disinfectant action, and the reversal was more pronounced at 4 degrees C than at 25 degrees C. In contrast, the rapid removal of cysts from the column eluates by centrifugation and filtration or the use of other reductants, notably cysteine and glutathione, did not similarly reverse the disinfectant properties of the column. Based on these data, we suggest that the disinfecting agent is acquired by the cyst in its passage through the resin column and that either the disinfecting agent or its reaction can be partially and specifically neutralized by Na2S2O3. We hypothesize that the time between disinfectant acquisition and activity is a function of the thickness of the Giardia cyst wall and consequently takes longer at the lower temperature. Nevertheless, resin-I5 appears to inactivate a larger number of cysts in a shorter period of time with lower residual halogen levels than do agents of other published methods.

Animals↗
PubMed1982

Viricidal capability of resin-triiodide demand-type disinfectant.

Polyoma, Newcastle disease virus, and adenovirus, as well as two coliphages, lambda and T4, were inactivated by strong base quaternary ammonium anion-exchange resin-triiodide. Organic matter interfered with viral inactivation capability of the resin-triiodide. The viruses, as they were being inactivated by the resin disinfectant beads, were not retained or filtered by the beads.

Adenoviruses, Human↗