[Postoperative rhabdomyolysis secondary to diaphragmatic necrosis].
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Diaphragm↗
Biomedical subjects
F Bordet
Publications and source records attributed to F Bordet.
An evaluation of the Gram stain in protected bronchoalveolar lavage fluid for the early diagnosis of ventilator-associated pneumonia.
We investigated the usefulness and reliability of the Gram stain value versus quantitative cultures in the early diagnosis of ventilator-associated pneumonia (VAP) using the protected bronchoalveolar lavage (PBAL). One hundred four mechanically ventilated patients (age = 52 +/- 19; SAPS II = 38 +/- 15) with a strong suspicion of VAP were consecutively included. One hundred sixteen PBAL were performed and mini-bronchoalveolar lavage were analyzed using the Gram stain standard method and the conventional quantitative culture technique. VAP diagnosis was based on a positive quantitative culture of mini-bronchoalveolar lavage fluid (cutoff > or = 10(3) CFU/mL). A final diagnosis of VAP was established in 67 patients and there was no infection in 49 cases. Regarding detection of bacteria using the Gram stain, we found a sensitivity of 76.2%, a specificity of 100%, a positive predictive value of 100% and a negative predictive value of 75.4%. There was a good agreement with the final diagnosis (kappa statistic 0.73; concordance 86.2%). The degree of qualitative agreement between Gram stain and quantitative cultures was analyzed in the VAP group: the correlation was complete in 39% (26 of 67 VAP), partial in 28% (19 of 67 VAP) and there was no correlation in 33% (22 of 67 VAP). We conclude that despite its overall "good agreement," the Gram stain is of limited use for the rapid diagnosis of VAP and unreliable for the early adaptation of empirical antimicrobial therapy when using the noninvasive PBAL procedure.
Adult↗
Estimation of the dietary intake of pesticide residues, lead, cadmium, arsenic and radionuclides in France.
Estimation of the dietary exposure of French consumers to 10 pesticides (omethoate, oxydemeton, phosalon, phosphamidon, triazophos, dicofol (op' + pp'), parathion ethyl, dichlorvos, procymidon and vinchlozolin), three heavy metals (lead, cadmium and arsenic) and three radionuclides (134caesium, 137caesium and 131iodine) from collected duplicate portion in mass catering establishments in 1998/1999 are reported, and compared with those from previous French studies as well as those from other countries. Dietary exposure estimates appear to be reassuring, in that Estimated Daily Intake (EDI) estimates are generally low, representing at maximum only 4% of the Acceptable Daily Intake (ADI) for pesticide residues and 28% of the Provisional Tolerable Weekly Intake (PTWI) for heavy metals. Moreover, none of the three radionuclides has been found in duplicate meals. When comparisons are possible, estimated dietary exposures for heavy metals are lower than those from previous French studies and similar or above those from other countries.
Adolescent↗
[Emergency computed tomography in a general hospital center].
This retrospective study was performed to precise indications of emergency CT in a general hospital over a 30 months period. We tried to determine, with help of prior studies, the indications for CT of the brain in the management of acute meningitis, acute headache, and in the management of head injury. In acute meningitis, there is no evidence to recommend CT of the brain before lumbar puncture, except to identify patients at increased risk of cerebral herniation. The imaging study of choice in subarachnoid hemorrhage is non enhanced CT scan. This exam has to be performed in case of acute headache. The CT evaluation of patients with minor head injury remains controversial.
Acute Disease↗
[Acute gastric distension necessitating gastrostomy after anesthetic induction for surgical correction of type III esophageal atresia].
IPPV during anaesthesia for management of oesophageal atresia with tracheo-oesophageal fistula (TOF) can cause gastric insufflation. We report such a complication in a one-day-old newborn, who developed, 15 min after induction, a distension of the abdomen, hypoxia and bracdycardia. An emergency gastrostomy was performed. His status improved rapidly and surgery could be completed. TOF was located at the carina and had a large calibre. To avoid gastric distension in such cases, the tip of the tube is located just proximal to the carina, but distal to the fistula to prevent intubation of the latter. Difficulties are due to position of the fistula (carina, main bronchi) or its large bore. Gastric distension carries a risk of regurgitation and inhalation of gastric contents, elevation of hemidiaphragm and lung compression, decreased tidal volume, decreased venous return, cardiovascular collapse and cardiac arrest. When insufflation peak pressures are low, gastrostomy is benefitful, as in our case, as the tidal volume loss through the stomach is acceptable. In case of high insufflation pressures because of co-existing lung disease, gastrostomy is better avoided, as most if not all the tidal volume may be lost through the stomach.
Anesthesia, Inhalation↗
Iodised rapeseed oil for eradication of severe endemic goitre.
Iodised oil is traditionally based on the fatty acids (FAs) of the poppyseed, an expensive commodity. An equipotent but cheaper vehicle would be welcome. Iodination of rapeseed oil yields a product (Brassiodol) with a total iodine content of 376 mg/mL. Brassiodol has been compared with the poppyseed-based Lipiodol in two villages in Chad in the west African goitre belt. A 2 mL dose of Brassiodol is followed by urinary spillover of half the ingested iodine. The other half undergoes tissue sequestration and slow release, allowing protection against iodine deficiency for 9 months and regression of stage I/II goitre for longer than was achieved with Lipiodol. The prolonged protection offered by Brassiodol can be attributed to its unique lipid profile. The urinary output argues that 1 mL should not be exceeded, and at that dose the cost would be only 20 US cents per person per year.
Adult↗
[Tetraparesis in an infant after prolonged administration of pancuronium].
Long-term administration of pancuronium for ventilatory support of adults with ARDS may result in severe tetraparesis, with areflexia and atrophy of distal muscles. This adverse effect occurs rarely in paediatric intensive care units. We describe a case of tetraparesis after prolonged pancuronium infusion in a 9-month-old girl who experienced a severe bronchopneumonia caused by para-influenza virus, requiring endotracheal intubation and mechanical ventilation. To decrease chest wall rigidity, pancuronium was administered over 11 days, with a total dose of approximately 120 mg of pancuronium bromide. The day after discontinuation of the muscle relaxant she had a severe tetraplegia with areflexia, but normal head movements. Electromyography showed a normal neuromuscular transmission. She recovered from tetraplegia three months later. Other causes of peripheral neuropathy were eliminated. Electroencephalograms and head CT-scans were normal. The recovery pattern observed in our patient corresponded to the process of regeneration seen after axonal degeneration. It is suggested that these neuromuscular complications were caused by prolonged high-dosage pancuronium treatment, associated with corticosteroid and aminoglycoside administration.
Bronchopneumonia↗
Organochlorine pesticide and PCB congener content of French human milk.
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Eating↗
[Relationship between digital necrosis of the upper limbs and malignant conditions (author's transl)].
The authors report six new cases of necrosis of the fingers occurring during the course of a malignant condition. None of the patient was suffering from any other disease which could explain the digital necrosis. They discuss the mechanism of the relationship between the two conditions : blood hyperviscosity, thrombocytosis, polycythaemia, cryoglobulin and the production of immune complexes. The particular role of bleomycin is mentioned. The possibility of a true paraneoplastic syndrome is suggested.
Adult↗
[Therapeutic principles].
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Drug Therapy↗
[Joseph Genevrier (1876-1970)].
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France↗
[André Dufourt].
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History, 19th Century↗
[Ferdinand Piéchaud].
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History, 19th Century↗