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Biomedical subjects

M Boulanger

Publications and source records attributed to M Boulanger.

At least 55 records · Page 3Linked to original sources
PubMed1982

Hypertension following coronary artery bypass graft.

Hypertension following coronary surgery is generally reported at an alarmingly high incidence (30 to 75 per cent). A vigilance program carried out in 1977 at the Montreal Heart Institute disclosed a low incidence of 3.5 per cent in 200 consecutive unselected cases. A similar program in 1980 based on 160 cases showed an incidence of 23.7 per cent. This highly significant difference is found to be related to the differences in anaesthetic management which have occurred since 1977 when anaesthesia was primarily morphine 1.0 to 1.5 mg . kg-1 supplemented as needed with low dose halogenated agents and vasodilation therapy. In 1980, only one of the authors (J.T.) still uses this technique. The incidence of hypertension in 40 of his patients was 2.5 per cent. The others use low dose fentanyl (7.5 to 10 micrograms . kg-1) supplemented as needed with halogenated agents and vasodilating therapy; the incidence of hypertension in 160 cases was 23.7 per cent. Would these results be the same with an anaesthetic technique comparing both drugs at equipotent doses? A prospective clinical study is addressing this question.

Analgesics, Opioid↗
PubMed1980

Chronic granulomatous disease in an adult with recurrent abscesses.

Chronic granulomatous disease (CGD), produced by an inherited defect in the bactericidal capacity of polymorphonuclear neutrophils, is associated with recurrent abscess formation in regional lymph nodes, pulmonary parenchyma, and liver requiring surgical drainage. It is now becoming increasingly recognized that this is not a uniformly fatal disease of childhood. Instead, patients with milder forms of the disease are being detected during adulthood. General surgeons should be aware of the possibility of this diagnosis in a patient with recurrent pyogenic abscesses requiring drainage. Making the diagnosis of CGD is important because with chronic prophylactic antibiotic therapy and early aggressive treatment of recognized infections, the morbidity and mortality of patients can be favorably influenced. We describe a 27-year-old man with recurrent liver abscesses who was subsequently found to have CGD.

Abscess↗
PubMed1980

[The pre-operative visit in cardiovascular surgery].

This text is intended for new residents in the development of anaesthesia of the Montreal Heart Institute. It presents a classification of the risk of cardiovascular surgery used in that institution and discusses current problems encountered with this type of patient (pulmonary and coagulation problems, diabetes renal failure). The attitudes of anaesthetists of this institution towards patients' medication and premedication are also discussed. The risk is classified as usual, increased or high, depending on the presence (or absence) of several factors known to increase the risk: ventricular dysfunction, heart failure, unstable angina or recent infarction, significant involvement of other systems (unstable diabetes, renal insufficiency, significant pulmonary dysfunction), age, emergency surgery and non-cardiac surgery in the presence of important cardiac pathology. With surgical procedures carrying a high mortality, for example dissecting thoracic aneurysm, the usual risk is high and is classified as such. A table of the usual risk of current surgical procedures is proposed.

Adult↗
PubMed1980

[Views of patients after open heart surgery].

Twenty patients, selected at random, were followed up by means of interviews and questionnaires before and after open-heart surgery. Nine were professional or business people, two were office clerks, four were manual labourers and five were unemployed. The operative procedures consisted of valve replacement in eight patients, aortocoronary bypass in nine and correction of congenital cardiopathy in three. Anxiety factors before the operation centred around the fear of death (55%), invalidity (15%) and convalescence (10%). No anxiety was found in 20%. The family proved to be a negative factor in 31%, especially in wives of professionals. In the intensive care unit, 47% of patients complained of the noise and 26% of the nursing during the night shift; only 21% complained of pain. More than 70% of the patients appreciated the support of the interviewer, and especially the continuity of the follow-up throughout the hospital and convalescence phases.

Adolescent↗
PubMed1979

Intubation and other experiences in cardiac surgery: the consumer's views.

Recently publications have advocated earlier weaning and early extubation of the trachea in patients after cardiac surgery. Greater comfort of the patients is one of the advantages claimed for this policy. One hundred consecutive adult patients were questioned on the fifth postoperative day to assess the relative comfort or discomfort of the patients during tracheal intubation and ventilation. Overnight tracheal intubation and ventilation were easily tolerated by over 90 per cent of patients who had received morphine and diazepam. There was a high incidence of amnesia. Some of the other claimed advantages appear inconclusive and further study is desirable to elucidate the effect of early removal of the tracheal tube upon the indicence of pulmonary complications.

Adult↗
PubMed1979

Domperidone in the prevention of post-operative nausea and vomiting.

