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Biomedical subjects

D Robert

Publications and source records attributed to D Robert.

At least 199 records · Page 11Linked to original sources
PubMed1987

[Intracranial hypertension in comatose bacterial meningitis].

The intracranial pressure of 31 patients with bacterial meningitis, in a comatose state and with a score lower than 6 on Glasgow's scale, was monitored by means of an extradural captor in order to detect intracranial hypertension and optimize its treatment. All patients had intracranial hypertension during the first 48 hours. Brain perfusion pressure was inferior to 50 mmHg in 5 cases. Computed tomography of the brain showed cerebral oedema in 16 cases. Twenty (64%) of the patient survived, 15 of them without sequelae. Monitoring intracranial pressure in patients with bacterial meningitis and coma makes it possible to optimize treatment and shows that a less than 50 mmHg brain perfusion pressure is associated with a 100% death rate.

Adolescent↗
PubMed1987

[Erosive gastritis: an aggravating cause of anemia in patients treated for chronic renal insufficiency].

Anemia is one of the commonest and most serious complications of chronic renal failure. The causes are multiple, while gastrointestinal blood loss is often unrecognized. Eleven hemodialyzed patients underwent esogastroduodenoscopy (OGD) to investigate anemia requiring transfusion of 4 or more blood units in a 6-month period. The same investigator performed all the endoscopies using the following scores: 0 = no lesions, 1 = focal red appearance of the mucosa, 2 = bleeding of the mucosa due to the gastroscope, 3 = erosive lesions, and 4 = presence of ulcers. Patients with a score of 1 or more were treated with ranitidine in a dose of 150-300 mg daily for 6 months. The need for transfusions before and after OGD was compared. The results were as follows: 8 of 11 patients had a score of 1-3, 1 patient scored 4 and 2 patients had no lesions. After 6 months' treatment with ranitidine no differences in hematocrit values were noted but the need for transfusions was significantly reduced (8.6 +/- 1.4 blood units before OGD vs. 4.9 +/- 1.3 blood units in the 6 months following OGD). It is concluded that minimal lesions of the esogastroduodenal mucosa are very common in hemodialyzed patients and ranitidine treatment could reduce the need for blood transfusions in these patients.

Anemia↗
PubMed1987

Structural organization of the sperm chromatin in a fern (Scolopendrium vulgare) studied by spreading methods.

To investigate chromatin organization, we applied the spreading techniques to nuclei isolated from Scolopendrium spermatozoids. Well-dispersed chromatin shows three types of fibers: beaded fibers corresponding to a nucleosomal filament with adjacent nucleosomes in close contact, smooth fibers (14 nm in diameter) associated in a complex network, and knobby fibers constituted by local supercoiling of a very thin (4 nm) smooth filament. Along the knobby fibers, beads of variable size are irregularly spaced. The knobby fibers lie parallel and coalesce in thick bundles. The sperms basic proteins identified by electrophoretic analysis probably promote the supercoiling and the side-to-side attachment of the knobby fibers, which are all the more abundant in spread preparations. These results indicate that knobby fibers are probably located in the outer part of the sperm nucleus in which the chromatin is densely packed. As for the nucleosomal and smooth filaments, they may be situated in the inner part.

Cell Nucleus↗
PubMed1987

Comparison of high-frequency jet ventilation to conventional ventilation in adults with respiratory distress syndrome.

Sixteen patients with acute respiratory failure (ARF) were studied. In group I (12 patients, 15 explorations) patients were treated with continuous positive pressure ventilation (CPPV) during conventional ventilation (CV), pulmonary lesions (PL) were severe (Qsp/Qt = 0.24 +/- 0.16 with PEEP = 14 +/- 7 cm H2O) and high-frequency jet ventilation (HFJV) was performed without spontaneous ventilation (SV). In group II (5 patients, 12 explorations) patients were treated with intermittent mandatory ventilation (IMV) during CV, PL were moderate (Qsp/Qt = 0.13 +/- 0.05 with PEEP = 8 +/- 3 cm H2O) and HFJV was performed with SV. In both groups, frequency was 120 c/mn and I:E ratio = 1:2. The cannula size, the driving pressure and the PEEP (water column) were progressively adapted to obtain the same blood gases as those observed during CV, FIO2 being the same. Results on HFJV were compared to CV. In both groups there were no differences between PaCO2, PaO2, FIO2, Qsp/Qt during CV and HFJV. In group I peak airway pressure (PAWP), mean artery pressure (MAP), heart rate (HR), transmural mean pulmonary and wedge pressure (MPAPtm, PWPtm) were not different. Mean airway pressure (MAWP), PEEP and pleural pressure (PP) were higher, cardiac index (CI) was lower. In group II, PP, CI, MAP, HR, MPAPtm, MPWPtm were not different. PAWP was lower, MAWP and PEEP were higher. We conclude that during HFJV it is possible to obtain the same blood gas as during CV, but HFJV without CV may not be indicated in patients with severe PL, because circulatory impairment is higher.

Adult↗
PubMed1987

[Intracranial hypertension during status asthmaticus].

