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Biomedical subjects

J Chastre

Publications and source records attributed to J Chastre.

At least 73 records · Page 4Linked to original sources
PubMed1987

Pulmonary disposition of roxithromycin (RU 28965), a new macrolide antibiotic.

The penetration of roxithromycin (RU 28965), an ether oxime derivative of erythromycin, into the cells and fluid lining the epithelial surface of the lower respiratory tract was studied by performing fiber-optic bronchoscopy with bronchoalveolar lavage on eight patients who had received roxithromycin at 300 mg perorally every 12 h for 5 days. The apparent volume of epithelial lining fluid recovered by bronchoalveolar lavage was determined by using urea as an endogenous marker. There was a significant relationship (r = 0.75; P less than 0.02) between roxithromycin levels in plasma and epithelial lining fluid, with a correlation whose slope suggested that the level of drug penetration into the lining fluid was 0.2. Concentrations of the antibiotic in cells recovered by bronchoalveolar lavage (21 +/- 10 micrograms/ml) were 2 and 10 times higher than in plasma (11.4 +/- 5.7 micrograms/ml) and epithelial lining fluid (2.0 +/- 1.7 micrograms/ml), respectively. Thus, when administered perorally in humans, roxithromycin is markedly accumulated by resident alveolar macrophages in concentrations largely exceeding the MBCs of the drug for most facultative intracellular pathogens including Legionella pneumophila, despite low concentrations in the epithelial lining fluid.

Bronchitis↗
PubMed1987

Acute and latent pneumonitis after subcutaneous injections of silicone in transsexual men.

We evaluated 13 transsexual men who were hospitalized for symptoms resulting from illicit subcutaneous injections of silicone. Patients with acute silicone pneumonitis were admitted because of fever, bilateral pulmonary infiltrates, and hypoxemia (mean PaO2, 58 +/- 14 mm Hg). Most patients in this group had received new silicone injections within hours of admission, but one presented with the same clinical syndrome a few hours after a brawl. The alveolitis of acute silicone pneumonitis was characterized by increased numbers of alveolar macrophages, neutrophils, and eosinophils (p less than 0.05 compared with those in normal persons with a similar smoking history). Evidence of alveolar hemorrhage was also present in some cases. Alveolar macrophages contained large, pleomorphic, cytoplasmic inclusions, which were identified as silicone by atomic absorption and infrared spectrometry. Patients with latent silicone pneumonitis underwent clinical study at much longer times after the silicone fluid injections because they developed local inflammatory phenomena at the sites of previous injections. Pulmonary function studies usually showed slight restrictive changes, and bronchoalveolar lavage disclosed abnormalities similar to those found in patients with acute silicone pneumonitis, although to a lesser degree. Thus, illicit silicone fluid injection carries a serious respiratory risk since it can induce pneumonitis, followed in some patients by respiratory failure.

Acute Disease↗
PubMed1987

Pulmonary fibrosis following pneumonia due to acute Legionnaires' disease. Clinical, ultrastructural, and immunofluorescent study.

During a recent nosocomial outbreak, 20 critically ill patients with acute Legionnaires' disease were admitted to the intensive care unit of Hopital Bichat, Paris. Pulmonary specimens were obtained at surgery or immediately after death in 12 patients and were examined by light, immunofluorescent, and electron microscopy. Five of these 12 patients showed evidence of pulmonary fibrosis. In all of these five patients, infection with Legionella pneumophila was evidenced by bacteriologic methods, and other diseases known to cause fibrosis were excluded. The condition of four patients deteriorated rapidly with respiratory failure, and they died with pulmonary fibrosis. Only one patient finally recovered but was left with pulmonary sequelae. Two distinctive morphologic patterns were observed, one in which interstitial fibrosis was predominant and one in which intra-alveolar organization and fibrosis were also present. The alveolar epithelial lining and the basement membranes were disrupted in all patients, as evidenced by ultrastructural observations and by immunofluorescent studies showing gaps in the distribution of type 4 collagen and laminin. Types 1 and 3 collagen accumulated in areas corresponding to thickened interstitium and intra-alveolar fibrosis. Thus, some patients who survive the acute pneumonia of Legionnaires' disease may develop pulmonary fibrosis, and this process may lead to functional impairment or death despite prompt and appropriate treatment.

