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G Offenstadt

Publications and source records attributed to G Offenstadt.

At least 37 records · Page 2Linked to original sources
PubMed1999

Fatal herpetic hepatitis in adult following short corticotherapy: a case report.

Herpes simplex virus hepatitis (HSV hepatitis) is an uncommon and severe complication of HSV type 1 and HSV type 2 infection. HSV hepatitis affects mostly immunocompromised patients. We report the case of a young man without any previous known immunodeficiency who developed fatal HSV hepatitis in the first 8 days of oral corticotherapy given for ulcerative colitis. A prompt diagnosis was possible because HSV was recovered from peripheral blood leukocytes.

Acute Disease↗
PubMed1999

Prolonged sedation requiring mechanical ventilation and continuous flumazenil infusion after routine doses of clorazepam for alcohol withdrawal syndrome.

We report the cases of two patients who developed prolonged sedation after routine doses of clorazepam for alcohol withdrawal syndrome. They required prolonged mechanical ventilation (10 days for both patients) followed by continuous flumazenil infusion (16 days for one patient and 3 days for the other) to avoid reintubation. In the two patients, nordazepam accumulation (main active metabolite of clorazepam) was demonstrated as the cause of the coma. This accumulation could be attributed, in one case, to impaired hepatic cytochrome P 450 3A4 activity. Caution is required when prescribing benzodiazepines to alcoholic patients and the use of benzodiazepine which do not undergo hepatic oxidation by cytochrome P 450 such as oxazepam or lorazepam is suggested.

Aged↗
PubMed1999

[Phare study. Comparative study of combined cefepime-amikacin versus ceftazidime combined with amikacin in the treatment of nosocomial pneumonias in ventilated patients. Multicenter group study].

OBJECTIVE: To compare the associations of cefepime (2 g x 2/day) + amikacin (7.5 mg.kg-1 x 2/day) (= cefe-ami) and ceftazidime (2 g x 3/day) + amikacin (7.5 mg.kg-1 x 2/day) (= cefta-ami) in patients under mechanical ventilation suffering from a nosocomial pneumonia. STUDY DESIGN: Multi-centre, open, comparative, randomised study. PATIENTS: The study included 275 ICU patients enrolled either in the cefe-ami group (n = 141) or in the cefta-ami group (n = 134). METHODS: All cases were reviewed in a blinded fashion by the steering committee. RESULTS: Microbiology laboratory tests were positive in 74% of patients of the cefe-ami group and in 63% of the cefta-ami group respectively; 319 presumed causative strains of bacteria were isolated. The mean duration of treatment was 12 days for cefepime, 11 days for ceftazidime and 8 days for amikacin. In intention to treat, the clinical recovery rate was 48.2% in the cefe-ami group and 44.8% in the cefta-ami group respectively. In the population with a documented pneumonia, the clinical recovery was significantly better in the cefe-ami group (53.3%), than in the cefta-ami group (39.3%) (P = 0.05). In per protocol analysis, these rates reached 67.7% in the cefe-ami group and 68.2% in the cefta-ami group respectively. In the bacteriologically documented cases the eradication rates were 86.5% and 89.3% respectively. CONCLUSION: The efficacy rates of cefe-ami and cefta-ami combinations were similar in ICU patients under mechanical ventilation with a nosocomial pneumonia. However the cefe-ami association was significantly more efficient in the population with a bacteriologically documented pneumonia.

Amikacin↗
PubMed1998

Circulating endotoxin during initial antibiotic treatment of severe gram-negative bacteremic infections.

The impact of antibiotics on total endotoxemia and circulating tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, and IL-8 in 18 patients with severe bacteremic sepsis or septic shock due to gram-negative species was investigated. Endotoxemia, TNF-alpha, IL-6, and IL-8 were assayed before (H0) and 1 h (H1) and 4 h (H4) after the first antibiotic infusion. Endotoxemia decreased from H0 (median, 0.4 EU/mL; interquartile interval, 0.09-1.23) to H1 (median, 0.19 EU/mL; interquartile interval, 0.07-0.75; P = .03) and remained stable between H1 and H4 (median, 0.12 EU/mL; interquartile interval, 0.09-0.30; P = .4). IL-6 levels fell between H0 and H4 (P = .01) and between H1 and H4 (P = .03). IL-8 was higher at H0 than at H1 (P = .04) and at H4 (P = .01). These results suggest that endotoxemia is not increased by antibiotherapy of severe gram-negative bacteremia.

