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Kemoun G, Weiss E, El Houari L, Bonny V, Goury A, Caliez O, Picard B, Rudler M, Rhaiem R, Rebours V, Mayaux J, Bachet JB, Belin L, Demoule A, Decavèle M. Clinical features and outcomes of patients with pancreatic cancer requiring unplanned medical ICU admission: A retrospective multicenter study. Dig Liver Dis 2024; 56:514-521. [PMID: 37718226 DOI: 10.1016/j.dld.2023.08.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/27/2023] [Accepted: 08/17/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND We sought to describe the reasons for intensive care unit (ICU) admission and outcomes of patients with pancreatic cancer requiring unplanned medical ICU admission. PATIENTS AND METHODS Retrospective cohort study in five ICUs from 2009 to 2020. All patients with pancreatic cancer admitted to the ICU were included. Patients having undergone recent surgery were excluded (< 4 weeks). RESULTS 269 patients were included. Tumors were mainly adenocarcinoma (90%). Main reason for admission was sepsis/septic shock (32%) with a biliary tract infection in 44 (51%) patients. Second reason for admission was gastrointestinal bleeding (28%). ICU and 3-month mortality rates were 26% and 59% respectively. Performance status 3-4 (odds ratio OR 3.58), disease status (responsive/stable -ref-, newly diagnosed OR 3.25, progressive OR 5.99), mechanical ventilation (OR 8.03), vasopressors (OR 4.19), SAPS 2 (OR 1.69) and pH (OR 0.02) were independently associated with ICU mortality. Performance status 3-4 (Hazard ratio HR 1.96) and disease status (responsive/stable -ref-, newly diagnosed HR 2.67, progressive HR 4.14) were associated with 3-month mortality. CONCLUSION Reasons for ICU admissions of pancreatic cancer patients differ from those observed in other solid cancer. Short- and medium-term mortality are strongly influenced by performance status and disease status at ICU admission.
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Affiliation(s)
- G Kemoun
- AP-HP Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive - Réanimation (Département R3S), Paris, France.
| | - E Weiss
- AP-HP Nord, Université de Paris, Hôpital Beaujon, Département d'anesthésie-réanimation, Clichy, France; Université de Paris, UMRS1149, Centre de recherche sur l'inflammation, Liver Intensive Care Group of Europe (LICAGE), France
| | - L El Houari
- AP-HP Sorbonne Université, Hôpital Pitié-Salpêtrière, Département de Santé Publique, F-75013, Paris, France
| | - V Bonny
- AP-HP Sorbonne Université, site Saint-Antoine, Service de Médecine Intensive - Réanimation, Paris, France
| | - A Goury
- Unité de médecine intensive et réanimation polyvalente, Hôpital Robert Debré, CHU de Reims, France
| | - O Caliez
- AP-HP Sorbonne Université, site Pitié-Salpêtrière, Service d'hépato-gastro-entérologie, Paris, France
| | - B Picard
- AP-HP Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive - Réanimation (Département R3S), Paris, France
| | - M Rudler
- AP-HP Sorbonne Université, site Pitié-Salpêtrière, Service d'hépato-gastro-entérologie, Paris, France; Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine (CRSA), Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - R Rhaiem
- Service de chirurgie hépatobiliaire, pancréatique et oncologique digestive, Hôpital Robert Debré, CHU de Reims, France
| | - V Rebours
- AP-HP Nord, Université de Paris, Hôpital Beaujon, Service de Pancréatologie, Clichy, France; Université de Paris, INSERM, UMR 1149, pancreatic rare diseases (PaRaDis), centre de référence de maladies rares, Clichy, France
| | - J Mayaux
- AP-HP Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive - Réanimation (Département R3S), Paris, France
| | - J B Bachet
- AP-HP Sorbonne Université, site Pitié-Salpêtrière, Service d'hépato-gastro-entérologie, Paris, France
| | - L Belin
- Sorbonne-Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP. Sorbonne Université, Hôpital Pitié-Salpêtrière, Département de Santé Publique, F-75013, Paris, France
| | - A Demoule
- AP-HP Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive - Réanimation (Département R3S), Paris, France; Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
| | - M Decavèle
- AP-HP Sorbonne Université, site Pitié-Salpêtrière, Service de Médecine Intensive - Réanimation (Département R3S), Paris, France; Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France
