Biomedical subjects
Publications and source records attributed to J Canet.
Spontaneous perforation of the extra-hepatic bile ducts in infancy is rare and of unknown etiology. Its finding at laparotomy in a 2 month-old premature with artificial ventilation allows to underline that the diagnosis may be difficult and may necessitate ultrasonography and even hepatobiliary scintigraphy.
Oxygen arterial saturation (SaO2) was measured with a pulse oximeter in 209 patients after elective surgery. Measurements were made upon arrival in the recovery room (RR) and 1 hr later. On each occasion, the patients randomly and alternately breathed--for 10 min at a time--room air or 35% O2. Factors that might influence the incidence of postoperative hypoxemia were analyzed. After breathing room air for 10 min after arrival in the RR, the mean SaO2 was 90.7 +/- 3.9% (+/- SD). Twenty min after and 1 hr after arrival in the RR, mean SaO2 increased significantly to 92.4 +/- 3.5% (P less than 0.001) and 93.2 +/- 3.0% (P less than 0.001), respectively. Postoperative hypoxemia (SaO2 less than or equal to 90%) after breathing room air for 10 min at 10 min, 20 min, and 1 hr after arrival in the RR occurred in 43.8%, 26.9%, and 16.9% of the patients, respectively. Breathing 35% O2 for 10 min 10 min after arrival in the RR, as well as 20 min and 1 hr after arrival, significantly increased SaO2 above the SaO2 level after breathing room air by 5.7% (P less than 0.001), 4.3% (P less than 0.001), and 4.0% (P less than 0.001), respectively. A significant multiple correlation was found between low SaO2 levels while breathing room air on arrival in the RR and fentanyl dose, age, and concentration of halothane used intraoperatively (R = 0.46; P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
Recurrent bronchopulmonary and E.N.T. infections in a 2-month old child with complete situs inversus suggested an immotile cilia syndrome. Electron microscopy of the respiratory epithelium cilia demonstrated an ultra structural abnormality (defective radial spokes) typical of this recently discovered syndrome. This case is similar to 3 other cases in infants reported in the literature. It shows that the clinical manifestations of ciliary dysfunction may occur soon after birth and that early detection is desirable for optimal treatment. The type of abnormality detected and the percentage of cilia affected demonstrate that the syndrome is congenital and not acquired and provide information of the degree of ciliary dyskinesia. The genetic aspects are discussed. A diagnosis of "immotile cilia" syndrome should systematically be envisaged in infants with recurrent pneumonia or otitis of unknown aetiology, or when the clinical context (situs inversus, family history) is suggestive of the conditions.
To examine the performance of a new Venturi Mask (VM), PaO2 and PaCO2 were measured in 10 healthy volunteers before and while, breathing from a 0.24 O2 VM at 21/min of O2 flow for 20 min. FEO2, FECO2, VT, f, inspiratory (TI) and expiratory time (TE) and flow were also recorded during air breathing. Mean PaO2 increment observed during VM breathing was 1.8 kPa (SD 0.7). The FO2 measured at the face-piece of the VM while not in use was 0.247. The predicted increment of PaO2 corresponding to a FIO2 of 0.24 was calculated by the alveolar air equation and found to be 2.9 kPa (SD 0.2), indicating a diluting effect on the O2 concentration close to 40%, with an actual FIO2 of 0.228. The correlation coefficient (r) between dilution and a formula which includes initial acceleration of inspiration (VI 0.25), VT and the ratio TI/TT, was 0.94. Because the low O2 flow 0.24 VM model is markedly influenced by the patient's breathing, we conclude that it does not satisfactorily provide a stable and predictable concentration of supplementary oxygen. Theoretical considerations allow these results to be extended to other VM using low O2 flows for different O2 concentrations.
