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Biomedical subjects

P Erny

Publications and source records attributed to P Erny.

At least 37 records · Page 2Linked to original sources
PubMed1989

Incidence, causes and severity of injuries in Aquitaine, France: a community-based study of hospital admissions and deaths.

This paper reports the results of a study of injuries conducted during a one-year period within a defined geographic population of 2.7 million persons (Aquitaine, France). Cases were defined as unintentional or intentional injuries, either resulting in immediate death before reaching hospital or requiring hospital admission. During the one-year period, 1,181 deaths were registered and 8,190 hospital admissions occurred during the sample periods. The three leading causes of injury were falls (40 per cent), traffic accidents (27 per cent), and poisonings (15 per cent). The overall incidence of injuries was 136 per 10,000 person years. Incidence by sex and age was assessed for the main external causes. The ratios of nonfatal to fatal cases were calculated by sex and age and by external cause. The origin of the injury was suicide in 14 per cent of cases and assault or homicide in 3 per cent. The severity of injuries, assessed using an automatic computation of the Injury Severity Score (ISS), ranged from 1 to 66 with a mean of 6.9. Substantial variations of ISS were observed according to external cause. At the 8th day following admission, 31 per cent of hospital-treated patients were still hospitalized and 0.8 per cent had died in hospital. The outcome correlated well with the ISS.

Accidental Falls↗
PubMed1989

[Injuries and poisoning caused by various types of activities. Epidemiologic survey on death and hospitalization in Aquitaine].

From the data of a survey conducted in 1986 within the French area of Aquitaine and based on a representative sample of injuries having led to immediate death or hospitalization, different types of injuries were compared. Domestic and recreational accidents constituted the leading cause (41%) of injuries, followed by traffic accidents (28%) and suicides (13%). The overall ratio of immediate deaths to hospitalizations was 1 to 30 (1 to 10 for suicides, 1 to 20 for traffic accidents and 1 to 80 for domestic accidents). The overall annual incidence was 131 per 10,000 (respectively 20, 34 and 53 for suicides, traffic accidents and domestic accidents). The incidence by sex, age and type of accident was assessed. Among hospitalizations, about 3/4 of domestic and school accidents were falls; 45% of work accidents were cutting-piercing or being struck by an object, and 40% were falls; 90% of attempted suicides were poisonings. Using the Injury Severity Score (ISS), severity of injuries was the highest in traffic accidents. Traffic accidents also led to the highest hospital mortality within eight days (1.6%).

Accidents↗
PubMed1989

[An experimental and clinical study of a new intubation tube with a foam-filled cuff].

An experimental and clinical study of an endotracheal tube with a foam-filled cuff has been carried out. The experimental study showed that, during inspiration, the cuff was insufflated through the "T piece" connecting the cuff in the inspiratory limb of the ventilator circuit, preventing inspiratory leak. The intracuff pressure was equal to airway pressure. During expiration the gas insufflated into cuff leaked out through the "T piece" and intracuff pressure rapidly returned to zero. When N2O in 50% O2 was used for one hour, intracuff pressure did not increase. Twenty patients intubated with a foam-filled cuff tube, for ENT surgery, have been studied. The mean intubating time was 151 min +/- 36 and two patients were intubed, respectively, 26 hours and 28 hours. No complications were noted, 24 hours after extubation, during laryngeal fibroscopic control. Only two patients had light edema of the vocal cords and three of them had a light inflammation of the subglottic mucosa, without sore throat. No tracheal ischaemic damage nor tracheal mucosal inflammation were observed.

Adolescent↗
PubMed1988

[Comparative repercussions of general and spinal anesthesia on the psychological functions of the aged subject].