Adult↗
PubMed1986

[Urinary tract obstruction by Candida bezoars, or fungus balls].

Two patients admitted to an intensive care unit for severe bacterial infection develops Candida albicans superinfection with obstruction of the urinary canals by "fungus balls". The development of medico-surgical techniques using antibiotics and immunosuppressive drugs accounts for the increasing incidence of disseminated candidiasis. The kidneys are particularly sensitive to Candida infections. Fungus balls are conglomerates of mycelium which may result in obstruction of the urinary tract. Their clinical, radiological and ultrasonic features, as well as the microbiological and serological diagnostic problems they raise are described. Ultrasonically guided percutaneous nephrostomy is a very interesting technique for the diagnosis of the condition and its local treatment by drainage and lavage with amphotericin B. This antifungal, combined with flucytosine is still used for the systemic treatment of candidiasis.

Aged↗
PubMed1986

Intragastric pH profile during acute respiratory failure in patients with chronic obstructive pulmonary disease. Effect of ranitidine and enteral feeding.

The ability of H2 receptor antagonists and continuous enteral alimentation to maintain high intragastric pH in patients with chronic obstructive pulmonary disease (COPD) requiring mechanical ventilation was evaluated by continuously monitoring intragastric pH prior to and following sequential addition of ranitidine or continuous enteral alimentation (or both) to their therapeutic regimen. Prior to therapy, intragastric pH was less than 4.0 for 75 +/- 10 percent of the time, but never less than 1.0. Nevertheless, this moderate gastric acidity was associated with evidence of mucosal injury. Ranitidine failed to continuously maintain a high intragastric pH (pH less than 4.0 for 35 +/- 11 percent of the time; p greater than 0.2 compared to patients treated with placebo). Following administration of continuous enteral alimentation, intragastric pH fell, and ranitidine therapy only partially blocked this increase in gastric acidity induced by continuous enteral alimentation. We conclude that without treatment, patients with COPD who have acute respiratory failure may develop gastric mucosal injury despite the presence of only moderate intragastric acidity; however, ranitidine and continuous enteral alimentation are not effective in maintaining a high intragastric pH.

Acute Disease↗
PubMed1986

Prosthetic valve endocarditis. The case for prompt surgical management.

Clinical and morphologic features are described in 27 patients with prosthetic valve endocarditis. The interval from valve replacement to onset of symptoms of prosthetic valve endocarditis was less than 2 months in 10 patients, longer than 2 months but less than 6 months in seven patients, and longer than 6 months in 10 patients. The most frequent infecting organism was Staphylococcus (11 patients). In nearly all patients, infection spread behind the site of attachment of the valve prosthesis and resulted in valve ring abscesses. Twenty-three of the 28 infected prostheses were partially or almost completely detached, and in 15 patients the infection destroyed the entire valve anulus, burrowing to adjacent structures in six. Despite prolonged bactericidal antibiotic therapy, bacterial cultures of prosthetic valves removed at operation or autopsy were positive in 14 patients. Standard valve replacement was attempted in nine patients. All were hospital survivors, but two of these patients evidenced rapid postoperative valve dehiscence and required a complex surgical procedure at reoperation. The 14 other surgically treated patients had almost complete destruction of the annular root, and surgical repair was achieved by complex surgical techniques. There were five postoperative deaths, but nine patients survived with no further evidence of infection (mean follow-up 34 months). All patients with early prosthetic valve endocarditis who recovered underwent this type of operative technique. Total exclusion of the infected annular root, as described, may offer in patients with extensive endocarditic lesions the only possibility to eradicate the infection and to reduce the mortality.

Adolescent↗
PubMed1985

Use of granulated sugar in treatment of open mediastinitis after cardiac surgery.

19 critically ill adults with acute mediastinitis after cardiac surgery were treated with granulated sugar, either directly (11 patients) or after failure of continuous irrigation (8 patients). Mediastinal tissue cultures were positive in 18 patients. Packing the mediastinal cavity with granulated sugar every 3 or 4 h resulted in near-complete debridement of the wound and rapid formation of granulation tissue in all patients and sterilisation of the wound after an average of 7.6 days. Dressings were easy and painless to change. 5/19 (26%) patients died before discharge, but none because of wound complications. The rest were discharged on average 54.2 days (range 29-120) after initial debridement of the wound; 11 underwent secondary surgical closure of the wound and in 3 the wound healed by granulation tissue formation alone. No recurrence of sternal infection has occurred after a mean follow-up of 8.2 months (range 3 to 17).