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Marois C, Quirins M, Hermann B, Mouri S, Bouzbib C, Rudler M, Thabut D, Weiss N. [Metabolic encephalopathies]. Rev Med Interne 2019; 40:88-97. [PMID: 30638703 DOI: 10.1016/j.revmed.2018.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 11/12/2018] [Accepted: 11/15/2018] [Indexed: 12/16/2022]
Abstract
Metabolic encephalopathies (ME) are a common cause of admission to emergency rooms, to hospitalization wards or to intensive care units. They could account for 10 to 20% of causes of comatose states in ICU and could be associated to a poor outcome especially in older patients. Nevertheless, they are often reversible and are associated with a favorable outcome when diagnosed and rapidly treated. They correspond to an altered brain functioning secondary to the deficiency of a substance that is mandatory for the normal brain functioning or to the accumulation of a substance that can be either endogenous or exogenous. It preferably occurs in co-morbid patients, complicating its diagnosis and its management. Altered brain functioning, going from mild neuropsychological impairment to coma, movement disorders especially myoclonus and the absence of any obvious differential diagnosis are highly suggestive of the diagnosis. Whereas some biological samplings and brain MRI are essential to rule out differential diagnosis, some others, such as electroencephalogram, may be able to propose important clues in favor of the diagnosis. Once simple symptomatic measures are introduced, the treatment consists mainly in the correction of the cause. Specific treatment options are only seldom available for ME; this is the case for hepatic encephalopathy and some drug-induced encephalopathies. We will successively describe in this review the main pathophysiological mechanisms, the main causes, favoring circumstances of ME, the differential diagnosis to rule out and the etiological work-up for the diagnosis. Finally, a diagnostic and therapeutic strategy for the care of patients with ME will be proposed.
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Affiliation(s)
- C Marois
- Unité de réanimation neurologique, département de neurologie, Sorbonne université, groupement hospitalier Pitié-Salpêtrière Charles-Foix, Assistance publique des hôpitaux de Paris (AP-HP), 75013 Paris, France
| | - M Quirins
- Service de neurologie adulte, hôpital Bicêtre, Assistance publique des hôpitaux de Paris (AP-HP), 94250 Le Kremlin-Bicêtre, France
| | - B Hermann
- Unité de réanimation neurologique, département de neurologie, Sorbonne université, groupement hospitalier Pitié-Salpêtrière Charles-Foix, Assistance publique des hôpitaux de Paris (AP-HP), 75013 Paris, France
| | - S Mouri
- Brain Liver Pitié-Salpêtrière (BLIPS) Study Group, unité de soins intensifs d'hépatologie, service d'hépato-gastroentérologie, Inserm, centre de recherche Saint-Antoine, Sorbonne université, groupement hospitalier Pitié-Salpêtrière Charles-Foix, Assistance publique des hôpitaux de Paris (AP-HP), 75013 Paris, France
| | - C Bouzbib
- Brain Liver Pitié-Salpêtrière (BLIPS) Study Group, unité de soins intensifs d'hépatologie, service d'hépato-gastroentérologie, Inserm, centre de recherche Saint-Antoine, Sorbonne université, groupement hospitalier Pitié-Salpêtrière Charles-Foix, Assistance publique des hôpitaux de Paris (AP-HP), 75013 Paris, France
| | - M Rudler
- Brain Liver Pitié-Salpêtrière (BLIPS) Study Group, unité de soins intensifs d'hépatologie, service d'hépato-gastroentérologie, Inserm, centre de recherche Saint-Antoine, Sorbonne université, groupement hospitalier Pitié-Salpêtrière Charles-Foix, Assistance publique des hôpitaux de Paris (AP-HP), 75013 Paris, France
| | - D Thabut
- Brain Liver Pitié-Salpêtrière (BLIPS) Study Group, unité de soins intensifs d'hépatologie, service d'hépato-gastroentérologie, Inserm, centre de recherche Saint-Antoine, Sorbonne université, groupement hospitalier Pitié-Salpêtrière Charles-Foix, Assistance publique des hôpitaux de Paris (AP-HP), 75013 Paris, France
| | - N Weiss
- Brain Liver Pitié-Salpêtrière (BLIPS) Study Group, unité de réanimation neurologique, département de neurologie, Inserm, centre de recherche Saint-Antoine, Sorbonne université, groupement hospitalier Pitié-Salpêtrière Charles-Foix, Assistance publique des hôpitaux de Paris (AP-HP), 47-83, boulevard de l'Hôpital, 75013 Paris, France.
