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Biomedical subjects

P Mahieu

Publications and source records attributed to P Mahieu.

At least 19 recordsLinked to original sources
PubMed2000

A case of fatal diquat poisoning: toxicokinetic data and autopsy findings.

CASE REPORT: A 37-year-old man ingested in a suicide attempt 300 mL of a diquat solution (equivalent to 60 g diquat ion). The initial diquat serum concentration was 64 microg/mL 4 hours after poisoning. The clinical course was characterized by a progressive anuria and by neurological disorders (coma and seizures). The patient died 26 hours after poisoning from refractory cardiocirculatory collapse. Extracorporeal techniques removed 1.09 g of diquat which could be considered as significant in regard to the total amount that was likely absorbed, but they did not influence the clinical outcome. There was marked renal tubular damage at autopsy and the highest diquat tissue concentration was found in the kidneys.

Adult↗
PubMed2000

Pancreatic injury following acute methanol poisoning.

BACKGROUND: Methanol ingestion is a cause of potentially life-threatening poisoning with numerous systemic manifestations. Clinicians may overlook the possibility of acute pancreatitis in this setting. The objective of this paper is to document the incidence of this complication in a series of 22 patients and to discuss the respective role of methanol and ethanol in its pathogenesis. CASE REPORT: A 54-year-old woman developed acute necrotizing pancreatitis following acute methanol poisoning. She was treated by hemodialysis, ethanol infusion, and folinic acid, but, despite maximal supportive therapy, she died from multiple organ failure 54 hours after the ingestion. CASE SERIES: In a series of 22 consecutive patients admitted with a diagnosis of acute methanol poisoning, we found evidence of pancreatic damage in 11 patients. The abnormalities were present from admission and before ethanol therapy in 7 cases and developed after ethanol therapy in 4 cases. Seven patients had a history of chronic ethanol abuse, but no patient had previously suffered from acute or chronic pancreatitis. Three patients presented moderate-to-severe acute pancreatitis according to clinical and radiological criteria and required aggressive supportive therapy including peritoneal dialysis. One patient died from the direct consequences of acute necrotizing pancreatitis and 2 fully recovered from this event. Three patients evolved to brain death; autopsy revealed hemorrhagic lesions in the pancreas in only 1 case. CONCLUSIONS: Clinical, biological, and radiographic signs of acute pancreatic injury may be more common than previously realized. Acute methanol poisoning appears to produce pancreatic injury, although antidotal treatment with ethanol or prior chronic ethanol abuse may be contributing factors. Because ethanol treatment may complicate the pancreatic injury, fomepizole (4-methylpyrazole) may be the preferable antidote in acute methanol poisoning.

Acute Disease↗
PubMed1999

Two cases of acute methanol poisoning partially treated by oral 4-methylpyrazole.

OBJECTIVE: Since the use of 4-methylpyrazole (4-MP) in the treatment of humans with methanol poisoning is poorly documented, we report two cases of acute methanol intoxication partially treated by this potent alcohol dehydrogenase (ADH) inhibitor. SETTING: Intensive Care Unit in a university hospital. PATIENTS: A 56-year-old man and an 18-year-old woman were observed, respectively, 41 and 16 h after the voluntary ingestion of an unknown amount of methanol. INTERVENTION: In both cases, ethanol was used as the first antidote. In the first patient, hemodialysis was also performed on admission because a high methanol level (0.72 g/l) and visual impairment were noted. In the second patient, ethanol therapy was withdrawn after 12 h when clinical and biological signs of acute pancreatitis became evident. Both patients received multiple oral doses of 4-MP. No recurrence of metabolic acidosis occurred and the 4-MP therapy was well tolerated. CONCLUSION: While the use of 4-MP is better documented in cases of ethylene glycol poisoning, it could also become an accepted option for the management of methanol poisoning since 4-MP offers advantages over ethanol therapy.

Administration, Oral↗
PubMed1999

Assessment of chronic constipation: colon transit time versus defecography.

