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88a177d4-d1a5-47c0-acb9-c61a890ac4cc
| 0 |
Maintenance antipsychotic therapy: is the cure worse than the disease? The serious long-term complications of maintenance antipsychotic therapy led the authors to undertake a critical review of outpatient withdrawal studies. Key findings included the following: 1) for a least 40% of outpatient schizophrenics, drugs seem to be essential for survival in the community;
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88a177d4-d1a5-47c0-acb9-c61a890ac4cc
| 1 |
2) the majority of patients who relapse after drug withdrawal recompensate fairly rapidly upon reinstitution of antipsychotic drug therapy; 3) placebo survivors seem to function as well as drug survivors--thus the benefit of maintenance drug therapy appears to be prevention of relapse; and 4) some cases of early relapse after drug withdrawal may be due to dyskinesia rather than psychotic decompensation.
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88a177d4-d1a5-47c0-acb9-c61a890ac4cc
| 2 |
The authors urge clinicians to evaluate each patient on maintenance antipsychotic therapy in terms of feasibility of drug withdrawal and offer practical guidelines for withdrawal and subsequent management.
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9523b5a3-9ac7-4f5a-94cb-173512b4c3df
| 0 |
Task delegation to physician extenders--some comparisons. This study uses a task delegation questionnaire to compare 1973 physician extender practices in seven primary care-oriented sites with a physician attitude survey made in 1969. One additional site using no physician extenders was included as a control. The study involves both major types of physician extenders (physician assistants and nurse practitioners) in ambulatory practices with at least one year of experience in using such personnel.
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9523b5a3-9ac7-4f5a-94cb-173512b4c3df
| 1 |
With minor exceptions, actual task delegation patterns conform with the 1969 attitudes of physicians as to which tasks "could and should" be delegated to physician extenders.
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974220d0-284a-4871-afcd-f11186dac14a
| 0 |
Chest roentgenography as a window to the diagnosis of Takayasu's arteritis. The chest roentgenographic findings in Takayasu's arteritis include widening of the ascending aorta, contour irregularities of the descending aorta, arotic calcifications, pulmonary arterial changes, rib notching, and hilar lymphadenopathy. The single most important diagnostic sign is a segmental calcification outlining a localized or diffuse narrowing of the aorta. The other signs may be suspicious or suggestive, but the diagnostic accuracy increases when several findings are present simultaneously.
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1e445aee-01f7-41ed-a31d-11a20bd8ded4
| 0 |
Evaluation of the Nissen antireflux procedure by esophageal manometry and twenty-four hour pH monitoring. Fifteen normal volunteers without symptoms of gastroesophageal reflux and sixteen patients with symptoms of gastroesophageal reflux unresponsive to medical management and having endoscopic esophagitis had esophageal manometry and twenty-four hour pH monitoring of the distal esophagus. The symptomatic patients underwent a Nissen antireflux procedure and were restudied at four months. After surgery, patients had less reflux, a higher sphincteric pressure, and an equal amount of sphincter within the abdomen as did asymptomatic control subjects.
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4de90b10-fb1a-4488-a062-d62f323718a8
| 0 |
[Plasma renin activity and plasma aldosterone during anaesthesia and operative stress and beta-adrenergic blockade (author's transl)]. In 21 patients undergoing ear operations associated with minimal bleeding plasma renin activity and plasma aldosterone concentration were studied before and during surgical procedure, and in the postoperative state.
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4de90b10-fb1a-4488-a062-d62f323718a8
| 1 |
Studies were performed in two groups, one without (n=9) and one with beta-adrenergic blockade by Practolol (n=12). Plasma renin activity increased significantly during halothane anaesthesia alone whereas the surgical manipulations did not further influence mean values significantly. Thus, it seems to be established that anaesthesia per se influences renin secretion.
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4de90b10-fb1a-4488-a062-d62f323718a8
| 2 |
On the other hand Practolol does not show an inhibiting effect. The plasma renin increase following anaesthesia is due to the hemodynamic including renal hemodynamic, changes as well as to activation of the sympatho-adrenal system. Changes in plasma aldosterone are variable. For the greater part of patients with beta-adrenergic blockade an increase during the operative procedure was found.
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4de90b10-fb1a-4488-a062-d62f323718a8
| 3 |
However, in some patients especially in the control group, plasma aldosterone was unchanged or decreased in spite of increasing renin values. Significantly lower plasma potassium concentration in these cases seems to indicate the important contributing role of potassium for the short-term regulation of aldosterone secretion. Plasma sodium concentration remained unchanged for the periods studied.