Abnormalities of the ciliary function have been found as an important factor in chronic respiratory diseases. For the study of the ciliary beat frequency, we developed a stroboscopic method using a stroboscopic illuminator ( Strobo Hertz) substituted to the normal light of an inverted optic microscope (Leitz). The ciliated cells obtained either by nasal scraping or tracheobronchial brushing were maintained in a culture medium (IP 199) at 37 degrees C. The ciliary beat frequency was measured at various times, at least one hour after the sampling. Nasal scraping, was performed with a curette in 17 children from 10 months to 16 years who complained of chronic respiratory diseases. Ciliated cells were obtained in 14 samples. In one of them 5 years old with a situs inversus, although the ciliated cells were numerous, the cilia appeared immotile. In the 13 others, the frequency was from 7 to 11.5 Hz with a mean of 10.8 Hz. These results were compared to those obtained by tracheobronchial brushings performed in 7 patients from 4 months to 46 years who underwent an endoscopic investigation. The ciliary frequency was 7 to 10 Hz with a mean of 8.5 Hz. The study of the ciliary beat frequency obtained by nasal scraping seems to be a reliable method for the detection of abnormal ciliary function. Nasal scraping is a non invasive method. Moreover, the stroboscopic method is a non expensive tool.
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Analysis of our experience confirms in the domain of the newborn the fundamental notion of the Emergency medical call. The EMC has two objectives: 1--Emergency treatment before the patient is moved, and the correction of failing vital functions by a medical team skilled in problems of neonates. 2--Transportation of the neonate in a stable condition, to the Intensive Care unit. The quality of such transportation depends closely upon the quality of the medical care given and upon organisation. It can only be carried out in the context of a system coordinated by a "coordinating physician" (e.g. SAMU 94). This coordinating physician has responsibility for logistics, telephone coordination, and application of the call procedure as rapidly as possible. From a logistical point of view, only coordination between:--SAMU-SMUR;--Medical team of the Intensive care unit;--Requesting service make possible the provision and quality of continuous supplies of oxygen, warmth, sugar - all under aseptic conditions, indispensable to the quality of survival of the neonate. In addition, we feel it essential--that the delay before the call is answered be as brief as possible;--that the call should be dealt with by a mixed team, including at least one physician experienced in neonatal problems;--that the choice of vehicle used for transportation should be better adapted to the situation. This choice is the responsibility of the coordinating physician, who should base his decisions on two fundamental requirements:--rapidity of dealing with the call;--personal safety of those involved. This without losing sight of--Prevention of perinatal problems lies part with the detection of high risk pregnancies, with the aim of arranging delivery in specialised "mother and baby" centres where close collaboration between obstetrician and paediatrician is assured.--The development of transportation of the "high-risk" neonate, which is so costly in manpower and equipment, depends closely upon general concepts of health care in France, which should be aimed at:--the prevention of prematury;--the detection of high risk pregnancies;--the development of mother and baby centres.
The study of 16 newborn of birthweight less than or equal to 2,200 g characterized by a common point: the presence of PLACENTA PRAEVIA IN THE MOTHER, enabled us to come to grips with the severe respiratory distress that these newborn can have. From the clinical standpoint: there is always early respiratory distress. From the radiological standpoint: by far the most dominant pathology was interstitial edema, giving rise to a WET LUNG. From the biochemical standpoint: the blood gases were characterized in a certain number of cases by hypoxemia which was refractory to the usual forms of treatment. From the mechanical standpoint: measurements carried out in 4 patients confirmed the extraordinary fall in these patients' compliance. The clinical, radiological, blood gas and mechanical analysis enabled one to differenciate 2 main types of indications for artificial ventilation: -- acute hypoxemia, -- the idea of an increased need for oxygen. In these 2 types of indications for artificial ventilation, it was apparent that the treatment of choice is constant positive pressure which may or may not be combined with intermittent positive pressure. With this treatment technique, none of the patients progressed to massive atelectasis. It can be said that with the advent of techniques of ventilation by high pressure combining IPP with CPP, one has definitively eliminated from this pathological picture, the principal cause of death: --anoxia due to massive alveolar collapse.
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