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Biomedical subjects

P Desjars

Publications and source records attributed to P Desjars.

At least 19 recordsLinked to original sources
PubMed2003

Fatal acute granulomatous pulmonary aspergillosis in a healthy subject after inhalation of vegetal dust.

A previously healthy 28-year-old man presented a few hours after inhalation of vegetal dust with acute bilateral community-acquired pneumonia, which caused death in 10 days despite treatment with broad-spectrum antibiotics, intravenous amphotericin B, inotropic support, and mechanical ventilation. A postmortem lung biopsy indicated miliary granulomatous pulmonary aspergillosis. Six similar previously published cases of acute granulomatous pulmonary aspergillosis are reviewed. This entity in adulthood may reveal a defect in neutrophil or macrophage function, such as late-onset chronic granulomatous disease.

Acute Disease↗
PubMed1991

[Hemodynamic effects of dobutamine in hyperkinetic septic shock treated with norepinephrine].

A prospective study of the haemodynamic effects of dobutamine was carried out in six men and four women suffering from hyperkinetic septic shock, already treated with noradrenaline and dopamine. All ten patients had septic shock, defined as a mean arterial blood pressure of less than 70 mmHg and an urine output under 15 ml.h-1, persisting despite fluid loading, associated with positive blood cultures, increased white blood cell counts, and a septic area. Initial treatment consisted in fluid loading, so as to increase cardiac output whilst keeping pulmonary wedge pressure (Ppw) between 8 and 10 mmHg. Dopamine was then added, up to a dose of 15-20 micrograms.kg-1.min-1, in an attempt to improve coronary and renal blood flows. In patients in whom this failed, the amounts of dopamine were then decreased, down to 3 micrograms.kg-1.min-1, and replaced by noradrenaline. When patients had as steady cardiac index (CI) greater than 3 l.min-1.m-2 and a systemic arterial resistance index (RsaI) of less than 1,800 dyn.s.cm-5.m-2 for more than 60 min, they were included in the protocol. Dopamine was then replaced by increasing doses of dobutamine (0, 5, 7.5, 10, 15 and again 0 micrograms.kg-1.min-1). The usual haemodynamic parameters were measured and calculated once a steady state had been obtained at each dose (within 20 to 30 min). Ppw was kept between 8 and 10 mmHg by fluid loading with a 4% albumin solution. At the beginning of the study, patients had a mean blood pressure of 78 +/- 6 mmHg, a CI of 4.8 +/- 1.5 l.min-1.m-2 and a RsaI of 1,285 +/- 341 dyn.s.cm-5.m-2 RsaI.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Adult overwhelming meningococcal purpura. A study of 35 cases, 1977-1989.

The study objective was to describe the clinical, biologic, and hemodynamic features of adult overwhelming meningococcal purpura and to examine the prognostic factors by multivariate analysis at the time of admission to the intensive care unit. Thirty-five patients (greater than or equal to 13 years of age) with meningococcal infection, circulatory shock, and generalized purpuric lesions of abrupt onset were recorded in eight intensive care units from 1977 to 1989. The patients were young (mean age, 26.6 years; range, 13 to 68 years) and had been previously healthy. The female-to-male ratio was 3:1. Mortality was 54.3%, with most deaths occurring within the first 48 hours, usually secondary to irreversible shock with multiple organ failure. Ischemic complications (eight cases), prolonged heart failure (seven cases), and secondary septicemia (five cases) were the chief complications among survivors. Initial hemodynamic study after volume loading showed low stroke volume index (mean +/- SD, 29.4 +/- 13 mL/m2) and tachycardia (mean +/- SD, 138 +/- 16 beats per minute), a profile suggesting a greater myocardial depression than usually observed in gram-negative bacillary septic shock. Univariate prognostic analysis showed that four variables at the time of admission were associated with fatal outcome: a plasma fibrinogen level of 1.5 g/L or less, a factor V concentration of 0.20 or less, a platelet count lower than 80 x 10(9)/L, and a cerebrospinal fluid leukocyte count of 20 x 10(6)/L or less. Stepwise regression analysis showed that low fibrinogen level (less than or equal to 1.5 g/L) was the sole adverse prognostic variable (odds ratio = 2, 95% confidence interval, 1.5 to 2.7). Adult overwhelming meningococcal purpura is still associated with high mortality and morbidity. Low fibrinogen level at time of admission may permit early recognition of the most severely ill patients.

