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Biomedical subjects

J Motin

Publications and source records attributed to J Motin.

At least 73 records · Page 4Linked to original sources
PubMed1989

[Locoregional anesthesia in pediatrics].

Local anaesthesia may consist of a sensitive and a motor blockade. It is essentially used in human clinic for the sensitive blockade which is induced. All techniques or nearly are possible in regional anaesthesia for children if they are practised with discernment by a physician accustomed to the same techniques in adults. But caudal anaesthesia remains the most commonly performed and simple. The main advantages consist in abolition of intra- and postoperative pain, calm and comfort but also in a decrease of respiratory complications. There are two leading risks: infectious and especially toxic after an accidental injection of bupivacaine. These techniques should be systematically proposed but carefully carried out in all suffering children.

Anesthesia, Caudal↗
PubMed1989

[Caudal anesthesia in pediatric surgery. Pharmacokinetic study and clinical significance].

In 1987, 758 caudal anaesthesia allowed the execution of 41% of all our department's operations. Urological, genital, inguinal and lower limbs surgery were the most frequent. The injection into the extradural space through the hiatus sacralis always included the mixture of lidocaine with bupivacaine to speed up the beginning of the operation. The patients were split up into 2 equal groups and were given 1.25 ou 2.50 mg.kg-1 of bupivacaine (i.e. 0.50 ml.kg-1 of a 2.50 or 0.50% solution). Bupivacaine plasma levels were determined by high performance liquid chromatography in 40 patients from the first group and in 42 patients from the second. They reached their maximum about 500 or 1,000 ng.ml-1 respectively, 30 mn after the injection and always fell back 4 hours after the administration. These concentrations were compared with the levels obtained by infusion to the dog, which cause serious cardiac disorders with 6,000 to 8,000 ng.ml-1 levels, and elicit ventricular fibrillation with 8,000 to 10,000 ng.ml-1. So the safety margin appears greater when overdose and/or intravascular injection are avoided. Caudal anaesthesia is easy, fast acting and allows to relieve post-operative pain. It is suitable for all surgery below the umbilicus and can be used on an outpatient basis.

Anesthesia, Caudal↗
PubMed1989

Decreased immunoreactivity and binding activity of corticosteroid-binding globulin in serum in septic shock.

To investigate the mechanism(s) responsible for the depletion of corticosteroid-binding globulin (CBG) activity in serum in septic shock, we developed a radioimmunoassay (RIA) for human CBG, using a monospecific antiserum to human CBG raised in rabbits. CBG was purified from pooled human serum by precipitation with ammonium sulfate and successive affinity chromatography treatments on corticosterone-Sepharose and concanavalin A-Sepharose. Final purification was achieved by HPLC on a diethylaminoethyl-PW (polymer matrix) ion-exchange column. Typical standard curves established for the CBG immunoassay showed parallelism for pure CBG and serial dilutions of sera from patients with septic or nonseptic shock and from healthy controls. Measurements of CBG by RIA showed a significantly (P less than 0.001) lower CBG concentration in patients with septic shock (22.9 +/- 5.9 mg/L, mean +/- SD; n = 23) than in controls (39.9 +/- 6.5 mg/L, n = 21) or in patients with nonseptic shock (33.3 +/- 6.5 mg/L, n = 12). The correlation between the concentrations determined by RIA and the CBG binding capacity was significant (r = 0.619, P less than 0.001, n = 33). The electrophoretic mobility of CBG was similar in sera from septic shock patients and normal subjects (Rf = 0.52-0.56). This suggests that the depletion of the corticosteroid-binding activity in serum during septic shock is associated with a decreased amount of CBG.

Adult↗
PubMed1989

[Pulmonary contusions. Anatomo-radiologic aspects].

Simultaneous use of pathologic and microangiographic methods in 47 patients with lung contusions due to a closed chest injury with no parietal lesions differentiated between: early traumatic lesions consisting in alveolocapillary ruptures and hematomas distributed at random throughout both lungs, with immediate disseminated intraalveolar hemorrhage as a result; and secondary lesions, known as "shock lung", which are mainly the result of intraalveolar hemorrhage. All these lesions explain the usual development of various forms of fibrosis, responsible clinically for refractory hypoxia.

Adult↗
PubMed1988

[Nosocomial septicemia and pseudobacteremia caused by Serratia marcescens].