OBJECTIVE: The aim of this study was to determine the value of radiological colon transit time (CTT) measurements in relation to defecography (DFG) in chronically constipated patients. MATERIALS AND METHODS: In 30 patients with chronic constipation, total and segmental CTT was determined using radiopaque markers. In all of these patients defecography (DFG) was obtained. The patients were divided into three groups: In group I, 11 patients were classified with idiopathic constipation based on low stool frequency, normal DFG, or absence of symptoms of abnormal defecation. In group II, ten patients with rectal intussusception were diagnosed by DFG. In group III, there were nine patients with rectal prolapse or spastic pelvic floor syndrome, based on results of DFG. RESULTS: Group I, idiopathic constipation (n = 11), showed increased total CTT (mean, 93 h) and segmental CTT (right colon, 33 h (36%), left colon, 31 h (33%), rectosigmoid, 29 h (31%)). In group II, intussusception (n = 10), patients had normal mean total CTT (54 h) and a relative decrease in rectosigmoid CTT (mean, 13 h (24%)). In group III (n =9), rectal prolapse (n = 5) or spastic pelvic floor syndrome (n = 4), patients showed elevated total (mean, 167 h) and rectosigmoidal CTT (mean, 95 h (57%)). Mean total CTT was significantly different between groups I and II and between groups II and III, and mean rectosigmoidal CTT was significantly different between all three groups (P < 0.05). CONCLUSION: The use of total and rectosigmoidal CTT helps to identify the underlying pathophysiology of chronic constipation. Furthermore CTT helps to identify patients, who may benefit from DFG.

Adult↗
PubMed1999

How epileptogenic are the recent antibiotics?

OBJECTIVE: To review the clinical and experimental data concerning the serious neurologic adverse events, and more particularly seizures, which could be related to the administration of recent antibiotics, with special reference to cephalosporins, monobactams, carbapenems, and fluoroquinolones. DATA SOURCES: We have searched in the MEDLINE database over the years 1966-1998 the pertinent publications dealing with antibiotics related neurotoxicity. We used the thesaurus function and the following key words: antibiotics, neurotoxicity, seizures. Additional references were found in the articles sorted by the MEDLINE search. DATA SYNTHESIS: Neurotoxic manifestations following antibiotics administration are infrequently encountered under usual conditions. Experimental studies are helpful to demonstrate that these compounds might interact with a major component of the neurotransmission, the gamma aminobutyric acid (GABA) receptor complex. Structure-toxicity relationships can be described. For the clinician, the recognition of some predisposing factors related either to the patient (age, previous central nervous system disorder ...) or to the drug metabolism (reduced renal clearance, drug interactions ...) may help to minimise the risk of adverse neurologic manifestations. Several factors have to be taken into account before assessing causality: delay from administration, evolution, origin of the adverse event (risk factors, other drugs, non pharmacological origin), possibility of rechallenge, confirmation by biological testing or in vitro experiments....

Anti-Bacterial Agents↗
PubMed1999

Brain death diagnosis in misleading conditions.

The necessity of defining brain death (BD) arose from technological development in medical science. The definition of this concept had practical consequences and opened the way to organ donation from BD patients. Nowadays, the imbalance between the number of organs available for transplantation and the size of the demand is becoming critical. In most laboratories, a BD diagnosis is made according to precise criteria and in a well-defined process. BD diagnosis should be improved, not only to assure the safety and to preserve the human dignity of the patient, but also in order to increase the rate of organ donation. By analysing some epidemiological parameters in BD diagnosis and organ donation, it appears that BD diagnoses can be made more often and more rapidly if one has a reliable, accurate, and safe confirmatory test, especially under misleading conditions (hypothermia, drugs, metabolic disturbances). In our experience, the use of multimodality evoked potentials (MEPs) to confirm a BD diagnosis has many advantages: MEPs can be rapidly performed at the patient's bedside, assess the brain stem as well as the cerebral cortex, and are innocuous for the patient. Moreover, their insensitivity to the aforementioned misleading factors is sufficient to distinguish BD from clinical and EEG states that mimic BD. They give an immediate diagnosis, and no delay is required in BD confirmation if there is sufficient cause to account for BD. MEPs are a safe, accurate, and reliable tool for confirming a BD diagnosis, and their use can improve the organ donation rate while preserving the safety of the patient.

Brain Death↗
PubMed1999

Evoked potentials investigation of visual dysfunction after methanol poisoning.

