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G Berthelot

Publications and source records attributed to G Berthelot.

At least 19 recordsLinked to original sources
PubMed2000

Nosocomial endocarditis in the intensive care unit: an analysis of 22 cases.

OBJECTIVES: To review the intensive care unit experience of patients with admitted or acquired nosocomial endocarditis (NE) defined according to the Duke criteria. DESIGN: Prospective, cohort study. SETTING: University teaching hospital. PATIENTS: We reviewed the records of 22 patients documented with NE during a 6-yr period from 1992 to 1997. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Twenty-two patients (9 women/13 men) aged 38-83 yrs (mean 65+/-9 yrs) had a NE (prevalence of 5 per 1,000 admissions). For six patients, NE was the reason for the admission to the intensive care unit. For 17 patients, the time elapsed between admission and diagnosis of NE was 39+/-25 days. Sixteen patients were predisposed to infection and seven had underlying heart conditions that put them at risk for acute endocarditis: three prosthetic valves, two valvular diseases, and two cardiac pacemakers. In 21 cases (one unknown portal of entry), NE was the consequence of bacteremia related to a medical or surgical procedure: 11 intravascular devices, eight surgical wounds, one tracheal procedure, and one leg ulceration. The bacteriologic agents detected in blood cultures were: staphylococci (n = 17), Streptococcus (n = 2), Pseudomonas aeruginosa (n = 2), and Candida (n = 2). Fourteen patients underwent echocardiography according to cardiac signs (cardiac failure, new cardiac murmur, or embolic event). For the eight remainders, echocardiography was performed systematically because of fever and positive blood cultures. The lesions detected by 21 transthoracic and 17 transesophageal echocardiographs were the following: vegetations (n = 19), myocardial abscesses (n = 5), and valvular perforation (n = 1). On 16 surgical indications, only five patients underwent surgery because the others were in too poor of a condition. The overall mortality was 68% (n = 15) and was directly associated with NE in 36% of cases (n = 8). Seven patients (28%) were discharged 34 days after the diagnosis of endocarditis. CONCLUSIONS: NE is a frequent nosocomial infection that occurs late during hospitalization. Persistent fever with positive blood cultures is sufficient symptomology to promptly perform an echocardiogram. The poor prognosis is related to the poor condition of those patients who cannot be referred for surgical treatment.

Acute Disease↗
PubMed1999

Molecular analysis of Mycobacterium avium isolates by using pulsed-field gel electrophoresis and PCR.

Genetic relationships among 46 isolates of Mycobacterium avium recovered from 37 patients in a 2,500-bed hospital from 1993 to 1998 were assessed by pulsed-field gel electrophoresis (PFGE) and PCR amplification of genomic sequences located between the repetitive elements IS1245 and IS1311. Each technique enabled the identification of 27 to 32 different patterns among the 46 isolates, confirming that the genetic heterogeneity of M. avium strains is high in a given community. Furthermore, this retrospective analysis of sporadic isolates allowed us (i) to suggest the existence of two remanent strains in our region, (ii) to raise the question of the possibility of nosocomial acquisition of M. avium strains, and (iii) to document laboratory contamination. The methods applied in the present study were found to be useful for the typing of M. avium isolates. In general, both methods yielded similar results for both related and unrelated isolates. However, the isolates in five of the six PCR clusters were distributed among two to three PFGE patterns, suggesting that this PCR-based method may have limitations for the analysis of strains with low insertion sequence copy numbers or for resolution of extended epidemiologic relationships.

Electrophoresis, Gel, Pulsed-Field↗
PubMed1995

[Laparoscopic cholecystectomy. Technique and complications. Report of 2,665 cases].

Retrospective study of 2,665 laparoscopic cholecystectomies (LC) performed between April 1988 and December 1994 in the French technique with selective intra operative cholangiography. Obesity was present in 13% of patients, respiratory insufficiency in 4%, inflammation in 13% and common bile duct (CBD) stones in 4%. Those cases are now good indications for L.C. A conversion to laparotomy occurred in 52 cases (2%). The rate of post operative complications was 1.6%, including 24 non biliary complications with 2 death and 17 biliary ones concerning the CBD in 6 cases. Those results compare favourably with the ones of open cholecystectomy and the cost is about the half.

