Search PubMed⌕ Search

Biomedical subjects

M Freysz

Publications and source records attributed to M Freysz.

At least 19 recordsLinked to original sources
PubMed2006

[Disposable vs reusable laryngeal mask airway: a cost-minimization analysis].

JUSTIFICATION: According to French regulations concerning the risk of Creutzfeldt-Jakob disease transmission, traceability procedures of all sterile medical devices which need to be reused are mandatory. Despite sterilization processes, the reusable laryngeal mask airway (LMA) prion disease transmission remains possible. As a result, the disposable LMA has been introduced. OBJECTIVE: Assuming clinical equivalence was achieved, the cost of disposable vs reusable LMA was studied in a university hospital. STUDY DESIGN: A Cost-minimization analysis of disposable vs reusable laryngeal mask airway was realised. METHODS: Disposable LMA cost was calculated as the sum of product cost and elimination cost. Reusable LMA were autoclaved after hospital purchasing in two separate sterilizing processing units of the same hospital. Reusable LMA cost was determined combining materiel and labor costs. RESULTS: The reusable LMA cost depended on the sterilizing processing unit concerned and varied between 9.59 Euros and 9.69 vs 8.38 Euros for the single-use LMA. CONCLUSION: With the cost savings made possible by use of disposable LMA in both labor and consumables, this practice should be considered.

Cost Control↗
PubMed2005

Optimization of a model of red blood cells for the study of anti-oxidant drugs, in terms of concentration of oxidant and phosphate buffer.

The aggression of erythrocytes by an oxidative stress induces hemolysis. This paper aims to valid a model of erythrocytes in terms of composition of the phosphate buffer solution and of concentration of a well-known oxidant, AAPH. Three compositions of phosphate buffer solution are mixed with three concentrations of oxidant. The influence of these two parameters on hemolysis is independently studied by a variance analysis and a Kruskal-Wallis test when ANOVA is not available. The hemolysis rate increases with time at fixed oxidant concentration, but is not influenced by the composition of the buffer solution. The highest hemolysis rate, 90%, was only measured within 2 h with the highest oxidant concentration. If we retain this concentration of oxidant, the lower concentration of the buffer can by eliminated by a significant less hemolysis and the highest concentration of the buffer can by chosen in regard of the better precision for a similar hemolysis compared to the mean buffer. We hope to study the effect of anti-oxidant agent with such a model of erythrocytes.

Antioxidants↗
PubMed2005

[Risk stratification in pre-hospital management of myocardial infarction with ST elevation: value of a risk score profile].

The aims of this study were to evaluate new tools of risk stratification in an unselected population of myocardial infarction (MI), usable in a pre-hospital situation, and to compare the risk profile of these patients with those of other clinical trials or myocardial infarction registries. The risk scores of death at 30 days (TIMI score and TIMI risk index) based on data available in the context of coronary emergencies, were applied to the population base of the MI observatory of myocardial infarction in the Côte d'Or (RICO). The risk profile was expressed by the smoothed graph of frequency distribution of each score. The TIMI score applied to the RICO population had a high discriminating power (c = 0.80) for mortality whereas TIMI risk index was less powerful (c = 0.57). The risk profile of the RICO population was comparable to that of InTIME II, ASSENT 2 and the NRMI with reperfusion registry. The NRMI without reperfusion and the MAGIC studies had different profiles characterised by a shift in the graph towards high risk patients. The authors conclude that risk stratification scores, like the TIMI score, are valuable tools for early triage in the management of MI patients. The risk profiles allow comparative analysis of risk levels of populations notably with respect to other registries and also with respect to randomised clinical trials.

Aged↗
PubMed2003

In vivo and in vitro antioxidant properties of furosemide.

The aim of this study was to investigate in vivo and in vitro antioxidant properties of furosemide. In vitro, human red blood cells were submitted to oxidative stress (AAPH), in absence or in presence of different concentrations of furosemide. Potassium efflux was measured in order to quantify the oxidative stress after the action of AAPH on red blood cells. Allophycocyanin assay was also used to investigate antioxidant capacities of furosemide. For the in vivo experiment, male Wistar rats were used. A control group (n = 5) was treated by a daily intraperitoneal injection of saline solution (0.2 ml); 2 other groups (J0 and J+) were treated for 7 days by one daily intraperitoneal injection of furosemide (0.10 mg/kg/day). In the J+group, the injection of furosemide was done one hour before the experiment, while in the J0 group the last injection of furosemide was done on the 6th day and an injection of saline was performed one hour before the experiment. On the day of experiment, a laparotomy was performed under general anesthesia and blood was collected from abdominal aorta. Oxidative stress and antioxidant capacities were evaluated on Wistar rat red blood cells and plasma. In vitro results (oxidative challenge with AAPH) showed that oxidative stress was decreased in presence of furosemide. This was due to a potent free radical scavenging effect of furosemide. In vivo studies confirmed that furosemide had antioxidant properties. These data may be of great relevance in clinical practice, considering the use of large doses of furosemide in patients presenting pathology involving the production of free radicals.

