Gemcitabine-associated diffuse alveolar hemorrhage.
Explore the source record for details and available documents.
Aged↗
Biomedical subjects
A Neidhardt
Publications and source records attributed to A Neidhardt.
[Emergency neurology consultations in the university hospital setting: contribution of the neurologist to inpatient management].
While outpatient management for chronic neurological diseases is well-established, the impact of inpatient neurological examination in emergency room and university hospital remain largely underestimated. We prospectively studied the role of the neurologist in patient management, in a primary care university hospital. Over a period of 12 months, we prospectively recorded the demographics of patients requiring examination in the emergency room, the initial suspected neurological diagnosis of the emergency room, the final diagnosis of the neurology team, and the patients' outcomes. For each patient, the time between admission, the call and the neurological examination were recorded. Neurological examinations were performed in 2220 patients in whom 75.6 p.100 were performed in the emergency room. These latter patients corresponded to 14 p.100 of all patients admitted in the emergency room. Of examined patients, 52 p.100 were male and mean age was 56.9 +/- 21 years. The time between admission and examination was 32 min. (+/- 36 min), irrespective of the day of the week, and depended on the suspected diagnosis: shorter in stroke and status epilepticus (p<0.05), and longer in loss of consciousness and vertigo (p<0.01). Forty-four percent of the examinations took place in the evening and night. The reasons for examinations were: stroke (28.3 p.100), epilepsy (17.7 p.100), headaches (8.4 p.100), loss of consciousness (7.9 p.100), cognitive dysfunctions (4.1 p.100), neuropathies (4 p.100) and miscellaneous (8.1 p.100). Neurological examinations modified neurological diagnosis and treatment in more than 86 p.100 of the patients. Following neurological examination, 17.2 p.100 of the patients were able to go home, while the rest were admitted to the stroke unit (27.2 p.100), the general neurological unit (27.3 p.100) or in other departments (28.3 p.100), of which intensive care unit (5.3 p.100) or neurosurgery (5.9 p.100). Emergency neurologic examination improves neurological diagnosis and has a positive impact both on treatment and, more globally, in patient management.
Consultants↗
Oxygen toxicity and tolerance.
Normobaric oxygen toxicity is well described in all animal species. However susceptibility to oxygen exposure is highly variable according to age, species and strains. Similarly in humans, prolonged high oxygen exposure is reported to induce cough, shortness of breath, decrease vital capacity and increase alveolo-capillary permeability. The toxic FIO2 threshold (length of exposure and level) is still debated. In patients with previous lung injury, this threshold is even more difficult to delineate as pathologic pulmonary lesions might result from hyperoxia or primary lung insult. Oxygen free-radicals play a key role in the pathophysiology of oxygen toxicity. Oxygen resistance or tolerance is obtained with intraperitoneal, intravenous and intratracheal endotoxin or cytokines administration. Previous exposure to high oxygen concentration is also reported to increase survival rate and decrease pulmonary lesions in animal models. Protection may rely on antioxidant enzymes synthesis, nitric oxide production, neutrophils recruitment and modulation of alveolar macrophages activity. In humans, oxygen tolerance might be suspected through several clinical studies reporting favorable outcome after long term-oxygen exposure. Better knowledge of the risks of prolonged high oxygen exposure is important to re-evaluate the goals of mechanical ventilation (FIO2, SaO2, PEEP) and/or to develop treatments to prevent oxygen toxicity (surfactant, antioxidant enzymes).
Animals↗
[Inhalation anesthesia in unusual situations: the Eole 2 NA ventilator].
The volumetric ventilator Eole 2 NA has been adapted to work as an anaesthesia machine with low flow or closed system. This modified device is very easy to use in exceptional situations: because of its strength and reliability; its favorable quality/price ratio; versatile electrical supply: mains (220 volts) or 24 D.C.V. from internal battery (2 hours autonomy) or external battery (8 hours autonomy); gas economy: less than 1 L.min-1 of fresh gas flow, whether O2/N2O = 0.5 L.min-1 of each gas or 1 L.min-1 delivered by an oxygen concentrator. Clinical trials are discussed.
Anesthesia, Inhalation↗
[Is the malleable mattress harmful for the spinal cord?].
When the inside pressure of mouldable mattress is lowered isotropic deformation can be harmful for spinal cord. The axial force is measured placing stress gauge in a metallic manikin and in corpse (T2-L1), then on the cephalic top of volunteers. When soles and head are included in an usual mattress, during the retraction stress values raise up to 484 N at 262 mbar for manikin, to 150 N at 315 mbar for corpse, to 102 N at 310 mbar for cephalic top of the volunteers. In comparison, a prototype was tested. Results were improved on metallic models but not on human corpses or volunteers. This test allowed us a better understanding of the mechanism of the stress. It is possible to propose precautionary measures during patient immobilization (to provide a space between soles, head and mattress) and to build a new stressless mattress.
