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Biomedical subjects

E Lepresle

Publications and source records attributed to E Lepresle.

At least 19 recordsLinked to original sources
PubMed1997

[Tracheal intubation in prehospital resuscitation: importance of rapid-sequence induction anesthesia].

OBJECTIVE: To investigate complications of emergency endotracheal intubation (EEI), possibly facilitated by rapid-sequence induction, in the prehospital critical care setting: 1) the difficulty of intubation; 2) the cardiorespiratory consequences of intubation; 3) the relationship between the occurrence of complications and prognosis. STUDY DESIGN: Prospective non randomized, open study. PATIENTS: All patients treated over a 5-month period by a physician-manned ambulance service and requiring EEI. METHODS: Patients were allocated either in with cardiac arrest (CA) group or a group with maintained spontaneous circulation (SC). Difficulty of intubation was assessed by the number of attempts. RESULTS: Two hundred and twenty-four consecutive EEI were carried out by physicians (46%) and residents (38%) not trained in anaesthesia, anaesthetists (8%), or nurse anaesthetists (7%). Trachea was intubated after a maximum of three attempts in all patients. Success rate at the first attempt was 91%. It was 92% in CA patients (n = 76) and 90% in SC patients (P = 0.59). Anaesthetic induction, with (n = 112) or without (n = 12) succinylcholine, was used to facilitate 84% of intubations in SC patients. Complications occurred in 30 patients (20%). There was no relationship between the latter and hospital mortality, duration of ventilatory support, duration of stay in the intensive care unit. CONCLUSION: In this study, EEI in SC patients was frequently facilitated by rapid sequence induction and was associated with a high success rate at the first attempt, as in CA patients. Morbidity was low. All physicians involved in emergency airway management should be skilled in this technique.

Adolescent↗
PubMed1990

[Optimal length of antibiotic therapy in aspirated cerebral abscess].

Between 1983 and 1988, 22 patients with brain abscess were admitted to our neurosurgery department; 2 patients deeply comatose on admission and who died on the first day were excluded from this study. Treatment consisted of needle aspiration of the abscess and antibacterial therapy initially using a broad-spectrum antibiotic later replaced, in all cases, by an antibiotic found to be active in vitro against the organism(s) isolated. The portal of entry was eradicated as early as possible. The duration of antibiotic therapy was determined according to the changes observed on computerized tomography images classified as cavitary, nodular, hypodense or normal. Nodular images were taken as reflecting an inflammatory state in the healing process, and hypodense images as sequelae, so that antibiotics were withdrawn in patients with such images. Altogether, 62 per cent of the patients received antibiotics for 60 days and 95 per cent for 90 days. There was no recurrence. In some patients with deep or, chiefly, multiple abscesses, treatment was pursued. In any case, antibiotics should not be given for more than 90 days if the initial treatment has proved effective, since cure is achieved in 45 to 60 days on average.

Anti-Bacterial Agents↗
PubMed1990

Antibiotic prophylaxis during prolonged clean neurosurgery. Results of a randomized double-blind study using oxacillin.

The efficacy of oxacillin as a prophylaxis for infection was analyzed in a 27-month randomized double-blind study of 400 patients who had undergone clean neurosurgical interventions lasting longer than 2 hours. Four neurosurgeons took part in the study and 356 patients were eligible for final analysis. Among the 171 patients treated with oxacillin, there was one case of infection (0.6%), compared to nine (4.9%) of the 185 patients given a placebo. The difference between the two groups was statistically significant (p = 0.0398). This study, together with others (randomized or not), clearly demonstrates the efficacy of antibiotic prophylaxis in prolonged clean neurosurgery.

Adolescent↗
PubMed1990

[Prevention of venous thrombosis in neurosurgery].

Prophylaxis of thromboembolism in the neurosurgical patient remains a difficult problem as anticoagulant treatment increases the inherent risk of hemorrhage into the operative site. This review report the incidence of lower extremity deep vein thrombosis given in the literature, and the results of an european investigation realised during september 1988.

Europe↗
PubMed1989

[The role of surgery and low molecular weight heparin in the treatment of cerebral venous thrombosis. Apropos of 2 cases].

For one case of thrombosis of sinus sagittalis superior joint haemorrhagic cerebral softening necessitates surgical draining of haemorrhagic focus grown to a true intracranial haematoma; for the another case direct low molecular weight heparin treatment obtained a mere evolution. Authors are of the opinion that early low molecular weight heparin treatment is able to avoid massive haemorrhage.

Adult↗
PubMed1989

[Thromboembolism in neurosurgery].

