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Biomedical subjects

C Gibert

Publications and source records attributed to C Gibert.

At least 73 records · Page 4Linked to original sources
PubMed1986

Short-term prophylactic antibiotics in patients undergoing prostatectomy: report of a double-blind randomized trial with 2 intravenous doses of cefotaxime.

The effect of short-term antibiotic prophylaxis on postoperative infection with 2 injections of cefotaxime begun preoperatively was evaluated in a double-blind, randomized, placebo-controlled trial at 1 center on 181 patients with preoperative sterile urine undergoing transurethral resection (90) or open prostatectomy (91). Antibiotic prophylaxis reduced the number of urinary infections significantly in both groups without altering the level of resistant pathogens. Cefotaxime lowered the incidence of postoperative infection in the early postoperative period from 30 to 4 per cent in the transurethral resection group and from 46 to 4.5 per cent in the open prostatectomy group. A significant difference was found between the 2 treatment groups in the incidence of perioperative bacteremia and postoperative fever. Among the patients undergoing an open prostatectomy a reduced rate of wound infection and a shorter duration of hospital stay were witnessed in the treated group. Thus, short-term chemoprophylaxis by cefotaxime is of benefit in reducing morbidity and hospital cost for prostatectomy by either procedure.

Cefotaxime↗
PubMed1986

Intragastric pH profile during acute respiratory failure in patients with chronic obstructive pulmonary disease. Effect of ranitidine and enteral feeding.

The ability of H2 receptor antagonists and continuous enteral alimentation to maintain high intragastric pH in patients with chronic obstructive pulmonary disease (COPD) requiring mechanical ventilation was evaluated by continuously monitoring intragastric pH prior to and following sequential addition of ranitidine or continuous enteral alimentation (or both) to their therapeutic regimen. Prior to therapy, intragastric pH was less than 4.0 for 75 +/- 10 percent of the time, but never less than 1.0. Nevertheless, this moderate gastric acidity was associated with evidence of mucosal injury. Ranitidine failed to continuously maintain a high intragastric pH (pH less than 4.0 for 35 +/- 11 percent of the time; p greater than 0.2 compared to patients treated with placebo). Following administration of continuous enteral alimentation, intragastric pH fell, and ranitidine therapy only partially blocked this increase in gastric acidity induced by continuous enteral alimentation. We conclude that without treatment, patients with COPD who have acute respiratory failure may develop gastric mucosal injury despite the presence of only moderate intragastric acidity; however, ranitidine and continuous enteral alimentation are not effective in maintaining a high intragastric pH.

Acute Disease↗
PubMed1986

Prosthetic valve endocarditis. The case for prompt surgical management.

Clinical and morphologic features are described in 27 patients with prosthetic valve endocarditis. The interval from valve replacement to onset of symptoms of prosthetic valve endocarditis was less than 2 months in 10 patients, longer than 2 months but less than 6 months in seven patients, and longer than 6 months in 10 patients. The most frequent infecting organism was Staphylococcus (11 patients). In nearly all patients, infection spread behind the site of attachment of the valve prosthesis and resulted in valve ring abscesses. Twenty-three of the 28 infected prostheses were partially or almost completely detached, and in 15 patients the infection destroyed the entire valve anulus, burrowing to adjacent structures in six. Despite prolonged bactericidal antibiotic therapy, bacterial cultures of prosthetic valves removed at operation or autopsy were positive in 14 patients. Standard valve replacement was attempted in nine patients. All were hospital survivors, but two of these patients evidenced rapid postoperative valve dehiscence and required a complex surgical procedure at reoperation. The 14 other surgically treated patients had almost complete destruction of the annular root, and surgical repair was achieved by complex surgical techniques. There were five postoperative deaths, but nine patients survived with no further evidence of infection (mean follow-up 34 months). All patients with early prosthetic valve endocarditis who recovered underwent this type of operative technique. Total exclusion of the infected annular root, as described, may offer in patients with extensive endocarditic lesions the only possibility to eradicate the infection and to reduce the mortality.