Beds↗
[A multifunctional anesthesia device: the K circuit].
A practical versatile anaesthesia device is described. An electrical pump provides room air to carry anaesthetic vapours. O2 can also be added if desired. Energy is supplied either by built-in batteries (12 volts = autonomy 6 hours) or external electric mains (12-30 volts or 220 alternative volts). The optimal recommended anaesthetic circuit is the Modified D Mapleson Circuit for economy in oxygen and anaesthetic vapours (for an adult only 6 l are needed). A non-rebreathing circuit can also be used: so draw-over ventilation or the use of an auto-inflating bag are possible when no electric power is available. If mechanically controlled ventilation is necessary, a specific ventilator can be adapted. This apparatus has already been manufactured and is very practical on the battle field or in developing countries.
Accidents↗
[Choice of respirators for anesthesia].
Criteria of quality of gases and vapours supply, ventilator, patient's circle circuit and monitoring devices are recalled to help the anesthetist to choose his anesthesia machine. Advantages of compact or modular apparatus are discussed. Four, now wellknown, anesthesia machines (modulus II+, Siemens 900 D+SAC985, Roche Kontron 4300 and Engstrom Elsa) were analysed in clinical controlled ventilation and in simulated spontaneous ventilation to study the imposed work of breathing. Results are discussed with regard to safety rules and to ergonomics, bearing in mind their respective prices. Comparison is made with an original "bisontin" prototype.
Anesthesia, Inhalation↗
[Automatic measurement of blood pressure: limits of oscillometric technique].
Non invasive blood pressure (NBP) measures are currently used in anesthesiology. The accuracy of this oscillometric technic has been tested with healthy patients, but not often with a wide pattern of pathology. The aim of this study is to point out the reliability of NBP during vascular surgery with patients suffering from arterial disease and atherosclerosis. It compares outcome with simultaneous catheter arterial blood pressure measurement (template technic). In this conditions, oscillometric method underestimates the systolic pressure value, and overestimates the diastolic one. The higher the level of arterial pressure is, the larger is the difference between this methods. It is clear that the automatic oscillometric technic is not so reliable if hypertension or atherosclerosis disease occurs. In order to improve this technic, automatic measures must take in account the degrees of arterial rigidity in its outcome.
Automation↗
[Considerations on the monitoring of soda lime. Consideration technique].
The choice of ethyl violet as a pH indicator in soda lime is not the best. Color change happens too late because pH alteration of the surface of soda lime is slower than in the core of the canister. Clinical and comparative measurement of wall temperature of two in series canisters is a good precaution. If the down stream canister is warmer than the upstream one, you must change the latter.
Anesthesia, Closed-Circuit↗
[High frequency jet ventilation in heated gas saturated in water vapor without a reserve of medical gas under pressure. An original method].
A prototype of high frequency jet ventilator is compared with a classic device: Gambro Soxijet ventilator. The advantages of the prototype are: no need of pressured medical gas; warming and saturated moisture of the gas. A powerful compressor (2 M3.H-1 flow--3 bar pressure) draws up the moistened and warmed gases and injects them into a double pneumatic capacity. The first capacity is pressure limited by a relief valve (3 bar). Exhausted gases flow back to the pump. A miniature pressure regulator, placed between the two capacities, rules the driving pressure. Gas mixture is injected through a solenoid valve controlled by an electronic twin-timer. Results of both devices are similar. However, our prototype seems to be very convenient for developing countries where medical gases under high pressure are not often available.
Developing Countries↗
[An analgesic strategy for tympanoplasties].
UNLABELLED: After induction with vecuronium, etomidate and then isoflurane or enflurane, nitrous oxide, useful at the beginning of tympanoplasty is washed out before the end of operation. So barotrauma on the graft is avoided. In the expectation of analgesia insufficiency, alfentanil is infused intravenously all over the operation period following two modes: constant flow mode (1.25 micrograms.kg-1.min-1) after a bolus (25 micrograms.kg-1): 33 patients; decreasing hyperbolic flow mode (H): cumulative dose = 10.8 x t0.5 (where t = minutes of infusion) = 47 patients. In this mode, plasma concentration is measured by 12 patients. RESULTS: the mean plasmatic level of alfentanil is steady during the 120 minutes duration of anaesthesia: standard deviation is higher than 30%. After high quality anaesthesia in both technics, recovery time was shorter with H mode than with constant flow one (extubation time = 46 +/- 31 min. versus 92 +/- 54 min). H. mode seems to be safer. Though, individual reactivity, drug interaction and genetic polymorphism must make us cautious! Two patients presented apnea 20 and 60 minutes after an efficient awakening.
