Biomedical subjects
G Menard
Publications and source records attributed to G Menard.
Vecuronium pharmacokinetics and pharmacodynamics during hypothermic cardiopulmonary bypass in infants and children.
PURPOSE: To determine the effect of moderate and deep hypothermic cardiopulmonary bypass (CPB) on the pharmacokinetic and pharmacodynamic behaviour of vecuronium in infants and children. METHODS: We studied 12 patients undergoing surgery for congenital heart disease under narcotic-nitrous oxide anesthesia. Neuromuscular blockade was maintained constant (TI 4-10% by Datex electromyograph) by adjusting a vecuronium infusion. Plasma vecuronium concentrations (Cpss) were analysed by HPLC to describe a pseudosteady-state during each of the pre-CPB, CPB and post-CPB phases. Paired arterial blood samples were taken 20 min apart after at least 20 min of constant infusion. RESULTS: Nine cases were analysed, mean age 20 mo, mean weight 9 kg. Three patients had deep and six moderate hypothermia. In the pre-CPB phase Cpss fell into two groups (mean +/- SD: 330 +/- 42 ng x ml(-1); 127 +/- 27 ng x ml(-1); P < 0.001); similarly the clearances showed a bimodal distribution (mean +/- SD: 5.08 +/- 0.94; 11.51 +/- 0.2 ml x min(-1) x kg(-1) P < 0.001), although in different patients. During CPB this bimodal distribution disappeared. Vecuronium infusion rate (VIR) decreased by 84% and 92% from pre-CPB to CPB phase in deep and moderate hypothermia groups respectively (P < 0.05), paralleled by decreases in Cpss of 36% (P > 0.05) and 52% (P < 0.05). CONCLUSION: Changes in vecuronium requirements and plasma concentrations during CPB demonstrate that vecuronium pharmacokinetics and pharmacodynamics are both affected by hypothermic CPB in infants. The finding of bimodal distributions for plasma vecuronium and vecuronium clearance highlights the need for individual monitoring of neuromuscular blockade in this age group.
Cisatracurium pharmacokinetics and pharmacodynamics during hypothermic CPB in infants
Explore the source record for details and available documents.
[External ophthalmomyiasis by Oestrus ovis from a beach in Var].
In the month of June, a young women on a beach in Hyeres, France, was afflicted by a sudden burning sensation in both eyes. Emergency room examination of the conjunctiva and conjunctival cul-de-sacs revealed the presence of moving organisms 1 mm. The diagnosis was external ophthalmomyiasis. Subsequent investigation of the site of contamination showed that it was located two kilometers from a herd of sheep. The purpose of this report is to underline the possibility of this albeit rare occurrence in France and to review diagnostic and therapeutic methods. In most cases accidental summertime contamination in man leads to minor clinical manifestations. Examination of the conjunctiva and conjunctival cul-de-sacs is necessary to remove larvae. Larvae can be easily identified on the basis of microscopic examination criteria. Identification is important to allow clinical physician to institute proper symptomatic treatment, attempt complete elimination of all larvae, and reassure the patient. Possible persistence of larvae and potential complications justify follow-up examination.
[Dangerous sharks in tropical seas].
Sightseeing travel in tropical zones is a growing industry. The risks incurred by travelers depend on the destination, duration of stay, individual behavior, and type of leisure activity. Water sports expose visitors to encounters with dangerous marine animals. Shark attacks are rare but always serious occurrences. Divers should handle any shark, regardless of size, with due precaution. Prevention of shark attack depends on avoiding encounters by not attracting the attention of the shark and knowing the proper attitude to adopt in case an encounter should occur. Active and passive protection can be used, but each method has advantages and disadvantages depending on the situation. Rescue operations are difficult due to the gravity of injuries and their occurrence in a marine environment. This along with the nature of the aggressor explain that many attacks are immediately fatal. Wounds are often deep with involvement of bone, blood vessels, and nerves. A possible source of complication in survivors is infection, which can involve uncommon microorganisms associated with bacteria in sharks mouth or marine environment.
[An ancient Egyptian treatise on ophiology].
Explore the source record for details and available documents.
[Leishmaniasis and human immunodeficiency virus: an emerging co-infection?].
Although not considered as indicative of AIDS, leishmaniasis presents a number of epidemiologic and clinical features that promote opportunistic infection in HIV patients. Accurate assessment of the incidence of this type of co-infection is difficult due to underestimation in endemic areas such as Africa and Asia. In these areas the WHO estimates that 2 to 9 p. 100 of HIV patients will develop leishmaniasis/HIV co-infection which could become a major concern. The characteristics of this co-infection have been documented. It is observed in adults between 20 and 40 years of age with a strong male sex bias. The visceral form is most frequent. Manifestations are similar to those observed in immunocompetent subjects but with the possibility of asymptomatic and low-grade forms (10 p. 100) and unusual locations suggesting multiorgan spreading in absence of host immune response. In addition to the time-tested standard procedures for diagnosis of parasitic disease, new serologic tests and genomic amplification are now available. Pentavalent antimonials have long been considered as the treatment of choice but they are not always effective and can have untoward effects. Amphotericine B especially in the liposomal form is a good alternative. The particularly high incidence of recurrence suggests that follow-up may be indicated but the modalities of prophylaxis have yet to be defined.
[Study of correlations between self-estimation of memory, psychometric test (SM9) and test of memory in daily life].
Assessment of memory performance is now well established. However, the normal form of assessment does not evaluate memory problems encountered during daily activities, a situation relevant to the evaluation of drug effects on memory components. The present study examines the ecological validity of psychometric tests. 49 individuals, from 20 to 89 years old without any identified pathology were included in the study, with the aim of establishing correlations between an autoquestionnaire of memory, a standard memory battery (SM9) and a daily memory video test (DMV). No correlation was found between self-estimation and objective tests or DMV. A strong correlation (r = 0.81) was found between SM9 and DMV. Imaged information and verbal coding appear to be essential parameters of objective tests. These results confirm the ecological validity of the objective psychometric tests and in particular of SM9.
[Randomized double-blind comparative study of minaprine (200mg/j) and of placebo on memory loss].
Thirty five subjects (age: 45-69 years) with subjective memory loss, without any other neuropsychiatric or somatic disease, were recruited in a phase II study. This double blind randomized versus placebo controlled study compared the effects of minaprine (200 mg/d) with placebo, in two parallel groups, during 2 months, on memory, attention and vigilance. Three psychometric tests were the main criteria of assessment: a standardized battery of memory tests (SM 5), the dual-coding test, the analysis of choice reaction times (CRT) and the critical flicker fusion point (CFF). A positive effect of minaprine was detected on words delayed recall (p = 0.028) and immediate recognition of words (p = 0.049). The global clinical tests (CGI, MacNair scale) were not statistically modified. Tolerability of minaprine and placebo were comparable. A positive pharmacodynamic activity on mnemonic performance is thus demonstrated in favour of minaprine (200 mg/d) in this specific population characterized by a memory complaint. These results would lead to a phase III study in which the main criteria would be global scales in order to confirm the clinical reliability of the present results.