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Biomedical subjects

B Becq-Giraudon

Publications and source records attributed to B Becq-Giraudon.

At least 91 records · Page 5Linked to original sources

[Acute reversible agranulocytosis during ceftriaxone treatment].

A 75-year-old man developed acute transient agranulocytosis. Hematologic data and course were suggestive of a toxic etiology. The patient had been admitted for pneumococcal septicemia and a polymicrobial abscess of the soft tissues of the left leg. At the time of diagnosis of the agranulocytosis, he had received 36 g ceftriaxone. The agranulocytosis resolved following discontinuation of ceftriaxone. This drug was, in all likeliness, responsible for the hematologic disorder. Renal failure occurred concomitantly with the agranulocytosis. Other similar cases have been reported. In view of these data, blood counts should be monitored in patients receiving prolonged courses of ceftriaxone.

Abscess↗

[Cardiac manifestations of Lyme disease].

Three cases of Lyme's disease with cardiac involvement are reported. One patient had myocarditis complicated by symptomatic complete AV block and two patients had asymptomatic 1st degree AV block. There were no abnormalities on echocardiography. The cardiac changes occurred between the 18th and 40th day after the onset of the disease and persisted 10 days: however these conduction defects may vary within a few hours. A rapid and complete cure was obtained with antibiotic therapy.

Adult↗

[Blood bactericidal activity and clinical course of 168 patients having septicemia].

The value of serum bactericidal activity (SBA) determination for assessing the effectiveness of antibiotic therapy was evaluated in a retrospective open study in 168 cases of septicemia. Outcomes in a first group (I) of 67 patients with a SBA of at least 1/4 were compared with outcomes in a second group (II) of 101 patients with a SBA below 1/4 or non-determined. Within these groups, outcomes of 37 septicemias due to Gram negative bacilli (subgroup Ia) and 22 staphylococcal septicemias (subgroup Ib) with a SBA greater than or equal to 1/4 were compared with outcomes in 26 septicemias due to Gram negative bacilli (subgroup IIa) and 22 staphylococcal septicemias (subgroup IIb) with a SBA less than 1/4. Statistical analysis of distribution of age, sex, underlying disease, biologic parameters and antibiotics given demonstrated no significant difference between the various groups. 56 patients (86.1%) recovered in group I, against 76 (79.1%) in group II; corresponding figures are 34 (91.1%) and 21 (84%) in subgroups Ia and IIa respectively. These differences are not significant (p greater than 0.05). Our findings suggest that an "effective" SBA fails to correlate with favorable outcome of septicemia.

Aged↗

[Cardiac insufficiency in infectious endocarditis].

The aim of this study of 101 cases of infective endocarditis was to determine the factors predisposing to cardiac failure, the prognostic factors of this complication and the therapeutic implications. A significant (p less than 0.05) Chi square test was the statistical reference. Fifty-two per cent of patients developed cardiac failure which was biventricular in 48 p. 100 of cases and the presenting symptom in 64 p. 100. The mean age of the patients with cardiac failure was 56.6 years with a clear male predominance. In 48 p. 100 of cases, cardiac failure complicated a pre-existing cardiac lesion which was usually acquired (84 p. 100). The commonest condition was valvular insufficiency of the aortic and mitral valves (70 p. 100 of cases with cardiac failure). Severe cardiac failure was observed more frequently and earlier in aortic than in mitral regurgitation. The commonest infecting organism was the streptococcus (53 p. 100 of cases with cardiac failure) and the most frequent presumed portal of entry was dental (25 p. 100). Arrhythmias were observed in 51 p. 100 of patients in cardiac failure, the commonest being atrial fibrillation (34 p. 100) complicating mitral valve disease in 56 p. 100 of cases; 17 p. 100 of arrhythmias were ventricular. Conduction defects were observed in 26 p. 100 of cases with cardiac failure, 55 p. 100 of which had aortic valve disease. Valvular vegetations were demonstrated by echocardiography in 43 p. 100 of cases with cardiac failure. Valve replacement had to be performed for resistant cardiac failure in 13 p. 100 of cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

[Current aspects of infectious endocarditis. Review of 101 cases].

One hundred and one cases of infectious endocarditis were reviewed, from 1966 to 1982. The mean age of the patients was 56.3 +/- 15 years. There was a marked predominance of men (70.2 p. 100); the commonest portal of entry was dental (45.9 p. 100); the number of iatrogenic portals of entry and cases of endocarditis on prosthetic valves has been increasing in recent years. Blood cultures were positive in 83 p. 100 of cases; the commonest responsible organism was the non-D streptococcus (31 p. 100 of cases) followed by the D streptococcus (18.8 p. 100), the staphylococcus aureus (17.8 p. 100), and the staphylococcus epidermidis (2.9 p. 100). Gram-negative bacilli were isolated in 9.9 p. 100 of cases. Rare and slow growing organisms have been isolated since 1977. Echocardiography was then introduced and helped the diagnostic in 70 p. 100 of cases. Circulating immune complexes were measured in 25 patients and were found to be raised in 14 cases (56 p. 100). The commonest complication was cardiac failure (43 p. 100) which led to valve replacement in the acute phase in 14 p. 100 of cases. The occurrence of cardiac arrhythmias was a poor prognostic factor. The other complications were neurological (15 p. 100), renal (10 p. 100), embolic (19 p. 100), and pulmonary (9 p. 100). The mortality rate in the acute phase was 30 p. 100 and the probability of a five year survival was 54 p. 100.

Adult↗

[Infectious endocarditis in the elderly].

