Biomedical subjects

K Michaud

Publications and source records attributed to K Michaud.

6 recordsLinked to original sources

PubMed2001

Hypothermia and undressing associated with non-fatal bromazepam intoxication.

A 42-year-old woman with a history of depression was found unconscious, lying near her car in an early autumn morning. The lower part of her body was undressed and there were multiple purple spots and excoriations on the body suggesting at first a sexual assault. On admission to the intensive care unit, she presented a hypothermia with a central temperature of 28.4 degrees C. The biological samples obtained at the hospital were analysed. Blood concentration of bromazepam was 7.7 mg/l, which is above the highest level reported till now in a case of fatal intoxication.

Adult↗

PubMed2001

Sudden death related to small coronary artery disease.

Two cases of sudden death of young people in apparently good health are reported. The only pathologic change found was a fibromuscular dysplasia of the artery supplying the conduction system of the heart with an important narrowing of the lumen and strong thickening of the arterial wall. The first case was of a 12-year-old girl who died suddenly while skiing; the second was of a 32-year-old man who died while talking to his wife. No other pathologic changes were found at autopsy, and the results of toxicologic analysis were negative. There was no individual or family history of cardiac diseases. These cases illustrate the importance of an analysis of the conduction system, including examination of the intramural coronary arteries supplying the conduction system.

Adult↗

PubMed1999

Fatal flecainide intoxication.

A fatal case attributed to flecainide acetate (Tambocor), a class Ic antiarrythmic drug, is presented. Flecainide was detected by GC/MS in gastric contents, blood and liver as well. The urine analysis revealed the presence of its dealkylated metabolite. Body fluids and tissue concentrations determined by GC/ECD were 7.7 mg/kg in femoral blood, 0.26 mg/kg in bile, 18 mg/kg in liver, 0.17 mg/kg in cerebrospinal fluid, 0.22 mg/kg in brain cortex and 28.9 mg/kg in urine. The total amount of flecainide in gastric contents was about 43 mg. Even taking into account the postmortem redistribution of flecainide, its blood level still remains in the toxic range.

Aged↗

PubMed1999

Fatal overdose of tramadol and alprazolam.

A 30-year-old woman, with history of depression, was found dead after the ingestion of an unknown quantity of Xanax (alprazolam), Tramal (tramadol) and alcohol. At the autopsy only a slight decomposition and a diffuse visceral congestion were noticed. Biological samples obtained at autopsy were analysed to detect the presence of alprazolam, tramadol and alcohol. Blood concentrations of alprazolam, alcohol and tramadol were 0.21 mg/l, 1.29 g/kg and 38.3 mg/l, respectively.

Adult↗

PubMed1998

Acute opiate overdose: characteristics of 190 consecutive cases.

AIMS: To characterize the population of drug users consulting the Emergency Room (ER) of a university hospital with acute opiate overdose (AOO) and to assess rate of referral to specialized treatment programme. DESIGN: Survey of a 12-month sample of AOO patients. MEASUREMENTS: Medical and psychosocial features of the drug users, details of emergency treatment and referral by a mobile resuscitation team (SMUR) and the ER of our hospital (CHUV-Lausanne, Switzerland). In addition fatal AOO cases were collected by the Institute of Forensic Medicine (IFM) during the same period. FINDINGS: One hundred and eighty-four cases of AOO (134 patients) were treated. The files of the IFM detailed six additional deceased cases. This population of drug users was characterized by an over-representation of men (73%), by young age (27.4 years), by a high rate of multi-drugs use (90%) and by a high rate of multiple previous overdoses (2.6). Average length of stay was 20.1 hours but 41% of cases stayed less than 8 hours. Only one patient was readmitted within an 8-hour period. When discharged, 78% returned home. Unexpectedly, 67% of patients were not referred to any therapeutic programme for drug addiction. CONCLUSION: This study shows the low mortality of AOO when treated but also demonstrates the need to improve psychosocial evaluation and referral of drug addicts admitted with AOO.

Adolescent↗

PubMed1994

The clinical and research significance of the erythrocyte sedimentation rate.

OBJECTIVES: To determine normal limits for erythrocyte sedimentation rate (ESR) in rheumatology clinics based on observations from patients with noninflammatory disorders (NID); to determine the proportion of patients with osteoarthritis (OA) excluded from clinical trials because of elevated ESR; to determine the proportion of patients with rheumatoid arthritis (RA) meeting ESR criteria for remission, clinical activity, and eligibility for clinical trials; and finally, to explain elevations of ESR in OA. METHODS: Cross sectional and longitudinal study of all rheumatic disease clinic outpatients with RA (N = 1,556, ESR = 12,683) and NID (N = 3,961, ESR = 5,706). RESULTS: For all NID the 90th, 95th percentiles were 33, 40 for women and 23, 31 for men. For patients with OA, 21.2% of women and 8.5% of men had ESR > or = 30 mm/h. ESR in women with OA but not men with OA or those with RA were significantly associated with body mass index. Twenty-nine (29.4) percent of men and 41.6% of women with RA satisfied the ESR remission criterion. When the active disease criterion was considered (ESR > or = 28 mm/h), only 54.5% of men and 62.6% of women, on the average, have active RA. CONCLUSION: The upper limit for normal ESR for women through age 60 is about 38 mm/h. A significant proportion of patients with RA with active disease will satisfy the ACR ESR criterion for remission, but only 54-63% of patients being treated in a rheumatology clinic will have active disease (ESR > or = 28 mm/h). Current use of the ESR as a criterion in clinical trials and remission criteria while based on wide clinical experience is contradictory and may not reflect actual data.

Adult↗