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Biomedical subjects

F Bonnet

Publications and source records attributed to F Bonnet.

At least 109 records · Page 6Linked to original sources
PubMed1997

Intra-articular morphine and clonidine produce comparable analgesia but the combination is not more effective.

Both intra-articular morphine and clonidine produce analgesia. This study was designed to compare the analgesic effects of the two drugs, used separately and in combination. We studied 90 patients undergoing arthroscopy of the knee under general anaesthesia. Patients were allocated randomly to receive 20 ml of intra-articular isotonic saline solution containing morphine 2 mg, clonidine 150 micrograms or both. Pain was assessed on an visual analogue scale after operation and time for rescue medication was measured. There was no difference in VAS scores between the three groups and the time for rescue analgesic was comparable. We conclude that intra-articular morphine and clonidine have comparable analgesic effects in the doses used. The combination of both drugs did not seem to increase analgesia.

Adolescent↗
PubMed1997

Changes in cerebral hemodynamics after a single dose of clonidine in severely head-injured patients.

alpha 2-Adrenergic agonists induce cerebral vasoconstriction, reduce intracranial pressure (ICP) in experimental animals and may be useful in the hemodynamic management of head-injured patients. We studied the effects of the alpha 2 agonist clonidine on the cerebral circulation in 12 head-injured patients (Glasgow Coma Scale score < 8). Middle cerebral artery flow velocity (MCAV), ICP, mean arterial pressure (MAP), and cerebral perfusion pressure (CPP), were continuously recorded before (T0), at the end (T1), and 30 min after (T2) a 10-min intravenous (i.v.) infusion of 2.5 micrograms/kg clonidine. The cerebral arteriovenous oxygen content difference (AVDO2) and Paco2 were sequentially obtained. ICP, Paco2, AVDO2, and MCAV did not change after clonidine administration. In contrast, MAP and CPP decreased (P < 0.05 and P < 0.05, respectively, at T1 and T2). Three subjects displayed a transient increase in ICP (> 10 mm Hg) at T1; this increase was concomitant with the decrease in MAP. Clonidine administered as an i.v. infusion may induce a critical but transient increase in ICP in some severely head-injured patients. This effect may result from cerebral autoregulatory vasodilation and increased cerebral blood volume as a response to the hypotensive effects of clonidine.

Adrenergic alpha-Agonists↗
PubMed1997

Use of transesophageal echocardiography for diagnosis of traumatic aortic injury.

This prospective study was conducted to describe the signs on transesophageal echocardiography (TEE) associated with traumatic aortic injury (TAI). Twenty-eight patients with TAI underwent TEE, and they were compared with a control group of 30 thoracic trauma patients without aortic injury. The TEE signs were classified as direct or indirect signs, and the quality of imaging was assessed. Patients' TEE images were compared with their anatomic lesions. The direct signs were thick stripes (n=19), false aneurysm (n=7), aortic dissection (n=6), free-edge intimal flap (n=15), aortic wall hematoma (n=2), fusiform aneurysm (n=13), and complete aortic obstruction (n=2). The indirect signs included minor increases in aortic diameter (n=7), impairment of the aortic Doppler color flow (n= 18), and an increase of aorta-probe distance, indicating hemomediastinum (n=23). TEE allowed diagnosis of recently described limited intimal lesions frequently missed by other conventional methods, and permitted rapid diagnosis of complete rupture in which fast degeneration means that more time-consuming methods are not practicable. Significant blurring of the aortic outline was noted in 20% of cases and intraluminal artifacts were observed in 36% of cases, but neither sign impaired accurate diagnosis of TAI. The echocardiographic signs of aortic injury are complex and may be confined to a short section of the aorta. Therefore, examination by a physician highly trained in echocardiography is necessary in such cases.

Adult↗
PubMed1997

[Isolated involvement of the trigeminal nerve of sarcoidosis origin].

