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Biomedical subjects

I Caubarrère

Publications and source records attributed to I Caubarrère.

At least 19 recordsLinked to original sources
PubMed1998

[Resistance to penicillin G and Streptococcus pneumoniae infection at the Hôpital Foch, Paris, France, in 1995].

UNLABELLED: Decreased susceptibility to penicillin G of pneumococcal strains is continuously increasing in France. OBJECTIVE: We assessed effect of resistance to penicillin on therapeutic management and mortality in adults with pneumococcal pneumonia in our hospital. METHODS: This one-year retrospective study (1995) included patients with proven pneumococcal infection (positive blood culture, pleural fluid, or specimens from the lower respiratory tract). Strains of Streptococcus pneumoniae were screened for susceptibility to antimicrobial agents. Resistance to penicillin G was defined as a minimal inhibitory concentration > or = 0.12 microgram/ml. Age immune and nosocomial status, first and second line antibiotherapy and death were compared according to the strains susceptibility to penicillin G. A p value below 0.05 was statistically significant. RESULTS: In 15 cases a pneumococcal strain susceptible to penicillin G was isolated while 23 patients were infected with a strain with a decreased susceptibility to penicillin G. Age was significantly higher in the latest group (61.6 versus 54.7 years) while no difference was noted between the 2 groups according to immune and nosocomial status, therapeutic management and death. DISCUSSION: Resistance to penicillin did neither appear to increase mortality nor to influence therapeutic management in patients with pneumococcal infection.

Adult↗
PubMed1997

Recurrent optic neuromyelitis with endocrinopathies: a new syndrome.

We report a new syndrome that we call "recurrent optic neuromyelitis with endocrinopathies" in eight Antillean women from Martinique and Guadeloupe Ocular involvement was either monocular or binocular, whereas myelopathy was acute or subacute. In seven patients, myelopathic symptoms recurred, and in six patients, visual problems recurred. Spinal cord involvement was a consistent band-like pseudo-syringomyelic dissociated sensory loss. All eight patients had endocrinopathies consisting of amenorrhea, galactorrhea, diabetes insipidus, hypothyroidism, or hyperphagia. Spinal cord MRI revealed cavitation-like images. Various immunosuppressant treatments had little effect on the uniformly deteriorating course, ending in blindness and paraplegia. Six patients died within 5 years of onset, and an autopsy in one patient showed multiple demyelinizing lesions of the spinal cord with thickened blood vessels walls without evidence of inflammation. These cases appear to constitute a syndrome distinct from MS and from classic Devic's syndrome, not only because of the association with endocrinopathies but because of the stereotypy of the recurrences, the absence of MRI lesions in the cerebral white matter, and the unusual image of cavitation of the spinal cord. The syndrome is also distinct from HTLV-I-associated paraparesis, which is endemic in the West Indies.

Adolescent↗
PubMed1997

[Pulmonary cryptococcosis during HIV infection. 15 cases].

We reviewed the records of 15 Human Immunodeficiency Virus (HIV) infected patients with pulmonary cryptococcosis (PC). PC was the first AIDS-defining manifestation in nine patients. HIV infection was identified simultaneously with the onset of PC in 4 patients. The CD4+ lymphocyte count was low in all cases (median, 24/m3). Chest radiography showed interstitial infiltrates in 13 instances, associated with pleural effusion in 5 cases and hilar adenopathy in 2 cases. In one case, chest-X-ray showed isolated pleural effusion and was normal in one patient. For 11 of 12 patients, bronchoalveolar lavage fluid culture was positive for Cryptococcus neoformans. Seven of 15 patients had evidence of extrapulmonary cryptococcal disease with positive cerebrospinal fluid culture. Serum cryptococcal antigen was detected in all 15 patients. Concomitant lung infection with Pneumocystis carinii was diagnosed in 4 patients. First-line regimen was fluconazole in 10 patients and amphotericin B in 4 patients. Fluconazole has been prescribed in 7 patients as a permanent suppressive therapy and should be continued indefinitely.