Adolescent↗
PubMed1985

Clinical and echocardiographic observations in pulmonary valve endocarditis.

Clinical and echocardiographic data from 12 patients with pulmonary valve endocarditis are described. Seven patients had isolated pulmonary endocarditis and in 5 patients other valves were infected (aortic, tricuspid, mitral or all 3). Two patients were heroin addicts and 4 had underlying heart disease (congenital heart disease in 3 and aortic regurgitation in 1 patient). The organisms involved were alpha streptococci in 3 patients (all with underlying heart disease), Staphylococcus aureus in 4, Streptococcus D bovis in 1 patient and Candida guillermondii in 1. M-mode and 2-dimensional echocardiography was performed in 10 patients and revealed vegetations in 8. Pulsed Doppler echocardiography was performed in 6 patients and revealed pulmonary regurgitation in all 6. Seven patients had pulmonary emboli. Four patients underwent surgery. Four patients died, including 1 after cardiac surgery. Five patients, including the patient infected with Candida guillermondii, recovered with antibiotic treatment.

Adolescent↗
PubMed1985

Use of granulated sugar in treatment of open mediastinitis after cardiac surgery.

19 critically ill adults with acute mediastinitis after cardiac surgery were treated with granulated sugar, either directly (11 patients) or after failure of continuous irrigation (8 patients). Mediastinal tissue cultures were positive in 18 patients. Packing the mediastinal cavity with granulated sugar every 3 or 4 h resulted in near-complete debridement of the wound and rapid formation of granulation tissue in all patients and sterilisation of the wound after an average of 7.6 days. Dressings were easy and painless to change. 5/19 (26%) patients died before discharge, but none because of wound complications. The rest were discharged on average 54.2 days (range 29-120) after initial debridement of the wound; 11 underwent secondary surgical closure of the wound and in 3 the wound healed by granulation tissue formation alone. No recurrence of sternal infection has occurred after a mean follow-up of 8.2 months (range 3 to 17).

Adult↗
PubMed1985

Nosocomial legionellosis, Paris, France. Evidence for transmission by potable water.

During a five-week period in 1981, six cases of legionellosis due to Legionella pneumophila serogroup 1 were recognized in a hospital in Paris, France. Four cases were clearly nosocomial in origin. There was a direct association between development of disease and exposure to potable hot water (p = 0.003). The entire hot water system was contaminated with L. pneumophila serogroup 1; monoclonal antibody testing demonstrated that the case isolate and the potable water isolates belonged to the same subgroup. Although serogroup 1 was isolated from both the cooling tower and its drift, the cooling tower isolate was antigenically distant from the case isolate. In other nosocomial outbreaks of legionellosis, multiple sources have been found within the hospital environment, but an epidemiologic association of disease with potable water had not been shown. The significant association of cases with exposure to the potable hot water supply, and the identification of case and potable water isolates of the same subtype, suggest that the potable hot water was responsible for transmission of disease in this outbreak.

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

Pharmacokinetics of apalcillin in intensive-care patients: study of penetration into the respiratory tract.

A pharmacokinetic study of apalcillin was performed in 12 patients in an intensive-care unit. All received a single dose of 30 mg/kg in a 30 min infusion followed by 90 mg/kg/day for four days; six patients (group A) were treated by intermittent administration for two days (30 mg/kg in 30 min infusion, three times daily), followed by continuous infusion for the next two days; six other patients (group B) first received continuous infusion followed by intermittent infusion. Serial serum specimens were collected after the first infusion and on the third and fifth days of treatment. Bronchial secretions were taken simultaneously via an endotracheal tube or the tracheostomy cannula, in order to study the penetration of the drug into the respiratory tract. Assays were performed by a microbiological method. A mean serum peak value of 87.1 +/- 6.13 mg/l 5 min after the end of the first injection was followed by a slow decrease in serum levels and a residual value of 6.29 +/- 3.21 mg/l (8h). Intermittent administration resulted in a mean serum peak of 79.56 +/- 12.35 mg/l whereas after continuous infusion, a steady state of about 30 mg/l was obtained. No significant difference was found between pharmacokinetic parameters for the two groups. In bronchial secretions, a mean peak value of 5.8 mg/l was attained by the second hour. Decreased levels in bronchial secretions measured after three or five days treatment were possibly related to a decrease in inflammation.