Sarcoidosic neurological manifestations are uncommon. Isolated cranial nerve's injury is exceptional. The authors report the case of a 29 year-old woman with a trigeminal nerve tumor. Surgery and anatomopathology led to the diagnosis of sarcoidosic infiltration. No other neurological or extra-neurological localization was found. Cranial fifth nerve injury was observed in 14 cases of the literature. In all cases, trigeminal nerve injury was described as associated with another disease's localization (neurological and/or extra-neurological). This observation seems unusual due to isolated nature of the presentation and complete resolution after surgery. This case illustrated the diagnosis and nosologic difficulties raised by granulomatous lesions, symptomatic or not, in the absence of systemic localization.

Adult↗
PubMed1997

[Value of imaging in the management of advanced stage ovarian cancer "experience of 72 computed tomographic examinations"].

OBJECTIVE OF THE STUDY: To place computed tomography (CT) in the evaluation of advanced stages of ovarian tumors throughout two years experience (1991-1992) of a Cancer Medical Center. MATERIALS AND METHODS: Study of 72 pelvic-abdominal CT examinations of 47 patients in stages III and IV, at the time of the initial diagnosis or during the treatment. The equipment used is a General Electric CE 10,000. The technique was conventional (digestive and intravenous opacification). These examinations were performed by practicing radiologists exclusively in cancerological units. RESULTS: Carried out in immediate post-operative patients incompletely surgically examined, CT allows the quantification of residue and therefore a new staging in two-thirds of the cases. In the process of adjuvant chemotherapy, CT reveals the persistence of residue in 71% of the cases with therapy implications. At the time of follow-up, CT is revealing of abnormalities in 74% of the cases carried out to systematic content, in 60% of the cases with concomitant elevation of CA 125 level. Abnormalities are always present when CT is carried out from clinical symptoms and elevation of CA 125 level (3 cases in 3). Localized recurrence was only described in 7.6% of the cases. CONCLUSION: CT is of relative usefulness for the assessment and surveillance of advanced stages of cancers. It contributes with accordance to the literature clarifying the criteria as "impossibility of resection" and according to our series, it contributes in redefining the stage; it participates, during the process of adjuvant therapy of avoiding the unuseful second-look procedures, without predicting "complete response"; finally it participates during the follow-up to the collection of the localized recurrence only situation susceptible to benefit from an efficient surgical treatment.

CA-125 Antigen↗
PubMed1997

[Results of the surgical treatment of epidermoid carcinoma of the mobile tongue and mouth floor. Apropos of 157 patients].

Squamous cell carcinomas of the oral cavity were treated in 157 patients by surgery as first-line (104) or salvage (53) treatment. Postoperative irradiation delivered either for locally advanced tumors (stade III-IV) or for unfavorable histological data (nodal or surgical margins involvement). The retrospective study with a mean time of follow-up of 2.5 years shows a loco-regional control rate of 75% statistically influenced by histological nodal status (p < 0.01). Cumulative and cause specific survival rates at 5 years are 41.1% and 57.2% respectively. T stage was found to be a prognostic factor of survival (p < 0.01) as bone involvement (p < 0.05). Surgical margins are influent on local control and survival only in absence of radiation.

Adult↗
PubMed1996

Nonprocurement of transplantable organs in a tertiary care hospital: a focus on sociological causes.

BACKGROUND: The purpose of this study was to investigate prospectively the medical and organizational causes of nonprocurement of transplantable organs and to provide explicit information on the determining factors of family response to donation request. METHODS: Medical causes investigated were age, human immunodeficiency virus, human T-cell lymphoma virus and hepatitis C virus status, documented malignancy, and chronic cardiac or renal failure. Organizational aspects investigated were cause and place of death and number of referrals. Sociological aspects were investigated by semidirective interviews with the families of the deceased. RESULTS: A total of 105 brain-dead patients and 42 families were included. Of the 105 patients, 9 were not eligible for donation because of medical reasons; cardiac arrest occurred before organ procurement in 6 cases. Denial of consent from the coroner occurred in 7 cases. Consent was requested from the families in 82 cases, obtained in 53 cases, and denied in 29 cases. Consent to donation was associated with openness of the process, information about brain death and transplantation, previously stated will of the deceased, favorable attitude of the deceased toward the medical profession, and a generally altruistic attitude of the deceased. Denial of donation was associated with poor understanding of brain death and fear of being deprived of the deceased body. CONCLUSIONS: Practical implications of this study include encouraging people to state their attitudes toward organ donation and improving the level of information available to the general public on the meaning of brain death and on the medical aspects of organ transplantation.