AIDS-Related Opportunistic Infections↗
PubMed1995

[Cytomegalovirus pneumopathies. What role should be given to cytomegaloviruses isolated from blood and bronchoalveolar lavage fluid in AIDS and from organ and bone marrow grafts?].

Cytomegalovirus (CMV) is often suspected as the causal agent in lung disease occurring in various immunodepressive states: AIDS, organ transplantation, bone marrow graft. The mechanisms involved in these three situations is however quite different. The role played by the cytopathogenic effect of the virus and the immune reaction of the host vary considerably depending on the underlying immunodepression. Thus, the criteria allowing to distinguish between CMV infection (presence of the virus or anti-CMV antibodies, no clinical signs) and CMV disease (generalized or organ specific disease resulting from the pathogenic effect of CMV replication) lack precision. The aim of this review of the literature is to assess the implicated immunovirology mechanism and thus the diagnostic (and thus therapeutic) criteria of CMV lung diseases. There is a graduation scale from AIDS, to organ transplantation and bone marrow allograft in the degree of immune reaction implicated in the lung disease and thus the need and timing of antiviral treatment. In AIDS, an interstitial pneumonia, associated with an isolation of CMV (whatever the sample origin, blood, bronchoalveolar lavage or the isolation technique) does not usually implicate treatment. Treatment may be indicated in rare cases (advanced stage immunodepression, high virus titre, endothelial involvement) or in cases in which the infection is also located in other organs. For organ transplantation, observation of CMV in blood or lavage samples in a patient with clinical or radiological signs would justify treatment. For lung transplantation, more so than for any other organ, treatment should be started early whenever respiratory signs are associated with evidence of CMV infection. Finally, in bone marrow allografts, the high rate of failure when pneumonitis has become patent implicates starting treatment immediately upon diagnosis of CMV infection. The strategy proposed here is based on a certain rationale but can be open to discussion. Controlled clinical trials are required to determine the most rigorous and coherent attitude. Finally, within the framework of the diseases examined here, search for lung disease caused by cytomegalovirus should not mask other organ localizations in, for example, the retina, the digestive tract.

AIDS-Related Opportunistic Infections↗
PubMed1994

Treatment of systemic vasculitis with cyclophosphamide and steroids: daily oral low-dose cyclophosphamide administration after failure of a pulse intravenous high-dose regimen in four patients.

The efficacy of cyclophosphamide (CY) in the treatment of severe systemic vasculitis has been demonstrated, but its optimal administration regimen remains to be defined. The four patients described participated in prospective therapeutic trials of polyarteritis nodosa (PAN) without hepatitis B infection markers, Churg-Strauss syndrome (CSS) and Wegener's granulomatosis (WG) and received daily oral low-dose CY after failure of a monthly pulse regimen. These patients were included in this study because of failure to induce clinical remission (two patients) and relapse during the course of treatment (two patients). The results were good with initial clinical remission in three patients and stabilization in one. One patient with WG relapsed 10 months after changing therapeutics. The advantages of the different administration protocols are discussed.

Administration, Oral↗
PubMed1991

[Double lung transplantation. The "bilateral single" graft].

We present 10 cases of a new double lung transplantation technique: following, then the other, without requiring cardiopulmonary bypass. This "bilateral single" lung transplantation procures all the advantages of single lung transplantation.

Adult↗
PubMed1989

[Continuous high-dose corticosteroid pressured aerosol therapy in steroid-dependent asthma].

