[Anatomical study of the sinus node in atrial arrhythmias in man. Apropos of 111 anatomo-clinical cases].
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Biomedical subjects
Publications and source records attributed to B Gosselin.
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Diisopyramide overdose induces an early and severe cardiogenic shock; hemoperfusion on resin (Amberlite XAD 4) is the most efficient treatment. In vitro, 92% of the drug is adsorbed in 240 min. In dog, the plasmatic epuration is 66% with a mean plasma clearance of 74% plasmatic flow. A woman who had absorbed 4.50 g diisopyramide showed an idioventricular rhythm. The cardiac electrical stimulation and positive inotrope drugs were inefficient. Hemoperfusion on resin Amberlite XAD 4 corrected hemodynamic and ECG disturbances in 4 h. The epuration was proved by the decrease of diisopyramide plasma level: 24.4 micrograms/mL before epuration, 1.9 micrograms/mL after epuration, and a mean plasma clearance of 107.8 mL/min (61% of the plasmatic flow). Hemoperfusion of resin (Amberlite XAD 4) is more efficient than hemodialysis (cuprophan) and hemofiltration (polyacrylonitrile). The system that we have used is well tolerated and of low cost.
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A four and a half year old boy was hospitalised with acute respiratory failure due to the inhalation during two hours of the smoke from an overheated frier. Oxygen, corticosteroids and furosemide led to clinical stabilisation but after 24 hours asphyxia developed. The trachea was found to be obstructed by a firm elastic substance which prevented intubation or bronchoscopy. Autopsy revealed massive cellular desquamation of the bronchial lining. The lumen was occupied by miscellaneous debris. There were multiple pulmonary infarcts. This is the second case of acute intoxication by acroleine. In the light of these two cases, treatment should consist of corticosteroids, antibiotherapy, inhalation therapy, and repeated bronchial aspiration.
Sixty three sessions of haemoperfusion on coated activated charcoal were carried out in 60 cases of poisoning. The indications concerned 2 clinical situations: - massive poisoning with coma (by hypnotics or chlorine-containing solvents) with high extracellular concentrations of the toxic agent, with the aim of reducing the duration of the coma; - intoxications with a high mortality rate, such as those due to paraquat, colchicine, digitoxine, tricyclic antidepressants, and heavy metals, even when plasma levels were low in relation to the dose ingested. Such discordance may be related not only to predominantly intracellular fixation, but also to low intestinal absorption. The effectiveness of haemoperfusion was estimated in terms of the amount of toxic substance extracted, measured either indirectly by repeated calculation of the arteriovenous difference multiplied by the flow rate through the column, or directly by elution of the column. This method for the removal of toxic substances would not appear to be life-saving, is too costly for the extraction obtained and is not free from specific complications. Thrombocytopaenia remains an epiphenomenon, but the frequency of infection is significantly higher than with haemodialysis. An effective and safe method for the vascular extraction of poisons, particularly one favourising removal of toxic substances from intracellular localisation, remains to be found.
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The authors report a case of hypersensitivity angiitis presenting with cutaneous, muscular, articular, and renal signs. They suggest a possible etiological mechanism for such disorders: a circulating immune-complex disease, and criticize the often improper interpretation of the results of lymphoblast transformation tests. Hypersensitivity angiitis, "ground base disease", requires investigation for possible underlying immunity abnormalities or neoplasms.
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A man of 19 years of age was found to have a diffuse livedo, a quadruple asphyxic acrosyndrome, and dementia. Angiography confirmed the presence of distal ischemia with multiple circulatory blocks and a reduced distal network. The patient died at the age of 25 years and histopathological examinations of the vessels demonstrated obstructive atheromatous lesions in the medium sized and small arteries of the brain and viscera. By comparing these findings with those observed in three other cases, in which biopsy of the pulp of the toe was also performed, the hypothesis can be advanced that these juvenile encephalic ischemic accidents are caused by atheroma, which can be detected, at an early stage, by studying the distal arteries in the finger or toe pulp.
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A medical application of a microprocessor system is presented. The definition of a system able to control the quality of the respiratory exchanges for a patient submitted to artificial ventilation is given. The measurement system is composed by two rapid analysers of CO2 and O2 (Beckman LB2 and OM 11), a flow meter devices and an airway pressure sensor (Monaghan M 700). The monitoring of the ventilation is based on the determination of FAECO2 simultaneous the determination of FECO2, FIO2, FEO2 and FAEO2 allow, with the sequential entries of the blood gaz values, to calculate: VA/V, D (a--A) CO2, D (A--a) O2, VO2, VCO2 and respiratory quotient. Now, we are working out a system composed by: a microprocessor (Intel 8080) which allows acquisition and treatment of the signals; a peripherical with a key board for the dialogue between the operator and the system; a visual display unit and a printer. Measurements are made on the patient every 13 mn during five respiratory cycles. All the stated above parameters are then computed. When there is a variation of FAECO2, an alarm is triggered, of predeterminated threshold is exceeded. This system simple, not too expensive, not invasive, has been conceived to work on one to four patients.