Hospitals, Special↗
PubMed1996

Structure and cellular distribution of mouse brain testican. Association with the postsynaptic area of hippocampus pyramidal cells.

The complete deduced primary structure of mouse brain testican has been established from cDNA cloning. The cDNA encodes a polypeptide of 442 amino acids belonging to the proteoglycan family. The mouse brain testican core protein is 95% identical to its human testicular counterpart. In situ hybridization investigations revealed that mouse testican mRNA is mainly present in a subpopulation of pyramidal neurons localized in the CA3 area of the hippocampus. An immunocytochemical approach, with antibodies directed against an overexpressed chimeric antigen, produced in bacterial systems, showed that testican is associated with the postsynaptic region of these pyramidal neurons. Testican includes several putative functional domains related to extracellular or pericellular proteins associated with binding and/or regulatory functions. On the basis of its structural organization and its occurrence in postsynaptic areas, this proteoglycan might contribute to various neuronal mechanisms in the central nervous system.

Amino Acid Sequence↗
PubMed1996

Bilateral massive adrenal haemorrhage complicating anaphylactic shock: a case report.

A case of bilateral adrenal haemorrhage complicating anaphylactic shock is reported. Hypovolemic shock related to peritoneal haemorrhage was the main feature landing to laparotomy. Ultrasonographic examination was not contributive, but CT scan easily documented the adrenal haemorrhage and must be considered a valuable diagnostic tool when adrenal haemorrhage is suspected.

Adrenal Cortex Diseases↗
PubMed1996

Peripheral analgesic effect of intra-articular clonidine.

Sympathetic nervous system stimulation, which releases noradrenaline, influences the nociceptor activity which develops after tissue injury. The alpha 2-adrenergic agonist, clonidine, produces analgesia through a central mechanism but also inhibits noradrenaline release at terminal nerve fibre endings. Clonidine may induce analgesia when administered at peripheral sites. This study assesses the potential analgesic effect of clonidine after intra-articular administration. Forty ASA I-III patients, scheduled for arthroscopic knee surgery under general anaesthesia were allocated randomly in 4 groups of 10 patients each, at the end of the surgical procedure. In the control group (group 1), the patients received 20 ml of intra-articular isotonic saline. In group 2, the patients received 150 micrograms of clonidine diluted in 20 ml of isotonic saline injected into the knee joint. In group 3, the patients were given 20 ml of intra-articular isotonic saline and clonidine 150 micrograms was injected subcutaneously. In group 4, morphine 1 mg, diluted in 20 ml of isotonic saline, was injected into the knee joint. Postoperative pain was assessed in a double-blind fashion using a visual analogue scale (VAS) at 1, 2, 3, 6 and 24 h after the end of surgery. VAS scores were significantly lower in groups 2 and 4, compared to groups 1 and 3, at 1 and 2 h after surgery. The delay between intra-articular injection and further postoperative analgesic administration was significantly longer (P < 0.05) in group 2 (533 +/- 488 min) compared to groups 1 and 3 (70 +/- 30 min and 132 +/- 90 min, respectively). The difference was not significant between group 4 (300 +/- 419 min) and the other groups. We conclude that a low dose of intra-articular clonidine produces analgesia unrelated to vascular uptake of the drug. This study further supports a peripheral analgesic effect of clonidine.

Adrenergic Agents↗
PubMed1996

Spinal clonidine produces less urinary retention than spinal morphine.

We have conducted a double-blind, randomized study in two groups of 20 patients each, undergoing hip surgery during spinal anaesthesia, to compare the incidence of urinary retention after spinal morphine or clonidine. Patients received 0.5% spinal bupivacaine 15 mg combined with either clonidine 75 micrograms or morphine 0.2 mg. After operation, patients were examined for micturition, bladder distension, or both; when they failed to void, they received naloxone 0.2 mg, and if bladder distension persisted, a catheter was inserted. At 12 h, all patients in the morphine group but only five in the clonidine group had bladder distension, and at 24 h this was present in seven and one patient in the morphine and clonidine groups, respectively (P < 0.001). Naloxone was given in 16 and one, and a catheter was placed in one and six patients in the morphine and clonidine groups, respectively (P < 0.001). We conclude that spinal clonidine impaired bladder function to a lesser extent than morphine.

