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J du Cailar

Publications and source records attributed to J du Cailar.

At least 55 records · Page 3Linked to original sources
PubMed1983

[Disseminated intravascular coagulation. Retrospective study of 14 acute obstetrical cases].

To test the value of diagnostic and therapeutic data in obstetric DIC, 14 women were selected who presented a severe clotless haemorrhage with fibrin degradation products and/or soluble complexes, decreased fibrinogen (0.87 +/- 0.47 g X 1(-1)), platelet count (75.7 +/- 41 X 10(3) X ml-1) and prothrombin complex (33.7 +/- 12%). The hypovolaemia was treated at the same time as heparin was given in a bolus injection of 0.5 mg X kg-1 followed by a constant flow infusion of 1 mg X kg-1 X day-1 in all patients. Relevant obstetrical treatment was performed in 71.4% of patients. Fibrinogen, fresh frozen plasma, prothrombin complex concentrate and platelet concentrate were given if required. One patient, with severe toxaemia, died. Haemorrhage was stopped in 92.8% of patients after 4.5 +/- 0.8 h. Reversible visceral complications occurred in 28% of cases. The initial data used was easily obtained and seemed to give a reliable diagnosis in acute obstetrical DIC. Substitutive treatment was discussed in correlation with the evolution: PCC seemed pointless; the use of fibrinogen must become exceptional when fresh frozen plasma is available. Heparin remained necessary.

Acute Disease↗
PubMed1982

[Prolonged functional disturbance of prolactin secretion after surgery under neuroleptanalgesia].

Plasma level of prolactin and its response to the injection of haloperidol were measured in nine women before and after elective gynecological surgery under neuroleptanalgesia using dextromoramidedroperidol combination. The day before the operation, the injection of haloperidol 0.25 mg intramuscularly increases the concentration of PRL by 5.4 +/- 1.9 mg/ml, while this response is completely abolished the day following the operation. Two days later, a tenfold increase in the dose of haloperidol (2.5 mg I.M.) is necessary to obtain a PRL response that equals that observed pre-operatively (5.8 +/- 1.2 ng/ml). The low plasma levels observed 24 and 48 hours post-operatively compared to the pre-operative level, illustrate a prolonged functional disturbance of the secretion of PRL.

Adult↗
PubMed1982

[A comparison of midazolam and diazepam for intramuscular premedication].

Two groups of 27 individuals--12 males and 15 females each--were constituted thanks to the envelopes technique. The first group received 10 mg of midazolam and the second 15 mg of diazepam as an intramuscular premedication, 30 minutes before a surgical operation. Sedation of preoperatoire anxiety was relevant in 26 subjects after midazolam and in 11 after diazepam (p less than 0,001). Amnesia related to the different times of the operative procedure was more frequent in the midazolam group than in the diazepam group: 70 p. 100 versus 4 p. 100 for the arrival into the operating room (p less than 0,001) and 96 p. 100 versus 78 p. 100 for the recovery on operating table (p less than 0,05). The effects on blood pressure, pulse rate and respiratory rate are not significantly different in both groups: neither is the local and general tolerance. Considering its greater efficiency with a similar tolerance, midazolam as compared with diazepam can be regarded as a superior intramuscular premedicant.

Adult↗
PubMed1982

[Use of a ternary mixture of local anaesthetics for peridural anaesthesia during urgent caesarean operation. Report on 125 cases].

125 caesarean operations are conducted under peridural anaesthesia with a mixture of local anaesthetics containing per milliliter: 2.5 mg of bupivacaine, 2.5 mg of etidocaine, 12.5 mg of lidocaine, and 5.10(-6) epinephrine. The dose injected is 23.37 +/- 1.98 ml, the volume necessary for blocking a metamer being 1.18 +/- 0.10 ml/segment. Satisfactory analgesia is obtained in 119 cases (95.2 p. cent), with adequate muscle relaxation in all cases. Block anaesthesia occurs after 5.81 +/- 0.67 min, last 197 +/- 62 min, and enable incision after 8.80 +/- 2.55 min with extraction of the infant after 13.72 +/- 2.85 min in 25 "extremely urgent" cases. Apgar is 8.98 +/- 1.62 after one minute and 9.68 +/- 1.31 after five minutes. These results prove that under perfect circumstances it is possible to get out the baby in about ten minutes.