Amidines↗
PubMed2003

[Bilateral pneumothorax and tamponade after acupuncture].

INTRODUCTION: The "target" of acupuncture is usually the muscle, but it occasionally approaches other anatomical structures such as the pleura, which may subsequently suffer damage. OBSERVATION: During a session of acupuncture, a 25-year-old woman had a malaise with shock and neurological disorders. The initial examinations revealed a bilateral pneumothorax associated with pericardial and peritoneal effusions. Symptomatic reanimation combining dopamine, left pleural draining and pericardial puncture led to rapid haemodynamic improvement. The etiological exploration, having eliminated an underlying pathology, concluded in the diagnosis of tamponade and bilateral pneumothorax following a session of acupuncture. COMMENTS: Our patient presented the association of two traumatic complications of acupuncture: cardiac tamponade due to haemopericardium and bilateral pneumothorax. Although these complications are rare, they must be known.

Acupuncture Therapy↗
PubMed2002

[Value of cervical plain radiography in unconscious trauma patient].

INTRODUCTION: The aim of this study was to evaluate the diagnostic value of cervical spine standard radiographs, performed in emergency, and compared with entire cervical helical CT with multiplanar reconstructions as reference. STUDY DESIGN: Open prospective study. PATIENTS AND METHODS: We conducted a six months prospective study including all patients over 15 years of age and unconscious (Glasgow Coma Scale < or = 12). Each patient underwent standard radiographs as well as helical CT of the entire cervical spine. Three senior surgeons and one senior radiologist evaluated the standard radiographs quality. The interpretation was performed by 7 different groups of judges. Two radiologists interpreted the helical CT. For each group, the sensibility, the specificity and the count of correct diagnosis for the standard radiographs were evaluated. The results of the correct diagnosis of each group were then compared to determine the most performant group. RESULTS: Fifty-one patients were included. Helical CT diagnosed spine injuries in 11 patients. The quality of standard radiographs was poor with less than 10% judged correct and 90% of the C7-D1 junction not visible. In the best group (radiologist), the sensibility was 50%, the specificity was 85% and the count of correct diagnosis was 78%. For the correct diagnosis, senior radiologist was significantly better than anaesthetist students, radiologist students and emergency physicians. CONCLUSION: The diagnostic value of standard radiographs was weak whatever the physician. Therefore, helical CT of the entire cervical spine is absolutely necessary and must be performed during the initial evaluation, if the haemodynamic conditions are required.

Adult↗
PubMed2002

[Evaluation of the learning curve of a new intubation technique: intubating laryngeal mask].

OBJECTIVE: Assessment of the learning curve of a new device for blind orotracheal intubation: Intubating laryngeal mask. STUDY DESIGN: Prospective clinical study. METHODS: Ten persons practicing anaesthesia (specialist, fellow, nurse) underwent videotape learning and manikin training required with the device. Each person had to carry out a tracheal intubation in ten consecutive patients undergoing scheduled surgery. No patient presented history or clinical sign of difficult airway management. Results were expressed as mean +/- SD. Main percentages were provided with their 95% confidence interval; the percentage comparison were performed using Chi 2 test. The significance level for overall analysis was p < 0.05. RESULTS: One hundred patients were included. The overall success rate of tracheal intubation with the intubating laryngeal mask was 88%. An easy learning curve was obtained according to the low failure rate that was observed. No failure was noticed after eight procedures. Significant diminution of the delay for tube insertion was observed during the practice (3 +/- 1.30 min for the first procedure and 1.16 +/- 0.60 min for the tenth procedure). Circumstances of the oral intubation were improved with muscle relaxation. Finally, all failure with the intubating laryngeal mask were followed by successful intubation using direct laryngoscopy. CONCLUSION: The intubating laryngeal mask is a new device for blind orotracheal intubation with an easy learning curve in patients without difficulty in airway management, even for non-selected operators.

