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Biomedical subjects

F Gouin

Publications and source records attributed to F Gouin.

At least 145 records · Page 8Linked to original sources
PubMed1990

[Aortic paraprosthetic infection. Diagnostic and therapeutic difficulties. Apropos of a case].

Despite advances in vascular surgical techniques and antimicrobial therapy, aortic graft infection remains a difficult clinical problem to manage. We report a case of secondary paraprosthetic fistula. All complementary investigations were negative and the fistula was diagnosed by laparotomy. In situ replacement of the infected graft was decided despite signs of infection. The postoperative course was complicated by septic shock, successfully treated by organism-specific antibiotic therapy. In conclusion, complementary investigations should not delay laparotomy in patients with a aortic prosthesis presenting with unexplained infection. They must be considered to be suffering from a graft infection until proven otherwise. Conditions in situ replacement of the graft appears to be possible under these.

Aortic Valve↗
PubMed1990

[Modification of ofloxacin pharmacokinetics induced by prolonged mechanical ventilation].

The pharmacokinetics of ofloxacin was studied in 12 intensive care patients, 6 of whom being under mechanical ventilation. All patients had a creatinine clearance greater than 60 ml/min/1.73 m2 and they were given 3 mg/kg. IV ofloxacin within 30 mn, with a twice daily regimen for 7 days. Pharmacokinetic studies were performed on day 1 (D1) and 7 (D7). Between D1 and D7 a significant increase in T 1/2 beta, AUC and blood levels were observed together with a decrease in total body clearance. Creatinine clearance was not modified between D1 and D7 but ofloxacin renal clearance was considerably altered. Abnormalities in ofloxacin renal tubular secretion may account for the drug cumulation which was observed during repeated administration in intensive care patients.

Aged↗
PubMed1989

[Use of norepinephrine in the treatment of septic shock].

The effects of noradrenaline were studied in 16 patients, with either a hyperkinetic septic shock syndrome or a septic shock resistant to dobutamine treatment. The study aimed to restore normal tissue perfusion pressure, assessed by a return to normal of urine output or blood pressure. An optimal left ventricular filling pressure, estimated by the pulmonary capillary wedge pressure, was obtained for each patient using a Swan-Ganz catheter. The administration of 10.6 +/- 0.5 micrograms.kg-1.min-1 dobutamine (starting dose: 6 micrograms.kg-1.min-1) was started when the cardiac index (CI) was less than 3.3 l.min-1.m-2 after vascular filling with plasma expanders. Patients became eligible for noradrenaline treatment when they fulfilled the following conditions: arterial systolic pressure (Pasys) less than or equal to 90 mmHg; systemic vascular resistances less than or equal to 600 dyn.s.cm-5; CI greater than 3.5 l.min-1.m-2; persistent oliguria (less than 30 ml.h-1). This drug was given at a constant rate with a starting dose of 0.5 micrograms.kg-1.min-1, increased every 10 min by 0.3 to 0.6 micrograms.kg-1.min-1 according to the effects on Pasys and hourly urine output. Eight patients received noradrenaline alone; the efficient dose was 0.9 +/- 0.2 micrograms.kg-1.min-1, and it was used for a mean 5.1 +/- 1 days. CI increased in those patients who were given both noradrenaline and dobutamine. Thirteen out of the 16 patients had a dramatic increase in urine output; only three patients remained oliguric. There were no effects on serum creatinine concentration, anion gap, intrapulmonary shunt and oxygen consumption.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Protein C deficiency and cerebral venous thrombosis in pregnancy].

A fatal case of cerebral venous thrombosis associated with protein C deficiency is reported. It occurred at six months of gestation in a 25 year old patient during her first pregnancy. She had generalized seizures. Computed axial tomography displayed cerebral haemorrhagic infarction, and the carotid angiograms signs of superior longitudinal sinus thrombosis. Before the patient's death on the seventh day after admission, protein C deficiency was discovered. The occurrence of thrombosis of the superior longitudinal sinus during pregnancy, as well as that of protein C deficiency in atypical cases of thromboembolic disease, are discussed.

