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Biomedical subjects

G Offenstadt

Publications and source records attributed to G Offenstadt.

At least 73 records · Page 4Linked to original sources
PubMed1992

[Immunotherapy of severe infectious states].

Although symptomatic treatments have been optimized, mortality in severe infectious conditions still exceeds 50% in many instances. Excessive activation of inflammation mediators, the endogenous relay of the initial stimulus, may account for the secondary occurrence of polyvisceral failure. This "internal" conception of severe infectious conditions opens new therapeutic possibilities including the modulation of the host's response. However, this new treatment of severe septic conditions, which complements antibiotic therapy and symptomatic measures, encounters several difficulties: a) proinflammatory mediators also have beneficial effects; b) as the mediator cascade is activated within a few hours, ordering immunity-modulating treatments early appears to be a logical step; c) monoclonal antibodies and recombining molecules are very expensive. Costs may be further increased by the probable need to use "cocktails" of antiinflammatory molecules. All these reservations show how technically blameless future clinical trials have to be. Cost efficiency and cost/benefit studies are also required. We may wonder whether society will make the financial choice to use these new treatments.

Anti-Inflammatory Agents↗
PubMed1992

[Bacteriostatic activity and killing curves of eight antibiotics against seven strains of penicillin G-resistant pneumococci].

Increasing resistance to multiple antimicrobial agents including penicillins is a current problem with Streptococcus pneumoniae. Seven cases of severe infection due to penicillin G-resistant pneumococci were seen in two teaching hospitals in Paris (France) during the first half of 1991; six of the strains were recovered from pulmonary secretions (protected brush specimens) and one from cerebrospinal fluid (CSF). The bacteriostatic activity and killing curves of eight antimicrobials against these seven strains were studied. Antimicrobial agents tested included penicillin G (PEN), amoxicillin (AMX), cefotaxime (CTX), imipenem (IPM), rifampin (RIF), vancomycin (VAN), fosfomycin (FOS), and erythromycin (ERO). MICs were determined using the agar dilution method. Killing curves were obtained using a liquid medium inoculated with 10(5) to 10(6) CFU/ml and subjected to continuous agitation; survivors were counted at baseline and after 1, 3 and 5 hours incubation. MICs of each antimicrobial (mg/l) for the seven strains were in the following ranges: PEN: 0.5-2, AMX: 0.5-2; CTX: 0.125-1; IPM: 0.03-0.25; RIF: 0.12-0.25; VAN: 0.25-1; FOS: 16; ERO: 0.06 greater than 4. Overall, bactericidal activity was greatest with vancomycin, followed by imipenem, then amoxicillin. The cefotaxime-fosfomycin combination proved synergistic and exhibited bactericidal activity (2MIC + 2MIC) for three of the seven strains. This study demonstrated the value of the cefotaxime-fosfomycin combination. Both these antimicrobials seem appropriate for the treatment of meningitis caused by penicillin G-resistant pneumococci provided their dosage is adjusted to achieve adequate drug levels in the cerebrospinal fluid.

Amoxicillin↗
PubMed1991

[Severe immunoallergic hemolytic anemia caused by a glafenine metabolite].

Three weeks after a surgical operation, a 74-year old woman was admitted to hospital for severe haemolytic anaemia. A strongly positive IgG type direct Coombs test pointed to a iatrogenic origin, but a search for anti-molecule antibodies directed against all medicines taken by the patient after surgery was negative. We extended our immunological investigations and were able to demonstrate the presence of IgG type antibodies directed against an ex vivo metabolite of glafenine.

Aged↗
PubMed1991

[Acidoketosis in a chronic alcoholic woman].

A 37-year-old chronic alcoholic female was admitted with epigastric pain, complete anorexia, vomiting and diarrhoea. She was dehydrated, and had polypnoea. Laboratory investigations revealed severe metabolic acidosis (pH 7.14) with a major anion gap (37.4 mmol.l-1), and ketone bodies in blood and urine. Blood glucose concentration was 6.1 mmol.l-1, there was no glycosuria. Rehydration (2 l.day-1 of 5% glucose) together with sodium bicarbonate (500 ml of 1.4% sodium bicarbonate over the first four hours) normalized the pH (7.37). The ketone bodies disappeared on the following day. During the acute illness, were found high blood levels of glucagon and low levels of insulin. The diagnosis of alcoholic ketoacidosis, the pathogenesis of which remains unknown, is discussed.

Acid-Base Equilibrium↗
PubMed1991

[Access of torsades de pointes in Legionnaires' disease: an uncommon adverse effect of erythromycin].

We report the case of a 77-year-old man with legionnaires's disease who, immediately after an intravenous infusion of one gram of erythromycin presented with wave burst arrhythmia with widening of the QT space. The blood level of erythromycin at the time of this adverse reaction was the same as the peak observed in young subjects after intravenous administration of this drug. Fourteen similar cases were found in the literature. In vitro and in vivo studies have shown that erythromycin may exert on the cardiac muscle fibres an electrophysiological effect similar to that of class I antiarrhythmic agents.

Aged↗
PubMed1991

[Pneumococcal pneumonia resistant to penicillin].

