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Biomedical subjects

B Regnier

Publications and source records attributed to B Regnier.

At least 73 records · Page 4Linked to original sources
PubMed1984

Tricuspid infective endocarditis: 56 cases.

Fifty six cases of tricuspid infective endocarditis (TIE) were seen over a period of 15 years. The patients were divided into three groups, on the basis of the site of entry: (a) Thirty one TIE after abortion (6 cases) or in association with drug addiction (25 cases) are characterized by the young age of the patients and the organism (29 staphylococci), the existence of repeated pulmonary emboli and the relatively favourable prognosis (3 deaths). (b) Twelve TIE due to an intravenous infusion catheter (9 cases) or a visceral site of entry: older patients, resistant organisms (3 gram negative bacilli, 8 staphylococci, 5 of which were methicillin-resistant) and with poor prognosis (8 deaths). (c) Thirteen TIE where the site of entry was unidentified, running a sub-acute course, 7 due to streptococci, and often associated with involvement of the left side of the heart, which was the dominant prognostic feature (6 deaths). Mortality was 30%. Of predominant importance in prognosis was the sensitivity of the organism: 6 deaths out of 9 TIE due to methicillin-resistant Staphylococcus aureus and 3 out of 31 TIE due to a sensitive staphylococcus (P less than 0.01). Seventeen underwent surgery. Tricuspidectomy (8 patients) should be reserved for cases of uncontrolled infection. Surgery is not justified by the persistence of pulmonary emboli.

Adult↗
PubMed1984

Pneumococcal endocarditis.

Among 369 patients with native valve infective endocarditis observed during a 14-year period, 17 were related to S: pneumoniae. Fourteen of them were observed in the last 7 years. At the time of admission 13 exhibited purulent meningitis, 6 of them being comatose. An apparent portal of entry was present in 13 patients including Pneumonia (n = 11) and otitis media (n = 2). Major alcoholism was present in 6 cases. The mean delay between the onset of fever and the discovery of the cardiac murmur was 15 days (range 1 to 60). Twelve patients exhibited congestive heart failure with acute pulmonary oedema in 9. The aortic valve was involved in 12 and the mitral valve in 7 (in 2 patients both mitral and aortic valves were involved). Myocardial and/or annular abscesses were found in 7 patients. Nine patients underwent surgical procedure (3 died) whereas 6 comatose patients were not operated on and died. The overall mortality was 59%. Although antibiotics are effective, the severity of anatomical lesions leads to prompt surgical treatment. The high mortality is mainly due to purulent meningitis.

Adult↗
PubMed1984

Surgery in infective endocarditis.

Three hundred and seventy eight patients with infectious endocarditis (IE) were studied, including 299 cases of native IE [154 subacute (SIE), 145 acute (AIE)] and 79 cases of prosthetic endocarditis (PIE). One hundred and fifty patients were operated on (40%): 117 for haemodynamic complications, 10 for bacteriological indications and 23 for mixed indications (112 patients in the acute phase). Complications were more frequent in AIE than in SIE, in PIE than in native IE. Surgery is more urgent in aortic insufficiency and in Oslerian mitral stenosis (7 cases) than in mitral insufficiency. Eight tricuspid valvulectomies were performed. In 5 cases out of 11 rupture syndrome was cured without surgery. The patient's clinical condition contra-indicated surgery in 63 cases. The surgical mortality was 51/150 (34%). It was significantly lower in SIE (21%) than in AIE (39%), in native IE than in PIE (53%), after antibiotic therapy than in the acute phase. Mortality was not higher when surgery was performed before the 8th day of antibiotherapy but perivalvular leaks were more common (31% vs 4%, P less than 0.01). Mortality was higher when the culture of valve was positive than when it was negative (45% vs 26%, P less than 0.06). However, surgery should be immediately considered in cases of haemodynamic complications.

Acute Disease↗
PubMed1984

Vancomycin pharmacokinetics in critically ill patients.