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7a7a18ca-0e5d-4703-94b9-6252e64afc07
| 0 |
[Surgical criteria for reoperation in abdominal surgery]. Analysis of the surgical criteria for reintervention in Abdominal Surgery led to the accentuation of a certain number of pictures of occlusion, general infectious syndromes, postoperative peritonitis, gastro-intestinal fistula and hemorrhagic syndrome. In all cases, the clinical examination can be misleading in particular in the case of peritonitis, and the history and non-surgical criteria must be strongly borne in mind.
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a207cc6c-e0c6-46ee-9d8f-a6fc8db01ff2
| 0 |
[Nephrologic criteria for reoperation (in the framework of abdominal surgery)]. 38 cases of abdominal surgery in acute renal failure, checked anatomically by reintervention or autopsy, were analyzed. The authors emphasize the frequency of the state of shock (2/3 of the cases) and the misleading nature of local signs. They stress the value of routinely checking creatinine clearance in the preoperative check-up in order to screen for latent renal failure.
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ba7faee0-b5a6-42e9-a074-97f274dafd73
| 0 |
[Criteria for reoperation in abdominal surgery (exclusive of surgical and nephrological criteria)]. In summary, 40 p. 100 of 104 reinterventions carried out in 71 patients from the Resuscitation sector were decided upon in the absence of surgical and nephrological criteria. The authors emphasize the value of the infectious syndrome (74 p. 100 of the cases), of water and electrolyte disorders (60 p. 100 of the cases), and of hypercatabolism (83 p. 100 of the cases).
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ad42643d-7705-4d66-9577-1b2556e1be13
| 0 |
[Preparation of the patient for reoperation]. The preparation of patients for reintervention should aim at the correction of: - states of shock and collapse, found in one out of three patients; - hydroelectrolytic disturbances (sodium depletion, hypochloremia, dyskaliemia); - and finally, re-establishment of the acid-base balance.
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ea96dc43-9475-4cb0-8ad1-e89b854f0a5e
| 0 |
[Anesthesia in reoperations in abdominal surgery]. Fifty one patients from different surgical units, hence anesthetized by different anaesthesists, underwent reinterventions in abdominal surgery. The indications for the first intervention essentially involved the supra-mesocolic region of the abdomen (62 out of 100 cases). The operative risk during the first intervention was on the average 18 pour cent.
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ea96dc43-9475-4cb0-8ad1-e89b854f0a5e
| 1 |
The protocol of the first anaesthesia which was known in 42 cases, was of the narco-ataralgestic type. The date of the return to the operation table varied from 1 to 60 days. The state of the patients was in general catastrophic (organic renal failure, acute respiratory failure).
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ea96dc43-9475-4cb0-8ad1-e89b854f0a5e
| 2 |
Here again the anaesthesia was of the narco-ataralgesic type but the choice of drugs varied depending on the patients' state. However non significant difference was noted in the average hourly drug consumption between the two interventions. Apart from one circulatory arrest during induction, in one patient with hemorrhagic shock, no death was attributable to the anesthetic technique.
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ea96dc43-9475-4cb0-8ad1-e89b854f0a5e
| 3 |
The authors, using these findings, attempt to pick out a practical line of behaviour.
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60bb383b-a296-46bc-b526-824a55fa4975
| 0 |
[Peroperative resuscitation in abdominal reoperations]. Resuscitation of these patients during operation is the only the logical continuation of their preparation. The authors therefore take up the preceding points while emphasizing: - checking vascular filling, by central venous pressure and hourly diuresis; - the necessity for a supply of carbohydrates, which is even more indispensable when the subjects were submitted to parenteral hyperalimentation previously; - the advantages of performing arterial blood gases in order to check artificial ventilation.
|
d7b655b5-1c2d-48f9-b7e3-1f3684cb45f9
| 0 |
[The surgical period]. Reinterventions demand adaptation of the anaesthesia to each particular case. Abdominal exploration and peritoneal toilet are the preliminaries of the surgical act. Continuous confrontation of anesthetic problems with surgical difficulties guarantee effective surgery.
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b8aadd8e-bfa3-485d-b293-881a56a2ee5a
| 0 |
[Respiratory problems following repeated abdominal surgery]. The authors analyzed a series of 100 patients who had undergone a total of 143 reinterventions and found respiratory manifestations in 86 cases. They emphasized the frequency of functional respiratory failure and studied the course of different clinical, radiological and laboratory parameters. The second part is concerned with the physiopathological mechanisms, recalling the main causes of postoperative hypoxemia. Finally the therapeutic chapter is centered on the chronology and modalities of artificial ventilation.
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ca1809cd-dc75-4a0d-ac93-dc19a54b05df
| 0 |
[Infectious problems in reoperations in abdominal surgery. Apropos of 104 operations]. Analysis of the problems with infection in a series of 104 reinterventions, enables one to accentuate the importance of infestation from intraperitoneal foci (70 p. 100 of the cases). Extra-peritoneal entry pathways are difficult to prove. Septicemia is found in one out of every three cases. In certain cases, preventive treatment of the extra-peritoneal entry pathways must be opposed to the effectiveness of the surgical act in the eradication of septic foci.
