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Biomedical subjects

J Motin

Publications and source records attributed to J Motin.

At least 37 records · Page 2Linked to original sources
PubMed1996

[Selective embolization of ruptured mycotic aneurysm of the duodeno-pancreatic arcade disclosing infectious endocarditis].

The authors report a case of rupture of a mycotic aneurysm of the duodenal pancreatic arcade in a 68 year old man presenting with shock, abdominal pain and rigidity, complicating a case of infectious endocarditis. Emergency treatment consisted of selective embolisation with a coil. This treatment, proposed in view of the clinical condition of the patient and the anatomical particularity of the regional arterial vascularisation, may be a valuable alternative to classical surgery in this type of pathology.

Aged↗
PubMed1995

[Effects of mechanical ventilation with PEEP on right to left intra-cardiac shunt caused by patent foramen ovale].

OBJECTIVE: To assess the presence of a patent foramen ovale (PFO) using colloid contrast transoesophageal echocardiography in mechanically ventilated patient with and without PEEP and it repercussion on PaO2. STUDY DESIGN: Prospective open before-after trial. PATIENTS: Forty-nine mechanically ventilated patients with respiratory failure (PaO2/FiO2 < 250). METHODS: PEEP assessment before and after adding a PEEP = 10 cmH2O. At each level of PEEP, semi-quantification of PFO was performed and arterial blood gases were withdrawn at FiO2 = 1, with 15 min at each level. Semi-quantification of the right-to-left intra cardiac shunt through a patent foramen ovale was obtained using the quantity of microbubbles in the left atrium on a basal short axis view. RESULTS: A PFO was detected in 11 out of 49 patients (22%). A right-to-left shunt developed in one and worsen in three patients when PEEP was added. In patients without a PFO, PaO2 increased significantly (from 119 +/- 10 mmHg to 145 +/- 10 mmHg, P < 0.001). In patients with a PFO, non significant changes occurred (118 +/- 15 mmHg to 120 +/- 17 mmHg). After adding PEEP, the difference between the two groups was significant (ANOVA, P < 0.05). Moreover, a PFO was present during the whole respiratory cycle in two out of 11 patients. These 2 patients exhibited a PaO2 < 100 mmHg with or without PEEP. CONCLUSION: This study suggests that mechanical ventilation with PEEP enhances an intracardiac right-to-left shunt through a PFO. This condition is responsible for the lack of improvement in blood oxygenation when PEEP is added. When a PFO is present all over the respiratory cycle, or when the oxygenation is worsened with PEEP, this positive pressure ventilation should be avoided. The deleterious consequences of mechanical ventilation on venous return may be minimized by partial ventilation and weaning from ventilator.

Echocardiography, Transesophageal↗
PubMed1995

[Clostridium perfringens septicemia associated with foodborne toxic infection and abortion].

A 32-year-old pregnant woman with poor life and hygiene conditions presented with premature labour, fever and diarrhoea. After admission she gave birth to a stillborn child. The examination revealed a septicaemia with massive haemolysis and renal failure. Six blood cultures obtained on admission yielded Clostridium perfringens. The outcome was favourable after an adapted antibiomicrobial therapy. This case illustrates the potential severity of Clostridium perfringens foodborne toxi-infection which can lead to abortion and septicaemia with massive haemolysis.

Abortion, Septic↗
PubMed1995

Effects of a continuous lipid infusion on glucose metabolism in critically ill patients.

The effects of lipid administration on carbohydrate oxidation rate remain controversial, particularly in critically ill patients. The aim of this study was to determine the effects of these patients of a continuous lipid infusion on glucose metabolism using indirect calorimetry and stable isotopes. We studied seven patients, mechanically ventilated, during two consecutive 24-h periods. Throughout the first period they received a continuous infusion of glucose (2 mg.kg-1.min-1) and amino acids. During the second period, in addition to the glucose, they received a continuous infusion of 1 mg.kg-1.min-1 of long-chain triglycerides emulsion. Substrate oxidation rates were calculated from pulmonary gas exchange and nitrogen excretion measurements. Glucose kinetic parameters were measured using primed constant infusions of [6,6-2H2]glucose and [1-13C]glucose. The lipid infusion did not modify the glucose metabolism parameters; 45% of the lipid supply was stored.

Aged↗
PubMed1995

[Post-traumatic dissection of the aortic isthmus with favorable outcome without surgical treatment. Value of transesophageal echocardiography].

We report a case of intimal rupture of aortic isthmus in a severe polytrauma patient diagnosed with transoesophageal echocardiography (TEE). TEE findings were as follows: localized intimal tear without increased aortic diameter or pseudoaneurysm, absence of mediastinal haematoma or false lumen. CT scan and MRI confirmed the diagnosis. Because of the associated injuries, surgery was delayed. Conservative management was successful and the patient was discharged without aortic surgery. A follow up TEE, 3 and 6 months later showed a thrombosis of the intimal tear without false aneurysm. This case underlines the value of TEE in patients with thoracic trauma, for surgical or nonsurgical management of aortic rupture and for the follow up of the patients.

