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Biomedical subjects

D Baron

Publications and source records attributed to D Baron.

At least 127 records · Page 7Linked to original sources
PubMed1987

Effects of low-dose cyclosporine A on toxicity and rejection in cardiac transplantation.

In conclusion, the low doses of CsA have significantly reduced nephrotoxicity and infectious complications. The patient survival has been acceptable, but there has been a disappointing incidence of rejection and graft loss in patients who have survived the first 3 months. We feel our experience would indicate that by targeting our CsA dosages to such low serum levels some of our patients receive suboptimal immunosuppression. Perhaps the best way of overcoming this is add a third maintenance immunosuppressive agent such as azathioprine to supplement immunosuppression. In fact, we have now changed our immunosuppressive protocol to include azathioprine while maintaining our CsA therapy at its current level.

Adolescent↗
PubMed1986

Enhanced survival in patients with heart failure and life-threatening ventricular tachyarrhythmias.

Previous reports have suggested that patients with heart failure and coexistent ventricular tachyarrhythmias have a 1-year mortality of 40% to 60%. To assess whether an antiarrhythmic management program could reduce mortality, we studied 20 consecutive patients with ventricular fibrillation (12) or ventricular tachycardia (eight) and heart failure. Coronary disease was the most common underlying cardiac disorder (85%). Heart failure was managed with digoxin (16), diuretics (16), and vasodilators (seven). All patients received antiarrhythmic drug therapy guided by both noninvasive and invasive studies. This included single (10) or combination drug therapy (10). Beta blockers were used alone or in combination for arrhythmia control in 11 patients. One-year survival was 89%. We conclude that an effective program can be developed for patients with life-threatening ventricular tachyarrhythmias and heart failure. Combination antiarrhythmic drug therapy is often required. Despite impaired left ventricular function, beta-blocking drugs can be used, and may be important.

Anti-Arrhythmia Agents↗
PubMed1986

Effect of glyceryl trinitrate on peripheral arteries alters left ventricular hydraulic load in man.

Effects of sublingual glyceryl trinitrate (GTN) were studied in ten patients without heart failure during diagnostic cardiac catheterisation following angiography. GTN caused substantial reduction in peak left ventricular and aortic pressure (19 mmHg) with lesser reduction in mean aortic pressure (9 mmHg) and no change in diastolic aortic pressure. Reduction in stroke volume (by 15%), associated with fall in left ventricular end diastolic pressure (by 4 mmHg) was insufficient to explain the marked (17 mmHg - 34%) reduction in pulse pressure. Decrease in pulse pressure was associated with loss of the late systolic peak on both the aortic and left ventricular pressure wave. This peak is caused by pulse wave reflection. GTN caused no change in peripheral resistance or in indices of aortic compliance (characteristic impedance, total arterial compliance) but was associated with reduction in fluctuations of both modulus and phase of aortic impedance. All these changes in pressure waves and in impedance spectra are explicable on the basis of decreased peripheral wave reflection. This can be attributed to the known vasodilatory effect of GTN on the peripheral arteries. Simulation of arterial vasodilatation in a multi-branched model of the systemic arterial system confirmed this interpretation. Dilatation of peripheral arteries explains in part the beneficial effects of GTN in adult man.

Adult↗
PubMed1985

Reliability of the bronchoscopic protected catheter brush in intubated and ventilated patients.

The reliability of a bronchoscopic protected catheter brush (BPCB) in the diagnosis of lower respiratory tract infection was studied in 17 intubated and ventilated patients, including seven patients free from such infection (group 1) and ten patients with suspected infection (group 2). A first sample was obtained in the lower trachea by aspiration through the fiberoptic bronchoscope and a second in a distal bronchus by the BPCB procedure. In group 1, all BPCB cultures were sterile, although lower tracheal cultures yielded two or more bacterial species, showing that uncontaminated specimens can be obtained by the BPCB procedure. In three patients of group 2, BPCB cultures remained sterile as a nonbacterial pulmonary disease was certified by open lung biopsy. In seven patients from group 2, BPCB cultures yielded all of the organisms isolated simultaneously by reference methods (ie, cultures of blood or pleural fluid, serologic tests, and open lung biopsy). In two of these patients, contamination of the BPCB specimens was ascertained by the reference method bacterial results. In this study the BPCB procedure was able to obtain uncontaminated specimens in intubated and ventilated patients and was mainly accurate in identifying the bacterial etiologic agents of lower respiratory tract infections.

Adult↗
PubMed1984

[Prophylactic antibiotic therapy with cefamandole in total hip surgery replacement using Charnley's tent. A randomized study].

