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Biomedical subjects

P Gajdos

Publications and source records attributed to P Gajdos.

At least 127 records · Page 7Linked to original sources
PubMed1983

[Long-term effects of plasma exchange in myasthenia. Results of a randomized study].

A randomized study was carried out in 14 myasthenia patients to compare the long-term effects of two therapeutic regimens. Group I patients received prednisone 1 mg/kg/24 h for one month, then in decreasing dosage; in case of failure at the end of the first month, cyclophosphamide 2 mg/kg/24 h was added to the prednisone treatment. Group II patients received the same treatment associated with 3 plasma exchanges over a 10-day period; these were continued, if required, at the rate of once a week. The minimum follow up was one year. The results (greater improvement in muscular strength and vital capacity) were better after one month in group I and thereafter similar in both groups. However, the mean daily dose of prednisone was higher in Group I. The number of exacerbations of myasthenia was greater in group II (11 versus 2 in group I over a 24-months period). The mean fall in anti-R Ach ab was about the same in both groups. This study confirms the rapid effectiveness of plasma exchanges and their value in severe myasthenia. The higher incidence of exacerbations in Group II was probably due to a rebound phenomenon and points to the need for combined immuno-suppressive treatment.

Adult↗
PubMed1983

Beneficial effects of dantrolene in the treatment of neuroleptic malignant syndrome: a report of two cases.

Two schizophrenic patients developed muscular rigidity, stupor, and hyperpyrexia consistent with neuroleptic malignant syndrome, 8 to 10 days after starting haloperidol therapy. Muscle rigidity was not affected by etybenzatropine or diazepam, but dantrolene, a direct-acting skeletal muscle relaxant, provided muscle relaxation with a concomitant decrease of fever and serum creatine kinase. Neuroleptic malignant syndrome and malignant hyperthermia are clinically similar, and dantrolene is effective in both; suggesting a muscular origin of fever in these two diseases.

Adolescent↗
PubMed1982

[Disseminated candidiasis. 23 cases collected in an intensive care unit].

Twenty-three cases of disseminated candidiasis (DC) were observed between 1965 and 1981. In 23 cases the DC was a complication of a preexisting disease process (16 abdominal surgery, 18 bacterial septicemia, 16 acute renal failure, 4 carcinoma) requiring polytherapy (23 antibiotherapy, 5 parenteral nutrition, 4 corticotherapy). The most frequent foci were ocular (6), peritoneal (5), renal (4), and pulmonary (3). Diagnosis was confirmed by blood culture (20), urine culture (12), culture of the catheter tip (7), isolation of candida from a localised focus and by anti candida antibodies in some patients. Nine patients were not treated and died; 14 patients were given antifungal agents: 6 died, three despite cure of DC. The recognition of favouring circumstances, early diagnosis and systematic treatment of all foci of candidiasis allow effective prophylaxis against DC; the last case in our series was in 1978.

Adult↗
PubMed1981

[Testing a cellulose diacetate membrane for plasma exchange (author's transl)].

A cellulose diacetate membrane was tested in 60 plasma exchanges (PE) carried out in 16 patients. Access to the vascular compartment was obtained through one single puncture by inserting a catheter into the femoral vein, the blood circuit being provided with an alternating clamp. The exchange of 2 plasma volumes (72.3 +/- 16 ml/kg) reduced IgG, IgA and IgM concentrations to 30.9 +/- 12.1%, 31.6 +/- 14.5% and 28.3 %/- 15.0% respectively of pre-PE concentrations. Similarly, the C3 and C4 complement fractions and factor B were reduced to 32 +/- 12%, 33 +/- 15% and 36 +/- 16% respectively of pre-PE values. The membrane was used several times in 7 patients; its performance remained the same after 3 consecutive uses. In view of its effectiveness and ease of application, the cellulose diacetate membrane appears to be particularly suitable for plasma exchanges in intensive care units.

Cellulose↗
PubMed1981

[Treatment of Gram-negative septicaemia with cefotaxime: 16 cases (author's transl)].

Sixteen patients, 9 to 81 years old, with Gram-negative septicaemia have been treated with cefotaxime. In all cases, the patients were hospitalised in an intensive care unit for a severe infection distinct from septicaemia. Cefotaxime was given alone to 11 patients and was administered by infusion over 20 to 30 minutes, every 4 or 6 hours, in a daily dose of 67 to 94 mg/kg to patients with normal of subnormal renal function. Gram-negative pathogens were sensitive to cefotaxime (MIC less than 1 mcg/ml in most cases). A clinical cure was obtained in 14 patients. In all the cases, tolerance was good. The very low MIC's of cefotaxime and the results in severe Gram-negative septicaemia justify the use of cefotaxime in monotherapy, in patients with severe life-threatening infections, when blood cultures appear to be positive for Gram-negative pathogens, even without awaiting antibiograms.

