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Biomedical subjects

J Trémouroux

Publications and source records attributed to J Trémouroux.

7 recordsLinked to original sources

Early diagnosis of peritoneal infection by simultaneous measurement of lactate concentration in peritoneal fluid and blood.

The level of lactate in peritoneal fluid has been suggested to be of great value in the early diagnosis of peritoneal infection [5]. However, this value is affected by multiple systemic factors producing lactic acidosis; these contributed to the high rate of false positive results, obtained in that study. In our study, a better correlation has been found between the peritoneal fluid to blood lactate gradient levels and the presence or absence of peritoneal infection. A threshold gradient level of 2.2 mmol/l in a total of 37 infected and 48 non-infected samples gave the best prediction with a sensitivity of 95% and a specificity of 96%.

Ascitic Fluid↗

Percutaneous intraaortic balloon pumping: initial experience.

The necessity of surgical procedures for insertion as well as for removal of the balloon catheter remains a serious disadvantage of IABP. The percutaneous technique of insertion and removal of a specially designed balloon catheter is therefore of a great interest. Our initial clinical experience shows that this is simple, rapid and safe and can be performed at the bedside in a few minutes by any physician experienced with arterial catheterization. Its hemodynamic efficiency is identical. No specific complications were encountered although two cases of pulmonary embolism were recorded. A causal relationship between pulmonary embolism and the percutaneous removal of a balloon catheter must therefore be considered.

Aged↗

Cardiac function early after repair of tetralogy of Fallot.

Hemodynamics of 12 patients with tetralogy of Fallot were monitored during the first 72 hours after surgical repair. Total immediate repair in 5 patients was followed after 24 hours by a greater decrease in cardiac index than that observed in the group of 4 patients with previous palliative shunt (minus 25 plus or minus 6 vs. minus 1 plus or minus 7 per cent, p smaller than 0.025). This difference disappeared after 48 hours, and the short-term follow-up periods of these two groups were equally smooth. Six patients with pulmonary stenosis requiring the placement of an outflow patch had higher right ventricular filling pressures (after 24 hours 13.8 vs. 10.8 mm. Hg, p smaller than 0.025; 2 to 4 weeks later 9.6 vs. 5.5 mm. Hg, p smaller than 0.05), suggestive of a persistent right ventricular depression. This ventricular depression must be attributed to the induced pulmonary insufficiency and to the presence of akinetic areas. Both these factors should therefore be carefully minimized during the surgical procedure.

Adolescent↗

[Acute necrotic hemorrhagic pancreatitis. Major complications (author's transl)].

Forty-four cases of acute necrotic haemorrhagic pancreatitis are studied. Fourteen cases were treated medically by peritoneal dialysis, 20 were treated surgically of which 16 had been medically treated by peritoneal dialysis. Fifteen died or 34%. Forty-one patients, 93.1% presented 8 major complications on admission and 2 complications were observed during the course of medical treatment (pulmonary shock and high digestive haemorrhage). The post surgical complications are excluded from this study. We report in order of frequency; effusion of the large peritoneal cavity (37 cases : 84%), hypocalcaemia less than or equal to 8 mg% (21 cases : 47.7%), renal insufficiency defined by a creatinaemia greater than or equal 2 mg% (17 cases : 38.6%), state of shock (13 cases : 29.5%), severe neurological disorders (11 cases : 25%), peritoneal haemorrhage (3 cases : 4.5%), disseminated intravascular coagulation (1 case : 2.2%), acute rabdomyolysis (1 case : 2.2%). Certain cases are particularly derogatory : pulmonary shock : 2 cases -- 2 deaths (100%); hypocalcaemia less than or equal to 7 mg/ : 6 cases -- 5 deaths (83.3%); acute tubular necrosis : 8 cases -- 6 deaths (75%); hypocalcaemia less than or equal 8 mg% : 21 cases -- 12 deaths (57.1%); high digestive haemorrhage : 3 cases -- 1 death (33.3%); amber known brown peritoneal effusion : 27 cases -- 12 deaths (44.4%); shock : 13 cases -- 5 deaths (38.5%). When in the same patients, less than 3 complications were present, the mortality rate was 20.8%. If more than 3 signs were observed the mortality rate rose to 53.3%. Except for pulmonary shock, six major complications were needed to give 100% mortality rate.

Acute Disease↗