A randomized study of one-day prophylactic antibiotic therapy in total hip arthroplasty was performed in 93 procedures in 84 patients. All patients were operated by the same surgeons with use of a clean air system. They were divided into two groups: K- without antibiotic, and K+ with intravenous cefamandole, 1.5 g before incision followed by 1.5 g every four hours up to the 24th postoperative hour. Clinical follow up by the surgeons included four examinations within the first year. There was no significant difference in age, repartition of sexes or acquired physical defects between the two groups. Major deep infections requiring revision surgery occurred early in one case in K+ and early in four cases and late in one in K6. Nine patients had bilateral hip replacement. Only one infection was observed, in the only patient who did not receive cefamandole for either procedure. Physical disability had no influence on infection. Microbial organisms isolated from deep infection foci were not consistently identical with pathogens previously identified in wound drainage fluid. Staphylococcus aureus was responsible for 4 of 6 deep infections. One-day prophylactic antibiotic therapy by cefamandole decreases the incidence of deep infection at the surgical site in total hip arthroplasty with use of a clean air system.

Cefamandole↗
PubMed1984

[Infections in surgery under extracorporeal circulation. Results of 3 years of antibioprophylaxis].

The present study was designed to evaluate perioperative antibio-therapy with cefamandol for the prevention of post-operative infections after surgery under cardiopulmonary bypass. 1 300 patients were studied. The incidence for wound infections was 1.3%, 0.9% for systemic, 1.3% for other infections. These results show a decrease in the frequency of infections in comparison with data from the literature.

Adult↗
PubMed1983

[Collective acute poisoning by nitrous gases].

A collective nitrous fumes poisoning (five cases) is reported. Two patients (case 3 and case 4) were comatose, in severe respiratory distress. Shock and slate blue cyanosis were noted. Physical examination and chest X ray revealed acute pulmonary edema-Methemoglobin levels were 71,3% (case 3) and 58% (case 4). Despite treatment both of them died from severe hypoxia resulting in cardiorespiratory arrest. Post-mortem examination was performed upon these four men. On admission the last one (case 5) was conscious, and in good hemodynamic condition. Acute pulmonary edema and cyanosis were present. Methemoglobin level was 37,3%. This patient recovered appropriate therapy. For case 1 and 2 acute anoxia due to methemoglobinemia seems to be cause of death. For cases 3 and 4 death is due to hypoxemia associated with pulmonary edema.

Accidents, Occupational↗
PubMed1982

[Complementary studies in acute bronchopulmonary infections except tuberculosis].

Development of a strategy for the investigation of pulmonary infectious disease is aimed at identifying the organism responsible for the infection in order to prescribe the appropriate antibiotic therapy. Factors involved in the choice of a method are the underlying condition (healthy, high risk or immunodepressed subject), the type of infection (primary, secondary), the technical abilities of the medical and bacteriological team and finally the value of the different techniques of isolation. The latter must provide a specimen which is not contaminated by the oropharyngeal flora. Their reliability involves definition of a reference method which can be used to test the other techniques in comparison, and requires comparison of the bacteriological results obtained with clinical and radiological data as well as the results of the resultant therapeutic decision. Indirect methods of investigation (blood cultures, serological studies) are relatively unfruitful. Criteria of value of direct methods of investigation are defined and applied to each method (expectoration, transtracheal aspiration, bronchial fibroscopy, transparietal puncture). On the basis of data in the literature and their own results, the authors undertake an analytical then comparative (in a given patient) study of the different methods, and identify their indications.

Biopsy↗
PubMed1981

[Gas gangrene of dental origin. Report on four cases (author's transl)].

Four patients developed diffuse cervicofacial cellulitis following an acute circumscribed infection of dental origin. Necrosis of skin, subcutaneous and muscle layers was associated with a severe generalised toxic infective syndrome, producing a clinical picture and following a course identical with that observed in gas gangrene of the limbs. Anaerobic germs, normally present in the buccodental region, were at the origin of the affection in all four cases, chronic dental lesions providing favourable anaerobic conditions for an increase in their virulence. Three factors appear to be of importance for the development of gas gangrene from dental abscesses: insufficient or lack of suitable surgical treatment, the use of antibiotics not active against anaerobic germs, treatment with corticoids or anti-inflammatory drugs. Once gas gangrene has developed, possible intramediastinal spread should be investigated. Treatment is essentially surgical (with excision of necrotic tissue and wide drainage), plus penicillin therapy and hyperbaric oxygen. The prophylaxis of these gas gangrene lesions is discussed.

Adult↗
PubMed1981

[Anaphylactoid shocks induced by infusion of a modified gelatin. Six cases (author's transl)].

One of these shocks occurred in course of a rapid infusion in a patient in whom catheters were previously inserted. So, an hemodynamic study was possible. This study shows a peripheral vasodilatation leading to a decrease of preload and cardiac output, and finally to a systemic hypotension which generally raises the alarm. These cases are the first anaphylactoid shocks reported after an infusion of modified gelatin. They demonstrate the general risk of anaphylactoid shock with all types of colloids.

Adult↗