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Biomedical subjects

P Desjars

Publications and source records attributed to P Desjars.

At least 37 records · Page 2Linked to original sources
PubMed1979

[Total replacement of an arm amputated near the shoulder. Difficulties during anesthesia and ressuscitation (author's transl)].

The authors report a recent observation of the total replacement of an arm amputated near the shoulder. The limb was perfused and cooled down from the site of the accident to the general hospital (distance about 50 miles) and was replanted within 13 hours. The procedure itself lasted about 8 hours. The bone replantation was the most critical difficulty for the surgeons. Venous repair was associated with hemorrhage and massive transfusion had to be performed to compensate heavy blood loss. In the post-operative period acute renal insufficiency and septicemia developed. After ten days an arterial rupture occurred and emergency amputation was performed. Recovery was uneventful and the patient was discharged nine weeks after his admission, his renal function being quite restored. The authors compare the hazards of this kind of operation and the chance of recovery of the functions of a replanted limb. They conclude by emphasizing the necessity of carefully choosing the cases for total arm replacement.

Adult↗
PubMed1978

Dobutamine in the treatment of depressed cardiac function: a study in patients with ischaemic heart disease during the early post-operative period.

Dobutamine was administered by intravenous infusion to 10 patients with ischaemic heart disease who had a low cardiac output syndrome following abdominal surgery. The dosage of dobutamine started from 2.5 mcg kg-1 min-1 and was increased stepwise to 5, 7.5, 10, 12.5 and 15 mcg kg-1 min-1. Cardiac index increased significantly from 2.05 +/- 0.32 to 3.03 +/- 0.61. min-1 min-2 with 15 mcg kg-1 min-1. Heart rate was unchanged with 7.5 mcg kg-1 min-1 but increased significantly from 97.7 +/- 18.5 to 126.1 +/- 21.5 beats. min-1 with 15 mcg kg-1. min-1. Stroke index increased significantly from 21 +/- 4.4 to 25.4 +/- 5.1 ml m-2. beat-1 with 7.5 mcg kg-1 min-1. Pulmonary wedge pressure fell significantly from 14 +/- 2.9 to 9.1 +/- 2.4 mmHg with 2.5 mcg kg-1 min-1. Mean arterial pressure showed no significant change. No side effects were observed in these patients. We conclude that in patients with depressed cardiac function dobutamine at low doses of 2.5 mcg kg-1 min-1 decreases afterload and filling pressures. At the average doses of 5 - 7.5 mcg kg-1 min-1 stroke index and cardiac index are increased. At higher doses of 10 - 15 mcg kg-1 min-1 heart rate and cardiac index increase while stroke index fails to increase further.

Aged↗
PubMed1978

Left ventricular function in tetanus: influence of therapy.

Nine patients hospitalized for tetanus were studied under the same protocol which included two haemodynamic studies with a preload trial (PLT). The first being made during therapy (diazepam barbiturate association), on the sixth day of hospitalisation, and the second one after recovery. The comparison of the results shows that before PLT the mean arterial pressuure (MAP) is significantly increased (p less than 0.05) in patients after recovery in comparison to the same patients undergoing therapy. After PLT there is no significant difference between the two groups. Lastly, the variation of the left ventricular function points under PLT shows no significant difference between patients during therapy and after recovery. These results suggest that the diazepamphenobarbital combination does not alter the left ventricular function of the patients undergoing this therapy during tetanus.

Diazepam↗
PubMed1978

[The effects of dobutamine in postoperative disorders of left ventricular function in coronary patients undergoing abdominal surgery. Apropos of 18 cases].

