Biomedical subjects
Publications and source records attributed to B Riou.
A case of septicaemia due to gram-negative bacilli secondary to maxillary sinusitis occurring is reported in a patient intubated through the nose. The search of a purulent nasal discharge and the portable X-ray film were important in establishing the diagnosis. Removing the tube and antibiotics usually give a prompt recovery.
Twenty-four patients suffering hyperglycemic hyperosmolar nonketotic syndrome were studied retrospectively to define initial prognostic factors. Twenty percent of these elderly patients (mean age 76 +/- 4.6 yr) had no history of diabetes, and only 54% experienced coma, which was not related to the level of plasma osmolality or to final outcome. The overall mortality was 46%, but death was directly related to nonmetabolic disorders in 64% of cases. Age; sex; acute precipitating factors (except precipitating drugs); admission levels of serum sodium, serum potassium, blood glucose, plasma osmolality, and serum creatinine; and insulin, macromolecular, and total fluid volumes infused during the first 24 h in the ICU were not related to death. The simplified acute physiology score was approximately the same for both survivors and nonsurvivors.
Mechanical ventilation was able to induce a decrease in cardiac output and regional blood flow, especially hepatic flow. Thus, hepatic elimination of drugs with a high hepatic-extraction ratio, which was linked to alteration in hepatic blood flow, could be reduced during mechanical ventilation. The aim of this work was to determine the effect of mechanical ventilation on pharmacokinetic parameters of lidocaine, which is a well-known nonrestrictive elimination drug at the hepatic level. Five patients (mean age, 58 years) with normal hepatic function and quite similar gasometric parameters before and after weaning from mechanical ventilation were studied. With a washout period of 48 hours between mechanical ventilation and spontaneous ventilation, each patient was submitted to the following protocol: lidocaine in a bolus (1.5 mg/kg intravenously), followed by infusion (1.0 to 1.7 mg/min for 120 minutes). The results were that the peak plasma concentration after the bolus during mechanical ventilation was 3.22 +/- 0.37 mg/L (mean +/- SE) vs 2.40 +/- 0.35 mg/L during spontaneous ventilation (p less than 0.02). Steady-state plasma concentration during mechanical ventilation was 2.10 +/- 0.20 mg/L vs 1.64 +/- 0.16 mg/L during spontaneous ventilation (p less than 0.01). Total clearance was 604.2 +/- 87.0 ml/min during mechanical ventilation vs 775.0 +/- 112.1 ml/min during spontaneous ventilation (p less than 0.01). Elimination half-life was 245.2 +/- 50.6 minutes during mechanical ventilation vs 160.0 +/- 40.6 minutes during spontaneous ventilation (p less than 0.05). Distribution volume was 188.6 +/- 50.2 L during mechanical ventilation and 183.0 +/- 50.8 L during spontaneous ventilation (not significant). These preliminary data clearly demonstrated a decrease in lidocaine elimination in patients submitted to mechanical ventilation, but the magnitude of dosage adjustment of such a highly hepatic-extracted drug in patients submitted to mechanical ventilation remains to be investigated.
The distribution of Gram-negative bacilli species and their susceptibility to various antibiotics were surveyed over a 18-month period in an intensive care unit. Gram-negative bacilli were isolated from blood cultures (65), urine cultures (191), respiratory tract samples (176) or miscellaneous samples (69). The bacilli most frequently isolated from blood cultures were enterobacteriaceae (95%), including Escherichia coli (46%), Proteus (22%) and Klebsiella pneumoniae (12%). Pseudomonas aeruginosa was predominant in respiratory tract samples, and Serratia marcescens was more frequently isolated from urine cultures than from other samples. Antibiotic susceptibility testing was performed using a standard disc diffusion method. In view of the susceptibility of blood isolates to the second-generation cephalosporins we consider that these are preferable to third-generation cephalosporins for first-line antibiotic therapy of septicaemia due to Gram-negative bacilli, except for hospital-acquired infections. More than 50% of the bacilli were resistant to ampicillin; ticarcillin and mezlocillin were not very active against Klebsiella. Nalidixic acid was very active on urine isolates and therefore seems to be a good first-line antibacterial for lower urinary tract infections.
Explore the source record for details and available documents.
The influence of oral amiodarone on the anticoagulant effect of the coumarin derivative acenocoumarol has been investigated prospectively in 10 patients with normal renal, hepatic and haematological function and who were not in cardiac failure. The daily dose of acenocoumarol was sufficient to produce a prothrombin activity of 25 to 35%. When the prothrombin time had become stable amiodarone 600 mg/d was administered for 1 week followed by 400 mg/d for the next 3 weeks. A decrease in prothrombin activity from 30.5 to 20.2% was observed, associated with a decrease in vitamin K coagulation factors, after a mean of 4 days following commencement of amiodarone. In 6 patients a prothrombin activity less than 20% required a 60% reduction in the dose of acenocoumarol after 1 week of amiodarone 600 mg, and a 33% reduction after 3 weeks of amiodarone 400 mg. There was no correlation between the plasma amiodarone and the decrease in prothrombin activity. Inhibition of acenocoumarol metabolism by amiodarone is the most likely explanation of these findings.