OBJECTIVE: To present results of electrophysiologic investigations of the visual toxicity observed during the early stage of methanol poisoning. DESIGN: Retrospective, clinical study. SETTING: A 7-bed intensive care unit in a university hospital. PATIENTS: Nineteen patients admitted with a diagnosis of acute methanol poisoning. INTERVENTIONS: Visual evoked potentials were obtained within the first 48 hrs after admission; a clinical follow-up examination was performed in 11 patients, and 12 patients were followed up by visual evoked potentials beyond the same delay. Correlations between the occurrence of an optic neuropathy and clinical, biological, and electrophysiological data were studied. MEASUREMENTS AND MAIN RESULTS: A significant correlation was found between arterial pH and blood formate concentration (r2 = 0.58, p = .003), between blood formate and bicarbonate concentrations (r2 = 0.36, p = .02), and between delay from ingestion and blood formate concentration (r2 = 0.44, p = .017). Clinical outcome was correlated not only with the bicarbonate (p = .007), formate (p = .018), and methanol (p = .03) concentrations and arterial pH (p = .004) but also with a well-defined electrophysiologic pattern during the acute stage. An index of global cortical functioning > or =3 was associated with death, whereas a global cortical functioning index < or =2 was associated with survival (p = .0058). Moreover, a statistically significant difference in long-term visual impairment was found between the subgroup with abnormal wave III morphology or a global cortical functioning index of 1-2 and the subgroup with normal wave III morphology and a global cortical functioning index <1 (p = .015). Results of the electrophysiologic studies were expressed as retinal dysfunction and optic nerve injury. Five patients had normal findings on electrophysiologic examination. Ten patients had early signs of retinal dysfunction that were fully reversed in the eight patients who were followed. Ten patients had persistent electrophysiologic signs of optic neuropathy. CONCLUSIONS: Although reversible retinal dysfunction is evident in the early stage of human methanol poisoning, its absence does not preclude development of optic neuropathy. The occurrence of optic neuropathy and early electrophysiologic data are correlated.

Acute Disease↗
PubMed1999

Successful double lung transplantation with a graft obtained from a methanol-poisoned donor.

A 25-year-old woman developed "brain death" 48 h after acute methanol poisoning. After the elimination of methanol and the correction of metabolic disorders, organ donation was discussed. The lungs were transplanted into a 46-year-old woman suffering from cystic "emphysematous-like" lesions as a complication of lymphangioleiomyomatosis. The procedure was not complicated, and we have an uneventful follow-up of > 12 months. In addition to the lungs, the kidneys and the liver were also removed and transplanted with success.

Acute Disease↗
PubMed1998

Ethylene glycol poisoning treated by intravenous 4-methylpyrazole.

A 19-year-old woman was admitted 45 min after ethylene glycol (EG) ingestion. The initial serum EG concentration was 1.34 g/l (21.6 mmol/l), the anion gap 14.5, and the osmolal gap 24. Renal function was preserved (serum creatinine 75.1 micromol/l). As the patient was seen soon after poisoning, before the development of metabolic acidosis, therapy with 4-methylpyrazole (4-MP) was proposed as an antidote. 4-MP was administered via the intravenous route (7 mg/kg as loading dose, followed by 3.6, 1.2, 0.6, and 0.6 mg/kg at intervals of 12 h). 4-MP alone was effective in preventing EG biotransformation to toxic metabolites (absence of metabolic acidosis and renal injury). Ethanol therapy, hemodialysis, and sodium bicarbonate administration were not required. The half-life of EG during 4-MP therapy was 11 h, with a mean EG renal clearance of 26.9 ml/min, and a total of 65.3 g EG was eliminated unchanged in the urine. 4-MP therapy was also well tolerated.

Acid-Base Equilibrium↗
PubMed1998

Effect of enteral versus parenteral feeding on hepatic blood flow and steady state propofol pharmacokinetics in ICU patients.

