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Biomedical subjects

D Grimaud

Publications and source records attributed to D Grimaud.

At least 73 records · Page 4Linked to original sources
PubMed1991

[Subacute arsenic poisoning].

A cas is reported of a 23-year-old man who voluntarily took a massive dose of arsenic (at least 8 g). In spite of the ingested amount and the acute nature of the poisoning, the patient survived 8 days. Gastrointestinal, neurologic and cardiac features were predominant including nausea, vomiting, choleroid diarrhoea, encephalopathy, peripheral neuropathy, and finally a fatal toxic cardiomyopathy. Metabolic acidosis, moderate cytolysis and an anticoagulant effect were also observed. This unique characteristic was partly due to a circulating anticoagulant with prothrombinase activity, as well as direct antivitamin K activity. Postmortem examination revealed: a congestive oesophagitis; a necrosing gastritis involving all the stomach wall; diffuse hepatic steatosis; skin lesions with vascular congestion and dermoepidermal detachment; discrete subepicardial congestive lesions. Arsenic was found in all tissues.

Acute Disease↗
PubMed1988

[Myxedematous coma. Prognostic and therapeutic re-evaluation].

The prognostic factors and therapeutic approaches in myxoedema coma--a rare but serious medical emergency--were re-evaluated from a retrospective study of 10 cases. The immediate respiratory risk can be prevented by referring these patients immediately to an intensive care unit. The patient's cardiovascular status before and after coma determines the prognosis for life and serves as guideline to treatment. Hormone replacement therapy with initial injection of a loading dose of thyroxine seems to improve the prognosis by ensuring rapid recovery of the principal vital functions.

Aged↗
PubMed1988

[Effects of positive expiratory pressure on cardiac output and estimated hepatic blood flow during controlled ventilation in man].

This study aimed to discover the effects of artificial ventilation with positive end-expiratory pressure (PEEP) on cardiac output and hepatic blood flow in ten patients with chronic stable post-anoxic or post-traumatic coma, without any cerebral oedema or any other visceral pathology. This study was carried out at four levels of end-expiratory pressure (0, 5, 12 and 29 cmH2O) and after 24 h of artificial ventilation with a PEEP arbitrarily fixed at 12 cmH2O. Cardiac output was measured by thermodilution and hepatic blood flow by applying Fick's principle on a continuous infusion of indocyanine green with an analysis of suprahepatic venous samples. Hepatic blood flow is given by the amount of indocyanine green infused (0.5 mg.min-1) divided by the difference between arterial and suprahepatic venous indocyanine green concentration. For all levels of PEEP, mean arterial, right atrial, wedge and suprahepatic pressures and hepatosplanchnic resistances were measured. Artificial ventilation with PEEP induced a fall of cardiac output and hepatic blood flow proportional with the increase in PEEP level. The fall in hepatic blood flow began to be statistically significant for a PEEP level of 5 cmH2O (-17%; p less than 0.01) and was maximum for a PEEP of 20 cmH2O (-49.51%; p less than 0.001). There was no linear correlation between cardiac output and hepatic blood flow: the fall in hepatic blood flow was more important than the fall in cardiac output. These changes in hepatic blood flow were accompanied by a significant increase in hepatosplanchnic resistances (p less than 0.01 for PEEP = 12 cmH2O), without any changes in other haemodynamic parameters or biological signs of hepatic disturbance.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

[Practical approach to complex acid-base disorders using a slide rule].

Diagnosis of mixed acid-base disturbances is often difficult. Nowadays it depends on biochemical and statistical interpretation, coupled with clinical data. The acid-base slide-rule is a useful tool to carry out this five step procedure, which it simplifies, giving rapidly at the patient's bed-side an objective support for the diagnosis of acid-base disturbances.

Acid-Base Imbalance↗
PubMed1985

[Effects of injectable flunitrazepam on hepatic and cardiac output in man].

The effects of intravenous flunitrazepam (0.03 mg X kg-1) on the estimated hepatic plasma output (DPHE), compared with the cardiac output (Q), were studied before its injection and 1 min afterwards. The question asked was whether the decrease in venous return led to a fall in hepatic perfusion. This study was made on patients in neurological coma without any organic lesion. The DPHE was measured by applying Fick's principle, using a continuous infusion of indocyanine green (ICG). The DPHE was given by the amount of ICG perfused in mg X min-1 divided by the arterial concentration of ICG less the concentration of ICG in the hepatic vein (in mg X 1(-1)). Cardiac output was measured by thermodilution. Flunitrazepam did not significantly modify either DPHE or Q; they fell by 5.6% and 3.4% respectively. None of the seven cardiovascular parameters changed during the time of the study. Thus, in unconscious patients with satisfactory haemodynamic conditions prior to the intravenous injection, flunitrazepam did not significantly modify hepatic perfusion.