Two therapeutic trials aimed at determining whether a high-dose inhaled corticosteroid, beclomethasone dipropionate (BDP), could reduce or suppress a long term and continuous treatment with a systemic corticosteroid, triamcinolone acetonide (TA), were carried out in a homogeneous population of severe, steroid-dependent asthmatics. The first one was a controlled, double-blind versus placebo trial involving 25 patients followed up for 5 months. The second one was an open trial involving 105 patients followed up for 12 months. In both trials the mean doses of TA were reduced by 60 to 65 per cent, and TA could be totally or nearly totally suppressed in almost 60 per cent of the cases with clinical and functional results that were equal or superior to those previously obtained with systemic corticosteroid therapy. It is concluded that: (a) continuous systemic corticosteroid therapy in mean doses of more than 5 mg/day of prednisone equivalent is now rarely indicated in patients with steroid-dependent asthma, and (b) inhaled corticosteroid therapy with BDP could be extended to cases of non steroid-dependent asthma inadequately controlled by bronchodilators.

Administration, Inhalation↗
PubMed1987

Bronchoalveolar lavage in amiodarone pneumonitis. Cellular abnormalities and their relevance to pathogenesis.

To investigate the contribution of direct cytotoxicity and immune-mediated hypersensitivity to the pathogenesis of amiodarone pneumonitis, we evaluated cells recovered by bronchoalveolar lavage from 13 patients with amiodarone pneumonitis. Alveolar macrophages from all patients contained two types of abnormal inclusions: small clear vacuoles and large phagolysosomes containing phospholipid in lamellar structures, abnormalities previously attributed to direct cytotoxicity from amiodarone. However, these changes were always associated with abnormalities in the numbers and types of immune and inflammatory cells present in the lower respiratory tract, which closely resemble those seen in hypersensitivity pneumonitis associated with inhaled antigens. Following discontinuation of amiodarone and institution of corticosteroid therapy, clinical improvement correlated with a return toward normal in the pattern of inflammatory cells present in the lung, although alveolar macrophages continued to display evidence of drug-induced cytotoxicity. These findings support the possibility that a cell-mediated immune response usually plays a role in the pathogenesis of amiodarone pneumonitis, although direct cytotoxicity may predispose these patients to the development of this abnormal immune response.

Aged↗
PubMed1986

[Syndrome of alveolar hemorrhage associated with systemic cholesterol embolism].

Vascular purpura and haemoptysis developed in a patient suffering from accelerated hypertension and rapidly progressive renal failure due to cholesterol embolism. Alveolar haemorrhage was diagnosed on the association of clinical and endoscopic results, and on the outcome of the disease. This syndrome is usually associated with other immunological disorders and raises the question of immunological phenomena being the cause of some of the clinical manifestations observed after cholesterol embolism.

Acute Kidney Injury↗
PubMed1986

[Variations in the distribution of bronchial arteries. Apropos of 72 arteriographies].

Anatomic distribution of bronchial arteries was studied by arteriography, and evaluation conducted of 72 images considered as being complete. Seven frequent types of distribution were note and findings compared with those of previous studies. Frequency of collateral circulation and of anastomosis was comparable with that reported in the literature. One new distribution pattern was observed: common lower trunk, right upper intercostobronchial trunk, left upper trunk.

Bronchial Arteries↗
PubMed1985

[Pneumopathies caused by hypersensitivity to amiodarone and associated nephropathies. Study by alveolar lavage].

Four cases of amiodarone-induced restrictive, hypoxaemic lung disease are described. The cumulative dosages of amiodarone were relatively low (30 to 100 g). Alveolar lavage studies showed a lymphocytosis and study of the lymphocytic sub-populations showed an increase in the OKT8 group, and an inversion of the OKT4/OKT8 ratio. The outcome was favourable on withdrawal of amiodarone and steroid therapy. The immunological origin of this form of lung disease was confirmed. Two patients had renal failure; in the first case, hypercalcaemia, hyperphosphoremia and renal calcification were observed. The second patient had endo- and extracapillary glomerulonephritis with C3 deposits and circulating immune complexes. Renal failure regressed in both cases on withdrawal of amiodarone and with steroid therapy.

Acute Kidney Injury↗