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Biomedical subjects

C Regamey

Publications and source records attributed to C Regamey.

At least 37 records · Page 2Linked to original sources
PubMed1998

Once-daily sparfloxacin versus high-dosage amoxicillin in the treatment of community-acquired, suspected pneumococcal pneumonia in adults. Sparfloxacin European Study Group.

The objective of this randomized, double-blind, multicenter study of 329 adult patients requiring hospitalization was to compare the safety and efficacy of sparfloxacin at a dosage of 200 mg once daily (following a 400-mg loading dose on day 1) with those of amoxicillin given as a 1-g oral dose three times daily for treatment of community-acquired pneumonia suspected to be due to Streptococcus pneumoniae. Success of treatment was determined by a combination of clinical assessment and chest radiography. Pneumococcal pneumonia was the confirmed diagnosis for 177 patients (54%). Overall rates of success among evaluable patients were equivalent between drugs, both at the end of treatment (sparfloxacin, 92%; amoxicillin, 87%) and at follow-up (sparfloxacin, 89%; amoxicillin, 84%). Sparfloxacin was well-tolerated and produced fewer gastrointestinal effects than amoxicillin. In conclusion, sparfloxacin is a safe and effective alternative to high-dose amoxicillin for the treatment of suspected pneumococcal community-acquired pneumonia.

Adult↗
PubMed1996

[Treatment of osteomyelitis with oral bactericidal antibiotics-- description of 9 cases].

The efficacy of oral bactericidal antibiotics in the treatment of osteomyelitis is analyzed retrospectively by a review of 9 cases histories. The first patient was treated in 1982. Clinical and laboratory controls were reviewed up to 1.1.1995. In 6 patients S. aureus was isolated, while in 3 patients the organism could not be cultured but gram + cocci were almost likely. 5 cases of osteomyelitis were acute, 4 were chronic and in one case there was an infection of an artificial knee prothesis. The isolated S. aureus were sensitive to the antibiotics prescribed. 8 patients received a combination of flucloxacillin (2-4 g/day) and rifampicin (600 mg/day); one patient was treated with the combination amoxicillin/clavulanic acid (1500/425 mg/day) followed by ofloxacin (400 mg/day) and finally co-trimoxazole (320/1600 mg/day). 3 patients received all antibiotics orally; in 6 patients oral administration followed a short intravenous course of the antibiotic combination. The duration of treatment varied between 6 and 23 weeks. Follow-up extended over 9 months (n = 1), 14 months (n = 3), 4-7 years (n = 3), and 10-12 years (n = 2). In 8 cases the osteomyelitis was cured (89%). In our view, a combination of bactericidal oral antibiotics with good penetration into bone tissue can be prescribed in selected cases of osteomyelitis to shorten or even avoid the standard intravenous therapy of acute or chronic diseases.

Administration, Oral↗
PubMed1996

Disseminated infection due to Actinomyces meyeri: case report and review.

Actinomyces meyeri is rarely isolated in cases of actinomycosis. We present a case of disseminated actinomycosis due to A. meyeri; the patient had an abscess of the lung, osteomyelitis of the tibia, and multiple skin abscesses. Cure was achieved with surgical debridement and administration of intravenous penicillin, followed by oral penicillin, for 1 year. A concomitant gram-negative bacillus, Actinobacillus actinomycetemcomitans, was also isolated. Review of the literature revealed only 26 well-documented cases of infection with A. meyeri. Male adults are mainly affected, and alcoholism is frequently the underlying condition in these patients. Associated bacteria were isolated in two-thirds of these cases. In contrast to other species of Actinomyces, A. meyeri often causes pulmonary infection and shows a tendency for hematogenous dissemination. Even though multiple organs are involved, the outcome for these patients is excellent when penicillin is administered for several months and surgical procedures are performed when necessary.

Abscess↗
PubMed1996

Sparfloxacin for the treatment of community-acquired pneumonia: a pooled data analysis of two studies.

