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Biomedical subjects

C Brun-Buisson

Publications and source records attributed to C Brun-Buisson.

At least 145 records · Page 8Linked to original sources
PubMed1987

Diagnosis of central venous catheter-related sepsis. Critical level of quantitative tip cultures.

The results of a simplified quantitative broth dilution quantitative tip culture (QTC) of 331 central venous catheters were compared with clinical data prospectively recorded in critically III patients to diagnose bacteremic or nonbacteremic catheter-related sepsis (CRS) (36 catheters), as opposed to contamination (42 catheters) or simple colonization from a distant septic focus (seven catheters). Thirty-five of 36 catheters associated with CRS yielded 10(3) colony-forming units per milliliter (CFU/mL) or more, and 3.8 X 10(2) Candida organisms grew from one. In contrast, 5 X 10(2) CFU/mL or less grew from 37 of 42 contaminated catheters. A QTC of 10(3) CFU/mL or more was 97.5% sensitive and 88% specific for the diagnosis of CRS. The QTC appeared especially useful for the diagnosis of CRS secondary to blood-borne seeding of catheters, or associated with coagulase-negative staphylococci.

Catheterization↗
PubMed1986

Blood-borne pulmonary infection with Nocardia asteroides in a heroin addict.

Nocardia asteroides frequently causes primary lung infection with possible hematogenous dissemination to various organs, especially in patients with altered immune responses. The preponderance of pulmonary infections suggests an airborne route of contamination. We report a case of pulmonary nocardiosis in a previously healthy intravenous heroin abuser. The clinical and epidemiologic data strongly suggest a paraphernalia blood-borne infection in this patient, a mode of contamination which has not been previously reported.

Adolescent↗
PubMed1985

[Acute adult respiratory distress syndrome after lymphography].

Pulmonary complications of lymphography are usually described as radiological infiltrates without clinical symptoms. However, a case is here reported of an adult respiratory distress syndrome occurring after lymphography in a 60 year old female lymphoma patient. Pulmonary oedema developed within 48 h; haemodynamic study showed a normal capillary wedge pressure. The patient died from intractable low cardiac output within 24 h. Post-mortem examination showed pulmonary lymphocytic infiltration and multiple fat emboli. The lack of lymphatic drainage was probably responsible for the intravascular passage of lipid-soluble contrast medium, this giving endothelial lesions. In such patients with preexisting lung disease or pulmonary involvement in haematological disease, lymphography has to be considered carefully.

Embolism, Fat↗
PubMed1985

Hypoxemia in acute pulmonary embolism.

Most patients with severe, acute pulmonary embolism (PE) have arterial hypoxemia. To further define the respective roles of ventilation to perfusion (VA/Q) mismatch and intrapulmonary shunt in the mechanism of hypoxemia, we used both right heart catheterization and the six inert gas elimination technique in seven patients with severe, acute PE (mean vascular obstruction, 55 percent) and hypoxemia (mean PaO2, 67 +/- 11 mm Hg). None had previous cardiopulmonary disease, and all were studied within the first ten days of initial symptoms. Increased calculated venous admixture (mean QVA/QT 16.6 +/- 5.1 percent) was present in all patients. The relative contributions of VA/Q mismatching and shunt to this venous admixture varied, however, according to pulmonary radiographic abnormalities and the time elapsed from initial symptoms to the gas exchange study. Although all patients had some degree of VA/Q mismatch, the two patients studied early (ie, less than 48 hours following acute PE) had normal chest x-ray film findings and no significant shunt; VA/Q mismatching accounted for most of the hypoxemia. In the others a shunt (3 to 17 percent of cardiac output) was recorded along with radiographic evidence of atelectasis or infiltrates and accounted for most of the venous admixture in one. In all patients, a low mixed venous oxygen tension (27 +/- 5 mm Hg) additionally contributed to the hypoxemia. Our findings suggest that the initial hypoxemia of acute PE is caused by an altered distribution of ventilation to perfusion. Intrapulmonary shunting contributes significantly to hypoxemia only when atelectasis or another cause of lung volume loss develops.

Acute Disease↗
PubMed1984

Redistribution of pulmonary blood flow induced by positive end-expiratory pressure and dopamine infusion in acute respiratory failure.

