Search PubMed⌕ Search

Biomedical subjects

Y Malledant

Publications and source records attributed to Y Malledant.

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

[Hypothermia helps in the drowned child. Report of a case].

Near-drowning is a leading cause of childhood mortality. Early induction of deep hypothermia has a protective effect on the brain, however. Favorable factors, most marked in early childhood, are both anatomic and physiologic. No parameter capable of predicting good neurologic recovery was identified by a review of the literature. Management rests on internal warming techniques and should be initiated immediately whenever apparent death occurs after exposure to cold. The case of a 29-month-old child who had complete cardiorespiratory arrest and a fall in body temperature to 22 degrees C after near-drowning and who made a full neurologic recovery is reported.

Body Temperature↗
PubMed1990

[Effects of propofol on intraocular pressure in surgery of strabismus in children].

Propofol was assessed for eye surgery in 20 children. ASA group I or II, 2-14 year-old, randomly assigned to 2 equal groups. Premedication, analgesia and muscle paralysis were similar in both groups. Group P patients were given an induction dose of 4 mg.kg-1 propofol, followed by an infusion of 15 mg.kg-1.h-1 for the first half hour, and then 10 mg.kg-1.h-1 to maintain anaesthesia. Group C patients were given 10 mg.kg-1 thiopentone for induction and halothane for maintenance. The quality of anaesthesia was assessed by monitoring adverse effects, heart rate, blood pressure, the length of anaesthesia, the delay of the first spontaneous breath and eye opening, and extubation. Intraocular pressure was measured before and 3 min after intubation, and 5 min after extubation. The quality of anaesthetic induction and maintenance were very similar in both groups. Pain occurred more frequently at the injection site with propofol (p less than 0.01). Children in group P recovered more quickly, and extubation was possible much earlier in this group (p less than 0.05). However, restlessness was significantly more frequent in group P (n = 9) than in group C (n = 1) (p less than 0.01). Systolic, diastolic blood pressure and heart rate were significantly lower in group P (p less than 0.05; 0.001; 0.001 respectively). No significant decrease in intraocular pressure in both groups was observed. The use of propofol for eye surgery in children is acceptable, despite some restlessness during recovery.

Adolescent↗
PubMed1989

[Digestive stress hemorrhage. Physiopathology and prevention].

Lesions of the gastroduodenal mucosa are seen very early on in virtually 100% of patients suffering from organ failure. Bleeding, even if it is only occult, defines acute stress-induced gastrointestinal tract bleeding (SGIB). The rates of SGIB vary according to the inclusion criteria: 13 to 100% microscopic SGIB, 2.3 to 9.5% haemorrhage with blood transfusion and/or shock. Gastrointestinal bleeding does not really influence the death rate of patients with SGIB (0 to 5% increase). Damage to the gastric mucosa may be due to an intraluminal aggression, and/or decreased mucosal and mural defence mechanisms. H+ ions and bile salts are mostly responsible for the former. Physiological quantities of H+ ions may be sufficient, as their abnormal diffusion into the gastric mucosa will reduce the mucosal pH (pHm), which is itself sensitive to microcirculatory modifications and systemic acidosis. There is a good correlation between bleeding and pHm. Bile salts are involved because of the usual increase in frequency and volume of gastric biliary reflux due to stress. Surfactant, mucosal alkaline layer and the microcirculation are all involved in gastric protection. The PGE2 synthetized by the gastric mucosa have a favourable influence on these 3 mechanisms. Changes in microcirculation and hypoxia are the predominant factors involved in stress-induced mucosal damage. The prevention of SGIB relies on the treatment of risk factors, a reduction of intraluminal aggression, and the support and/or stimulation of gastric defence mechanisms. Antacids and anti-H2 drugs aim to neutralize most of the H+ ions, being more efficient than placebo in increasing gastric pH greater than 4, although anti-H2 agents are responsible of a greater number of failures. The non-homogenous character of the patient groups studied and the diagnostic methods, as well as the increasing lack of placebo groups in the published studies make the interpretation of the results rather risky. Antacids and anti-H2 drugs are more efficient than placebo, and equally efficient, in preventing overt SGIB. Efficiency is increased by giving anti-H2 drugs continuously, and antacids hourly. Other agents are thought to protect mucosal cells, probably increasing mucosal defences. Amongst them are the prostaglandins, the most interesting of which are still being investigated, and sucralfate. The latter molecule is as efficient as antacids and anti-H2 drugs, and does not alter gastric pH, so reducing the number of nosocomial pneumonias. Its reduced cost and easy administration make it, at the present time, the treatment of choice of SGIB. The few rare contraindications of sucralfate will justify the infusion of anti-H2 drugs in those patients at risk.

Anti-Ulcer Agents↗
PubMed1989

[Comparative study of the administration of amikacin by intramuscular and intravenous routes in neonatal resuscitation].

