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Biomedical subjects

J P Loeb

Publications and source records attributed to J P Loeb.

12 recordsLinked to original sources
PubMed1993

[Fatal streptococcus A shock after thoracic surgery].

A 23-year-old man with relapsing pneumothorax underwent surgical removal of left apical lung bullae and pleural rubbing down. Forty-eight hours later, he suddenly developed a state of shock together with tachypnoea, oliguria, and a scarlet-like erythema of the face and trunk. Haemodynamic and other investigations led to the diagnosis of septic shock, although no portal of entry could be found. Despite antibiotics (vancomycin, gentamycin and pefloxacine) and symptomatic treatment, the patient's condition continued to worsen. He had a fever (40 degrees C) with abdominal tenderness. Exploratory laparotomy failed to disclose a septic foyer. On aspiration of the left thoracic cavity, a large pyothorax was found and 600 mls of pus were drained. Gram-positive cocci were found on staining and pefloxacine was replaced by mezlocillin. Nevertheless, the patient died within 24 h. Blood and pus cultures confirmed that the infection was due to a pyrogenic penicillin-sensitive group A Streptococcus. Similar cases have been described recently. Group A Streptococcus is suspected to cause severe infections with multiple organ failure, termed "toxic shock-like syndrome". The clinical similarity between the streptococcal and staphylococcal shocks calls for a precise bacteriological diagnosis, and treatment with antibiotics active on both germs.

Adult↗
PubMed1989

[Rapid sequence muscular relaxation: vecuronium versus succinylcholine].

Onset times and conditions of endotracheal intubation were compared in 340 patients. They were all classified ASA I or II and free from any condition which might interfere with the pharmacokinetics or pharmacodynamics of muscle relaxants. The patients were randomly assigned to 4 groups where different muscle relaxation techniques with vecuronium were used: "priming" group (n = 150, 10 micrograms.kg-1 followed by 100 micrograms.kg-1 4 min later), "high dose" group (n = 70, 250 micrograms.kg-1), "control" group (n = 60, 100 micrograms.kg-1) and "succinylcholine" group (n = 60, 1 mg.kg-1). All anaesthetic conditions were otherwise similar. Electromyographic monitoring of the hypothenar muscles displayed no impairment in the reaction to a train-of-four stimulus during the pre-relaxation period (4 min) in the "priming" group. No incident was observed in these patients. Ten % of control response were obtained in 61, 86, 135 and 210 s respectively, whereas maximum muscle blockade was obtained in 97, 174, 314 and 74 s respectively. Intubation scoring showed that optimum conditions were obtained when muscle responses were almost fully abolished. These data are in disagreement with those reports on the priming technique where intubation is carried out 60 s after administration of the relaxing dose.

Adolescent↗
PubMed1987

[Conditions of intubation with vecuronium using a priming principle].

Different protocols based on the priming principle have been proposed so as to enable rapid tracheal intubation with vecuronium. The conditions of such an intubation have been assessed in 47 ASA I or ASA II patients, with an empty stomach, using a priming dose of 0.01 mg X kg-1, followed by a second injection of 0.1 mg X kg-1 after a short interval of 4 min. An intubation score was defined using a nerve stimulator (Relaxograph Datex), by measuring the twitch in comparison with a reference value, as well as time before intubation for four groups of patients. Good intubation scores with a twitch approaching 50% was obtained in all and, in the same way, for a fifth group of patients, intubated in an arbitrary manner 60 s after the second dose of vecuronium. These results can be compared with those obtained by other authors using a different protocol. Nevertheless, this method does not match perfectly that of suxamethonium. Taking into account the side-effects and above all the inhalation risk existing after a priming dose, is it opportune to use this technique for the anaesthesia of a patient with a full stomach?

Adult↗
PubMed1979

Reflections on the intensive care of acute cervical spinal cord injuries in a general traumatology centre.

Fifty-one cases of cervical spinal cord injury were reviewed. The importance of the immediate comprehensive care after onset may be achieved successfully even in a General Traumatology Centre. The great majority of these patients were treated by orthopaedic methods as far as their vertebral injury was concerned. Mortality related to the spinal cord injury is 7.8 per cent. The methods used and our development are based on principles established by Sir Ludwig Guttmann; they have been shown to be durable and important.

Acute Disease↗
PubMed1978

Traumatic rupture of the aorta and paraplegia.

During the past 10 years, 15 traumatic ruptures of the aorta isthmus have been diagnosed. The most likely mechanism is that of a brutal deceleration. Three patients developed a complete mid-thoracic flaccid paraplegia. One died in a few hours of a complete rupture, the second after a few days from renal insufficiency, the third 12 days after, having been operated upon on the same day of the accident. All had associated lesions. Diagnosis can be very difficult in these patients, especially in the first few hours. Paraplegia is here considered as an aggravation ischaemic symptom with anuria and loss of blood circulation in the lower limbs. In delayed cases the vascular mechanism of the infarction of the spinal cord is discussed, either by compression of the intercostal arteries or by direct compression of the aorta itself. In our cases, the most likely mechanism is that of an obstruction of the lumen of the aorta by a torn inner coat. These patients must be transferred as quickly as possible to a cardiovascular surgical unit and operated upon immediately. Three cases of preoperative, rapidly progressive paraplegia with neurological recovery after the operation, have been reported in the literature.

Accidents, Traffic↗