Thirty three cases of infectious endocarditis in patients over 65 years of age (mean age: 72,5 years) observed between 1966 and 1982, were analysed; there were 22 male and 11 female patients, a male predominance of 67%. The data was compared with 68 cases of patients aged less than 65 years of age (mean age: 48,4 years; 49 male and 19 female patients, a male predominance of 72%) treated during the same period. In the patients over 65 years old, compared to those under the age of 65, we observed that: the previous condition of the cardiac valves was more commonly unknown (39% compared to 21%), rheumatic valvular disease was rare (12% of cases), the diagnosis was not delayed, the reason for hospital admission was usually a complication (30% compared to 7%), the two cardinal signs (pyrexia and a cardiac murmur) were always present, as in the younger age group, the urinary tract was the only commoner site of primary infection, the blood cultures were as frequently positive in both groups (79% compared to 85%), in cases with negative blood cultures, antibiotics had not always been given beforehand, but this was commoner than in the younger age group, the causal organisms and usual biological changes were unremarkable, echocardiography, often more difficult because of the high incidence of valvular thickening, remained a valuable tool for diagnosis and management, cardiac failure was more common (55% compared to 37%) as were neurological complications (24% compared to 10%) and renal failure, mortality was greater (39% compared to 25%) and higher in both groups in patients with aortic valve disease and infection with staph-aureus.

Aged↗

[Immunoblastic lymphadenopathy occurring during treatment with carbamazepine. 2 cases].

Dysimmune lymphadenopathies during carbamazepine treatment. A report of two cases. We report on two cases of dysimmune lymphadenopathies with histological aspect of angio immunoblastic lymphadenopathy (AIL) developing after administration of carbamazepine. Clinical manifestations consisted of fever, erythroderma, generalized pruritus, facial edema, lymphadenopathy, liver enlargement. The two patients had anemia, hypogammaglobulinemia, impaired liver function and a negative Coomb's test. Lymphocyte stimulation test with carbamazepine in vitro was positive in both cases. Lymph node biopsy disclosed the angioimmunoblastic proliferation characteristic of AIL. After discontinuing carbamazepine, a complete remission was obtained.

Carbamazepine↗

[Peripheral neuropathy during treatment with ornidazole].

The case is reported of an 18 year old patient who developed a peripheral neuropathy after being given 1.5 g ornidazole daily for 6 days and 2 g daily for 16 days (total dose: 41 g). Bilateral radial paralysis was noted clinically, whilst electrical investigations showed diffuse motor and sensitive anomalies. Three months after the drug had been stopped, all symptoms and signs had disappeared. The pathogenesis of this complication is discussed. The part played by ornidazole is suggested but cannot be proved because of the multiple disorders presented by the patient.

Adolescent↗

Rheumatological manifestations of infective endocarditis.

A retrospective study showed musculoskeletal manifestations in 32 of 108 patients treated for infective endocarditis in several departments at the Poitiers CHU. Such manifestations included articular pain or aseptic arthritis, typically involving the major joints, as well as vertebral osteomyelitis, low back pain (inflammatory or non-inflammatory), and myalgia. Patients showing such signs were generally younger than those without musculoskeletal involvement, diagnosis was made later, and prognosis was worse; streptococcus D was more often involved, and microscopic haematuria was more common. With the exception of vertebral osteomyelitis, the pathogenesis was not clear.

Antigen-Antibody Complex↗

[2 new cases of myocardial infarction after injection of vincristine].

The authors report two cases of myocardial infarction following the injection of vincristine. The vincristine is held responsible for several reasons: absence of past history or risk factors of coronary artery disease, no past history of mediastinal radiotherapy, the development of coronary manifestations several hours after the injection of vincristine. Both cases followed a fatal course. The pathophysiology of this iatrogenic complications is unclear. Any patient receiving such treatment should be carefully monitored clinically and electrocardiographically.

Aged↗

[Plasmodium falciparum malaria acquired in Kenya with type II or type III resistance to amino-4-quinolines].

The authors report a case of Plasmodium falciparum malaria acquired in Kenya by a French tourist under correct chloroquine prophylaxis. She recovered under quinine and a sulfadoxine-pyrimethamine association. This is a new case of high level resistance (R II or R III) of Plasmodium falciparum to amino-4-quinolines recognized in East Africa. Malarial chemoprophylaxis recommended until now for this area may need to be reviewed.

Adult↗

[Wissler-Fanconi syndrome and Still's disease in adults. Nosological and etiological problems and borderline forms. Apropos of 7 cases].

In both Still disease and Wissler-Fanconi syndrome, onset may occur in adulthood and the clinical picture includes acute, often migratory, polyarthritis, polymorphic exanthema and a major inflammatory syndrome with fever (often intermittent) and high polymorphonuclear leukocyte counts. The grounds for this double designation are not clearly stated in the medical literature: does it refer to two separate entities or not? Some authors plainly stand for a unitary opinion. We report on seven cases in adults, five of which recovered without sequellae, while two developed respectively into rheumatoid arthritis and seronegative polyarthritis. We therefore propound a dualistic concept although, in the present state of our knowledge, there is no means of predicting at onset whether the disease will resolve or progress towards polyarthritis. We suggest that the term Still disease be used only when chronic and/or destructive arthritis develops. Among the forms which are neither chronic nor destructive, there seems to be a number of cases in allergic patients with poor tolerance of chrysotherapy. Some of these patients could recover after the cure of an often latent focal infection, usually of the upper respiratory tract, ear or oral cavity, resistant to antibiotics. In the other cases, corticosteroid therapy is usually very effective in arresting an exacerbation of the disease.

Adult↗