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Biomedical subjects

J C Manelli

Publications and source records attributed to J C Manelli.

At least 37 records · Page 2Linked to original sources
PubMed1991

[Respiratory failure in a HIV seropositive heroin addict female].

A 31-year-old woman, heroin addict since ten years, and infected by the human immunodeficiency virus (HIV) since one year, was admitted to the intensive care unit for respiratory failure (PaO2 = 40 mmHg and PaCO2 = 14.8 mmHg, despite breathing pure oxygen). She had been followed up for 6 months for increasing dyspnoea due to chronic cor pulmonale for which no satisfactory explanation had been put forward. Artificial ventilation with 8 cmH2O positive end-expiratory pressure and 100% oxygen was completely inefficient. She died within a few hours. Postmortem lung biopsy revealed talc particles within interalveolar walls and alveolar macrophages as well as the expected alterations in blood vessels. Pulmonary hypertension due to talc microemboli is a well-known cause of respiratory failure in heroin addicts. Such a diagnosis should not be overlooked in a patient infected with HIV. Respiratory failure may not be only due to opportunist infections, or tumours related to the HIV infection.

Adult↗
PubMed1990

[Neurophysiological study of propofol (2-6 diisopropylphenol): experimental data].

Propofol was assessed in laboratory animals using an experimental technique which leads to an over all appreciation of central nervous system function. After Bimar and Naquet, (1966) a battery of neurophysiological tests in the cat investigate specific primary pathways (visual evoked potentials), non specific pathways (arousal reaction) and hemodynamic response to painful aggression (stimulation of dentine). Propofol appears to be a powerful narco-hypnotic drug. More, it have an original property which is quite rapidly effective and unconnected with narcosis: a protective hemodynamic ("sympathoplegic or neuroleptic") effect. So, propofol, a new anesthetic agent, seems to be a progress with regard to other drugs used previously.

Anesthesia, Intravenous↗
PubMed1990

[Metabolic risks in surgical hysteroscopy].

Operative hysteroscopy is often carried out using glycine as an irrigant. This solution has interesting properties but also metabolic effects that are very well known by urologists. This study is concerned with the biological changes that have occurred after one hundred surgical hysteroscopies of which twenty nine were carried out using glycine. In hysteroscopy the significant variations are concerned with blood levels of protein, the haematocrit, changes in sodium levels and glycaemia. 44.9% of patients had changes greater than 5% as compared with the pre-operative levels. These changes concerned the haematocrit readings and in 57.1% the changes in protein in the blood and in sodium in 12%. The haematocrit changes, the protein changes and to a lesser degree the sodium changes could be correlated with one another but not with changes in glycine levels in the blood. Whatever the pathology inside the uterus, glycine went through in equal quantities. It was particularly significant when there was perforation of the uterus. It is linked to the glycine balance and to the length of time the operation had taken. When a mean quantity of fluid of 2.6 litres was used to irrigate, levels after the operation as compared with before the operation had multiplied 4.5 times. This corresponds to the dosage of glycine used. In five patients out of twenty nine post-operative quantities were 10 times those before operation. The consequences of these changes in glycine levels are variable and seem to be more significant in women who have never been pregnant or who are very heavy. Using vasoconstrictor agents does not alter these metabolic changes.

Adult↗
PubMed1989

[Autologous transfusion by peroperative salvage in orthotopic transplantation of the liver].

As large quantities of blood are required during orthotopic liver transplantation, intraoperative autotransfusion is therefore often carried out in adult patients. This study aimed to assess the ease of use of this technique, its efficiency and possible side-effects. Intraoperative blood salvage was carried out using a Cell Saver 4R (Haemonetics) in 14 patients. The chest blood was collected, anticoagulated with heparin and sodium citrate, centrifuged and washed with Ringer lactate. During surgery, and the subsequent 5 days, the following data were recorded: red cell and platelet count, haemoglobin concentration, parameters of renal function, potassium, citrate and fibrinogen levels, parameters of renal function, blood cultures and the extubation delay. Autotransfusion was simple to use, with no side-effects during the procedure. An average of 20.5 red cell packs were required, of which 59.2 +/- 2.3% were supplied by autotransfusion. The volume of transfused blood was similar, or inferior, to other studies. The different haematological parameters, blood gases and serum potassium levels remained stable. Only 4 +/- 2.8 red cell packs were required postoperatively to maintain a stable haematocrit value. There was no increase in thrombin time, and therefore no effect due to the used heparin. Citrate levels were correlated with the amount of autotransfused blood. They were lower than in other studies because autotransfusion limited the citrate load. There was no haemolysis. Postoperative renal function remained normal. There was no change in the blood coagulation profile, except when large volumes were transfused, resulting in a dilutional coagulopathy. Extubation was always carried out during the first two postoperative days. Bacteriological studies remained negative, no bacteraemia being noted. During orthotopic liver transplantation autotransfusion is a simple, reliable technique, with few side-effects.