An epidemiological survey was carried out which included a dual epidemic of septicaemia and pseudo-bacteremia caused by Serratia marcescens. The survey enabled 15 septicaemias and 43 pseudobacteremias to be detected in a regional hospital between March and August, 1983. Two mishandlings were at the origin of the outbreak: citrated tube normally reserved for coagulation tests were severely contaminated by Serratia marcescens, and inaccurate samplings had been made. Once the mechanisms of contamination were found, specific preventive measures put an end to the epidemic. The authors insist on the need for uncontaminated tubes and citrate solutions and for the development of precise sampling methods which are essential to avoid the occurrence of pseudo-bacteremia or septicaemia. It is important to detect such epidemics at an early stage by an efficient control of nosocomial infections, thus avoiding their extension.

Blood Specimen Collection↗
PubMed1988

[Evaluation of the efficacy and tolerance of flumazenil in antagonism of the effects of flunitrazepam on the central nervous system].

The efficacy and tolerance of flumazenil were assessed in a double-blind randomized multicentre trial on 120 ASA I or II patients aged 40.3 +/- 13.9 years. They were anaesthetized with flunitrazepam (25.1 +/- 10.5 micrograms.kg-1.h-1), fentanyl (4.4 +/- 1.9 micrograms.kg-1.h-1) and either vecuronium or pancuronium; residual neuromuscular blockade was antagonized at the end of surgery. 61 patients received flumazenil and 59 a placebo. Sedation comprehension and temporo-spatial orientation were scored at 0, 5, 15, 30, 60, 120 and 240 min after the administration of flumazenil or placebo. Local and general tolerances were evaluated 1 h and 24 h after administration. At the 24th h, the observer's assessment of consciousness, pain, respiration, coughing and vomiting were noted, as well as his identification, or not, of flumazenil or the placebo and their efficacy. Both groups were statistically homogeneous and comparable. Significant and marked efficacy was noted between the 5th and 30th min. There was no difference, at 24 h, between the flumazenil and placebo groups. In most cases, flumazenil was identified by the observer and its efficacy felt to be excellent. No major untoward effect of flumazenil was noted; however a mild and short lasting anxiety occurred in three patients. Tolerance was deemed to be excellent.

Adolescent↗
PubMed1988

A case of sotalol poisoning with fatal outcome.

The case of a 58 year old woman who died after ingestion of 14.4 g of sotalol and 50 mg of triazolam is described. Despite medical treatment, intracardiac pacing and hemodialysis, cardiovascular failure persisted and became irreversible. High sotalol concentrations were observed in plasma (65 micrograms/ml) and in post mortem tissues samples. Tissue to plasma ratios ranged from 2.5 to 6. The high drug concentration found in heart tissue (104.4 micrograms/g) explains the difficulties experienced in the sotalol poisoning.

Chromatography, High Pressure Liquid↗
PubMed1988

Continuous measurement of pulmonary gas exchange during general anaesthesia in man.

We report a system for the continuous measurement of oxygen uptake (VO2) and carbon dioxide output (VCO2) during open-circuit anaesthesia. Gas concentrations were measured by a mass-spectrometer, and expired flow by a pneumotachograph. The values measured by the system were compared in vitro to values produced by a nitrogen-dilution technique. Excellent correlations were found. Continuous measurements were performed in 21 patients anaesthetized for abdominal surgery. Compared to pure intravenous anaesthesia (flunitrazepam-fentanyl), anaesthesia including the administration of nitrous oxide or nitrous oxide and halothane led to more pronounced and sustained decreases in VO2 and core temperature, with a better cardiovascular stability. Two hours postoperatively, VO2 was not different from preoperative values. After a transient increase at the onset of anaesthesia, the respiratory exchange ratio (VCO2/VO2) returned to preoperative values, and then remained subsequently unchanged. Based on these observations, the system described provides an accurate approach to noninvasively monitoring the pulmonary gas exchange in the operating room.

Aged↗
PubMed1987

Energy expenditure in the acute renal failure patient mechanically ventilated.

