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Biomedical subjects

M Gaillard

Publications and source records attributed to M Gaillard.

At least 73 records · Page 4Linked to original sources
PubMed1987

Treatment in serious lower limb injuries: amputation versus preservation.

A study of patients with serious lower limb injuries is presented. With these injuries it is important to decide whether the limb should be salvaged at the risk of losing a life. Seventy-six patients are described and compared with a group of patients with similar injury severity scores but without serious lower limb injury. It is concluded that it is often preferable to amputate the limb rather than to risk the patient's life. Attempts at preservation of a limb were unsuccessful in 20 of the 54 patients in whom this was attempted. Secondary amputation was often performed in unsatisfactory conditions because of general complications that had resulted from the delay.

Accidents, Traffic↗
PubMed1987

Early medical care and mortality in polytrauma.

This study attempts to objectively estimate the efficiency of early medical care. It is based on the comparison of two series of multiple injured patients. Ten years separated the two groups and during this period, an Emergency Medical Aid Service (SAMU 94) was created. The positive effect of early medical care was established through the variations of injury severity indices currently used in polytrauma: after the institution of Mobile Intensive Care Medical Units on the site of accidents cardiac arrests were ten times less numerous although lesions were more serious in the second series. Without taking into account the mortality rate of lower-limb trauma, where crush syndromes were very numerous, mortality rate decreased as far as spinal, chest, abdominal, and pelvic traumas were concerned. An estimation of the cost of such a system raised the problem of maximizing the efficiency of improved early medical care.

Efficiency↗
PubMed1986

[Treatment of severe injuries of the lower limbs. Identification of clinical criteria of severity].

The choice and timing of therapeutic methods for injuries of the lower limbs were evaluated in 60 patients. Primary amputation had to be performed in 18 of them, and conservative treatment was attempted in the others. Sixteen secondary amputations were necessary, mostly for arterial lesions. These results were not in agreement with the general severity of injury, as evaluated by the Injurity Severity Score. There was a significant difference in mortality depending on whether it was decided to amputate secondarily or to preserve the limb. When local signs of complication were present, this difference was highly significant. Age over 50 and arterial lesions were aggravating factors. When present together with an already high severity score, these factors should suggest immediate amputation as a life-saving measure.

Adolescent↗
PubMed1986

Determination of "in vitro" degradation of protamine in plasma by three different methods.

Three techniques for the quantitative or semi-quantitative determination of the degradation of protamine in plasma are described. One is based on the measurement of liberated arginine, since arginine is the single most important constituent of protamine (80% in weight). The second utilizes successive estimations of protamine by addition to a secondary heparinized medium in which excess heparin is measured by thrombin time and polybrene titration. The third method employs electrophoresis on cellulose acetate, and offers direct visualization of the soluble complexes formed between protamine and albumin, and of their degradation. When applied to an incubation mixture containing diluted plasma (1 : 8) and protamine 0.8 mg/ml, the first two methods were well correlated and showed that protamine degradation proceeded linearly with time. The third method had good semiquantitative agreement with the two former. The rate of protamine degradation was different when estimated by each of the three methods, due probably to the different physico-chemical reactions involved.

Arginine↗
PubMed1986

Alcoholism in polytrauma.

Alcoholism is a blight which implicates numerous areas. Polytrauma requires a sometimes long and expensive hospitalization, with a mortality of approximately one in three. In 250 patients (the mean ISS is the same for patients who died, whether nonalcoholics, chronic alcoholics, or occasional drinkers), there was a significant difference between the mortality rate of two-wheeled vehicle drivers and the mortality rate of the light vehicle drivers (p less than 0.05). The risks of morbidity and mortality amongst alcoholics increased for chronic alcoholics (60%) regardless of sex or age differences. Mortality of occasional drinkers was 13.3%, 51% of the offenders were chronic alcoholics. Chronic alcoholism in polytraumatology appears to be a serious element since 59% of multiple injured patients had blood alcohol concentration greater than 1.20 gm/L, 65% greater than 0.80 gm/L, and 70% greater than 0.50 gm/L. Thus chronic alcoholism is a serious index in traumatology.

Accidents, Traffic↗
PubMed1986

Pre hospital intensive care in multiple trauma children.

From January 1979 to December 1984, 1,272 calls, concerning injured children, aged 11 days to 15 years, justified the intervention of a Mobile Medical Emergency and Intensive Care Service, in the department of "Val-de-Marne" near Paris. Three hundred and twenty-two were very serious trauma children (25%); 45 were in cardiac arrest, and 41 died on the scene of the accident despite the intensive cares delivered by the anesthetists or pediatricians. Two hundred and eighty-one children were hospitalized in an intensive multiple trauma pediatric unit (97 cases) or in a neurosurgical pediatric unit (184 cases). The mode of accident was traffic accident (252), fall (48), fire arms (4), knife wounds (7), hanging or strangulation (9), others (2). They concerned 119 females and 203 males. 126 were multiple trauma children (40%). 37% of these accidents happened between May and July, and 40% occurred between 3 to 6 p.m. The 322 children immediately received medical care but 26% died during their hospitalization (17% in the first 24 hours). Thus mortality rate is 35% (114 cases).

Accidents, Traffic↗
PubMed1984

Emergency medical care in France.

Emergency Medical Aid (AMU) has existed on an organized basis in France for ten years. Considering that every call for medical assistance requires an answer the SAMU (Emergency Medical Aid Service) acts as a switchboard. Its implantation in a hospital and its powerful centralized telecommunications make it possible to adapt responses to the type of case: serious ones require sophisticated equipment, whereas non-serious ones come under a General Practitioner. Treatment is free. Minor cases are taken care of by "omnipractitioners" who can be contacted by the SAMU via portable radio transceivers. Serious cases are dealt with by the Mobile Emergency and Intensive Care Service (SMUR); they either drive or fly to the spot within an average time-limit of ten minutes. The SMUR teams are composed of a physician, a nurse, often a student and a driver or a pilot. The physician makes the diagnosis, radios a description of the case and gives first-aid treatment. The minimal SMUR equipment fits into two cases. The SAMU also have other missions such as: teaching, prevention, disasters. The French system is aimed at reducing inequality in emergency situations and guaranteeing the whole population permanent medical care. Its cost to the public, however, is only +1 per inhabitant per year.

Emergency Medical Service Communication Systems↗
PubMed1984

Neonatal distress. Interest of early medical care and medicalized transport.

From January 1979 to December 1981, amongst the 1200 interventions concerning neonatalogy, SAMU'94 pediatric unit was called out 1070 times for newborns less than 8 days old (i.e. 36% of the pediatric unit entire activity). These were being transferred: either from their birth place to a neonatology department, or to an intensive care unit; either from a neonatalogy department to a medical or surgical intensive care unit (the first transport having not been medicalized then). Have not been included in our study: newborns transferred from one intensive care unit to another, or just after an operation, or for special investigations (catheterization, ultrasound scanning, computerized tomography. . .). Concerning those 1070 newborns, two facts were noticed: Firstly, their initial clinical state was unstable. Secondly, diagnoses were very often made by clinical examination alone: in 3% of the cases, the situation was desperate with decease despite intensive resuscitation; 6.4% belonged to preoperative surgical pathology; 8.6% were born at home; 60% required hospitalization in a medical intensive care unit; and 30% only needed simple attendance in a pediatric department. Thus, before their admission to the adequate hospital 70% of the transfered newborns required and benefited from the pediatric mobile team's adjusted medical care.

Ambulances↗