The authors report a case of community-acquired pneumonia in a patient with chronic obstructive lung disease. The initial antibiotic therapy consisted of an amoxicillin-clavulanic acid combination and intravenous macrolides. Twenty-four hours after admission, blood cultures were positive for pneumococcus. Pending the results of disc sensitivity tests, the antibiotic therapy was modified and amoxicillin alone was prescribed. Clinical deterioration then developed rapidly, as the pathogen was amoxicillin-resistant. Subsequently, the patient recovered under erythromycin therapy. As illustrated by this case, the emergence of pneumococci resistant, or showing low sensitivity to penicillins raises the problem of the antibiotic therapy to be used against community-acquired lung diseases.

Amoxicillin↗
PubMed1991

[Inhibitors of factor VIIIc and pregnancy. Review of the literature].

Circulating anticoagulants directed against factor VIII coagulant activity are very rarely encountered. Eighteen per cent of them have been described in the peripartum period of primiparae aged 28 years on average. The clinical signs are the same as those of constitutional haemophilia, but they differ in frequency. The most common of these signs are haematoma, ecchymoses and haematuria. The diagnosis is confirmed by prolongation of clotting time alone, presence of an anticoagulant in blood and specific assay of the deficient coagulant factor. These inhibitors are usually immunoglobulins of the IgG type. The cause and pathogenesis of the disease are unknown. Treatment consists of administering coagulant factors in haemorrhagic periods and immuno-suppressive therapy. Spontaneous remissions are frequent.

Adult↗
PubMed1990

[Non-lactic metabolic acidosis].

The definition of metabolic acidosis (MA) is a primary decrease in plasma bicarbonate concentration. The visceral consequences are largely dependent on the degree of acidosis and the rapidity of its onset; they have been studied mainly in animal studies and therefore, extrapolation to the clinical situation should be cautious. The MA can be classified in two groups according to whether the anionic serum gap is increased or normal (hyperchloremic acidosis). The etiologies of the first group are lactic acidosis, the cetoacidoses and renal failure. The hyperchloremic acidoses usually result from gastro-intestinal bicarbonate losses; the biochemical diagnosis of rarer causes of hyperchloremic acidosis is facilitated by measuring the serum potassium, urinary pH and the urinary anionic gap. Although all causes of MA must be treated, the use of bicarbonate should be discussed in each individual case.

Acid-Base Equilibrium↗
PubMed1990

Capillary leakage complicated by compartment syndrome necessitating surgery.

A single episode of systemic capillary leak syndrome is reported in a HIV-positive patient. The shock had necessitated the infusion of large amounts of fluid with concomitant diffuse swelling and weight gain leading to compartment syndrome of both legs. This required surgical relief. The initial high hematocrit (62%) and low serum protein concentration (48 g/l) with normal factor V (molecular weight above 300,000) concentrations are the hallmark of capillary leak when they are associated with hypovolemic shock. It must be emphasized that fluid resuscitation may worsen the muscle damage with ultimate compartment syndrome. Therefore, it appears reasonable to monitor muscular pressure during volume expansion in patients with capillary leak syndrome, severe shock and muscular swelling.

Adult↗
PubMed1990

[Evaluation of the efficacy of plasma exchange in Leber's disease].

Amaurosis congenita of Leber is a hereditary optic neuropathy, usually bilateral, that quickly leads to blindness. There is no effective treatment. The inflammatory aspect of the papillary lesions in the early stage, in addition to the beneficial effect of plasma exchanges reported for other optic neuritides, led us to propose such a therapeutic regimen to 6 young adult men afflicted with the disease. This treatment was initiated early, before optic nerve atrophy occurred. The plasma volume exchanged was 3.2 +/- 0.5 liters/session and 4.2 +/- 1.8 (3 to 7) exchanges were performed. The exchanges were always well tolerated. Three patients subjectively reported improvement immediately following the exchanges but only one had some improvement of his visual acuity. However, a more sensitive evaluation of the ability to distinguish contrasts revealed improvement in patients whose visual acuity remained unchanged. This visual gain was lost 3 months later. Therefore, it appears that plasma exchanges are not the treatment of choice for this disease.

Adult↗
PubMed1990

[Specificity and serum concentrations of tumor necrosis factor in septic shock].

Several lines of evidence implicate tumor necrosis factor (TNF), a cytokine produced by monocytes-macrophages, in the systemic manifestations of shock induced by Gram-negative bacteria. Whether the increase of circulating TNF levels is specific to septic shock as compared to sepsis without shock or to non-septic shock is still unclear. Since TNF values recorded at the time of admission to the hospital vary widely, statistical analysis has not been possible. Therefore, we postulated that the evolution of a patient's TNF serum level as compared to his initial value may better distinguish the survivor from the non-survivor than a single initial determination. Using a radioimmunoassay, we measured the TNF concentrations in the sera of 7 patients with severe infections without shock, 16 patients with septic shock and 8 patients with non-septic shock. Blood samples were drawn within the first 12 hours after the onset of shock. Patients with cancer, HIV infection, or under steroid therapy were excluded. Repeated measurements were made during the first 3 days of septic shock in 10 patients. The circulating TNF level, determined upon admission, appears to be neither specific nor predictive of the outcome of septic shock. In contrast, persistently high levels of circulating TNF seem to be well correlated with a poor prognosis, since 5 out of 6 patients with elevated TNF values died of septic shock.

Adult↗