Twenty mechanically ventilated patients with acute renal failure were studied on 31 occasions to determine their energy expenditure (EE) during a 2 h period before a hemodialysis. Oxygen consumption and CO2 elimination were measured continuously with a mass spectrometer system. EE (1660 +/- 48 kcal day-1) was close to the total caloric intake (1682 +/- 83 kcal day-1) and represented 1.19 +/- 0.03 times the predicted resting energy expenditure (PREE) with large inter-individual variations (0.7-1.7 PREE). EE/PREE was higher when sepsis was present (1.31 +/- 0.03 versus 1.14 +/- 0.02; p less than 0.05). Glucose oxidation rate (4.35 mg kg-1 min-1) exceeded glucose intake (2.6 mg kg-1 min-1). Respiratory quotient was 1.02 +/- 0.01. Nitrogen loss was 17.3 +/- 1.7 g day-1 and nitrogen balance -11.9 +/- 1.9 g day-1. In conclusion, EE values were scattered but never exceeded 1.7 times the PREE. Sepsis increased EE. With a nutritional support covering EE, nitrogen balance remained markedly negative and a preferential utilisation of glucose and lipogenesis occurred.

Acute Kidney Injury↗
PubMed1987

[Methanol poisoning].

The neurological signs, the cerebral CAT scan aspects and the ocular problems seen in five cases of acute methanol poisoning are reported; these were, respectively, coma requiring assisted ventilation, convulsions, hypotonicity, hypodensity of the putamen, and amaurosis and papillary oedema. The simplified acute physiologic score varied from 11 to 26; the value of 26 was observed in the only death of the series. Pathogenesis of the metabolic acidosis, as well as the different parts played by formic acid, lactic acid and ketone bodies are discussed. A normal or lowered serum potassium in a case of unexplained metabolic acidosis associated with an osmotic gap should make one think of the diagnosis. Macrocytosis, an indirect sign of folic acid deficiency, was in favour of a poor prognosis. The treatment included early gastric lavage, alkalinization, blocking of the metabolism of methanol by ethanol and haemodialysis with a bicarbonate dialysate enriched in ethanol; this corrected the acidosis and permitted the elimination of the toxic metabolites (clearance of methanol: 159 ml X min-1; half-life of methanol during purification: 3.46 +/- 1.32 h; quantity extracted: 246 g). The possible advantages of 4-methyl-pyrazol and alkyldiol derivatives need further confirmation.

Acidosis↗
PubMed1987

[Myocardial infarction during postoperative peridural analgesia with opiates].

A case of postoperative myocardial infarction is reported. It occurred seven days after intra-abdominal surgery (left hemicolectomy), in a patient with coronary heart disease. Diagnosis was delayed because of lack of pain; it was suggested by cardiogenic shock occurring 48 h after the initial phase. The patient had been receiving postoperative epidural analgesia with an opioid (pethidine); this may explain the pain was missing, so delaying the diagnosis.

Analgesia↗
PubMed1987

[High frequency jet-ventilation in esophagotracheal fistula].

High-frequency jet-ventilation (HFJV) is not widely used, mainly because of technical problems and difficulty to assess its efficiency. However, there is general agreement on following major indication: artificial ventilation in patients with oesotracheal fistula. In the case reported here, HFJV allowed efficient ventilatory support through an endotracheal tube with deflated cuff. Weaning was progressively obtained. Surgery and postoperative course were uneventful.

Adult↗
PubMed1987

[Totally implantable venous-access systems: apropos of experiences of 30 patients].

Thirty-one totally implantable venous access system were investigated in patients who required intravenous administration of chemotherapy, drugs, nutrients solutions, blood products and blood sampling. Mean duration of venous access was 179 days (ranged from 9 to 429 days). Eight complications were observed, five benign without consequence on port system use, three severe (infections) requiring its removal. No death occurred during implantation and port system use. Patient acceptance was better than with other methods for repeated vascular access. In patients requiring prolonged chemotherapy, totally implantable venous access systems represent a new technique of long term venous access, with easy implantation and lack of restriction of daily activities. Review of literature show that complications are most frequently local and easy to manage. Four types of complications may have severe consequences for patient and/or port system use: catheter occlusion, venous thrombosis, local and/or general infection, and skin necrosis subsequent or not to extravasation. They represent the major cause of port system removal, but this is seldom necessary. Acquired experience allow to justify an earlier implantation of totally implantable venous access systems before chemotherapy and destruction of available surface vessels.

Adult↗