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Biomedical subjects

R Denis

Publications and source records attributed to R Denis.

At least 55 records · Page 3Linked to original sources
PubMed1983

Impaired renal concentrating ability during resuscitation from shock.

Renal concentrating ability was tested in 20 severely injured patients who received an average of 21 blood transfusions. Timed measurements were made of urine output (UO), and the clearance of creatinine glomerular filtration rate (GFR), sodium (CNa), osmols (COsm), and free water (CH2O) during operation and were repeated at 12 and 18 hours postoperatively, and on postoperative days 2 and 4. During operation the GFR was markedly reduced (36 mL/min), while UO, CNa, and COsm were all markedly increased (8.5, 5.9, and 8.1 mL/min, respectively). The CH2O was positive (0.4 mL/min). Following operation the rate of renal excretion of water and solutes was still high: UO, 4.0 mL/min; CNa, 4.3 mL/min; and COsm, 6.0 mL/min. Five hours postoperatively the CH2O had returned to normal. By day 2 the excretion rate of water had returned closer to normal: UO, 2.1 mL/min; CNa, 2.6 mL/min; COsm, 4.0 mL/min; the CH2O was normal. Subsequent study results were normal. These data demonstrate a renal concentrating impairment during and following operation. An osmotic diuresis, transient tubular ischemia, a washout of interstitial inner medullary osmoles, or some cryptic factor may be causative.

Glomerular Filtration Rate↗
PubMed1983

Effect of albumin resuscitation on canine coagulation activity and content.

Prior work showed that albumin resuscitation in man leads to decreased coagulation activity and coagulation protein content. These observations were tested in 20 splenectomized dogs shocked by control hemorrhage and resuscitated with the sequential infusion of: (1) 20 ml/kg balanced electrolyte solution (BES) or 5% albumin/BES; (2) shed blood; (3) 30 ml/kg BES or 5% albumin/BES; (4) 250 ml blood stored from the time of splenectomy. Either BES or 5% albumin/BES was given for the next 3 days. Coagulation activity (fibrinogen, plasminogen, factor VIII, and prothrombin) and coagulation protein content (factor VIII by specific canine antigen) were measured preshock, post resuscitation, and daily for 3 days. Albumin resuscitation significantly (p = greater than 0.05) reduced coagulation activity of fibrinogen (423 +/- 145 vs. 274 +/- 80 mg/dl SD), factor VIII:C (64 +/- 24 vs 42 +/- 16% SD), prothrombin (195 +/- 44 vs. 141 +/- 22% SD) but did not alter CPC of factor VIII:RAg (142 +/- 83 vs. 156 +/- 141% SD). Lower coagulation activity after 5% albumin/BES resuscitation in conjunction with no change in factor VIII:RAg content which is produced by the vascular endothelium suggest that impaired hepatic synthesis may lead to the reduced coagulation activity after albumin resuscitation.

Albumins↗
PubMed1983

Changing trends with abdominal injury in seatbelt wearers.

Seatbelts were incorporated as standard equipment for automobiles constructed in North America in 1964. The first seatbelt law was made mandatory in Canada as of 1 January 1971. Between January 1976 and January 1980 38 patients involved in automobile accidents while wearing passive restraints were treated at l'Hôpital du Sacré-Coeur: 32 of these 38 patients had signs and symptoms of abdominal injury. These patients wearing passive restraints had an unusually high incidence of gastrointestinal injury in comparison to previously reported patients not wearing restraints. Twenty-seven of the 32 patients had injury to the bowel or the bowel mesentery. This different spectrum of injuries is most likely related to the altered physics of rapid deceleration caused by restraint with the lap belt and shoulder harness.

Abdominal Injuries↗
PubMed1983

Role of Roux-en-Y feeding jejunostomy for patients with acute head injury.

The total care of a patient with severe head injury is challenging and may extend for weeks, months, or even years. A major challenge of this care includes nutritional support: swallowing is impaired, aspiration accompanies gastric tube feeding, parenteral nutrition is limited to short term in hospital care, and needle jejunostomy or transabdominal jejunostomy are prone to inadvertent removal. The role of Roux-en-Y feeding jejunostomy was evaluated in 13 patients with acute head injury. Procedure related complications include prolapse of the ostomy (1 patient) and stoma-ischemia requiring revision (1 patient). The effect of ostomy tube feedings on gastric acid secretions was studied in five patients, and no significant change was noted when saline feeding was compared to blenderized diet feeding. Blenderized diet feedings were advanced gradually, and antidiarrheals were added as needed once gastrointestinal function returned. In conclusion, Roux-en-Y feeding jejunostomy provides an attractive, safe method for long-term enteral nutrition in the head injury patient. Easy replacement of the feeding tube facilitates nursing care, and the threat of acid-induced stress gastric bleeding is not enhanced.

Adult↗
PubMed1983

Effect of end-expiratory pressure on total oxygen dynamics.

The role of altered end-expiratory pressure on total oxygen dynamics was studied prospectively in 18 patients with injuries and sepsis. Eight patients received high tidal volumes (12 to 18 ml/kg), continuous positive airway pressure, and intermittent mandatory ventilation (CPAP/IMV); 10 patients received low tidal volumes (8 to 10 ml/kg) with zero end-expiratory pressure and assist control mode of ventilation (ZEEP/A-CM). CPAP/IMV patients had better oxygen tension, reduced physiologic shunting in the lung (24% versus 18%), and an improved arterial tension: inspired oxygen concentration ratio. CPAP/IMV patients also had significantly higher central filling pressures that were associated with significant reductions in cardiac output (8.2 L/min versus 6.4 L/min). The reduced cardiac output appeared to be a result of a reduction in left ventricular stroke work index. Consequently, the total oxygen delivery was reduced for all 3 days following insult and for the cumulative data for all 3 days (266 versus 306 ml/min) in the CPAP/IMV patients. Oxygen consumption was also reduced in the CPAP/IMV patients; this reduction was not significant for each of the first 3 days but was significant when the data for the 3 days were added to the analysis (306 versus 272 ml/min). Future prospective randomized studies are needed to determine the most effective use of ventilatory support on total oxygen dynamics including oxygen delivery and oxygen consumption.

Adult↗
PubMed1980

Obituary.

Explore the source record for details and available documents.

Anesthesiology↗
PubMed1978

A simple method for measuring separate glomerular filtration rate using a single injection of 99mTc-DTPA and the scintillation camera.

A new technique for measuring glomerular filtration in each kidney has been developed using a scintillation camera and the 99mTc-DTPA complex. The technique has been applied to 101 children with various uropathies. Correlations with the total and separate creatinine clearance, the HgCl2 uptake test, and the maximal urinary concentration have been good. The reproducibility of the method has been satisfactory in a small number of patients. The test is particularly adapted to children because of its simplicity, reduced trauma, short duration (20 minutes) and low-radiation dose. In contrast to some other radioisotope techniques, it can be carried out in infants.

Adolescent↗
PubMed1975

Physiological changes associated with unilateral pulmonary ventilation during operations on the lung.

No important changes in the respiratory parameters were observed during one-lung anaesthesia. However, this kind of thoracic intervention can be accompanied by a dramatic fall in arterial oxygen tension. Methods to avoid tissue hypoxia have been described. In our series no complications whatever occurred in the operative and post-operative periods which could be related to the oxygenation of the patient.

Adult↗