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Biomedical subjects

D Patte

Publications and source records attributed to D Patte.

At least 19 recordsLinked to original sources
PubMed1995

[Datura stramonium poisoning: the diagnosis is clinical, treatment is symptomatic].

Datura stramonium is a hallucinogenic plant found in urban or rural areas. It contains three main toxic alkaloids: atropine, scopolamine, and hyosciamine. Consumption of any part of the plant can result in severe anticholinergic toxicity. Clinical symptoms are those seen in atropine poisoning, particularly hallucinations and mydriasis. Prognostic is good in this study. Patients always require hospitalisation because of agitated behavior. Symptomatic treatment is efficient. Clinicians should be aware of the potential abuse of botanicals such as jimson weed to avoid excessive investigations.

Adolescent↗
PubMed1994

A kidney biopsy is clearly mandatory to confirm the indication of plasma exchanges in adult haemolytic uraemic syndrome.

In case of haemolytic uraemic syndrome, it is not always possible to identify on a pure clinical basis the different kidney lesions responsible for the syndrome. We report a series of six cases without thrombotic microangiopathy, which emphasizes the need to perform a kidney biopsy as early as possible, so as to confirm the actual usefulness of plasma exchanges (PE) commonly carried out in emergency in every case of adult haemolytic uraemic syndrome. PATIENTS AND METHODS--Files of patients who were treated for haemolytic uraemic syndrome over the past 14 years were reviewed. Patients in whom thrombotic microangiopathy had been excluded by renal histology data were studied. Every patient was promptly treated with hypotensive drugs, so as to obtain blood pressure levels not exceeding 160-90 mmHg. Dialysis was performed in two patients. Daily PE with fresh frozen plasma were carried out in three patients as early as the first 24 hours after admission, and discontinued immediately after thrombotic microangiopathy could be excluded. RESULTS--All the patients met the usual criteria for diagnosis of haemolytic uraemic syndrome. Elevated liver enzymes were also found in the four cases of preeclampsia, consisting with diagnosis of severe HELLP syndrome. One case was associated with oestrogen therapy. Glomerular lesions were seen in four patients: slight endotheliosis in three cases of preeclampsia; marked lesions of IgA mesangial deposits in the patient who had been treated by contraceptive pill. Three patients had acute tubular necrosis and three had intense lesions of nephrosclerosis. Complete remission was obtained in every case of preeclampsia. Renal failure persisted in two cases (IgA glomerulopathy and one case of nephrosclerosis). DISCUSSION--The histological heterogeneity of haemolytic uraemic syndrome has been already well demonstrated. Typical lesions of thrombotic microangiopathy are usually classified into predominant glomerular lesions, pure arteriolar and mixed lesions. In other cases, thrombotic microangiopathy is not found: kidney lesions may be glomerular (endotheliosis, various subtypes of glomerulonephritis), tubular (acute tubular necrosis) or vascular (nephroangiosclerosis). In every aetiological circumstance, several different lesions may be found together. The usefulness of PE has been proved in thrombotic thrombocytopenic purpura, has been suggested in haemolytic uraemic syndrome and to a lesser extent in persistently severe HELLP syndrome. Unfortunately, none of these reports gave any information about kidney lesions responsible of acute renal failure. CONCLUSION--The haemolytic uraemic syndrome is a syndrome: thrombotic microangiopathy has to be proven when treatment by PE is planned, except in some severe clinical circumstances.

Adult↗
PubMed1994

[Reflections apropos the stopping of dialysis treatments].

In North America, the withdrawal from dialysis is one of the major causes of death among patients treated for end-stage renal disease, especially when it comes to the elderly. The reasons for the decision to terminate treatment are either medical or can be seen in what we commonly call the "quality of life", even though the latter is difficult to define. Situations such as these are hardly ever referred to in European medical literature. They create difficult psychological, ethical and event legal problems that need to be anticipated and resolved for each individual case. According to the authors, the basis for this thinking and the debate surrounding the termination of treatment as well as the final decision to do so ultimately rest with the physician. The quality of the relationship established between patient, family and medical staff during the course of treatment is essential in situations like these.

Ethics, Medical↗
PubMed1991

Severe non-hypoxic bradycardia during disconnection from the ventilator during the recovery phase of ARDS.

Four patients with adult respiratory distress syndrome developed sinus bradycardia during weaning procedures with no evidence of hypoxemia. Bradycardia occurred immediately after the patients' endotracheal tubes were disconnected from the ventilator and most of the time resolved after reconnection. However, 3 patients eventually deteriorated, requiring advanced life support and for one of them, cardiac pacing. The precise mechanism of these bradycardic episodes remains unclear but was unrelated to hypoxemia or acid-base disorder.

Adolescent↗
PubMed1990

The subcoracoid impingement.