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a34ce3b8-ba3e-4dc5-8d03-f17bfa371da7
| 0 |
[Nutrition in the surgical patient with complications]. Parenteral feeding in complicated abdominal surgery has been a definite therapeutic progress. However the authors emphasize the divergent attitudes concerning the amounts of nitrogen which should be supplied as well as the variations in the calories-nitrogen ratio. They propose a practical attitude which must be reevaluated individually.
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59ce67ba-4fa0-4dd3-addf-8f1a65e03896
| 0 |
[Surgical problems. (Apropos of reoperations in abdominal surgery)]. Out of 1,500 laparotomies carried out between january 1970 and december 1973, 49 patients, i.e. 3.2 p. 100 underwent 61 reinterventions: one out of three patients died. Almost 60 p. 100 of these patients who had undergone operations had essentially parietal complications. The authors analyze the different syndromes which had led to the reintervention while making a special place for parietal problems.
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cfc643b3-e05e-48d9-9a50-dae930d3c07c
| 0 |
[Prognostic factors in reoperations in abdominal surgery. Apropos of 104 operations]. Analysis of the prognostic factors in abdominal surgical reinterventions accentuates the disparaging character of age, associated defects and emergency. Intercurrent respiratory complications, as well as infectious and renal complications make the prognosis considerably worse.
|
82df1a55-fb29-4852-916d-06e7a7f573c6
| 0 |
[Respiratory signs of surgical complications after abdominal operations]. The authors present 29 cases of post-operative respiratory complications in abdominal surgery in subjects without any past history of respiratory disorders. They stress the diagnostic value of these cases of acute respiratory failure shown in a third of the cases of surgical complications.
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96dba659-61cd-40c1-8acd-02af525d2f58
| 0 |
[Medico-surgical evaluation of 71 reoperations in abdominal surgery]. The authors thoroughly checked 71 reinterventions in abdominal surgery. They again found the importance of the factor of infection, respiratory, complications and oligoanuria. The overall percentage of deaths was 58 p. 100, age and associated defects made the prognosis worse.
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f8559641-a6ea-4b1f-b9c8-47a8481175b2
| 0 |
[Postoperative peritonitis. Use of metabolic disorders as criteria for reoperations]. The authors compared three groups of subjects: - the first group (11 patients) : re-operated for post-operative peritonitis; - the second group (6 patients) : re-operated for evisceration without any underlying lesion;
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f8559641-a6ea-4b1f-b9c8-47a8481175b2
| 1 |
- the third group (8 patients) : non-reoperated, complicated abdominal surgery. Study of the different laboratory parameters helped to identify a number of changes which could plead in favor of reintervention, in the group of peritonitis. Among these modifications, the progressive fall in the urinary Na/K ratio and the negativity of the nitrogen balance appear to play a privileged role.
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ee7fbf02-a534-4203-8565-b543d77a8372
| 0 |
[Our experience with reoperations in abdominal surgery. (54 reoperations in 46 patients in the last 4 years)]. The authors analyze 54 reinterventions in abdominal surgery in 46 patients, and present the lesions found on reintervention. In one out of two cases there is an intra-peritoneal septic focus. In more than 25 p. 100 of the cases the lesions were multiple. They oppose the localized septic foci and the occlusions which are of good prognosis, with the diffuse septic foci, acute pancreatitis and fistulae whose course is more often than not fatal.
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decf7add-5407-4e1a-90fa-5435c3672f4c
| 0 |
[Demythification of acupunctural anesthesia]. The so-called method of acupuncture anesthesia uses a series of techniques: selection of patients, psychotherapy, premedication, adjuvants (morphinomimetics, local anesthetics), choice of points (very varied) whose specificity has not been demonstrated, mechanical or electrical stimulation (with very differents depending on the "schools".
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decf7add-5407-4e1a-90fa-5435c3672f4c
| 1 |
The effects of these procedures are inconstant. They are slowly established. At best, they are manifested by a hypo-esthesia which is more or less wide-spread and is not accompanied by any "anti-reflex" protection. The action of the organism's different functions is not known in detail.
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decf7add-5407-4e1a-90fa-5435c3672f4c
| 2 |
There are no statistical studies in the strict sense of the term, in man. It can be roughly estimated that out of 100 surgical patients chosen, about 30 undergo the intervention in acceptable conditions in the western world. The cases, although nothing is concealed in Hanoï as well as in Peking, are difficult, and should only be handled by experienced anesthetists-resuscitators, with knowledge of acupuncture.
