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Biomedical subjects

J P Brun

Publications and source records attributed to J P Brun.

At least 19 recordsLinked to original sources
PubMed2005

Predictive perioperative factors for developing severe sepsis after major surgery.

BACKGROUND: Early identification of high-risk patients undergoing major surgery can result in an aggressive management affecting the outcome. METHODS: We designed a prospective cohort study of 93 adult patients undergoing major oncological surgery to identify the predictive risk factors for developing postoperative severe sepsis. RESULTS: Nineteen of 93 patients developed a severe sepsis after surgery; seven of the septic patients died in intensive care unit. Multivariate analysis discriminated preoperative and postoperative (first and second day after surgery) predictive risk factors. The postoperative severe sepsis was independently associated with preoperative factors like male gender (OR 4.7, 95% CI between 1.5 and 15.5, P<0.01) and Charlson co-morbidity index (OR 1.3, 95% CI between 1.07 and 1.6, P<0.01). After the surgery, the presence of systemic inflammatory response syndrome (OR 4.0, 95% CI between 1.02 and 15.7, P<0.05) and a logistic organ dysfunction score on day 2 (OR 3.3, 95% CI between 1.9 and 5.7, P<0.001) were found as independent predictive factors. CONCLUSION: We have shown that some of the markers that can be easily collected in the preoperative or postoperative visits can be used to screen the patients at high risk for developing severe sepsis after major surgery.

Adult↗
PubMed2005

Procalcitonin, interleukin 6 and systemic inflammatory response syndrome (SIRS): early markers of postoperative sepsis after major surgery.

BACKGROUND: Patients who undergo major surgery for cancer are at high risk of postoperative sepsis. Early markers of septic complications would be useful for diagnosis and therapeutic management in patients with postoperative sepsis. The aim of this study was to investigate the association between early (first postoperative day) changes in interleukin 6 (IL-6), procalcitonin (PCT) and C-reactive protein (CRP) serum concentrations and the occurrence of subsequent septic complications after major surgery. METHODS: Serial blood samples were collected from 50 consecutive patients for determination of IL-6, PCT and CRP serum levels. Blood samples were obtained on the morning of surgery and on the morning of the first postoperative day. RESULTS: Sixteen patients developed septic complications during the first five postoperative days (group 1), and 34 patients developed no septic complications (group 2). On day 1, PCT and IL-6 levels were significantly higher in group 1 (P-values of 0.003 and 0.006, respectively) but CRP levels were similar. An IL-6 cut-off point set at 310 pg ml(-1) yielded a sensitivity of 90% and a specificity of 58% to differentiate group 1 patients from group 2 patients. When associated with the occurrence of SIRS on day 1 these values reached 100% and 79%, respectively. A PCT cut-off point set at 1.1 ng ml(-1) yielded a sensitivity of 81% and a specificity of 72%. When associated with the occurrence of SIRS on day 1, these values reached 100% and 86%, respectively. CONCLUSIONS: PCT and IL-6 appear to be early markers of subsequent postoperative sepsis in patients undergoing major surgery for cancer. These findings could allow identification of postoperative septic complications.

Adult↗
PubMed2000

[Syphilis in Europe in antiquity: the fetus of Costebelle and other new gifts from osteoarchaeology].

Tomb Nr 1 of the ancient cemetery of Costebelle, attributed to the 4th century AD, contained the skeleton of a pregnant female and that of her foetus in the pelvic cavity. This was aged seven months, was almost complete and showed an exceptional example of bony lesions suggestive of infection. Its etiology suggested the likelihood of early congenital syphilis. This case raises the question of the theory of the importation of venereal disease into Europe, about a 1000 years later, by the crews of Christopher Columbus. The foetus of Costebelle is not an isolated example : other osteo-archaeological findings make a case for the existence of a treponeme (venereal or non venereal) in Europe before 1493.

Americas↗
PubMed1995

[Feasibility and tolerance evaluation of 2 routes of preoperative administration of interleukin 2].

Preoperative interleukin 2 (IL2) administration has been performed, in order to diminish the post-operative immunodepression in cancer patients. The aim of this study was to compare two different ways of preoperative IL2 administration, ie, intravenous (iv) and subcutaneous (sc), in terms of feasibility and tolerance. Nineteen surgical procedures were performed in 18 patients: a) 10 following the administration of 12 IU/m2/24 hours IL2 IV, with a continuous infusion, from day 5 to day 3 before surgery; b) 9 following the administration of 18 IU IL2, in 2 SC injections per day, from day 4 to day 2 before surgery. Tolerance was evaluated by both clinical and biological parameters, before, during, and after surgery. Hyperthermia and capillary leak syndrome were more important in the iv versus sc injection group. Insomnia and digestive troubles were more frequent in the iv injection group as well. However, we noticed few and equivalent cutaneous and respiratory complications in both groups. In conclusion, the tolerance of IL2 was better after sc versus iv injection. However, the toxicity of iv infusion of IL2 was moderate and could be limited by preventive treatments; moreover there was no consequence on the scheduled surgical procedure.