Adolescent↗
PubMed1983

[Adsorption of insulin directly added to infusion bottles].

A study of insulin adsorption to infusion system was undertaken in the situation of direct addition of insulin alone in the infusion bottles, with use of 125I-labelled insulin and non labelled insulin. The infusion solutions tested were glucose solutions (5, 10, 15 and 30%). There is an important adsorption of insulin (75%) to the infusion system when the insulin concentration in the solution is low. The effluent insulin is not degraded. The glucose content of the solution does not influence the phenomenon. Adsorption of insulin decreases when the insulin concentration in the solution is increased and a plateau is reached starting from an insulin concentration in the solution of about 400 ng/ml; at higher concentrations, 80 to 90% of insulin that has been initially put in the bottle is recovered. Since the insulin concentrations in the solutions used in clinical practice are higher than 400 ng/ml, this adsorption phenomenon can be neglected and therefore can explain the efficiency of this mode of insulin-therapy. Kinetics of effluent insulin is a plateau, stable all along the infusion. Thus, direct addition of insulin alone into infusion bottles is an efficient and controlled mode of insulin-therapy if a minimal insulin concentration in the infused solution has been reached.

Adsorption↗
PubMed1983

[Adsorption of insulin introduced directly into perfusion bottles].

A study of insulin adsorption to infusion system was undertaken in the situation of direct addition of insulin alone in the infusion bottles, with use of 125I-labelled insulin and non labelled insulin. The infusion solutions tested were glucose solutions (5, 10, 15 and 30%). There is an important adsorption of insulin (75%) to the infusion system when the insulin concentration in the solution is low. The effluent insulin is not degraded. The glucose content of the solution does not influence the phenomenon. Adsorption of insulin decreases when the insulin concentration in the solution is increased and a plateau is reached starting from an insulin concentration in the solution of about 400 ng/ml; at higher concentrations, 80 to 90% of insulin that has been initially put in the bottle is recovered. Since the insulin concentrations in the solutions used in clinical practice are higher than 400 ng/ml, this adsorption phenomenon can be neglected and therefore can explain the efficiency of this mode of insulin-therapy. Kinetics of effluent insulin is a plateau, stable all along the infusion. Thus, direct addition of insulin alone into infusion bottles is an efficient and controlled mode of insulin-therapy if a minimal insulin concentration in the infused solution has been reached.

Adsorption↗
PubMed1981

[Effects of dopamine on cardiac and hepatic index in man (author's transl)].

Dopamine is known to increase cardiac output and, to a greater extent, renal blood flow. The purpose of this study was to find out whether renal blood flow is increased partly at the expense of splanchnic blood flow. The splanchnic blood flow was evaluated by measuring, according to Fick's principle, the estimated liver blood flow during a continuous infusion of indocyanine green. Each determination was coupled with a measurement of the cardiac output, using a thermodilution method. The results were corrected to body surface, thus providing a cardiac index (Cl) and a hepatic index (Hl). The study involved 10 subjects free from hepatic, haemodynamic or haemorrhagic disease and was carried out in 3 stages: determination of initial values, then of values under dopamine (10-12 micrograms. kg. min) and finally, control of return to initial levels. The results showed that dopamine produced a significant (p less than 0,01) increase in Cl (mean 44%) and an equally significant (p less than 0,01) increase in Hl (mean 66%), the difference between the two increases being also significant (p less than 0.05). There was a strong correlation between Cl and Hl during dopamine fusion.

Cardiac Output↗
PubMed1981

Increase in hepatic blood flow and cardiac output during dopamine infusion in man.

The object of this paper was to evaluate the effect of a continuous dopamine infusion (10--12 micrograms/kg . min) on the estimated hepatic blood flow (EHBF) and cardiac output (CO) in man. Measurements were made in 3 periods: the initial control state, during dopamine infusion, and after the infusion. The CO (by thermodilution) and EHBF (by hepatic vein sampling after continuous indocyanine green (ICG) infusion) were measured during each phase. Ten subjects, with inapparent hepatic disease, hemorrhage, or hemodynamic anomalies, were studied. The results showed a 64% increase in the EHBF and a 49% increase in the CO. All subjects showed a return to the original baseline state after infusion. The EHBF/CO was 14% in the control period, 17.3% during infusion, and 13.4% after dopamine infusion. These changes were not statistically significant. Dopamine, therefore, increased both EHBF and CO, but the existence of intrahepatic dopaminergic receptors could not be established.

Cardiac Output↗