Biomedical subjects
Publications and source records attributed to P Barbier.
A one month old child inadvertently received an intravenous bolus injection of 50 mg of lidocaine instead of contrast iodine. The clinical picture comprised collapse, respiratory arrest, convulsions and coma. The calculated maximum level of lidocaine was 5.39 mg/l. The recovery was complete. The toxicity of lidocaine is discussed.
The aim of this study is a double-blind evaluation of the efficacy and safety of rioprostil, 300 micrograms, compared with ranitidine, 150 mg, when given twice a day for 4 or 8 weeks in patients with active, uncomplicated gastric ulcer disease. A total of 194 patients are entered into the study, of which 182 are statistically evaluated for efficacy. Eighty-seven receive rioprostil and 95 receive ranitidine. All patients receive two oral doses of study medication daily. After 4 weeks' treatment, 47.1% of the patients receiving rioprostil are endoscopically healed compared with 53.7% of those receiving ranitidine. After 8 weeks' treatment, the cumulative cure rates are 76.2% and 80.9% respectively. Side effects occur in 26% of the patients receiving rioprostil and in 15% of the patients receiving ranitidine. Gastrointestinal side effects are most common. Changes in stool consistency (i.e. soft stools or mild diarrhoea) are the most reported symptoms in patients receiving rioprostil. These effects are generally self-limiting. Three patients on rioprostil and one patient on ranitidine discontinue treatment due to side effects. No clinically significant changes in biochemical variables occur in either group throughout the treatment period. Rioprostil, 300 micrograms b.d., is a safe and effective treatment for gastric ulcer disease. Healing rates and alleviation of pain are comparable for both treatment groups. The change in stool consistency with rioprostil is of only minor clinical importance, that is, it occurs on about 2% of treatment days.
We report the results of a trial of omeprazole 20 mg daily versus ranitidine 150 mg b.i.d. in the short-term management of erosive or ulcerative esophagitis. The principal aim of the trial was to assess the healing rates of the esophageal lesions. The trial was conducted in 19 centers (16 in France and 3 in Belgium). The lesions of the esophageal mucosa were defined as follows: grade 2 (n = 112), round or linear erosions; grade 3 (n = 33), confluent erosions affecting the total esophageal circumference; or grade 4 (n = 11), erosions as described above plus deep ulcerations or peptic stenosis which did not need endoscopic dilatation. The main criterion was the complete healing of esophageal lesions after 4 weeks of treatment. Patients were randomly allocated to double-blind treatment with omeprazole or ranitidine. Clinical and endoscopic examinations were done on inclusion in the trial and at day 29 +/- 6, and again at day 57 +/- 6 if esophagitis was unhealed. No patient was excluded from the analysis on an "intention-to-treat" basis, and 25 patients were excluded from the "per protocol" analysis, mainly because of poor compliance with the trial protocol. The healing rate at weak 4 was 50 of 62 patients (81 p. 100) treated with omeprazole and 31 of 69 patients (45 p. 100) with ranitidine (p less than 0.001). The corresponding figures at week 8 were 58 of 61 (95 p. 100) and 40 of 61 (65 p. 100) (p less than 0.001).
We evaluated the left ventricular mass index (LVMI) and the functional response to cold pressor and handgrip tests in 74 untreated essential hypertensive patients and 26 age and sex-matched normals. The same measurements were repeated in 22 essential hypertensives after 6 and 12 months of treatment (captopril or nitrendipine, plus diuretic or beta-blocker in a few cases) and in 21 essential hypertensives after withdrawal of treatment, a reduction in the LVMI and a further increase in blood pressure. Left ventricular systolic function was evaluated by the relationship between left ventricular end-systolic stress and fractional shortening. Highly significant negative correlations, with similar slopes and intercepts, were found between end-systolic stress and fractional shortening under basal conditions, after regression of left ventricular hypertrophy and after withdrawal of treatment, both at rest and at the peak of stress tests. An examination of each point of the relation between end-systolic stress and fractional shortening showed that very few points were beyond the 95% prediction limits of the correlation obtained in normal volunteers. These results indicate that left ventricular systolic function is normal in most untreated essential hypertensives, and is usually well maintained after regression of left ventricular hypertrophy during long-term treatment as well as after withdrawal of treatment, both at rest and during an acutely induced afterload increase.