Adult↗
PubMed1994

[Training evaluation of the nursing staff in patient-controlled analgesia].

Intravenous patient-controlled analgesia (PCA) is an effective technique to relieve most forms of acute postoperative pain. However it is not easy to apply. An adequate training of the nursing staff has been for a safe and successful use in the recovery room and the wards as well. Our study was aimed to assess such a training. The most common errors during training period included the incorrect preparation of syringes and the inadequate use of i.v. lines. Errors in programming were spontaneously rectified by using a special procedure. Specific acute pain nurse teams were trained. To optimize the pump use and promote safety and efficacy, special protocols and procedures were devised. PCA is now accepted as a normal nurse procedure. There is no longer any resistance against the introduction of PCA in the wards. Training of nursing staff for the use of PCA devices is essential in order to avoid "human errors". PCA has become routine for the management of postoperative pain.

Analgesia, Patient-Controlled↗
PubMed1993

[Foot equipment of diabetic arteriopathy].

Surgical appliances have a place of choice in the care of the foot with trophic lesions in diabetics, after partial amputation and as a preventive measure when it is free from trophic disorders. The type of appliance will depend on the footwear and the possibility of wearing orthopedic soles, whatever the stage of the affection. For the foot free from trophic disorders the shoes should be wide fitting, in soft leather and of the seamless type. Made to measure shoes should be reserved for badly deformed feet. The soles should be molded in silicone or polyurethane to distribute weight bearing and to avoid it over zones at risk. Appliances for the foot with trophic lesions should allow the resumption of walking. If the lesions are too extensive an orthosis is performed or a specific type of slipper with molded soles is worn to avoid pressure on the wounds. After amputation of toes a silicone orthoplasty is used to fill the interdigital space to avoid deformity of the other toes. If a front of foot has been amputated a corrected silicone molded sole with false extremity is applied. For a back of foot amputation an orthoprosthesis is made, preferentially in silicone introductible in a regular high sided shoe. In order to fulfil its preventive or temporary role, the appliance should evolve with time and be followed up regularly with close collaboration between the diabetic specialist the podologist and the orthotist.

Amputation, Surgical↗
PubMed1991

Pharmacokinetics and tissue penetration of a single 1,000-milligram, intravenous dose of metronidazole for antibiotic prophylaxis of colorectal surgery.

The levels of metronidazole in serum and tissue penetration of metronidazole were studied after prophylactic administration in 11 patients undergoing elective colorectal surgery. A single dose of 1,000 mg given intravenously was administered before surgery. Adequate drug levels in serum (greater than or equal to MIC for 90% of strains tested [MIC90] for Bacteroides fragilis) were found in all patients throughout the procedure. Mean peak (15-min) and last-determined (24-h) metronidazole levels in serum were 28.8 +/- 8 and 4.2 +/- 1.7 mg/liter, respectively. The beta-phase elimination half-life was 9.5 +/- 2.3 h, and the clearance and apparent volume of distribution were 57 +/- 13 ml/min and 0.7 +/- 0.1 liter/kg, respectively. In the colonic wall at surgical anastomosis, tissue metronidazole levels greater than or equal to MIC90 for B. fragilis were found in 91% of patients. In the abdominal wall fat and epiploic fat, tissue metronidazole levels greater than or equal to MIC90 for B. fragilis were found in 40 to 60% of patients at surgical incision and closure. No anaerobic infection occurred during the study.

Aged↗
PubMed1991

[Pharmacokinetics and tissue penetration of single-dose netilmicin used for antibiotic prophylaxis during colo-rectal surgery].