Adolescent↗
PubMed1981

[A new plasma exchange technique : coagulation studies (author's transl)].

Coagulation studies were performed during and after 60 continuous plasma exchanges in 15 patients with neurologic disorders. One or several plasmapheresis were performed on each patient using a new filtration material "Plasmaflo" from Asahi Medical, Tokyo. During each exchange involving massive heparin infusion, two total plasma volumes were removed and replaced isovolumetrically by a material devoid of clotting factors (albumin and Plasmion). The variation of the platelet count was moderate (mean reduction of 19%). An important and rapid fall of all coagulation factors was observed, and during a single exchange procedure the extent of the fall was comparable for all coagulation factors. The mean reduction during plasmapheresis was 70%. However, a difference in the rapidity of normalisation was observed between the various proteins (F.V. : 24 h, A.T.III : 72 h). A particular property was noted concerning factor VIII. In all cases, a normal or high level of VIII : C as well as of VIII R : Ag was reached 3 hours after exchange. In some cases an increase could be observed even during plasmapheresis. No hemorrhagic diathesis was noted despite massive heparin administration to the patients and a striking decrease of blood procoagulant factors. On the other hand, one patient developed femoral vein thrombosis following the 8th exchange.

Blood Coagulation Factors↗
PubMed1980

[Determination of anti-acetylcholine receptor antibodies in myasthenia and its treatment by plasma exchange and immunosuppressants].

Recent works have confirmed the auto immune mechanism in myasthenia gravis, that Simpson had hypothetized early as 1960. A post synaptic blockage, of which Ach-R antibodies seem to be chiefly responsible, is now accepted though the exact pathogenesis remains unknown. The immuno assay of these antibodies is still difficult; their blood level evaluates the course of the disease and the effectiveness of the treatment. The withdrawal of the antibodies by plasma exchange (P.E.) and the inhibition of their secretion by immunosuppression (I.S.) lead to remission in many cases. Principle of the immuno assay and results of P.E. and I.S. are reported in 21 cases.

Adolescent↗
PubMed1980

[Orthostatic hypotension in tetraplegic patients (author's transl)].

Blood pressure regulation was studied in nine patients with tetraplegia following total cervical section. Ten minutes after placing the patients in an inclined position at 30 degrees there was a marked reduction in blood pressure, an increase in heart rate, and absence of increased peripheral resistance. Valsalva's maneuver was pathological in all cases (lack of overshoot). Circulating catecholamines were measured in five cases and were low in decubitus and did not react to orthostatism. Plasma renin and aldosterone levels were at the upper limits of normal and reacted strongly to orthostatism. Marked hypersensitivity to exogenous angiotensin and noradrenaline was observed in all cases. These modifications result from section of the sympathetic efferent pathways. High plasma renin levels and their increase during orthostatism are not incompatible with these findings and probably result from intervention of renal baroreceptors. Whatever the mechanism involved, this increase in plasma renin activity could play an important role in the control of blood pressure in tetraplegic patients.

Adolescent↗
PubMed1980

[Radiological appearances of post-traumatic fat emboli. A report on 27 cases (author's transl)].

Initial radiological appearances and changes occurring during the course of post-traumatic fat emboli in 27 patients are described. An alveolar filling syndrome usually appears after a free interval of 44 hours, and is followed by an interstitial syndrome on about the 12th day which usually regresses completely by the 20th day without sequelae. Five of the 27 patients died of either secondary infection or anoxia.

Embolism, Fat↗
PubMed1978

Membrane oxygenators for acute respiratory insufficiency. Clinical use in 11 patients.

Extracorporeal circulation with a membrane oxygenator (ECMO) was used in 11 patients with acute respiratory insufficiency who did not respond to conventional treatment. By pass was veno-arterial in every case, seven times with femoral artery return, three times with axillary artery return, and once with both femoral and axillary return. Five patients died on ECMO. Six patients were taken off ECMO and two of them are long-term survivors. In nine cases ECMO allowed short-term control of respiratory failure. The respective roles of oxygen supply from ECMO and the haemodynamic changes incurred by its use are discussed. Although use of ECMO for long periods seems less hazardous now, present results are restricted by the lack of therapy for the underlying pulmonary lesions.

Acute Disease↗
PubMed1977

[Hypercalcemia during acute intermittent porphyria. Apropos of 3 cases].

3 cases of hypercalcemia are reported, among 14 tetraplegic patients with porphyria. The calciuria, the estimations of parathormone, calcitonin and the isotopic calcium balance studies, suggested in the two most serious cases, hypercalcemia due to immobilisation. The main factor seems to be the duration of the immobilisation. The predisposing role of renal failure and catecholamines is discussed.

Acute Disease↗