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Biomedical subjects

F Bricaire

Publications and source records attributed to F Bricaire.

At least 163 records · Page 9Linked to original sources
PubMed1987

Fifty cases of late prosthetic valve endocarditis: improvement in prognosis over a 15 year period.

The clinical course, prognostic factors, and management of 50 cases of late prosthetic valve endocarditis, occurring more than two months after valve replacement, were reviewed. Twenty nine cases that presented from 1971 to 1980 were compared with 21 cases that presented from 1981 to 1985. Apart from an appreciable decrease in the frequency of neurological complications between the first period (38%) and the second period (10%) no differences in clinical or bacteriological features were seen. Seventeen (59%) of the 29 cases in the earlier period and four (19%) of the 21 cases in the later period died. The rationale for antimicrobial treatment was similar during both periods. Cardiac surgery was performed in eight of 29 cases between 1971 and 1980 and in 11 of 21 between 1981 and 1985; the mean (SD) time between diagnosis of endocarditis and operation was 28 (19) days and 43 (44) days respectively. Six of the eight cases operated on in the first period died as did two of the 11 operated on in the second period. Twenty seven of the 29 cases presenting between 1971 and 1980 were treated with anticoagulants--either warfarin (15 of 27) or heparin sodium (12 of 27). Sixteen of the 21 cases presenting later were given anticoagulants and 15 of these cases were given heparin sodium. Control of anticoagulation was inadequate in nine of the 27 cases treated with anticoagulants during the first period and in only two of 16 treated during the second period. During the first treatment period neurological complications were more frequent when control of anticoagulation was inadequate.

Adult↗
PubMed1987

[Adrenal lesions in AIDS: anatomopathological study].

Systematic autopsy studies of 100 patients with AIDS confirmed a high incidence of adrenal lesions. Eighty eight cases were analysed, 79 men and 9 women; 57 had opportunist infection alone, 6 had Kaposi sarcomas and 30 had an association of both pathologies. The adrenal glands were normal in 19 cases and abnormal in 64 cases. One case has non-specific spongiocytic depletion and 4 were uninterpretable because of necrosis. The main adrenocortical changes were inflammatory (N = 37) or necrotic (N = 22). The commonest sites were in the adrenal medulla in the cortex or at the cortico-medullary junction. There was a high incidence of cytomegalic inclusion bodies (44 cases). In 7 cases specific lesions were observed; cryptococcus (1), toxoplasmosis (1), tuberculosis (2), Kaposi (3). Adrenal insufficiency was diagnosed before death in only 3 cases.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Comparative trial of acyclovir and vidarabine in disseminated varicella-zoster virus infections in immunocompromised patients.

A comparative assessment of vidarabine and acyclovir in the treatment of varicella and disseminated zoster in immunosuppressed patients was undertaken. Thirty-eight immunosuppressed patients with varicella (N = 18) or disseminated zoster (N = 20) were treated intravenously with 10 mg/kg/day of vidarabine or 30 mg/kg/day of acyclovir for 5 days according to a preestablished code within each diagnosis group--varicella and disseminated zoster. Two deaths, although not directly related to VZV infection, were observed in the vidarabine-treated varicella group. The times to cessation of formation of new lesions and to the disappearance of fever were similar for vidarabine and acyclovir in each group. In the varicella group, VZV was isolated on day 5 in four out of five vidarabine patients versus one out of five acyclovir patients. No severe adverse effects were observed with either drug. Neutropenia present in patients of both drug groups was transitory and most often related to previous cytolytic chemotherapy. These data suggest that either vidarabine or acyclovir could be used in the treatment of severe VZV infections in immunosuppressed patients, although a larger number of patients would be required for definitive conclusion. Because of the large amount of solute required for vidarabine administration, acyclovir may be preferred when the risk of cardiorespiratory failure is high.

Acyclovir↗
PubMed1986

[Association of bacterial endocarditis and alcoholic cirrhosis in 9 patients].

Ten cases of bacterial endocarditis were observed in cirrhotic patients. In 7 cases, endocarditis was due to group D Streptococcus, 5 of which were Streptococcus D. bovis. Special features were the involvement of tricuspid valve and the involvement of two or more valves in 4 cases. Surgery was necessary in the acute phase in 5 patients: cure was definitely obtained in 8 cases after a particularly long interval. A colonic lesion could have been the portal of entry in some cases. Liver cirrhosis was considered as a predisposing factor for bacterial endocarditis, especially due to group D Streptococcus or to other bacteria of intestinal origin. This is probably related to the frequency of the colonic origin of group D Streptococcus endocarditis. Loss of filter function of the liver may partly explain the features of these forms of endocarditis.

Adult↗
PubMed1986

[Tuberculosis in the immunodepressed patient].

Tuberculosis is one of the opportunist infections which may complicate the course of many immunodepressive conditions generally those affecting cell-mediated immunity as the Koch bacillus is an organism which develops intracellularly provoking the activation of the cellular type of defence reaction. Recently, patients with malignant disease and immunosuppressive therapy have been joined by those with the acquired immunodepressive syndrome. It is important to understand that the frequency of tuberculosis in immunodepression is a reflection of the frequency of the disease in the general population. In addition, the diagnosis of atypical forms of tuberculosis can be difficult: the presenting signs are not specific and extrapulmonary forms are common. Therefore, tuberculosis should be suspected whenever immunodepressed patients develop unexplained symptoms. All practical means of confirming the diagnosis should be employed and the patient given a course of antituberculous drugs if there is any doubt as early treatment is an important prognostic factor.

