Search PubMed⌕ Search

Biomedical subjects

P Alquier

Publications and source records attributed to P Alquier.

At least 37 records · Page 2Linked to original sources
PubMed1994

Hemodynamic changes in acute adrenal insufficiency.

OBJECTIVE: Acute adrenocortical insufficiency is an unusual cause of isolated shock. The purpose of this study is to describe the cardiovascular changes in 6 patients with acute adrenal insufficiency presenting with hemodynamic instability. DESIGN: Retrospective and prospective study. SETTING: Medical intensive care unit in a university hospital. PATIENTS: 6 patients studied by right cardiac catheterization. MEASUREMENTS AND RESULTS: Results before glucocorticoid treatment show two possible hemodynamic states: 1) myocardial depression with hypovolemia in 3 patients, and 2) hyperdynamic shock with high cardiac output and diminished systemic arterial resistance in 3 other patients. The 3 patients presenting hyperdynamic shock were all given intravenous fluid therapy of over 20 ml/kg before the first hemodynamic measurement. For 2 other patients with low cardiac index and high systemic arterial resistance studied prospectively, 20 ml/kg intravenous fluid therapy transformed the hemodynamic state to hyperdynamic shock. The cardiovascular effect of glucocorticoid treatment studied in 4 patients was resulted in an improvement in the left ventricular systolic work index. CONCLUSIONS: Diagnosis of acute adrenocortical insufficiency must be considered if clinical manifestations are present suggesting septic shock without any obvious infectious cause in patients having undergone considerable intravenous fluid therapy as an initial course of treatment.

Acute Disease↗
PubMed1994

Efficacy of 4-methylpyrazole in ethylene glycol poisoning: clinical and toxicokinetic aspects.

Potentially fatal ethylene glycol intoxication in an adult with normal renal function was treated with 4-methylpyrazole administered three hours after the incident occurred. The plasma ethylene glycol concentration was 3.5 g l-1 on admission. The metabolic acidosis present on admission resolved within four hours, and the subsequent clinical course was uneventful. The apparent plasma half-life of ethylene glycol was 16 h and the mean renal and plasma clearances of ethylene glycol were 24 and 25 ml min-1, respectively. These results support the hypothesis that complete blockade of hepatic metabolism of ethylene glycol is achieved by 4-methylpyrazole. The only side-effect observed as a result of treatment was a transient slight increase in serum transaminase activity.

Adult↗
PubMed1993

[Pyomyositis. Apropos of 5 cases].

Four patients meeting the "classical" criteria for spontaneous pyomyositis are reported. No local cause was found. Risk factors included diabetes mellitus (2 patients), hemopathy (one patient), and alcohol abuse (one patient). Causative organisms (Staphylococcus aureus in 3 cases and Salmonella sp in one case) were recovered from blood cultures, an unusual occurrence. CT scan studies ensured the diagnosis in every case. An additional case of pyomyositis due to Staphylococcus aureus illustrates the difficulties in the definition of disease. This patient, whose muscle lesions were remarkably well visualized by MRI with injection of gadolinium, developed infection of the sacro-iliac joint adjacent to the muscular focus of infection. This patient may have had either "primary" pyomyositis with spread to the adjacent joint or "secondary" pyomyositis caused by the joint infection which was recognized only later. Advances in medical imaging techniques suggest that the nosology of pyomyositis should be broadened using this terminology. This would underscore the unique characteristics of "classical", "primary" pyomyositis and emphasize imaging, diagnostic and therapeutic facets of the disease which are shared by both entities.

Adult↗
PubMed1992

[Metabolic acidosis in severe acute asthma. Effect of alkaline therapy].

Respiratory acidosis of severe acute asthma is a severity factor. In this paper the treatment of associated metabolic acidosis is discussed. Among 34 consecutive episodes of severe acute asthma with acidosis (pH < 7.35) treated with continuous adrenaline perfusion, theophylline and hydrocortisone hemisuccinate, respiratory acidosis was observed in 12, metabolic acidosis in 2 and mixed respiratory and metabolic acidosis in 20. The association of hypercapnic acidosis with hypochloraemic acidosis reflected a time of installation longer than when respiratory acidosis only was present (p < 0.05). Among the 22 patients who had metabolic acidosis on admission, 14 were treated with 168 +/- 82 mmol of sodium bicarbonate, the remaining 8 patients being untreated and acting as controls. The rapidity with which pH was corrected was the same in the treated and untreated groups (9.1 +/- 5.5 hours vs 6.7 +/- 3.7 hours), whereas dyspnoea (respiratory rate < 18/min) was more rapidly corrected in the treated group that in controls (11.6 +/- 5.7 hours vs 5.9 +/- 5.9 hours; p < 0.05). It is concluded that in more than 50% of the cases respiratory acidosis of severe acute asthma is associated with a metabolic acidosis. Correcting this metabolic acidosis with sodium bicarbonate results in improvement of respiration, perhaps by facilitating the action of bronchodilator catecholamines.

