[An example of an acceptable combination in the treatment of arterial hypertension].
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Adult↗
Biomedical subjects
F Gouin
Publications and source records attributed to F Gouin.
[Comparative study of venous contamination with low FiO2 and with pure oxygen in disease-induced pulmonary edema].
A comparative study of the venous contamination (Qs/Qt = (Cc'O2 - CaO2) / (Cc'O2 - C-vO2) under FIO2 = 0.45 - 0.6 and under FIO2 = 1, was realised in 9 patients with lesions of pulmonary oedema. Increasing the FIO2 lead to an increase in the venous contamination three times (average increase was 36 p. 100 of the initial value), to no change two times and a decrease four times (average decrease of 34 p. 100). The values of the venous contamination under average FIO2 are statistically lower in the group where it rises on increasing the FIO2 than in that in which it falls or remains unchanged (p is less than 0.005).
Humans↗
[Effect of dobutamine on intra-pulmonary shunt].
A study of the development of intra-pulmonary shunts was carried out in ten subjects following an intra-venous administration of a 7.5 microgram/kg/min dose of dobutamine by electric syringe. All the subjects were on a respirator (FiO2=0,6 most often) and frequently with P.E.E.P. The shunts were determined at the FiO2 by which the subject was being treated. The cardiac flow was measured by thermodilution. In 9 cases out of 10 the intra-pulmonary shunt is sharply increased already in the first half hour by dobutamine. The shunt values are in the order of: -- 17.94p. 100 +/- 7.19 before the drug -- 26.50 p. 100 +/- 12.85 half an hour after the infusion beginning. The shunt increase is thus 47p. 100 of the average original value after half an hour, which is significant (p less than 0.01). The shunt is then stable at the attained value (hourly average : 26.05 +/- 12.25). These observations are discussed in relation to the obtained effects on the cardiac outout, to the PaO2, and to the quantity of transported arterial oxygen. It appears in this series that, in spite of the shunt increase, there is no risk of cellular oxygen deficiency.
Acid-Base Equilibrium↗
[Antibiotic treatment in acute peritonitis].
The selection depends on several factors and in particular: -the means of transport by which the antibiotic reaches the peritoneum : the aminosides and the betalactamines attain the peritoneum easily while the polymyxins do not; -the causative agent: most often it is a gram negative aerobic or anaerobic bacteria. The entero-bacteria predominate but in the last few years Bacteroides fragilis has been frequently encountered giving rise to numerous studies. The flora is most often polymicrobic. The betalactamines act on gram positive bacteria whether they are aerobic or anaerobic. The aminosides are active against aerobic gram negative bacteria. The same can be said for Colimycine (except for certain Proteus and Providencia). All these antibiotics (other than carbenicillin) are not effective against Bacteroides fragilis which are however very sensitive to lincomycine, to the cyclines and in particular to doxycycline and to the derivatives of imidazole. The laboratory is an important aid in judging therapeutic effectiveness by determining the bacteriacidal strength of the serum and even the serum level of the antibiotic whatever the cause it is imperative: to avoid toxicity and to pay particular attention to the frequent problem of renal insufficiency in these subjects.
Acute Disease↗
[Sodium nitroprusside in neurosurgery. Apropos of 34 cases].
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Adult↗
[Bacteroides fragilis septicemia].
On the basis of eight cases of Bacteroides fragilis septicaemia, the authors review recent data from the literature related to this topic. They first note the increasing prevalence, accounting for approximately 10 per cent of all septicaemias at the present time. They note that the most frequent portals of entry are sites of localised suppuration, related on the one hand to digestive or gynaecological surgery and, secondly, to the post-partum or post-abortum period. From a therapeutic standpoint, they stress the important role of imidazole derivatives (metronidazole or tinidazole) which are the most effective antibiotics at present. Certain authors even suggest their use on a preventive basis in high risk subjects.
Adult↗
[Glucide intolerance and its pathogenic mechanisms during parenteral feeding].
Hyperglycaemia during parenteral alimentation occurs either as a result of an error in the supplies provided or as a result of diminished carbohydrate tolerance. The circumstances surrounding the development of carbohydrate intolerance are essentially : severe infections, major catabolic states, renal insufficiency, extensive burns, pancreatic problems and diabetes. From a pathogenic standpoint, there are two dominant elements : disturbances in hepatic gluconeogenesis and changes in insulin secretion and in resistance to insulin. The physiopathology is dominated by the risk of hyperosmolarity. Hypoglycaemia occurs most frequently as the result of a manit fest error : too sudded interruption of carbohydrate supplies or two high dosage of exogenous insulin.
Blood Glucose↗
[Clinical signs and etiological aspects of metabolic encephalopathies excluding liver encephalopathy and realimentation syndrome].
The clinical picture of metabolic encephalopathies has no aetiological specificity. It combines disturbances in conscious level dominated by disorientation and time and space and disturbances in motor activity, in particular tremor and asterixis. For each of the aetiologies studied, the following are considered: the circumstances of onset, the clinical and laboratory picture, the physiopathology and the treatment. From a diagnostic standpoint, particular emphasis should be placed upon the circumstances of onset which alone give any indication. The majority of these encephalopathies are caused by a lack of respect for simple rules in parenteral alimentation or by deficiencies. It is thus essentially an iatrogenic pathology. Treatment should be above all preventive.
