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Biomedical subjects

P Charbonneau

Publications and source records attributed to P Charbonneau.

At least 19 recordsLinked to original sources
PubMed1999

Elective laparoscopic management of sigmoid diverticulitis. Results in a series of 110 patients.

BACKGROUND: The aim of this study was to evaluate the results of elective laparoscopic treatment of sigmoid diverticulitis. METHODS: Between November 1991 and February 1998, 110 patients were treated by elective laparoscopic colectomy for sigmoid diverticulitis. The main data recorded were postoperation pain, return of bowel function, operation time, duration of hospital stay, and early and late complications. RESULTS: Mean age of patients was 63 years (range, 36-83 years). Nine patients (8.2%) required conversion to laparotomy because of severe adhesions, inflammatory process, or obesity. The mean operation time was 167 min. Return of bowel function was 2.3 days. Mean postoperation stay was 8.2 days. There was no perioperation death, and the morbidity rate was 7.3%, with two complications related to the laparoscopic approach (1 trocar site bowel incarceration and 1 small bowel fistula). Of the patients with complications, four (3.6%) needed reoperation. During the follow-up (6-79 months), no incisional hernia was observed. CONCLUSIONS: Laparoscopic colectomy for sigmoid diverticulitis is feasible and safe in more than 90% of cases. Benefits of the laparoscopic approach are the improved early postoperation course and the reduction of parietal sequelae.

Adult↗
PubMed1998

Evaluation of laparoscopic management of common bile duct stones in 220 patients.

BACKGROUND: The aim of this study was to evaluate the feasibility and results of laparoscopic management of common bile duct stones (CBDS). METHODS: From October 1990 to November 1996, 220 patients with CBDS have been managed laparoscopically. CBDS were suspected or diagnosed preoperatively in 130 patients (59.1%) and at intraoperative cholangiography (IOC) in 90 patients (40.9%). A transcystic duct extraction (TCDE) was attempted in 112 patients and a primary choledochotomy in 108 patients. RESULTS: TCDE was successful in 77 cases (68.8%). The 35 failures were treated by 29 laparoscopic choledochotomies, 1 intraoperative and 5 postoperative endoscopic sphincterotomies (ES). A choledochotomy was thus performed in 137 cases and was successful in 133 cases (97.1%). The four failures were managed by three laparotomies and one postoperative ES. The overall success rate was 95.5% (210/220). There was 4 deaths (0.9%) within the 1st postoperative month in ASA 3 patients and the morbidity rate was 9.1% (20/220). There were 7 residual stones (3.2%). CONCLUSIONS: Laparoscopic desobstruction of CBDS appears to be safe and effective and has the advantage to be a single-stage procedure. It could become in the future with refinement of instrumentation and skill of surgeons the best treatment for the majority of patients harboring CBDS.

Adult↗
PubMed1997

[Results of laparoscopic treatment of diverticular sigmoiditis. Apropos of 85 cases].

The authors report their experience of laparoscopic management of sigmoid diverticulitis in 86 patients operated from november 1991 to december 1996. Out of them, 9 patients in whom sigmoiditis was revealed by an acute complication underwent an emergency procedure and 76 patients were operated electively. The mean hospital stay was 9.2 days (range 5 to 15 days) and the mean time of passage of flatus was 2.4 days. Benefits of laparoscopic management of sigmoid diverticulitis consist of improvement of early postoperative course and absence of abdominal wall sequelae. The decrease in mean hospital stay in not significant except for patients who underwent an emergency procedure.

Adult↗
PubMed1994

Teicoplanin: a well-tolerated and easily administered alternative to vancomycin for gram-positive infections in intensive care patients.

