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Biomedical subjects

J M Boles

Publications and source records attributed to J M Boles.

At least 37 records · Page 2Linked to original sources
PubMed1987

Measurement of irradiation doses secondary to bedside radiographs in a medical intensive care unit.

The authors prospectively studied the radiation doses to radio-sensitive organs secondary to bedside radiographs in intensive care patients and in a control phantom. Dosimeters were taped on different organs during each bedside X-ray. The mean radiation doses, expressed in 10(-5) Gy (m-rad), for an "average patient" who was hospitalized 9 days and had 6 chest X-rays were respectively: 292 to the sternal bone marrow; 239 to the thyroid gland; 3 to the testes; 1 to the ovaries; 605 to the eye for 2 maxillary sinus X-rays. No diffused irradiation was measured during a 2-month period in the intensive care unit nor on dosimeters worn by four nurses.

Adult↗
PubMed1987

Ultrasensitive assay of thyroid stimulating hormone in patients with acute non-thyroidal illness.

Serum TSH in critically ill euthyroid patients is generally within the normal range when measured with conventional radioimmunoassays. Sensitive immunoradiometric assays allow detection of low levels of serum TSH. We assessed this method in a prospective study of 34 euthyroid patients admitted to our critical care unit. Serum TSH ranged from 0.12 to 3.60 mU/l and was significantly lower for the whole group than in the controls (P less than 0.001), as also were serum total T4 and T3 values (P less than 0.001). However, 21 patients had a serum TSH within the normal range (group 1) and 13 patients (33%) had a serum TSH less than 0.40 mU/l (group 2). The two groups did not differ in age, sex, type and severity of illness, outcome, and serum T4 and T3 levels. However, the magnitude of TSH increase from the baseline value after the i.v. injection of 200 micrograms of TRH, assessed by the 30 min TSH/basal TSH ratio was significantly higher in group 2 (P less than 0.05). These results suggest that a substantial proportion of patients with acute illness have a clearly low serum TSH, unaccounted for by age, sex, type or quantified severity of illness, serum T4 and T3 levels. In addition, the secretory capacity of the pituitary to exogeneous TRH is significantly enhanced in those patients with low basal TSH.

Acute Disease↗
PubMed1987

[Antibioprophylaxis of Meningococcus group B meningitis. Must we implicate the use of the spiramycin].

A fatal meningitis due to a spiramycin-sensitive group B Neisseria meningitidis occurred 13 days after interruption of a prophylactic antimicrobial therapy with spiramycin. The efficacy of recommended antimicrobial preventive treatment is discussed with regard to this case, other published cases and to the known partial and short term eradication of the naso-pharyngeal carriage of Neisseria meningitidis.

Adult↗
PubMed1987

[Attempt at preventive treatment of esophagitis caused by intubation during intensive care].

A randomized prospective trial was designed to evaluate the preventive treatment of esophagitis in 31 intensive care patients who had a nasogastric feeding tube for at least 10 days. Fourteen patients (group B) received no preventive treatment while 17 patients (group A) received 300 mg of cimetidine every 6 h intravenously and 11 g of colloidal aluminium phosphate every 4 h per os. All patients were fed a standard diet through their nasogastric tube at a constant rate of 30 Kcal/kg/day. Endoscopic controls at day 1 and 10 showed that the number of initial and final esophagitis was not different in groups B and A: 7 and 8 at day 1, 11 and 10 at day 10, respectively. The inefficiency of this preventive treatment suggested that acid gastroesophageal reflux is not a major factor in the occurrence of nasogastric feeding tube-induced esophagitis. However as esophagitis is associated with a more severe Knaus index and a greater number of gastric stress ulcer risk factors, it is suggested that decreased defense of the mucosa may be a key factor in the occurrence of this type of esophagitis.

Adult↗
PubMed1987

[Severe pneumopathy and acute renal insufficiency disclosing Chlamydia psittaci infection: resistance to the treatment with erythromycin].

The authors report one case of psittacosis with acute respiratory distress syndrome, acute tubulo-interstitial nephropathy and jaundice. Erythromycin therapy was uneffective but recovery was obtained with minocycline and rifampicin treatment. Early diagnosis of Chlamydia psittaci infection is mandatory in order to prevent severe complications and to institute appropriate antimicrobial therapy.

Acute Kidney Injury↗
PubMed1984

Acute renal failure caused by extreme hyperphosphatemia after chemotherapy of an acute lymphoblastic leukemia.

The authors report a documented case of hyperphosphatemia-induced nephrocalcinosis after chemotherapy of an acute lymphoblastic leukemia (ALL). Microscopic examination of the kidney showed numerous calcium deposits with concentric structure in the calyces and in the tubules. Electronic microsound analysis proved the deposits to be composed of calcium phosphate. The nephropathy mechanism is studied, and a review of the 34 similar cases of this acute tumor lysis syndrome is made. Some suggestions are put forward to present the consequences of this therapy-induced syndrome.

Acute Kidney Injury↗
PubMed1984

[Yersinia enterocolitica septicemia occurring in a hospital milieu. A case with septic shock in an immunocompromised patient].

A case of Yersinia enterocolitica septicemia is reported. This case is unusual as the infection was apparently acquired within the hospital and septic shock occurred during the course. Immunodeficiency, which is nearly consistent in similar observations and was established in the index case, was apparently caused by protein-calorie deficiency, without any of the usual associations reported in the literature.

Aged↗
PubMed1984

Simple assessment of the nutritional status in the critically ill patient.

The assessment of nutritional status in intensive care patients can be easily accomplished. The first step is to record the patient's complete medical and social history, and to perform a thorough clinical examination in search of signs of nutritional depletion. Several tests, simple and unexpensive, are available to assess the different compartments of the body such as: anthropometric measurements, weight, skinfold thickness and arm muscle circumference and area; biochemical assays, 24-h urinary excretion of creatinine and 3 methylhistidine, serum albumin, transferrin, thyroxin binding prealbumin (TBPA) and retinol binding protein (RBP). The authors report their own data, collected in 150 patients. Nearly all the patients' values are significantly lower than those of the controls; CHI, serum proteins and energy are related to the prognosis; most variables show significant interrelationship: TBPA and RBP are the most frequently decreased values.

Adult↗
PubMed1984

Neurologic complications in a group of 86 bacterial endocarditis.

Criteria defined by von Reyn were applied to 86 cases of bacterial endocarditis. Neurologic complications (NC) were categorized according to Pruitt definitions. Neurologic accidents were observed in 48 cases. They were the first clinical manifestation in 20 patients. Neurologic events were of poor prognosis in BE, mortality increasing from 26% in patients without NC to 83% in patients with NC (P less than 0.01). Two factors affect the incidence of NC: first, the location of endocarditis with 76% of NC in mitral valve endocarditis compared with 37% in other cases (P less than 0.005); and second the infecting organism: 71% of NC in staphylococcus aureus endocarditis versus 45% in endocarditis with other bacteria (P less than 0.02). Cerebral embolism was the most common NC (25 cases) related to an occlusion of the middle cerebral artery in 21 cases with a fatal outcome in 19 patients. Other NC included 15 intracranial hemorrhages with the evidence of an aneurysm in 4 cases, 6 septic meningitis, 2 macroscopic abscesses, and 2 multiple microscopic abscesses. This study emphasizes the high rate and severity of NC in staphylococcal mitral endocarditis despite antibiotic therapy and supports early surgery in this group of bacterial endocarditis.

Adolescent↗