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Biomedical subjects

M Gaillard

Publications and source records attributed to M Gaillard.

At least 55 records · Page 3Linked to original sources
PubMed1989

EMS in France.

Explore the source record for details and available documents.

Adolescent↗
PubMed1989

[Socioeconomic implications of the practice of thrombolysis in the acute stage of myocardial infarction].

The use of variegated and costly thrombolytic agents for the treatment of myocardial infarction in its acute phase may have medico-social advantages. In the present study, these advantages were evaluated after one year from two age and sex matched populations: 40 patients who underwent thrombolysis and 38 patients who did not. Compared with the first hospitalizations, the difference was + 4,000 francs, rising to + 11.000 francs with the drug Eminase. A questionnaire including medical, social and economic data was sent to the 78 patients and was filled by 63 of them, remaining unanswered by one patient who had thrombolysis and 10 patients who did not. Readmission to hospital showed a 44.000 francs difference to the benefit of patients who underwent thrombolysis. Ancillary care and return to work were similar in both groups. Cost expectancy was 119.500 francs for patients who had thrombolysis and 122.000 francs for those who did not. Thrombolysis therefore is a cost reduction factor, but its influence on costs is less pronounced when it is performed soon after the onset of myocardial infarction. Thrombolysis is more expensive when carried out at home than in hospital. In this study, the excess cost (+ 5.000 francs) was due to the relatively small number of patients and to the loss of professional activity which may be an uncertain factor. Mortality at one year was nil when thrombolysis was performed within the first two hours (12 patients) and rose to 16.6 percent between 2 and 3 hours (18 patients) and 30 percent after 3 hours (10 patients). Conducted on a necessarily limited number of patients, this multiple criteria study was also aimed at establishing a method to evaluate the health expenditures imposed by the introduction of new and costly treatment in the management of myocardial infarction.

Adult↗
PubMed1989

[Prehospital thrombolysis. Evaluation of preliminary experiences at Val-de-Marne].

Benefits of thrombolysis have been shown to be greater when therapy is administered early, and this led us to consider the value of starting thrombolytic treatment in the patient's home. However, this implies the transfer of responsibility of patient management from the cardiologist to the physician in charge of the mobile emergency care team. A study was undertaken in the Val-de-Marne department to assess the benefits and risks of this therapeutic approach. The first phase was designed to evaluate the reliability of the emergency care team's diagnosis and the second phase of the study was a randomised double blind prehospital therapeutic trial of a thrombolytic agent, acylated streptokinase (intravenous bolus of 30 units in 4 minutes) against placebo. The nature of prehospital treatment was revealed on hospital admission and thrombolytic therapy was immediately given to those patients allocated to placebo at home providing the admitting cardiologist confirmed the indication. A total of 100 patients were included; 57 were allocated to thrombolytic therapy and 43 to placebo in the prehospital phase. The diagnosis of acute coronary insufficiency was confirmed in all cases and 97 p. 100 of patients had signs of acute myocardial infarction. No complications were attributable to prehospital administration of the thrombolytic. The average time gain in instituting treatment was 60 minutes. At control coronary angiography, 72 p. 100 of the coronary arteries thought to the responsible for the infarct were shown to be patent. The global left ventricular ejection fraction of patients treated with thrombolysis at home was 56.7 p. 100 compared with 53.4 p. 100 in the placebo group.(ABSTRACT TRUNCATED AT 250 WORDS)

Ambulances↗
PubMed1989

[Epidemiology of gyneco-obstetric emergencies (within the framework of emergency medical care)].