Two cases of Legionnaires' disease proven by seroconversion in indirect immunofluorescence are reported. Creatine phosphokinase (CPK) was increased in both patients, and one had rhabdomyolysis with acute renal failure and acute respiratory distress. A review of the literature brought out 9 other cases of rhabdomyolysis associated with Legionnaires' disease. Myalgias are an inconstant warning symptom; renal impairment is present in more than one half of the cases, and although pulmonary lesions are moderate, respiratory muscle involvement may require mechanical ventilation. In view of the severe complications of rhabdomyolysis, CPK should be systematically assayed in patients with Legionnaires' disease; 57 p. 100 of whom, according to published reports, have high CPK levels. In a retrospective study of bacterial pneumonia caused by common pathogens, we found that CPK was elevated in 31 p. 100 of the cases. The mechanism of muscular involvement is discussed.
Some biological data of 63 acute alcoholic poisoning (without drug ingestion) in adults were studied during a brief hospitalization. Mean arterial blood concentration of lactate was 2,34 mmol/l +/- 0,13, of ethanol was 53 +/- 3,68 mmol/l. No correlation was found between these two variables and we have not registered lactic acidosis. Arterial blood acid base balance was normal for 24 of 38 unconscious patients. The results of other fourteen showed moderate acidosis, either mixed or respiratory either metabolic, without hypoglycemia or ketonuria. No correlation between arterial blood ions H+ concentration (44,72 +/- 1,18 nmol/l (m +/- sem) and concomitant arterial blood ethanol concentration was found. Moreover, no correlation between 46 blood glucose concentrations (without prior glucose perfusion) and alcoholemia was found. Only two 18 hours fasting chronic alcoholics showed hypoglycemia. These results confirm that acute ethanol intoxication is a potential respiratory emergency in adults, and not a metabolic one (this last pattern being true for children). No confusion between acute intoxication and alcoholic ketoacidosis, alcohol induced fasting hypoglycemia or shoshin beriberi must be made.
Lower respiratory tract secretions (LRS) were sampled during a two year period in patients undergoing mechanical ventilation using a method previously described by Matthew et al. Only those LRS positive for gram-negative bacilli were reported in this study. The patients were separated in two groups: those with nosocomial pneumonia due to gram-negative bacilli (NP+ group) and those without (NP- group). The species most often isolated from LRS were: Pseudomonas aeruginosa (25%), Proteus (20%), Escherichia coli (18%), Klebsiella pneumoniae (10%), Acinetobacter calcoaceticus (8%) and Haemophilus influenzae (7%). The spectrum of gram-negative species was not statistically different in either group of patients. The numbers of gram-negative bacilli isolated from each LRS were more important in the NP+ group (p less than 0.001), but so was the duration of mechanical ventilation before each LRS (p less than 0.01). In this group also, a specific bacteriological diagnosis with only one species was possible in 3 out of the 13 cases; a tentative diagnosis only was possible in 10 cases: in 6 cases, the responsibility of two (or more) species was suggested. The susceptibility to antibiotics of gram-negative bacilli isolated from LRS was moderate. A third generation cephalosporin together with amikacin seemed to be the best choice of antibiotics when no specific bacteriological diagnosis could be made with the LRS.
Explore the source record for details and available documents.
A 53 year old man with an anaplastic bronchial carcinoma was hospitalised for septic shock and acute respiratory distress after a cutaneous, probably staphylococcal infection, and died in spite of anti-staphylococcal antibiotherapy. The autopsy showed pulmonary, cardiac, cerebral and renal aspergillosis. A right heart aspergillous endocarditis, very rare in this pathology, was also discovered but there were no cardiac valves lesions. The patient was in an "immunodepressed" state as usually observed in pulmonary aspergillosis. The endocardial localisation of aspergillosis and the "pseudo-miliary" appearances of the pulmonary lesion indicated an extra-pulmonary portal of entry, cutaneous or intravenous which is unusual in this pathology. This hypothesis is supported by previous reports of pulmonary aspergillosis where right heart endocarditis is exceptionally rare and by aspergillous left heart endocarditis after open heart surgery where pulmonary aspergillosis is absent.
Antimicrobial sensitivities, especially trimethoprim-sulfamethoxazole, were studied in all clinical isolates of Escherichia coli in an intensive care unit for over 18 months. Twenty-four per cent of strains were resistant to trimethoprim-sulfamethoxazole. Combined resistance to ampicillin +/- chloramphenicol (+/- tetracycline) and streptomycin (+/- kanamycin) with resistance to trimethoprim-sulfamethoxazole was demonstrated. These data confirm the previously reported increasing trimethoprim-sulfamethoxazole resistance which is probably plasmid-mediated and specify the resistances associated with trimethoprim-sulfamethoxazole resistance. These findings suggest that widespread prophylaxis in granulocytopenic patients with lower urinary tract infection by the trimethoprim-sulfamethoxazole association should be re-examined.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
A 46-year old patient under noramidopyrine treatment was admitted for acute renal failure. Renal biopsy was performed and showed acute interstitial nephritis without staining at immunofluorescent microscopy. In vitro and in vivo immunological tests using noramidopyrine as antigen were all negative. Abnormal serum creatinine levels were still present 4 months later. To our knowledge, noramidopyrine has rarely been the cause of interstitial nephritis (only one other case has been published), but it has frequently been responsible for drug-induced blood diseases, and noramidopyrine-related drugs have previously been involved in drug-induced nephritis. As the renal damage can probably be explained by a delayed hypersensitivity reaction, an early corticosteroid treatment would help in improving renal function.
Explore the source record for details and available documents.