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Biomedical subjects

D Elkharrat

Publications and source records attributed to D Elkharrat.

At least 37 records · Page 2Linked to original sources
PubMed1989

Trial of normobaric and hyperbaric oxygen for acute carbon monoxide intoxication.

The value of hyperbaric oxygen in the treatment of acute carbon monoxide intoxication was assessed in 629 adults who had been poisoned at home in the 12 h before admission to hospital. In patients without initial impairment of consciousness (group A) the effect of 6 h of normobaric oxygen (NBO) (group A0, n = 170) was compared with that of 2 h of hyperbaric oxygen (HBO) at 2 atmospheres absolute (ATA) plus 4 h NBO (group A1, n = 173). At the 1 month follow-up 66% of A0 and 68% of A1 patients had recovered. In patients with initial impairment of consciousness the effect of one session of HBO (group B1, n = 145) was compared with that of two sessions (group B2, n = 141); all group B patients also received 4 h of NBO. At 1 month of follow-up 54% group B1 and 52% group B2 patients had recovered. The 7 patients left with neuropsychiatric sequelae (3 B1, 4 B2) and the 4 who died (2 B1, 2 B2) had all presented with coma. HBO was not useful in patients who did not lose consciousness during carbon monoxide intoxication, irrespective of their carboxyhaemoglobin level, nor were two sessions of HBO in patients who sustained only a brief loss of consciousness. The prognosis is poorest for those presenting with coma; the trial needs to be pursued in this group of patients until the power of the study is sufficient to demonstrate the value or otherwise of HBO.

Accidents, Home↗
PubMed1989

[Gas gangrene after aseptic orthopedic surgery].

Gas gangrene following scheduled orthopedic surgery is not uncommon. In order to assess its frequency and prognosis, identify possible predisposing factors and suggest preventive measures, we reviewed the records of 22 patients (14 males and 8 females, mean age 40 +/- 20 years) admitted between 1969 and 1987 who developed gas gangrene in the wake of orthopedic surgery. In all cases the lower limbs were the site of operation: the knee in 9, the hip in 4, the femur in 4 and the leg in 5 cases. Surgical procedures included on-site foreign material in 19 cases, pneumatic tourniquet in 6 and prolonged vascular stretch in 9. Infection was diagnosed within 1.4 +/- 1.1 days of surgery; local signs, especially crepitants and pain, were prominent for the diagnosis. Pathologic findings consisted of myonecrosis in 18 patients and cellulitis in 4. Local bacteriological studies, carried out in 19 patients, yielded organisms in 14, including 12 with Clostridia perfringens. Four patients (one despite surgical treatment) died within 24 hours of admission. The remainder were treated with a combination of surgery, antimicrobial therapy (18) and hyperbaric oxygen (17). Subsequently, 13 patients had severe functional disability, while 5 recovered without sequelae. In view of the poor prognosis of gas gangrene, several preventive measures are suggested during aseptic surgery of the lower limbs. Careful skin preparation, cleaning of the anal region and short-term prophylactic antibiotic therapy with cefamandole or amoxycillin-clavulanic acid, are among them.

Adult↗
PubMed1989

[Treatment of severe myasthenia gravis with cyclosporin. A 12-month open trial].

Cyclosporine A, an immunosuppressor and immunomodulator, has been proposed as an alternative in patients with autoimmune disease not responding to the usual immunosuppressants. We treated with cyclosporine 19 patients with severe myasthenia gravis in a 12-month open uncontrolled trial. There were 14 women and 5 men aged 51.5 +/- 18.5 years (range 20 to 81 years) who had had the disease for 50.8 +/- 43.6 months. Myasthenia gravis was generalized in 18 and ocular in 1. Previously, 4 patients had been unsuccessfully treated with azathioprine, 1 with cyclophosphamide, 12 with steroids; 5 had undergone thymomectomy and 5 thymectomy. Anti-acetylcholine receptor antibodies (AChR-ab) were detected in the sera of 15. The severity of the disease was assessed by a myasthenic muscle score (MMS) ranging from 0 to 100 and a 5-grade functional scale (FS) from 1 = severe disability to 5 = complete remission. Depending on changes in MMS and FS, the effectiveness of cyclosporine was deemed very good, good or nil. Cyclosporine was administered orally 3 times daily in doses of 5.6 +/- 1.6 mg/kg/day over 11.6 +/- 1.6 months. The final dosage was targeted to achieve a peak serum level and a trough level respectively below 200 and 100 mg/ml, and was adapted if side effects occurred. No other cytotoxic drug was allowed. Seventeen patients completed the treatment (M12); 1 died of uterine cancer at M6 and 1 was lost to follow-up at M5. At M12 clinical results were considered very good in 6 patients, good in 8, nil in 3. The MMS increased significantly from 56.1 +/- 17.2 (n = 19) at D0 to 83 +/- 15 (n = 17) (P less than 0.0005), as did the FS, from 2 +/- 1 to 3.7 +/- 0.85 (P less than 0.0005). Subsequently, cyclosporine was discontinued in 7 of the 14 patients who responded well and maintained in 7 at a reduced dosage (3.4 +/- 0.8 mg/kg/day). In the former group 3 patients relapsed 1, 1 and 5 months respectively after the drug was withdrawn; the remainder had, at the last follow-up (29.6 +/- 8.5 months from D0), MMS 62.9 +/- 34.1 and FS 3 +/- 2. In the latter group, at the last follow-up (17.6 +/- 3.6 months), MMS was 86.7 +/- 16.6 and FS 4.2 +/- 0.8, differing significantly from D0 values. AChR-ab titers and CD4/CD8 were unaltered at M12.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Serum demyelinating activity and Guillain-Barre syndrome: favorable effect of plasma exchange].

The present study was designed to determine whether plasma exchange has a beneficial effect on the activity of the demyelinating factor present in the serum of patients with the Guillain-Barre syndrome. The demyelinating activity was assessed electrophysiologically after subperineurial injection of 20 to 30 microliters of serum into the rat sciatic nerves Serum was obtained from 26 patients from the French Cooperative Trial, among whom 12 had plasma exchange. Sera were drawn at hospital admission (DO) and at D15, D30 and D60. They consistently produced conduction block in a large proportion of motor axons, measured by the ratio of amplitudes of the motor action potential elicited by stimulation at both proximal and distal sites of injection. The serum activity diminished during the time course of the illness earlier in patients receiving plasma exchange and even more in patients with the less severe clinical score at the plateau phase. Serum from patients without motor sequelae after one year evolution did not produce conduction block prior to D30, as compared to sera from patients with sequelae which were still very active. This work add biological data to the positive results of plasma exchange in Guillain-Barre syndrome obtained by the North American and French Cooperative Trials.

Adult↗
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

[Beta adrenergic receptor blockade : a self-limited phenomenon explaining the benignancy of acute poisoning with beta adrenergic inhibitors. Report of a series of 40 patients seen at the Fernand-Widal Toxicology Center, with a 0% mortality rate (author's transl)].

Acute poisoning with beta adrenergic inhibitors is rare although such drugs are widely prescribed. Between 1966 and 1980, 40 cases were recorded at the Fernand-Widal Toxicology Center. 40% of patients were asymptomatic and 25% had sinus bradycardia. 35% of patients had specific toxic signs, either atrioventricular block (20%) or hemodynamic disorders (15%); the latter were seen only when associated heart disease was present or when another cardiotropic agent had been absorbed. No deaths were recorded. This favorable prognosis may result from the self-limited nature of poisoning with beta blocking agents, myocardial function being similar to that which follows denervation. In severe cases, management includes pacing and glucagon.

Acute Disease↗