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Biomedical subjects

J Motin

Publications and source records attributed to J Motin.

At least 19 recordsLinked to original sources
PubMed1992

A new radioimmunoassay using a commercially available solid support for the detection of IgE antibodies against muscle relaxants.

It is well established that muscle-relaxant drugs may be responsible for anaphylactoid reactions during anesthesia. In this study, we developed an in vitro test with a commercially available solid phase for the detection of specific IgE directed to the tertiary or quaternary ammonium groups of neuromuscular-blocking drugs. The solid-phase complex was P-aminophenylphosphoryl-choline (PAPPC) immobilized on agarose, and an RIA was performed with an antihuman IgE labeled with 125I. The results, expressed as the percentage of 125I-labeled anti-IgE linked to the solid phase, were at 0.41 +/- 0.19 for 34 control sera from nonallergic healthy adults, with an upper limit estimated at 1%. The values obtained with the sera of 31 allergic patients ranged from 0.6% to 41% with a sensitivity of 97%. The specificity and the positive predictive value of the PAPPC RIA were 97% and 94%, respectively. These results were compared with results of other RIAs with morphine, trimethylamine, triethylamine immobilized on epoxy-activated Sepharose, and choline hydrochloride immobilized on Sepharose (quaternary ammonium Sepharose RIA) and with Phadebas RAST succinylcholine and Phadebas RAST alcuronium. The PAPPC RIA appears to be the most efficient test to screen sera for the presence of IgE antibodies directed to neuromuscular-blocking drugs. One major advantage is that this solid phase is commercially available and ready to use. This advantage will improve the accuracy in the comparison of the results with results from different laboratories.

Anaphylaxis↗
PubMed1992

Bronchoalveolar lavage in trauma patients for diagnosis of fat embolism syndrome.

Fat embolism syndrome (FES) is a rare but serious complication occurring after long bone fractures. Presence of fat droplets in cells obtained by bronchoalveolar lavage has been proposed as a specific tool for FES diagnosis in trauma patients. We evaluated this technique over a 15-month period in 85 patients. Twenty-eight patients were excluded. The remaining 57 patients were divided into three groups: group 1, 26 patients without trauma as control; group 2, 22 patients with trauma but without evidence of FES; and group 3, nine patients with trauma and evidence of FES. Six of 26 patients in group 1 and nine of 22 patients in group 2 exhibited fat droplets in alveolar macrophages, whereas three of nine patients of group 3 had not. This study suggests that (1) presence of fat droplets in alveolar macrophages is not a reliable method for diagnosis of FES after long bone trauma, and (2) many conditions are associated with fat droplets in alveolar macrophages.

Adult↗
PubMed1991

Plasma fibronectin and complement following infusion of colloidal solutions after spinal anaesthesia.

A randomized study of 30 patients undergoing uncomplicated surgery under spinal anesthesia was conducted to assess the influence of colloids on the kinetics of plasma fibronectin and complement. Both are opsonins of the reticuloendothelial system; moreover fibronectin is concerned with host resistance against septic complications following trauma and surgery. The patients were assigned to receive either Ringer's lactate (Group 1), gelatin (Group 2) or dextran 40 (Group 3). Blood samples were withdrawn before colloids or Ringer's infusion and during the 4 postoperative days. There was a reduction in plasma fibronectin throughout the study in groups 1 and 3, but an increase in group 2 by 24 h. The adhesion of plasma fibronectin to gelatin was maximal 1 h after infusion (44%) and remained significant up to day 2 in group 2. There was no relationship in groups 1 and 3. C3 and C4 components of complement exhibited a low value in the early post-operative period, due to hemodilution. This study shows an in vivo fibronectin-gelatin interaction, and suggests that gelatin infusion inhibits the increased shift of plasma fibronectin at the site of tissue injury after surgery.

Adult↗
PubMed1991

Short- and long-term prognosis, functional outcome following ICU for elderly.