A pooled data analysis of two double-blind studies encompassing 1137 episodes of community-acquired pneumonia in hospitalised adults, of which 560 were treated with sparfloxacin and 577 were randomised to comparator antibacterial agents (amoxycillin/clavulanic acid, erythromycin or amoxycillin administered at reference dosages), was performed. The global efficacy rate at the end of treatment in evaluable patients treated with sparfloxacin was 88.3% compared with 84.1% in those who received comparator antibacterial agents. This analysis verified the efficacy of this new aminofluoroquinolone, given orally once daily, in the treatment of community acquired pneumonia. The overall outcome favoured sparfloxacin for use in the empirical treatment of community-acquired pneumonia.

Adult↗
PubMed1996

[Clinical presentation of primary cytomegalovirus infection in a non-immunodepressed adult].

In the immunocompromised patients and during foetal life an acute infection due to the cytomegalovirus (CMV) causes great morbidity. In adults without predisposing factors the acute infection with CMV is rarely symptomatic, but can also provoke fever, fatigue, headache and anorexia for weeks. The peripheral blood smear shows big atypical lymphocytes within a relative lymphocytosis. The suspicion of the CMV infection is confirmed by the serological evidence of IgM anti-CMV antibodies. There is no etiological treatment, the evolution is spontaneously favorable most of the time. Establishing the diagnosis is reassuring for the patient and for the physician and avoids unnecessary analyses and treatments. We describe a series of 11 adults without predisposing factors who contracted an acute cytomegalovirus infection.

Adult↗
PubMed1995

[Various new pathogens in pneumonia].

The table summarizes the many newly recognized agents causing lower respiratory tract infections: gram + cocci, Streptococcus agalactiae, enterococci; gram-rods, acinetobacter, Aeromonas hydrophila, Eikenella corrodens; Mycobacterium tuberculosis resistant to multiple drugs, intracellular organisms and viruses. Some details are given in four chapters: Pneumococci resistant to penicillin G which must be detected and impose new therapeutic strategies; Chlamydia pneumoniae with its difficulties for the diagnosis and the absence of standardized therapeutic trials; Streptococcus pyogenes with a recrudescence of severe and invasive infections, TSS and virulence factors; the pulmonary Hantavirus syndrome with 105 patients recognized (mortality 52%) in the USA and Canada, the homeland of the deermouse (Peromiscus maniculatus).

Chlamydophila pneumoniae↗
PubMed1994

[Proposal for a shortened i.v. antibiotic treatment as cost-saving measure in the treatment of uncomplicated infections].

New oral antibiotics with high rates of absorption and good bioavailability make it possible to reduce costs by shortening the i.v. treatment period. During two 2-month periods we analyzed every patient of the Medical Department who received i.v. treatment. We tried to reduce i.v. treatment duration simply by discussion with the responsible physician, guided essentially by the clinical course. The number of patients with reduced i.v. treatment were compared with a control period. We found that by this means, an i.v. treatment period of 4-7 days could often be reduced to 1-3 days. The main target pathologies with corresponding cost savings appeared to be infections of the lower respiratory tract, with a cost-saving potential of 1.4 days (p < 0.0001) and urinary tract infections with a cost-saving potential of SFr. 179.-(US$ 138.-) per case.

Administration, Oral↗
PubMed1994

[Paradoxical pulse].

Pulsus paradoxus is one of the cardinal signs of cardiac tamponade and must be looked for at bedside examination of any patient who presents a clinical picture of low cardiac output. This paper reviews the definition of pulsus paradoxus and the way to measure it noninvasively. We then discuss the physiological fluctuation of systemic blood pressure during respiration and the various mechanisms which lead to an exaggeration of this phenomenon during tamponade. The sensitivity and specificity of this sign are also discussed. Finally, the role of echocardiography in the diagnosis of cardiac tamponade is shortly presented, as this method appears to be very accurate and sensitive in evaluating the hemodynamic embarrassment associated with pericardial effusion.

Blood Pressure↗
PubMed1993

Familial primary gastric lymphoma.

Familial lymphoma is uncommon and is usually associated with various forms of hereditary immunodeficiencies. Primary gastric lymphomas that occurred in three adults from the same family, who had no overt immunodeficiency or cancer of non-lymphomatous origin, are reported. Two sisters presented with a low grade lymphoma of the mucosa associated lymphoid tissue type. Their father presented with a high grade form of later onset. All lymphomas have been phenotypically characterised as being of B cell origin. Epstein-Bar virus DNA was detected by polymerase chain reaction in the biopsy specimen of the high grade lymphoma but bcl-2/JH protooncogene rearrangement, t (14:18), was not identified in either the low or high grade lymphoma specimens tested.