Adolescent↗
PubMed1989

Norepinephrine therapy has no deleterious renal effects in human septic shock.

We investigated 25 patients (aged 20 to 70 yr) in septic shock with low systemic vascular resistance in order to assess the effects on renal function of prolonged (24 to 240 h) norepinephrine (NE) infusion (range 0.5 to 1.5 micrograms/kg.min). Two sets of renal function tests were made: a) control study before NE therapy after the initial intravascular loading and on dopamine infusion (mean dosage 14 +/- 2 micrograms/kg.min); b) in the last 24 h of NE infusion associated with dopamine (2 to 3 micrograms/kg.min). The following renal function tests were measured: urine flow rate, creatinine, osmolar and free water clearances, and fractional excretion of sodium (FENa). Data were collected only in 22 nonanuric patients: urine flow rate, creatinine, and osmolar clearance increased (p less than .001), and free water clearance (p less than .001) and FENa (p less than .02) decreased. These results suggest that NE (0.5 to 1.5 micrograms/kg.min) may be used in the treatment of human septic shock without deleterious renal effects.

Adult↗
PubMed1987

A reappraisal of norepinephrine therapy in human septic shock.

The effectiveness and safety of iv infused norepinephrine (0.5 to 1 microgram/kg X min) were evaluated in 12 hyperdynamic vasodilated septic patients, who remained hypotensive despite iv volume expansion and antimicrobial and dopamine therapy. During norepinephrine infusion, mean arterial pressure and systemic vascular resistance index increased (p less than .001) and heart rate decreased (p less than .02). Cardiac index either increased or was unchanged in ten patients and decreased slightly in the remaining two patients. Urine flow increased (p less than .01) and was more than 0.5 ml/min when a critical renal perfusion pressure was reached if renal damage was not overwhelming. We conclude that norepinephrine may improve arterial BP and urine flow when volume replacement and dopamine therapy have failed to reverse the hypotension of septic shock.

Adult↗
PubMed1985

Preoperative acute volume loading in patients with pheochromocytoma.

Ten patients with pheochromocytoma underwent preoperative acute volume loading to determine whether fluid infusion severely increased pulmonary capillary wedge pressure without improving forward flow, and to provide a guide for intraoperative volume replacement. In one patient, volume loading confirmed baseline pressure data suggesting a discrepancy between right and left ventricular filling pressures. In a second patient with normal baseline wedge pressure, volume loading revealed an unsuspected ventricular dysfunction. During subsequent surgery, both volume and speed of fluid infusion were adapted to the preoperative ventricular response.

Adrenal Gland Neoplasms↗
PubMed1985

[Preoperative vascular loading. A guide for the management of volume expansion in the surgery of pheochromocytoma].

The most acurate fluid replacement is needed for the operative management of patients with pheochromocytoma. Pulmonary capillary wedge pressure monitoring must be incorporated into routine practice for assessing left ventricular filling pressure because discrepancies between central venous pressure and left-sided filling pressure may occur, even in patients apparently free of cardiopulmonary dysfunction. The response to preoperative acute volume loading was used in 11 patients--to detect preoperatively patients in whom fluid infusion was associated with a dangerous increase in pulmonary wedge pressure without improvement in forward flow and--to provide a guide for intraoperative volume replacement. This method confirmed informations suspected from baseline pressure data in one patient: distorsion between right and left ventricular filling pressures. Furthermore it showed an unsuspected ventricular dysfunction in a second patient with normal baseline pulmonary capillary wedge pressure. Both volume and speed of operative fluid challenge were adapted to this preoperative ventricular response.

Adrenal Gland Neoplasms↗
PubMed1984

[Measurement by mass spectrometry of oxygen consumption and carbon dioxide production in mechanically ventilated patients].

The authors present a technique of VO2 and VCO2 measurements by a non invasive method in mechanically ventilated patients. Inspirated and expirated gas are sampled respectively in the inspiratory limb of the patient's breathing circuit and in a mixing chamber. Gas samples are analysed by mass spectrometry in the laboratory. Expiratory flow rate is determined by the ventilator flowmeter. To evaluate this procedure the authors have studied the stability of the inspirated and expirated gas samples and the reproductibility of measurements. In a patient with respiratory and haemodynamic stable status this method measures VO2 within 8,2% and VCO2 within 7%.