The mechanism by which mechanical ventilation (MV) with positive end-expiratory pressure (PEEP) improves hypoxemia in patients with acute respiratory failure (ARF) is unclear, and may be attributed in part to a decrease in cardiac output inducing by itself a reduction of the shunt. Using the multiple inert gas elimination technique we evaluated the effects of PEEP on ventilation-perfusion (VA/Q) distribution in 8 patients while cardiac output was maintained at control value by means of a dopamine infusion. In each patient, evaluation was performed during MV without PEEP (control) then with PEEP (17 +/- 2 cm H2O) and dopamine. After application of PEEP, PaO2, PvO2, and oxygen transport (TO2) increased significantly, whereas venous admixture decreased from 37.5 +/- 5 to 17 +/- 2% (p less than 0.01). Comparison of VA/Q distribution during PEEP and zero end-expiratory pressure documented a redistribution of pulmonary blood flow; the shunt decreased markedly from 30 +/- 4 to 13 +/- 2% (p less than 0.001), whereas the fraction of cardiac output distributed to "normal" VA/Q ratio units (0.1 to 10) increased from 62 to 78.5% (p less than 0.001). Dead space increased slightly with PEEP, from 44 to 49% (p less than 0.01) of total ventilation. The pattern of ventilation distribution was essentially unaltered; specifically, no additional high VA/Q mode was observed during PEEP. It is concluded that cardiac output maintenance with dopamine infusion during PEEP does not suppress the beneficial effects of PEEP on gas exchange, but induces a redistribution of pulmonary blood toward the main VA/Q ratio.

Acute Disease↗
PubMed1984

Total respiratory pressure-volume curves in the adult respiratory distress syndrome.

To assess the value of measuring compliance in the adult respiratory distress syndrome, sequential pressure-volume curves were obtained in 19 patients with this syndrome. Analysis of the pressure-volume curves allowed separation of the patients into the following four groups: (1) group 1 (n = 6), normal compliance measured during deflation, little hysteresis, and no inflection in the ascending limb of the pressure-volume tracing; (2) group 2 (n = 8), normal compliance during deflation, increased hysteresis, and presence of an inflection; (3) group 3 (n = 10), decreased compliance during deflation, marked hysteresis, and presence of an inflection; and (4) group 4 (n = 10), reduced compliance during deflation, no increased hysteresis, and no inflection. These patterns were correlated with the stage of the adult respiratory distress syndrome and to the pattern of the chest x-ray film. Group 2 corresponds to the initial stage of the syndrome and to pure alveolar opacities on the chest x-ray film. Group 3 is seen later in the course of the syndrome and corresponds to mixed alveolar and interstitial opacities. Group 4 corresponds to patients with end-stage adult respiratory distress syndrome (two weeks) and a predominant interstitial pattern on the chest x-ray film. Group 1 corresponds to a nearly normal chest x-ray film and to recovery.

Adolescent↗
PubMed1984

Legionnaires' disease and hairy-cell leukemia. An unfortuitous association?

Four cases of legionnaires' disease were diagnosed by specific serologic tests in a group of 33 immunocompromised patients admitted to the same hematologic department for acute febrile pneumonitis. The underlying disease of these four patients was hairy-cell leukemia (HCL) in three cases and allogeneic bone marrow transplantation in the other. This article stresses the enhanced susceptibility of patients with HCL to Legionella pneumophila and discusses its possible causes, especially monocyte deficiency. We propose the use of erythromycin as part of the initial empiric antibiotic therapy in immunocompromised hosts with acute pneumonitis until the results of specific serologic tests or isolation of L pneumophila is obtained.

Adult↗
PubMed1983

[Hyperthermia during parenteral nutrition].

In a woman with caustic burn of the oesophagus total parenteral nutrition (3000 calories, 16 g nitrogen daily) resulted in a rise in body temperature from 37 to 39 degrees C. Temperature returned to normal when nutrition was discontinued to rise again when it was resumed. No infection or other cause of fever was detected. This case suggests that high calorie and nitrogen parenteral nutrition may induce hyperthermia, the possible mechanisms of which are discussed.

Adult↗
PubMed1983

[Post-operative peritonitis. Surgical tactics and antibiotic therapy].

