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Biomedical subjects

B Regnier

Publications and source records attributed to B Regnier.

At least 55 records · Page 3Linked to original sources
PubMed1988

Treatment of central nervous system toxoplasmosis with pyrimethamine/sulfadiazine combination in 35 patients with the acquired immunodeficiency syndrome. Efficacy of long-term continuous therapy.

Thirty-five patients with the acquired immunodeficiency syndrome (AIDS) and central nervous system toxoplasmosis, seen over a 30-month period, were treated with the combination pyrimethamine/sulfadiazine. All patients had clinical and computed tomographic scan findings consistent with active neurotoxoplasmosis. Mean duration of total therapy was six months. During the first two months of therapy, four patients died of acute neurotoxoplasmosis and 31 showed improvement. Of the 24 patients evaluable for long-term therapy, 14 (58 percent) achieved complete resolution and 10 had late clinical (n = 7) and/or computed tomographic scan (n = 6) sequelae. Six patients experienced 10 relapses, which occurred within six weeks of treatment discontinuation in seven of 10. Reintroduction of the combination led to complete resolution of the relapse in eight cases. These clinical results were correlated with brain anatomic findings in the 15 autopsied cases. Side effects, noted in 25 of 35, were mainly hematologic toxicity (n = 21) and cutaneous rash (n = 12). However, the combination had to be definitively stopped in only two cases and sulfadiazine alone had to be withdrawn in eight other cases. These data suggest that pyrimethamine/sulfadiazine is highly efficacious in neurotoxoplasmosis and that life-long therapy is needed to prevent relapses in patients with AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Pharmacokinetics of teicoplanin in critically ill patients with various degrees of renal impairment.

The pharmacokinetics of teicoplanin were studied in 15 adult patients in the acute phase of severe infections caused by gram-positive cocci. All the subjects were given a daily intravenous bolus dose of 6 mg of teicoplanin kg-1 (body weight). The pharmacokinetic study was performed over a 48-h period after injection 4. The subjects were categorized according to their mean creatinine clearances (ml.min-1.kg-1) during the study period: group 1 (n = 3), greater than 1.6; group 2 (n = 6), 0.8 to 1.6; and group 3 (n = 6), 0.15 to 0.8. Mean concentrations of teicoplanin in serum at 1, 24, and 48 h were 33 +/- 8, 9 +/- 3, and 6 +/- 2.5 micrograms.ml-1, respectively. The mean half-lives of the concentration-time curve from 12 to 48 h were 28 +/- 4, 44 +/- 24, and 48 +/- 14 h in groups 1, 2, and 3, respectively (group 3 versus group 1: P less than 0.05). The mean area under the serum concentration-time curve from time zero to 24 h was 344 +/- 92 mg.h.liter-1, and the mean hybrid volume of distribution was 1.09 +/- 0.46 liter.kg-1. These values were similar for the three groups, with a trend for larger areas under the curve in group 3. Creatinine clearance correlated directly with the total body clearance of teicoplanin (r = 0.70) and with the renal clearance of teicoplanin (r = 0.82). However, in critically ill patients, the wide interindividual variations in pharmacokinetic parameters are more relevant than those related to the variations in renal function when creatinine clearance is above 0.30 ml.min-1.kg-1. We concluded that, in such conditions, monitoring of concentrations of teicoplanin in serum is mandatory.

Adolescent↗
PubMed1987

Penetration of ciprofloxacin into cerebrospinal fluid of patients with bacterial meningitis.

We evaluated the diffusion of ciprofloxacin into the cerebrospinal fluid (CSF) in 23 patients with bacterial meningitis or ventriculitis undergoing treatment with other antibiotics. Three successive ciprofloxacin doses of 200 mg were administered intravenously at 12-h intervals, first between days 2 and 4 and again between days 10 and 20 after the admission. Concentrations of ciprofloxacin in plasma and CSF obtained at 60, 120, 240, and 480 min after the third infusion were determined by high-performance liquid chromatography. In addition, serial samples were obtained from ventricular fluid in four patients. The concentrations of ciprofloxacin in CSF ranged from 0.35 to 0.56 micrograms/ml. These concentrations were equal to or higher than the MICs for most of the enterobacteria.

Adult↗
PubMed1987

Two-year evaluation of misoprostol for carcinogenicity in CD Sprague-Dawley rats.