Acidosis↗
PubMed1992

[Iodoform poisoning. 3 cases].

Three cases of iodoform poisoning are described following dressings with 10% iodoform gauze (0.10 x 5 m) on extended wounds. Five, ten and sixteen days after the beginning of dressings, the patients became confuse, hallucinated, and one of them was subsequently comatose. Vomiting, fever, tachycardia with premature ventricular beats and shortening of P-R interval, slight increase of transaminases and proteinuria were observed. Within a few days (3 to 8) after the iodoform dressings were discontinued, the signs of iodoform toxicity disappeared. The toxicity of iodoform is probably unrecognized if the rarity of the observations published and the amount of iodoform gauzes annually sold are compared.

Adult↗
PubMed1992

[Use of intravenous adrenalin in severe acute asthma].

The efficacy of and tolerance to intravenous Adrenaline (IV) have been assessed in cases of acute severe asthma (AAG). From January 1983 to March 1990 there were 56 episodes of AAG treated by intravenous Adrenaline using an average dose of 0.33 microgram per kilogramme per minute, in association with intravenous steroid therapy and Aminophylline (0.6 mg/kg per hour). A group of 12 patients were ventilated before admission and were excluded from the study. Two groups were defined on the basis of their admission PaCO2: Group A with 30 episodes of AAG and a PaCO2 above 45 mm of mercury, Group B with 14 episodes of AAG and a PaCO2 of less than 45 mm of mercury. The clinical improvement was equally rapid in both groups on average 8.7 (plus or minus 8.2) hours in Group A and 14.6 (plus or minus 15.7) hours in Group B. Artificial ventilation was only required in 2.3% of cases (7% in Group A and none in Group B). Treatment using intravenous Adrenaline is well tolerated as is shown by the absence of any worsening of the tachycardia, the significant fall in blood pressure after correcting the PaCO2 in Group A and the absence of any raised blood pressure in Group B. In conclusion, treatment with intravenous Adrenaline associated with IV Theophylline and IV corticosteroids based on the fact of its rapid action and that it is well tolerated, means that this drug should be considered as part of the therapeutic arsenal during acute severe asthmatic attacks in patients who are breathing spontaneously.

Acute Disease↗
PubMed1991

Aminohydroxypropylidene bisphosphonate (AHPrBP) treatment of severe immobilization hypercalcaemia in a young patient.

We report a case of severe hypercalcaemia in a 16-year-old patient, 24 weeks after immobilization for quadriplegia. The biochemical and histomorphometric parameters showed increased osteoclastic resorption and decreased osteoblastic formation. Hydration, chair sitting, salmon and porcine calcitonin, sodium etidronate were unable to normalize the hypercalcaemia. The new antiosteoclastic agent, 3-amino-1 hydroxypropylidene-1, 1-bisphosphonate (AHPrBP), was effective in normalizing serum calcium and biochemical parameters of osteoclastic activity within five days. Bone histomorphometry showed a marked reduction in osteoclastic activity after AHPrBP treatment, as well as a drastic depression of osteoblastic activity, presumably due to the reduction of bone turnover. This case represents to our knowledge, the first successful use of AHPrBP in the treatment of immobilization hypercalcaemia.

Adolescent↗
PubMed1991

[Electroencephalographic silence after intoxication with a carbamate tranquilizer].

A case of acute meprobamate poisoning in a 43 year-old-woman is reported. Twenty five hours after admission in the intensive care unit, deep coma and cerebral electrical silence were observed whereas the meprobamate plasmatic concentration was 250 mg/l. The patient recovery was uneventful. Meprobamate analysis must be performed for unexplained coma with isoelectric EEG.

Adult↗
PubMed1988

[Cerebral edema with hyperammonemia in valpromide poisoning. Manifestation in an adult, of a partial deficit in type I carbamylphosphate synthetase].

A case of cerebral oedema developed during an apparently common attempted suicide with valpromide is reported. The most conspicuous biochemical abnormality was hyperammonaemia. The oedema proved refractory to the standard medical treatment of intracranial hypertension, and decompressive craniectomy was performed with only minor sequelae. The cerebral oedema cum hyperammonaemia syndrome led to the discovery, in this hitherto asymptomatic adult subject, of a 50 per cent deficiency in type a carbamyl phosphate synthetase liver activity. By completing such a deficiency, valproate may produce an extremely serious syndrome resembling the neonatal encephalopathy due to complete enzyme deficiencies in the urea cycle. All valpromide or valproate intoxications probably are cerebral oedemas with hyperammonaemia akin ti Reye's syndrome. All accidents of this type occurring during treatment or poisoning with valproate should be investigated for urea cycle enzyme abnormalities.

Adult↗