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Thabut D, Mallet M, Tripon S, Rudler M, Weiss N. Cirrhotic patients in icu with gastro-intestinal bleeding managed according to recent guidelines display altered brain hemoglobin oxygen’s saturation assessed by near infrared spectroscopy. Intensive Care Med Exp 2015. [PMCID: PMC4796769 DOI: 10.1186/2197-425x-3-s1-a692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Weiss N, Monneret D, Imbert-Bismuth F, Tripon S, Mallet M, Rudler M, Thabut D. Blood-brain barrier dysfunction assessed by protein S-100 beta levels in cirrhotic patients in ICU. Intensive Care Med Exp 2015. [PMCID: PMC4798052 DOI: 10.1186/2197-425x-3-s1-a813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Rudler M, Cluzel P, Corvec TL, Benosman H, Rousseau G, Poynard T, Thabut D. Early-TIPSS placement prevents rebleeding in high-risk patients with variceal bleeding, without improving survival. Aliment Pharmacol Ther 2014; 40:1074-80. [PMID: 25230051 DOI: 10.1111/apt.12934] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 06/25/2014] [Accepted: 08/04/2014] [Indexed: 01/02/2023]
Abstract
BACKGROUND Early-TIPSS (transjugular intrahepatic portosystemic shunt) placement may improve rebleeding and reduce 1-year mortality, compared to standard management in high-risk patients with cirrhosis and variceal bleeding. AIM To obtain external validation of this therapeutic approach. METHODS We performed a prospective study including all consecutive patients with Child-Pugh C 10-13 cirrhosis or Child-Pugh B with active bleeding at endoscopy admitted to our ICU between March 2011 and February 2013 for variceal bleeding. TIPSS were placed within 72 h after stabilisation. Patients were matched for gender, age, Child-Pugh score, MELD score and to patients from a historical cohort hospitalised before March 2011. RESULTS 31/128 patients with cirrhosis (77.4% men, mean age 53.2 ± 9.0 years old, MELD score 20.9 ± 6.9, Child-Pugh C: 77.4%) admitted for acute variceal bleeding between March 2011 and February 2013 (TIPSS+ group) were matched to 31 historical patients (TIPSS- group). Uncontrolled bleeding occurred in 1/31 patients in the TIPSS+ group vs. 2/31 patients in TIPSS- group (P = 0.55). The 1-year probability of being free of rebleeding was higher in the TIPSS+ group (97% vs. 51%, P < 0.001). Actuarial 1-year survival was not different between the two groups (66.8 ± 9.4% vs. 74.2 ± 7.8%, P = 0.78). Acute cardiac failure occurred more frequently in the TIPSS+ group (25.8% vs. 6.4%, P = 0.03). CONCLUSIONS Early-TIPSS placement effectively prevents rebleeding in high-risk patients with variceal bleeding but does not significantly improve survival. This might be due to the high proportion of patients with Child-Pugh C cirrhosis in our series. Cardiac failure may play a role and must be investigated before the procedure, when possible.