A prospective, randomized multicentre study was conducted in order to evaluate the potentially superior tolerability profile of teicoplanin plus netilmicin compared with vancomycin plus netilmicin in patients in ICUs. We considered that these glycopeptides have been shown to have comparable efficacy and that comparative tolerability is of paramount importance, particularly in severely ill patients. A total of 56 patients were enrolled into the study (36 males and 20 females). Twenty-four patients were included in the teicoplanin plus netilmicin group (15 males, 9 females: mean age 56.8 years). The mean simplified acute physiological score (SAPS) was 9.4 (range 4-20). Thirty-two patients were randomized to receive vancomycin plus netilmicin (21 males, 11 females; mean age 56.4 years). The mean SAPS was 9.3 (range 2-16). Septicaemia was the most common infection (14 cases in each group). Most infections were caused by Staphylococcus aureus or coagulase-negative staphylococci. The mean daily doses were: for teicoplanin, 457 mg (6.7 mg/kg); for vancomycin, 1678 mg (24.4 mg/kg); and for netilmicin 263.3 mg (3.9 mg/kg) in the teicoplanin group and 248 mg (3.8 mg/kg) in the vancomycin group. The trough levels of teicoplanin in the serum remained mostly between 7 and 10 mg/l, while more fluctuation was seen in patients receiving vancomycin. The mean trough levels of netilmicin in the serum were 1.2 (SD 0.9) mg/l in the teicoplanin group, compared with 1.7 (SD 1.4) mg/l in the vancomycin group (NS: p > 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Review of piperacillin/tazobactam in the treatment of bacteremic infections and summary of clinical efficacy.

One method of resistance to beta-lactam antimicrobials involves production of beta-lactamases, enzymes that render the beta-lactam ineffective. Beta-lactamase inhibitors have been combined with beta-lactam antibiotics to combat beta-lactamase producing organisms. One such agent, piperacillin/tazobactam, has been shown to be safe and effective therapy for infections usually treated with a combination of antibiotics such as polymicrobial and nosocomial infection, and has been used for empiric therapy in cases of serious infection. A survey of the literature shows that piperacillin/tazobactam is a safe and efficacious therapy for bacteremia as well as soft tissue, intra-abdominal, and lower respiratory tract infections. When combined with an aminoglycoside, it is also useful in the treatment of severe nosocomial respiratory infections.

Bacteremia↗
PubMed1993

[Extrapulmonary and disseminated pneumocystosis in HIV infection].

Three cases of extrapulmonary disseminated Pneumocystis carinii infection are reported. All 3 patients had HIV infection with less than 50 CD4 lymphocytes per cubic millimeter and were having aerosols of pentamidine as prophylactic treatment of pneumocystosis. P. carinii may invade numerous organs and in particular the liver, spleen and bone marrow. Extrapulmonary lesions, often pan-symptomatic, are to be feared in deeply immunodepressed patients receiving prophylactic aerosols of pentamidine. Infection of the choroid can be detected by systematic ophthalmoscopy. An early diagnosis raises hopes of a good, if temporary, response to treatment.

AIDS-Related Opportunistic Infections↗
PubMed1992

Detection of enteroviruses in endomyocardial biopsy by molecular approach.

Enteroviruses are considered to be the most common agents implicated in myocarditis and cardiomyopathy. Recent studies have suggested persistent enterovirus infection in chronic disease showing the presence of enteroviral RNA in the myocardium. We used gene amplification by PCR which can demonstrate directly the presence of enteroviral sequences in endomyocardial biopsies. The primers were chosen in the 5' non-coding region of the genome representing highly conserved sequences among enteroviruses and therefore allowed the amplification of the majority of enteroviruses. The hybridization of the amplified products was effected with specific general riboprobe derived from 5' non-coding sequences internal of the amplified fragments. The results include 105 patients distributed in 6 groups: 45 idiopathic dilated cardiomyopathies with 66.7%, 17 alcoholic cardiomyopathies with 52.9%, 10 myocarditis with 30%, 5 multifactorial cardiomyopathies with 40%, 5 patients with immunosuppressive therapy with 100%, and 23 control group without viral etiology with 39.1% positive samples. The study suggested a positive link between viral infection and cardiomyopathies, but did not allow a direct relation between enterovirus infection and idiopathic dilated cardiomyopathy to be established.

Adolescent↗
PubMed1991

[Thrombotic thrombocytopenic purpura. A case diagnosed by MRI].

A 67-years old woman developed sudden headache and transient vertigo. One week later, left arm paresis appeared and the patient became comatose. Investigations showed thrombocytopenia with hemolytic anemia and the presence of numerous irregularly contracted red cells (schizocytes). This was consistent with the diagnosis of thrombotic thrombocytopenic purpura. As focal neurological manifestations and widespread mental changes were still present when she emerged from coma, magnetic resonance imaging was performed showing numerous small infarcts in the white and grey matters.

