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Biomedical subjects

C Bismuth

Publications and source records attributed to C Bismuth.

At least 73 records · Page 4Linked to original sources
PubMed1983

[Pure defibrination after timber rattlesnake bite].

The only disorder of coagulation observed after a timber rattlesnake (Crotalus horridus) bite was a total absence of fibrinogen which lasted 64 hours despite hourly administration of cryoprecipitates. The pure defibrination experimentally obtained with this particular species of crotalid snakes underlines the specificity of the coagulation disorder and the impossibility of identifying the coagulopathy induced by venom poisoning without laboratory examination.

Adult↗
PubMed1983

[Anti-glafenine circulating antibodies: demonstration and frequency in acute renal insufficiency following intake of glafenine in toxic doses].

From 1970 to 1981, acute glafenineeeeeeee poisoning was observed in 106 patients, including 37 with acute renal insufficiency (ARI). From 1977 to 1982, the search for anti-glafenin antibodies was carried out systematically by direct and indirect tests for antiglobulin on erythrocytes, and by leucoagglutination and complement fixation tests on platelets in the presence of glafenin. An antibody was detected in only one of the 17 ARI patients studied. This antibody, IgM, has been studied along with glafenin, floctafenin, antrafenin and their metabolites. The rareness of such an antibody confirms the direct nephrotoxic action of glafenin, a drug responsible for half of the renal insufficiencies observed in an intensive care unit specialized in toxicology.

Acute Kidney Injury↗
PubMed1983

[Hypo-oxygenation in paraquat poisoning. Apropos of 6 cases].

The toxicity of the weed-killer paraquat is related to the formation of superoxyde radicals responsible of a progressive and usually lethal pulmonary fibrosis. Recognition of lipid peroxidation of membrane bilayers by free radicals as the causative factor pointed to oxygen as an important cofactor in the severity of paraquat poisoning. It has been shown that any FiO2 over 21% accelerates this process and increases the the mortality of rats and humans. FiO2 21% gave a significant reduction of mortality in rats (DOUZE 1976). We proposed this therapy (1978-1879) in 6 cases of paraquat poisoning. It was conducted with induction of a barbiturate coma, hypothermia, curarisation and hypo-oxygenation (FiO2 around 14% thanks to the adjunction of nitrogen to assisted ventilation). In 5/6 patients, these technics did not prevent the evolution towards death. This evolution was in fact predicted, according the following prognostic factors: suicide, more than a mouthful ingestion, oesophago-gastric burns detected by endoscopy, organic renal failure, high plasma paraquat level. Associated methods of elimination (Fuller's earth, provoked diarrhea, furosemide, hemoperfusion and hemodialysis) did not change the early established prognosis. The only survival was observed in an accidental poisoning with undetectable plasma paraquat and isolated oral burns: the herbicide had been probably spit out. This survival cannot be related to hypo-oxygenation. This failure is not definitive, according to us: this therapy should be undertaken only after minimal, accidental poisoning possibly evolving to pulmonary fibrosis. It appears unuseful in massive, suicidal poisonings, leading readily to a lethal circulatory failure.

Adolescent↗
PubMed1983

[Inhalation pneumonia in toxic comas. Apropos of 200 cases with 4 deaths].

In 1946, Mendelson described 66 cases of gastric juice inhalation during obstetrical work with no mortality. Other studies studying different populations (essentially in post-operative condition) denounced a mortality from 19 to 64%. In Forensic Medicine, a bronchial regurgitation of gastric juice is denounced in 1/3 lethal toxic comas. This regurgitation can be the direct cause of the death, it also can be an epiphenomena, as suggests the high level of inhalation in agonic process of any cause: 1/4 of autopsy findings. In our department, 200 cases of inhalation pneumonia, during comatose intoxications have been registered between 1972-1982, with a frequency of 1/28 patients. All the patients were under assisted ventilation. 4 deaths occurred in this serie. This 2% mortality suggests the curability of gastric juice inhalation during comatose intoxications in not specifically respiratory-orientated intensive Care Units. These relatively good results are probably party related to the patients' recruitment: young population without underlying organic disease, with a rapid turnover and little hazards of nosocomial superinfections.

Adolescent↗
PubMed1983

[Reversibility of severe digitoxin poisoning with antidigoxin antibodies].

We report a case of severe digitoxin poisoning treated at the stage of ventricular fibrillation by infusion of FAB antidigoxin fragments with low in vitro covering properties. There were no side effects. The possibility of rapidly reversing the prognosis will permit the use of specific FAB fragments before the onset of potentially lethal cardiac arrhythmias, when these antibodies become more generally available.

Aged↗
PubMed1983

[Prognostic factors in acute paraquat poisoning. A retrospective study of cases registered by the Poison Control Center of Paris in 1981].