Adult↗
PubMed1996

Clonidine increases the sweating threshold, but does not reduce the gain of sweating.

We tested the hypothesis that clonidine produces a dose-dependent increase in the sweating threshold but does not reduce the gain of sweating. Six healthy male volunteers were evaluated, each on three separate days in random order. In one, saline was administered; in another, a 2-micrograms/kg bolus of clonidine was followed by an infusion at 2 micrograms.kg-1.h-1, and on a third day, a 4-micrograms/kg bolus was followed by an infusion at 4 micrograms.kg-1.h-1. Core temperature was measured at the tympanic membrane and mean skin temperature was determined from four sites. A chest sweating rate of 40 g.m-2.h-1 was considered significant. The core temperature triggering sweating, adjusted to a designated mean skin temperature of 34 degrees C, identified the threshold for this response. Gain was defined by the adjusted core temperature increase required to augment sweating from 100 to 300 g.m-2.h-1. degree C-1. Plasma clonidine concentrations were 0.8 +/- 0.1 and 1.6 +/- 0.2 ng/mL on the small- and large-dose days, respectively. Clonidine administration increased the sweating threshold approximately 0.4 degree C (P < 0.05), but the increase was comparable at each dose. The gain of sweating was approximately 0.2 degree C and was not influenced by clonidine administration. The thermoregulatory effects of clonidine thus resemble those of volatile anesthetics, opioids, and propofol. These data suggest that the antishivering effect of clonidine results from central thermoregulatory inhibition rather than a specific peripheral action on thermogenic muscular activity. Unlike other sedatives and anesthetics, the concentration-dependence of clonidine demonstrates a ceiling beyond which the administration of an additional drug fails to enhance the effect, suggesting that the thermoregulatory effect of clonidine may be limited, even at high plasma concentrations. The gain of sweating was well preserved indicating that this response remains effective in the presence of sedatives and anesthetics.

Adrenergic alpha-Agonists↗
PubMed1996

Comparison between radionuclide ejection fraction and fractional area changes derived from transesophageal echocardiography using automated border detection.

BACKGROUND: Left ventricular fractional area changes (FAC) can be derived from transesophageal echocardiography using an automated border detection system. However, FAC has not yet been compared to left ventricular ejection fraction (EF) evaluated by a reference technique. The aim of this study was to correlate transesophageal echocardiography automated FAC to EF derived from radionuclide angiography to obtain a quantifying method of global left ventricular systolic function at the bedside. METHODS: Ten critically ill patients, whose lungs were mechanically ventilated, were included in this prospective study. Patients were scheduled for radionuclide EF evaluation when at least 75% of the endocardium was clearly visualized on transesophageal echocardiography. Patients with esophageal pathology or cardiac dysrhythmia were excluded. Ejection fraction derived from radionuclide angiography was measured using technetium 99m. Echocardiographic data were obtained using an ultrasound system with automated border capabilities. Simultaneous measurements of left ventricular EF and FAC were obtained for each patient, both before and after starting a dobutamine intravenous infusion to modify left ventricular contractility. RESULTS: Mean values for radionuclide EF and transesophageal echocardiography FAC were, respectively: 55% +/- 19% (range 19-89%) and 46% +/- 18% (range 17-80%). Left ventricular EF and FAC were significantly correlated (r = 0.85, SEE = 9.6%). Variations of EF and FAC, induced by dobutamine, were also correlated (r = 0.70, SEE = 4.9%). CONCLUSIONS: Fractional area changes determined by transesophageal echocardiography using automated border detection correlate well with radionuclide EF and may be used at the bedside to quantify left ventricular function in selected intensive care unit patients.

Echocardiography, Transesophageal↗
PubMed1996

Orthopaedic treatment and passive motion machine: consequences for the surgical treatment of clubfoot.