Adult↗
PubMed1982

[Midazolam as an intramuscular premedication agent: definition of posology as a function of age].

In order to determine the optimal posology of midazolam as an intramuscular premodication according to age, three groups of 25 patients were constituted. The mean age of group 1 receiving 0.12 mg . kg-1, was 31.6 +/- 7.3 years, the mean age of group 2, receiving 0.16 mg . kg-1, was 31.8 +/- 7.6 years and the mean age of group 3, receiving 0.10 mg . kg-1, was 73.8 +/- 8.2 years. The results were the following: sedation of anxiety was good or very good in respectively 80 p. 100 and 95 p. 100 of patients in groups 2 and 3, versus 48 p. 100 in group 1; a reversible sleep was obtained in 18 p. 100 of cases in group 2 and 44 p. 100 in group 3; no patient was asleep in group 1; overall clinical results were found satisfactory in 80 p. 100 of patients in group 2, and 95 p. 100 in group 3 versus 48 p. 100 in group 1. Neither incident nor adverse reactions were to be reported. There was no modification in respiratory rate; the slight hemodynamic modifications which appeared can be attributed to atropine sulfate administered together with midazolam. In conclusion, the appropriate posology of midazolam administered intra-muscularly decreases with age, from 0.16 mg . kg-1 for the thirty years old patients to 0.10 mg . kg-1 for the seventy years old patients. Midazolam exhibits a remarkable cardiorespiratory neutrality event in the elderly.

Adult↗
PubMed1981

[Midazolam in preoperative sleep].

In order to determine the hypnotic effects of midazolam administered per os, the drug was compared with meprobamate and a placebo in patients about to undergo surgery. The study involved 83 patients, 57 female and 26 male: 67 cases of maxillofacial surgery and 16 cases of gynaecological surgery. The study was carried out using the technique of comparison in parallel series of single doses of midazolam (15 mg) with meprobamate (250 mg) and a placebo according to the double placebo technique. The patients were aged between 18 and 60 years, male and female, and were included without any particular attention being paid to sufferers from sleep disturbances or not. The variables selected for the study were 29 in number concerning the assessment of the patient of sleep and awakening, surveillance of the time taken to fall asleep, the duration and quality of sleep and the state after awakening.

Adolescent↗
PubMed1981

[Pharmacokinetic basis of constant-flow administration of drugs during long-lasting anesthesia].

The criteria for intravenous administration of anesthetics or their adjunctives in continuous and constant flow remain imprecise and incompletely understood. Drugs with a very short half-life are usually preferred, without this being a restrictive notion. The theoretical bases for the kinetics of constant flow intravenous infusion are well known but not the practical carrying out, and the practitioner remains confronted with various fundamental questions. Indeed, the quantity administered must take in account it's elimination, but what happens in cases of destructive metabolism, above all when the metabolites are toxic? On the other hand, can the kinetics observed for a given dose be extrapolated to any dose that is administered? Using real examples during constant-flow anestesia, we reconsider a simple calculation method based on the total clearance for a given substance and providing the theoretical constant-concentration level. This study shows how complex the kinetics of constant-flow administration area. All these techniques should be preceded before human application, by serious research on adequate experimental models.

Anesthetics↗
PubMed1981

[Prognostic value of cutaneous delayed hypersensitivity tests in patients with acute decompensation of chronic respiratory failure. Relation to the nutritional state].

This study involved 15 chronic respiratory failure patients admitted to intensive care because of acute decompensation. Study of delayed hypersensitivity skin tests made it possible retrospectively to divide these patients into two groups according to whether tests were positive or negative. Group A: patient positive on admission and remaining so: or negative becoming positive on the 10th day = 8 patients. Group B: patient negative and remaining negative; or positive on admission and becoming negative on the 10th day = 7 patients. In group A, 7 patients survived, whilst one died of an intercurrent condition. In group B, all the patients died. Study of nutritional balance showed a deficiency in protein metabolism--with hypoproteinaemia, hypoalbuminaemia, decrease in creatine index, negative nitrogen balance--combined with a deficiency in trace elements. Such disturbances were particularly marked in group B. Under the influence of nutritional therapy, these deficiencies tended to return to normal in reacting subjects but worsened in non-reacting subjects. In patients of this type, nutritional therapy must be administered well before acute decompensation. It should be able to prevent the latter in a substantial number of cases.

