Biomedical subjects
Publications and source records attributed to J P Bellefleur.
The authors report a case of emphysematous psoas abscess. The patient, a 55 year-old man, was insulinorequerant diabetic. He presented with abdominal pain and diabetic ketoacidosis. The diagnosis was made by CT-scan. No portal of entry was found. The evolution was fatal before surgery in spite of probabilistic antibiotherapy.
Snakebites constitute a public health problem in Africa, with some 600,000 envenomations and 20,000 estimated deaths per year. Hospital care of cases guided by written protocols which take into account the epidemiological and physiopathological data, as well as the hospital situation, starts in the emergency room and is based on the diagnosis of envenomation, either by vipers or elapids. If this diagnosis is confirmed, intensive treatment must ensue. It includes a non-specific component, particularly the treatment of hypovolemia, consumptive coagulopathy tissue necrosis and respiratory failure and a specific component, immunotherapy the only ethiological treatment. The latter consists in giving an iv injection of polyvalent purified immunoglobulin fragments against the venom. This attention is included in a general public health policy which takes into account the organization and financing of the treatment.
The purpose of this report is to describe a case of severe snake bite with envenomation by an African puff adder (Bitis arietans). Presenting symptoms warranted administration of antivenon upon admission. The patient's general condition improved. However bite-related trauma caused extensive phlyctenuar edema of the lower extremity with a high risk of compartimental syndrome due to hardening and compression. Due to the high risk for postoperative infection at our facility, aponevrotomy to relief pressure was not undertaken immediately. Instead management consisted in close surveillance with repeated measurement of peripheral pulses by Doppler ultrasound and of intracompartimental pressure. The outcome was favorable without need for aponevrotomy. This case demonstrates the value of intracompartimental pressure measurement in cases involving this type of envenomation in function of available technical facilities.
Explore the source record for details and available documents.
The results of balloon aortic valvuloplasty (BAV) in 218 adult patients with valvular aortic stenosis (AS) are reported. In most cases, 3 transcutaneously introduced balloons of successively increasing size were used. Tolerance was excellent in 64%, whereas a decrease in blood pressure below 60 mm Hg during inflation was observed in 36%. The left ventricular-aortic peak to peak gradient decreased from 72 +/- 25 to 29 +/- 14 mm Hg (p less than 0.001) and the aortic valve area increased from 0.52 +/- 0.18 to 0.93 +/- 0.33 cm2 (p less than 0.001). The final aortic valve area was greater than or equal to 1 cm2 in 69 patients (32%). In only 6 cases (3%) the aortic valve area did not change or increased by less than 10%. A clear improvement in the results was observed with gained experience and better catheters. There was 1 death and 1 stroke in the procedure room, and 3 strokes after BAV. Nine patients died shortly after the procedure. There were local complications (hematoma or thrombosis) at the femoral puncture site in 28 (13%) patients. Clinical follow-up was obtained for 144 patients (mean 8 months). There were 24 deaths. In the 120 remaining cases, symptomatic improvement was good in 84%, with decrease or disappearance of dyspnea, angina or both. This study demonstrates that BAV is feasible in adult AS at a low risk and is able to produce marked clinical improvement in most cases.
Explore the source record for details and available documents.
Modulation of a parasystolic rhythm implies that the latter is affected by nonparasystolic beats in predictable ways. When modulation occurs the diagnosis of ventricular parasystole cannot be made by applying the well-known 'classical' criteria. This report deals with clinical tracings from three cases having modulated parasystole with unusual characteristics. Case 1 showed a 24-hour diurnal variability of parasystolic modulation characterized by its occurrence during only part of the period of sleep (from 1 to 5 am). In case 2, modulated ventricular parasystole produced episodes of intermittent ventricular bigeminy with fixed coupling resembling those attributed to a reentry mechanism. The proper diagnosis was made when the sinus cycle length changed abruptly. Finally, in case 3, the idionodal rhythm from a patient with complete AV block was shown to be not only parasystolic, but also modulated. In addition, the idionodal rhythm was entrained (captured) in a concealed fashion by paced beats so that the post-pacing events did not conform with those occurring during overdrive pacing of parasystolic nonmodulated, or nonparasystolic, idionodal rhythms. These findings constitute the clinical counterpart of experimental studies performed with microelectrode techniques.
A recent review of the literature corroborated that several factors explained why supraventricular impulses falling gradually earlier in the cycle could traverse the His-Purkinje system while other impulses occurring later could fail to do so. The present report deals with the coexistence (in the same patient) of three distinct mechanisms whereby progressively more premature impulses could be "unexpectedly" conducted. Phase III left bundle branch block coexisted with the following conduction disturbances in the right bundle branch; late "pseudosupernormal" conduction sandwiched in between periods of phase III and phase IV block; intermediate "pseudosupernormal" conduction resulting from the so-called type 2 gap, during which propagation occurred, but with H-V intervals longer than later in the cycle; early "true" supernormal conduction (related temporarily to the end of the T wave) exposed when a premature ventricular beat reached the affected zone in a concealed retrograde fashion. These findings show how, with block late in the cycle, conduction in earlier part of the cycle was not always due to "true" supernormal conduction.