Biomedical subjects
Publications and source records attributed to A Bertrand.
Tetracyclines are remarkably effective in brucellosis and give consistently good results. However, recurrences have been reported even after correct management. Combination therapy with tetracycline and streptomycin, advocated by the FAO/WHO, has improved results without giving complete satisfaction. Association of tetracycline with rifampicin suggested on sound theoretical grounds, has given promising results.
Sixty patients including forty two males and eighteen females, age range: 18-87 years, received antibacterial single drug treatment with latamoxef for septicemia. Forty nine patients had underlying conditions including multiple trauma, neoplasm, cardiovascular, metabolic and respiratory tract diseases. Causative pathogens were isolated in all cases. The predominant isolates were E. coli (thirty), Klebsiella pneumoniae (tent) and Enterobacter (seven). A single organism was isolated in fifty seven cases; in the other three cases two organisms were isolated from blood cultures. Mean daily dosage was 46.6 +/- 6.1 mg . kg-1 (range: 14-113 mg . kg-1). In the majority of cases (fifty two) dosage was 3 g . d-1 or less; in thirty cases it was no higher than 2 g . d-1. Duration of therapy ranged from six to thirty eight days. Serum titer was measured in many cases and latamoxef blood levels were assayed in nine patients. A satisfactory clinical response was achieved in fifty eight cases and fifty eight bacteriological cures were also obtained. There was no statistically significant difference in therapeutic response between the 2 g and 3 g daily dosage groups. Tolerance was very good; untoward effects were few and required drug discontinuation in one case only.
1. Nasal and bronchial mucociliary clearance have been studied in ten non-smokers (aged 19-23 years). Nasal mucociliary transport was evaluated by measuring the transport rate of a single radioactive (99mTc) particle deposited on the nasal mucosa. Bronchial clearance was measured after inhalation of insoluble radioactive anionic particles (diameter 7.4 +/- 1.5 micrometer). The initial deposition of the aerosol and subsequent clearance over 1 h was monitored with a gamma-camera. 2. The initial particle deposition was concentrated centrally and was similar in all subjects. The percentage of the total deposition located in the central zone was 78.2 +/- 5.8. The range for nasal transport rate (0-12.6 mm/min) and bronchial mucociliary clearance (18.6-77.0%) was large. 3. An inverse relationship (rS = -0.63, P less than 0.05) was observed between nasal transport rate and bronchial clearance, suggesting that, in young non-smokers, the lower the rate of the nasal mucociliary transport the faster the bronchial mucociliary clearance.
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Isotope investigation of reflex sympathetic dystrophy is not limited to an evaluation of bony up-take, it also includes examination of the early dynamic scintigraphy of the vessels. The late views of bone scans reflect, above all, the bone's affinity for phosphate complexes i.e. the degree of osteoblast activity. Generally, dystrophies, independent of their site, show increased locoregional uptake, often quite intense, which appears early in the course of the disease. This supports histopathological findings. There are several advantages in using the bone scan in the investigation of reflex dystrophy: early diagnosis before the development of radiological signs, precise evaluation of the local extension of the dystrophic process and detection of the incidence of multifocal forms, follow-up of the course of the disease, definition of new clinical forms: patchy algodystrophy partial, decalcifying dystrophy, sub-radiological dystrophy, the aetiology in certain sites (especially the hip). Early dynamic scans that dystrophy is accompanied by an increase in the vascular compartment and decreased circulatory flow, a sign of the local stage of the disease. There is also an increase of the interstitial compartment, greater than that of the vascular compartment, explaining the presence of edema. The pathophysiological information gained from dynamic studies is matched by the therapeutic information: evaluation, or even prediction, of the effect of a given drug (cortisone, calcitonin).
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Fifty one cases of Pseudomonas aeruginosa bacteriaemia observed during the last 12 years are reported. Thirty five patients were over fifty years old; 92 p. cent were admitted for several days and about 50 p. cent were in post-operative period. A previous antibiotherapy and an impaired status are promotive factors. The respiratory or peritoneal origins are the most frequent. All patients were feverish; 24 have had an infectious shock which was inaugural in 12 cases. Seven pneumonitis, 3 endocarditis, one pericarditis and 2 osteitis were observed. An ecthyma gangrenosum was noted in three patients. Mortality was 70 p. cent. Comparison between recovered and died patients improved bad prognosis of old age, post operative period, neoplasic, previous organica weakness and pulmonary or peritoneal origins. Used alone, colimycin has seemed to be more effective than aminosid antibiotics; but their association with betalactamins was better. An in vitro study of the susceptibility of 100 Pseudomonas aeruginosa strains has proved the interest of piperacillin and cefsulodin; azlocillin, cefoperazone and ceftriaxone are just less effective.
