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Biomedical subjects

P Paris

Publications and source records attributed to P Paris.

At least 37 records · Page 2Linked to original sources
PubMed1991

A prehospital model of intraosseous infusion.

STUDY OBJECTIVE: Before the implementation of an intraosseous infusion protocol by the City of Pittsburgh paramedics, we undertook a study to compare the establishment of a simulated intraosseous infusion in three different prehospital settings. The purpose of this study was to determine the time to establish an intraosseous infusion and the success rate at the scene and en route to the hospital using this model. DESIGN: Prospective study. SETTING: Three prehospital scenarios: classroom (scene); a medic unit traveling at 25 mph and making slow, steady turns (turns); and a medic unit traveling at 30 to 35 mph with sudden stops and starts (stop and go). TYPE OF PARTICIPANTS: Paramedics and emergency medicine residents. MEASUREMENTS AND MAIN RESULTS: Successful placement of the IO needle was confirmed by the aspiration of marrow or the free flow of 5 to 10 mL of normal saline without extravasation into the surrounding tissue. The procedure was timed from skin entry to establishment of infusion. All participants were successful in establishing IO infusion, with 84.8% of infusions achieved in less than one minute in all settings. The scene had somewhat shorter mean and median times and a higher first-attempt success rate, but the differences between scenarios were not significant. CONCLUSION: Using a simulated model, IO access can be established successfully in the prehospital setting. The minimal time delay in establishing IO infusion may make it an appropriate technique for use at the scene or en route to the hospital.

Allied Health Personnel↗
PubMed1991

[Dumbbell-shaped nerve-tissue tumors of the posterior mediastinum. Apropos of 5 cases].

The authors present 5 cases of dumbbell neurogenic tumors with intraspinal extension. There were 4 neurilemmomas in four adults and 1 ganglioneuroma in one child. These tumors were benign. Neurological signs were observed in two cases. Widening of the intervertebral foramen at the level of the tumor is a very suggestive sign of dumbbell tumor confirmed by CT-Scan or MRI. Precise morphologic features must be assessed before embarking on the operation. The procedures used were: thoracotomy only in two cases, laminectomy then thoracotomy because of neurological signs in two cases, thoracotomy then laminectomy to fully remove tumor remnants in one case. No major morbidity was noted. The neurological symptoms resolved in two cases. A combined two-team approach with thoracic and neurosurgeons working together has not been used so far, but this possibility is probably the best choice for the future.

Adult↗
PubMed1991

[Dumbbell neurogenic tumors of the posterior mediastinum. Apropos of five cases].

The authors present 5 cases of dumbbell neurogenic tumors with intraspinal extension. There were 4 neurilemmomas in four adults and 1 ganglioneuroma in one child. These tumors were benign. Neurological signs were observed in two cases. Widening of the intervertebral foramen at the level of the tumor is a very suggestive sign of dumbbell tumor confirmed by CT-Scan or MRI. Precise morphologic features must be assessed before embarking on the operation. The procedures used were: thoracotomy only in two cases, laminectomy then thoracotomy because of neurological signs in two cases, thoracotomy then laminectomy to fully remove tumor remnants in one case. No major morbidity was noted. The neurological symptoms resolved in two cases. A combined two-team approach with thoracic and neurosurgeons working together has not been used so far, but this possibility is probably the best choice for the future.

Adult↗
PubMed1991

[One liver for 2 transplantation recipients. How to divide the portal pedicle?].

It is possible to obtain two hepatic transplants from a single cadaveric liver by separation or right and left livers or by separation of the right lobe from the left lobe medial to the umbilical cleft. We attempt to define the ideal basis of separation of the structures of the portal pedicle, based on anatomical study of 25 livers. One should ideally section the left portal vein, the right branch of the hepatic artery, the left hepatic duct. The segment I must be systematically resected, the segment IV must be resected after a separation of the right lobe from the left lobe. A cholangiogram and an arteriogram are indispensable prior to hepatic division.

Dissection↗
PubMed1990

Treatment of experimental liver metastases in the rat by continuous intraportal infusion of 5-fluorouracil and heparin: a pilot study.