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decf7add-5407-4e1a-90fa-5435c3672f4c
| 3 |
Certain of the method's advantages only appear in comparison with bad "chemical" anesthesia (atoxicity, simplicity, economy), others are practically investions (anallergic effects, anti-infections, anti-shock) or at least abuse of language. The disadvantages apart from the inconstancy of effectiveness, the absence of "protection", the duration of induction, consist of lack of standardization of techniques, difficulties of animal experiments and the lack of rational explanation of the mechanism of action.
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72fbd520-6b1c-4a85-be0c-f730f04f89f1
| 0 |
[Study of the effects of Alfatesin on cerebral blood flow in cats]. The cerebral haemodynamic effects of CT 1341 also called Alfatesin, an anaesthetic steroid, were studied in the cat by means of the Xenon 133 isotopic clearance method to measure the cerebral blood flow. The injection or intravenous drip of Alfatesin in animals whose arterio PCO2 was kept unchanged induced a cerebral blood flow diminution, the importance of which was proportional to the injected dose.
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72fbd520-6b1c-4a85-be0c-f730f04f89f1
| 1 |
The cerebral blood flow fall was partly due to a cerebral arterio vasoconstriction evidenced by direct observation of the cortex vessels and by a diminution of the intracranial presure. During a deep anaesthesia induced by Alfatesin with recurrent burst suppression, there was a loss of cerebral blood flow autoregulation while the CO2 cerebral vascular reactivity was maintained.
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72fbd520-6b1c-4a85-be0c-f730f04f89f1
| 2 |
This last result accounts for the increase in cerebral blood flow parallel to the hypercapnia that could be observed among animals breathing freely.
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3fc30da2-1750-4d84-b1ec-3bb14fbaa5ad
| 0 |
[Effects of Alfatesin on total cerebral blood flow in humans]. The total cerebral blood flow was measured by the Xe 133 in 9 patients, before and during a pure Alfatesine induced anaesthesia. With a perfusion flow of 0,04 ml/kg/mn, the total flow underwent a mean fall of 38 p. 100 that was linked neither to any systemic pressure variations nor to variations of the PaCO2. This fall was linked to a cerebral arterio vasoconstriction as it was evidenced by arteriographic images.
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75f0b10c-f78e-4455-8388-da000d9f6875
| 0 |
[Study of pressor drops during continuous peridural analgesia in gerontologic surgery]. A statistical study bearing upon othe fall of blood pressure concomitant with the setting of peridural anaesthesia was carried out upon an homogeneous series of patients over 75 belonging to groups III and IV of the A S A classification for interventions seating below the IXth metamere.
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75f0b10c-f78e-4455-8388-da000d9f6875
| 1 |
From this study, it seems to follow that: - for starting maximum arterial tensions over 180 mm/Hg, pressure falls are virtually constant in absolute value; - the most important variations in pressure falls are to be found in abdominal surgery; - the lowest figure in blood pressure which accompanies the achievement of surgical analgesia takes place about the 24 th minute whatever the type of surgery can be;
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75f0b10c-f78e-4455-8388-da000d9f6875
| 2 |
- no significant link can be evidence between the importance of the fall in blood pressure and the consumption of the mixture required for surgical analgesia.
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a48f28d4-be62-414f-ac76-8889fecf3ed0
| 0 |
[Harzard of chronic exposure to halothane for operating room personnel]. This study shows that the staff working in an operating room is repeatedly being exposed to appreciable doses of halothane vapours. A continuous measurement of the concentrations in the ambient air gave results ranging from 5 to 30 ppm.
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a48f28d4-be62-414f-ac76-8889fecf3ed0
| 1 |
Summits from 50 to 70 ppm were noted. The inhaling of halothane was evidenced by the presence of brominated metabolites in the urine of the staff. A mean 14,59 mg/l was found with women anaesthesists. Therefore it is quite possible that the halothane spread in the air should be held responsible for the discomfort felt in particular by anaesthesists.
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a48f28d4-be62-414f-ac76-8889fecf3ed0
| 2 |
To prevent this risk of chronic intoxication by those vapours, there ought to be a device permitting either to evacuate them outside or to collect them while regenerating the polluted air through an active carbon filter if one has not got at one's disposal an airing system offering over 20 renewals of fresh air per hour.
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a48f28d4-be62-414f-ac76-8889fecf3ed0
| 3 |
The fitting up of a permanent control device equipped with warning light and bell is also justified.
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bf7bb059-c4a7-43f5-8d74-0926c6731c50
| 0 |
[Organization of first aid on the northern motorway in Picardy. Role of the regional Medical First Aid Unit]. The Picardy regional S.A.M.U. implanted in Amiens, has participated in the implantation of antennae of the S.M.U.R. whereby aid can be given accident cases on the northern motorway.
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bf7bb059-c4a7-43f5-8d74-0926c6731c50
| 1 |
After a brief historical review of the creation of these antennae, and presentation of what exists in the sections of the northern motorway not in Picardy, the means of the regional S.A.M.U. are presented, and the way it which it functions, with regards to specific problems concerning medical aid on the motorway.