Aortic Rupture↗
PubMed1994

[Value of the cytology of bronchoalveolar lavage in the early diagnosis of nosocomial lung infections in patients with thoracic injuries].

Mechanically ventilated patients, especially those with thorax trauma, suffer commonly from nosocomial pneumonia. In these patients, conventional diagnostic criteria for bacterial pneumonia may not be completely reliable, as an accurate interpretation of the chest radiograph is too difficult. The invasive means for the diagnosis of pneumonia (protected specimen brush, bronchoalveolar lavage), require 24-48 hours to obtain the results of cultures. Therefore no information is available to guide the initial choice of antimicrobial therapy. For some authors, the quantification of intracellular bacteria, present in cytocentrifuged preparations made from lavage fluid, may provide rapid identification of patients with pneumonia. We evaluated the benefit of this type of analysis in thorax trauma patients. In 36 patients, 48 samples were taken. With a threshold value of 10% of cells containing intracellular organisms, microscopic examination had a sensitivity and a specificity of 83%. We conclude that this technique may be useful for the early diagnosis of nosocomial pneumonia in ventilated thorax trauma patients.

Bronchoalveolar Lavage Fluid↗
PubMed1994

[Arterial embolism caused by an intra-aortic thrombus or a patent foramen ovale? Diagnosis by transesophageal echocardiography].

This case report demonstrates the value of transoesophageal echocardiography (TOE) in comparison with transthoracic echocardiography as it allows a better view of the thoracic aorta, the auricles, the interauricular septum and the cardiac valves, especially in the intubated and ventilated patients. A 84-year-old woman was admitted to the ICU for hypoxia after carotid-subclavian bypass surgery for acute ischaemia of the left upper limb. The TOE showed a dilated right heart and a patent foramen ovale, compatible with pulmonary embolism as well as two thrombi in the aortic arch. The patient died on the 8th postoperative day from refractory hypoxia. the autopsy confirmed the pulmonary embolism and the intraaortic thrombi. It is concluded that TOE, readily feasible is indicated in case of hypoxia, shock and systemic embolism without cause immediately recognizable, especially in ventilated patients.

Aged↗
PubMed1993

[Intra-macrophage lipid particles collected by bronchoalveolar lavage: incidence and diagnostic value].

This study aimed to determine the incidence and diagnostic value of fat-laden alveolar macrophages obtained by bronchoalveolar lavage (BAL). In 128 patients, including 66 patients admitted for multiple trauma, 158 BAL were carried out. However, 41 BAL from 32 patients were excluded because of poor quality of samples (not enough macrophages, too many ciliated cells, or haemorrhage). All the patients were intubated and mechanically ventilated, having pulmonary infiltrates on the chest film. BAL samples were examined after staining with oil-red-O. They were considered to be positive when more than 5% of alveolar macrophages contained fat droplets. Among them 14 out of 47 patients (30%) without multiple trauma were positive; 7/14 had never been given any intravenous lipid infusion, and 5/14 had aspiration pneumonia (as opposed to 3/32 patients with negative BAL). Further 27 patients out of the 49 (55%) with multiple trauma were positive. Among them 10/49 had clinical evidence of fat embolism, however, only 7/10 had positive samples. All these last ten patients had been given intravenous lipid infusions. The rate of positive alveolar macrophages was correlated neither with the plasma triglyceride concentration, nor the Fracture Index Score, nor the delay between the end of the lipid infusion and the BAL. There was no significant difference in PaO2/FIO2 ratio between the patients with positive and negative BAL. Positive BAL was significantly associated with lipid infusions. The data therefore suggest that the presence of fat-laden alveolar macrophages are associated with various pathological pulmonary conditions, particularly aspiration pneumonia and lipid infusions.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Histamine release assay and radioimmunoassay for the detection of IgE antibodies against neuromuscular blocking drugs.

It is well established that muscle-relaxant drugs may be responsible for anaphylactoid reactions during anaesthesia. In the present work we evaluated in 41 patients who had experienced anaphylactoid reactions during general anesthesia, the value of different radioimmunoassays (RIAs) and of an histamine release assay (HRA). The RIA was performed with different solid phases as PAPPC (para amino phenyl phosphoryl choline), morphine, TMA (trimethylamine) and TEA (triethylamine). The results were expressed as the percentage of 125I anti-human IgE adsorbed onto the solid phase. The sensitivity was estimated respectively at 95, 82, 93 and 64%. The results were significantly in accordance with those obtained with QAS-RIA (from Guéant) but a weak correlation was seen with Phadebas Rast succinylcholine (r = 0.85 and 0.53 respectively). The HRA gave with the NMBD incriminated a sensitivity of 88%. The correlation between HRA and IDR for the drug involved was 89% and 43% for the other NMBDs. The PAPPC RIA was apparently the most efficient test to screen sera for the presence of IgE antibodies whatever the NMBDs involved in anaphylaxis. An advantage is that this solid phase is commercially available and therefore this RIA can be used routinely with a high sensitivity, allowing the comparison of the results obtained by different laboratories.

