Biomedical subjects
Publications and source records attributed to J Leroy.
We report a case of nonfatal complete atrio-ventricular (A-V) block after injection of 125 mg of furosemide by a central vena cava catheter. Accidents with this diuretic are very rare but this observation shows that it could induce A-V conduction disturbances. When large quantities of this diuretic must be used, we would recommend a slow injection rate to avoid such accidents.
The treatments of 400 consecutive patients admitted in a 22-bed adult medical intensive care unit (ICU) were analysed prospectively. One hundred and thirty-one different drugs were prescribed with a mean of 5 +/- 4 drugs per patient (means +/- SD), during 8 +/- 11 days. The most commonly prescribed drugs were 1) preventive drugs, 2) antibiotics, 3) psychoactive drugs and analgesics. Two-thirds of the drugs were administered by a parenteral route. Mean daily cost was low: 57 FF per patient (6.3 US dollars, 1984), most of this being due to the prescription of antibiotics (59.8%). The wide range of drugs prescribed in different ICU precludes the compilation of a restricted list of drugs to be used in ICU. Nevertheless, prescription guidelines are suggested consisting of the discussion, for each patient, of the prescription of any of four types of drugs: those of the organ failure(s), of the underlying disease(s), preventive drugs, and finally comfort drugs.
This study involved two stages: In vitro study. Three LMWHs, CY 216-CY 222 (Choay) and PK 10169 (Pharmuka), were compared to standard heparin, SH (Choay), and to a high-molecular-weight heparin, HAF (Choay), which particularly revealed a dissociation of anti-Xa (++) and anti-IIa (+) activities for the LMWHs: (table: see text) In vivo study. Healthy volunteers. Subcutaneously injections of PK 10169 or CY 222 according to various protocols (rythm of injections, dosage). For both LMWHs, the dissociation of anti-Xa and anti-IIa activities reoccurs in vivo. A peak of anti-Xa effect was observed 3 to 4 hours after the injections. The duration period of this activity is about 12 hours. The importance of the global platelet tests HT and TEG (modified for the highest doses) should be noted. Study of haemorrhagic tendencies in patients with slight thrombotic risk. From this preliminary study, protocols with CY 216, CY 222 and PK 10169 are proposed for the prevention of thrombotic risk in orthopaedic surgery (injections at 12-hour intervals).
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This report concerns 34 cases of heparin-associated thrombocytopenia in which standard heparin has been systematically replaced by LMW heparin CY 216 Choay. There were 21 women and 13 men, mean age, 69 years. Twenty-six of the 34 cases had thrombotic complications. All of the patients were treated by standard heparin of porcine mucosal origin, in most cases for prevention of deep vein thrombosis and pulmonary embolism. Twenty-six cases occurred along with orthopedic and traumatologic surgery (especially for total hip replacement, 15 cases). Four cases involved vascular surgery and three involved medical thrombotic disease. Standard heparin treatment was always replaced by LMW heparin CY 216. Initial doses were 0.30 ml three times daily, later increased to obtain global hypocoagulability. Surgical procedures (embolectomy and vena cava filter) were carried out when necessary. Five patients had thrombolytic treatment (urokinase) in conjunction with LMW heparin. The overall results were 31 recoveries, but with seven severe sequelae (three amputations and four hemiplegias) most often attributable to the first ischemic attack, and three deaths. For the last 16 patients, indirect platelet aggregation tests were performed (control platelet-rich plasma plus patient platelet-poor plasma plus LMW heparin): nine cases had negative tests, with nine recoveries and seven cases had positive tests, with five recoveries and two deaths.(ABSTRACT TRUNCATED AT 250 WORDS)
Group R streptococci have caused many cases of septicaemia and meningitis in patients handling live or slaughtered pigs which were the only known reservoir of group R streptococci. A human case, due to a wild boar, is reported here and it is therefore concluded that there exist both a domestic (pig) and a wild (wild boar) reservoir of group R streptococci.
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A 1981 retrospective study in the Iles Saintes (Guadeloupe) points to an estimated average number of cases per year of 30 +/- 25 par 10,000 inhabitants, involving 2.6 +/- 1.6 outbreaks per year of this endemic disease. The infection is most common from August to October. The attack rate is 87%. The symptoms, as described by 112 former patients, include the usual digestive and neurological signs, with oculonasal symptoms being particularly frequent. Only in half the cases does the disease require medical care (doctor, dispensary, hospital). The median duration of the illness is 3 weeks. Two patients out of 3 are bedridden. More than one-third present sequelae. Three families of fish are responsible for these cases of food poisoning: the Carangidae, Sphyraenidae, and Muraenidae. The microphagous herbivora species are not incriminated. The results are compared to other series of data published for the Antilles and for the Pacific.
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In a case of massive intestinal haemorrhage during typhoid fever the bleeding area was located by angiography to the superior mesenteric artery, and excision of the ileo-colonic junction was performed. Pathological study of the lesions showed necrosis of Peyer's plaques resulting in section of small submucosal arterioles. The necrosis itself was caused by initially endothelial lesions, later completed by thrombosis. The complication is exceptional. This case is reported in order to draw attention to the usefulness of mesenteric arteriography and the effectiveness of surgery in massive intestinal haemorrhages.
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A literature review, following the observation of 4 cases of pneumococcal septicemia in splenectomized patients, demonstrated that infection was frequent in subjects with functional or anatomical asplenia, usually in the form of a pneumococcal septicemia. Infection occurs one hundred times more frequently in splenectomized patients than in the general population. The risk of developing an infection varies from one patient to another, and is related to the motive for splenectomy, the period since operation, and the age of the patient at the time of surgery. Pneumococcal septicemia in such cases is distinguished by its insidious nature and its very poor prognosis, the outcome being fatal in 50 to 70 p. cent of cases. This justifies intensive prophylactic measures: partial splenectomy, heterotopic transplantation, anti-pneumococcal vaccination, and long-term antibiotic therapy. None of these methods offers absolute protection, and indications for splenectomy should therefore be limited to the strict minimum.
The authors treated 9 patients with rheumatoid arthritis by plasma exchange. In the 5 cases with purely joint involvement, the treatment was not effective, with one exception. In the 4 other cases, with polyneuropathy and vasculitis, plasma exchange resulted in a rapid regression of the symptoms. Thus cases of polyneuropathy and vasculitis due to rheumatoid arthritis are good indications for treatment by plasma exchange.
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