Adolescent↗
PubMed1994

[Complications of celioscopic cholecystectomy in 2006 patients].

The development of laparoscopic cholecystectomy is only justified if it can ensure the good results obtained by laparotomy. The purpose of this work is to study all complications which occurred in a homogeneous group of patients. From May 1988 to January 1993, we operated on 2006 patients by laparoscopy (724 men and 1282 women) with a mean age of 50.6 years. Signs of stones in the common bile duct were noted in 4.1% and acute cholecystitis was detected in 12.5%. A conversion to normal laparotomy was necessary in 2.1% of patients. All complications were systematically investigated restrospectively in any patient hospitalised for more than five days. Residual stones in the common bile duct were not taken into consideration when they were not complications obviously related to the operation. We observed five intraoperative complications (4 hemorrhages, 1 ileum puncture) and 40 postoperative complications (25 non biliary and 15 biliary). The 25 non biliary complications consisted of: 1 death by pulmonary embolism, 9 hemorrhages, 4 cases of acute pancreatitis, 4 subphrenic abscesses, 2 colon punctures, 2 parietal complications, 1 ulcer perforation, 1 myocardial infarction and 1 phlebitis. The 15 biliary complications consisted of: 3 lateral punctures of the common bile duct, 9 fistulas of the cystic duct (4 with a residual stone in the common bile duct and 5 without), 2 punctures of an abnormal right hepatic duct, one of which was treated by "Roux en Y loop" intestinal diversion, and a late stenosis of the common bile duct.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Extracorporeal lithotripsy associated with laparoscopic cholecystectomy: results of 60 patients.

Gallbladder extracorporeal lithotripsy was performed on 60 patients before laparoscopic cholecystectomy. Of the 44 cases with solitary stones (range, 17-45 mm; mean +/- SEM, 26.9 +/- 0.1 mm), satisfactory fragmentation was obtained in 77.2%. Of the 16 cases with multiple stones (range, 11-25 mm; mean +/- SEM, 14.9 +/- 0.7 mm), satisfactory fragmentation was obtained in 18.75%. Minimal adverse effects were observed both clinically and macroscopically during surgery. Upon histologic investigation, only two small gallbladder lesions could be attributed to extracorporeal lithotripsy. No changes in blood chemistry tests were recorded. When carried out with high performance equipment, extracorporeal lithotripsy appears to be an interesting procedure that permits an appreciable reduction in the number of parietal wall incisions that need to be widened, therefore simplifying laparoscopic cholecystectomy when dealing with large stones.

Adult↗
PubMed1993

[Celioscopic treatment of acute obstructions of the small intestine. Immediate results in 25 patients].

Laparoscopic treatment of small intestinal obstruction is associated with immediate advantages and it may be expected that the recurrence rate will be decreased because of the reduction of wound scars. Between september 1989 and september 1991, 25 patients (16 men and 9 women), mean age 53.8 years, underwent initial laparoscopy for acute small intestinal obstruction. These patients had undergone a total of 43 (1.7 per patient) laparotomies an average of 13 years previously. One patient had never been operated on, 13 had one previous laparotomy, five had two, four had three, and two had four previous laparotomies. Laparoscopic treatment of intestinal obstruction was possible in nine cases including three cases of bands and six cases of adhesions. In sixteen cases, laparoscopy had to be completed by laparotomy, 13 immediately and 3 secondarily. The cause of immediate failure was the impossibility of finding and/or treating the cause in seven instances, four cases of intestinal wounds, on case of intestinal necrosis which required resection, and one case of missed right colonic carcinoma. The cause of secondary failure were incomplete release of adhesions, volvulus, and missed left colonic carcinoma in one case each. Mean hospital stay and postoperative ileus were significantly shorter in the "laparoscopy" group than in the laparoscopy + laparotomy group (p < 0.001). Two complications, with one death, were noted in the laparoscopy + laparotomy group. In conclusion, laparoscopic treatment of intestinal obstruction seems possible but in less than half of cases. Failures are related to the difficulty with which the abdomen may be explored. Laparoscopic treatment should not be pursued in case of problems.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1992

[Appendectomies by celioscopy. Results in 78 patients].