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bf7bb059-c4a7-43f5-8d74-0926c6731c50
| 2 |
The results of the S.M.U.R. activities are presented and discussed. The necessity for good coordination of medical aid, the fundamental role of the regional S.A.M.U., is particularly emphasized.
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bf6876b1-e7d5-4216-af6e-c3f4ab6f0a68
| 0 |
[Helicopters and medical first aid units. Role of Medical First Aid Unit 94]. For the transport of injured and sick patients, the helicopter (even the mono-turbine type) offers greater advantages when compared to land vehicles: - more comfort (less vibrations, accelerations and decelerations); - a greater speed, that is to say a 61 p.
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bf6876b1-e7d5-4216-af6e-c3f4ab6f0a68
| 1 |
100 gain of time upon the distance and a gain from 29 up to 44 p. 100 upon the total amount of time taken up by each transport. This gain in time enables valuable specialised medical teams to be more available: - more precise time-tables than by land which namely makes it easier to receive the patients.
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bf6876b1-e7d5-4216-af6e-c3f4ab6f0a68
| 2 |
The drawbacks are linked with the risks which are not nonexistent but rather less serious than by land. The drawbacks also depend upon the weather-conditions (although this factor does not matter much in our area), upon nuisances such as the noise (which is more important but far more transitory than by ambulance) and chiefly upon the cost of air-transport.
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bf6876b1-e7d5-4216-af6e-c3f4ab6f0a68
| 3 |
In fact, the mean cost of a medical land transport amounts roughly to one thousand Francs, a quarter of which only does represent the actual cost of medical aid. For a similar transport, the helicopter comes to a 47 mns flight. There are several ways of making good use of a helicopter.
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bf6876b1-e7d5-4216-af6e-c3f4ab6f0a68
| 4 |
Practical problems have been solved. The "SAMU 94" experience goes back to 1973 and includes over 500 transports by helicopter essentially with the help of the teams and the helicopters belonging to the Paris Base (Civil Protection and the Fire-Brigade). For flights over urban areas, it is to be desired in the future that only twin-turbine helicopters should be used.
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fc3f84f8-819d-47b5-90f9-0f6abc940b23
| 0 |
[Clinical and therapeutic problems posed by hangings. Apropos of 67 cases]. Starting from a collection of 67 cases of hanging taken over by the Anesthesia Resuscitation Department belonging to Reims Hospital University Centre, the authors report their clinical observations and make an analytical confrontation of this type of accident according to various criteria such as:
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fc3f84f8-819d-47b5-90f9-0f6abc940b23
| 1 |
- the initial physical condition of the victims; - the evolution of the symptoms; - the various medical treatments used. The immediate consequences of miscarried hangings lead to a physio-pathological argument dealing mainly with the neurological and breathing manifestations. The elements of this argument enable the writers to back up certain therapeutic orientations among which hyperbaric oxygen therapy and early prescription of which seems to be wished for in the most severe forms of hanging.
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bcad6bd3-c6a3-4e28-b4b8-f149caa03ba0
| 0 |
[Severe complications of subclavian vein catheterization]. The authors report 4 observations of severe involvement induced by sub-clavian catheterization: - 2 catheter-embolisms; - 1 venous thrombosis and one hydrothoraxx. One embolism and the hydrothorax were caused by a faulty puncturing. The thrombosis was the result of a relative stenosis of the vein induced by a loop of the catheter in the Pirogoff confluent. Next, the authors develop the facts given by the literature bearing upon each one of these complications.
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c8cc3ff6-ace7-498c-9688-793a8163a1cb
| 0 |
[Acute renal insufficiency and fat embolism]. The authors report ten cases of renal insufficiency observed among a series of 43 cases of fat embolism. It is a matter of eraly oligoanuria (starting beween the 2nd and the 4th day). Its severity depends on the lesions involved : prolonged cardio-vascular collapse - cranio-encephalic lesion. The renal insufficiency does not seem typical of fat embolism. It must be essentially linked to a cardio-vascular collapse and/or to a disseminated intra-vascular coagulation.
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42de1d87-a106-43e6-867b-92fe9cc98de4
| 0 |
[Effects of nasogastric intubation on respiratory resistance and work in newborn and premature infants]. The nasal resistance participates for almost 50 p. 100 in the resistance of airways (RVA) of the new-borns whose respiration is mainly nasal. The possibility of an oral respiration in case of partial or total occlusion of nasal way is almost null.
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42de1d87-a106-43e6-867b-92fe9cc98de4
| 1 |
In order to determinate the effects of a naso-gastric suction of the RVA 10 normal infants (3 prematures, 7 new-born babies) were studied by plethysmographia. The presence of the suction brought a systematic and significant increase of RVA (the coefficient of transformation = 1,318 +/- 0,21 p is less than 0,001).