Pharmacokinetics and tissue penetration of netilmicin were studied after the use of a single dose (6 mg/kg) given for antibioprophylaxis in colo-rectal surgery. Thirteen patients, scheduled for elective surgery, were given 6 mg/kg IV netilmicin over 30 min, together with 1000 mg IV ornidazole. Netilmicin peak serum concentration (10 min after end of infusion) was 24.4 +/- 3.4 mg/l and trough level (24 h) was 0.9 +/- 0.5 mg/l. Plasma elimination half-life was 409 +/- 70 min, le volume apparent volume of distribution was 38 +/- 101 and total body clearance was 0.07 +/- 0.02 ml/min. Adequate netilmicin levels (5 greater than or equal to CMI 90 of involved pathogens Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus) were obtained in 100 per cent of patients in abdominal wall and epiploid fat, at time of opening, and in colonic wall at time of anastomosis. Adequate levels were obtained at time of closure in abdominal wall and epiploid fat in 92 to 100 per cent of patients. In situation of allergy to beta-lactam antibiotics, the use of netilmicin in combination with ornidazole may be recommended.

Aged↗
PubMed1990

[Tissue penetration of single-dose cefotetan used for antibiotic prophylaxis in colorectal surgery].

Pharmacokinetics and tissue penetration of cefotetan were studied after a single injection of 2 g for antibiotic prophylaxis in colo-rectal surgery. Beta half-life was 4.3 +/- 1 h, total body clearance was 0.74 +/- 0.2 ml/kg/min and volume of distribution was 270 +/- 76 ml/kg. At time of laparotomy, cefotetan concentration was 14.2 +/- 7 micrograms/g in abdominal wall fat and 16.4 +/- 1 micrograms/g in epiploic fat. In the colonic wall, cefotetan concentration was 33.3 +/- 16 micrograms/g. At time of abdominal closure, cefotetan concentrations were 6.3 +/- 3 micrograms/g in the abdominal wall fat and 6.1 +/- 4 micrograms/g in the epiploic fat.

Abdominal Muscles↗
PubMed1989

[Protein C deficiency and cerebral venous thrombosis in pregnancy].

A fatal case of cerebral venous thrombosis associated with protein C deficiency is reported. It occurred at six months of gestation in a 25 year old patient during her first pregnancy. She had generalized seizures. Computed axial tomography displayed cerebral haemorrhagic infarction, and the carotid angiograms signs of superior longitudinal sinus thrombosis. Before the patient's death on the seventh day after admission, protein C deficiency was discovered. The occurrence of thrombosis of the superior longitudinal sinus during pregnancy, as well as that of protein C deficiency in atypical cases of thromboembolic disease, are discussed.

Adult↗
PubMed1988

Zopiclone, a cyclopyrrolone hypnotic: review of properties.

Zopiclone is a non-benzodiazepine hypnotic with a pharmacological spectrum of activity which resembles that of the benzodiazepines (BZD), but it binds to the GABA complex at a site different from the BZD receptor. Pharmacokinetic properties class ZPC in the category of hypnotics with intermediate-short half-life (5-7 hours) and explain the low incidence of unwanted effects reported. The influence of zopiclone 7.5 mg on sleep architecture is minimal. In healthy volunteers, the amount of deep sleep is increased. No depressant effect on respiratory function and no rebound effect has been demonstrated.

Azabicyclo Compounds↗
PubMed1987

Vecuronium or suxamethonium for rapid sequence intubation: which is better?

The effects of suxamethonium, and of vecuronium given after three subparalyzing (priming) doses, on the time of onset of neuromuscular blockade and on the resultant intubating conditions were compared. This study involved five groups of 10 patients (ASA class I or II) who were premedicated with flunitrazepam 0.015 mg kg-1 i.m. Anaesthesia was induced with thiopentone 6 mg kg-1 and fentanyl 0.003 mg kg-1. In groups 2, 3 and 4 the patients were given a priming dose of vecuronium 0.01, 0.015 and 0.02 mg kg-1, respectively. Three minutes later the intubating dose of vecuronium was given: 0.1 mg kg-1 (group 1), 0.09 mg kg-1 (group 2), 0.085 mg kg-1 (group 3), 0.08 mg kg-1 (group 4). When the electromyographic response was 95% of control, the trachea was intubated. In groups 2, 3 and 4, the onset time was significantly decreased compared with group 1. Increasing the priming dose from 0.01 mg kg-1 did not offer any advantage. The duration of blockade (time from the intubating dose to 15% recovery) was not significantly increased with any priming dose. In group 5, the trachea was intubated after suxamethonium 1.5 mg kg-1. Mean onset time, which was significantly shorter than in the other groups, was half that of the groups that received a priming dose. Intubation conditions were better in group 5 than in the other groups (P less than 0.01).

Adult↗
PubMed1986

[Sex education in childhood and adolescence. Point of view of a gynecologist].

The author discusses the many problems associated with sex education, but, in view of the sexual problems encountered by adults, argues in favor of early sex information. It is easier to inform than to correct misinformation. At what age? By whom? The parents, teachers and doctor all have their role to play.

Adolescent↗