Increasing doses of dobutamine were administered to the first group of 10 coronarians having undergone and abdominal surgical procedure, and presenting, one hour after awakening from the anesthesia, hemodynamic modifications with a diminution of cardiac index (CI), systolic index (SI), systolic work index of the left ventricle (SWILV) increase in the pulmonary capillary pressure (PCP), and in the total peripheral resistance (TPR), as well as an acceleration of the cardiac rate (CR). Doses of dobutamine of 5 or 7.5 microgram.kg-1.min-1 corrected the IC, PCP and TPR. Dobutamine ameliorated the SI and SWILV in an increasing fashion up to a dose of 10 microgram.kg-1.min-1 only and without restoring them to the control values of the pre-operative period. CR progressively increased with the increasing of the doses reaching 126 +/- 21.5 beats min-1 for 15 microgram.kg-1.min-1. Extrasystoles appeared at dose levels of 12.5 and 15 microgram.kg-1.min-1 in two patients. Tests of vascular filling (pre-charge tests) carried out in the second group of patients under 10 microgram,kg-1.min-1 of dobutamine and in a third group under 15 microgram.kg-1.min-1 showed a good cardiac adaptation to filling, equal or superior to that of the pre-operative period. It also appeared that the amelioration of CF obtained with a moderate vascular filling (300 ml of low molecular weight dextran) under 10 microgram.kg-1.min-1 of dobutamine is greatly superior to the amelioration obtained by 10 to 15 microgram.kg-1.min-1 of dobutamine.

Abdomen↗
PubMedDate not supplied

[Circulatory and metabolic disturbances in accidental hypothermia (author's transl)].

This work sums up several studies: clinical observation (electrocardiogram, cardiac rhythm, circulatory state), and biology (glycemia, blood oxygenation, acid-base balance) in 24 cases of accidental hypothermia, not related to poisoning by central nervous system depressive agents; haemodynamics in 18 of these cases; pathology of the myocardium in 11 cases; haemodynamics and microscopy of the myocardium in dogs with slowly induced or prolonged hypothermia; finally an electron microscope study in hypothermic rats. Electrocardiographic study and continuous monitoring of cardiac rhythm and tracing show, in addition to well known manifestations (bradycardia, lenghtening of QT, J wave), acute dysrhythmias, particularly circulatory arrests by asystole during or even 72 hours after rewarming. The clinical haemodynamic changes, measurable (cardiac output, mean arterial pressure, central venous pressure), or computable (stroke volume, peripheral resistances) are observed during rewarming. Several haemodynamic developments can be distinguished: --favourable evolution when the initial disturbances (decrease in cardiac output and in stroke volume, increase in peripheral resistances) disappear without any therapeutic support: --haemodynamic developments showing at a certain time evidence of hypovolemia requiring only moderate vascular replacement; --haemodynamic developments showing myocardial damage. In some cases, only hypothermia accounts for these. In circulatory arrests during or after rewarming, these haemodynamic disturbances raise the hypothesis of severe cardiac changes due to hypothermia itself.

Acid-Base Equilibrium↗
PubMedDate not supplied

[Hemodynamic effects of equipotent doses of phenoperidine and fentanyl in man].

The haemodynamic effects of phenoperidine and fentanyl were studied in ten patients with craniocerebral trauma who presented no surgical indications. They were all mechanically ventilated with a constant tidal volume and rate and their cardiovascular state was stable. The patients were given 5 gamma/kg of fentanyl intravenously; the haemodynamic measurements were performed at two mn interval for 20 mn. Three hours later, the patients were given 30 gamma/kg of phenoperidine intravenously and the haemodynamic measurements were performed similarly. Phenoperidine and fentanyl had the same effects: a significant fall in heart rate, mean arterial pressure and cardiac index without any change in pulmonary wedge pressure. These changes do not dangerously alter the haemodynamic condition of the patients and thus are not a contra-indication to the general use of phenoperidine and fentanyl in anaesthetic practice and in intensive care.

Adult↗
PubMedDate not supplied

[A prognostic study of 238 cases of chest trauma. Influence of the delay in admission in an intensive care unit (author's transl)].

238 cases of chest trauma were studied according to the same protocol. With this protocol we can perform on the one hand a comprehensive study of the prognosis according to the thoracic lesions and associated lesions and on the other hand a prognostic study according to the delay of admission in a intensive care unit. All our data show that the most serious lesion is the pulmonary contusion and that mortality increases if an associated lesion is present, according to its nature. On the other hand a comparison was performed between the patients directly admitted in the intensive care unit (GI) and the patients hospitalized after a delay (GII) this comparison shows that in G II patients the rate of complications was higher, the mortality more important and respiratory sequelae more frequent than for patients of GI with thoracic lesions of the same importance or less important. These data show that an early admission of chest trauma patients in an intensive care unit is desirable and that the duration of this hospitalization must be at least 3 or 6 days.

Adult↗