In three consecutive patients suffering from life-threatening asthma in a comatose state (mean age: 37 +/- 4 yr; Glasgow coma score: 3; bilateral mydriasis), intracranial pressure was monitored with an extradural transducer set-up a mean of 2 h after the onset of the coma. The aims were to detect intracranial hypertension and to improve its therapy. Basal therapy associated: 1) mechanical ventilation; 2) theophylline 1.5 g X 24 h-1, salbutamol 30 mg X 24 h-1, hydrocortisone 2 g X 24 h-1, pancuronium 0.5 mg X kg-1 X 24 h-1; 3) pentobarbitone 35 mg X kg-1 X 24 h-1, normal hydration, normothermia and 30 degrees head-up tilt. If the intracranial pressure rose above 15 mmHg, an i.v. bolus of pentobarbitone (5 mg X kg-1) was given if the barbiturate blood level was equal or below 100 micrograms X l-1. In case of failure, a dose of mannitol (20 mg) completed the therapy if blood therapy was equal or below 320 mosm X l-1. All patients developed intracranial hypertension (21, 53 and 23 mmHg, respectively). The intracranial hypertension followed the bronchospasm and disappeared with it. Hypoxaemia, hypercapnia and high peak airway pressures could explain the intracranial hypertension. All patients recovered without sequelae. This data should make us use with great care all treatments likely to increase the intracranial pressure during life-threatening asthma.

Adult↗
PubMed1987

Occupation and pregnancy outcome.

Over a two year period, 1982-4, 56067 women, delivered or treated for a spontaneous abortion in 11 Montreal hospitals covering 90% of such admissions, were interviewed in detail regarding their occupational, social, and personal characteristics in their most recent and past pregnancies--104,649 in all. These data were analysed in relation to four main adverse outcomes--spontaneous abortion, stillbirth (without defect), congenital defect, and low birth weight (less than or equal to 2500 g). For comparison with observed numbers, expected figures were calculated by logistic regression using up to eight potentially confounding variables. Sixty occupational groups in six main industrial sectors were examined in current and previous pregnancies, with tests for heterogeneity between these two estimates of risk. Women in managerial, health, and clerical sectors had little evidence of excess of any of the four outcomes, by contrast with those in sales, service, and manufacturing sectors. Substantial and statistically significant excesses of spontaneous abortion were observed in nursing aides, women in sales occupations and food and beverage service; of stillbirth in agriculture and horticulture, leatherwork, and certain sales occupations; of congenital defects in women in child care, certain service occupations, and the manufacture of metal and electrical goods; and of low birth weight in chambermaids, cleaners, and janitors, and in women employed in the manufacture of food and drink, metal and electrical goods, and clothing.

Abortion, Spontaneous↗
PubMed1987

Effect of calcitriol in the control of plasma calcium after parathyroidectomy. A placebo-controlled, double-blind study in chronic hemodialysis patients.

Severe, prolonged hypocalcemia in observed in some, but not all, hemodialysis patients after parathyroidectomy performed because of uncontrolled hyperparathyroidism. The aim of the present study was to investigate whether calcitriol and calcium supplementation in the immediate period after parathyroidectomy (days 1-14) was of more help in the control of plasma calcium than calcium supplementation alone. Fourteen hemodialysis patients were enrolled in a prospective, randomized, double-blind and placebo-controlled study. From the day after parathyroidectomy, 7 patients received calcitriol and the remaining 7 a placebo using incremental doses adjusted to the degree of hypocalcemia (up to 4 micrograms/day for calcitriol). Plasma calcium, phosphorus, alkaline phosphatase and immunoreactive parathyroid hormone levels before parathyroidectomy were comparable in both patients groups, as was the lowest plasma calcium achieved after parathyroidectomy. The decrease in plasma calcium after parathyroidectomy was related to plasma alkaline phosphatase and to the number of osteoclasts and osteoblasts on bone biopsy surface before parathyroidectomy. The mean decrement of plasma calcium (days 3-9) as compared to that before parathyroidectomy was less pronounced in calcitriol-treated than in placebo-treated patients (0.25 +/- 0.06 versus 0.45 +/- 0.05 mM, mean +/- SEM, p less than 0.025). Treatment with placebo was interrupted before day 14 because of persistent severe hypocalcemia in 4 of 7 patients, whereas calcitriol treatment was continued in all 7 patients up to 14 days. Patients on calcitriol treatment required less mean calcium supplements (days 1-9) than patients receiving placebo (37.4 +/- 3.2 versus 49.4 +/- 3.7 g, p less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Calcitriol↗
PubMed1987

[Value of thrombolysis in situ without general fibrinogenolysis in pulmonary embolisms of more than 5 days duration].

Fibrinogenolysis induced by thrombolytics exposes the risk of haemorrhagic complications. The efficacy is proved for pulmonary emboli of recent origin. The aim of this study is to research into the effect of local administration of low dose urokinase in six patients aged 40 (+/- 16 years) and presenting with old emboli (10 +/- 4 days). The initial clinic picture was serious with shock (2 cases), hypoxaemia (6 cases), pulmonary arterial hypertension (mean 40 +/- 8 mmHg) and a Miller index of 58 (+/- 8%). Mechanical ventilation was necessary four times. Urokinase was administered in situ using a Swan Ganz catheter, with 1,000 units per Kg per hour for six hours followed in sequence with 30 microkatals per hour of plasminogen for two hours. This eight hourly rotating sequence was followed for at least 72 hours. Six patients were cured with an end of treatment (5 +/- 2 days) improvement in their hypoxaemia of 22%, a fall of 47% of the pulmonary arterial pressure and a rise of 71% in the Miller index. The fibrinogenesis fell by 11% and the thrombolytics could not blamed for any side-effect. The sequence urokinase-plasminogen in low dose administered locally may represent an alternative treatment for severe and long standing pulmonary emboli in patients with a risk of haemorrhage.

Adult↗