The efficacy of orthopaedic treatment and its influence on clubfoot surgery has never been truly demonstrated. In the unsorted mass of clubfeet treated, it is difficult to determine exactly how effective orthopaedic treatment is for severely affected feet. If properly performed, perfectly synchronized, and supported by a Kinetec machine, such treatment can noticeably reduce the rate of operation and, when operation is still required, reduce its extent. In grade II soft > stiff feet with scores of 5-10, Kinetec-supported orthopaedic treatment is extremely effective. Operation is required in 32% of cases only, and posterior surgery is often sufficient. Lateral release, in this category, is never required. In grade III stiff > soft feet, with scores of 10-15, the efficacy of orthopaedic treatment associated with the Kinetec machine is far from negligible and operation most often includes posterior and medial release (PMR), variably associated with plantar release. Lateral release is exceptional (15%), and operation is necessary in 75% of cases. In grade IV stiff = stiff feet, with scores of 15-20, orthopaedic treatment with the Kinetec machine has a true, though limited, effect. In this category, operation is necessary in 90% of cases. Lateral release is performed in 50%. In the postoperative period, orthopaedic treatment combined with use of the Kinetic machine must be continued. Orthopaedic treatment coordinated with use of the machine has considerably shortened the duration of plaster cast immobilization; 2 months when operation included posterolateral-medial (PLMR) release or PMR, and only 1 month when operation was posterior release (PR). The machine has noticeably changed the results and has indisputably influenced operation on the whole.

Clubfoot↗
PubMed1996

Are neurologic events occurring during carotid artery surgery predictive of postoperative neurologic complications?

BACKGROUND: Per- and postoperative neurologic complications occurring during carotid artery surgery may be related to different mechanisms. Nevertheless, recent studies suggest that they are related and that patients who develop reversible neurologic events peroperatively are at risk of postoperative neurologic complications. We, therefore, studied 265 patients operated under regional anaesthesia to assess the incidence and the pathogenesis of per- and postoperative neurologic disorders and their relationship. METHOD: Neurologic function was adequately assessed in 261 patients during surgery. The operation was uneventful in 234 patients, while 27 suffered from transient ischaemic neurologic deficit occurring mainly during carotid artery clamping. RESULTS: Postoperative neurologic complications occurred in 6 (2.5%) of the patients who were symptom-free during surgery and in 1 (3.7%) of the patients who experienced neurologic deficit during surgery (NS). In this group, two additional patients had peroperative neurologic deficit which lasted a few hours postoperatively so that the total incidence of postoperative neurologic deficit (11.1%) was significantly higher than in the other group (P < 0.05). Emboli (N = 3) and carotid artery thrombosis (N = 3) were the main causes of postoperative neurologic deficit. CONCLUSION: We conclude that patients who have suffered from a peroperative neurologic complication were more frequently in an unstable neurologic condition postoperatively. However, the incidence of "new" neurologic deficit, separated by a free interval from the one occurring peroperatively, was not significantly different in this group.

Adult↗
PubMed1996

Respiratory resistance by end-inspiratory occlusion and forced oscillations in intubated patients.

Measurement of respiratory impedance by the forced oscillation technique (FOT) in intubated patients requires corrections for the flow-dependent resistance, inertance, and air compression inside the endotracheal tube (ETT). Recently, we published a method to correct respiratory impedance for the mechanical contribution of the ETT. To validate this correction, we compared the respiratory resistance obtained with this method (Rfo) to the intrinsic (Rmin) and total resistances (RT) measured by the airway-occlusion technique (OCT) in 16 intubated sedated paralyzed ventilated patients. The FOT was applied at functional residual capacity in the 4- to 32-Hz frequency range, whereas the OCT was performed at the end of a normal constant-flow inspiration. Rmin corrected with Rfo measured at 16 and 32 Hz [Rfo(16) = 1.10 x Rmin + 0.10 cmH2O.s.l-1, r = 0.96, P < 0.001; Rfo(32) = 0.93 x Rmin + 0.72 cmH2O.s.l-1, r = 0.97, P < 0.001]. RT corrected with Rfo at 4 Hz [Rfo(4) = 1.11 x RT - 1.48 cmH2O.s.l-1; = 0.92; P < 0.001]. We conclude that the FOT improved by correction for the behavior of the ETT is in good agreement with the OCT in intubated patients.

Adult↗