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Biomedical subjects

D Baron

Publications and source records attributed to D Baron.

At least 181 records · Page 10Linked to original sources
PubMedDate not supplied

[Comparison of fosfomycin-penicillin M and penicillin M-gentamycin. Apropos of 35 severe infections caused by methicillin-sensitive Staphylococcus aureus].

Two combined antibiotic treatments were compared in 35 cases of methicillin-sensitive Staph. aureus infection. Eighteen patients (including 17 with septicaemia) received penicillin M (methicillin or oxacillin) and gentamicin daily for a mean period of 11 days. Clinical and bacteriological cure was obtained in 14 cases; 2 of these 14 patients developed superinfection with gentamicin-resistant enterobacteria, 1 relapsed and 2 had renal impairment. Seventeen patients (including 15 with septicaemia) were given fosfomycin and penicillin M for a mean period of 17 days. Clinical and bacteriological cure was obtained in 16 patients; the patient with clinical and bacteriological failure died. There was no superinfection or relapse; 3 patients had hypokalaemia and 1 had renal damage caused by methicillin. The clinical and bacteriological results, therefore, were in favour of the fosfomycin-methicillin combination, but the only statistically significant difference between the two groups concerned the complications.

Adolescent↗
PubMedDate not supplied

Confidence in the diagnosis of early spondylarthropathy: a prospective follow-up of 270 early arthritis patients.

OBJECTIVE: To study the confidence of office-based rheumatologists (OBR) and a college of 5 experts in their diagnosis of spondylarthropathy (SpA) for early arthritis after more than 2 years of follow-up; to determine whether at that time the degree of confidence was improved by the fulfilment of the ESSG criteria. METHODS: 270 patients with early-onset (< 1 year) arthritis were prospectively followed-up for 29+/-11 months. At the final examination, OBR and the college of 5 experts rated their confidence in the diagnosis of SpA on a 0-10 analogue scale and on a 1-4 Likert scale, respectively. RESULTS: After 29+/-11 months OBR had classified 56 patients (21%) as SpA, while a collegial diagnosis of probable (N = 32) or certain SpA (N = 14) was made for 46 patients (17%). At the final examination OBR confidence in their diagnosis (gold standard) was only 6.7+/-2.4 for all 56 cases of SpA. The cumulative fulfilment of ESSG criteria for SpA after 29+/-11 months correlated with the confidence of OBR and the experts in SpA, but improved only slightly the final confidence of OBR (7.1+/-2.3 versus 6.7+/-2.4 for all 56 SpA). Similarly, OBR confidence for the 18/56 SpA patients positive for HLA-B27 was only 7.1+/-2.0. Only 21 of these 56 patients were considered as SpA at baseline, although 37/56 (66%) had fulfilled ESSG criteria since thefirst examination. CONCLUSION: This study indicates a probable lack of consensus on the nosology of early SpA and the limited help provided by the ESSG criteria to differentiate early SpA from otherforms of arthritis at baseline.

Adolescent↗
PubMedDate not supplied

[Circulatory and metabolic disturbances in accidental hypothermia (author's transl)].

This work sums up several studies: clinical observation (electrocardiogram, cardiac rhythm, circulatory state), and biology (glycemia, blood oxygenation, acid-base balance) in 24 cases of accidental hypothermia, not related to poisoning by central nervous system depressive agents; haemodynamics in 18 of these cases; pathology of the myocardium in 11 cases; haemodynamics and microscopy of the myocardium in dogs with slowly induced or prolonged hypothermia; finally an electron microscope study in hypothermic rats. Electrocardiographic study and continuous monitoring of cardiac rhythm and tracing show, in addition to well known manifestations (bradycardia, lenghtening of QT, J wave), acute dysrhythmias, particularly circulatory arrests by asystole during or even 72 hours after rewarming. The clinical haemodynamic changes, measurable (cardiac output, mean arterial pressure, central venous pressure), or computable (stroke volume, peripheral resistances) are observed during rewarming. Several haemodynamic developments can be distinguished: --favourable evolution when the initial disturbances (decrease in cardiac output and in stroke volume, increase in peripheral resistances) disappear without any therapeutic support: --haemodynamic developments showing at a certain time evidence of hypovolemia requiring only moderate vascular replacement; --haemodynamic developments showing myocardial damage. In some cases, only hypothermia accounts for these. In circulatory arrests during or after rewarming, these haemodynamic disturbances raise the hypothesis of severe cardiac changes due to hypothermia itself.