Adult↗
PubMed1997

[Analysis of patients' perception of their stay in a medical intensive care unit. Les trois equipes d'infirmières].

OBJECTIVES: Evaluate patients' appraisal of their stay in a medical intensive care unit and analyze their anxiety. PATIENTS AND METHODS: Two 5-month prospective studies with specific questionnaires were filled out by patients with the help of a psychologist. The first study (61 patients) evaluated global appraisal of the stay and the second study (53 patients) focused on anxiety using questionnaires also filled out by nurses. RESULTS: The study population was not different from the global population admitted to intensive care during the same period. The patients felt secure in 97% of the cases but suffered pain (53%), insomnia (62%), discomfort due to noise (49%) or light (37%), and expressed anxiety (55%). The second study confirmed the anxiety in 61% of the patients. Using surrogate markers of anxiety, the psychologist judged that anxiety was underestimated in 20% of the cases. In 17%, anxiety was expressed by patients but not felt to be present by nurses. DISCUSSION: In order to decrease the anxiety of patients admitted to a medical intensive care unit, every effort should be made to lessen pain and unnecessary discomfort. All personnel working in the unit should be able to recognize the patients' anxiety.

Anxiety Disorders↗
PubMed1997

[Central venous catheters. Prospective surveillance of a hospital].

OBJECTIVES: All the central venous catheters (CVC) inserted at the Saint-Antoine Hospital between December 5, 1994 and June 6, 1995 were prospectively studied in order to better define practices in the management of CVC and to determine the rate of catheter-related infections. METHODS: The following data were recorded for each CVC: insertion procedure, clinical data, catheter dressings, removal, catheter-related infections, bacteriological findings. Catheter-related infections were distinguished from probably catheter-related infections and localized skin infections. RESULTS: Among 325 patients, a total of 414 catheters were inserted. At the end of the surveillance period, 350 (85%) had been removed, 43 (10%) were still in place and 21 (5%) were lost to follow-up. Analysis of procedures such as cutaneous disinfection, routine replacement of the i.v. sets or changes of dressings showed wide variations between care units and within the same unit. The overall incidence of catheter-related infections was 0.24 per 100 days of catheterization. Infections occurred 29 +/- 34 days after insertion. Microorganisms responsible for catheter-related bacteremia were mostly Gram positive (84%) and Gram negative (16%). Sixty-two infections (15%) were clinically suspected by physicians, leading to the catheter removal in 84% of cases. Out of the 43 CVC sent to the laboratory, 29 (67%) were negative (i.e., "sterile") in quantitative culture of the tips as described by Brun-Buisson, suggesting that the CVC was unnecessarily removed. Bacteriological analysis ordered by physicians were not always relevant. For example, 76% of CVC received by the laboratory were systematically sent although they were not suspected of infections. Conversely, only 61% of exsudate formation at the insertion site were collected and analyzed. CONCLUSION: This study was designed to recall good guidelines to the hospital staff. Results will lead to the development of a better use of antiseptics and to the implementation of appropriate and standardized procedures to reduce risk infection.

Adult↗
PubMed1997

High doses of hydroxyethyl starch and human albumin have similar effects on monocyte function and oncotic pressure.

The accumulation of hydroxyethyl starches (HES) in monocytes/macrophages has raised concern over their potential detrimental effects on host defences. We assessed prospectively the function of circulating monocytes isolated from patients treated with plasma exchange (PE) using HES. The study was carried out in the medical intensive care unit of a university hospital. Eight patients underwent PE for neurological disorders. Each patient underwent three PEs, 48 h apart. The total exchange volume was 4 L per PE. Only 4% human albumin was used for the first PE. In the second and third PEs, the plasma substitute was 2 L of HES (200,000/6%/0.62) and 2 L of albumin. Mononuclear cells were collected before and immediately after each PE and 48 h after the last PE. They were placed in suspension culture and incubated with lipopolysaccharide (LPS). Monocyte function was assessed in terms of procoagulant activity (PCA) and tumour necrosis factor alpha (TNF-alpha) production. LPS-stimulated PCA increased after the first PE (P < 0.05). Stimulated TNF-alpha production increased, but not significantly so. Similar effects were observed after the second and third PE (P < 0.05 for stimulated TNF-alpha). Values 48 h after the last PE were similar to those obtained before the second PE, suggesting that repeated infusions of HES had no detrimental effect on monocyte function. Furthermore, plasma oncotic pressure was preserved after PE with HES. These results support the partial replacement of costly human albumin with HES during repetitive PE, and suggest that HES might be a safe plasma expander in septic patients.

