Presse Med
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Randomized Controlled Trial Clinical Trial
[Absence of effect of enalapril on the glycemic control and peripheral sensitivity to insulin in 10 diabetic patients treated with subcutaneous continuous infusion of insulin].
In diabetic patients, it has been suggested that angiotensin converting enzyme inhibitors may be associated with unexplained hypoglycaemic episodes. Such a side effect may limit the use of these drugs in diabetic hypertensive patients. Ten insulin-dependent diabetic patients mean age 38.4 +/- 13.1 years, mean diabetes duration 10.3 +/- 6.6 years (m +/- SD) were selected on the basis of good glycaemic control: HbA1: 7.6 +/- 0.9 per cent (upper limit of normal value less than 7.5 per cent) on continuous subcutaneous insulin infusion. ⋯ The incidence of hypoglycaemic episodes was similar. Neither peripheral insulin sensitivity was modified by enalapril. In the conditions of this study, enalapril did not interfere with glycaemic control in insulin-dependent diabetics in good metabolic control.
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The techniques for sealing with the Tissucol fibrin glue, used in repair of aortic dissections and aneurysms, are described. We applied this method to 24 patients operated upon for acute (9 cases) or chronic (15 cases) lesions of the thoracic aorta. ⋯ Provided strict precautions are taken, this adjuvant haemostatic method considerably improves the immediate prognosis of acquired aortic lesions. Other operations of cardiac surgery may benefit from these sealing techniques the cost of which must be weighed against the blood transfusion units that are saved.
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The difference between oxygen consumption during spontaneous and controlled ventilation represents the oxygen cost of breathing. Swan-Ganz catheters enable oxygen consumption to be calculated as the product of cardiac index by arteriovenous oxygen concentration. This method was used in 25 patients on the day after anaesthesia and mitral valve replacement to predict the success of weaning from mechanical ventilation. ⋯ Two patients had an oxygen consumption below the physiological threshold (115 ml.min-1.m-2): one could be weaned, but not the other. Haemodynamic parameters did not change significantly during weaning. Thus, measurement of oxygen consumption through a Swan-Ganz catheter does not predict the success of weaning after mitral valve replacement, but the catheter can diagnose a low cardiac output needing treatment before weaning.
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A case of cerebral oedema developed during an apparently common attempted suicide with valpromide is reported. The most conspicuous biochemical abnormality was hyperammonaemia. The oedema proved refractory to the standard medical treatment of intracranial hypertension, and decompressive craniectomy was performed with only minor sequelae. ⋯ By completing such a deficiency, valproate may produce an extremely serious syndrome resembling the neonatal encephalopathy due to complete enzyme deficiencies in the urea cycle. All valpromide or valproate intoxications probably are cerebral oedemas with hyperammonaemia akin ti Reye's syndrome. All accidents of this type occurring during treatment or poisoning with valproate should be investigated for urea cycle enzyme abnormalities.