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Biomedical subjects

J Dubost

Publications and source records attributed to J Dubost.

17 recordsLinked to original sources
PubMed1991

Effects of hypotension on cutaneous and subcutaneous blood flow in anaesthetized humans.

The aim of this study was to determine the effect of controlled hypotension on subcutaneous and cutaneous haemodynamics in humans. Moderate hypotension was achieved with nitroglycerin (NTG) and sodium nitroprusside (SNP) infusion during narconeuroleptanalgesia in seven patients. Subcutaneous and cutaneous blood flow were measured by a superficial and deep heat clearance (HC) technique. The mean arterial pressure (BPa) decreased by 23%-30% and heart rate (fc) increased but only during NTG infusion (+22%; P less than 0.02). Subcutaneous and cutaneous blood flows remained unchanged despite a significant decrease in calculated cutaneous resistance (NTG: -26%, P less than 0.01; SNP: -34%, P less than 0.02] and subcutaneous vascular resistance changed only with SNP (-31%, P less than 0.02). After hypotension was discontinued the subcutaneous blood flow decreased (-13%, P = 0.05), whereas subcutaneous vascular resistance returned to its control values. An inverse relationship was found between fc and BPa (NTG: r = -0.525, P less than 0.01; SNP: r = -0.622, P less than 0.01) as well as with subcutaneous blood flow (NTG: r = -0.653, P less than 0.001; SNP: r = -0.573, P less than 0.01). In addition, we found oscillatory changes in deep HC values which differed in magnitudes (NTG 0.22 (SEM 0.09) W.m-1.degree C-1 vs SNP 0.42 (SEM 0.1) W.m-1.degrees C-1, P less than 0.01) and frequencies (NTG 0.02 (SEM 0.006) Hz vs SNP 0.01 (SEM 0.002) Hz, P less than 0.01). Despite unchanged blood flow, the effects of controlled hypotension on cutaneous and subcutaneous haemodynamics were different depending on the type of drug. These differences may have been related to counterregulatory responses and/or to direct vascular effects.

Adult↗
PubMed1991

[Randomized study of amoxicillin-clavulanic acid versus amoxicillin-metronidazole combinations in pyogenic infections of dental origin].

Thirty patients, without any valve defect, cardiac malformation or previous antibiotic administration and presenting dental infections, have been treated either with amoxycillin-clavulanic acid or amoxycillin and metronidazole. Aerobic and anaerobic bacteria have been isolated. These infections were due to mixed flora. Nearly one half of anaerobes were Peptostreptococcus, S. milleri and S. sanguis being predominant among aerobes. The species identified were those found in the mouth in the absence of infection becoming as opportunistic flora. The percentage of cures was equivalent in the two groups. the association amoxycillin-clavulanic acid seems to be as active as amoxycillin + metronidazole on the microflora isolated from dentogenous pyogenic infections.

Adolescent↗
PubMed1991

[The amnesic effects of midazolam in premedication of children].

The aim of this study was to check local and general tolerance as well as anxiolytic and amnesic effects of midazolam intramuscular administration as a premedication in 4 to 10 years old children. A double blind, comparative study with a placebo was achieved, after drawing lots, in 40 children divided into two equal groups. Premedication consisted of either midazolam or injectable water administrated with a posology of 0.3 to 0.5 mg.kg-1 combined, in both cases, with atropine sulfate (0.015 mg.kg-1). Results confirmed good local and general tolerance. Also anterograde amnesia was found to be excellent: 17 children in the midazolam group did not remember a photograph shown after premedication, instead of only one in the placebo group. Anxiolytic effects, similar in both groups, cannot be considered owing to the too short interval of time from premedication to induction.

Anxiety↗
PubMed1988

Cutaneous and subcutaneous blood flow during general anaesthesia.

The vasodilator effect of anaesthetic agents on cutaneous vessels has often been investigated. In contrast, although subcutaneous tissue is concerned with metabolism and thermoregulation, the effects of anaesthesia on subcutaneous blood flow have not been well documented. The purpose of this study was to determine the magnitude of changes in cutaneous and subcutaneous blood flow during general anaesthesia in Man. Anaesthesia was induced with flunitrazepam in 15 patients before facial plastic surgery. Blood flow was estimated using heat thermal clearance (HC). Two HC sensors in different areas allowed the measurement of superficial and deep HC. Systolic (SABP), diastolic (DABP) and mean arterial blood pressure (MABP), heart rate (HR), and rectal and mean skin temperature were also recorded. After induction of anaesthesia, HR increased significantly (p less than 0.05) whereas SABP, DABP and MABP remained unchanged. The rectal-toe temperature gradient fell from 6.3 +/- 4.1 degrees C to 3.4 +/- 1.1 degrees C (p less than 0.01) suggesting a reduction in vasomotor tone. Superficial HC increased from 0.37 +/- 0.06 to 0.42 +/- 0.08 W.m-1.degrees C-1 (p less than 0.05) whereas deep HC decreased from 0.33 +/- 0.07 to 0.31 +/- 0.09 W.m-1.degrees C-1 (NS) and returned to the control value thereafter. Rectal temperature and mean skin temperature were unchanged. The changes in deep HC are similar to those previously observed in muscle during induction of anaesthesia. Our results show that anaesthesia mainly affects cutaneous blood flow, without any significant change in subcutaneous blood flow during the early phase of anaesthesia in human beings.