OBJECTIVE: The main objective of this study was to evaluate the effect of switching from parenteral to enteral feeding on liver blood flow and propofol steady-state blood concentrations in patients in the intensive care unit (ICU). DESIGN AND PATIENTS: Steady-state blood concentrations of propofol were measured in eight ICU patients before (on days D -3, D -2, and D -1) and after (on days D + 1, D + 2, and D + 3) switching from parenteral to enteral feeding (on day DO). All patients received a continuous intravenous infusion of propofol (4.5 mg x kg(-1) x h(-1)) from several days before the start of the study, continuing throughout the experimental period. Hepatic blood flow was estimated by measuring steady-state D-sorbitol hepatic clearance. RESULTS: Hepatic blood flow was high and was not affected by switching from parenteral to enteral feeding: 33 +/- 8 ml x min(-1) x kg(-1) (mean +/- SD) and 33 +/- 10 ml min(-1) x kg(-1) on D -3 and D -1, respectively, as compared to 37 +/- 11 ml x min(-1) kg(-1) and 34 +/- 8 ml x min(-1) x kg(-1) on days D + 1 and D + 3, respectively. Systemic clearance of propofol was much higher than liver blood flow with average values on the six observation days ranging from 74.0 to 81.2 ml x min(-1) x kg(-1) and was not affected by switching from parenteral to enteral feeding. CONCLUSIONS: Liver blood flow and systemic clearance of propofol were not affected by switching from parenteral to enteral feeding in the eight ICU patients studied. Extrahepatic clearance accounted for at least two thirds of the overall systemic clearance of propofol.

Adult↗
PubMed1998

Tumour necrosis factor (TNF) gene polymorphism influences TNF-alpha production in lipopolysaccharide (LPS)-stimulated whole blood cell culture in healthy humans.

TNF-alpha is involved in infectious and immuno-inflammatory diseases. Different individuals may have different capacities for TNF-alpha production. This might determine a predisposition to develop some complications or phenotypes of these diseases. The aims of our study were to assess the inter-individual variability of TNF-alpha production and to correlate this variability to a single base pair polymorphism located at position -308 in TNF gene. We studied 62 healthy individuals. TNF-alpha production after LPS stimulation was evaluated using a whole blood cell culture model. The TNF gene polymorphism was studied by an allele-specific polymerase chain reaction. Other cytokines produced in the culture, soluble CD14 concentrations and expression of CD14 on blood cells were also measured. Among the 62 individuals, 57 were successfully genotyped. There were 41 TNF1 homozygotes and 16 TNF1/TNF2 heterozygotes. TNF-alpha production after LPS stimulation of whole blood cell culture was higher among TNF2 carriers than among TNFI homozygotes (929pg/ml (480-1473pg/ml) versus 521 pg/ ml (178-1307 pg/ml); P<0.05). This difference was even more significant after correction of TNF-alpha production for CD14 expression on blood cells. In conclusion, the single base pair polymorphism at position -308 in the TNF gene may influence TNF-alpha production in healthy individuals.

Adult↗
PubMed1998

Immunological status of competitive football players during the training season.

We investigated possible immunological changes in 15 professional football players before, during and after the sports season. We studied the leucocyte count as well as different functions such as T-lymphocyte proliferation, NK activity, chemotaxis and phagocytosis of neutrophils. Training and competitions did not produce any change in the total number of leucocytes but increased neutrophil counts and decreased T4 lymphocyte counts. We also observed a slight decrease of T-lymphocyte proliferation and a significant decrease of neutrophil functions. On the other hand, training and competitions did not induce significant changes in the number of NK cells nor in the total NK cytotoxic activity. The different change observed tended to normalize after the sports season. Our results suggest a predominant neutrophil function depression in football players during a training season which could partly explain the susceptibility of elite athletes to infections.

Analysis of Variance↗
PubMed1998

[Clinical case of the month. Hepatoportal sclerosis in a patient treated with azathioprine].

We report a case of hepatoportal sclerosis in a renal transplant patient treated with azathioprine. The initial symptom was ascites. On the biochemical level, there were cholestasis without cytolysis or hepatocellular insufficiency. A presinusoidal portal hypertension was found on haemodynamic studies, without portal thrombosis at CT-scan. A diagnosis of hepatoportal sclerosis was evoked on histology and attributed to azathioprine. This case gives an illustration of a classical albeit rare complication of azathioprine. The indolent pattern of the disease and the risk of variceal bleeding point out the need for a hepatic follow-up during the treatment.

Adult↗