[Acute severe pneumopathie: legionnaires' disease?].
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Biomedical subjects
Publications and source records attributed to C Gibert.
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Overdosage of muscle relaxant has been given as a possible explanation for the hypotensive episodes occurring during the management of tetanus. The aim of the present work was to study the pharmacokinetics of pancuronium during long term infusion. Pancuronium was administered to eight patients with severe tetanus for a period varying from 8 to 24 days. The concentration of pancuronium was measured daily in plasma and urine using a fluorimetric method. The plasma concentration varied from 0.27 to 0.48 microgram/ml. No tendency to accumulation was observed. The plasma concentration fell rapidly below the level associated with muscle relaxation when pancuronium was discontinued. This absence of accumulation can be explained by a rapid elimination of pancuronium through the kidney according to a process of ultrafiltration.
Four tricuspid endocarditis cases are reported. Echocardiography found, four times, large vegetations on the tricuspid leaflets leading to the diagnosis. The degree of tricuspid insuffisancy was appreciated by the RV/LV ratio. Successive echos have permitted to survey the evolution and specially to establish a clear decrease of abnormal tricuspid echoes succeeding to pulmonary embolisms. In the four cases, surgery confirmed the diagnosis.
The appearance of a diastolic murmur in a pyrexial patient 15 days after trauma was suggestive of infectious endocarditis. This diagnosis was excluded, especially by echocardiography, and the aortic incompetence was attributed to the trauma. The value of echocardiography and the features of other reported cases are discussed with referrence to this case.
After retrospective in intensive care unit of 100 severe cases of pneumococcal infection in three years, the authors analyse the circumstances of onset (occurring in autumn of winter), the general status (without evident high risk population), the symptomatology (84% of meningitis, 30% of pneumonia), the origin of infection (essentialy otitis media in meningitis). The case fatality rate is 39%. Frequency of multiple visceral localisations and of bacteremias is emphasized.
Immunological survey of 3 patients with proved rabies encephalitis shows three interesting facts. 1) An IgM local synthesis, sometimes proportionally higher than IgG local synthesis, is observed in 8 CSF (among 13 investigated) and detected early, during the first week of the disease for 2 patients. 2) A relative poor IgG response is noted; this response is absent in one and decreasing in the 2 others patients despite their progressive aggravation. 3) A very little elevation of blood nucleic antibodies is detected in 5 CSF only. This very poor synthesis of antinucleic IgG contrast with their common increase in viral encephalitis. Thus, a viral immunosuppression may be discussed in rabies encephalitis, which may contribute to the lethal prognosis.
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Techniques usually employed for the detection of rabies' antibodies are costly, time consuming, and sometimes fail to detect early antibodies. The introduction of immunoenzymatic techniques in the serology of viral disease represents a new and important advance. We therefore adapted this technique to the detection of rabies antibodies. We have found that the sera from rabies patients who had not received antirabies treatment do not show seroneutralizing antibodies until several days after the onset of symptoms. However, antibodies can be detected some days earlier by the immunoenzymatic method in the same samples. Furthermore, the immunoenzymatic test was applied to the detection of both the IgM or the IgG class of antirabies antibodies using an antihuman Ig-or antihuman IgG-peroxydase conjugate.
Five patients were found during surgery or at necropsy to have the mitral valve orifice obstructed by vegetations. They had had unexplained severe and recurrent episodes of acute febrile pulmonary oedema, and four had few cardiac ausculatory findings. Three patients died suddenly and unexpectedly; the other two were operated on and survived. In view of its ominous prognosis, acute mitral valve obstruction should be considered in patients whose pulmonary symptoms are compatible with endocarditis and are not adequately explained by the findings on examination of the heart. The condition, which should be confirmed by echocardiography, requires emergency surgery.
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9 cases of Pseudomonas aeruginosa endocarditis are reported and the results of this study are compared with the data of the literature. The source of infection was known in 8 patients: 7 were nosocomial infections (cardiac catheterization in 5 cases, cardiac surgery in 2 cases). The diagnosis was made in 8 patients with left-sided endocarditis. In 1 patient tricuspid endocarditis was diagnosed on postmortem examination. Carbenicillin associated with an aminoglycoside antibiotic appeared to be the most effective treatment when prescribed for several weeks. 6 of 9 patients died of uncontrolled septicemia, 3 of whom underwent surgery which was twice performed because of poor hemodynamic status. In the other 3 patients drug administration was effective at first. However, a relapse occurred in these three cases compelling another effective antibiotic therapy. Surgery was peformed in these three patients. Valve cultures were negative in two cases and positive in 1. These 3 patients survived. They are still alive after a follow-up period of 2 or 3 years.