Adult↗
PubMed1997

A paradoxical effect of bronchodilators.

Lactic acidosis previously has been reported during treatment of asthma with beta-2 agonists. However, this metabolic disturbance never had any clinical consequence. We report a case of a patient with asthma in whom beta-2 agonist administration increased dyspnea by metabolic acidosis due to a sharp increase in lactate levels (hyperlactatemia) and led to inappropriate intensification of bronchodilator therapy.

Acidosis, Lactic↗
PubMed1996

[Physiopathology and new treatments of septic shock].

It is currently accepted that the consequences of sepsis are highly dependent on host response, largely controlled by the inflammatory reaction. Inflammation in response to infection is a continuous process from simple local reaction which regresses rapidly to systemic reaction leading to multiple organ failure. Septic shock is a specific aspect of severe infection dominated by persistent hypotension despite vascular filling. The high mortality of severe infection and shock-the incidence is about 40,000 cases per year in France -explains why new therapeutics are aimed at controlling the inflammatory reaction. The disappointing failure of several multicentric studies has placed the focus on several points. The inflammatory process is a very complex network involving a large number of subtile interactions. A given cell or a given moderator can have both beneficial and toxic effects. Results, obtained under experimental conditions quite different from human pathology should be interpreted with utmost caution before extrapolating to man. The activity of new drugs must be perfectly and completely demonstrated before starting clinical trials. The patient population in septic shock is quite varied, requiring clinical and biological markers capable of better defining those patients which could best benefit from new drugs. Much progress has been made in the methodology in large clinical trials. It is clear that a posteriori analysis of subgroups must be abandoned and that research must continue in this high-mortality pathology. The upcoming clinical trials will benefit from acquired experience.

Endotoxins↗
PubMed1996

AIDS in a medical intensive care unit: immediate prognosis and long-term survival.

OBJECTIVE: To help physicians decide whether to admit patients with acquired immunodeficiency syndrome (AIDS) to the medical intensive care unit (MICU). DESIGN: Case series study of AIDS patients admitted to the MICU between October 1990 and October 1992 and followed up until April 1993 (median follow-up, 1 year). SETTING: The MICU in a 970-bed teaching hospital in Paris, France. PATIENTS: A total of 120 consecutive AIDS patients with acute respiratory failure (50%), central nervous system dysfunction (22.5%), pneumothorax (12.5%), shock (10.8%), or miscellaneous conditions (4.2%). A total of 86 patients were discharged alive from the MICU. MAIN OUTCOME MEASURES: Predictive factors for mortality during and after MICU stay. RESULTS: Multivariate analysis identified 3 factors predicting poor MICU outcome: Simplified Acute Physiology Score I (SAPS I) above 10 (relative risk [RR], 6.1; 95% confidence interval [CI], 1.5-26.6), time between AIDS diagnosis and MICU admission more than 1 year(RR, 6.0; 95% CI, 2.1-17.5), serum albumin level less than 30 g/L (RR, 4.9; 95% CI, 1.3-18.2). The CD4 cell count, beta2-microglobulinemia, and previous opportunistic infections had no influence on MICU mortality. After MICU discharge, survival rates were 86% at 1 week, 82% at 1 month, 53% at 6 months, and 39% at 1 year. The Karnofsky scale score and the number of previous opportunistic infections were simultaneously associated with post-MICU outcome. Predictive factors for MICU survival did not influence post-MICU survival. CONCLUSION: The MICU mortality was related to immediate severity (assessed within 48 hours of admission) and the time between AIDS diagnosis and MICU admission. Long-term survival after MICU discharge depended only on the severity of AIDS. We conclude that AIDS patients should be admitted to the MICU on the same basis as other patients.

Acquired Immunodeficiency Syndrome↗