The authors studied over a period of four years emergencies in pregnancy. These were seen in patients who were brought in from an outside hospital to a perinatal centre or when transferred from hospitals to a general maternity unit or to a high risk unit for neonatal and maternity care. 382 pregnant women needed to be looked after (293 from outside hospital and 89 transferred from another hospital). Treatment was given especially in the 3rd trimester of the pregnancy to three groups: before labour (60 cases); during labour (211 cases) and; after delivery (30 cases). There were in the same categories 37 cases before labour, 9 cases during labour and 30 cases after labour transferred from one hospital to another. The diagnosis were, in particular, 47 cases with a high risk of premature labour, 5 cases with haemorrhage and placenta praevia, 27 cases of pre-eclampsia, 211 cases in labour of which 120 were outside hospital. There were 14 cases of maternal illness, 3 cases of trauma and 4 cases of cardiac arrest. There was a high risk of prematurity in 33 cases of labour outside a maternity hospital. The neonatal mortality rate for the first six days after delivery was ten times higher than that for all neonates born in the same county in the same period of time as this series took. But the authors noted that pre-eclampsia cases received care at high risk units but premature cases did not necessarily.

Adolescent↗
PubMed1989

[Epidemiology of severe cranial injuries in children and the prognosis of injured patients hospitalized in neurosurgery units].

Over five years (1979-1983), 1,058 children who sustained injuries in the Val de Marne District (near Paris) were treated by the Emergency and Intensive Care Mobile Unit. Among these patients, 17.8% had an isolated, severe head injury (Glasgow score less than 12) and were admitted to a neurosurgical unit; the age and sex distribution in this group was comparable to that of the entire group of injured children (2/3 boys). The severe head injury was caused by a motor vehicle accident in 47% of cases and a fall in 34% of cases. One half of patients had a skull fracture; all patients with an extra-dural (14 cases) or sub-dural (7 cases) hematoma had a skull fracture. Seventy per cent of patients had cerebral edema and 25% had a meningeal hemorrhage. Immediate severe neurologic disorders (Glasgow score less than 9) were present in 53% of cases and 27% of patients had focal neurologic signs. Mean duration of the stay in the neurosurgical unit was 6 to 15 days. Mortality was 15.3%; in most cases (75%) death occurred within the first 48 hours. One-year morbidity was very significant; 67% of surviving children had residual disease, and 40% had severe sequelae.

Adolescent↗
PubMed1988

[Home thrombolysis for myocardial infarction. A multicenter study of the feasibility and evaluation of short-term prognosis].

It has been proven since 1986 that in myocardial infarction the sooner thrombolysis is performed the better. Forty-four patients were selected to enter a double-blind randomized trial in which they received either an acylated plasminogen streptokinase activator complex or a placebo. The injections were given intravenously at home within the first 3 hours (within the first 2 hours in 26 of them), by doctors from Mobile care units. This home treatment in the acute phase made it possible to gain 75 minutes on average, and up to 90 minutes when it was performed by an anaesthetist trained in emergency management. No serious complication, such as haemorrhagic or allergic reaction, occurred, and arrhythmia was no more frequent in the treated group than in the placebo group. Home thrombolysis did not delay admission to a cardiology Intensive Care unit (66 min. versus 64 min). Mean coronary patency was 75 per cent, and up to 82 per cent, in patients treated within 2 hours of the first symptoms. There was no significant difference between areas of reperfused or not reperfused patients in relation to time (P less than 0.08). Diagnosis sensitivity was 100 per cent. Thus, home thrombolysis is feasible and safe when performed by trained emergency medical teams and when criteria for inclusion and exclusion are fulfilled.

Double-Blind Method↗
PubMed1988

[Protaminase activity of plasma. III. Role of conversion enzyme (kininase II) in protaminase activity of plasma].

Kininase I (carboxypeptidase N) and kininase II (angiotensin converting enzyme) were isolated from human plasma by gel filtration on Sephadex G 200, then separated and partially purified by ion exchange chromatography. These two partially purified enzymic preparations allowed us to demonstrate that protamine underwent an extensive degradation only when both kininases acted simultaneously. The effects of CoCl2, an activator, and of several inhibitors, amongst which captopril, suggest that the same enzymatic system is responsible for the in vitro protaminasic activity of diluted unfractionated plasma.

Carboxypeptidase B↗