Aged↗
PubMed1981

[Study of delayed skin hypersensitivity using the multitest in an intensive care unit].

A multiple puncture procedure was employed to determine delayed skin hypersensitivity in 76 patients admitted to an Intensive Care Unit. This new method enables the responses to 7 antigens to be measured after a single application. Patient reactivity was assessed on admission (D0) and during hospitalisation (D7 and D14). Results were analysed as a function of modifications in antigenic response during hospitalisation, and its incidence on subsequent infection and mortality. Mortality in anergic patients was 85.71 p. cent, infection being the cause in 90 p. cent of these cases. A very association was found between anergy and mortality (p less than 0.001). These results suggest that cell immunity skin tests in patients admitted for intensive care treatment can be of some value for assessing prognosis. Tests must be repeated during hospitalisation, however, as immunity defences progress, in fact--in one direction or another--up to the 14th day or even beyond, an a single test on the day of admission is insufficient for prognostic purposes.

Adolescent↗
PubMed1980

[Improvement in nitrogen sparing by branched amino acids during parenteral nutrition].

Two groups of ten patients each, staying in a Intensive Care Unit, received exclusive parenteral alimentation with different concentrations of branched chain amino acids (BCAA). Group A received studied solution containing 12 g N (852 mmol) with 41,1 p. 100 BCAA. Group B received control solution containing 18 g N (1278 mmol) with 21,1 p. 100 BCAA. Every patient received 60 nonprotein Kcal x kg-1 body weight/24 hr. The study was performed on five days. Measured parameters were: daily (D0 to D5) N balance, blood urea N and total protein and urinary alpha amine N, and after therapy (D6) amino acid levels. Results have shown no statistical significant difference between both groups. N balance became less negative during the therapy. Amino acid levels were in the normal range and alpha amine urinary elimination remained low in patients with parenteral nutrition. These results indicate that 12 g (852 mmol) N in BCAA rich solution are as efficient as 18 g (1278 mmol) N in standard solution, allowing a N sparing.

Amino Acids↗
PubMed1980

[Decrease in BSP clearance during epidural anesthesia at a constant flow rate. Clinical implications].

The fractional clearance K1 of bromsulphthalein was measured in twelve surgical patients at an interval of a least 48 hours. The first measurement was performed pre-operatively and the second postoperatively 24 hours after the operation, whilst the patients were receiving analgesia by the epidural injection of lignocaine at a constant flow rate. Between the two determinations there was a fall in BSP clearance of 25 +/- 11 p. 100 (range: -8 and -40 p. 100) P less than or equal to 0.0001. The clinical implications are discussed on the basis of concrete examples.

Adult↗
PubMed1980

[Effects of almitrine on the pulmonary circulation].

Almitrine was injected intravenously at a dose of 1 mg.kg-1 over a period of sixty minutes in eight men aged from 49 to 69 years suffering from chronic bronchitis and obstructive airway disease, with signs of chronic cor pulmonale. During the study, patients on artificial respirator were in stable ventilation. Measurements gave the following results: arterial pO2 rose at all the times of study (P < 0.02). Arterial pCO2 decreased, the difference being significant 20 minutes after the end of the infusion. Q tended to increase accompanied by a slowing in heart rate, an increase in cardiac index and in systolic ejection work (P < 0.01 at T60). Pw increased (with P < 0.05 at the 20th minute) and subsequently varied in the same direction in parallel with pulmonary resistance. The authors concluded that almitrine, apart from its well known effects on ventilatory mechanics, results in blood gas changes with are not directly correlated with variations in VE by direct action on pulmonary vascular flow with any notable improvement in the upper zones of the lung.

Aged↗
PubMed1980

[Comparison of two E.E.C. baths by study of the oncotic pressure-pulmonary artery pressure gradient].