Adult↗
[The reliability of slow flow isoflurane vaporizers].
Two new vaporizers for isoflurane were tested and verified with very low flows: Ohmeda Tec 5 and Penlon PPV Sigma vaporizers. This work completes a previous one [1]. The Ohmeda Tec 5 appeared to be quite reliable. The Penlon vaporizer gave pretty good results too. However a gas flow with vibratory component can affect the result by decreasing dramatically the concentration of inhaled isoflurane.
Anesthesia, Inhalation↗
Structural dynamics in F1ATPase during the first reaction cycle of ATP hydrolysis.
The velocity of ATP hydrolysis, catalyzed by purified F1ATPase from Micrococcus luteus, was decelerated on decreasing the temperature. At 13 degrees C one reaction cycle is completed after 20 s. Hydrolysis was triggered upon rapid mixing of the enzyme with ATP. During the first reaction cycle, succeeding structural alterations of the F1ATPase were traced by time resolved X-ray scattering. The scattering spectra obtained from consecutive intervals of 1 s, revealed the F1ATPase to pass a conformational state exhibiting an expanded (6%) molecular shape. The expanded state was observed between 45% and 65% of the time required to complete the reaction cycle. This points out a conformational pulsation during ATP hydrolysis.
Adenosine Triphosphate↗
[Emergency anesthesia with halothane-air. Techniques; indications; limits].
A new apparatus for anaesthesia has been developed for disaster situations. A turbine pushes room air through a halothane vaporizer to a modified D. Mapleson system. A battery provides an autonomy of two hours with an air flow of 5 liters per minute. Electrical current used is 220 volts external or 12 volts. Oxygen can be added during inductions and when there is imbalance in the hemodynamic or respiratory function. One series of 20 patients successfully underwent this procedure. Oxygen monitoring was performed with percutaneous PO2, SaO2, FiO2. Only one patient with cardiac disease needed oxygen adjonction (2 l.min-1) to raise his SaO2 level above 95%. Thus it is possible to have the optimum FiO2 with the lowest amount of halothane and oxygen.
Air↗
[Arrhythmia in anesthesia and intensive care].
There is a high incidence of dysrhytmias in the operating room and I.C.U. Calling again diagnosis criteria using common leads of the E.E.G. leads to suggest a treatment approach taking the main effect of non cardiac factors in account, before the use of antiarrhythmic drugs. The Puech classification takes many data into consideration: electrophysiological properties, cardiac disease and trigger mechanism of dysrythmias. So, it is a better practice in a dysrythmia therapy to examine all these characteristics in order to choose an adjusted treatment.
Anesthesia, General↗
[Closed-circuit anesthesia in children].
The aim of this study is to demonstrate how easy and suitable is the closed system in infants and children. An original circuit, adapted from the Bain-Spoerel system, is used. Its principle is to draw-up the expired gas through a soda lime canister by a pump, whose flow is 14 l.min-1. ("Circuit Bisontin"). For this study, 20 infants and children underwent anesthesia with isoflurane, in spontaneous or mechanical ventilation (with a "bag in the bag" principle ventilator). The lowest body weight was 2.7 kg. The advantages are a minimal dead space and no expenditure of energy during spontaneous ventilation thanks to an internal high flow and the absence of internal one-way valve. Gas monitoring is achieved by a four gas analyser (Capbomac Datex).
Adolescent↗
[Value of the radionetwork of the transportation company in Besançon for alarm forwarding].
The C.B. users offered for a few years a way for putting-out the distress on the highway. There were 2,000 in Besançon and surroundings in 1982. Today they are becoming no existent. Since then a new system of alarm run is born with 150 buses, 178 kilometers of net-travel and a sweep frequency of 10 min from 6h30 a.m., to 8h p.m, and of 30 min until 12h p.m. The 250 "C.T.B." drivers assume a regular surveillance of the urban and suburban highways. A standard message in used between the C.T.B. (Besançon Company of Buses.) regulation and Samu 25, regulation which allows to fix circumstances, place of road accident and inventory of casualties: 27 emergency calls are received in 1987, 50 in 1988. It might be possible to use other private or public radiotelephonic network.
Communication↗
[Repetitive inhalation anesthesia in rats].
Inhalational anesthesia in the rat seems a good process, by a rapid induction and awakening if a steady state ventilation-perfusion ratio and no pollution are obtained. Animals are cooped up in an "induction-box" which is joined to a scavenger system. Anesthesia maintenance is assumed with a Bain circuit and allows short and frequent anesthesia. Isoflurane does not markedly decrease circulatory and respiratory factors at low concentration (2%). So any anaesthetist can do himself such a practical system.
Anesthesia, Inhalation↗