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42de1d87-a106-43e6-867b-92fe9cc98de4
| 2 |
In the nine infants for whom the resistant work (WR) was estimated is increased proportionaly to the increase of RVA (deltaRVA) (coef. of transformation = 1,44 +/- 0,44, p is less than 0,001). However the proportional increase of WR is not systematic superior for 3 prematures and 1 new-born baby and similar in one case.
|
42de1d87-a106-43e6-867b-92fe9cc98de4
| 3 |
These variations can be explained by various adjustments of the V. The increase of work imposed by the presence of a naso-gastric suction cannot be underestimated in particular for the prematures.
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49b51546-e253-4801-9ada-b3efca3003a3
| 0 |
[Treatment of severe forms of idiopathic respiratory distress in newborn infants using constant negative perithoracic pressure]. 49 children with a severe idiopathic respiratory distress syndrome were treated by continuous negative pressure ranging from 5 cm of water to a negative pressure of 13 cm of water around the thorax.
|
49b51546-e253-4801-9ada-b3efca3003a3
| 1 |
The partial pressure of oxygen rose significantly in the majority of cases, and the alveolo-arterial gradient also significantly diminished by more than 100 mm of mercury. 29 children were treated by this method alone, but in 20 other children owing to the failure of constant negative pressure, respiratory assistance either by intermittent pressure ventilation or intermittent positive pressure ventilation was associated.
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49b51546-e253-4801-9ada-b3efca3003a3
| 2 |
On the whole 35 out of 49 children survived. The complications which were met with are analyzed. Continuous negative pressure seems to be a safe and effective method for improving oxygenation in the idiopathic respiratory distress syndrome.
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966177a0-5b21-4bb6-a49b-fc151e2186cc
| 0 |
[PAH clearance measurement without urine samples in the newborn infant with respiratory distress]. PAH clearance was carried out in 12 newborns, hospitalized in the infantile resuscitation unit for respiratory distress. 6 of these children weighed less than 2.5 kg, 4 had hyaline membrane disease, 6 had either amniotic abnormalities or transitory tachypnea, 2 were surgical patients:
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966177a0-5b21-4bb6-a49b-fc151e2186cc
| 1 |
one right diaphragmatic hernia, one post-operative respiratory complication after intervention for neonatal occlusion. In 9 cases the newborn was under controled artificial ventilation associated with PEEP at 5 to 7 cm of water. In all of the cases, the hemodynamic, metabolic and blood gas conditions were normal.
|
966177a0-5b21-4bb6-a49b-fc151e2186cc
| 2 |
A control series of 11 newnorn was carried out in a pediatric unit, the clearance was done without urine samples, the rough value of the figures found varied from 5.5 ml per minute to 30 ml per minute in the respiratory distress series and 16 to 62 ml per minute in the control series.
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966177a0-5b21-4bb6-a49b-fc151e2186cc
| 3 |
The analysis of these results in rendered difficult by the juxtaposition of several factors: Choice of a reference criterion: body surface area, PAH space, patient's weight theoretical weight of the kidneys. The factor of prematurity. The problem of the date of the investigation in comparison with the date of birth.
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3daace93-1668-4727-9724-e7140c0836d9
| 0 |
[Transport of "high-risk" newborn infants. (Apropos of 159 emergency calls by the SAMU 94-Service d'Aide Médicale Urgente-Emergency Health Service)]. Analysis of our experience confirms in the domain of the newborn the fundamental notion of the Emergency medical call. The EMC has two objectives:
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3daace93-1668-4727-9724-e7140c0836d9
| 1 |
1--Emergency treatment before the patient is moved, and the correction of failing vital functions by a medical team skilled in problems of neonates. 2--Transportation of the neonate in a stable condition, to the Intensive Care unit. The quality of such transportation depends closely upon the quality of the medical care given and upon organisation.
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3daace93-1668-4727-9724-e7140c0836d9
| 2 |
It can only be carried out in the context of a system coordinated by a "coordinating physician" (e.g. SAMU 94). This coordinating physician has responsibility for logistics, telephone coordination, and application of the call procedure as rapidly as possible. From a logistical point of view, only coordination between:
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3daace93-1668-4727-9724-e7140c0836d9
| 3 |
--SAMU-SMUR;--Medical team of the Intensive care unit;--Requesting service make possible the provision and quality of continuous supplies of oxygen, warmth, sugar - all under aseptic conditions, indispensable to the quality of survival of the neonate. In addition, we feel it essential--that the delay before the call is answered be as brief as possible;
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3daace93-1668-4727-9724-e7140c0836d9
| 4 |
--that the call should be dealt with by a mixed team, including at least one physician experienced in neonatal problems;--that the choice of vehicle used for transportation should be better adapted to the situation. This choice is the responsibility of the coordinating physician, who should base his decisions on two fundamental requirements:
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3daace93-1668-4727-9724-e7140c0836d9
| 5 |
--rapidity of dealing with the call;--personal safety of those involved. This without losing sight of--Prevention of perinatal problems lies part with the detection of high risk pregnancies, with the aim of arranging delivery in specialised "mother and baby" centres where close collaboration between obstetrician and paediatrician is assured.