Aged↗
PubMed1992

[Hyperkalemia during prolonged use of angiotensin II-converting enzyme inhibitors in end-stage renal insufficiency].

Hyperkalemia is a severe complication of end-stage renal failure. To evaluate whether ACE inhibitors may even worsen the propensity to develop hyperkalemia in this condition, we have analyzed retrospectively pre-dialytic blood pressure and serum potassium in 15 patients on chronic hemodialysis before and during long-term ACE inhibition. This treatment induced a significant drop in blood pressure (from 173 +/- 3/90 +/- 2 to 159 +/- 5/85 +/- 2 mm Hg [p < 0.05]), whereas serum potassium increased from 4.9 +/- 0.2 to 5.5 +/- 0.2 mM (p < 0.05), irrespective of the dosage of ACE inhibitor and of the residual diuresis. Hyperkalemia was well tolerated and was corrected in all patients by dialysis; treatment was discontinued in only one case. In conclusion, ACE inhibitors represent effective antihypertensive treatment in end-stage renal failure. However, long-term ACE inhibition may be accompanied by a worsening of hyperkalemia, which could be accounted for by a reduced effect of aldosterone on extrarenal potassium homeostasis.

Angiotensin-Converting Enzyme Inhibitors↗
PubMed1992

[Acute poisoning due to oral intake of an organic solvent].

We report a case of paint thinner intoxication by oral intake, with loss of consciousness, upper gastrointestinal injuries, renal failure, rhabdomyolysis and cervical plexus injury. The clinical picture was similar to other cases reported in the literature.

Acute Kidney Injury↗
PubMed1992

[Lesional pulmonary edema associated with tocolysis by hexoprenaline sulfate].

We report the case of a 24-year-old white female in need of tocolysis during the 25th week of pregnancy with i.v. hexoprenaline, while suffering from a discrete influenza-like syndrome with nasal discharge and sinusitis. A few hours later fulminant acute adult respiratory distress syndrome (ARDS) developed. ARDS is a rare (0.5-5%) but feared complication of tocolysis with beta-2 mimetic agents and magnesium sulfate. Its physiopathology is obscure, but iatrogenic hyperhydration and lesions of the alveolar-capillary membrane are suspected. In this case both factors were involved, but lesions of the alveolar-capillary membrane were predominant. A direct toxic effect of beta-2 mimetic agents on the alveolar-capillary membrane has not been demonstrated and other factors favoring pulmonary edema during tocolysis with beta-2 mimetic agents, especially infections, are discussed.

Adult↗
PubMed1990

[Renal and neurological toxicity of acyclovir. Apropos of a case].

The occurrence of anuria and stupor in a patient treated with acyclovir afforded the opportunity to discuss the renal and neurological toxicity of this drug. Acute renal insufficiency by crystallization of acyclovir and intratubular obstruction is a not infrequent side effect. The risk depends on the dose, the administration mode, the patient's state of hydration and preexisting renal failure. The evolution is typified by a rapid onset (after 24-48 h) and a prompt recovery after ending the treatment. The demonstration in urinalysis of crystals within leukocytes helps to establish the diagnosis. Neurological involvement can vary from confusion to coma. The cerebrospinal fluid is normal and the electroencephalogram shows diffuse slowing. A favorable outcome after ending treatment is the rule. Awareness of the risk factors associated with renal and neurological toxicity should lead to a reduction of its frequency.

Acute Kidney Injury↗
PubMed1990

[Subglottic stenosis: unrecognized type of presentation of Wegener's granulomatosis].

Most patients with Wegener's granulomatosis initially present with upper airway symptoms, persistent rhinosinusitis or otitis media. We report the case of a young female who presented with progressive dyspnea, inspiratory stridor and barking cough due to a subglottic stenosis. We would like to stress this often unrecognized type of presentation. The differential diagnosis, the limitations of histopathological examinations, and the interest of looking for anticytoplasmic antibodies in the diagnosis of Wegener's granulomatosis, are briefly discussed.

Adolescent↗