In a series of open pilot studies, intravenous domperidone was given to three groups of post-operative patients, at doses ranging from 10 mg to 60 mg. As a result of these studies, it was decided that a regime of 20 mg initially, followed by maintenance doses of 10 mg at 6 hourly intervals was highly effective in preventing post-operative nausea and vomiting. Consequently this regime was chosen to evaluate domperidone against placebo in a double-blind study involving 106 patients. The results showed that only three out of 53 patients (5.7%) on active treatment were having nausea and vomiting compared with 16 of 53 patients (30.2%) on placebo. It is concluded that this regime is effective in preventing post-operative nausea and vomiting.

Antiemetics↗
PubMed1979

The effect of high glucose concentration on the proliferation and the synthesis of lipids in endothelial cells in culture.

Influence of glucose concentration on growth and lipid synthesis was investigated in human endothelial cells in culture. The biosynthesis of lipids from acetate and glucose was present in endothelial cells, but a high glucose level in the culture medium failed to modify lipid synthesis. Neosynthesis in the lipidic fraction in the medium is higher when precursor is acetate compared to glucose.

Acetates↗
PubMed1979

Blood saving techniques: indications and contraindications.

Pre- and peroperative blood saving can be realised in different ways, without inducing important changes in the biological parameters of the organism. Different replacement solutions are studied in detail. Three principal techniques are as follows: a) The peroperative autotransfusion consists in recovering the blood lost in the operative field during the surgical intervention, filtering it and transfusing it at the end of surgery. b) The peroperative normodilution consists in collecting a certain amount of blood (till up 2 l.) from the patients before operation; it is replaced by plasma expanders and transfused at the end of operation. c) The third technique, called the 'frog leap', consists in collecting blood during the weeks preceding surgery, in various amounts in function of the importance of the estimated blood loss. This blood is stored and transfused during intervention.

Blood Preservation↗
PubMed1977

Fenfluramine long-term administration and brain serotonin.

Long-term administration of fenfluarmine induced a decrease of brain 5-HT to the same extent as did an acute dose. 48 h after drug withdrawal, the brain serotonin level returned to the control value. The present study provides evidence to suggest that a degenerative lesion of 5-HT neurons is not involved in fenfluramine activity.

Animals↗
PubMed1976

[A new way of access into the internal jugular vein].

This paper describes a new technique for the canulation of the internal jugular vein. A transsection of the neck at the level of C4 (upper border of the thyroid cartilage) (Figure 1) shows the relative position of the internal jugular vein, the carotid artery and the sternocleidomastoid muscle. The internal jugular vein at this level is more superficial than is usually imagined. A cutaneous point of entry placed at the level of the thyroid cartilage on the medial border of the sternocleidomastoid muscle would be directly above, at the zenith of the carotid artery. From that point, moving a needle externally hugging the posterior aspect of the muscle will make it possible to reach the vein while actually moving away from the carotid artery.

Carotid Artery Injuries↗
PubMed1975

[Conservation of the blood].

Many factors already contribute to limit the amount of bank blood available for therapeutic use; a possible reduction in the amount of available blood could stem from the relative indifference of young people towards the gift of blood and the increase in the size of the pool of positive carriers of Australian antigen. Moreover, new operations appear (coronary by-pass) which increase the demand for blood. It is imperative that we adopt attitudes and practice techniques that will contribute to the conservation of blood. This paper discusses the advantages of an active blood bank committee which, alone, can reduce the consumption of blood by 20 percent. Moreover, actual techniques for conservation of blood are reviewed: controlled hypotension, haemodilution and intraoperative blood salvage.

Attitude of Health Personnel↗
PubMed1975

Fenfluramine and 5-hydroxytryptamine?. Part 1: Is fenfluramine or norfenfluramine involved in the decrease of brain 5-hydroxytryptamine.

Both fenfluramine and de-ethylated fenfluramine decrease the brain stores of 5-hydroxytryptamine (5-HT). As the fenfluramine metabolite is present in the brain of the rat after fenfluramine injection, it could be suggested that the depletion of brain 5-HT elicited by fenfluramine is mediated by its metabolite. Comparative studies on 5-HT lowering effects and drug brain levels, indicate a primary effect of fenfluramine, following by the rising involvement of the de-ethylated compound in the sustained effect.

Animals↗
PubMed1975

Fenfluramine and 5-hydroxytryptamine. Part 2: Involvement of brain 5-hydroxytryptamine in the anorectic activity of fenfluramine.

As it is well-known, fenfluramine produces anorexia and decrease in brain 5-hydroxytryptamine (5-HT). As it has been suggested that the anorectic effect of fenfluramine may be due to a release of brain 5-HT, we have examined the influence of several drugs active on 5-HT mechanisms and metabolism, on the anorexigenic activity of fenfluramine. These studies were made in relationship with the depletion of 5-HT levels and the concentration of brain fenfluramine or m-trifluoromethyl-isopropylamine. The results have confirmed the involvement of a tryptaminergic mechanism in fenfluramine anorexia and suggest the hypothesis that fenfluramine itself can interfere with the serotoninergic system in the brain (stimulation of tryptaminergic neurons directly).

Amides↗