|
3daace93-1668-4727-9724-e7140c0836d9
| 6 |
--The development of transportation of the "high-risk" neonate, which is so costly in manpower and equipment, depends closely upon general concepts of health care in France, which should be aimed at:--the prevention of prematury;--the detection of high risk pregnancies;--the development of mother and baby centres.
|
6b6e6ae4-b41c-4644-a472-105caae1f509
| 0 |
[Transport of newborn infants. Apropos of 114 cases]. The transport of 114 newborn less than 24 hours old carried out in 1972 and 1973 by the Paris SAMU (Professor M. CARA'S Unit) is studied. (he delay of arrival of the medical team is on the average one hour, the child arrives in the Resuscitation center approximately two and a quarter hours after the call.
|
6b6e6ae4-b41c-4644-a472-105caae1f509
| 1 |
In 15 cases an umbilical catheter was put in place; in 27 cases the child was intubated, artificial ventilation was carried out during transport. On arrival, from the mean values, the temperature was 25.2 degrees, the pH 7.28, the pO2 112, the blood sugar 1.53 g.
|
6b6e6ae4-b41c-4644-a472-105caae1f509
| 2 |
Three practical conclusions must be drawn: reserve high risk deliveries for specialized centers, when the degree of emergency compells delivery in a badly equipped center, contact the SAMU from the beginning of labour, render the actions carried out by the transporting doctor even more rigorous and controled, which implies an organized SMUR which is well equipped and trained.
|
10f59af3-e6c6-4fe5-8be4-fa835fb4cc78
| 0 |
[Vascular and infectious enteropathy in newborn infants. Reflections on pathogeny; clinical and therapeutic deductions. Apropos of 45 cases]. Necrotizing enterocolitis of the new-born has an anatomical definition: lesions discovered during surgery or on post-mortem examination. Progress in neanatal shock reveals facts already known in the adult and in experimental medicine:
|
10f59af3-e6c6-4fe5-8be4-fa835fb4cc78
| 1 |
concept of preferential and circulatory by-pass. A considerable decrease in blood flow is seen in the latter during shock; this shock is sometimes not important. Mesenteric circulation is the best example. This syndrome should therefore be included in the major vascular changes of neonatal period. Vascular and infectious enteropathy is a broader term which seems more appropriate because of aetiological and therapeutic implications.
|
10f59af3-e6c6-4fe5-8be4-fa835fb4cc78
| 2 |
The aetiology should be considered as a sum of several factors varying from one patient to another (multifactorial disease). The circulatory component remains very important. Its severity depends on whether or not it is treated. Four notions should be defined: -- Census of population of subjects with "high risk" of vascular and infectious enteropathy (score trial);
|
10f59af3-e6c6-4fe5-8be4-fa835fb4cc78
| 3 |
-- Isolation of clinical pictures corresponding to a medical or surgical stage; Grouping of elements for immediate and long term prognosis; -- Grouping of elements for immediate and long term prognosis; -- Proposal of preventive treatment to the "high risk" patients (surgery; continuons parenteral and enteral feeding are intientionally left out in this paper).
|
10f59af3-e6c6-4fe5-8be4-fa835fb4cc78
| 4 |
The interest of this concept of the disease is to eradicate severe forms as in the neonatal idiopathic respiratory distress syndrome where a similar concept was adopted.
|
10047082-7041-49e2-9d8a-8db36347d6a2
| 0 |
[Pre-, per-, and postoperative resuscitation in thoracic surgery in newborn infants]. The authors report their five year-experience in reanimation during thoracic surgery in the new-born. The report concerns 66 cases (43 atresias of the oesophagus and 23 diaphragmatic hernias). Prognosonis depends on: 1 -- A permanent temam of suitably qualified doctors ready to carry out at any time the required therapy on the infant.
|
10047082-7041-49e2-9d8a-8db36347d6a2
| 1 |
2 -- Free air way (kinesitherapy, continous and prolonged suction of oesophageal atresias and bronchial suction). 3 -- Ventilation (surgery on clean lungs in atresias, diaphragmatic prosthesis and suturing of skin in hernias). Respect of these rules in diaphragmatic hernias saved 12 lives out of 23;
|
10047082-7041-49e2-9d8a-8db36347d6a2
| 2 |
in oesophageal atresias, 16 survived out of 16 cases classified as good cases, and the total survival rate was 73%.
