Biomedical subjects
Publications and source records attributed to J M Saissy.
A case of tétanos was treated through intrathecal injections of baclofen. This new technique was pioneered in Anglo-saxon countries and has made it possible in the present case to success fully treat a Mollaret's third-stage generalized tetanus, without a tracheotomy or controlled ventilation. Because of its simplicity low cost, this technique could be another way of treating African tetanus.
The authors undertook a preliminary study of two categories of patients to link morbidity and mortality to the nutritional condition of patients before and after surgery: the first group of patients were to be operated on for cancer; the second group was to act as a control group. For both groups, a study was made before and after surgery, of the nutritional condition of the patients and of progress, respectively. The findings revealed signs of de-nutrition in both groups and a distinct correlation between post-operation complications and the degree of de-nutrition. Hence, in the case of cancer, it is recommended some nutritional preparation before the operation.
The current clinical and therapeutic aspects of cerebral malaria in non-immune adult subjects living in endemic areas of Africa were evaluated in 10 men (mean age: 40 + or - 11, 4 years). On admission, 8 patients had fever, 3 were truly comatose with a Glasgow score of 7 or more. All had negative central venous pressure and only one was in a state of hyperkinetic shock. Respiratory symptoms were present in 8 cases, and jaundice was observed in 8 cases. Three patients has a haemoglobin level lower than 8 g/100 ml, and 8 had thrombocytopenia. Blood creatinine levels above 240 umol/l and blood bilirubin levels above 50 umol/l were found in 6 and 8 patients respectively. Plasma creatine phosphokinase was above 500 iu/l in 7 cases, and PaO2 was above 70 mmHg in 7 cases. All patients received quinine, combined with doxycycline in 6 cases. Infectious complications occurred in 5 patients, with 2 septic shocks. Two patients developed acute pulmonary oedema. Five patients died. This study shows that cerebral malaria in non-immune subjects living in endemic areas produces multivisceral deficiency similar to that observed in imported malaria. Its prognosis can be improved by loading doses of quinine and by a better prevention of nosocomial infections.
Severe and complicated malaria is a fatal from a human Plasmodium falciparum infection. In clinical practice cerebral malaria in children, with unrousable coma, hyperthermia, generalized convulsions, frequently hypoglycemia, is different of severe in non immunized adults resulting in multiple organ failure with degree of impaired consciousness less important. Specific treatment requires quinine with loading dose: 16.7 mg/kg then 8.3 mg/kg every 8 hours for 7 days. Symptomatic therapy, artificial ventilation in particular is indispensable. Recovery is usual in children although neurological sequelae are frequent. In adults evolution is often complicated with pulmonary edema, aggravation of coma, nosocomial infection, and sometimes late multiple organ failure.
Levels of TNF alpha, IL-6-, soluble R IL-2, and fibronectin, were evaluated in fifteen patients with cerebral malaria. Relations between cytokines levels and parasitemia were assessed. Concentration of IL-6, and soluble R IL-2, correlated with parasitic density on admission. It was appeared, that IL-6, would be a prognostic factor, as interesting as TNF alpha.
Anaesthesia for removal of pheochromocytomas requires preoperative preparation of patients so as to normalize blood pressure. During operation, hypovolemia linked with the sudden fall of circulating catecholamines as well as hypertension during handling of the tumor are to be managed. A case of a 11 year child with pheochromocytoma is reported. Once the diagnosis had been established, various attempts to normalize blood pressure failed. Despite a precarious condition, the operation could be performed. During surgery, hypertension occurred and three hypotensive drugs failed to correct it. It ceased after removal of the tumor. The postoperative course was uneventful. The authors discuss the role of the type of catecholamines and their concentration in the failure of antihypertensive medication.
A double blind study has been carried out on 60 women undergoing gynaecological surgery: they were divided into 2 groups who were given as premedication either midazolam: 10 mg, or diazepam: 15 mg intramuscularly. No significant differences between both groups concerning heart rate, blood pressure and respiratory rate were found. After 30 min sedation of anxiety was noted in 30 subjects (100%) after midazolam and in 20 subjects (67%) after diazepam (P less than 0.001). After 45 min good sedation was found in 19 patients (63%) after midazolam and in 4 patients (13%) afer diazepam (P less than 0.001). Amnesia related to preoperative period was more frequent in the midazolam group than in the diazepam group: 67% VS 13% (P less than 0.001). Amnesia of the immediate postoperative period was 100% in both groups. Midazolam as compared with diazepam can be regarded as a superior intramuscular premedicant. This superiority can been explained by a rapid and good resorption.
