Exercise-induced death in sickle cell trait: role of aging, training, and deconditioning.

The pathophysiological process of exercise-induced death in subjects with sickle cell trait (SCT) remains unclear. Concerning the cause of death, authors have suggested stressful environmental conditions such as altitude, heat and humidity, or abnormal patient conditions such as deconditioning, fatigue, and disease. These conditions are thought to lead to hypoxemia, hyperlactatemia, acidosis, dehydration, hyperthermia, or exercise-induced rhabdomyolysis, all of which may initiate sickle cell crisis, disseminated intravascular coagulation, myoglobinuria, and renal failure. We report the case of a 41-yr-old, healthy, and apparently well-conditioned subject with SCT who died during a cross-country race under normal environmental conditions in good weather (in terms of temperature and humidity). The medical and athletic history of the subject were unremarkable. We refer to an epidemiological study that reported a relation between age and exercise-induced sudden death in subjects with SCT. We then review the pathophysiological effects of aging in association with deconditioning and high-level training reported in the literature, particularly the decrease in aerobic metabolism in deconditioned subjects, and the exercise-induced hypoxemia in highly trained subjects. We discuss the consequences of deconditioning and high-level training in subjects with SCT during exercise, and conclude that these factors may be involved in the age-dependent risk of exercise-related sudden death in subjects with SCT.

[Analytical study and processing of information from a primary intervention report]. / Etude analytique et traitement de l'information à partir d'une fiche primaire d'intervention.

Analytical study of treatment of information from a primary intervention by the S.A.M.U. were brought about with the aim of performing a "statistical" study of enumeration of the various possibilities, using three "standard" programmes. After exploitation of the statistical data, the card index is stocked on conventional magnetic tape and verified by different parameters permitting its identification. In addition, the concatenation of different card indices is easy to obtain, which makes it possible to carry out research into all existing file cards regardless of the month or year.

[A case of survival after 65 hours of immersion in the Mediterranean]. / A propos d'un cas de survie aprés 65 heures d'immersion en Méditerranée.

Survical time of a man immerged in sea water at a mean temperature of 20 degrees C was 65 hours. This remarkable tolerance of a professional diver to hypothermia is attributed to his adapted clothing and safety equipment, and to favourable atmospheric conditions. On the light of this accidental immersion, one must reconsider out of date concepts concerning sea rescue with respect to water temperature, clothing equipment of the ship-wrecked, meterological conditions and circonstances of accident.

[Continuous measurement of arterial pressure by means of an arterial catheter. Its value in secondary transport]. / La mesure en continu de la pression artérielle par voie sanglante, Son intérêt dans les transports secondaires

It is of no much use to try to assess the cardiovascular condition of patients with impending or confirmed shock by taking the blood pressure with the classical arm cuff, especially if arterfacts such as noise, vibrations, shaking etc... are interfering. Instant continuous measurement of blood pressure by means of arterial cannulation avoids those drawbacks and is a sure and efficient method of assessment of an often unstable, precarious and sometimes aggravated cardio-vascular condition by the very transportation. The S.A.M.U. of Montpellier used this technique in 15 cases. The authors are reporting their experience and also are evoking some technical problems that may occur.

[Use of constant perithoracic negative pressure in the transport of newborn infants with severe forms of idiopathic respiratory distress]. / Utilisation d'une pression négative constante périthoracique pour le transport des nouveau-nés atteints de formes sévères de détresse respiratoire idiopathique

The authors used for transportation of neonates in severe idiopathic respiratory distress the continuous perithoracic negative pressure method suggested by OUTBRIGE and STERN in neonate intensive care. The authors are describing the material used and are presenting their first encouraging results. This technique improves conditions and therapeutic efficiency in thus treated infants. The easy handling and accessibility of apparatus constitue an efficient and not too aggressive mean of treatment of those particularly frail and difficult to treat infants during transportation.

[The setting up of a computer system for records of first entries at the emergency medical assistance service in Montpellier]. / Mise en place d'un système d'exploitation par ordinateur de dossiers de fiches primaires au SAMU de Montpellier

The setting up of a computing device to exploit the files of first transports at the MONTPELLIER SAMU was started essentially in order to constitute a document both accurate and of easy access, able to memorize the physical and mental behaviour of a patient in a transient state. The results thus obtained include: 1 -- An analytical study with a part devoted to general data such as the number of injured people or of patients, the number of calls from various sources, the means of intervention etc. and a more specific part dealing with type of accident the determination of the traumatic impacts, the first therapy etc.; 2 -- A synthetical study that constitutes the second phase of the dealing with information thanks to the drawing up of graphs indicating the number of calls per accident according to the time, the age, the number of serious cases etc.