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Biomedical subjects

M Bourgeois

Publications and source records attributed to M Bourgeois.

At least 19 recordsLinked to original sources
PubMed1992

Energy expenditure during synthetic surfactant replacement therapy for neonatal respiratory distress syndrome.

Little information is available on the energy expenditure of infants with increased work of breathing from respiratory distress syndrome (RDS). A study was carried out to determine whether surfactant replacement therapy modifies respiratory gas exchange in newborn infants with RDS and an arterial-alveolar oxygen tension ratio of less than 0.22. In a double-blind, placebo-controlled, rescue trial, infants received either two 5 ml/kg doses of a synthetic surfactant, Exosurf Neonatal, or air placebo. Of 23 infants ventilated for RDS, 11 were randomly assigned to receive air and 12 to receive surfactant. Oxygen consumption, carbon dioxide production, respiratory quotient, and metabolic rate were measured by computerized, closed-circuit, indirect calorimetry. Concomitantly, transcutaneous oxygen and carbon dioxide tension were continuously recorded. Oxygen consumption and carbon dioxide production remained constant during the period infants received surfactant. In patients randomly assigned to surfactant, a decrease in respiratory quotient was observed after the first (p less than 0.025) but not the second dose. This decrease was possibly related to a change in substrate utilization. The improved clinical outcomes reported among infants receiving surfactant were not accompanied by changes in energy expenditure.

Calorimetry, Indirect↗
PubMed1992

Reducing transmitted radiation in dental radiography.

A significant amount of radiation escapes the rear of an image receptor in conventional dental radiographic procedures despite the placement of a lead-containing backing at the rear of the film pack. The purpose of this investigation was to place additional layers of lead on the film pack in an attempt to reduce transmitted radiation to tissues behind the film. Reduction of dose to tissues behind the film causes a reduction in scatter radiation to critical organs such as the thyroid gland and salivary glands. A thermoluminescent lithium fluoride dosimetry system (TLD) was used and calibrated in both the beam of interest and tissue of interest. A tissue-equivalent anthropomorphic phantom was used for dose determination. Successive layers of lead foils were added to the image receptor, and dose was determined for each additional lead foil in the tissues behind the image receptor. Two sets of exposure conditions were used, namely: 70 kVp, 10 mA, and 0.6 s, and 90 kVp, 10 mA, and 0.6 s. The beam-film-patient orientation used was for a first molar bitewing radiographic projection. Four lead layers (three additional foils equalling 3.92 x 10(-3) mm of lead) on the conventional film package resulted in a significant dose reduction. Four layers of lead resulted in a dose less than one-third that of the conventionally shielded package.

Models, Structural↗
PubMed1992

A protocol for aerosol therapy in acute hospitalized asthmatics.

The most important element in the treatment of acute hospitalized asthmatics is salbutamol administered via wet nebulization prescribed usually on a subjective evaluation of the patient's status. This study outlines a novel protocol that incorporates the FEV1 variable as the major objective parameter in a feedback loop. Data from patients admitted in the year prior to the initiation of the protocol (N = 348) were compared with similar data from patients hospitalized the year following institution of the protocol (N = 238). There were no withdrawals from the protocol due to adverse effects nor were there any deteriorations requiring ICU admission. A significant decrease in the length of hospitalization and the number of salbutamol prescriptions per hospitalization was observed after, relative to before, institution of the protocol (2.2 vs. 2.6 days; 2.3 vs. 3.8; p < .05, respectively). It is concluded that this protocol is safe and efficient, and may also be more efficacious than a nonstandardized approach for treating the hospitalized asthmatic child.

Acute Disease↗
PubMed1992

Improvement in 'stat' laboratory turnaround time. A model continuous quality improvement project.

BACKGROUND: Continuous quality improvement is being advocated as the process that, if adopted, would improve the efficiency, productiveness, and quality of medical institutions, thereby helping to solve the health care crisis our country is facing. To determine if these techniques could be effective in a tertiary-care multispecialty group practice, a model project was undertaken. The model project chosen was to determine if we could improve the turnaround time for "stat" laboratory examinations performed in our large outpatient facility. METHODS: A 10-member team consisting of everyone involved in the process of laboratory testing was empowered to evaluate the present process and make appropriate changes. With traditional techniques of quality improvement, the process was assessed, data were collected and statistically analyzed, changes were introduced, and data were recollected and analyzed. RESULTS: After intervention, the preanalytic delays were reduced by 76% and the postanalytic delays by 88%. Waiting time for patients was reduced by an average of 62%. By instituting the changes suggested, the institution saved $225,000 on a one-time basis and $40,000 to $50,000 on a recurring basis. CONCLUSION: Adoption of quality improvement techniques appears to be a desirable management paradigm that should be explored by all medical institutions interested in maximizing the quality of care offered while at the same time minimizing its cost.