Researchers must gather all anatomic and clinical information and evaluate the results of various imaging techniques and operative procedures if more is to be learned about anteromedial subcoracoid or coracohumeral impingement. Although the impingement syndrome constitutes an anatomic and clinical entity, more must be learned about the pathogenesis to arrive at well-founded surgical solutions.

Humans↗
PubMed1990

Classification of rotator cuff lesions.

Among various studies reporting the outcome of surgical repairs of rotator cuff tears, comparisons are very difficult because of the absence of a classification system. A proposed classification system takes into account the extent of the tear, its topography in the sagittal and frontal planes, the trophic quality of the muscle, and the integrity of the long head of the biceps. The new classification system exploits the advances in diagnostic imaging and is useful in the assessment of nonoperatively treated patients.

Cartilage↗
PubMed1989

Severe hypoxemia in a case of midgut carcinoid tumor.

A 33-year-old woman treated for carcinoid tumor developed severe hypoxaemia. This hypoxaemia may have been related to an extracardiac right-to-left shunt. The pathogenic role of vasoactive agents is discussed and comparisons made with cirrhosis-associated hypoxaemia.

Adult↗
PubMed1989

Clinical trial of clonidine hydrochloride as an antisecretory agent in cholera.

Clonidine hydrochloride (an alpha 2-adrenoceptor agonist) was tested for antisecretory effects in patients with cholera in a randomized controlled trial. Nineteen adults with diarrhea due to Vibrio cholerae were treated with clonidine (0.9 mg/24 h orally for 72 h) and 18 served as controls. During the first 24 h of treatment and for 24 h afterwards, the mean +/- SD concentrations of sodium (in millimoles per liter) in the stools of clonidine-treated patients were 120.6 +/- 10.9 and 112.3 +/- 11.9, which were significantly lower than 135.5 +/- 17.1 and 125.0 +/- 16.4 in the controls (p less than 0.01). Stool chloride concentrations (in millimoles per liter) were also significantly less in the clonidine group during the same periods: 82.1 +/- 16.8 and 62.4 +/- 19.4 vs. 92.1 +/- 18.3 and 78.0 +/- 23.0, respectively (p less than 0.05). Concentrations of potassium but not bicarbonate were also significantly reduced in the stools of clonidine-treated patients (p less than 0.05). However, there were no significant differences in the mean +/- SD stool volumes (in liters) between the clonidine and the control group in any of the six 12-h periods after treatment or in the cumulative volumes in 72 h (24.2 +/- 10.6 and 22.9 +/- 8.3, respectively). We conclude that clonidine causes modest reduction of stool electrolyte loss but does not significantly reduce fecal fluid loss in patients with cholera.

Adult↗
PubMed1989

Nephrotic syndrome associated with chronic lymphocytic leukemia: an immunological and pathological study.

Three patients with B chronic lymphocytic leukemia and the nephrotic syndrome had atypical membranous glomerulonephritis or lobular membranoproliferative glomerulonephritis with subepithelial and subendothelial deposits containing IgG1 kappa, IgG1 lambda or IgM and IgG by immunofluorescence, respectively. A monoclonal cryoglobulin was intermittently found in the serum in one case. In two patients, kidney deposits were made of organized microtubular structures. Intracytoplasmic immunoglobulin inclusions in the two patients' lymphocytes showed a very similar electron microscopic pattern. The immunologic phenotype of leukemic lymphocytes was analogous in the three cases (with expression of CD2) and suggestive of a late maturation step. A complete remission of the nephrotic syndrome was observed after therapy with chlorambucil (and prednisone). These observations suggest a direct role of monoclonal immunoglobulins in kidney disease.

Aged↗
PubMed1988

Rotator cuff tear--relationship between clinical and anatomopathological findings.

Rotator cuff tears (RCT) are frequent and increase with age. Why do only a relatively small percentage cause a permanent severe handicap justifying surgery? Is there a relationship between size and site of the tear and the clinical symptoms? How do they influence the postoperative result? These questions were answered in a prospective study of 76 operated patients. We adopted D. Patte's classification of the RCT into four groups according to the site and size of the lesion. Our figures were compared with those obtained by Patte in an analogous study of 256 cases. Of the tears in our series, 56.5% belonged to groups I and II, which means that only the supraspinatous and occasionally also the subscapular muscles were involved. In 100% of the cases in group I we found only pain, whereas a pure symptomatology with pain alone was presented in only 51% of group II, in 48% of group III, and in 0% of group IV. Groups III (35.5%) and IV (8%) represent more extensive tears, involving not only the anterior part of the rotator cuff, e.g., the supraspinatous tendon, but also to a more or less severe extent, the infraspinatous and sometimes even the teres minor. In group IV the extensive tear is combined with osteoarthritic changes. In both groups a mixed symptomatology (pain and pseudoparalysis) is the rule. The result of operative treatment is satisfactory in all groups as far as pain relief is concerned. The improvement of active ROM is not as evident and seems, as expected, to be related to the severity of the lesion.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