Consciousness Disorders↗
[New opportunist infection due to a Bacillus. A case of bacteremia with Bacillus licheniformis].
The authors report a case of bacteriemia with Bacillus licheniformis in a pregnant woman with coagulation disorders (acute fibrinolysis). Eight blood cultures were positive. Recovery rapidly occurred. The origin of this affection is discussed : a venous mode of entry is possible, either by the use of contaminated infusion fluid, or following several catheterizations.
Bacillus↗
[Treatment of septicemia and severe infections with a cefradine-tobramycin combination].
The cefradine-tobramycine association was used in 11 cases of septicaemia and in 10 cases of non-septicaemic severe poly-infections. In 15 cases, the treatment was undertaken because of the serious state of the patients before the bacteriologic results were known. This association is characterized by its great effectiveness and its very good tolerance, mainly from the renal point of view. The results shown here corroborate those two elements.
Adult↗
[Complications and contraindications of corticotherapy].
In a review of the classical complications of corticotherapy the aouthors tried, in the light of the literature, to take into consideration the ideas received as compared with the numerical conclusions of statistical studies on large series. Then they presented the patient treated with corticoids, faced with the surgical intervention. They tried to demonstrate that adrenal insufficiency, if present, is only exceptional and that all of the incidents, observed during and immediately after surgery must not be attributed to it.
Adrenal Cortex Hormones↗
Ventilation and blood-gas studies during experimentally produced Mendelson's syndrome in the dog.
Hydrochloric acid was instilled into the bronchial tree in anaesthetized dogs. A severe respiratory acidosis resulted. The metabolic component of acid-base balance was little affected.
Acidosis, Respiratory↗
[Criteria for reoperation in abdominal surgery (exclusive of surgical and nephrological criteria)].
In summary, 40 p. 100 of 104 reinterventions carried out in 71 patients from the Resuscitation sector were decided upon in the absence of surgical and nephrological criteria. The authors emphasize the value of the infectious syndrome (74 p. 100 of the cases), of water and electrolyte disorders (60 p. 100 of the cases), and of hypercatabolism (83 p. 100 of the cases).
Abdomen↗
[Preparation of the patient for reoperation].
The preparation of patients for reintervention should aim at the correction of: - states of shock and collapse, found in one out of three patients; - hydroelectrolytic disturbances (sodium depletion, hypochloremia, dyskaliemia); - and finally, re-establishment of the acid-base balance.
Acid-Base Imbalance↗
[Peroperative resuscitation in abdominal reoperations].
Resuscitation of these patients during operation is the only the logical continuation of their preparation. The authors therefore take up the preceding points while emphasizing: - checking vascular filling, by central venous pressure and hourly diuresis; - the necessity for a supply of carbohydrates, which is even more indispensable when the subjects were submitted to parenteral hyperalimentation previously; - the advantages of performing arterial blood gases in order to check artificial ventilation.
Abdomen↗
[Nutrition in the surgical patient with complications].
Parenteral feeding in complicated abdominal surgery has been a definite therapeutic progress. However the authors emphasize the divergent attitudes concerning the amounts of nitrogen which should be supplied as well as the variations in the calories-nitrogen ratio. They propose a practical attitude which must be reevaluated individually.
Abdomen↗
[Prognostic factors in reoperations in abdominal surgery. Apropos of 104 operations].
Analysis of the prognostic factors in abdominal surgical reinterventions accentuates the disparaging character of age, associated defects and emergency. Intercurrent respiratory complications, as well as infectious and renal complications make the prognosis considerably worse.
Abdomen↗
[Blood gas determination and calculation of shunts in nonhemodynamic pulmonary edemas].
Qs/Qt is usually determined by the "oxygen" method. The standard equation for calculation of percentage shunts is therefore: (see article) In the case for an FiO2 of I and when PaO2 is greater than 150 mm Hg, the equation can be expressed in terms of the difference in partial pressures of oxygen between the alveolus and the artery: (see article) The determination of Qs/Qt then necessitates, apart from calculation of PaO2 measurement of the O2 content of mixed venous blood, taken from the pulmonary artery. When an indwelling catheter for the sampling of mixed venous blood is not available, samples of superior vena cava blood can be used instead. The error thereby introduced into the calculation of Qs/Qt is debatable. Strictly, only the sampling of mixed venous blood permits precise determination of Qs/Qt. As long as the variations in Qs/Qt, more than its real value at a give time, are worth supervising, superior vena cava blood gives a rather satisfactory approximation. Various graphs relating Qs/Qt to PaO2 or to the alveolo-arterial difference have been proposed and are discussed. The other methods of determining Qs/Qt are also looked at. The value of determination of the shunt during non-hemodynamic edema, and especially in the patient under artificial ventilation with P.E.E.P., is emphasised.
Blood Gas Analysis↗