Carbon Dioxide↗
PubMed1983

[Acute hydrocephalus in tuberculous meningitis in adults].

The authors report a case of tuberculous meningitis in a young man who developed acute hydrocephalus as soon as the fifteenth day of the course of the disease. Attention is drawn to the importance of computerized tomography in investigating sudden deterioration in patients with tuberculous meningitis. Emphasis is put on the value of a shunt procedure which, in the case reported here, led to immediate improvement before antituberculous chemotherapy could have been effective.

Adolescent↗
PubMed1983

[Myxedema coma. Apropos of 8 cases].

Eight cases of hypothyroid coma observed between 1971 and 1981 are reported, and their main clinical, biological and therapeutic features described. Three out of the 8 patients died. Physiopathological and therapeutic comments are made with reference to these cases and previous reports, concerning the hypothermia, cardiac and respiratory function, hyponatraemia and the endocrine disturbances observed in hypothyroid coma.

Aged↗
PubMed1983

[Collective acute poisoning by nitrous gases].

A collective nitrous fumes poisoning (five cases) is reported. Two patients (case 3 and case 4) were comatose, in severe respiratory distress. Shock and slate blue cyanosis were noted. Physical examination and chest X ray revealed acute pulmonary edema-Methemoglobin levels were 71,3% (case 3) and 58% (case 4). Despite treatment both of them died from severe hypoxia resulting in cardiorespiratory arrest. Post-mortem examination was performed upon these four men. On admission the last one (case 5) was conscious, and in good hemodynamic condition. Acute pulmonary edema and cyanosis were present. Methemoglobin level was 37,3%. This patient recovered appropriate therapy. For case 1 and 2 acute anoxia due to methemoglobinemia seems to be cause of death. For cases 3 and 4 death is due to hypoxemia associated with pulmonary edema.

Accidents, Occupational↗
PubMed1982

[Fluid loading in the surgical care of pheochromocytoma. Hemodynamic study].

Collapse following removal of pheochromocytoma can be usually prevented by fluid loading. Fluid infusion is administered at the early beginning of the surgical procedure and is accelerated just after removal. Some authors prefer to start the fluid infusion in the preoperative period. In every cases preload measurements are of primary importance for a safely fluid administration. Problems of fluid loading in course of pheochromocytoma surgery are studied in six patients. Hemodynamic data are collected during pre, per and postoperative periods. Pre and post operative rapid fluid loading was performed in three patients in order to obtain a left ventricular function curve. Before any fluid treatment, two groups of patients are distinguished: 1) five hypovolemic patients who are about to receive 1 000 +/- 300 ml to normalize pulmonary wedge pressure, 2) one patient with high pulmonary wedge pressure and with alterated myocardial performance observed during rapid fluid loading. Combined use of sodium nitroprusside and fluid loading allowed to control hypertensive accesses and preload elevations and to prevent collapse following tumor removal. Hypovolemia and myocardial lesions are not necessarily present in all cases of pheochromocytoma. The routine use of a pulmonary artery catheter is warranted to improve cardiac pump function by combined fluid and vasodilator management.

Adrenal Gland Neoplasms↗
PubMed1981

[Sodium nitroprusside in ischaemic complications of acute ergot poisoning (author's transl)].

Various treatments have been tried against ischaemic complications of acute ergot poisoning, but no definite therapeutic approach based on a sufficient number of cases has yet been proposed. The mechanism of vascular spasm, the action of sodium nitroprusside and the good results obtained in 7 cases reported in the literature and in 2 personal cases have prompted the authors to suggest the use of this drug as first-choice treatment in these patients.

Acute Disease↗
PubMed1981

[Anaphylactoid shocks induced by infusion of a modified gelatin. Six cases (author's transl)].

One of these shocks occurred in course of a rapid infusion in a patient in whom catheters were previously inserted. So, an hemodynamic study was possible. This study shows a peripheral vasodilatation leading to a decrease of preload and cardiac output, and finally to a systemic hypotension which generally raises the alarm. These cases are the first anaphylactoid shocks reported after an infusion of modified gelatin. They demonstrate the general risk of anaphylactoid shock with all types of colloids.

Adult↗