This paper reviews the epidemiology and the physiopathology of lower extremity deep vein thrombosis in neurosurgical patients as described in the literature. Prophylaxis of thromboembolism in the neurosurgical patients remains a difficult problem as anticoagulant treatment increases the inherent risk of hemorrhage into the operative site.

Animals↗
PubMed1987

[Cerebral abscesses. Therapeutic attitude].

The surgical treatment of cerebral abscesses has changed over recent years and consists, in most cases, of aspiration based on the data supplied by computerized tomography. The purpose of aspiration is threefold: to avoid a major surgical operation, to empty the abscess and thereby reduce its size, and to identify the responsible germ(s). A retrospective study of 35 cases shows that abscess of the brain remains a serious disease that jeopardizes the patient's vital and functional prognosis. Despite improvements in sample collection and isolation techniques, no microorganism is found in 30% of the cases. Therapeutic success therefore is dependent upon the effectiveness of emergency chemotherapy using combinations of two or three antibiotics. Monitoring with computerized tomography avoids unnecessarily prolonged treatments.

Adolescent↗
PubMed1987

[Cranial traumatology. Recent statistical data].

The authors describe a one-year prospective study carried out in Créteil from October, 1983 to October, 1984 in 155 selected patients admitted for at least 24 hours with traumatic head injury. Patients with gunshot wounds of the head were excluded from the study. 30% of the patients were infants, 60% were adults aged between 15 and 60, and 5% were over 60; 48% were not comatose (initial Glasgow symptomatic score [GSC] greater than or equal to 8) and 36% were free of any neurological symptom. Prognosis was related to the initial neurological status, to the patient's age and to underlying diseases, such as alcoholism. 10 out of 11 patients with an initial GSC of 4 or less died, against 12 out of 144 with a GSC above 5. At the first CT scan, 10% were found to have an extradural haematoma, but the examination was normal in 20% of patients with neurological symptoms and/or coma; 22% of the CT scans were abnormal without any clinical symptom, as was the case, in particular, with 4 extradural haematomas. Surgery was performed in 24% of all patients and in 17.4% of infants, whereas the percentage reached 30% in alcoholic patients, due to the frequency of intracerebral haematomas in this population. In 16% of the 155 cases, barbiturates were used to treat uncontrolled intracranial pressure higher than 20 mmHg. 15% of the 155 patients deteriorated; a second operation was necessary in 9 cases. The final outcome on discharge was: 112/155 patients with good recovery or moderate disability, 22 with severe disability, 5 with persistent vegetative state and 21 deaths.

Adolescent↗
PubMed1987

[Occipital intraosseous epidermoid cyst producing a clinical picture simulating benign intracranial hypertension. A clinical case].

The authors describes a 17 years old woman with a small occipital intradiploic epidermoid cyst simulating a benign intracranial hypertension on an initial CT scanner. Digital angiography showed torcular compression by the tumor. Intracranial pressure and sagittal sinus pressure were analysed and implicated the epidermoid cyst as the cause of the intracranial hypertension.

Adolescent↗
PubMed1985

Altered capillary permeability in neurogenic pulmonary oedema.

Two cases of fatal neurogenic pulmonary oedema are depicted. The hemodynamic study failed to document any hypertensive crisis or pulmonary hypertension. By contrast, the low values of pulmonary capillary wedge pressures and the high protein concentration in tracheal fluid suggest a pulmonary capillary wall lesion.

Adult↗
PubMed1983

[Acute Actinobacillus actinomycetem comitans aortic endocarditis].

A 55 year old man presented an acute massive primary aortic endocarditis, with blood cultures showing the presence of Actinobacillus actinomycetem comitans. The rapidly worsening character of this endocarditis, which required an emergency valve replacement, was the hallmark of this case. The clinical and haemodynamic signs of the often missed massive acute aortic incompetence are recalled.

Actinobacillus Infections↗
PubMed1983

[Use of benzodiazepines in anesthesia and resuscitation].

Diazepam, clorazepate and flunitrazepam are used to premedicate , to anesthetize and after the intervention. Anxiolysis , sedation, hypnosis, muscle relaxation, amnesia and seizure prevention justified their employment. They have few side effects. Anesthesiologist just have to be careful of their long-acting effects as for ambulatory anaesthesia.

Alcoholism↗
PubMed1982

[Treatment of acute necrotizing pancreatitis with peritoneal lavage. 12 cases].

In an intensive care unit 12 consecutive patients with acute necrotizing pancreatitis were treated with peritoneal lavage. All clearly improved: pain was promptly relieved and the symptoms of shock and respiratory failure regressed. None of the patients died during the first 10 days. The five deaths recorded were due to late septic shock consecutive to suppuration of the pancreatic gland. It is concluded that peritoneal lavage helps to tide patients over the critical first days of severe acute pancreatitis.

Acute Disease↗