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Affiliation(s)
- M Rudler
- Department of Hepatogastroenterology, La Pitié-Salpêtrière Hospital, 47-80 boulevard de l'Hôpital, Assistance Publique-Hôpitaux de Paris, Pierre et Marie Curie University, Paris, France
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Rudler M, Thabut D. Letter: Peptic ulcer bleeding and liver cirrhosis--different diseases and different prognosis, too? Authors' reply. Aliment Pharmacol Ther 2013; 37:369-70. [PMID: 23281729 DOI: 10.1111/apt.12181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 11/24/2012] [Indexed: 12/08/2022]
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Rudler M, Rousseau G, Benosman H, Massard J, Deforges L, Lebray P, Poynard T, Thabut D. Peptic ulcer bleeding in patients with or without cirrhosis: different diseases but the same prognosis? Aliment Pharmacol Ther 2012; 36:166-72. [PMID: 22607536 DOI: 10.1111/j.1365-2036.2012.05140.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Revised: 04/03/2012] [Accepted: 05/01/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Physiopathology and prognosis of peptic ulcer bleeding (PUB) have never been described in cirrhotic patients. AIM To assess risk factors and outcome of PUB in two groups of patients with PUB with or without cirrhosis. METHODS We included prospectively all patients with PUB referred to our ICU of Hepatology and Gastroenterology between January 2008 and March 2011. All patients were treated according to international recommendations. Diagnosis of cirrhosis was based on clinical, biological and morphological exams. Aetiologies, characteristics and outcomes of PUB were compared in cirrhotic vs. noncirrhotic patients. RESULTS A total of 203 patients with PUB were included prospectively. Twenty-nine patients had cirrhosis (group Cirr+), and 174 patients had no cirrhosis (group Cirr-). Demographic data were similar between the two groups except for age and alcohol consumption. Aetiology of cirrhosis was alcohol in 97% of cirrhotic patients. Characteristics of PUB were not different between the two groups. Ninety-three per cent of patients with cirrhosis had endoscopic portal hypertension. Aetiology of PUB was different between the group Cirr+ and Cirr- (Helicobacter pylori = 10.3% vs. 48.8%, P < 0.0001; NSAID's = 17.2% vs. 54.0%, P < 0.0001; idiopathic PUB = 79.3% vs. 23.8%, P < 0.0001). Outcome was comparable concerning re-bleeding (7.0% vs. 6.9%, P = 0.31), need for arterial embolisation (10.3 vs. 8.6%, P = 0.76), need for salvage surgery (0 vs. 1.7%, P = 0.31) and mortality (3.0% vs. 1.1%, P = 0.87). CONCLUSIONS Physiopathology of PUB seems to be different in patients with cirrhosis. In cirrhotic patients, PUB occurs almost only in alcoholics. In our series, prognosis was similar to general population. PUB in cirrhosis might be related to portal hypertension and/or alcohol.
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Affiliation(s)
- M Rudler
- Department of Hepatogastroenterology, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Pierre et Marie Curie University, France.
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Rudler M, Rousseau G, Benosman H, Massard J, Deforges L, Lebray P, Poynard T, Thabut D. Peptic ulcer bleeding in patients with or without cirrhosis: different diseases but the same prognosis? Aliment Pharmacol Ther 2012. [PMID: 22607536 DOI: 10.1111/j.1365-2036.2012.05140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
BACKGROUND Physiopathology and prognosis of peptic ulcer bleeding (PUB) have never been described in cirrhotic patients. AIM To assess risk factors and outcome of PUB in two groups of patients with PUB with or without cirrhosis. METHODS We included prospectively all patients with PUB referred to our ICU of Hepatology and Gastroenterology between January 2008 and March 2011. All patients were treated according to international recommendations. Diagnosis of cirrhosis was based on clinical, biological and morphological exams. Aetiologies, characteristics and outcomes of PUB were compared in cirrhotic vs. noncirrhotic patients. RESULTS A total of 203 patients with PUB were included prospectively. Twenty-nine patients had cirrhosis (group Cirr+), and 174 patients had no cirrhosis (group Cirr-). Demographic data were similar between the two groups except for age and alcohol consumption. Aetiology of cirrhosis was alcohol in 97% of cirrhotic patients. Characteristics of PUB were not different between the two groups. Ninety-three per cent of patients with cirrhosis had endoscopic portal hypertension. Aetiology of PUB was different between the group Cirr+ and Cirr- (Helicobacter pylori = 10.3% vs. 48.8%, P < 0.0001; NSAID's = 17.2% vs. 54.0%, P < 0.0001; idiopathic PUB = 79.3% vs. 23.8%, P < 0.0001). Outcome was comparable concerning re-bleeding (7.0% vs. 6.9%, P = 0.31), need for arterial embolisation (10.3 vs. 8.6%, P = 0.76), need for salvage surgery (0 vs. 1.7%, P = 0.31) and mortality (3.0% vs. 1.1%, P = 0.87). CONCLUSIONS Physiopathology of PUB seems to be different in patients with cirrhosis. In cirrhotic patients, PUB occurs almost only in alcoholics. In our series, prognosis was similar to general population. PUB in cirrhosis might be related to portal hypertension and/or alcohol.
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Affiliation(s)
- M Rudler
- Department of Hepatogastroenterology, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Pierre et Marie Curie University, France.