The recent development of laparoscopic surgery has included the treatment of acute appendicitis. We report our results after three years' experience of this type of surgery. We have operated on 78 patients (54 men, 44 women) mean age 28.9 years, suspected of varying degrees of acute appendicitis. The operation was completely carried out by laparoscopy on 71 occasions, including treatment of an abscess in 4 cases and peritonitis in 4 cases (3 of which were sub-mesocolic and one was generalised). The laparoscopy was transformed into laparotomy in 7 cases, 4 of which were due to difficulties of appendix dissection. Mortality was zero. Four complications occurred: 2 minute infections of the trocar hole, one more severe parietal infection which was a cause of readmission and antibiotic treatment, one "syndrome of the fifth day". In conclusion, laparoscopic appendicectomy appears to be quite feasible in the majority of cases, particularly when the appendix is ectopic, with marked abdominal thickening and peritoneal reaction. The postoperative course is uneventful. The laparoscopic technique is very comfortable for the patient during the postoperative period. This technique is becoming increasingly feasible with the operator's experience, and this appears to us to constitute good training for any form of laparoscopic surgery.

Acute Disease↗
PubMed1991

Laparoscopic cholecystectomy: historic perspective and personal experience.

Operative laparoscopy has been an important diagnostic and therapeutic method in gynecological surgery for more than 15 years. Laparoscopic gastrointestinal surgery has only recently become accepted among general surgeons. Laparoscopic appendectomy was the first such procedure performed, in 1983, followed by cholecystectomy in 1987. Laparoscopic biliary tract surgery has been shown to offer the patient a number of advantages in patient care, such as reducing the length of hospitalization and recovery, minimizing postoperative pain and discomfort, and nearly eliminating the disfigurement associated with a major abdominal operation. Although initially offered only to those patients with uncomplicated biliary tract disease, this procedure is now safely performed in individuals with acute cholecystitis and choledocholithiasis. We describe the development of laparoscopic gastrointestinal surgery in Europe as well as our method of performing endoscopic cholecystectomy. The current results of 690 laparoscopic cholecystectomies performed at our institution are included.

Animals↗
PubMed1991

Prosthetic valve endocarditis due to Thermomyces lanuginosus Tsiklinsky--first case report.

The first case of Thermomyces lanuginosus endocarditis occurring on a porcine heterograft prosthesis, secondary to a Staphylococcus aureus infection of the aortic valve, is reported. The diagnosis was made post-mortem by direct examination of the prosthesis and culture of surgical samples on Sabouraud's agar. Identification was based on the presence of warty, dark brown aleurioconidia. The route of contamination could not be established but the most likely cause was the air of the operating room or the insertion of a contaminated graft.

Adult↗
PubMed1990

Coelioscopic cholecystectomy. Preliminary report of 36 cases.

Intra-abdominal endoscopy, routinely used for gynecologic operations can be extended safely for cholecystectomy in uncomplicated cholelithiasis. Thirty-six patients underwent coelioscopic cholecystectomy with few and only benign complications. The main advantages are cosmetic preservation, reduction of postoperative pain, shortening of hospital stay, and early recovery of a normal activity.

Abdominal Pain↗
PubMed1990

[Cholecystectomy with celioscopy. 330 cases].

Laparoscopic cholecystectomy is possible. Under general anesthesia, the optic and the instruments are introduced through 4 trocarsheaths. The cystic duct and artery are dissected and clipped. The gallbladder freed by the retrograde way is removed through the umbilicus. 330 laparoscopic cholecystectomies were done with few and only benign complications. The advantages are the simple post-operative course, the short hospital stay and the minimal parietal traumatism. Some limits remains in case of too much peritoneal adhesions.

Adult↗
PubMed1990

[A simplified surgical approach in choledochal lithiasis reducing the complexity and severity of this surgery. Study of a series of 153 cases].

