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Biomedical subjects

T Poirier

Publications and source records attributed to T Poirier.

13 recordsLinked to original sources
PubMed1998

The use of a selective axillary nerve block for outpatient hand surgery.

UNLABELLED: Although no guidelines concerning discharge criteria after axillary plexus block are available, many institutions consider recovery of motor function as a critical factor. With the midhumeral approach, the four main nerves of the upper extremity can be blocked separately using a peripheral nerve stimulator. The aim of this double-blind study was to block the radial (R) and musculocutaneous (MC) nerves with lidocaine, and the median (M) and ulnar (U) nerves with bupivacaine to recover motor function of the elbow and wrist more rapidly while maintaining long-lasting postoperative analgesia at the operative site. Patients undergoing surgery for Dupuytren's contracture were randomized into two groups in a double-blind fashion: in the control group (n = 17), each of the four nerves was infiltrated with 10 mL of a mixture of 2% lidocaine and 0.5% bupivacaine, whereas in the selective group (n = 17), the R and MC nerves were blocked with 10 mL of 2% lidocaine each and the M and U nerves were blocked with 10 mL of 0.5% bupivacaine each. Recovery of motor block was significantly faster in the selective group (231 +/- 91 vs 466 +/- 154 min). However, time to first sensation of pain was not different between groups (707 +/- 274 vs 706 +/- 291 min). In conclusion, this new approach at the midhumeral level enables the anesthesiologist to selectively administer local anesthetics on different nerves. IMPLICATIONS: In outpatients undergoing surgery for Dupuytren's contracture, a midhumeral block was used with the musculocutaneous and radial nerves blocked by lidocaine and the median and ulnar nerves blocked with bupivacaine. Recovery of motor function and time to discharge were shorter compared with patients who received the mixture on all four nerves.

Ambulatory Surgical Procedures↗
PubMed1993

[Nosocomial Aeromonas hydrophila pneumonia complicating toxic coma].

A 24-year-old male homosexual drug addict was admitted in coma and circulatory failure after a 10 g overdose of acebutolol. The usual resuscitative measures were undertaken, together with administration of adrenaline and gastric lavage. Six hours of external cardiac massage and pacing, and high catecholamine doses (36 mg.h-1 of adrenaline and 60 micrograms.kg-1 x min-1 of dobutamine) were required before the circulatory system became again spontaneously efficient. After this acute episode, the patient improved despite acute tubular necrosis. On the third day, bilateral alveolar and interstitial lesions were found on the chest film. Bronchoalveolar lavage and protected distal brushings were carried out. Both Aeromonas hydrophila and Staphylococcus aureus were found in the cultured brushings. Treatment with ceftriaxone, vancomycin and amikacin was introduced. This nosocomial pneumonia was very haemorrhagic, resulting in several bloody casts responsible for several episodes of atelectasis. The patient was definitely extubated on the 18th day, and left the ICU 23 days later without any sequela. His HIV status was negative. Four other infections with the same strain of Aeromonas hydrophila occurred at the same time as this patient's. The common source for this germ was found to be soft water. Several measures have since been undertaken: removal of a centralized water softener, filtration and higher chlorine content in the water circuit, and updating of intensive care protocols for disinfection of equipment.

Acebutolol↗
PubMed1992

[The effect of a combination of propofol and fentanyl on cerebral blood flow. A study using transcranial doppler].

The results of the association propofol fentanyl on the velocity of the middle cerebral artery were studied by means of a transcranial doppler on twenty ASA I patients without any intracranial pathology. Anaesthesia induction by propofol (2.5 mg.kg-1) and fentanyl (2 micrograms.kg-1) induced a significant fall of average velocities (p: 0.0001) and an increase of the resistance index (p: 0.0001) without any associated variation of mean blood pressure and CO2 expiratory fraction. These results corroborate the variations of cerebral blood flow and cerebral vascular resistances reported in the literature and give evidence, in all probability, of a cerebral autoregulation phenomenon.

Adolescent↗
PubMed1991

[Primary Salmonella brandenburg peritonitis in a non-immunosuppressed female patient].

Primary peritonitis is rare; the bacteria involved are mainly, by order of frequency: Escherichia coli, Streptococcus pneumoniae, and the other streptococci. Extraintestinal sites of minor salmonellosis are exceptional, although they are constantly progressing, especially since the spread of the HIV-induced epidemic. We report one case of primary Salmonella brandenburg peritonitis, whose mechanism could not be explained, in a non-immunodepressive female patient.