A study was carried out to determine amikacin blood levels in 44 neonates who were admitted to a Pediatric Intensive Care Unit. Amikacin was administered by intravenous or intramuscular route. The levels obtained with both methods were similar. The results of our study indicate that amikacin levels should be monitored in neonates to avoid toxic concentrations of this drug. On the basis of this study a new neonatal dosage schedule is proposed.

Amikacin↗
PubMed1989

[2 cases of the HELLP (Hemolysis Elevated Liver Low Platelet) syndrome].

Recently described by Weinstein, the "HELLP syndrome" is an entity of the pre-toxemic syndrome; its precise physiopathological mechanism, related to a thrombotic micro-angiopathy, is still not clearly established. Therefore, the treatment remains symptomatic, associated with the treatment of the toxemia. Two cases occurring in twin pregnancies are reported.

Adult↗
PubMed1988

[Value of the renal graft as a function of blood creatinine of the donors].

In a series of 851 renal transplantations, the fate of the grafted kidneys was studied in relation to the donors' renal function. The actuarial survival curves of the grafts showed no significant difference at 24 months between donors with blood creatinine levels below or above 150 mumol.l-1. Seventy-five of the 99 kidneys obtained from donors with high blood creatinine were functioning at 2 years. It would appear that the classical doubts about renal procurement from donors with high blood creatinine levels should be reconsidered.

Adolescent↗
PubMed1988

[Spontaneous rupture of an adenoma of the liver during pregnancy].

Must often reporting to an hepatic subcapsular hemorrhage with pre or true eclampsia, Spontaneous rupture of adenoma of the liver during pregnancy is unusual entity. Very exceptionally cases of rupture of anatomic hepatic lesion underlying had been reported. About a new case, diagnosis, physiopathologic and management problems are approached.

Adenoma↗
PubMed1987

[Prolonged intravenous infusion of morphine. Pharmacokinetic study].

Critically ill patients require optimal pain control without undesirable side-effects. Continuous intravenous morphine infusion is often chosen instead of the conventional intermittent administration. In the present study, the pharmacokinetic characteristics of morphine were studied in five subjects receiving a constant rate intravenous infusion with the attainment of a steady state. The plasma levels were compared with values derived from bolus intravenous administration in five other patients. The concentrations of unchanged morphine were determined in serum using high performance liquid chromatography with an electrochemical detector. The decay of plasma concentrations after a single dose fitted a triexponential function consistent with a three compartment pharmacokinetic model. Postinfusion plasma concentrations fitted a two compartment model. Derived values (mean +/- SEM) of total body clearance were significantly different between groups (p less than 0.05), while mean values of terminal elimination half-life (t 1/2 Kel) were similar. It was concluded that values of total distribution volume were significantly different. The extent of morphine distribution varied more than twofold between the two groups of patients. This was interpreted as a consequence of an important underestimation in the extent of distribution tissues after administration of a single dose.

Adult↗
PubMed1986

[Repair of a suprahepaticocaval injury under extracorporeal circulation].

The case of a 29-year old man who presented with haemorrhage from hepatic veins and the retrohepatic vena cava is reported. On the belief that a conventional technique would be dangerous, total extracorporeal circulation was used as a supportive procedure. The method facilitated anatomic definition of the venous injuries. The repair could then be calmly and precisely carried out because of a practically bloodless operative field. The procedure was well tolerated and the postoperative course was uneventful; the patient was discharged 15 days later. Many surgical techniques have been described for the repair of traumatic injuries of the inferior vena cava and hepatic veins, but all with a high level of peroperative mortality. So, cardiopulmonary bypass and hypothermia seemed to be a useful procedure. However, some points need further consideration: heparin administration may promote bleeding from other lesions and, in the case of associated gastrointestinal injuries, the risk of major septic dissemination is great.

Adult↗
PubMed1986

[Spontaneous rupture of the esophagus].

Eighteen patients (16 men and two women), aged 20 to 77 years, were admitted to the University hospital between 1973 and 1984 for a Boerhaave's syndrome. Fourteen over eighteen were more than forty years old. Other particular features were the frequency of alcoholism (11 patients) and the lack of preexisting gastrointestinal symptomatology. The cardinal symptom, pain, occurred in 17 cases. It was preceded in 10 subjects by vomiting. Subcutaneous emphysema was only found in five patients, but standard chest X-ray showed seven times a pneumomediastinum. Pleural effusion was present in 14 subjects. Thirteen patients underwent thoracotomy: five within 48 h (1 death) and eight after 48 h (4 deaths); two further deaths were due to withholding surgery, and a third by performing bipolar oesophageal exclusion at a late stage (8th day); six of these deaths were related to local infection. The clinical and radiological features of Boerhaave's syndrome are presented in a review of the literature; particular attention is paid to the various methods of treatment.

Adult↗