Despite progress in general supportive measures the mortality in post-operative peritonitis remains high (around 50%). Reoperation and antimicrobial therapy are two major steps in the care of such patients. Reoperation should be considered on clinical grounds. Its major aim is to suppress the source of peritoneal infection, usually in this setting a breach in intestinal integrity. This is best achieved by temporary cutaneous enterostomy. Thorough peritoneal lavage is mandatory to ensure the removal of all particulate matter and pus. The procedure is ended by wound closing, leaving the skin layer open. Very infrequently, laparostomy has to be performed, either because of necrotizing wound infection, or deliberately, in face of peritoneal failure. If possible, when rapid healing permits delayed wound closure, laparostomy should be temporary. Antimicrobial therapy is started preferably with or just before reoperation, and is aimed at the known pathogens in post-operative abdominal sepsis, namely Bacteroïdes fragilis and enterobacteriaceae. A combination of nitro-imidazole and aminoglycoside or 3rd generation cephalosporin appears suitable in most cases. The duration of antimicrobial therapy is difficult to define at present but it should at least encompass the operation itself and the following 48 hours. The value of more prolonged use has not yet been established.

Anti-Bacterial Agents↗
PubMed1983

A new device for measurement of pulmonary pressure-volume curves in patients on mechanical ventilation.

Measurement of total (lung plus chest wall) pulmonary compliance is routinely obtained in mechanically ventilated patients by dividing the tidal volume (VT) by the airway pressure (Paw) gradient from end-inspiration to end-expiration. In order to obtain the pressure-volume (P-V) tracing during inspiration, we developed a method using a continuous and slow (1.7 L/min) oxygen inflow. When gas flow is kept constant, changes in lung volume are proportional to time and do not require direct measurement. In 22 patients, P-V curves traced using the continuous-flow method were identical to those obtained from the syringe method. The advantages of the inflow method are simplicity, reproducibility, and better visualization of the initial part of P-V curve.

Humans↗
PubMed1983

[Suppurating splenic infarction originating from endocarditis].

Three cases of splenic infarction complicated by abscess formation during bacterial endocarditis are reported. In all three cases there were associated clinical abdominal signs and, in one case, there was persistently positive hemocultures. The diagnosis was made by CAT scanning. The three patients underwent splenectomy and one patient also underwent valve replacement the same day. The methods of early diagnosis of splenic complications during endocarditis and the indications of splenectomy are discussed. Ultrasonography and abdominal CAT scanning are the most sensitive diagnostic methods for splenic lesions. As splenic rupture is associated with a high mortality and this complication may occur at any time during infarction complicated by abscess formation, early splenectomy is justified when abdominal clinical signs are elicited associated with a persistent, infectious syndrome with or without positive blood cultures, under appropriate antibiotic therapy. Splenectomy should also be considered if valve replacement is carried out in the same circumstances to avoid infection of the prosthesis.

Abscess↗
PubMed1982

Influence of age, previous health status, and severity of acute illness on outcome from intensive care.

Age, previous health status (HS), and severity of acute illness were assessed prospectively on 228 unselected patients admitted over 1 yr to the multidisciplinary ICU, to determine their influence on outcome. One hundred and fifty patients (66%) were discharged from the ICU, but the survival rate fell to 50% at 6 months, and was similar after 1 yr (49%). Over a 6-month period, there was improved HS in survivors which gradually leveled off. Compared to prior HS, the final HS was worsened in 37% of survivors. Three factors were important predictors of late survival: age under 50, good previous HS, and less than two visceral failures. We conclude that evaluation of ICU outcome should provide information on 6-month survival and HS and include important variables as age, previous HS, and severity of acute illness.

Acute Disease↗
PubMed1981

[Non-ketotic hyperglycaemic coma with diabetic lipaemia and hyponatraemia (author's transl)].

A 68-year old male patients without personal or family history of diabetes mellitus developed diabetic lipaemia with severe hyponatraemia and became deeply comatose. The low blood sodium level (110 mmol/l) was consecutive to hyperglycaemia (45 mmol/l), hyperlipaemia (65 g/l) and true sodium depletion. This rare form of type V hyperlipidaemia is attributed to deficiency of heparin-activated lipoprotein lipase; it rapidly responds to insulin therapy. Hyponatraemia is a prominent feature of the syndrome, but it is partly due to blood dilution resulting from hyperglycaemia and therefore fictitious. For accurate measurement of sodium depletion blood sodium levels must be adjusted taking into account blood lipoprotein and glucose levels.

Aged↗