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Case report of a 48-year-old man with a severe tetanus managed with conventional treatment associated with subarachnoid administration of baclofen. An epidural catheter was placed in spinal fluid at level L3-L4. Two injections of 1 mg baclofen at an interval of 1 hour amended the spasticity. Thereafter the treatment was maintained with a continuous infusion of 2 mg.24 h-1 over 20 days which resulted in an efficient control of spasticity. The final outcome was favourable.
Two cases of cerebral malaria with hyperkinetic shock are reported. The first case concerned a 39-year-old european male who was not taking any prophylactic anti-malarial drugs. After having had headache and fever for a week, he was admitted to the intensive care unit (ICU) in coma and with jaundice. His initial systolic blood pressure was 60 mmg, with a central venous pressure (CVP) of -3 cmH2O. Five-hundred ml of modified fluid gelatin increased the CVP without raising the blood pressure. Haemodynamic investigations revealed a cardiac index (CI) = 5.2 l.min-1.m-2, peripheral arterial resistances (Rsa) = 290 dyn.s.cm-5, oxygen consumption (VO2) = 120 ml.min-1.m-2. Despite treatment with dopamine and dobutamine, the patient died 3 h after his admission, with a CI of 1.9 l.min-1.m-2. The second patient was a 14-year-old senegalese girl, admitted in circumstances similar to the first case. Initial haemodynamic investigations gave the following figures: CI 6.5 l.min-1.m-2, Rsa = 476 dyn.s.cm-5, VO2 = 174 ml.min-1.m-2. Recovery was obtained with fluid replacement therapy and dopamine. In the absence of another associated infectious disease, the plasmodial origin of the septic shock would seem to be the most likely in both cases. Pathophysiological mechanisms of these algid forms of malaria remain enigmatic. Various factors are discussed: cytoadherence of erythrocytes infected with Plasmodium falciparum, immunological disturbances, or a specific endotoxin.
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The use of high thoracic epidurals for post-thoracotomy pain relief in 156 patients is reviewed. Analgesia was maintained with a continuous infusion of a local anaesthetic, bupivacaïne 0.5% 40 ml, mixed with a narcotic, fentanyl 10 ml (perfusion rate between 3 and 7 ml/h). There was successful analgesia in 92%, with efficient ventilation, effective cough, no respiratory distress and only 8 cases of fibroaspiration. Only two significant respiratory complications occurred, due to incorrect management of the peridural route: the analgesic mixture was too concentrated and was injected by bolus instead of by continuous infusion. Other complications occurred, 8 cases of nausea or pruritus, 4 hallucinations, 10 cases of urinary retention lasting more than 24 h, 14 superior limb palsies and 22 Horner's oculopapillary syndrome. All of these complications were minor, easy to manage, and resolved after stopping peridural infusion. In conclusion, peridural analgesia is highly effective and improves the atmosphere in post-thoracotomy wards.
Ultrafiltration, a method of extra renal filtering, which accomplishes an iso-osmotic removal of water an sodium from the plasma, was used in twelve patients. It is reserved for terminal persistent heart failures. In one case, it preceded a heart transplant. Simple to carry out, this technique is well tolerated when the pulmonary pressure is elevated, respecting an ultrafiltration output inferior or equal to 500 ml/h. Immediate improvement of the patients is spectacular. A new treatment failure may impose long-term ultrafiltration sessions. Failure of the medical treatment, impossibility of heart transplant, must be an indication for ultrafiltration which improves the comfort, and most likely the life expectancy of patients with persistent heart failure.
A case of toxic shock syndrome occurring during a menstrual period, and associated with severe hypophosphataemia, is reported. The patient was a 21-year old woman using tampons. On the fourth day, she developed encephalopathy with decreased consciousness and hyperventilation. Severe hypophosphataemia was noted. A phage-group-1 Staphylococcus aureus, producing TSST-1 and enterotoxin A, was isolated from vaginal, pharyngeal and skin sites. Pathogenesis and role of hypophosphataemia in toxic shock syndrome are emphasized.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.