Twenty years after the publication of the first cases, the intoxication with the herbicide Paraquat still has a low prognosis because of no efficient treatment. But many studies have allowed the definition of prognostic factors. Nearly, BISMUTH and als(2) demonstrated that the following criteria are significant: the oral route, the gastric lesions, the organic renal failure, the plasma-Paraquat concentration. Through a series of cases collected in 1981 at the Poison Control Center of Paris, the following prognostic factors have been studied: route of administration, sex of patient, circumstances of the poisoning, ingested volume, concentration of the solution, existence of an emetic in the commercial solution, gastric content, lesions of the upper digestive tract (mouth, oesophagus, stomach), renal impairment, hepatic failure, blood gasometry, lung function tests, plasma and urine paraquat concentrations. Forty-one cases were collected during this period, with thirty-four concerning acute Paraquat poisonings in humans. We studied twenty-seven of them caused by acute oral poisoning, with accidental circumstances in nine cases (two died) and intentional circumstances in eighteen cases (all died) (other cases concerned two ocular projections, four inhalations and one skin projection). The interest of this new investigation is the particularity of our series. Because of our recruitment (larger geographic distribution of patients, larger diversity of circumstances, of routes of administration, of ingested quantities, of treatments...). This series of cases is quite different from others previously published. This study confirms the validity of prognostic factors defined by BISMUTH and als(2). The factors, which look significant, strictly depend on the ingested quantity.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1983

Beneficial effects of dantrolene in the treatment of neuroleptic malignant syndrome: a report of two cases.

Two schizophrenic patients developed muscular rigidity, stupor, and hyperpyrexia consistent with neuroleptic malignant syndrome, 8 to 10 days after starting haloperidol therapy. Muscle rigidity was not affected by etybenzatropine or diazepam, but dantrolene, a direct-acting skeletal muscle relaxant, provided muscle relaxation with a concomitant decrease of fever and serum creatine kinase. Neuroleptic malignant syndrome and malignant hyperthermia are clinically similar, and dantrolene is effective in both; suggesting a muscular origin of fever in these two diseases.

Adolescent↗
PubMed1982

[Digitoxin poisoning: reversing ventricular fibrillation with Fab fragments of anti-digoxin antibody].

Purified Fab fragments of ovine anti-digoxin antibodies (Wellcome Foundation) were used to treat a patient who attempted suicide by absorbing 10 mg of digitoxin (serum concentration 265 micrograms/l). The poor prognosis, as assessed clinically and from serum potassium levels (7.5 mEq/l), seemed to warrant such a treatment. The weak (6.85%) cross-reactivity elicited in vitro between the anti-digoxin antibodies and digitoxin was compensated by increasing the doses, but improvement was observed with 3.6 g, i.e. about half the effective dosage initially considered. The criteria of effectiveness were clinical, electrocardiographic (reversal of the ventricular fibrillation), biochemical (simultaneous and opposite changes in extra- and intracellular potassium levels, suggesting that ATPase inhibition by digitalis is a reversible process) and toxicological: there was an increase in digitoxin serum levels suggesting displacement of the drug from tissue sites to plasma and other extracellular compartments where the Fab fragments are distributed, and Fab-bound digitoxin appeared fairly rapidly in the urine, which suggested shunting of the normal hepatic metabolic pathway.

Aged↗
PubMed1982

[Approach to cochleovestibular tolerability of aminoglycosides in man. Demonstration of a methodology apropos of a controlled comparative trial of dibekacin versus gentamicin].

A controlled trial comparing the effects of dibekacin and gentamicin in 30 patients has enabled us to standardise the most commonly used vestibulocochlear tests. None of the patients treated with dibekacin showed any auditory disturbance. The only abnormality detected was on vocal audiometry in 7 patients treated with gentamicin. Could vocal audiometry be the first paraclinical test capable of detecting aminoglycoside ototoxicity?

Clinical Trials as Topic↗
PubMed1982

[Paraquat poisoning. Prognostic and therapeutic evaluation in 28 cases].

Since a mouthfull of the herbicidal compound Paraquat usually results in death from caustic burns, renal tubular necrosis, circulatory failure of pulmonary fibrosis, the fact that 11 out of 28 people poisoned in the period 1972-1980 survived deserves consideration. The most significant prognostic factors appear to be: (1) the mode of penetration: all 4 patients poisoned through the skin and/or the respiratory tract survived; (2) the volume of Paraquat absorbed: death from circulatory failure occurs within less than 72 hours with more than 50 mg/kg, while 35 to 50 mg/kg produce progressive pulmonary fibrosis; (3) the content of the stomach at the time of ingestion: food can neutralize the compound; (4) the finding of gastric lesions on early endoscopy; (5) evidence of acute renal failure; finally and mostly (6) Paraquat blood levels during the first 24 hours, as measured by radioimmune assays; lethal levels are 2.0, 0.6, 0.3, 0.16 and 0.10 mg/l at 4, 6, 10, 16, and 24 hours respectively. There is no overlapping between values obtained in patients who died and survivors. In this series, the course of the intoxication, as predicted from the initial prognostic factors, was unmodified by the treatments applied (Fuller's earth, dialysis, charcoal haemoperfusion, furosemide, immediate hypooxygenation). The survival of two patients with restrictive respiratory pathology seems to be ascribable to the circumstances of poisoning rather than to the treatment.

Acute Disease↗
PubMed1982

[Prognostic factors in acute digitalis poisoning].

The prognostic significance of various clinical and biochemical factors was investigated in 179 patients who had ingested more than 2 mg digitoxin. The mortality rate in this series was 17%. Supraventricular arrythmias had no influence on prognosis, but the death risk was higher in males and in patients with AV block. It increased with age, with digitoxin and potassium serum levels and even more with persistent hyperkalemia. Two other factors--previous heart disease and vomiting--were also significant in patients without heart block. Calculated on the basis of 4 clinical factors, the mortality rate varied from 2 to 74%. The death risk in acute digitalis poisoning can therefore be easily assessed simply from clinical criteria.

Acute Disease↗