Anaphylaxis↗
PubMed1993

[Early somatosensory (SEP) and auditory (AEP) evoked potentials in anoxic coma: prognostic value].

Early somatosensory (SEP) and auditory (BAEP) evoked potentials, when recorded within the first seven days of the course of anoxic coma, appear to be reliable to evaluate anoxic ischemic cortical or under-cortical lesions. Prognosis depends especially on cortical SEP (N20-P25): the lack of SEP is a good outcome predictor of death (abnormal BAEP) or of vegetative status (normal BAEP); the presence of normal and bilateral cortical SEP (with normal BAEP) allows to predict awakening, without prejudging of neurologic sequelae, even if they are severe.

Acoustic Stimulation↗
PubMed1993

Metabolic effects of hemodialysis with and without glucose in the dialysate.

This study was conducted in eight acute renal failure patients undergoing mechanical ventilation to test if the addition of glucose in the dialysate prevents metabolic and hormonal changes induced by hemodialysis. Hemodialysis was performed with a bicarbonate dialysate, a polyacrilonitrile membrane and a continuous heparinization. Two four-hour hemodialysis sessions were performed in each patient: one without glucose (GFD) and one with glucose (GD) in the dialysate at a concentration close to each patient's initial plasma glucose concentration. Oxygen consumption and carbon dioxide elimination, glucose insulin, aceto-acetate and free fatty acids were measured before, during and after the sessions. Oxygen consumption and carbon dioxide elimination were measured with a system using a mass spectrometer. Hemodynamic state and temperature remained constant. Before hemodialysis, respiratory quotient (RQ) values were the same in both groups. There was no change in RQ during GD. There was a decrease in RQ during GFD. Glucose and insulin concentrations decreased during GFD and remained unchanged during GD. Aceto-acetate concentration remained constant under both conditions. Free fatty acids concentration increased to the same extent during GD and GFD. The authors conclude that the addition of glucose in the dialysate prevents the decrease in RQ induced by hemodialysis. This effect is most likely related to a decreased mobilization of non-glucidic fuels.

Acute Kidney Injury↗
PubMed1993

Recovery of [13C]bicarbonate as respiratory 13CO2 in mechanically ventilated patients.

Measurement of the nutrient oxidation rate with 13C as a tracer requires knowledge of the value of its coefficient of fractional recovery in the expired gas (FR). We measured FR in nine intensive care patients who were mechanically ventilated and received total parenteral nutrition. NaH13CO3 was administered at a priming dose (3.75 mumol.kg-1.min-1) followed by a continuous infusion (0.05 mumol.kg-1.min-1). Metabolic rate and pulmonary carbon dioxide elimination (VCO2) were measured by using a mass-spectrometer system. The 13C-12C ratio was measured in the expired gas with an isotopic-ratio mass spectrometer and FR was calculated by using standard equations. The average value of FR was 0.899 +/- 0.026 (means +/- SE) and remained stable for each patient on 2 consecutive days. Between patients, the coefficient of variation of FR was 8.6%. Metabolic rate was the only physiological factor found to affect the FR value.

Adolescent↗
PubMed1993

Hypercortisolism in septic shock is not suppressible by dexamethasone infusion.

OBJECTIVE: To explore the feedback regulation of glucocorticoids on corticotropin secretion in patients with septic and nonseptic circulatory shock. DESIGN: Prospective study. SETTING: An intensive care unit of a general hospital. PATIENTS: Two groups of patients with septic shock (n = 11) or nonseptic shock (n = 7). A control group (n = 20) was also studied. INTERVENTIONS: Intravenous dexamethasone (1 mg/hr for 4 hrs) suppression test. MEASUREMENTS: Plasma concentrations of corticotropin-releasing factor, beta-lipotropin, and corticosteroid-binding globulin measured by radioimmunoassays, and plasma cortisol measured by radiocompetition assay; the ratio of cortisol to corticosteroid-binding globulin calculated as the free cortisol index. MAIN RESULTS: In both groups of patients, the concentrations of plasma cortisol and beta-lipotropin, and the ratio of cortisol to corticosteroid-binding globulin, were higher than normal subjects (p < .001) and were not different between septic and nonseptic shock patients, whereas the plasma corticosteroid-binding globulin concentration was significantly (p < .001) lower in septic shock patients than in normal subjects (444 +/- 154 vs. 696 +/- 56 nmol/L [22.0 +/- 7.6 vs. 34.5 +/- 2.8 mg/L]), but not significantly lower in nonseptic shock patients (607 +/- 157 nmol/L [30.0 +/- 7.8 mg/L]). In contrast to the complete suppressive effect of dexamethasone infusion on cortisol and beta-lipotropin concentrations in normal subjects, dexamethasone did not suppress cortisol or lipotropin in either septic or nonseptic shock patients. CONCLUSIONS: During circulatory shock, hypercortisolism is associated with high concentrations of lipotropin, and is not suppressible by intravenous dexamethasone infusion.

Adult↗
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↗