Continuous portal venous infusion of 5-fluorouracil (5-FU) and/or heparin immediately following injection of tumor cells into the portal system in unrestrained rats has been assessed as a pilot study to examine whether the incidence of liver metastases could be reduced and survival therapy improved. Thirty-six rats were divided into four groups according to the treatment administered for 7 days by portal infusion: heparin, 5-FU, 5-FU + heparin and physiological saline solution as a control. After a 90-day follow-up, metastases were observed in every rat injected with tumor cells with the exception of one rat in the heparin group. The 90-day actuarial survival rates for the treatment groups of heparin, 5-FU, 5-FU + heparin and control were 44% (4/9), 11% (1/9), 33% (3/9) and 22% (2/9) respectively, with the survival curves not differing significantly. The apparently improved survival rate in the heparin group may be due to the insufficient period of observation. The conclusions of this study may be only preliminary owing to both the insufficient period of observation and the small number of rats, but the inhibitory effect of 5-FU on the development of liver metastases was disappointing as a result of the large number of tumor cells injected into the portal system. The technique used in this study, which enabled continuous portal venous infusion of drugs to be performed in unrestrained rats, may provide a useful model for the study of continuous infusion in the rat.

Adenocarcinoma↗
PubMed1990

Intestinal dysmotility syndromes in the elderly: measurement of orocecal transit time.

Altered bowel habits are common symptoms in the elderly, yet the pathophysiology of age-related gastrointestinal dysmotility syndromes is poorly understood. The present study was designed to correlate changes in orocecal transit time (TT) in healthy elderly subjects with or without gastrointestinal dysmotility complaints. Twenty-two geriatric facility resident volunteers, mean age 82 yr (range 65-94 yr) participated, of whom 16 had gastrointestinal dysmotility symptoms. Orocecal TT in the elderly subjects did not differ from that in younger adult controls (100 +/- 11 min vs 93 +/- 20 min). However, orocecal TT was longer in geriatric females (112 +/- 14 min) than in males (70 +/- 6 min, p less than 0.01). We conclude that age alone does not prolong orocecal TT, except when dysmotility symptoms have been present for a prolonged period.

Aged↗
PubMed1990

[Pulmonary metastasis with left intra-atrial extension of liposarcoma. Apropos of a case].

The direct extension of a neoplastic thrombus of the pulmonary veins into the left atrium is extremely rare. The authors report the case of a pulmonary metastasis from a liposarcoma of the thigh extending into the pulmonary veins and prolapsing into the left atrium. The patient was successfully treated by tumorectomy under cardiopulmonary bypass then by left upper lobectomy.

Adult↗
PubMed1988

Critical cardiac transport: air versus ground?

The helicopter transport of acute cardiac patients has become increasingly common, although no study has examined solely the effect of such transport on outcome in this subset of patients. A combined air and ground critical care transport service provided the opportunity for a direct comparison of patients with acute cardiac conditions (myocardial infarction or unstable angina) transported either by our helicopter or by a specially equipped critical care ground vehicle. Both air and ground components were similarly equipped in terms of personnel and medical equipment. Seventy-eight (27 ground, 51 air) transport cases were studied. Both patient groups were comparable in terms of age, sex, Killip classification, and diagnosis. Serious untoward events, defined as arrhythmias, chest pain, hypotension, bradycardia, seizures, and cardiac arrest, occurred in 41% of air transports and 7.5% of ground transports (P less than .002). The overall incidence of untoward events was also significantly greater with air transports (25/51, or 49%) than with the ground vehicle (4/27, or 15%; P less than .005). The reasons for these differences are unknown.

Aged↗
PubMed1987

Acute epidural abscess.

Acute epidural abscess is a neurosurgical emergency requiring prompt diagnosis and treatment. The devastating consequences of delayed or missed diagnosis require consideration of acute epidural abscess in the differential diagnosis of back pain. Knowledge of the natural history and presentation of this disease will allow its early recognition and minimize the morbidity and mortality resulting from misdiagnosis. We present a case of advanced pneumococcal epidural abscess complicated by pneumococcal meningitis and review the literature on this subject.

Abscess↗
PubMed1983

Continuous intravenous administration of drugs.

Continuous intravenous administration of drugs may be a problem in clinical practice; for several reasons patients do not always receive the dose of drug intended for them. Problems of parenteral fluid composition are related to the solvent, dilution and drug interactions. Physical factors influencing drug stability are light and adsorption onto perfusion sets. Examples are reported for each problem. A practical solution, based on personal experimentation, is proposed for diazepam and nitroglycerin administration.

Adsorption↗