Ampicillin↗
PubMed1984

Prospective evaluation of the protected specimen brush for the diagnosis of pulmonary infections in ventilated patients.

To determine the relative cultural accuracy of the bronchoscopic protected specimen brush (PSB) in ventilated patients, we compared this method in the same area of the lung with histologic and bacteriologic examinations of pulmonary specimens. The procedures were concluded just after death when the ventilator was still functioning. Samples via the PSB were taken from a branch of the anterior basal bronchus of the left lower lobe, and immediate left thoracotomy was performed to obtain peripheral specimens from the corresponding segment for quantitative cultures. Twenty-six patients were studied; 6 had histologically proved pneumonia. Using quantitative cultures, a correlation was evidenced between PSB and lung cultures, especially in the subgroup of patients who received no antibiotic during the week preceding their death. No pneumonia was observed when PSB cultures isolated no organisms in concentrations greater than 10(3) colony-forming units (cfu) per ml. The PSB cultures at a level of 10(3) cfu/ml identified every patient with histologically proved pneumonia and every microorganism present in concentrations of 10(4) cfu/g or greater in the lungs. Moreover, in the subgroup of patients receiving no antibiotic, only 4 microorganisms were isolated by the PSB in concentrations greater than 10(3) cfu/ml and not found in the lung.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1984

Acute pneumonitis with bilateral pleural effusion after talc pleurodesis.

We describe a patient who developed acute pulmonary distress with bilateral interstitial infiltrates and pleural effusion following talc pleurodesis. Talc particles, obtained by bronchoalveolar lavage, were identified by transmission electron microscopy and chemical analysis. The patient improved with corticosteroid therapy. Acute respiratory failure can be a potential hazard of talc pleurodesis.

Adult↗
PubMed1984

[Bronchial diffusion of new anti-pseudomonal beta-lactams. Clinical significance].

In treating severe respiratory infections due to Pseudomonas aeruginosa and in patients with cystic fibrosis, new anti-pseudomonal beta-lactams constitute a good alternative to the traditional aminoglycoside antibiotic therapy. Among several criteria for the choice of an antibiotic, estimation of intrabronchial levels is to be taken into account. The authors report the results of the study of a new semi-synthetic penicillin, apalcillin, and two cephalosporins (cefsulodin, ceftazidime), active in vitro against Pseudomonas; their penetration into respiratory secretions was evaluated in 48 patients, intubated, tracheostomized, or undergoing fiberoptic bronchoscopy. Antibiotic concentrations were measured by the microbiological procedure. Bronchial penetration of apalcillin was early and noticeable, reaching a bronchial peak representing 20% of the simultaneous seric concentration. The local levels of cefsulodin and of ceftazidime did not differ from those achieved with cephalosporins studied previously; the bronchial peak reached 5,6 micrograms/ml for both drugs 2 hours after administration; this bronchial level corresponded to 15 to 20% of the serum concentration. The clinical response could not be evaluated due to the severe underlying pathology which compromised the outcome of the disease in the patients of this study. However, at least for apalcillin, a significant correlation was noted between bronchial levels, susceptibility of bacteria isolated in patients, and eradication of susceptible organisms.

Anti-Bacterial Agents↗
PubMed1983

[Pulmonary thromboembolic complications of catheterization using the Swan-Ganz catheter].

Twenty-two adult patients who had required catheterization with a Swan-Ganz catheter and had thrombosis of the internal jugular vein were investigated for pulmonary embolism. In 4 of these, pulmonary embolism was detected by angiography, and 2 patients who died with the catheter in situ had also pulmonary embolism. In 5 out of these 6 patients prophylactic heparin treatment failed to prevent this complication. This study suggests that the Swan-Ganz catheter placement is indicated only when the value of the information to be gained exceeds the potential risk.

Adolescent↗