Aged↗
PubMed2001

[Recurrent fatal pseudomembranous colitis].

BACKGROUND: Clostridium difficile pseudomembranous colitis may trace a fulminent course and require surgery. CASE REPORTS: Outcome was fatal despite subtotal colectomy in the reported case of recurrent Clostridium difficile pseudomembranous colitis. Infrequent localization, low serum albumin and an unfavorable clinical course were observed. DISCUSSION: Rapid surgical treatment with large resection is mandatory in such cases, particularly in patients of rectal and sigmoid remnant involvement.

Adult↗
PubMed2001

[Tracheal gas insufflation avoids hypercapnia in patients with severe head trauma and acute lung injury].

PURPOSE: The purpose of the ventilatory management of acute respiratory distress syndrome (ARDS) is to avoid any barotrauma to the lungs by decreasing the tidal volume at the expense of permissive hypercapnia. This hypercapnia is extremely dangerous for severe head trauma patients because it increases intracranial pressure. The solution could be the use of tracheal gas which insufflation (TGI) allows the reduction of arterial carbon dioxide tension (PaCO(2)) while controlling airway pressures. CLINICAL FEATURES: We report the cases of two patients with ARDS and severe head trauma. The decrease of tidal volume ( by 60 and 25% respectively) in association with tracheal gas insufflation allowed to reduce plateau airway pressure (<35 cm d'H(2)O) and PaCO(2) (in the first case by 23% and in the second case, by 11% for the second hour then by 24%), while intracranial pressure remained constant or was lowered (in the second case by 39% for the second hour). TGI consisted in insufflating fresh gas via a small catheter placed in the trachea (0(2) at 6 L*min(-1) in the first patient and 4 L*min(-1) in the second case). CONCLUSION: TGI appears to be an important component of ventilatory management when ARDS is associated with severe head trauma.

Adult↗
PubMed2001

Lateral approach to laparoscopic repair of left diaphragmatic ruptures.

Video-assisted repairs of traumatic diaphragmatic ruptures have been described where thoracoscopy or laparoscopy in the supine position were used. This study aims to validate a new lateral laparoscopic approach for left diaphragmatic repairs. Six consecutive patients were operated on for left diaphragmatic rupture using a lateral approach (Gagner's position). A series of 362 consecutive patients presenting with abdominal or thoracic trauma with or without diaphragmatic rupture over a 2-year period were reviewed retrospectively. Contraindications for immediate or delayed lateral laparoscopic approach were studied. The lateral approach provided complete visibility of the subdiaphragmatic space, easy reduction of herniated organs, easy thoracic inspection and cleaning, the use of low peritoneal pressure, full range of instrumental motion, and rapid diaphragmatic repair. No operative mortality or morbidity was noted. Altogether, 14% to 50% of the patients with diaphragmatic ruptures were candidates for immediate lateral laparoscopic repair. Associated spleen injury in 50% of the cases was the main contraindication. The lateral laparoscopic approach provides better exposure of the diaphragm on the left side and facilitates the diaphragmatic repair especially with a large herniation. Immediate repair is possible in selected cases (14-50%). There is no contraindication in case of delayed diagnosis.

Abdominal Injuries↗
PubMed2001

[Mastocytosis: general anesthesia with remifentanil and sevoflurane].

Mastocytosis is a disorder with potential anaesthesia complications. Reviewing the literature, anaesthetic management of mastocytosis is controversial. We report the successful use of remifentanil and sevoflurane in a woman with systemic mastocytosis. No reaction nor histamine release was observed in these cases.

Adjuvants, Anesthesia↗
PubMed2001

Hypopituitarism after surgical clipping of a ruptured cerebral aneurysm.

