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Biomedical subjects

M Tanguy

Publications and source records attributed to M Tanguy.

13 recordsLinked to original sources
PubMed1990

[Fatal maternal streptococcus A infection after cesarean section].

A case is reported of an infection with Streptococcus pyogenes, occurring 24 hours after an elective Caesarean section in a 30 year old woman. She worsened during the first 48 h, with shock (Pasys less than 70 mmHg, pH 7.28) as well as abdominal tenderness and guarding. Laparotomy revealed peritonitis, and subtotal hysterectomy was carried out. Gram positive cocci were found in the peritoneal exudate, with bacterial cultures yielding Streptococcus pyogenes. Histopathological examination of the specimen revealed necrosing endomyometritis with septic thrombophlebitis. During the immediate post-operative period, there were several prolonged episodes of circulatory arrest treated with dobutamine, adrenaline, and noradrenaline. Multiple organ failure occurred during the next five days, despite antibiotic therapy (vancomycin, tienamycin, amikacin) and intensive care. It included jaundice, thrombocytopaenia (10 G.l(-1] adult respiratory distress syndrome (ARDS). A further laparotomy was carried out because of abdominal and thigh cellulitis, with completion of the hysterectomy and bilateral salpingo-oophorectomy. Streptococcus pyogenes was still present in the peritoneal cavity. There followed an improvement, with a return to normal of the platelet count, haemodynamic stability such that vasoactive drugs were no longer needed, and a decrease in the degree of jaundice. However, the ARDS worsened, and the patient died 15 days after the Caesarean section. There have been recent reports of similar cases, suggesting an increase in the virulence of group A streptococci linked to a re-emergence of exotoxin A.

Adult↗
PubMed1990

Effects of halothane on human and rat hepatocyte cultures.

The aim of this study was to investigate direct cytotoxicity to human and rat hepatocytes in primary culture from halothane and compare it with that of isoflurane, which is known to be minimally metabolized and less toxic in vivo. Both human and rat parenchymal cells were isolated by the two-step collagenase perfusion method and after attachment to plastic were incubated with either volatile anesthetic for 24 h. All the cultures were maintained in 20% O2 condition and were not induced prior to anesthetic treatment. Temperature, atmosphere conditions, and anesthetic concentrations were kept constant during the study period. Evaluation of cytotoxicity was based on morphologic, biologic (determination of both extracellular and intracellular lactate dehydrogenase activity), and metabolic (protein synthesis and secretion) end points. Protein synthesis and secretion rates were found to be the most sensitive parameters in hepatocyte cultures from both species. Protein synthesis was inhibited by 18% and protein secretion by 50% in the presence of 1 and 1.25 mM halothane, respectively, in human cell cultures (P less than 0.05). With 1.25 mM halothane intracellular lactate dehydrogenase was also decreased; lactate dehydrogenase leakage and morphologic alterations were detected only beyond 5 mM halothane. By contrast, in rat hepatocyte cultures protein secretion was inhibited by 26% and protein synthesis by 20% in the presence of 0.1 and 0.75 mM halothane, respectively, whereas morphologic alterations and a 37% lactate dehydrogenase leakage increase were observed with the concentration of 1 mM (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Digestive stress hemorrhage. Physiopathology and prevention].

Lesions of the gastroduodenal mucosa are seen very early on in virtually 100% of patients suffering from organ failure. Bleeding, even if it is only occult, defines acute stress-induced gastrointestinal tract bleeding (SGIB). The rates of SGIB vary according to the inclusion criteria: 13 to 100% microscopic SGIB, 2.3 to 9.5% haemorrhage with blood transfusion and/or shock. Gastrointestinal bleeding does not really influence the death rate of patients with SGIB (0 to 5% increase). Damage to the gastric mucosa may be due to an intraluminal aggression, and/or decreased mucosal and mural defence mechanisms. H+ ions and bile salts are mostly responsible for the former. Physiological quantities of H+ ions may be sufficient, as their abnormal diffusion into the gastric mucosa will reduce the mucosal pH (pHm), which is itself sensitive to microcirculatory modifications and systemic acidosis. There is a good correlation between bleeding and pHm. Bile salts are involved because of the usual increase in frequency and volume of gastric biliary reflux due to stress. Surfactant, mucosal alkaline layer and the microcirculation are all involved in gastric protection. The PGE2 synthetized by the gastric mucosa have a favourable influence on these 3 mechanisms. Changes in microcirculation and hypoxia are the predominant factors involved in stress-induced mucosal damage. The prevention of SGIB relies on the treatment of risk factors, a reduction of intraluminal aggression, and the support and/or stimulation of gastric defence mechanisms. Antacids and anti-H2 drugs aim to neutralize most of the H+ ions, being more efficient than placebo in increasing gastric pH greater than 4, although anti-H2 agents are responsible of a greater number of failures. The non-homogenous character of the patient groups studied and the diagnostic methods, as well as the increasing lack of placebo groups in the published studies make the interpretation of the results rather risky. Antacids and anti-H2 drugs are more efficient than placebo, and equally efficient, in preventing overt SGIB. Efficiency is increased by giving anti-H2 drugs continuously, and antacids hourly. Other agents are thought to protect mucosal cells, probably increasing mucosal defences. Amongst them are the prostaglandins, the most interesting of which are still being investigated, and sucralfate. The latter molecule is as efficient as antacids and anti-H2 drugs, and does not alter gastric pH, so reducing the number of nosocomial pneumonias. Its reduced cost and easy administration make it, at the present time, the treatment of choice of SGIB. The few rare contraindications of sucralfate will justify the infusion of anti-H2 drugs in those patients at risk.