Adult↗
PubMed1984

Pharmacokinetics of apalcillin in intensive-care patients: study of penetration into the respiratory tract.

A pharmacokinetic study of apalcillin was performed in 12 patients in an intensive-care unit. All received a single dose of 30 mg/kg in a 30 min infusion followed by 90 mg/kg/day for four days; six patients (group A) were treated by intermittent administration for two days (30 mg/kg in 30 min infusion, three times daily), followed by continuous infusion for the next two days; six other patients (group B) first received continuous infusion followed by intermittent infusion. Serial serum specimens were collected after the first infusion and on the third and fifth days of treatment. Bronchial secretions were taken simultaneously via an endotracheal tube or the tracheostomy cannula, in order to study the penetration of the drug into the respiratory tract. Assays were performed by a microbiological method. A mean serum peak value of 87.1 +/- 6.13 mg/l 5 min after the end of the first injection was followed by a slow decrease in serum levels and a residual value of 6.29 +/- 3.21 mg/l (8h). Intermittent administration resulted in a mean serum peak of 79.56 +/- 12.35 mg/l whereas after continuous infusion, a steady state of about 30 mg/l was obtained. No significant difference was found between pharmacokinetic parameters for the two groups. In bronchial secretions, a mean peak value of 5.8 mg/l was attained by the second hour. Decreased levels in bronchial secretions measured after three or five days treatment were possibly related to a decrease in inflammation.

Ampicillin↗
PubMed1984

Aortic input impedance in heart failure: comparison with normal subjects and its changes during vasodilator therapy.

This study was aimed at the evaluation of aortic impedance in patients with congestive heart failure. Aortic impedance (simultaneous measurements of aortic pressure and blood flow), mean (Wm) and pulsatile (Wp) powers were compared in 11 normal subjects and in 12 patients with heart failure. Pulse wave velocity (C: modified Moëns-Korteweg equation, simultaneous measurements of aortic pressure and radius) was determined under control conditions in all normal subjects and in 7 patients with heart failure. Impedance curves in patients with heart failure were characterized by increased values of the impedance modulus at 0 Hz (peripheral resistance) and at low frequencies. The characteristic impedance, C, and phase were not different from normal subjects. In six patients with heart failure, impedance curves were studied during nitroprusside infusion. During the infusion of the vasodilator, the impedance modulus at 0 Hz and at low frequencies decreased. The characteristic impedance was unchanged. The zero intercept of the phase was shifted towards lower frequencies. These results show that the changes in impedance curves in patients with heart failure are due to greater peripheral resistance and wave reflection. During nitroprusside infusion the stroke volume increased and the aortic blood flow became more pulsatile (greater values of low frequency components). This modification accounts for the increased values of Wm and Wp, and is related to decreased peripheral resistance and wave reflection.

Adult↗
PubMed1984

Prospective evaluation of the protected specimen brush for the diagnosis of pulmonary infections in ventilated patients.

To determine the relative cultural accuracy of the bronchoscopic protected specimen brush (PSB) in ventilated patients, we compared this method in the same area of the lung with histologic and bacteriologic examinations of pulmonary specimens. The procedures were concluded just after death when the ventilator was still functioning. Samples via the PSB were taken from a branch of the anterior basal bronchus of the left lower lobe, and immediate left thoracotomy was performed to obtain peripheral specimens from the corresponding segment for quantitative cultures. Twenty-six patients were studied; 6 had histologically proved pneumonia. Using quantitative cultures, a correlation was evidenced between PSB and lung cultures, especially in the subgroup of patients who received no antibiotic during the week preceding their death. No pneumonia was observed when PSB cultures isolated no organisms in concentrations greater than 10(3) colony-forming units (cfu) per ml. The PSB cultures at a level of 10(3) cfu/ml identified every patient with histologically proved pneumonia and every microorganism present in concentrations of 10(4) cfu/g or greater in the lungs. Moreover, in the subgroup of patients receiving no antibiotic, only 4 microorganisms were isolated by the PSB in concentrations greater than 10(3) cfu/ml and not found in the lung.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