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Biomedical subjects

S Mérat

Publications and source records attributed to S Mérat.

11 recordsLinked to original sources
PubMed2005

[Organization of an operational site. Comparison of the durations of intervention planned and real].

OBJECTIVE: To improve planning of our operational site by comparing the durations of intervention scheduled by the surgeons and the real durations of occupation of room of intervention, surgical procedure and surgical operation. STUDY DESIGN: Prospective study carried out of December 8, 2003 to February 27, 2004. PATIENTS AND METHODS: Anaesthetic and surgical times of the interventions of visceral and gynaecological surgery were raised. From these data several durations were calculated like the duration of occupation of the room of intervention, surgical procedure and surgical operation. These durations were compared with the durations envisaged by the surgeons to carry out the planning of the operational activity. RESULTS: Two hundred and ten interventions were studied. The analysis showed that there was a significant difference between the duration planned and the real duration of occupation of the room of intervention 45 minutes [5-125] (p<0.0001). The duration planned corresponded with duration of surgical operation, duration which did not take into account anaesthetic induction and surgical installation. CONCLUSIONS: The effectiveness of the planning of an operational site depends on the exactness of the durations scheduled, which are used for its realization. It is significant that all the actors of the operating theatre suite use the durations closest to reality.

Appointments and Schedules↗
PubMed2004

[Anaesthesia and amiodarone-associated hyperthyroidism].

Amiodarone can induce severe hyperthyroidism that justifies its withdrawal and initiation of antithyroid drugs. Impossibility to stop amiodarone, failure to control hyperthyroidism and unfavourable evolution can lead to thyroidectomy. Cardiac manifestations, persistence of hyperthyroidism and interactions between amiodarone and anaesthetic or haemodynamic drugs may contraindicate anaesthesia. We report nine consecutive cases of amiodarone-associated hyperthyroidism that prompted us to perform thyroidectomy under general anaesthesia. The features and anaesthetic data of patients were noted. The antithyroid medical treatment failed in all patients. After thyroidectomy, evolution was favourable in all nine cases, without any intra or postoperative complication, in spite of the extent of hyperthyroidism and the severity of the associated cardiac problems. Despite potential high risks, thyroidectomy for amiodarone-induced hyperthyroidism does not seem to increase morbidity or mortality and allows a quick return to euthyroidism and reintroduction of amiodarone.

Adult↗
PubMed2003

[Acute poisoning by chemical warfare agent: sulfur mustard].

OBJECTIVE: To review story, mechanism of action, clinical and therapeutic bases of a sulfur mustard poisoning, by accidental, terrorism or war exposure. DATA SOURCES: References were obtained from computerised bibliographic research (Medline), from personnel data (academic memoir, documents under approbation of the National Defense Office) and from the Library of Military Medical Service. DATA SYNTHESIS: Sulfur mustard is a chemical warfare agent with peace time results: leak, accidental handling, acts of terrorism. Sulfur mustard is a vesicant agent, an organochlorine agent, who alkylate DNA. Under liquid or gas form its main target are skin and lungs. Clinical effects are like burns with loss of immunity, with respiratory failure, ophthalmic, gastrointestinal and haematological signs. The last studies have improved knowledge about the mechanism of action, detection, protection and treatment. Methods for determination of sulfur mustard are based on gas chromatographic method and mass spectrometry. During sulfur mustard contamination the first priorities of treatment are to remove victims from the contaminated place and to initiate decontamination. Emergency workers and materials must take protection to avoid secondary contamination of emergency unit. With treatment of vital functions and respiratory failure, the new ways of treatment are about N-acetyl cysteine for lung injury, poly (ADP-ribose) polymerase inhibitors, calmodulin antagonists and Ca(++) chelators. Interactions between sulfur mustard and anaesthetic agents are not well known and are based on clinical observations. CONCLUSION: Emergency care unit can be confronted with sulfur mustard during accidental contamination or acts of terrorism. First and most efficacy priorities of treatment are to remove and to decontaminate victims. New means of detection and treatment are studied since several years but are not still appropriate to human victims or mass treatment.

Alkylating Agents↗
PubMed2002

[Severe pneumococcal meningitis and ceftriaxone allergy].

We report the case of a 51-year-old man with an allergy to amoxicillin/acid clavulanique who presented with Streptococcus pneumoniae meningitis. Initial treatment consisted of an association of antibiotics including ceftriaxone. Six days after treatment was initiated the patient developed skin reaction and the diagnosis of allergy to ceftriaxone was established by the dosage of specific IgE. Typically Streptococcus pneumoniae meningitis is treated with vancomycin and a third-generation cephalosporin. This association had to be modified because cross allergy to cephalosporins could have developed in this patient who had previously reacted to penicillins.

Ceftriaxone↗
PubMed2002

[Paraplegia and the sitting position].

The sitting position in neurosurgery may lead to complications such as air embolism and neurological complications. We report the case of a 16-year-old male who suffered from post-operation paraplegia after surgery for Arnold Chiari disease. This patient had several risk factors and serious morphological spinal abnormalities. We propose to include monitoring of somatosensory evoked potentials (SSEP) during this surgery in order to detect this type of devastating incident.

Adolescent↗
PubMed2001

[BIS monitoring may allow the detection of severe cerebral ischemia].

PURPOSE: To show that the bispectral index (BIS) is not only a monitor of the depth of anesthesia but that acute decreases of the index may be related to severe cerebral ischemia. CLINICAL FEATURES: Several clinical observations suggest that an unexplained fall of the BIS may be the result of cerebral ischemia. Somatosensory evoked potentials decreased in parallel to the decrease in BIS during carotid clamping in a 58-yr-old patient undergoing carotid endarterectomy. In a 62-yr-old patient undergoing resection of an aortic aneurysm, the BIS decreased from 40-50% to 8% as the cardiac index and central venous O(2) saturation decreased. The BIS returned to normal values when the low cardiac output was corrected pharmacologically. CONCLUSION: While the BIS is a well accepted monitor of the depth of anesthesia, several factors, unrelated to anesthesia, can modify the index. Thus, to adjust the level of anesthesia based solely on the BIS could be inappropriate. While the sensitivity and specificity of the BIS for this indication have not been determined, we suggest that the BIS may be useful to detect severe cerebral ischemia.

Brain Ischemia↗
PubMedDate not supplied

[Methemalbuminnemia after massive hemolysis during blackwater fever].

We report a case of blackwater fever with brown plasma due to the presence of methemalbumin. The discovery of plasma with this color is a rare event at the laboratory. This compound appears during intravascular hemolysis or hemorrhagic pancreatitis when the ability of haptoglobin and hemopexin to bind free hemoglobin has been exceeded. In these cases some of heme is oxidized to hematin and taken up by serum albumin to form an albumin-hematin complex called methemalbumin. The major clinical problem is to evoke the diagnosis of methemalbuminemia and not confuse with methemoglobinemia. In our case, methemalbumin was detected and quantified using a scanning spectrophotometer. Its diagnostic and clinicals consequences are discussed.

Anemia, Hemolytic↗