Acid-Base Equilibrium↗
PubMedDate not supplied

Hyperlipidemia after heart transplantation.

Because hyperlipidemia may be a factor in the development of late graft atherosclerosis after heart transplantation, we have studied serum lipid levels in patients during the first year after transplantation. Serum cholesterol and triglyceride levels were measured in the preoperative period and at regular intervals up to 12 months after transplantation in 22 consecutive heart transplant recipients. Patients were divided into two groups: group 1 included 10 patients with underlying ischemic heart disease, and group 2 had 12 patients with underlying idiopathic dilated or valvular cardiomyopathy. Mean serum cholesterol concentrations in both groups increased substantially after operation and peaked at 3 months (respective rises of 35% and 30%). By 12 months after transplantation 50% of group 1 and 33% of group 2 manifested a significant degree of hypercholesterolemia (plasma cholesterol greater than 6.5 mmol/L, 250 mg/100 ml). Mean serum triglyceride concentrations increased in both groups during the latter part of the first year (respective increases of 44% and 13%). At 12 months only 10% of group 1 and 8% of group 2 manifested a significant degree of hypertriglyceridemia (plasma triglycerides greater than 3.0 mmol/L, 265 mg/100 ml). Over the first postoperative year there was a progressive increase in body weight, and this correlated highly with the increase in serum lipid levels (r = 0.90 for serum cholesterol and r = 0.84 for serum triglycerides). The role of conventional risk factors including hypercholesterolemia in the development of graft atherosclerosis remains uncertain, but until their role is defined, further strenuous efforts at weight control as a means of preventing or managing hyperlipidemia need to be explored.

Adult↗
PubMedDate not supplied

Effectiveness of minimal dosage cyclosporine in limiting toxicity and rejection.

The optimal dose of cyclosporine to achieve minimal toxicity and adequate control of rejection remains undetermined. We initiated our program with an immunosuppressive protocol designed to reduce drug toxicity, to reduce early severe rejection, and to provide adequate long-term immunosuppression. Because of increasing reports of nephrotoxicity associated with cyclosporine, we adopted a protocol of low-dose cyclosporine combined with steroids and equine antithymocyte globulin. The mean preoperative creatinine was 0.12 +/- 0.08 mmol/L and by 1 year after transplant was 0.13 +/- 0.04 mmol/L. Cyclosporine dose at 1 year was 5 +/- 2 mg/kg/day, and the serum cyclosporine level was 120 +/- 40 ng/ml. However, at 1 year 85% of the patients were hypertensive. The incidence of rejection in the first year after transplantation was 1.46 episodes per patient. Incidence of infection was 0.85 episodes per patient. The 3-month survival was 91%, and the actuarial 1-year survival was 76%. Seventy percent of our mortality was due to rejection, and four patients suffered significant graft damage in the period 3 months to 1 year, two requiring retransplantation. Although these low doses of cyclosporine have reduced nephrotoxicity and infectious complications, hypertension remains a significant problem. Moreover, although survival is acceptable, the incidence of graft rejection causing death or loss of function is of concern. This may indicate that cyclosporine at this dosage needs supplementation by a third immunosuppressive agent such as azathioprine.

Actuarial Analysis↗
PubMedDate not supplied

[Prophylactic antibiotic therapy in surgery: applications in digestive surgery].

Prophylactic use of antibiotic presently constitutes one essential method in the prevention of postoperative infections in digestive surgery. Prophylactic antibiotic therapy is based upon well-codified general rules and on indications determined by the type of surgery, the micro-organismal flora in the organ in question and relevant risk factors. An overview of these principles and indications is presented. The options available for different types of digestive surgery (gastroduodenal, biliary, colorectal) are reassessed in light of defined indications and the results of randomized trials.

Anti-Bacterial Agents↗