Variations in oncotic pressure-pulmonary artery diastolic pressure gradient and in intrapulmonary shunt were studied in two groups of patients undergoing surgery with extracorporeal circulation for aortocoronary bypass of excision of an aneurysm. The two groups, differed only in terms of the E.C.C. bath (Group A: Ringer Lactate; Group B: DDextran 60,000). The effects of E.C.C. on these parameters were as follows: - decrease in both groups in the gradient (OP-PAP) (respectively P < 0.001 and P < 0.01) but with a more marked decrease in group A than in group B (P < 0.05) with non-negativisation of the gradient in that group; - non-significant variations in Qs/Qt in both groups without any correlation with gradient (OP-PAP). The onset of pulmonary oedema associated with a decrease in gradient (OP-PAP) leads to the suggestion of the use of Dextrans in pathological situations where OP is low or PAP high and all the more so when both of these factors are present.

Blood Pressure↗
PubMed1980

[Plasma concentration of fentanyl administered at a constant flow rate during prolonged anesthesia].

By radio-immunological estimation using fentanyl H-3, a study was undertaken in ten adults under anaesthesia of long duration obtained by infusion at a constant rate of alfadione and fentanyl of the plasma concentration of fentanyl during and after anaesthesia. Anaesthesia was induced by the administration of 4.3 ml of alfadione and 0.084 mg of fentanyl. The maintenance dose was on average 0.15 ml/kg-/h-1 +/- 0.03 of alfadione and 2.96 micrograms/kg-1/h-1 +/- 0.58 of fentanyl. The mean duration of anaesthesics was 388 minutes +/- 104. The results of this study showed that from the third hour onwards a plateau of serum concentration was established around a mean value of the order of 4.8 micrograms/l-1. The study of excretion curves demonstrated the existence of a three compartment system with respective half lives of 12.75 and 510 minutes. Maintenance of a stable plasma concentration may be explained by an increase in tissue diffusion (increase in mid and long term half life in comparison with single injections) and by increased metabolism. This study provided pharmacokinetic evidence to justify the administration of fentanyl at a constant flow rate preceded by a loading dose.

Adult↗
PubMed1980

[Comparison of postoperative blood levels of prolactin and somatotropin after two methods of anesthesia].

Prolactin and somatotrophin were measured during the postoperative period in two series of 15 patients after gynaecological surgery. Samples were collected for four days at the same times during the 24 hours period. The anesthetic given in the first group was a neuroleptanalgesia of dextromoramide-droperidol type followed by postoperative analagesia using a noramidopyrine compound. In the second group, epidural anaesthesia was given, followed postoperatively by the injection of lidocain at constant rate interrupted between the final two samples. In the neuroleptanalgesia group, from a basal levels of 11 micrograms.l-1, prolactin rose to 22 micrograms.l-1 on the evening after surgery (p less than 0.001) to subsequently stay on a plateau between 6 and 8 micrograms.l-1 (p less than 0.025 to p less than 0.005). From a basal level of 2.8 micrograms.l-1, somatotrophin rose to 9 micrograms.l-1 (p less than 0.05) then fell progressively from 7.5 to 2 micrograms.l-1 (NS on D1, D2, D3). In the epidural group, from a basal level of 13.5 micrograms.l-1, prolactin rose to 23 micrograms.l-1 on the evening after surgery (NS) to fall sharply on D1 to 5.6 micrograms.l-1 (p less than 0.01) and then follow a plateau on D2 and D3 of the order of 11 to 12 micrograms.l-1 (NS). From a basal level of 1.9 micrograms.l-1, somatotrophin rose to 10 micrograms.l-1 (p less than 0.001) to fall again to 4.5 micrograms.l-1 on D1 (p less than 0.01) and to 2 micrograms.l-1 on D2 and D3 (NS). Comparison of these two groups showed a difference only on D2 with regard to somatotrophin (p less than 0.05) and on D2 and D3 with regard to prolactin (p less than 0.025 and p less than 0.05). These results are discussed. They do not indicate any fundamental difference in the endocrine response to aggression in relation to the two types of anaesthetic studies.

Anesthesia↗