Anti-Ulcer Agents↗
PubMed1987

[Prolonged intravenous infusion of morphine. Pharmacokinetic study].

Critically ill patients require optimal pain control without undesirable side-effects. Continuous intravenous morphine infusion is often chosen instead of the conventional intermittent administration. In the present study, the pharmacokinetic characteristics of morphine were studied in five subjects receiving a constant rate intravenous infusion with the attainment of a steady state. The plasma levels were compared with values derived from bolus intravenous administration in five other patients. The concentrations of unchanged morphine were determined in serum using high performance liquid chromatography with an electrochemical detector. The decay of plasma concentrations after a single dose fitted a triexponential function consistent with a three compartment pharmacokinetic model. Postinfusion plasma concentrations fitted a two compartment model. Derived values (mean +/- SEM) of total body clearance were significantly different between groups (p less than 0.05), while mean values of terminal elimination half-life (t 1/2 Kel) were similar. It was concluded that values of total distribution volume were significantly different. The extent of morphine distribution varied more than twofold between the two groups of patients. This was interpreted as a consequence of an important underestimation in the extent of distribution tissues after administration of a single dose.

Adult↗
PubMed1986

[Repair of a suprahepaticocaval injury under extracorporeal circulation].

The case of a 29-year old man who presented with haemorrhage from hepatic veins and the retrohepatic vena cava is reported. On the belief that a conventional technique would be dangerous, total extracorporeal circulation was used as a supportive procedure. The method facilitated anatomic definition of the venous injuries. The repair could then be calmly and precisely carried out because of a practically bloodless operative field. The procedure was well tolerated and the postoperative course was uneventful; the patient was discharged 15 days later. Many surgical techniques have been described for the repair of traumatic injuries of the inferior vena cava and hepatic veins, but all with a high level of peroperative mortality. So, cardiopulmonary bypass and hypothermia seemed to be a useful procedure. However, some points need further consideration: heparin administration may promote bleeding from other lesions and, in the case of associated gastrointestinal injuries, the risk of major septic dissemination is great.

Adult↗
PubMed1986

[Spontaneous rupture of the esophagus].

Eighteen patients (16 men and two women), aged 20 to 77 years, were admitted to the University hospital between 1973 and 1984 for a Boerhaave's syndrome. Fourteen over eighteen were more than forty years old. Other particular features were the frequency of alcoholism (11 patients) and the lack of preexisting gastrointestinal symptomatology. The cardinal symptom, pain, occurred in 17 cases. It was preceded in 10 subjects by vomiting. Subcutaneous emphysema was only found in five patients, but standard chest X-ray showed seven times a pneumomediastinum. Pleural effusion was present in 14 subjects. Thirteen patients underwent thoracotomy: five within 48 h (1 death) and eight after 48 h (4 deaths); two further deaths were due to withholding surgery, and a third by performing bipolar oesophageal exclusion at a late stage (8th day); six of these deaths were related to local infection. The clinical and radiological features of Boerhaave's syndrome are presented in a review of the literature; particular attention is paid to the various methods of treatment.

Adult↗
PubMed1975

Antibodies to herpes simplex virus types 1 and 2: a comparative study using indirect haemagglutination in carcinoma of the cervix and in other malignant conditions.

The authors used a technique of indirect haemagglutination to compare levels of antibody to Herpesvirus simplex types 1 and 2 in groups of patients with carcinoma of the cervix, together with other malignant conditions and in comparison to controls. A significant difference in the mean titre of antibody to type 2 virus is revealed between the carcinoma group and the B controls. The significance of the antibody assays is assessed by a study of the specificity of the antibodies found and by an assay of antibody which cross reacts with Herpesvirus simplex type 1.

Adult↗