Acquired Immunodeficiency Syndrome↗
PubMed1985

[Digestive manifestations of the acquired immunodeficiency syndrome (AIDS): study in 26 patients].

We studied the gastrointestinal manifestations in 26 cases of AIDS. The patients belonged to two different epidemiological groups: the first group included thirteen french homosexual men, the second group included 6 Haitians, 6 Africans and a Pakistanian, none of them admit homosexual activity. The clinical manifestations were: chronic watery diarrhea in 17 cases, bloody diarrhea in 2 cases; loss of weight in the 26 cases; dysphagia in five cases; jaundice in one patient (due to Kaposi sarcoma of the ampulla of Vater). The digestive lesions found, alone or associated, were necrotizing enteritis (2), ulcerative colitis (1), pseudomembranous colitis (1), Candida esophagitis (10), erythematous duodenitis (6), proctitis (4), Kaposi sarcoma (3), diffuse (2) or localized (1). Thirteen patients out of the 26 presented opportunistic digestive infections due to one or several germs. These were 10 cases of esophageal infection (due to Candida albicans) and 8 cases of enterocolonic infection due to Cytomegalovirus (3 cases), Cryptosporidium (3 cases), Mycobacterium avium intracellulare (1 case), Cryptococcus neoformans (1 case). The other digestive infections cases were due to non-opportunistic pathogens: Entamoeba histolytica (3 cases); Giardia lamblia (3 cases); Strongyloides stercoralis (2 cases); Salmonella typhi (2 cases); Shigella (1 case); Herpes simplex virus (1 case). No difference was noticed between the homosexual and the heterosexual groups with respect to the nature and the frequency of the digestive infections.

Acquired Immunodeficiency Syndrome↗
PubMed1984

[Pseudomonas aeruginosa meningitis treated with azlocillin. 5 cases].

Prior to the introduction of new beta-lactam antibiotics, such as ureidopenicillins and some third generation cephalosporins, the choice of antibiotics for the treatment of meningitis caused by Ps. aeruginosa was limited, and even now, this infection remains of poor prognosis. Five patients with meningitis, aged from 18 to 75 years, were treated with azlocillin. The strains of Ps. aeruginosa isolated were all sensitive to azlocillin, the zones of inhibition being greater than 20 mm in diameter with bacteriostatic concentrations. Azlocillin was administered 8-hourly by intravenous injection in doses of 30 g/day in 3 cases and 15 g/day in 2 cases. The mean duration of treatment was 33 days (range 23-50 days). In addition to azlocillin 4 patients received an aminoglycoside (tobramycin or amikacin) parenterally and, in one case, intrathecally. Four patients underwent a surgical operation on the focus of infection between the 9th and 13th days of treatment. In 3 of these 4 patients surgery was necessary to obtain apyrexia, but in all cases the CSF was already sterile when it was performed. The outcome was favourable in all 5 cases. One patient relapsed on 4 occasions due to persistent petrous bone fistula; each time, the azlocillin treatment was reinstituted and brought about clinical and bacteriological cure. The germ was eradicated in CSF on the 3rd day of treatment in 3 patients and on the 7th day in one. One patient developed transient eosinophilia and another, transient neutropenia after 30 days. It is concluded that azlocillin, associated with an aminoglycoside, is an active and effective antibiotic for the treatment of Ps. aeruginosa meningitis.

Adolescent↗
PubMed1984

Late prosthetic valve endocarditis. Bacteriological findings and prognosis in 29 cases.

Of 296 incidences of infectious endocarditis seen between 1971 and 1980, 29 cases of late prosthetic valve endocarditis (10%) occurred in 26 patients who had undergone valve replacement more than two months previously. The prosthesis was mitral in 8 cases, aortic in 9 cases, and multiple in 12 cases. The clinical picture consistently associated fever together with a regurgitation murmur in 12 cases (41%), a splenomegaly in 7 cases, a neurologic accident in 13 cases and other signs of endocarditis in 10 cases. Blood cultures were positive in 28 cases. The diagnosis was confirmed anatomically in 11 cases. Thirty-one causative agents were identified: 15 streptococci (48%), most of them were group D (11/15), 11 staphylococci (35%) 6 Staphylococcus aureus, 5 Staphylococcus coagulase negative and 5 other species. Two relapses and 3 recurrent infections were noted. The death rate was 58% with some factors being associated with a higher death rate: non-streptococcal micro-organism (87%) regurgitation murmur (83%) cardiac failure with dysfunction of the prosthesis (89%) neurologic complication (91%). Eight valve replacements were performed within a mean period of 32 days after the onset of the antibiotherapy with a death rate of 75%. It decreased to 50% for patients treated with antibiotic alone, and as low as 23% for Streptococcal endocarditis. These results suggest that earlier and more frequent indications for cardiac valve replacement could be an alternative to improve the prognosis.

Endocarditis, Bacterial↗