Although worsening cerebral function in the elderly is often said to be due to anaesthesia, it still remains to be proved that anesthesia acts on an elderly patient's psychological make-up. This study aimed to compare the psychological effects of general or spinal anaesthesia on 35 patients more than 70-yr old under repair of a subcapital femoral fracture, after having excluded 63 patients. They were randomly divided into two groups, the first receiving a spinal anaesthetic with 1.5 mg.kg-1 prilocaine (RA; n = 19), and the others a general anaesthetic with 5 mg.kg-1 thiopentone, dextromoramide, nitrous oxide and enflurane (GA; n = 16). None of the patients wer given a premedication. They underwent a battery of six psychological tests before and 36 h after surgery, all carried out by the same physician. Six patients in GA group and three in RA group developed a transient fall in mean blood pressure just after anaesthetic induction (not significant). There were no significant differences between the two groups in age, sex distribution, ASA class and performance in the tests, both before and after surgery. Individual psychological scores did not differ either. In the RA group, the postoperative tests were even better carried out than before surgery (p less than 0.05). It could therefore be concluded that anaesthesia alone has little impact on the psychological status of elderly patients.

Aged↗
PubMed1988

[Molecular mechanism of action of local anesthetics].

The main target of local anaesthetics on nervous tissue is the sodium channel. Molecular biology and electrophysiology have shown different mechanisms of action on this sodium channel, which depend on the chemical structure and electrostatic charge of the local anaesthetic molecule. There are two main types of action, shown up on the isolated axon, a direct one on the sodium channel itself and an alteration in the lipids surrounding the channel. These effects have been shown on the isolated axon and explain the anaesthetic effect by an inhibition of the sodium current. Experimental studies have also shown the effects of local anaesthetics on different organelles within the cell, and so on intracellular metabolism. Mitochondrial energetic metabolism, and therefore ATP synthesis, is reduced by local anaesthetics at several levels. The respiratory enzyme chain is inhibited by small concentrations of local anaesthetic, especially NADH dehydrogenase and ubiquinone succinate dehydrogenase. Moreover, local anaesthetics increase the mitochondrial membrane permeability to protons, thus removing the moving force behind ATPase activity in ATP synthesis; this leads to a drastic fall in available energy. This effect is further increased by a direct inhibition of ATPase and ATP/ADP translocation. Other enzyme systems of other organelles are also disturbed by local anaesthetics, such as the endoplasmic reticular Ca++ ATPase, which is inhibited, so altering the calcium concentration within the cytosol. Local anaesthetics also inhibit lipolysis and glycogenesis. Receptors such as the acetylcholine receptors are blocked by local anaesthetics. The mechanism of action of these drugs on all these protein systems is two-fold: an alteration of protein structure, but also of the lipids surrounding them.(ABSTRACT TRUNCATED AT 250 WORDS)

Action Potentials↗
PubMed1987

Uncoupling effects of local anesthetics on rat liver mitochondria.

We demonstrate in this paper that bupivacaine, a local anesthetic, can act alone as an uncoupler of rat liver mitochondria. It stimulates state 4 respiration, induces a swelling in potassium acetate (in the presence of valinomycin), and collapses the transmembrane potential. Lidocaine, another local anesthetic, requires the presence of a lipophilic anion such as TPB- to produce the same effects. TPB- can also reinforce the action of bupivacaine. These differences in action of the two local anesthetics can be explained by the difference in the liposolubility.

Animals↗
PubMed1987

[Results of resuscitation in injured elderly patients].

This study assessed the results of intensive care in elderly trauma patients and quantified the different factors involved in the final outcome. It included 116 patients, aged 65 years or more, and covered a two year period. The following parameters were obtained for each patient: age, severity of trauma (ISS and SAPS), head injury (GCS), prehospital health status (ESA), survival after three months and quality of survival. Three months after trauma, overall mortality was 45.7%. Survivors were 72.8 +/- 4.9 year old, while those that died were 75.3 +/- 7.5 year old (p = 0.01). Mean ISS was 19.7 +/- 8 and mean SAPS was 9.4 +/- 3.2. The risk of death was 3.6 (1.6 to 8.1) times greater if ISS was over 15. The same risk was 4.7 (2.1 to 11.1) times greater if SAPS was over 9. GCS was 8.8 +/- 4.4 in dead patients and 12.5 +/- 2.4 in survivors (p = 0.001). The risk of death was 10.4 (4.2 to 26.2) times greater if GCS was under 8. The final prognosis could be assessed with the following exponential model: Survival = 1/(1 + exp - (8.7 - 0.07 X age - 0.07 X ISS - 2.9 X GCS*), where GCS is equal to 0 if the real GCS was under 8, and equal to 1 otherwise. The ESA did not affect mortality. Three months after trauma, the degree of independence was the same as before in 87% of survivors. It was concluded that age and the severity of trauma were the most important factors in determining prognosis in geriatric trauma patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1986

[Measuring severity in trauma resuscitation].

