Biomedical subjects
Publications and source records attributed to A Cornil.
After a retrospective study of 17 cases of caustic intoxication in the intensive care unit, the epidemiologic, pathophysiologic, clinic and therapeutic aspects are reviewed. The following procedure is suggested: early endoscopies, abstention of any gastric lavage, corticosteroids and empiric antibiotic therapy and the most early possible introduction of a parenteral nutrition.
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We report the case of a 25-year-old woman who voluntary swallowed mercuric oxycyanide and presented an anuric acute renal failure. The treatment was classically based upon the use of chelating agents and haemodialysis. Recovery of renal function was excellent. We discuss then more widely the clinical, physiopathologic and therapeutic aspects of acute intoxication with inorganic mercury salts.
Bronchial tumors invading the mediastinum are no longer systematically regarded as inoperable. Curative surgery has produced a significant survival rate and led to the adaptation of the TNM classification. The degree of invasion of the pulmonary artery is a criterion of operability. The authors are trying to assess the role of MRI with regard to CT and DSA for the measurement of invasion. Their study deals with the prospective assessment of ten patients. The MRI examinations have been carried out with a 0.5 and 1.5 T supraconductive magnet (Philips Gyroscan). Cardiac gating has been used for acquisition. The planes of section are axial, transverse or oblique along the greater axis of the pulmonary arteries. CT examinations in 9-mm thick sections with and IV contrast injection demonstrate the contact of the tumor with the mediastinum. The digital angiograms have been taken with an intravenous injection into a vein of the bend of the elbow or into a femoral vein. Six cases have been verified at surgery. In all cases, the invasion predicted with MRI proved to be correctly assessed. In three cases, MRI provides additional information to the combined findings of CT and DSA. MRI is a good complement for the preoperative assessment of patients with large tumors invading the mediastinum but for which curative surgery is indicated.
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The thermal effects of Nd:YAG, argon, and CO2 laser beams are observed on enamel, dentin, and dental pulp by means of computerized infrared thermography and thermocouple. This study shows that the Nd:YAG laser beam deeply diffuses through the enamel and dentin to the pulp. The argon laser effects are inconsistent depending on whether the enamel surface is cleaned, but after cleaning, the superficial and deep temperatures are low. With the CO2 laser, the enamel and dentin surfaces reach very high temperatures, but only low temperatures are measured in the pulp chamber.
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The prolactin response to 200 microgram thyrotropin-releasing hormone (TRH) IV was studied in seven patients with diabetic ketoacidosis, at the start of the treatment, and again, in the same patients, five days after recovery, when the diabetes was well controlled. Normal basal prolactin concentrations and prolactin responses to TRH were found in both situations. There was no correlation between basal prolactin concentrations, or magnitude of prolactin responses to TRH, and any of the metabolic variables measured. These findings do no suggest a role for prolactin in the development of diabetic ketoacidosis.
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A 52 year old woman developed a severe encephalopathy with status epilepticus of six days duration in the terminal course of an acute hepatitis associated with hyperammonaemia and hyperventilation. Acute haemorrhagic lesions were observed in the brain, involving symmetrically both amygdala and cornu Ammonis. The sequential occurrence of these lesions with status epilepticus are discussed in the light of data from the literature.
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Adrenocortical function and plasma growth hormone pattern were investigated in 15 patients with chronic obstructive lung disease, in a period of acute respiratory failure and again after recovery. During the acute period, secretion rate and plasma concentrations of cortisol were markedly enhanced; urinary excretion of cortisol metabolites was only slightly increased, suggesting an alteration of the catabolism of cortisol under these conditions; adrenocortical sensitivity to corticotropin and capacity of maximal adrenal secretion were normal. The increase of cortisol secretion was probably due to hypoxemia and/or hypercapnia acting through the hypothalamo-pituitary axis. During the chronic phase of respiratory insufficiency, adrenocortical secretion and responsiveness were within the normal range. Finally, respiratory failure did not stimulate the secretion of growth hormone.
The authors present a series of 72 observations of septic shock. The overall hospital mortality is 51%. Aggravating factors with worst prognosis are a cirrhosis (90% mortality) and wrong antibiotics before shock occurred (88% mortality). Some therapeutic acts (cannulae, venous catheter, urinary catheter, immuno-depressing treatment) increase penetration of gram positive germs of hostipal origin. The germs account for 30% of cases, the most frequent being staphylococcus. Among gram-negative organisms, one finds colibacilli, pseudomonas and last klebsiella. Usual entrance site was respiratory (33%). On clinical grounds we found equal frequency of "warm" shock with vasodilatation (mortality 30%) and "cold" shock (mortality 67%). A certain degree of renal failure sometimes necessitating dialysis is the rule. Intravascular disseminated coagulation occurred 3 times out of 46; 13 had hemorrhage. Finally acid-base disorders were usually of the metabolic acidosis type with respiratory alkalosis. Treatment consists in restauring volemia with abundant perfusions under control of central venous and arterial pressures and diuresis. Antibiotherapy, bactericidal and with wide spectre or specific for the suspected germ, must be immediately started. Importance of surgical debridement when required is evidenced by the low mortality of those cases (2 deaths out of 12). We use steroids systematically at high dosage, intravenous. Vasoactive or tonicardiac drugs are used selectively. Their efficiency and that of steroids are not prooved. Finally a review of the literature concerning the physiopathology and treatment of septic shock and its complications is presented.
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