Female↗
PubMed1990

[Pleural symphysis with tetracyclines for pneumothorax. The value of thoracic peridural analgesia].

The aim of this study was to assess the value of peridural thoracic analgesia (ATP) to prevent pain observed during pleural symphysis with tetracycline (STP) for pneumothorax (PNO). 12 patients (age 27 +/- 6 years) having a spontaneous PNO benefited from 13 SPT (1 gm, tetracycline diluted in 60 cc of normal saline) under cover of an APT (at the D5-D6 level) with Fentanyl (0.1 mg) and Bupivacaine 0.5% adrenalin (1 mg/kg). The protocol was used on three successive days. Repeated determinations of blood bupivacaine levels were performed in 9 patients on the first day. No patient had an intolerable pain which required injection of parenteral morphine and/or an interruption of the protocol. For two patients (one of them having a right symphysis and then a left symphysis one month later) the treatment sessions to achieve a symphysis were totally painless. 10 patients experienced moderate pain, mainly on the first day, which was relieved by reinjection of peridural bupivacaine (25 mg) (n = 9) or by the parenteral injection of non morphine analgesia (n = 1). No patient had a respiratory depression, collapse or bradycardia. The blood bupivacaine levels were always significantly less than the toxic levels (1.6 mg). The results observed suggest that APT, (Fentanyl and Bupivacaine) is an effective method, non toxic and well tolerated for the prevention of intolerable pain which is seen in SPT for PNO.

Adult↗
PubMed1988

Protective and autoimmune epitopes of streptococcal M proteins.

Several rheumatogenic serotypes of streptococcal M protein have been shown to contain both protective and cardiac tissue crossreactive epitopes. By synthesizing peptides copying different regions of M protein polypeptides, we were able to localize the protective and heart crossreactive epitopes. Some epitopes are only opsonic, some are only crossreactive, whereas others are both opsonic and tissue crossreactive. Multivalency of vaccines can be obtained by synthesizing protective peptides of one M serotype in tandem with protective peptides of other M serotypes. Such hybrid peptides evoke protective immune responses against the related streptococci without evoking tissue crossreactive immunity.

Animals↗
PubMed1987

[Theophylline overdoses on admission to a resuscitation unit].

The aim of this study is to assess in a prospective fashion the causes and the frequency of overdosage with Theophylline on admission to intensive care units, in patients on long term treatment with oral Theophylline and/or had previously received an intravenous injection (IV) of Aminophylline. In 72 patients [52 chronic airflow obstruction (or BPCO), 21 asthmatics] admitted for acute respiratory insufficiency (IRA) the blood level of Theophylline on admission to intensive care (T0) was determined systematically, and was in the toxic range (greater than 29 mg/l) in 17% of cases (12/72). In patients with T0 greater than 20 mg/l, repeat measurements of Theophylline clearance were carried out: 12 hours after admission by studying the fall in plasma levels (Cl1), then after 8 days (+/- 5) while perfusing IV Aminophylline at a constant flow (Cl2) and finally after changing over to slow release oral Theophylline 18 days (+/- 10) after admission (Cl3). Cl1 was less than 35 ml/kg/h in 9 patients (group I) and greater than 55 ml/kg/h in 3 patients (group II). All the patients in group I were on oral Theophylline in a dose which was not excessive (mean 10.6 +/- 3.3 mg/kg/24 h) and only one patient received an injection of IV Aminophylline. In group I, the clearance of Theophylline was very low initially (Cl1 = 18.6 +/- 9.6 ml/kg/h) and finally rose (Cl2 = 34.7 +/- 14 ml/kg/h p less than 0.02; and Cl3 = 46.9 +/- 24 ml/kg/h p less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1985

[Spontaneous rupture of the spleen during the development of chronic pancreatitis. One case].

Spontaneous rupture of the spleen is a relatively rare occurrence during the course of chronic pancreatitis. The physiopathology remains imprecise and mechanical factors are associated with pancreatic enzyme diffusion and vascular changes in explaining its aetiology. The diagnosis is difficult since it often mimics an acute exacerbation of pancreatitis or even actual acute pancreatitis when the existence of the pancreatic condition is not previously known. Abdominal echotomography or peritoneal puncture-lavage and, now, CAT scanning are the key factors in reaching the diagnosis.

Adult↗