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Cefotaxime was administered as sole treatment (49 cases) or after failure of another previous antibiotic (17 cases) to 66 patients suffering from infectious diseases. The 78 infections thus treated included urinary tract infections (35), septicaemia or endocarditis (25), respiratory tract infections (7), osteitis (5), meningitis (4), biliary infection (1), and skin infection (1). The pathogens identified were more often enterobacteria: Serratia: 23, E. coli: 15, Klebsiella: 7, Proteus: 7, Enterobacter: 1, Providentia: 1, Pseudomonas: 5, Staphylococcus: 7, Pneumococcus: 4, Streptococcus: 2, Branhamella: 1. Cefotaxime was given either intravenously (2/3 of cases) or intramuscularly, at an average daily dose of 3.75 g (mean: 1.5-8 g). It was administered alone to 49 patients suffering from septicaemia and urinary tract infections caused by E. coli, Klebsiella and especially Serratia, and it was combined in 17 cases, particularly in meningitis and bone infections. The overall results of cefotaxime given in serious diseases were especially favourable in debilitated patients (88% therapeutic success). The local tolerance was good and side effects were not observed in any patient. Cefotaxime seems to be an active antibiotic, indicated in many severe septicemic or not septicemic infections, more particularly in diseases with multiresistant Gram negative pathogens.
We examined the effect of a 5 mmol/l concentration of EDTA on the stabilization of the five serum creatine kinase MM isoenzymes, resolved by thin-layer isoelectric focusing. In patient sera, total CK and CK-MB activities were stable during storage of the samples for two months at 4 degrees C even in the absence of EDTA. However, EDTA stabilized the labile MM and MM1 sub-bands, which are the first to appear in the blood after the release from the damaged tissue and its addition to blood samples intended for determining the MM sub-band pattern is recommended. The stabilizing effect of EDTA was emphasized at higher temperatures. EDTA protected the CK-MM pattern in myocardium extracts made in normal serum and incubated at 37 degrees C during 40 h, but was unnecessary when myocardium was homogenized in heat-inactivated serum. It is thought that EDTA could act by inhibiting a heat-labile component of human serum.
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The authors describe a new method of segmental analysis of the left ventricle by equilibrium gamma cinecardiography. The left ventricle in the left anterior oblique projection was divided into 16 triangular sectors with reference to the centre of gravity of the radioactivity of the end diastolic frame. The following parameters were calculated for each sector (the spatial equivalent of a quarter of an orange): end diastolic, end systolic and ejection activity and the regional ejection fraction. The percentage of normal and asynergic regions was deduced. The end diastolic activity of regions with ejection fractions of over 0,47 was compared to the total end diastolic activity to obtain the percentages. This method of segmental division has the advantages of being completely automatic, based entirely on an objective reference calculated by computer and of giving very reproductible quantitative results. The clinical applications in a series of I400 patients examined by this method were numerous (the detection of dyskinesia in acute myocardial infarction). It was particularly useful in chronological and follow-up studies (exercise scintigraphy before and after glyceryl trinitrite).
The authors report 118 cases of brucella osteoarthritis, of which 61 were observed over the last ten years. The most frequent localisations are spinal (53.4%), sacro-iliac (34.5%) and coxofemoral (15.5%). The clinical aspects are not very specific. The general signs, frequent during coxitis and to a lesser degree in spondylodiscitis, are rare during sacro-iliac involvement. The radiological appearance is mainly characteristic in the spine. The diagnosis is usually made in the laboratory, depending on a search for specific antibodies and delayed hypersensitivity tests. Treatment requires the use of intra-tissular and intra-cellular penetrating antibiotics (tetracycline and rifampicin) administered for a long period. The course usually leads to a cure without sequelae.
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