Aged↗
PubMed1990

[Syndrome of multiple organ failure].

The multiple organ failure syndrome (MOF) is a relatively new entity defined as the successive occurrence of respiratory (ARDS), hepatic, renal, myocardial, gastro-intestinal or neurological failure in patients with hyperkinetic haemodynamic and hypermetabolic states. The etiologies are: infection, septic and non-septic shock, burns and multiple injuries. The MOF syndrome is considered to be a generalised "inflammatory reaction" to tissue aggression involving a cascade of mediatory factors (TNF, interleukines...) of macrophagic, lymphocytic origin, causing multiple organ failure. The treatment depends on early correction of cellular hypoxia related to circulatory disturbances, nutritional support, anti-infective therapy and, in the near future, "control of mediator activity" (immunotherapy).

Antibodies, Monoclonal↗
PubMed1990

[Computer and acid-base disorders].

The diagnosis of acid-base disorders has been subject to computerised analysis for many years. Expert systems, an application of artificial intelligence, have been validated. They are of help to clinical decision making, enabling the different diagnostic possibilities of given acid-base and hydro-electrolytic situations to be evaluated and appropriate therapy to be instituted. Computer networks improve the transmission of laboratory results to the intensive care units and the integration of data facilitates the monitoring of biochemical tendencies. Computers can also be used for teaching acid-base physiology and pathology.

Acid-Base Imbalance↗
PubMed1989

[The cost of hospital acquired infections].

Two complementary studies were carried out. a) A three months study on nosocomial infection frequency, with a simultaneous assessment of the nosocomial infection risk factors (infected or non infected body on entry in the department, the kind of pathology, simplified scores of seriousness) and of the length of the hospital stays to compare the average length of stay for overinfected patients and for nosocomial infection non contaminated patients, after checking those factors through adjustment, themselves responsible for a prolongation of the stays. b) An evaluation of the cost of the sole antibiotics used in the treatment of a Serratia nosocomial infection epidemic which developed in the department. The quantitative and qualitative analysis of each case was made by the prescribing doctor in order to attribute its proper costs to each case. Over a three months period, 112 patients were considered as presenting a risk of nosocomial infection, which means that they were hospitalized in the department for more than 48 hours. Twenty two nosocomial infection carriers were examined; they represented 38 cases of overinfection. The length of stay was of 10.3 days among the non carriers of nosocomial infection, and of 32.4 days among the overinfected patients, but more interesting is the figure of 13.2 days per case. Over a year, it thus amounts to 1,950 hospitalization days due to nosocomial infections, which corresponds, in a department of 24 beds, to an average of 5 beds occupied permanently. Besides, the antibiotic for the 12 Serratia nosocomial infection carriers was evaluated to a cost of F. 75,000.

Costs and Cost Analysis↗
PubMed1989

[Detection of nosocomial infections: a proposal of a protocol for a prospective study].

If meant to be effective, the detection of nosocomial infections demands considering the means that should be used for a daily gathering of necessary complete information. An experiment led in a medical intensive care unit have suggested the elements of such a gathering work. This must be prospective and aimed to relate the frequency, more that the importance of nosocomial infections. It will be carried by a willing and specialized nurse, and will be limited to the necessary warning signs only. As a rule, the information linked to the infection causes will not be looked for. Finally, a special care will be given to ensure a good feedback to the clinician, which is the main purpose of that work. Yet, such an information gathering protocol has to be flexible, and it is even one of its survival conditions regarding the variety of means and requirements inherent of each department.

Clinical Protocols↗
PubMed1988

[Postoperative hypoglycemia after excision of pheochromocytoma. A case].

A case of hypoglycaemia consecutive to excision of a bilateral phaeochromocytoma in a 33-year old patient with Sipple's syndrome is reported. The severity of the hypoglycaemia (1.3 mmol/l) accounted for the brain lesions which ultimately resulted in the patient's death. Eight cases of hypoglycaemia occurring in similar circumstances have been published. The condition is due to the massive release of insulin during the hours that follow removal of the tumour. This results in the persistence of the peri-operative hyperglycaemic stimulation and in the suppression of the previous inhibition of insulin secretion due to alpha-adrenergic stimulation of catecholamines in the beta-cells of Langerhans' islets.

Adrenal Gland Neoplasms↗