Adult↗
PubMed1989

Comparison of two methods of bacteriologic sampling of the lower respiratory tract: a study in ventilated patients with nosocomial bronchopneumonia.

The purpose of this prospective study was to compare the results of bacteriologic assessment of the lower respiratory tract in mechanically ventilated patients by two sampling techniques: fiberoptic protected brush biopsy or blind bronchial aspiration of secretions. Thirty-three mechanically ventilated patients with acute bronchopneumonia were studied. Paired samples were collected by both techniques 47 times. Identical results were obtained in 93% of the cases. In 28 pairs, one or several identical organisms were cultured. In 16 pairs, no bacteria were isolated; in the three remaining pairs, results were contradictory. In five patients with concomitant positive blood cultures, the same organisms were cultured from fiberoptic protected brush biopsy, blind bronchial sampling, and blood cultures. These findings support the fact that blind bronchial sampling can be recommended for bacteriologic assessment of the lower respiratory tract in mechanically ventilated patients with diffuse nosocomial bronchopneumonia.

Biopsy↗
PubMed1989

[Plastic surgery of the anterior cruciate ligament: experimental study of intra-articular aramid fibers in dogs].

The authors explored the possibility of replacing an anterior cruciate ligament with an aramid fiber (Kevlar) implant. This study was performed in intra-articular site in 9 dogs and the average implantation period was 5 months. Studies were carried out by macroscopic, photon microscopy, and electron microscopy examination of the samples obtained at the time the animals were sacrificed. Clinical and radiographic studies of the knees were performed in order to assess functional consequences. Overall, the results showed a partial or complete rupture of 10 neoligaments out of the 17 studied ligaments; on the other hand, osseous anchorage and reintegration in the intra-articular zone appeared satisfactory. Kevlar fiber only partially meets the performance specifications for an artificial ligament intended to serve as an anterior cruciate ligament substitute. Some positive results have encouraged the authors to carry on further this experimental study.

Animals↗
PubMed1988

Pefloxacin in the treatment of nosocomial lower respiratory tract infections in intensive care patients.

Pefloxacin was used to treat nosocomial pulmonary infections in 46 mechanically ventilated patients. All patients had one or more underlying diseases and were given pefloxacin at a dose of 800 mg or 1200 mg daily in two or three divided doses. The commonest bacterial isolates were Staphylococcus aureus, Pseudomonas aeruginosa and enterobacteria. Of these patients, 33 (72%) showed a favourable response, one patient relapsed and 12 (26%) were considered failures. Superinfections occurred in 10 (22%). Of the 62 isolated potential pathogens, 53 (85%) were completely eradicated. Side effects were mild and treatment was withdrawn in only three patients. Pefloxacin can be considered as a possible therapeutic agent for the treatment of nosocomial pulmonary infections.

Adolescent↗
PubMed1988

Tobramycin dosing in mechanically ventilated patients. Inaccuracy of a 'rule of thumb'.

The ability of a simple rule of thumb, based on creatinine clearance, to predict tobramycin serum concentrations was evaluated in mechanically ventilated patients. They were given tobramycin intravenously over 30 min at 8 h intervals. Creatinine clearance was estimated from the formula developed by Cockcroft & Gault (1976, Nephron 16, 31-41) or was calculated after urine collection for 24 h. The loading dose was 1.5 mg/kg and then dose adjustments were performed on a daily basis. Patients were studied on day 1 and day 3. Mean values of peak and trough levels were within the therapeutic range, but individual values were outside the therapeutic range in 30% to 70% of patients on both day 1 and day 3, most of the patients having subtherapeutic serum concentrations. This was mainly related to the high volume of distribution of tobramycin calculated in these patients. These results further emphasize the need to monitor serum concentrations and to use an individual pharmacokinetic method to make dose adjustment.

Adult↗