OBJECTIVE: The causes of hypopituitarism in adult life are most frequently cerebral tumors, pituitary infarction, head trauma, pituitary surgery, or irradiation. We report a case of hypopituitarism after surgical clipping of a ruptured cerebral aneurysm. Two previous cases after the rupture of a cerebral aneurysm have been reported. DESIGN: Case report. PATIENTS: One 42-yr-old man. MEASUREMENTS AND MAIN RESULTS: A 42-yr-old man was admitted as an emergency for unconsciousness. The computed tomography showed a massive subarachnoid hemorrhage, and specific angiography showed an aneurysm in the internal carotid. The aneurysm was successfully clipped through craniotomy. The patient's hospital course was marked by a few episodes of pulmonary infection, and a tracheotomy was performed. The patient was transferred to the rehabilitation unit; he received a rating of 9 on the Glasgow Coma Scale. Seven months after rupture of the aneurysm, the patient was readmitted to the intensive care unit for septic shock, with pulmonary infection associated with vomiting and diarrhea. Despite standard therapy and inotropic support, there was no improvement of his clinical condition. Adrenal failure was then suspected. Treatment was started immediately with hydrocortisone (50 mg) four times a day. Within hours, his clinical condition improved. The following month, the patient was weaned off his tracheotomy and had nearly recovered. Endocrine tests confirmed the cortisol insufficiency but also hypothyroidism and hypogonadotropic hypogonadism secondary to hypopituitarism. CONCLUSION: Our case is the first one reported of hypopituitarism after surgical clipping of a ruptured cerebral aneurysm.

Adult↗
PubMed2001

Could heart rate variability predict outcome in patients with severe head injury? A pilot study.

Despite major improvements in the resuscitation of patients with head injury, the outcome of patients with head trauma often remains poor and difficult to establish. Heart rate variability (HRV) analysis is a noninvasive tool used to measure autonomic nervous system (ANS) activity. The aim of this prospective study was to investigate whether HRV analysis might be a useful adjunct for predicting outcome in patients with severe head injury. Twenty patients with severe head trauma (Glasgow Coma Scale [GCS] or= 10) to HRV in patients characterized by a worsened neurologic state (GCS < 10). Statistical analysis used the Kruskal-Wallis test, P < .05. To assess whether HRV could predict evolution to brain death, receiver operating characteristic (ROC) curves were generated the day after trauma for Total Power, natural logarithm of high-frequency component of spectral analysis (LnHF), natural logarithm of low-frequency component of spectral analysis (LnLF), and root mean square for successive interval differences (rMSSD). Seven patients died between Day 1 and Day 5 after trauma. Six of those had progressed to brain death. In these six patients, at Day 1, Global HRV and parasympathetic tone were significantly higher. Referring to the area under the rMSSD ROC curve, HRV might provide useful information in predicting early evolution of patients with severe head trauma. During the awakening period, global HRV and the parasympathetic tone were significantly lower in the worsened neurologic state group. In conclusion, HRV could be helpful as a predictor of imminent brain death and a useful adjunct for predicting the outcome of patients with severe head injury.

Accidental Falls↗
PubMed2000

Lidocaine inhibits potassium efflux and hemolysis in erythrocytes during oxidative stress in vitro.

Lidocaine is a widely used local anesthetic agent. The aim of this work was to study the action of lidocaine on human red blood cells exposed to an oxidative stress in vitro. Blood was obtained from healthy volunteers. After separation from plasma, the erythrocytes were suspended in phosphate buffer. Oxidative stress was induced by incubation with a free radical generator, the 2,2' azobis (2-amidinopropane) hydrochloride (AAPH). Erythrocytes were incubated with or without lidocaine at two concentrations (36.93 and 73.85 microM) and with or without AAPH (20 mM). Electron paramagnetic resonance (EPR) spectroscopy was performed to identify the free radical species generated by AAPH using the spin trap 5-5'-dimethyl-L-pyroline-N-oxide (DMPO). Different sets of experiments were run. Potassium efflux was measured by flame photometry in each group at time 0 min and every 30 min of the experiment for 2 h. Hemolysis was studied by the Drabkin method at increasing concentrations of AAPH (20, 50, and 100 mM) and with or without lidocaine (36.93 microM). The oxygen radical absorbance capacity (ORAC) was measured by using allophycocyanin (APC) as a fluorescent indicator protein, and the antioxidant capacity of lidocaine (36.93 microM) was studied by the analysis of fluorescence of the APC. AAPH was shown to produce alkoxyl free radicals. Oxidative stress induced a marked increase in the potassium efflux and the hemolysis that was AAPH dose-dependent. Lidocaine inhibited the potassium efflux and delayed the occurrence of hemolysis. Lidocaine did not show any antioxidant properties for the free radical species generated by AAPH. In this model, lidocaine protects erythrocytes against oxidative stress. This effect is not explained by a free radical scavenging property. The results may be of great interest in clinical practice such as intravenous regional anesthesia or the prevention of ischemia-reperfusion injury.

Amidines↗