The surgical treatment of stones of the common bile duct by transcystic extraction of stones without biliary and peritoneal drainage greatly simplifies biliary surgery. Postoperative course and average hospital stay are similar to those encountered after conventional cholecystectomy. This surgical option was successfully achieved in almost 60% of the 153 patients with stones of the common bile duct of our series, operated between 1981 and 1987. Other patients were treated more conventionally because of failure or impossibility of complete transcystic extraction of stones. A choledochoduodenostomy was performed in 28 patients. In a limited number of patients (n = 12) endoscopic sphincterotomy was associated pre or postoperatively with the surgical treatment. Although 25% of the patients were older than 75 years, there was no operative mortality, which demonstrates that biliary surgery can be performed safely without any vital risk. Successful transcystic extraction of stones simplifies the course of stones of the common bile duct and should be attempt more often.

Adult↗
PubMed1990

[Cholecystectomy under celioscopy].

Cholecystectomy which is the best treatment for gallstones can be performed via laparoscopy in cases of uncomplicated stones. Thirty patients have been operated upon by this technique. The advantages are: small scars, easy recovery and short hospital stay. Nevertheless there are some risks, particularly hemorragic and traumatic complications in the biliary tract, so that operation must be done by a surgeon trained in biliary surgery.

Adult↗
PubMed1989

[Cholecystectomy by coelioscopy].

Operative coelioscopy, widely used in gynaecological surgery and appendicectomy, can be helpful in cholecystectomy. Sixty-three patients have been operated upon by this technique which has the advantages of small scars and rapid recovery with shortening of hospital stay. At the moment, its sole indication is cholecystolithiasis without acute complication. The risks associated with this new technique justify a careful selection of its indications and make it imperative for the operator to be a surgeon with wide experience of biliary tract surgery.

Adult↗
PubMed1989

[In vitro antibacterial activity of a new macrolide, miokamycin. Results of a multicenter study].

Minimal inhibitory concentration (MIC) of miokamycin (M) were evaluated by agar dilution for 1,024 bacterial strains isolated in 6 hospitals and classed as a function of susceptibility and resistance to macrolides, lincosamides, streptogramins group (MLS). MIC of M ranged from 0.25 to 4 micrograms/ml (mode MIC 1-2) on Staphylococcus susceptible to MLS and on MLSB inducible strains; M was inactive on MLSB constitutive strains. MIC of M ranged from 0.016 to 4 micrograms/ml (mode MIC 0.12 to 0.5) for Streptococci and Pneumococci susceptible to erythromycin (E) and from 0.12 to greater than 128 for strains resistant to E. Enterococci susceptible to E were inhibited by 0.5 to 2 micrograms/ml (mode MIC 1) and strains resistant to E by 4 to greater than 128. Haemophilus were inhibited by 2 to 64 micrograms/ml (mode MIC 32), Neisseria by 0.12 to 4 (mode MIC 0.5-1) and B. catarrhalis by 0.12 to 8 (mode MIC 1). L. pneumophila was very susceptible to M: MIC 0.016 to 0.12 (mode MIC 0.06). MIC of M ranged generally from 0.5 to 2 micrograms/ml (mode MIC 1) for C. perfringens and from 0.03 to 2 (mode MIC 1) for B. fragilis. Thus, M was shown to be among macrolide antibiotics of resistance non-inducing type on MLSB inducible resistance strains. Its activity was similar to that of spiramycin slightly superior on Staphylococci, slightly inferior on Streptococci and Enterococci, similar on Pneumococci, very superior on Neisseria, Legionella and anaerobes. M had a good activity on Branhamella and, as others macrolides, was poorly active on Haemophilus.

Bacteria↗
PubMed1988

[Placental passage of cefodizime].

The aim of this study was to evaluate the placental transfer of cefodizime (HR 221) in 28 women undergoing a cesarean section. After a single injection of 1 g cefodizime i.m., maternal blood, amniotic fluid and foetal cord blood samples were collected after 0.5 to 12 hours. The antibiotic assay was carried out by a microbiological procedure. The results showed a significant placental transfer of cefodizime with an early peak of 5.8 micrograms/ml at the 2nd hour in the cord blood and a progressive diffusion of the drug in the amniotic fluid until a maximal value of 9.9 micrograms/ml 11.5 hours after injection.

Amniotic Fluid↗