Peak and trough vancomycin serum levels were measured in 37 severely ill patients following dosing using the Moellering nomogram. The peak and trough serum concentrations were 61.2 +/- 23 and 22.6 +/- 16.5 mg/l, respectively, and higher than expected. Vancomycin pharmacokinetics obtained from 10 other patients were also studied. In five patients with a creatinine clearance greater than 1 ml min-1 kg-1, a mean plasma elimination half-life of 7.8 +/- 2.8 h was calculated. In the five other patients with markedly reduced renal function (creatinine clearance less than or equal to 1 ml min-1 kg-1), the mean elimination half-life was 18.3 +/- 10.2 h. A correlation was observed between the vancomycin and creatinine clearance. Important inter-patient variations of vancomycin clearance for the same creatinine clearance was also noted. Tubular damage in critically ill patients with severe sepsis may explain our results of the decreased vancomycin elimination.

Creatinine↗
PubMed1984

Penetration of pefloxacin into cerebrospinal fluid of patients with meningitis.

We evaluated the diffusion of pefloxacin into the cerebrospinal fluid (CSF) in 15 patients with bacterial meningitis or ventriculitis, 14 of whom were treated with other antibiotics. Three doses of pefloxacin were administered at 12-h intervals to 11 patients intravenously and to 4 patients orally. Individual doses were 7.5 mg/kg in seven patients and 15 mg/kg in eight patients. Plasma and CSF levels were determined by a high-performance liquid chromatographic assay. The concentrations of pefloxacin in CSF were measured 2 h after the third intravenous dose and 4 h after the third oral dose. In patients receiving 7.5 mg/kg, peak levels in plasma ranged from 6.8 to 16 micrograms/ml, and trough levels were from 2 to 7.5 micrograms/ml. Concentrations in CSF ranged from 2.4 to 9 micrograms/ml. In patients receiving 15 mg/kg, peak levels in plasma ranged from 14 to 18.6 micrograms/ml, and trough levels were from 4 to 13.2 micrograms/ml. Concentrations in CSF ranged from 6.5 to 13 micrograms/ml. These preliminary data indicate that pefloxacin diffuses well into the CSF of patients with inflamed meninges.

Adolescent↗
PubMed1983

Neutropenia due to beta lactamine antibodies.

Neutropenia developed in 13 patients during treatment with beta lactamines. The time of onset ranged from eight to 27 days after beginning treatment and occurred with doses as low as 40 mg/24 hours. Concomitant symptoms were eosinophilia, rashes, and fever. Leucoagglutinins were detected in eight out of nine patients by the microleucoagglutination technique. Clinical and serological findings suggested that neutrophils become sensitised as a result of absorption on the cell membrane of drug-antibody immune complexes. An immune mediated pathogenesis for neutropenia induced by beta lactamine seems highly probable.

Adult↗
PubMed1983

[Treatment of enterobacterial meningitis in adults with intravenous lamoxactam].

Meningitis caused by Gram-negative bacilli creates difficult problems since most strains are multiresistant. The purpose of this study was to evaluate the effectiveness of lamoxactam administered intravenously. Eleven patients admitted to an intensive care unit with meningitis due to Gram-negative bacilli were treated with this antibiotic, administered alone in 9 cases. Three patients had ventriculitis. Eight survived. The MICs ranged from 0.06 to 0.5 microgram/ml in 10 cases. The CSF was sterilized and rapidly became normal. Meningeal concentrations varied from 1-5 to 62 micrograms/ml and the CSF was bactericidal. In one female patient the CSF was sterile on the 5th day of treatment but remained abnormal; the meningeal concentration of lamoxactam (35 micrograms/ml) was much higher than the MIC (2 micrograms/ml) but below the MBC (128 micrograms/ml), which was consistent with the absence of bactericidal effect of the CSF. Owing to its very low CMIs and satisfactory passage through the blood-brain barrier, lamoxactam administered alone can be successful in the treatment of Gram-negative meningitis and ventriculitis. However, the bactericidal effect of the CSF should be rapidly assessed.

Adult↗
PubMed1983

Influence of posture on gas exchange in artificially ventilated patients with focal lung disease.

Six patients were artificially ventilated for a focal lung disease localized to one lung in four cases and to both lower lobes in two. Despite an inspired oxygen concentration of 100% the mean PaO2 was 115 mmHg. The addition of PEEP slightly improved PaO2 in two patients but led to deterioration in four. We therefore studied the effects of posture. Patients with unilateral disease were placed in the lateral position with the healthy lung dependent. The two patients with both lower lobes involved were tilted into the Trendelenburg position. The mean PaO2 rose from 98.4 to 199.5 mmHg. Posture was maintained as long as a beneficial effect was demonstrable. The disappearance of this effect was associated either with recovery (three patients) or with the extension of the pneumonia (three patients). The improvement of gas exchange can be accounted for by the rearrangement of ventilation/perfusion relationships. This management could avoid the need for differential lung ventilation.