Among 1532 ICU patients we analysed 295 elderly patients (19%) aged more than 70-years-old. We determined prospectively the immediate and subsequent one-year outcome with a study of the predictive value of their ICU admission parameters. Then we followed the ICU survivors over the year after discharge (1, 6, 12 months) by quality of life questionnaires. ICU mortality was 26.7%; SAPS was the only predictor of short term mortality. On ICU discharge, 216 elderly were followed at 1, 6, 12 months; the one-year cumulative mortality was 49% from ICU discharge, majority of deaths occurring over the first month. Age, previous health status and SAPS had a predictor value of one-year mortality for ICU survivors. 103 patients were alive at one year: 88% returned to home, 72% had a relatively good functional status allowing an independent life, and 82% had the same or improved functional status.

Activities of Daily Living↗
PubMed1991

[Colloid substitutes and hematocrit measurement by micromethods].

A study was carried out to determine whether centrifugation and resistivity were reliable methods for measuring haematocrit of blood diluted with dextran or gelatin. The values obtained with the minicentrifuge Compur M 1100 (Bayer) (group 2) and with the Stat-Crit (Fumouze) (group 3) were compared with those obtained with the reference method (Coulter counter Model S + 2, Coultronics) (group 1). The study included 10 healthy subjects, aged 21 to 43 years. In each, sodium, potassium, chloride and protein concentrations were determined. Two further 10 ml blood samples were taken to be diluted with increasing amounts of either a fluid modified gelatin (Plasmion) or a dextran 40 (Piasmacair). The dilutions carried out were 0, 10, 20, 30, 40 and 50%. For each one, the haematocrit was measured using all three methods. The values obtained with undiluted blood were similar with the three methods. However, when blood was diluted with a dextran, haematocrit values were underestimated, whatever method was used, but by no more than 5% (difference not statistically significant). The result was the same with the centrifugation method for blood diluted with gelatin. On the other hand, values obtained with the resistivity technique for these samples were underestimated up to 15.5% (50% dilution; p less than 0.05). This was due to the negative electric charge of the gelatin, which lowered the haematocrit value in proportion to the concentration of gelatin. Although the technique is easier than centrifugation, measuring haematocrit with a resistivity method should be avoided in patients receiving a fluid modified gelatin.

Blood Chemical Analysis↗
PubMed1991

[Tooth injuries during intubation: a new preventive device].

This study analyses 126 cases of dental injuries occurring during endotracheal intubation, reported to the service of litigations of the hospitals in Lyon over a ten-year period, and giving rise to a complaint. The overall rate was 1 out of 4,000 cases of intubation. The true incidence may be greater. As expected, the upper jaw teeth are most often involved, especially the left incisors. Among them 24.3% of the involved teeth were normal. Dental fractures were the most common lesion, together with total or partial dislocations. A questionnaire was sent to 534 anaesthetists to assess the main difficulties which they encounter when carrying out endotracheal intubation. The results of this enquiry demonstrated that anaesthetists were very aware of dental risks when carrying out intubation, and that there was a lack of efficient protective measures. Among them 81.2% claimed they would use a protective device from time to time, and 17.4% routinely, if one were available. Therefore we designed such a device. It is gutter-shaped, made with two different plastics, the more rigid one being on the outside. It fits over the upper jaw teeth. There is an indentation in the front, to check whether the device is placed correctly. The inner surface is made of foam which dulls the pressure which may be exerted on the device during intubation. This device was tested in 108 patients. Intubation was easy with the device in place in 73.2% of patients; mouth opening was reduced by a mean of 4.2 +/- 0.5 mm. The device made intubation more difficult, and even impossible, in patients whose mouth opened no more than 3.5 cm.(ABSTRACT TRUNCATED AT 250 WORDS)

Dental Implants↗
PubMed1991

Oxygen uptake after major abdominal surgery: effect of clonidine.