|
d026acd8-97d5-4275-a093-774258de5755
| 0 |
[Congenital cardiopathies appearing during the neonatal period. The view points of the cardiologist, the hemodynamics specialist, the surgeon, and the anesthetist]. The best chances of survival for a new-born depend on the following factors: the possibility of clinical and haemodynamic diagnosis of the malformation, adequate reanimation and surgery.
|
d026acd8-97d5-4275-a093-774258de5755
| 1 |
All this must be carried out as early as possible. Although catheterization is very risky it should be complete and as fast as possible, under monitoring of ventilation and haemodynamies. Reanimation is very important before, during and after surgery; it should be more preventive than curative. Very often, surgery is only palliative at this age.
|
d026acd8-97d5-4275-a093-774258de5755
| 2 |
Taking into account progress in surgical techniques, the authors report their experience in anaesthesia and ressuscitation of 100 patients under 10 days old. They were all operated on in Laennec in Professor MATHEY's department but only some of them were catheterized there.
|
6822085a-ba3b-4556-b7b3-f987f1a5c90b
| 0 |
[Leukomalacia and subsequent brain status in relation to intensive neonatal care]. Leucomalacia or white matter necrosis is one of the major aspects of neonatal encephalopathies, especially in the premature baby. These necroses are found mainly in the deep periventricular white matter of the "semi-oval centre". Characteristically, they are ischaemic and their anatomical and histological progress is rapid:
|
6822085a-ba3b-4556-b7b3-f987f1a5c90b
| 1 |
coagulation necrosis with rapid axonal fragmentation followed by polymorphic cellular reaction with glial cells and macrophages. Regeneration in the minor forms consists of glyosis process in severe forms; multiple cavities appear in a few weeks. Physiopathogenic hypotheses put forward are related to: 1 -- the very anatomic aite:
|
6822085a-ba3b-4556-b7b3-f987f1a5c90b
| 2 |
special tissue and terminal arteries, 2 -- onset of myelinization process, 3 -- associated clinical and biological lesions such as hypoxia, acidosis and hypotention. These lesions are symptom-free during the neonatal period. One of us suggested in 1962 that these could be the anatomical basis of spastic monoplegia or diplegia (LITTLE's disease).
|
6822085a-ba3b-4556-b7b3-f987f1a5c90b
| 3 |
All motor cerebral sequelae have disappeared since 10 years. This is particularly significant mainly in the case of spastic diplegia of the former premature baby under 2500 g. This decrease coincides with improvement in neonatal care, especially correction of hypoxia, acidosis and cardiovascular collapse. These findings seem to support the pathogenic hypotheses.
|
b4ec351e-4dde-4b9a-9a26-ae358534748b
| 0 |
[Neonatal listeriosis (based on 43 cases)]. Using results in 43 cases from two neonatal units (Paris-Tours), the authors emphasize the essential facts concerning neonatal listeriosis. 1 -- Incidence: -- of an infectious maternal disease (32 cases out of 43), -- of permaturity (60% of cases), -- and of foetal distress (72%).
|
b4ec351e-4dde-4b9a-9a26-ae358534748b
| 1 |
2 -- Clinical study: Early neonatal infectious are the only forms seen; clinical signs appear before the first day (40 out of 42). These is septicaemia with mainly respiratory signs (olypnoea, laboured breathing). Their presence and clinical history should incite to take swabs of the orifices and carry out blood culture.
|
b4ec351e-4dde-4b9a-9a26-ae358534748b
| 2 |
The new-born are given double antibiotherapy (penicline and aninoside or kanamycine and gentalline) while waiting for laboratory reports. This routine treatment based on maternal past history and on mild clinical signs at this stage has improved the prognosis of these septicaemias (16 deaths out of 43 children).
|
183e8181-3fb3-4f39-a26e-94dc7fd182e0
| 0 |
[Appearance of coagulation disorders in the non-healthy newborn infant]. Coagulation abnormalities are particularly frequent in neonatal pathology and justify exploration of hemostasis in the newborn. First of all we established a profile of coagulation in the newborn using our own results and data from the literature. Contrasting with a deficit in numerous factors (II - VII - IX - X - XI - and XII), overall coagulation is normal, or even increased.
|
183e8181-3fb3-4f39-a26e-94dc7fd182e0
| 1 |
The fibrinolytic system is characterized by a low plasminogen level but the activity of this system is transitorily increased. Then we recall the known syndromes: avitaminosis K, constitutional deficits in the coagulation factors, isolated thrombopenia, disseminated intravascular clotting. However numerous problems persist. Abnormalities in the clotting factors are frequently difficult to interpret.
|
183e8181-3fb3-4f39-a26e-94dc7fd182e0
| 2 |
Correlation between the clinical and laboratory pictures does not always exist. We emphasize the necessity for preventive measures.
|
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