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Poynard T, Massard J, Rudler M, Varaud A, Lebray P, Moussalli J, Munteanu M, Ngo Y, Thabut D, Benhamou Y, Ratziu V. Impact of interferon-alpha treatment on liver fibrosis in patients with chronic hepatitis B: An overview of published trials. ACTA ACUST UNITED AC 2009; 33:916-22. [DOI: 10.1016/j.gcb.2009.06.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Thabut D, Rudler M, Massard J. Rupture de varices œsophagiennes chez les malades atteints de cirrhose : quelles sont les questions encore sans réponse ? ACTA ACUST UNITED AC 2008; 32:614-9. [DOI: 10.1016/j.gcb.2008.03.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2007] [Revised: 03/18/2008] [Accepted: 03/26/2008] [Indexed: 01/06/2023]
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Rudler M, Pouchot J, Paycha F, Gentelle S, Grasland A, Vinceneux P. Low dose methotrexate osteopathy in a patient with polyarticular juvenile idiopathic arthritis. Ann Rheum Dis 2003; 62:588-9. [PMID: 12759303 PMCID: PMC1754555 DOI: 10.1136/ard.62.6.588] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Rudler M, Marquier E. [Medicolegal aspects of acute alcoholic intoxication]. Rev Prat 1993; 43:2081-4. [PMID: 8134789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The médico-legal aspects of acute alcohol intoxication mainly concern driving while under the effect of alcohol and the regulation thereof. In France, the legal limit is 0.8 mg of alcohol per litre of blood and 0.4 mg per litre of expired air. Examination is made by breathalyser on expired air. In the blood, measurement is performed by oxidation-reduction or gas chromatography, and in the expired air, by alcoholometry. Determination of the level of blood alcohol remains only approximate and a minimal indicator, given the variable number of factors that may intervene.
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Affiliation(s)
- M Rudler
- Laboratoire de toxicologie de la Préfecture de police, Paris
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Chéron G, Rambaud C, Rey C, Mahut B, Canioni D, Lavaud J, Rouzioux C, Hubert P, Rudler M, Brousse N. [Sudden crib death. Experience in a referral center 1986-1991]. Arch Fr Pediatr 1993; 50:293-9. [PMID: 8379815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Sudden infant death syndrome (SIDS) may have several etiologies, all of which must be identified in order to recognize those infants believed to be at risk. One of the best ways to do this is by prospective studies on a large population of infants who died of SIDS. METHODS A total of 171 infants who died from SIDS between January 1, 1986 and June 30, 1991, were studied. 154 infants were completely investigated, including a post mortem examination. They were assigned to one of 4 groups, according to whether death was due to diseases of poor prognosis (group A), diseases that are occasionally fatal but potentially treatable (group B), minor diseases not normally fatal (group C), or was essentially unexplained (group D). RESULTS The classical risk factors for SIDS were found in this population: incidence peaked in males (sex-ratio 1.5), during the cold seasons (62%), between 1 and 6 months of age (94%), mainly between 1 and 4 months of age (84%). Symptoms were definitely present during the 2 days before death in 50%. 20% of cases had clinical histories of congenital disease, complicated or recurrent postnatal disease, or fulminant recent disease. Group A included 107 infants (69% of the 154 completely investigated patients). Premature birth (17.5%) and low birth weight for gestational age (10.5%) were more frequent in our series than in the normal population. CONCLUSION The cause of death was identified in about 75% of cases. This possibility improves management of further siblings of SIDS victims even though the variety of risk factors makes prevention of SIDS difficult.