To examine the effect of an alpha-2 agonist, clonidine, on oxygen uptake and on the incidence of postoperative shivering, 28 patients presenting for major abdominal surgery were randomly assigned in a double-blind manner to one of two groups. Intraoperatively, 14 patients received 5 micrograms.kg-1 clonidine infused over 3 h (clonidine group), and 14 patients received placebo (placebo group). Oxygen uptake was measured continuously over the first 3 postoperative hours with a mass spectrometer system. Circulatory variables, esophageal temperature, and skin temperature were measured over the first 6 postoperative hours. Heart rate, mean arterial pressure, rate pressure product, and norepinephrine concentration were decreased in the clonidine group (P less than 2 x 10(-4)). There were no differences among groups in the incidence of shivering and in the rate of increase of esophageal temperature. By contrast, oxygen uptake was lower in the clonidine group (P = 4 x 10(-4)). This contrasting pattern may be secondary to a reduction in the intensity of mean muscular tremor in the clonidine group.

Adjuvants, Anesthesia↗
PubMed1990

[Early somatosensory and auditory evoked potentials in anoxic coma. Role in evaluating and prognostic value].

Early somatosensory (ESEP) and auditory (EAEP) evoked potentials were recorded in 27 patients with severe coma (Glasgow score less than 5) following cardiorespiratory arrest, within the first 7 days of its course. Somatosensory responses were elicited by stimulation of the median nerve. ESEP were abolished in 17 patients due to a parietal thalamo-cortical lesion. Among these, 6 patients died within one month and 11 presented with a persistent vegetative state. In all patients EAEP were obtained, showing functional brainstem activity. Low-voltage EAEP, especially for peak V (inferior colliculus or upper part of the brainstem), was sometimes observed. One patient, in whom ESEP and EAEP were initially abolished, died rapidly. In 9 other patients scalp-recorded ESEP and EAEP were normal; all emerged from coma including 5 with good neurological recovery and 4 with neurological sequelae. Clinical, electroencephalographic and computerized tomographic data appeared to be devoid of predictive value at the same initial period. In view of their sensitivity to anoxia and to cerebral oedema, even with neurosedative drugs, ESEP seemed to be reliable in predicting outcomes and in evaluating central nervous system lesions at cortical and subcortical levels (basal ganglia and brainstem) after cardiorespiratory arrest.

Adolescent↗
PubMed1990

Intestinal decontamination in a polyvalent ICU. A double-blind study.

A double blind, placebo-controlled trial was performed to test the efficacy of prevention of nosocomial infections by selective digestive decontamination. Placebo or tobramycin (80 mg) and colistin (100 mg) was given four times daily via the gastric tube. Amphotericin B (500 mg/6 h) was administered to all patients. As our ICU is divided into two separate subunits, intestinal decontamination or placebo was administered alternatively to patients of the two subunits during two 3-month periods, separated by a 2-month period without prevention. The decontamination (n = 97) and placebo groups (n = 84) were similar with respect to age, sex, severity score and diagnostic categories on admission. Intestinal decontamination alone failed to significantly reduce the number of infected patients (26% vs 34.5%, p = 0.20), but was effective on ICU-acquired infections (0.33 vs 0.60, p = 0.02) especially gram-negative infection rates (0.17 vs 0.43, p = 0.01). The onset of the first ICU-acquired infection was delayed (9 vs 13 days, p less than 0.001) and incidence of pneumonia (2 vs 13 cases, p less than 0.01) including bacterial pneumonia (0 vs 8 cases, p less than 0.01) was significantly decreased. However, mean ICU stay and mortality were not significantly modified by intestinal decontamination.

Amphotericin B↗
PubMed1990

The effects of norepinephrine infusion on oxygen consumption in a patient with septic shock.