Adult↗
PubMed1989

[Fibrinolytic activity in patients undergoing hepatic transplantation].

Bleeding complications during liver transplantation have been attributed to accelerated fibrinolysis. In order to determine its cause, 11 adults (mean age: 38.9 +/- 13.2 yr) undergoing liver transplantation were studied. There were three groups of patients: cirrhosis (n = 4), fulminating hepatitis (n = 4) and one group including a primary biliary cirrhosis, a hepatic metastasis and a hepatoma. The following factors were studied in the immediate preoperative period, at different surgical times throughout the procedure and 2-3 h after the end of the abdominal sutures: platelet count, prothrombin concentration, fibrinogen, activated kephalin time, factors II, V, VII + X and VIIIc, antithrombin III, protein C, D-dimers, fibrinogen and fibrin degradation products (PDF), plasma plasminogen, tissue plasminogen activator (tPA) and the fast tPA inhibitor (PAi). Preoperatively, only the two patients with hepatic cancer had a normal haemostatic profile. Throughout the procedure, all patients had only moderate changes in platelets, coagulation factors and their inhibitors, and plasminogen, because platelet concentrates and fresh frozen plasma were transfused. Levels of tPA rose, becoming very high during the anhepatic period and just after graft reperfusion. An abrupt fall occurred at the end of surgery. There were important individual differences in tPA activity. PAi activity was low during the preanhepatic and anhepatic stages, rising rapidly after revascularization.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Coagulation Factors↗
PubMed1988

[Oral dantrolene in a parturient with myotonic dystrophy and susceptibility to malignant hyperthermia].

A 33 year old woman, with myotonia atrophica and a known susceptibility to malignant hyperthermia, presented during her second pregnancy with multiple episodes of hyperthermia. They were associated with a rapid rise in the serum creatine phosphokinase (CPK) level, and not with infection or a myotonic crisis. Because of the obstetric conditions, caesarean section was planned. Preoperative oral dantrolene was used as prophylaxis. Six days after the start of this treatment, CPK and serum myoglobin levels were back within the normal range. There were no side-effects for the mother nor for the foetus. There were no further increases in either CPK or serum myoglobin levels during surgery or afterwards, but the rectal temperature remained markedly raised for 48 h after the delivery. Oral dantrolene was given during the first nine postoperative days. The occurrence of episodes of high fever during pregnancy linked to MHS and myotonia atrophica is discussed, as well as the anaesthetic management of such a patient. Side-effects of dantrolene for the mother or the foetus are also considered, especially as foetal levels of this drug would seem not to reach therapeutic levels. It would appear interesting to measure maternal dantrolene blood levels, especially if high doses are administered, to avoid reaching therapeutic levels in the foetus.

Administration, Oral↗
PubMed1988

[Central toxicity of local anesthetics. New data].

The central nervous toxicity of local anaesthetics has long been thought to be limited to the generalized tonicoclonic convulsions which follow the appearance of such symptoms as sleepiness, tingling of the lips, slurred speech, numbness, etc. Also the central nervous system was considered to be more sensitive than the cardiovascular system. However, recent experimental studies would seem to indicate that at least the more potent local anaesthetics, such as bupivacaine, have deleterious effects on parts of the brain other than the cerebral hemispheres. This may point to an involvement of the central nervous system (the amygdala and vasopressor areas of the floor of the fourth ventricle) in the pathogenesis of the hypotension and arrhythmias which may be seen at the same time as central nervous system signs of systemic toxicity. This is important for the treatment of such accidents: should a convulsion occur alone, sodium thiopentone, a muscle relaxant and a benzodiazepine, with oxygen and assisted breathing, will be the treatment; should an arrhythmia occur, its treatment should also include an anticonvulsant drug, such as a benzodiazepine. The prophylactic use of benzodiazepines should also be encouraged.

Anesthetics, Local↗
PubMed1988

Bupivacaine acute toxicity protection by diazepam in mice.

1. The effects of acute and 8-day administration of diazepam (DZP) on the acute toxicity of bupivacaine in the mouse were studied. 2. Protection of bupivacaine-induced acute toxicity by DZP appears to be dose-dependent after treatment for 8 days but not after acute treatment.

Animals↗
PubMed1987

[Hemodynamic effects of propofol used alone for the induction of anesthesia].