Ambulatory Care Facilities↗
PubMed1992

[Fluvoxamine. Study of treatment effect on a group of 189 hospitalized patients with depression].

The study of a sample of 189 inpatients with the diagnostic of Major Depressive Disorder (DSM III-R) treated with fluvoxamine showed: a good compromise efficacy/tolerance in 75% of cases; an interruption of treatment in 25% of cases, schematically divided in early gastric intolerance and in late resistance. 2.5% of manic switches have been observed and contribued, with this pattern of good results, to confirm the major antidepressant activity and good tolerance of fluvoxamine.

Bipolar Disorder↗
PubMed1992

[Homicide is strongly correlated to depression and not to mania].

Typical manic episodes could be the cause of penal infractions, usually benign. In contrast, forensic studies show a close relationship between depression, suicide and homicide. Killers (16-28%) are often depressed when they commit a crime. In the UK and USA, 4-35% of killers commit suicide immediately after their crime. Assessment of a depressed patient must include an evaluation of the risk of homicide as well as the risk of suicide. The past history of depression and suicidal attempts, the presence of depressive symptoms and suicidal ideas, are good predictors of impending danger of aggression and sometimes of homicide.

Bipolar Disorder↗
PubMed1991

[Tianeptine in episodes of major depression with melancholia and signs of endogenicity].

The effectiveness and good acceptability of tianeptine have been demonstrated in episodes of major depression without melancholia or signs of psychosis which are the valided indications of the tianeptine. In a way of research program, a multicenter study was conducted in 30 patients with D.S.M. III criteria for major depression with melancholia and signs of endogenicity as defined by the Newcastle scale. The patients were treated in a double-blind trial for 42 days. Administration of a placebo for 4 days prior to beginning the study was designed to eliminate rapid responders to placebo. The antidepressant effectiveness was evaluated on the Hamilton (HDRS), Montgomery and Asberg (MADRS) and global clinical impression (GCI) scales. The effect was satisfactory and statistically significant. Seventeen of the 30 patients (57 percent) included in this study improved with tianeptine (CGI-item 2). Results were comparable whatever the diagnosis established on DSM III criteria: bipolar depression, major depression, recurrent or isolated forms. The acceptability evaluated from patient complaints, measurement of blood pressure and laboratory tests was very satisfactory. Treatment was withdrawn in 14 patients with no subsequent withdrawal symptoms. These findings show that tianeptine can be prescribed with success for major depression episodes with melancholia (DSM III) and signs of endogenicity, although it cannot be concluded that patients should be given this treatment in first intention for this type of depression.

Adult↗
PubMed1991

Efficiency of transcranial electrostimulation on anxiety and insomnia symptoms during a washout period in depressed patients. A double-blind study.

In order to test the efficacy of cerebral electrostimulation (electrosleep) as an alternative to drug therapy for the treatment of anxiety and insomnia, we conducted a double-blind study in a sample of 21 depressed inpatients submitted to a 5-day period of drug washout on admission to the psychiatric department. During this withdrawal period, anxiety and insomnia were exacerbated in the placebo group, whereas anxiety decreased and sleep duration improved in the active treatment group, with a divergent evolution during the 5-day washout period. The depressive criteria did not respond differentially to treatment, however. Thus, the effects of this drug washout period are markedly attenuated by cerebral electrostimulation, which is of possible interest in the management of psychotropic drug withdrawal.

Adult↗
PubMed1991

Left ventricular thrombus in a 2-year-old boy with cardiomyopathy: lysis with recombinant tissue-type plasminogen activator.

A 2-year-old boy with cardiomyopathy and clinical signs of cardiac failure presented with an echodense structure in the left ventricle. This structure was seen from different echocardiographic views adjacent to a hypokinetic area of the apex and lateral free wall. It was different in texture and motion from the underlying myocardium and thus met the diagnostic criteria of a left ventricular thrombus. This thrombus protruded into the cavum and was partly mobile. In view of a high embolic risk, thrombolytic therapy with recombinant tissue plasminogen activator was started. The thrombus resolved within 72 h without any embolic or bleeding complications. No recurrence of the thrombus was observed during a 3-month follow up period.

Cardiomyopathies↗
PubMed1991

[Identification of temporal epilepsy in children: contribution of sphenoidal electrodes].

The authors have evaluated the indications, method and results of utilising sphenoidal electrodes in epilepsy. This method makes it possible to study the hippocampal area which cannot be studied by extra-cranial electrodes. It also localizes in the temporal lobe complex seizures without investigation by an electroencephalogram, or with a non-specific electroencephalographic picture. Thus, sphenoidal electrodes enable temporal seizures to be identified and localized, leading to more specific neuroradiological exploration, and therefore to the selection of patients for specific surgery.

Adolescent↗