The carcinogenic potential of misoprostol, a synthetic prostaglandin E1 analogue with anti-ulcer potential, was evaluated in CD Sprague-Dawley rats. The compound was given daily by gavage at 24, 240, and 2,400 micrograms/kg, up to 150 times the daily human dose for 2 years. Necropsies were done on all animals and the incidences of non-neoplastic and neoplastic changes analyzed for significance by life table methods. The only statistically significant non-neoplastic finding was epithelial hyperplasia and hyperkeratosis of the gastric mucosa. These changes, which are characteristic of some prostaglandins, were expected. Other non-neoplastic findings were typical of known spontaneous conditions in this strain of rats. The most frequent neoplasm was the pituitary adenoma, followed by the mammary fibroadenoma, mammary adenoma, mammary adenocarcinoma, and thyroid C-cell adenoma. A rare neoplasm, squamous cell carcinoma of the ovary was found in two rats. There was no evidence that misoprostol is carcinogenic for CD Sprague-Dawley rats.

Alprostadil↗
PubMed1987

Twenty-one-month evaluation of misoprostol for carcinogenicity in CD-1 mice.

Misoprostol, a synthetic prostaglandin E1 methyl ester analogue with anti-ulcer potential, was evaluated for its carcinogenic potential in CD-1 strain mice. The compound was given daily by gavage at 160, 1,600, and 16,000 micrograms/kg for 21 months. Necropsies were done on all animals and the incidences of non-neoplastic and neoplastic changes analyzed for significance by life table methods. The only statistically significant non-neoplastic compound-related findings were epithelial hyperplasia and hyperkeratosis of the gastric mucosa and hyperostosis of bone in the marrow cavity of sternebrae and femurs. The changes in the gastric epithelium are characteristic of some prostaglandins and were expected. The bone hyperostosis was associated with misoprostol in high dosages, and was considered unique to the mouse. Other non-neoplastic findings were typical of known spontaneous conditions in mice. The most frequent neoplasm was the hepatocellular adenoma followed by lymphosarcoma, lung alveolar carcinoma, and Harderian gland adenoma. Several proliferative lesions of the duodenum were considered to be spontaneous. These were focal avillous hyperplasia, focal atypical hyperplasia, and junctional polyp. There was no evidence that misoprostol is carcinogenic for CD-1 mice.

Alprostadil↗
PubMed1987

[Cerebral toxoplasmosis in immunosuppressed patients: diagnosis and treatment].

Central nervous system toxoplasmosis was diagnosed in 12 immunosuppressed patients, eleven of whom had AIDS. Fever (9/12), confusion (7/12) and focal neurological manifestations (6/12) were the main clinical signs. Lumbar puncture yielded abnormal cerebrospinal fluid in 6/6 cases. Cerebral computed tomographic scan abnormalities, homogenous (2/12) or ring-like (9/12) contrast-enhancing mass lesions and/or low density lesions (6/12), were present in all patients. Brain biopsy confirmed T. gondii infection in 7/8 cases. The combination pyrimethamine-sulfadiazine accounted for complete resolution (4/8) or partial improvement (4/8) in eight out of 12 patients. Mean duration of therapy was 6.5 months (1-21.5 months) in 11 patients. No relapse was observed. In three cases spiramycin was ineffective in the prevention of neurotoxoplasmosis.

Acquired Immunodeficiency Syndrome↗
PubMed1986

[Treatment of septicemia and endocarditis with pefloxacine. 15 cases].

The therapeutic effectiveness of pefloxacin was evaluated in 15 patients admitted to an intensive care unit and suffering from septicaemia or endocarditis. Seven of these patients had a focal infection (acute anterior mediastinitis or epiduritis). Pefloxacin was combined with an aminoglycoside in 13 cases and with rifampicin in 1 case. Blood cultures became or remained negative in all patients. The associated focus of infection was sterilized in 5 patients; a pefloxacin-resistant pathogen was subsequently isolated in 2 other patients. Three patients died some time after the infectious episode. The minimum inhibitory concentration of pefloxacin ranged from 0.25 to 2 mg/l. The bactericidal activity of the serum at peak concentration was greater than or equal to 1/8 in all cases and greater than or equal to 1/32 in 10 cases. No resistant mutants were selected during treatment. However, 8 strains of a species different from that of the initial pathogen were isolated from a site other than the primary focus. Pefloxacin can therefore be used successfully in the treatment of systemic infections, but close monitoring of bacterial ecology is required.

Adult↗
PubMed1986

Experience with imipenem/cilastatin in the intensive care unit.