A 65-year-old man developed postsurgical septic shock, unresponsive to plasma volume expansion and administration of dopamine and dobutamine. A continuous norepinephrine infusion was then started and the dose increased to 0.62 micrograms.kg-1.min-1 until the mean arterial pressure was 70 mmHg. Prior to and during the norepinephrine infusion, oxygen consumption was continuously measured with a mass spectrometer system. There was a parallel increase in mean arterial pressure and oxygen consumption (+ 35%). There was also an increase in cardiac index and oxygen delivery. Systemic vascular resistance was only transiently increased. In this case with septic shock, norepinephrine infusion improved hemodynamic variables with an associated increase in oxygen consumption.

Aged↗
PubMed1990

[Frequency of infections in intensive care units: an incidence survey].

During a nine months period, 568 patients entered the Polyvalent Intensive Care Unit and were prospectively studied: 153 became infected and 289 infections were diagnosed. Urinary tract infections (31%) in patients with indwelling catheter, lower respiratory tract infections (22%) in tracheally intubated and ventilated patients and bacteremias (19%) totalized 75% of all I.C.U. acquired infections. Post operative and trauma patients were more frequently infected than medical patients. E. coli (19%), S. aureus (14%), Enterococcus (13%) and P. aeruginosa (12%) were isolated and resistance to antibiotics was not always important. The prescribed treatment was an association of antibiotics in 55% of cases. The group whose patients were infected had a longer stay in I.C.U. and a higher mortality rate than group of uninfected patients.

Cross Infection↗
PubMed1990

[Measurement of gas exchange in anesthesia and during resuscitation: principles and applications].

Pulmonary gas exchange measurements can be performed in ICU with commercially available devices. During open-circuit anaesthesia, measurement of VO2 and VCO2 requires the acquisition of fractional concentration of inspired and expired nitrogen, the appropriate calibration of sensors according to the use of anaesthetic gases and to take into account the unsteady state of nitrogen body stores after a change in FiN2. This technique can be readily used to measure energetic expenditure or to specific applications as oxygen cost of breathing, respiratory effects of parenteral nutrition or the metabolic effects of various anaesthetic procedures in man.

Anesthesia↗
PubMed1989

Effects of protein intake on pulmonary gas exchange and ventilatory drive in postoperative patients.

The effects of different protein regimens on pulmonary gas exchange and ventilatory drive were examined in eight postoperative patients receiving inspiratory pressure support ventilation. They were studied during 60 consecutive hours, which included two 12-h periods of high protein intake (33%) of total caloric intake provided as protein), each of them being preceded and followed by a 12-h period of standard protein intake (14% of total caloric intake provided as protein). Throughout the study, total caloric intake was 1.5 times the predicted resting energy expenditure. Nitrogen was provided as a 24% branched chain amino acid (BCAA) solution during the period of standard protein intake. During the periods of high protein intake, it was provided as a 24% and a 41% BCAA solution. Pulmonary gas exchange was continuously measured during the second half of each period, with the use of a mass spectrometer system. Measurements of the ventilatory response to CO2 (FICO2 0, 1.5, and 3%) were achieved at the end of each dietary regimen. O2 consumption, CO2 production, respiratory quotient, minute ventilation, and PaCO2 were the same for the three protein regimens. Changing protein intake failed to affect the ventilatory response to CO2. The authors conclude that, in postoperative patients having inspiratory pressure support ventilation, the administration of a high protein intake does not affect the ventilatory drive and the pulmonary gas exchange.

Carbon Dioxide↗
PubMed1989

Disseminated Geotrichum capitatum infection in a patient with acute myeloid leukemia.

A case of invasive Geotrichum capitatum infection is reported; a young patient had an acute leukemia for which he received a chemotherapy, and presented sepsis with blood cultures for Geotrichum capitatum, namely Dipodascus spicifer; this pathogen only described in cactus rot, is responsible for the first case of a human disseminated infection reported in literature. Then he developed a splenic and epididymic infection, with positive cultures for Geotrichum capitatum after splenectomy and castration. Treatment with amphotericin B and itraconazole was started with low minimal inhibitory concentration (0.1 microgram/ml). The patient died of massive hemoptisis. Autopsy findings demonstrated a lung, brain and kidneys seeding.

Adult↗