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Affiliation(s)
- G Chéron
- Département de Pédiatrie, Necker-Enfants Malades, Paris
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Hazebroucq V, Rudler M. [Radiological study of firearm projectiles. 3: Projectiles for sifled firearms]. J Radiol 1992; 73:557-62. [PMID: 1294730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- V Hazebroucq
- Service du Pr A. Bonnin, Radiologie A, Hôpital Cochin, Paris
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Hazebroucq V, Rudler M. [Radiological study of firearm projectiles. 2. Projectiles of smooth-bore guns]. J Radiol 1992; 73:133-7. [PMID: 1602439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- V Hazebroucq
- CCA, Service du Pr A. Bonnin, Hôpital Cochin, Paris
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Hazebroucq V, Rudler M. [Radiological study of firearm projectiles. 1. Introduction: the guns]. J Radiol 1992; 73:67-71. [PMID: 1545416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- V Hazebroucq
- Service du Pr A. Bonnin, Radiologie A, Hôpital Cochin, Paris
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Rudler H, Audouin M, Chelain E, Denise B, Goumont R, Massoud A, Parlier A, Pacreau A, Rudler M, Yefsah R, Alvarez C, Delgado-Reyes F. Aminocarbene complexes of chromium and molybdenum: initiators for cascade reactions with alkynes leading to new heterocyclic compounds via nitrogen ylides. Chem Soc Rev 1991. [DOI: 10.1039/cs9912000503] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Parlier A, Yefsah R, Rudler M, Rudler H, Daran J, Vaissermann J. Bidentate alkene aminocarbene complexes of chromium: Alkyne insertion with ring expansion versus alkyne insertion with cyclopropanation: Formation and crystal structure of a dihydroazepinechromium tricarbonyl complex. J Organomet Chem 1990. [DOI: 10.1016/0022-328x(90)80112-d] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Alvarez-Toledano C, Parlier A, Rudler H, Rudler M, Daran J, Knobler C, Jeannin Y. Synthèse de complexes du tungstène, du chrome et du rhénium contenant un ligand 1,4-bidenté carbéne-alcéne. J Organomet Chem 1987. [DOI: 10.1016/0022-328x(87)80252-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lecomte D, Trophilme D, Rudler M, Josset P, Lageron A. [Pulmonary complications in "sniffers"]. Rev Fr Mal Respir 1983; 11:713-717. [PMID: 6658157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
When a sudden death occurs, a necropsy is of the upmost value, but sometimes it does not yield the anticipated benefit; in this situation histological study of the specimens may help the diagnosis. We describe two decreased "sniffers" with pulmonary lesions that could have explained their sudden deaths. The histological appearance is often not recognised and considerably worsens the prognosis in subjects inhaling certain drugs.
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Parlier A, Rose F, Rudler M, Rudler H. Dinuclear μ-alkylidene complexes of tungsten from mononuclear, heteroatom-substituted vinyl-alkylidene complexes of this metal. J Organomet Chem 1982. [DOI: 10.1016/s0022-328x(00)96214-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rudler H, Rose F, Rudler M, Alvarez C. Preparation and reactivity of mononuclear and dinuclear carbene-alkene complexes of tungsten. ACTA ACUST UNITED AC 1982. [DOI: 10.1016/0304-5102(82)80007-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gaultier M, Conso F, Rudler M, Leclerc JP, Mellerio F. [Acute ethylene glycol poisoning]. Eur J Toxicol Environ Hyg 1976; 9:373-9. [PMID: 1026432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
During last 7 years, 13 cases of acute ethylene glycol poisoning have been observed with 4 fatal outbreaks. All cases--except one--were accidental. Six patients had drunk a mixture of antifreeze in water as they were lost in a desert. A patient who had taken 970 ml of ethylene glycol survived. In one case, death was due to irreversible brain damage; two other fatalities occurred from cardiorespiratory distress. CNS involvement was noticed in 8 cases and acute renal failure-constantly controlled-occurred in 9 patients. Post mortem examination has shown bi-refringent calcium oxalate crystals in both kidney and brain. Specific treatment with ethanol has been performed in 3 cases with ingestion of large amounts of toxic who were seen before definitive renal lesions have occurred. Emphasis is placed in symptomatic treatment including gastric lavage, extrarenal epuration and conservative management.
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Rapin J, Renault H, Robert J, Rudler M, Nouel JP. [Metabolism of bleomycin labled with a divalent cation. 2. Study of urinary metabolites in the rat and comparative study of tissue elimination of the cation alone or chelated by bleomycin]. Therapie 1973; 28:941-9. [PMID: 4136403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Robert J, Renault H, Rapin J, Rudler M, Nouel JP. [Cobalt-57 labeled bleomycin metabolism in the mouse. 1. Distribution and Kinetics]. Therapie 1973; 28:933-40. [PMID: 4136316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Gaultier M, Pebay-Peyroula F, Rudler M, Leclerc JP, Duvaldestin P. [Acute ethylene glycol poisoning]. Eur J Toxicol 1970; 3:227-34. [PMID: 5520477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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