Twenty-two patients admitted to the ICU with a severe nosocomial infection caused by multi-resistant Gram-negative bacilli were treated with imipenem combined with cilastatin. We treated nine cases of meningo-ventriculitis, eight cases of septicaemia, four cases of mediastinitis, and one case of pneumonia. The bacteria responsible were Acinetobacter spp. (10), Pseudomonas aeruginosa (5), Enterobacter cloacae (5), Klebsiella pneumoniae (3), Proteus spp. (2), Streptococcus spp. (2), Serratia marcescens (1). More than one pathogen was isolated in five cases. The dosages ranged between 1.5 g to 4 g per day by intravenous infusion; the highest doses were used for the treatment of meningitis. The mean duration of treatment was 17 days. An aminoglycoside was combined with imipenem in 18 cases. Cure was obtained in 17 out of the 22 cases. Very rapid sterilization of the CSF in the cases of meningitis and ventriculitis was noted. Two patients died rapidly despite eradication of the bacteria. One case of meningitis relapsed but cure was subsequently obtained with continuation of the same treatment. In three cases of Ps. aeruginosa infection, resistant mutants were isolated from the sites of infection and were responsible for two failures and one colonization. Imipenem appears to be an antibiotic of choice in severe nosocomial infections including meningo-ventriculitis, especially those caused by Acinetobacter spp. and Ps. aeruginosa. It is also one of the few antibiotics active against both streptococci and multi-resistant Gram-negative bacilli. Careful bacteriological monitoring is recommended during treatment.

Adolescent↗
PubMed1985

[Treatment of severe staphylococcal infections. Failure of rifampicin in combination therapy. 4 cases].

Seven patients with severe methicillin-resistant Staphylococcus aureus infections (5 with bacterial endocarditis, 1 with mediastinitis and 1 with meningitis and septicaemia) were treated with rifampicin combined with vancomycin in 6 cases and with gentamicin in 1 case. The 7 strains initially isolated from haemocultures were resistant to methicillin and sensitive to rifampicin. In 4 of these patients (3 of whom received vancomycin and 1 gentamicin) clinical and bacteriological failure was observed, with selection of rifampicin-resistant mutants. Bactericidal activity was always mediocre in both serum and cerebrospinal fluid, with insufficient vancomycin and gentamicin concentrations in 3 patients. An in vitro study of the combined antibiotics by the chequer-board method suggested antagonism in 3 of these 4 cases. Thus, in spite of its excellent activity and unquestionable effectiveness, rifampicin should be used with caution in severe staphylococcal infections.

Anti-Bacterial Agents↗
PubMed1985

Preclinical toxicology profile of misoprostol.

The toxicity of misoprostol has been extensively examined in a variety of in vitro and in vivo studies. Preclinical studies evaluated acute and chronic toxicity, mutagenicity and carcinogenicity, and reproductive toxicity. Single oral dose studies in rodents and non-rodents indicate a safety margin of at least 500 to 1000 fold between lethal doses in animals and therapeutic doses in humans. Chronic toxicity studies (52 weeks) have been performed at daily oral doses of up to 300 and 9000 micrograms/kg body weight in dogs and rats, respectively. Rectal temperatures were increased at 100 and 300 micrograms/kg in dogs and serum iron was increased at 9000 micrograms/kg in rats. Stomach weights were increased in dogs and rats in a dose-correlated manner related, at least in part, to an increase in the number of normal epithelial cells (gastric hyperplasia). When drug treatment was stopped rectal temperatures, serum iron and stomach weights reverted to normal. Electron microscope studies on hyperplastic tissue showed that the ultrastructure was not affected. Hyperostosis has been observed, mainly in female mice, following prolonged drug treatment at high doses. Histological studies of bone tissues of rats and dogs and radiological studies of long bones of dogs following chronic administration of misoprostol showed that bone development was normal in all respects. Mutagenicity studies were negative and misoprostol was not fetotoxic or teratogenic in rats at oral doses up to 10000 micrograms/kg body weight, or in rabbits at doses up to 1000 micrograms/kg body weight.(ABSTRACT TRUNCATED AT 250 WORDS)

Alprostadil↗
PubMed1984

[Chronic endocarditis on valve prosthesis. 6 cases].

Six cases of chronic endocarditis (more than 1 year duration) have been extracted from a series of 72 cases of endocarditis (delayed in 49) associated with intracardiac prosthesis observed over a 15-year period. In these 6 cases endocarditis developed 6 months to 2 years after valve replacement. The prosthetic material included 3 Starr-Edward's valves, 2 Hancock's valves and 1 intracardiac patch. The micro-organism isolated were Streptococcus in 3 cases, Serratia and Corynebacterium in 1 case each. The 18-month to 5-year course of the disease was marked by 2 to 5 relapses separated by long periods of apyrexia. The most significant complications were dysimmune syndrome (5 cases), embolic accidents (2 cases) and prosthesis disinsertion (4 cases). Five patients benefited from antibiotic therapy; 4 were operated upon with recurrent disinsertion in 2 cases. Two patients died, one of repeated disinsertion, the other of myocardial dysfunction. Bacteriostatic antibiotics were administered continuously to 3 patients whose endocarditis persisted or relapsed, with satisfactory results in two cases followed-up for more than 2 years.

Adult↗