Effect of deuteration on the metabolism and clearance of some pharmacologically active compounds--synthesis and in vitro metabolism of deuterated derivatives of dronedadrone.

The synthesis and in vitro metabolism studies of a family of specifically deuterated derivatives of dronedarone are described. Metabolic stability and clearance of the parent compound are not sensitive to deuterium substitution, irrespective of the position of the heavy label.

[D-Dimer determination combined with clinical probability for the diagnosis of leg venous thrombosis].

Objective: To evaluate the results of combination of D-Dimer test and simple clinical model for the diagnosis of deep vein thrombosis (DVT).

Materials And Methods: Inclusion: clinical suspicion of DVT. Non inclusion criteria were Clinical model performed by the referring physician included probability varying from high to low.

Severe accidental hypothermia treated in an ICU: prognosis and outcome.

Study Objectives: To assess the characteristics and outcomes of patients admitted to an ICU for severe accidental hypothermia, and to identify risk factors for mortality.

Methods: All consecutive patients admitted to an ICU between January 1, 1979, and July 31, 1998, with a temperature of < or = 32 degrees C were retrospectively analyzed. Rewarming was always conducted passively with survival blankets and conventional covers.

Circulating endotoxin during initial antibiotic treatment of severe gram-negative bacteremic infections.

The impact of antibiotics on total endotoxemia and circulating tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, and IL-8 in 18 patients with severe bacteremic sepsis or septic shock due to gram-negative species was investigated. Endotoxemia, TNF-alpha, IL-6, and IL-8 were assayed before (H0) and 1 h (H1) and 4 h (H4) after the first antibiotic infusion. Endotoxemia decreased from H0 (median, 0.

[Analysis of patients' perception of their stay in a medical intensive care unit. Les trois equipes d'infirmières].

Objectives: Evaluate patients' appraisal of their stay in a medical intensive care unit and analyze their anxiety.

Patients And Methods: Two 5-month prospective studies with specific questionnaires were filled out by patients with the help of a psychologist. The first study (61 patients) evaluated global appraisal of the stay and the second study (53 patients) focused on anxiety using questionnaires also filled out by nurses.

Influence of acute renal failure on FPIA rapid serum assay of midazolam and its main metabolite.

We recently developed a simple and fast assay technique, providing the possibility of monitoring of midazolam (M) during sedation. We compared HPLC vs FPIA for the measurement of the sum M plus alpha 1-hydroxymidazolam (OM), its main and pharmacologically active metabolite, in the serum of sedated ICU patients; this activity referred to as M-like. We identified certain patients in whom M-like activity appeared abnormally high in comparison with HPLC assays.

Comparison of high-performance liquid chromatography and polyclonal fluorescence polarization immunoassay for the monitoring of midazolam in the plasma of intensive care unit patients.

Midazolam (M) is used as an induction agent for anesthesia. The main metabolite is alpha-hydroxymidazolam (OM), which is pharmacologically active. Use of M for sedation is a recent application, rapidly gaining favor.

Endotoxemia and bacteremia in patients with sepsis syndrome in the intensive care unit.

Study Objectives: To study circulatory endotoxin (ET) in patients with sepsis syndrome (SS) in order to answer three questions: (a) How often and at which concentration is ET present in the plasma of patients with SS and is the presence of ET a prognostic marker in this situation? (b) Is detection of ET helpful in predicting Gram-negative bacterial infections with or without bacteremia? (c) What are the kinetics of clearance of ET concentrations in plasma?

Design: Prospective study of consecutive patients fulfilling Bone's criteria for SS.

Setting: Medical ICU in a teaching hospital.

Patients: The study included 93 patients.

Prospective evaluation of self-extubations in a medical intensive care unit.

Objective: To evaluate the incidence, associated factors and gravity of self-extubations.

Design: Prospective study about all patients intubated over an 8 month period.

Setting: A medical intensive care unit of a University Hospital.

Meningoencephalitis due to penicillin-resistant Streptococcus pneumoniae.

The case of a 68-year-old man suffering from pneumococcal meningoencephalitis is reported. Antibacterial susceptibility tests revealed a multiply resistant pneumococcal strain. High doses of cefotaxime were necessary to sterilize the cerebrospinal fluid despite the achievement of a satisfactory level of antibiotic in the cerebrospinal fluid with moderate dosage.

[Efficacy and tolerance of Elohes in plasma exchanges].

This study aimed to compare two plasma substitution regimens used during plasma exchanges (PE). It was a prospective cross-over randomized trial. Each patient (n = 12) had two PE at a 48 h interval.

[Fortuitous discovery of the association of true and false aneurysm of the left ventricle after cardiogenic shock].

The authors report the fortuitous diagnosis of a true and a false left ventricular aneurysm in a 77 year old man with severe ischaemic heart disease and calcific aortic stenosis, admitted for cardiogenic shock. The association of these two forms of aneurysm is very rare. Clinical and paraclinical diagnosis is difficult.

[Severe immunoallergic hemolytic anemia caused by a glafenine metabolite].

Three weeks after a surgical operation, a 74-year old woman was admitted to hospital for severe haemolytic anaemia. A strongly positive IgG type direct Coombs test pointed to a iatrogenic origin, but a search for anti-molecule antibodies directed against all medicines taken by the patient after surgery was negative. We extended our immunological investigations and were able to demonstrate the presence of IgG type antibodies directed against an ex vivo metabolite of glafenine.

[Pneumococcal pneumonia resistant to penicillin].

The authors report a case of community-acquired pneumonia in a patient with chronic obstructive lung disease. The initial antibiotic therapy consisted of an amoxicillin-clavulanic acid combination and intravenous macrolides. Twenty-four hours after admission, blood cultures were positive for pneumococcus.

[Access of torsades de pointes in Legionnaires' disease: an uncommon adverse effect of erythromycin].

We report the case of a 77-year-old man with legionnaires's disease who, immediately after an intravenous infusion of one gram of erythromycin presented with wave burst arrhythmia with widening of the QT space. The blood level of erythromycin at the time of this adverse reaction was the same as the peak observed in young subjects after intravenous administration of this drug. Fourteen similar cases were found in the literature.

[Acute respiratory distress caused by distal neoplastic pulmonary emboli].

In contrast to pulmonary parenchyma metastases or lymphangitic carcinomatosis, neoplastic emboli of small pulmonary arteries and capillaries frequently go unrecognized and are only discovered at autopsy. Five patients (48 +/- 12 years old) were admitted to 3 intensive care units for severe acute respiratory failure and died between the first and the tenth day following hospitalization. Each patient had a history of rapidly progressive dyspnea, and physical examination showed clinical evidence of right ventricular failure.

[Listeria rhombencephalitis caused by Listeria monocytogenes with a cerebrospinal fluid initially normal].

A case of rhombencephalitis due to Listeria monocytogenes in a non immunocompromised patient, with initially normal cerebrospinal fluid, was marked by potentially fatal neurovegetative disorders and severe neurological sequelae partly due to delay in diagnosis and treatment. The possibility of Listeria infection should be considered in patients with fever and cranial nerves deficits, in order to initiate an appropriate antibiotic therapy and to keep the subject under close monitoring in an intensive care unit.

[Porcine valvular bioprosthesis. Results 6 years later].

Between January, 1977 and December, 1980, 128 porcine bioprostheses were implanted in 109 European patients hospitalized at the Boucicaut hospital, Paris: 47 were aortic valve replacements (AVR), 43 mitral valve replacements (MVR) and 19 dual valve replacements (DVR). The operative mortality rate was 11% (12 patients): MVR 21%, AVR 6.4%, DVR 0%.