Eighty patients undergoing pelvic or abdominal surgery for cancer were randomized in two groups for prevention of postoperative thromboembolism: 40 patients received a 15,000 IU day-1 Calciparine prophylaxis and 40 patients a 5000 anti-Xa U/d Fragmin prophylaxis for 10 days. In the Calciparine group, two patients (5%) developed postoperative pulmonary embolism but none developed it in the Fragmin group. Two patients in the Fragmin group (5%) developed isotopic DVT, which was not confirmed by phlebography. There was no deep vein thrombosis of the lower limbs in the two groups. Important postoperative bleeding (one patient in the Calciparine group and two patients in the Fragmin group) was similar in both groups. Moderate and minor bleeding were significantly lower in the Fragmin group. Haemoglobin and haematocrit changes, total blood loss and transfusion requirements were not different in both groups. It is concluded that, over a 10-day period, one daily 5000 U Fragmin prophylaxis was as effective and safe as three daily 5000 IU Calciparine injections.
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A series of 80 patients operated for total hip prosthesis under epidural anesthesia was randomly allocated to treatment with Kabi 2165 (n = 40): 2,500 U anti-Xa preoperatively and evening of operation and 2,500 U anti-Xa morning and evening daily up to the 9th or 10th day postoperatively, or standard heparin (n = 40): 3,750 U preoperatively and then 8 hourly, at a dose adjusted with thrombin time and cephalin + activator time, daily up to the 9th or 10th day. Phlebography was performed routinely on the 9th or 10th day. Venous thrombosis occurred in 7 patients (17.5%) in the Kabi 2165 group, including two high, potentially emboligenic, localizations (5%), and in 4 patients (10%) in the standard heparin group, including 2 potentially emboligenic clots (5%). The difference is not statistically significant (total number: p = 0.5; potentially emboligenic: p = 0.33). Pulmonary embolism did not occur. Overall tolerance, evaluated from hemoglobin and hematocrit values, intra- and post-operative bleeding and operation wound hematoma and at injection site was comparable in the two groups.
Sustained hypertension is a stimulus for development of cardiac hypertrophy, which may be either concentric or eccentric. For a given rise of aortic pressure, left ventricle (LV) wall stress (afterload) may remain normal or reduced in the former and become enhanced in the latter condition, and the LV systolic function may vary in a direction opposite to that of wall stress. It is unknown whether there are also differences in contractile properties that may have a role in the shift from normal systolic function. To clarify this we evaluated the velocity of LV fiber shortening and the fractional fiber shortening in normotensive and hypertensive subjects with normal heart size (group 1), or concentric LV (group 2) or eccentric LV (group 3) hypertrophy during baseline and after an acute hemodynamic overload induced by a cold pressor test (CPT). We found that the functional pattern in the two conditions was similar to normal in group 1, significantly enhanced during baseline and CPT in group 2, and was depressed during baseline and more so during CPT in group 3. These findings suggest that the contractile properties of the two types of hypertrophy are different, supported by the slope of the force-length line defined by the end systolic stress-end systolic volume relation in the baseline and during the hemodynamic overload imposed by the CPT. This line was steeper than normal in group 2 and less steep than normal in group 3. It remains to be defined whether the two types of hypertrophy are a separate disorder or represent a different stage of the same disease.
Clinical and radiological analysis of a population of 80 patients undergoing hemodialysis showed a high incidence of joint symptoms and radiological abnormalities which could not with certainty be attributed to renal osteodystrophy (Part 1). In this same population, laboratory and pathologic studies were performed. Blood chemistry proved abnormal in most cases (fibrinogen, aluminum, beta 2 microglobulin). Histopathologic studies (bone or synovial) were performed in 20 samples. Amyloid deposits were found in 8 samples, and crystal deposits in 3. We consider the idea that amyloid may be responsible for the observed lesions to be an interesting possibility. A better understanding of the behavior of different dialysis membranes may clarify the pathophysiological mechanisms of this disease.
