Biomedical subjects
J Labrousse
Publications and source records attributed to J Labrousse.
[Changes in the electrocardiogram in status asthmaticus].
The aim of this study, based on the electrocardiographic analysis of 42 patients in status asthmaticus, is to define the basic criteria which may be used as a basis for electrocardiographic differential diagnosis. The following ECG changes were observed: the pulmonary "p" wave is common, sometimes with exaggerated amplitude in peripheral leads, however, in the precordial leads, the voltage of the "p" wave is reduced; most cases have a vertical heart with clockwise rotation and mild right axis deviation, S1 Q2 Q3 and the transitional zone displaced to the left. Ten cases also had a S1 S2 S3 appearance and three cases showed Q1 Q2 Q3, simulating myocardial infarction; there is poor progression of the R wave in the precordial leads and marked persistence of the S wave in the left precordial leads. In some cases, a QS complex dominates the right precordial leads. A variation in the amplitude of the QRS with the respiratory rhythm is often seen in V1 and V2; ventricular repolarization shows a lowered J point with an upward oblique ST segment in the peripheral leads. However, in the precordial leads, the repolarization is normal except for three cases which presented a frank hypokalaemia. The mechanism of these electrocardiographic changes appears to depend on the vertical position of the heart caused by over expansion of the lungs and pulmonary arterial hypertension. The elements of the electrocardiographic differential diagnosis with myocardial infarction and pulmonary embolism are discussed.
[Circulatory arrest: diagnosis and treatment].
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[Acute respiratory and circulatory failure. Prognostic value of plasma fibronectin levels].
Plasma fibronectin (FNp) concentrations were measured in 63 patients with acute respiratory failure and 28 patients with circulatory failure, using Laurell's electroimmunoassay method. Measurements were made in the acute phase and repeated in the course of the disease. The mean FNp concentration in 20 controls was 262 +/- 59 mg/l. FNp values were normal in the acute phase of chronic obstructive pulmonary disease and in cardiogenic pulmonary oedema. In contrast, they were significantly decreased in adult respiratory distress syndrome and in acute pneumonia, as well as in acute circulatory failure, notably from septic shock. FNp values were also considerably reduced in patients with severe disseminated intravascular coagulation syndrome. Clinical improvement was accompanied by a return to normal of FNp concentrations. The mortality rate was greater in patients with low FNp values than in those with normal values.
[Acute gangrenous acalculous cholecystitis disclosed by postoperative septic shock].
Three cases of acute gangrenous acalculous cholecystitis, revealed by a postoperative septic shock, are reported. Clinical examination was negative and the surgery gave the diagnosis. Infection with biliary stasis and ischaemia accounts for this pathological entity. The very serious prognosis of this condition can only be reversed by cholecystectomy.
Adult respiratory distress syndrome and silicone injection.
This report describes a case of adult respiratory distress syndrome (ARDS) after massive subcutaneous injections of silicone. The patient, a 23 year-old transsexual man, treated with mechanical ventilation, died on the 12th day of hospital, in septic shock and refractory hypoxemia. Autopsy findings revealed empty vacuoles surrounded by macrophages in various organs, especially in lung tissue. Toxicological analysis by emission by high frequency induced plasma showed silicone in the organs with histological lesions. The pathophysiology of this ARDS is considered.
[Fatal pneumopathy linked to subcutaneous injections of liquid silicone into soft tissue].
The case of a 23-year old transsexual male who developed a lethal lung disease 48 hr after a 1 l subcutaneous silicone fluid injection is reported. Histologic examination showed optically empty oil red O negative vacuoles in several specimens, and particularly in the lungs; refractile particles of silicium were also found. We identified the material as silicium, and evaluated its quantity in tissues by atomic absorption and spectrometric and toxicological analysis. Experimental studies and rare human accidents suggest that silicone fluid is transported by migrating phagocytes, thereby explaining lymph node, spleen, liver, adrenal and lung deposits. In our patient's report, we added gradual blood contamination to explain the progressive development of respiratory failure with the severity of the respiratory disorder linked to the massive dose injected. Massive silicone blood embolization could be excluded because of the interval between the injection and emergence of the first clinical signs.
[Erica respirator (Engström). Presentation and evaluation].
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[Acute pulmonary edema after inhalation of gastric fluid].
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[Critical study of the different concepts of optimal positive end-expiration pressure (PEEP)].
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[Acute epiglottitis in adults. Three cases and review of the literature (author's transl)].
Acute epiglottitis is much less frequent in adults than in children. Three personal cases are reported and clinical findings associated with epiglottitis in adults are reviewed; sudden onset of acute respiratory failure is outlined. Mechanical desobstruction of airway may be required promptly, tracheostomy being often preferred to tracheal intubation. Overall prognosis has been evaluated from 130 cases reported in the literature in the last twenty years: the mortality rate, reaching 24,6 per cent in 73 cases published between 1958 and 1973, has been reduced to 5 per cent in 60 most recent cases. This improvement reflects a better understanding of the disease and as more properly defined therapy.
[Diffuse interstitial pulmonary amyloidosis (author's transl)].
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[Importance of studying total static pulmonary compliance in artificial ventilation].
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[Effects of almitrine in asphyxial attack in chronic respiratory insufficiency managed with artificial ventilation].
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[Monitoring patients on artificial ventilation].
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[Artificial ventilation to separate lungs].
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[Bacterial endocarditis complicated by hepatic purpura].
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[Optimal expiratory positive pressure during artificial ventilation. Application in the treatment of respiratory distress syndrome in the adult (author's transl)].
In a group of 14 patients (7 males and 7 females) ventilated artificially for acute respiratory distress syndrome, the authors defined a level of optimal expiratory positive pressure giving an FiO2 = 1, an arterial pO2 greater than or equal to 400 mmhg and/or an intrapulmonary shunt less than or equal to 15%. Improvement in arterial pO2 under such conditions would appear to be related to maximum alveolar recrutment. This optimal level of expiratory positive pressure would appear to be independent of values of total static pulmonary compliance. The long term use of this technique would seem to be encouraging.