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J L Sebbah

Publications and source records attributed to J L Sebbah.

11 recordsLinked to original sources
PubMed1999

[Pre-hospitalization treatment with Abciximab in the preparation of patients for primary angioplasty in the acute phase of myocardial infarct. Immediate and long-term (one month) results].

Percutaneous transluminal coronary angioplasty (PTCA) is an alternative to fibrinolysis in the treatment of acute myocardial infarction (AMI). However, after balloon PTCA, the rate of early re-occlusion, of re-infarctus and of restenosis remains high. Stent implantation with antiplatelet drug regimen (aspirin, ticlid) limits these risks. Abciximab (new GPIIb/IIIa receptors inhibitor) reduces PTCA complications rate in the acute coronary syndromes. Intravenous administration of abciximab can restore a normal flow in the infarcted related coronary artery (IRA) after few minutes. A monocentric, non randomized, prospective pilot study was iniated to assess the feasibility of pre-hospital treatment with abciximab in preparation to primary PTCA stenting in AMI (primary endpoint) and to appreciate potential benefits in initial IRA patency as well as prevention of PTCA thrombotic complications (secondary endpoint). Between April 1997 and January 1998, 38 AMI were treated with abciximab in pre-hospital phase (group A). Mobil Intensive Care Unit (MICU) team implemented the treatment and guaranteed immediate transport to the cathlab (abciximab bolus-coronary angiography time = 37 +/- 17 min). Immediate results were compared to those of 198 paired patients who were treated for AMI during the same period (Group T). Initial IRA flow TIMI grade 3 was significantly higher in group A, 24%, than in group T, 9% (p < 0.017). The rates of per-procedural complications (no flow, distal embolism), of local complications, of transfusions were not significantly different. During 1 month follow-up, there was no significant difference between group A and group T concerning death, re-MI, stent thrombosis and new revascularization. To conclude, the pre-hospital treatment with abciximab in AMI is feasible by MICU medical team without any delay of the cathlab admission. It is associated with no increased hemorrhagic complications rate. The abciximab pre-hospital treatment improves the initial IRA patency. These encouraging preliminary results expect to be confirmed by larger, multicentric, randomized and prospective studies.

Abciximab↗
PubMed1985

[Torsades de pointes and hypomagnesemia].

The authors report a case of "Torsades de pointe" occurring in a patient subjected to intensive surgical care and presenting several causes of magnesium loss: mutilating abdominal surgery, exteriorized gastric fistula, administration of Henle's loop diuretics, electrolytic disorders and exclusive parenteral nutrition without any magnesium Mg supplement. The arrhythmia appeared in the third week and the usual treatment was ineffective. The level of plasma magnesium was below the measurable values on three separate occasions. The administration of magnesium sulphate corrected the dysrhythmia which did not recur. Experimental and clinical data demonstrating the antiarrhythmic effect of magnesium are recalled. The electrophysiological explanation is based on the inhibition of potassium and calcium flow across the cell membrane; magnesium ion has a stabilizing membrane effect and an antagonistic effect on ectopic automaticity. They are particularly important on slowly depolarizing tissue (nodal cells) or partially depolarized cells (ischaemic or digitalis treated cardiac tissue). In intensive care, circumstances for magnesium depletion by digestive or renal losses and by lack of parenteral magnesium supplement are frequently combined. Systematic intravenous administration of magnesium is necessary when such conditions are found and whenever ventricular or auricular dysrhythmias occur.

Calcium↗
PubMed1984

[Postoperative pernicious malarial attack in a subject, a native of an endemic zone].

The case of an Angolan woman who underwent, in her country, an hysterectomy requiring the transfusion of two whole blood units is reported. In the immediate postoperative period, acute renal failure with anuria set in, justifying the patient's transfer to an intensive care unit in France. Upon admission, she had a thick blood film and serology work-up for Plasmodium falciparum, both of which were negative. On the 20th day, the patient presented a pernicious malarial crisis with a concurrent rise in IgG and IgM titres, indicating recent contamination. The mode of infection is discussed: contaminating anopheline bites associated with the interruption of chemoprophylaxis rigorously followed up till then; post transfusion malaria, almost unavoidable in an endemic country; accidental inoculation by Plasmodium falciparum of the dialysis equipment. Finally, the possibility of pernicious malaria aggravating the initial acute renal failure and hypocalcaemia is also discussed.

Acute Kidney Injury↗