During the last 12 years, we performed 78 reoperations upon the biliary tract for benign disorders. Not included were early complications after the initial operation or endoscopic manipulation. The indications for reoperations were obstructive jaundice, recurrent colic and asymptomatic biliary fistula in 57, 18 and three patients, respectively. Endoscopic retrograde cholangiography was found to be the preoperative diagnostic method of choice. Intraoperative examination demonstrated cholangiolithiasis in 48 patients (five patients with stenosis), stenosis of the bile duct in eight, sump syndrome after choledochoduodenostomy in six and cholangitis without any further pathology in three. In three patients, the revision was negative. Several reinterventions were carried out: exploration of the bile ducts (12 per cent with papillotomy), removal of a biliodigestive anastomosis and a biliary enteric anastomosis in 52, 12 and 14 patients, respectively. The postoperative cholangiogram showed residual stones in 12 patients. Two-thirds of the stones disappeared spontaneously and one-third were removed endoscopically. There were local complications in 12 of the patients. The mortality rate was 6.4 per cent. All of these patients were more than 70 years old and were considered at high risk. In spite of endoscopic retrograde cholangiography, the number of operative reinterventions upon the biliary duct system has hardly declined over the last few years. This is partly due to new specific complications in connection with endoscopic retrograde endoscopy (perforation, hemorrhage or pancreatitis).
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(+/-)-Tulipalin B was prepared in six steps from phenyl sulfide and ethyl 2-bromopropionate. The sensitizing power in the skin of (+/-)-tulipalin A (1a) and B (1b) and of the beta-acetoxy derivatives (1c) was studied. All are able to induce allergic contact dermatitis (ACD) and give cross-reactions. gamma,gamma-Disubstituted analogues (with a -(CH2)5- chain in the gamma-position) were synthesized and used to induce ACD in guinea pigs: they all were sensitizers and cross-reacted. However no cross-reaction was demonstrated between gamma,gamma-unsubstituted and gamma,gamma-substituted compounds showing a great specificity of ACD.
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The experience with snake bites, causing local complications is discussed. Whenever systemic envenomation occurs, antivenin is the treatment of choice. Tissue necroses are treated by early debridement and a possible closed compartment syndrome demands the open fasciotomy.
Three patients with massive lower gastrointestinal bleeding are reported. In all cases, the bleeding source was localized by emergency selective mesenteric angiography. The histologic lesion found in the resected specimen consisted of a minute mucosal ulcer with an abnormally large eroded submucosal artery without evidence of true angiodysplastic changes. The clinicopathological picture is similar to the rare solitary stomach ulceration, described as "Exulceratio simplex Dieulafoy."
Splenic infarcts are represented by wedge-shaped, oval or linear areas. Haemorrhagic infarcts are characterised by being hyperdense. Disseminated infarction occurs predominantly in myeloproliferative diseases. During the early stages, the infarct appears as an ill-defined hypodense defect, with non-homogeneous contrast enhancement. During the acute and sub-acute stage, the density of the infarct is low and there is no contrast enhancement. During the chronic stage, its density increases and there is slight contrast enhancement. Complications following splenic infarcts, such as abscesses, bleeding and rupture can be demonstrated by CT with great accuracy. Problems in differential diagnosis may occur if there are atypical manifestations of the infarct, with respect to abscess or leukaemic infiltrations.
We have examined the mechanisms mediating the release of renin elicited in man by reduction of renal perfusion pressure. Fifteen patients with essential hypertension and six normotensive subjects were investigated during diagnostic renal arteriography. Renal neural receptors were inhibited by propranolol (10 mg i.v.) and activated by a standard cold pressor test. Vascular receptors were stimulated by unilateral reduction of renal perfusion pressure by 50%, using a balloon-tipped catheter. The stimulus caused release of renin. In hypertensives, arterial plasma renin increased by 44, 69 and 73% of control at 5, 15 and 30 min, respectively. Adrenergic activation by cold raised the arterial and the renal venous renin by approximately 50% of control and caused a fourfold rise when it was combined with the arterial obstruction. Following propranolol the renin response to reduction of the renal perfusion pressure was delayed and reduced, and cold stimulation, both alone and in combination with arterial obstruction, failed to stimulate renin release. Findings were qualitatively and quantitatively similar in the normotensive group. This study supports the hypothesis that the renin response to reduction of renal perfusion pressure in man results from an interaction of adrenergic and vascular receptors. It cannot be stated whether the former are synergistic or supplementary to the latter, even though adrenergic activation by cold stimulation provides evidence that a synergism between the two may exist.
Allergic contact dermatitis is essentially enantiospecific: sensitization to one enantiomer generally does not imply elicitation to the mirror-image allergens. Examples from patients allergic to Frullania, and from the literature (usnic acids, 4-methoxydalbergiones, gamma-methyl-alpha-methylene-gamma-butyrolactones, frullanolides) are discussed.