ISS is the most widely used anatomic trauma severity index. This scale uses clinical judgement. It is therefore a subjective method, the validity of which is somewhat questionable. The aim of this study was to compare the clinical index ISS with a new non-specific score; the "simplified acute physiology score" (SAPS). Five-hundred trauma patients were checked retrospectively. Were excluded small traumas which did not require ICU hospitalization. ISS were all calculated by the same specialist and SAPS was drawn out of the initial blood sample examination. The sensitivity (proportion of true positive) and the specificity (proportion of true negative) were calculated for the two scores at all different cut-off points. "Receiver operating characteristic curves" (ROC) were drawn and their areas were compared by means of the Hanley test. The best Youden index, i.e. the fewest false positives for the most true positives, was also calculated. Mean ISS was 23.3 +/- 9.2. Youden index was 0.1; sensitivity and specificity were respectively 57 and 52% for the cut-off points. Mean SAPS was 8.7 +/- 4.3. Youden index was 0.3 and sensitivity and specificity were respectively 68 and 62%. ROC curve area for SAPS was 0.69 +/- 0.02. ROC curve area for ISS was 0.56 +/- 0.03 (p = 0.0001). In trauma, SAPS seemed to be a better predictor of outcome than ISS.

Evaluation Studies as Topic↗
PubMed1986

[Hemodilution and tissue oxygenation].

In a healthy person, when the haematocrit decreases in acute moderate haemodilution, oxygen delivery and oxygen pressures are preserved or improved by increasing the cardiac output. With a haematocrit of about 0.32, oxygen transport is maximum if the patient's heart function is normal, with no coronary heart disease. If the haematocrit falls below 0.25, there is a risk of anoxic anaemia, by splanchnic and cutaneous vasoconstriction and by a limitation of coronary blood flow adaptation to an increase in cardiac output. If oxygen requirements are increased by muscle exercise, fever, other stresses or when respiratory hypoxaemia occurs, extreme haemodilution is rapidly responsible for an oxygen debt. In all situations, the tissue oxygenation is compromised in the case of hypovolaemia.

Animals↗
PubMed1986

[Peroperative autotransfusion].

Between April 1976 and December 1984, 297 patients underwent major elective and emergency surgery using intraoperative autotransfusion (Bentley ATS unit). An amount of 732 l of blood was reinfused, representing 61% of the total intraoperative blood transfusion. Thanks to this method, an average 2.46 l of blood per patient was spared, with a range of 0.9 to 6 l according to the type of surgery (elective or emergency). Twelve accidents are reported, including four bradycardias (less than 45 b X min-1), two air emboli and six haemorrhages due to an excess of anticoagulation. These complications were related either to poor technique (too great a transfusion output) or insufficient blood anticoagulation control. Simplicity of use and high transfusion output of the device adapted to the blood loss are the advantages of intraoperative autotransfusion.

Adult↗
PubMed1984

[Neonatal bacterial infections. Kinetic study of C-reactive protein and orosomucoid].

Changes in serum concentrations versus time of C reactive protein and orosomucoid were investigated in 134 neonates with either materno-foetal infection (group A, n = 111) or nosocomial infection (group B, n = 23). Both proteins were significantly elevated in group A neonates, with mean +/- S.E.M. values of 0.029 +/- 0,003 g/l for C reactive protein (n = 111) and 0.56 +/- 0.003 g/l for orosomucoid (n = 37). In cases with superinfection serum levels of both proteins rose before clinical symptoms developed. Changes in orosomucoid concentrations occurred a few hours after changes in C reactive protein concentrations. Monitoring C reactive protein and orosomucoid levels, in an excellent means of assessing the effectiveness of treatment and of deciding on its withdrawal when both proteins return to normal values.

Bacterial Infections↗