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Biomedical subjects

E Maury

Publications and source records attributed to E Maury.

At least 37 records · Page 2Linked to original sources
PubMed1999

Fatal herpetic hepatitis in adult following short corticotherapy: a case report.

Herpes simplex virus hepatitis (HSV hepatitis) is an uncommon and severe complication of HSV type 1 and HSV type 2 infection. HSV hepatitis affects mostly immunocompromised patients. We report the case of a young man without any previous known immunodeficiency who developed fatal HSV hepatitis in the first 8 days of oral corticotherapy given for ulcerative colitis. A prompt diagnosis was possible because HSV was recovered from peripheral blood leukocytes.

Acute Disease↗
PubMed1999

Prolonged sedation requiring mechanical ventilation and continuous flumazenil infusion after routine doses of clorazepam for alcohol withdrawal syndrome.

We report the cases of two patients who developed prolonged sedation after routine doses of clorazepam for alcohol withdrawal syndrome. They required prolonged mechanical ventilation (10 days for both patients) followed by continuous flumazenil infusion (16 days for one patient and 3 days for the other) to avoid reintubation. In the two patients, nordazepam accumulation (main active metabolite of clorazepam) was demonstrated as the cause of the coma. This accumulation could be attributed, in one case, to impaired hepatic cytochrome P 450 3A4 activity. Caution is required when prescribing benzodiazepines to alcoholic patients and the use of benzodiazepine which do not undergo hepatic oxidation by cytochrome P 450 such as oxazepam or lorazepam is suggested.

Aged↗
PubMed1998

Circulating endotoxin during initial antibiotic treatment of severe gram-negative bacteremic infections.

The impact of antibiotics on total endotoxemia and circulating tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, and IL-8 in 18 patients with severe bacteremic sepsis or septic shock due to gram-negative species was investigated. Endotoxemia, TNF-alpha, IL-6, and IL-8 were assayed before (H0) and 1 h (H1) and 4 h (H4) after the first antibiotic infusion. Endotoxemia decreased from H0 (median, 0.4 EU/mL; interquartile interval, 0.09-1.23) to H1 (median, 0.19 EU/mL; interquartile interval, 0.07-0.75; P = .03) and remained stable between H1 and H4 (median, 0.12 EU/mL; interquartile interval, 0.09-0.30; P = .4). IL-6 levels fell between H0 and H4 (P = .01) and between H1 and H4 (P = .03). IL-8 was higher at H0 than at H1 (P = .04) and at H4 (P = .01). These results suggest that endotoxemia is not increased by antibiotherapy of severe gram-negative bacteremia.

Adult↗
PubMed1997

[Analysis of patients' perception of their stay in a medical intensive care unit. Les trois equipes d'infirmières].

OBJECTIVES: Evaluate patients' appraisal of their stay in a medical intensive care unit and analyze their anxiety. PATIENTS AND METHODS: Two 5-month prospective studies with specific questionnaires were filled out by patients with the help of a psychologist. The first study (61 patients) evaluated global appraisal of the stay and the second study (53 patients) focused on anxiety using questionnaires also filled out by nurses. RESULTS: The study population was not different from the global population admitted to intensive care during the same period. The patients felt secure in 97% of the cases but suffered pain (53%), insomnia (62%), discomfort due to noise (49%) or light (37%), and expressed anxiety (55%). The second study confirmed the anxiety in 61% of the patients. Using surrogate markers of anxiety, the psychologist judged that anxiety was underestimated in 20% of the cases. In 17%, anxiety was expressed by patients but not felt to be present by nurses. DISCUSSION: In order to decrease the anxiety of patients admitted to a medical intensive care unit, every effort should be made to lessen pain and unnecessary discomfort. All personnel working in the unit should be able to recognize the patients' anxiety.

Anxiety Disorders↗
PubMed1997

Studies on ether-phospholipids of vascular smooth muscle cells. Identification of a rapid Ca(2+)-dependent hydrolysis of alkyl-phosphatidylethanolamine promoted by endothelin-l.

We have investigated the metabolism of 1-O-[3H]octadecyl-sn-glycero-3-phosphocholine ([3H]lyso PAF) and [3H] myristic acid in secondary cultures of aortic smooth muscle cells (SMC) to characterize the origin of second messengers generated upon stimulation with endothelin-l (ET-l). When cells were labelled with [3H]lyso PAF, we observed a transfer of the label from phosphatidylcholine (PC) to phosphatidylethanolamine (PE) In contrast, incubation with [3H]lyso PAF labelled mainly alkyl-subclasses while [3H]myristate was associated with diacyl-subclasses. Using these specific labelling procedures, we have shown that ET-l induced a strong hydrolysis of PE. This hydrolysis was specific for alkyl-PE with a maximum after 5 s of stimulation. We have also observed an extracellular Ca(2+)-dependent increase in diglyceride (DG), phosphatidic acid (PA) and mainly triglyceride (TG) concomitant to alkyl-PE hydrolysis. Thus, alkyl-DG generated from alkyl-PE appears to be a major product in ET-l stimulation of SMC. These results suggest a new level of complexity in the signal transduction cascade involving a specificity for phospholipid subclasses.

Animals↗
PubMed1997

High doses of hydroxyethyl starch and human albumin have similar effects on monocyte function and oncotic pressure.

The accumulation of hydroxyethyl starches (HES) in monocytes/macrophages has raised concern over their potential detrimental effects on host defences. We assessed prospectively the function of circulating monocytes isolated from patients treated with plasma exchange (PE) using HES. The study was carried out in the medical intensive care unit of a university hospital. Eight patients underwent PE for neurological disorders. Each patient underwent three PEs, 48 h apart. The total exchange volume was 4 L per PE. Only 4% human albumin was used for the first PE. In the second and third PEs, the plasma substitute was 2 L of HES (200,000/6%/0.62) and 2 L of albumin. Mononuclear cells were collected before and immediately after each PE and 48 h after the last PE. They were placed in suspension culture and incubated with lipopolysaccharide (LPS). Monocyte function was assessed in terms of procoagulant activity (PCA) and tumour necrosis factor alpha (TNF-alpha) production. LPS-stimulated PCA increased after the first PE (P < 0.05). Stimulated TNF-alpha production increased, but not significantly so. Similar effects were observed after the second and third PE (P < 0.05 for stimulated TNF-alpha). Values 48 h after the last PE were similar to those obtained before the second PE, suggesting that repeated infusions of HES had no detrimental effect on monocyte function. Furthermore, plasma oncotic pressure was preserved after PE with HES. These results support the partial replacement of costly human albumin with HES during repetitive PE, and suggest that HES might be a safe plasma expander in septic patients.

Adult↗
PubMed1997

A paradoxical effect of bronchodilators.

Lactic acidosis previously has been reported during treatment of asthma with beta-2 agonists. However, this metabolic disturbance never had any clinical consequence. We report a case of a patient with asthma in whom beta-2 agonist administration increased dyspnea by metabolic acidosis due to a sharp increase in lactate levels (hyperlactatemia) and led to inappropriate intensification of bronchodilator therapy.

Acidosis, Lactic↗