Adult↗
PubMed1982

[Shock during leptospirosis icterohaemorrhagica. Four cases (author's transl)].

Four patients with leptospirosis icterohaemorrhagica (LH) were admitted to an intensive care unit in a state of shock. Haemodynamic studies showed that the shock was due to three different mechanisms which were often associated or successive in the same patient: (1) septic shock with fall of systemic vascular resistance (SVR) and no widening of arteriovenous oxygen difference (AVDO2); (2) cardiogenic shock, probably due in part to specific myocarditis, with reduced left ventricular work and normal or high pulmonary wedge pressure; and (3) hypovolaemic shock with the increased SVR and widened AVDO2. These data suggest that haemodynamic studies are required in patients with LIH associated with shock in order to determine its mechanism and provide guidelines for its treatment.

Adult↗
PubMed1982

[Gram negative bacilli endocarditis ].

Gram negative bacilli endocarditis are unfrequent. Nevertheless we encountered 28 cases of them (8.8%) among 320 endocarditis of which 10 were primitive and 7 cases (10.9%) among 65 prosthetic endocarditis. Bacterial species were 12 Pseudomonas aeruginosa, 2 Ps, stutzeri, 1 Ps. maltophilia, 2 Klebsiella pneumoniae, 2 Escherichia coli, 3 Serratia marcescans, 1 Enterobacter cloacae, 1 Brucella, 1 Hemophilus aphrophilus, 1 Fusobacterium funduliformis, 18 cases were hospital acquired infections related to cardiac surgery (4 cases), intracardiac catheterization (5 cases), intravenous catheter (4 cases). Uncontrolled infection or cardiac insufficiency underwent respectively in 14 and 18 cases. The overall mortality was 50 p. cent. The death occurred more frequently in primitive endocarditis (70%) than in secondary native endocarditis (45%) or prosthetic endocarditis (29%). It was also more frequent in Pseudomonas endocarditis (59%) than with other species (36%) and more frequent when cardiac sufficiency was present (50%). 15 patients underwent surgical procedure of which 6 died (40%). The results were better if the infection was cured before surgical procedures: 5 deaths occurred when the culture of the valves remained positive (9 cases) but none when it was negative. The 5 most recent cases of prosthetic endocarditis were cured. Since 1979, no death occurred among treated patients. we concluded that surgery is usually necessary but after an effective antibiotic therapy over a 4 or 6 week period.

Adolescent↗
PubMed1982

[Psittacosis as a cause of acute respiratory distress syndrome (author's transl)].

Diagnosis of acute, primary extensive pneumopathies provoking severe hypoxemia is particularly difficult, became of the non-specific radiological findings, resulting from the oedema and associated alveolar collapse, and the fact that the clinical picture and biological test results are not very characteristic of a particular etiology. Similar findings may be obtained, therefore, in bacterial pneumopathies so-called typical pulmonary affections, certain forms of acute, tuberculosis, and other types of infection of three patients admitted for acute respiratory insufficiency, two died after treatment with a betalactamine, alone or associated with an aminoside, subsequent serology providing evidence of psittacosis. Diagnosis was immediately established in the third patient, the wife of one of the other cases, and she recovered after erythromycin treatment. The lungs of the two patients that died showed suggestive bronchiolitis and peribronchiolar alveolitis, together with obliterative alveolar granulations and fibrosis, probably secondary to the psittacosis, and responsible for the fatal outcome. Psittacosis as a cause of an extensive pneumopathy of probable infectious origin may easily pass unrecognized, typical etiologies being infections due to pneumococcus, Legionella pneumophila. Mycoplasma pneumoniae, and viruses. Erythromycin, active against these microorganisms, would therefore appear to be the antibiotic therapy that should be prescribed initially, those with wider spectrums being reserved for cases with atypical radiological findings, or when precise bacteriological data is available.

Adult↗