Haemodynamic effects of propofol were studied during induction of anaesthesia, in 20 patients undergoing abdominal aortic replacement. Eight of them suffered from coronary arterial disease. Propofol was used at a dose of 2 mg X kg-1. During 5 min after propofol administration, no drug was administered. Neither plasma expansion nor tracheal intubation were carried out. Haemodynamic changes were: 17% decrease in systolic arterial pressure, and 13% decrease in diastolic arterial pressure, associated with a 12% decrease in cardiac output and 7% decrease in systemic vascular resistances; no change in heart rate in spite of the decrease in arterial pressure; and a mild increase in diastolic pulmonary arterial pressure. Left ventricular systolic work and rate pressure product decreased, suggesting a favourable incidence in coronary disease by lowering myocardial oxygen consumption. Nevertheless, it must be considered that, in the group studied, patients with coronary disease receiving beta-blocking drugs were excluded. So, mild haemodynamic changes observed here have to be confirmed in patients suffering from more severe coronary arterial disease.

Aged↗
PubMed1987

Evaluation of a Bayesian method of amikacin dosing in intensive care unit patients with normal or impaired renal function.

Our study was designed to determine the population pharmacokinetic parameters of amikacin in intensive care unit patients and to develop a Bayesian method allowing individual estimation of pharmacokinetic parameters. A two-stage method was used for estimating the population characteristics of the pharmacokinetic parameters. Calculations of optimum doses and dosing intervals were based on individual parameters. Our results indicate that the Bayesian method is capable of estimating the individual pharmacokinetic parameters with no significant bias and good precision. Individualization of amikacin dosage was assessed 70 times in 52 patients. To determine the predictive performance of the method, observed peak and trough levels were compared with predicted values by computing precision, bias, and correlation. The amikacin dosing method was unbiased and showed a high correlation coefficient (r = 0.962) between measured and predicted drug serum concentrations. No significant differences were found between the predicted and observed peak (17.3 +/- 3.5 and 17.3 +/- 3.8 micrograms/ml, respectively) and trough (2.86 +/- 0.93 and 3.08 +/- 1.41 micrograms/ml, respectively) amikacin serum concentrations. Among the 52 patients, wide variations were observed in the pharmacokinetic parameters (Vd = 0.21-0.50 L/kg; t 1/2 = 1.1-22 h) and the daily doses (2.8-42 mg/kg/day).

Adolescent↗
PubMed1986

[Bacteroides fragilis meningitis. 2 cases].

In this study based on 2 personal cases and 23 cases from the literature the main clinical and therapeutic features of meningitis caused by Bacteroides fragilis are reviewed. The disease occurs in either very young or elderly people, with contributing factors in 54% of the cases. Clinically, the infectious syndrome is associated with meningoencephalitis and sometimes motor disorders. Although septicaemia is present in 80% of the cases, the patient's general condition is moderately affected. Blood leucocyte counts are definitely increased and CSF disturbances are those common to all types of bacterial meningitis. The initial focus of infection can be determined in 60% of the cases. The mortality rate is higher in adults than in children. Neurological complications are frequent. Nitro-imidazole derivatives, which are active against Bacteroides fragilis and reach high CSF concentrations, constitute the treatment of choice.

Adult↗
PubMed1984

[A severe form of Mediterranean boutonneuse fever].

A severe case of boutonneuse fever was reported which was only diagnosed after death. The infectious syndrome and cutaneous eruption were associated with meningitis, encephalitis, hypoxaemia and thrombocytopaenia. The absence of an initial lesion ("tache noire") and the notion of recent German measles contamination explained the late diagnosis. Serious cases of boutonneuse fever were usually rare; they were better known as Rocky Mountain spotted fever, a rickettsial infection of the same group, the clinical symptoms of which were very similar and which gave the same proteus agglutination reactions as with boutonneuse fever. An earlier diagnosis, now possible thanks to immunofluorescent techniques using skin biopsies, should enable earlier treatment.

Acute Disease↗
PubMed1984

[Effects on muscular and general proteolysis in burn patients of a solution enriched with branched amino acids].

In order to assess the effects of a branched chain amino acid (BCAA) enriched solution on urinary nitrogen loss and muscle protein breakdown, 22 burnt patients were randomly divided into two groups immediately after hospital admission: 11 patients received a 22% BCAA amino acid solution, 11 patients received a 41% BCAA amino acid solution. Nitrogen intake was 0.2 g per day during the first 4 days in each group. Urinary total nitrogen, urinary creatinine and urinary 3,methylhistidine (3,MeHis) were measured for 4 days. Nitrogen balance, 3,MeHis/nitrogen ratio and 3,MeHis/creatinine ratio were calculated in each group. The two groups were compared using Student's test. Nitrogen, creatinine and 3,MeHis urinary excretion, and nitrogen balance were not significantly different in the two groups, except for urinary nitrogen on day 3 which was slightly higher in the 41% BCAA group. The 3,MeHis/nitrogen ratio on day 1, day 2 and during the whole study period, as well as the 3,MeHis/creatinine ratio on day 2, were significantly lower in the 41% BCAA group. These results were in agreement with a decrease in muscle/whole body urinary nitrogen excretion. However, no beneficial effect upon nitrogen loss or nitrogen balance was shown by using the 41% BCAA rich amino acid solution.

Adolescent↗