Adult↗
PubMed1986

[Tracheal rupture in closed cervicothoracic injuries].

Two cases are reported of tracheal fracture occurring during blunt cervico-thoracic trauma. The first case emphasized the impossibility of passing a tracheal tube below the fracture preoperatively, without the fibreoptic or rigid tracheoscope which has the added advantage of making an accurate diagnosis of the fracture. The clinical and paraclinical signs could only lead to a suspicion of the diagnosis, but not its confirmation. The second case showed the use of different ventilatory means during and after surgery (separate lung ventilation, jet ventilation, high frequency ventilation) in case of proximal fractures. The monitoring of intratracheal pressure should be used so as to have the best ventilation for the lowest pressures in the suture zone.

Accidents, Traffic↗
PubMed1986

[Creatine phosphokinases and serum and urinary myoglobin following a procedure in prolonged knee-chest position for the treatment of spondylolisthesis].

Rhabdomyolysis following the knee-chest position was studied in 15 patients scheduled for surgery for spondylolisthesis. A comparison was made between 11 patients scheduled for orthopaedic surgery: ligamentoplasty (6 patients), total hip prosthesis (5 patients) and 11 patients scheduled for long oral surgery. The measurements carried out were blood CPK before surgery, 4, 8, 12 and 24 h after the beginning of surgery, and at days 2, 3 and 4. Blood and urinary myoglobin were measured at days 1, 2, 3 and 4 after surgery. The results were tested with the Mann and Whitney test. There was no statistical change in CPK and myoglobin in the test population. Following the knee-chest position, there was a statistical increase of CPK in all patients, with great individual variations. Myoglobinaemia and myoglobinuria were observed in six patients, these not being correlated with the variations of CPK. Nevertheless, the maximal increase of CPK and myoglobin was seen in one patient, without any modification of diuresis but with an increase of creatininaemia at 220 mmol X l-1. In this series, rhabdomyolysis was real. CPK was not a good index of the release of haematic pigments, the only dangerous ones. A qualitative search for myoglobinuria is suggested, this being followed, or not, by alkalization to prevent acute renal failure.

Adolescent↗
PubMed1986

[Intramandibular angioma with an arteriovenous fistula. Apropos of a case].

A patient with intramandibular angioma and arteriovenous fistula (high output arterial angiodysplasia) required 4 separate hyperselective embolizations and a surgical excision. The problems of embolization, surgical technique and indications for operation of this happily rare, serious vascular malformation are analyzed.

Adolescent↗
PubMed1985

[Circulatory arrest in the operating room in a patient with a congenital long QT syndrome].

Reversible cardiocirculatory arrest was observed during orthopaedic treatment of a digital dislocation in a 37 year old female patient. Cardiological studies showed a prolonged QT interval (0.6 s) in the patient and her daughter, associated with hypokalemia (3.4 mmol) in the former. The diagnosis suggested was that of Romano-Ward's syndrome. Preparation and choice of anaesthesia are discussed.

Adult↗
PubMed1985

[Post-traumatic hyperthyroxinemia or hyperthyroidism].

A fifteen year-old girl presented with several fractures after a road traffic accident. Five days later, fat embolism occurred, complicated by adult respiratory distress syndrome (ARDS) and disseminated coagulation (DIC). She was successfully managed in the intensive therapy unit, and was transferred to a general surgery after five weeks. Tachycardia and fever persisted without any other sign of infection. Clinical examination showed exophthalmos and a thyroid murmur. The venous concentration of T4 was increased: 204 nmol . 1(-1) (N: 70-150), whereas that of T3 was normal: 2.3 nmol . 1(-1) (N: 1-1.25). No other investigations were performed. The regression of clinical symptoms and a normalization of T4 were seen after treatment (carbimazole and acebutolol). Post-traumatic hyperthyroidism is discussed. Although classical, this syndrome was not well documented, as was shown in the literature survey. After trauma or an acute illness, an early fall in thyroid hormone concentrations was usually seen; a late increase in T4 was a rare occurrence.

Adolescent↗
PubMedDate not supplied

[Hemodynamic parameters and blood-free surgical field with nitroglycerin in maxillofacial surgery].

73 oral facial surgery have been performed using controlled-hypotension induced with nitroglycerin (NTG) to reduce surgical bleeding. Surgical bleeding has been reduced in more than 45% of cases. But frequent lack of correlation between blood pressure, heart beat and bleeding might imply vascular reflex mechanisms induced by controlled-hypotension using NTG. Hemodynamic parameters such as blood pressure and heart rate seem to be insufficient to monitor controlled hypotension efficiency on surgical bleeding. The use of peroperative tissues blood flow monitoring may help for the better understanding of surgical bleeding during controlled-hypotension using NTG.

Adolescent↗