Life-threatening 5-fluorouracil-like cardiac toxicity after treatment with 5-fluorocytosine.
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Biomedical subjects
Publications and source records attributed to J Jourdan.
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BACKGROUND: The significance of anti-human leukocyte antigen immunoglobin G (IgG) detected in the posttransplantation course of heart graft recipients remains unclear. METHOD: Sera from 121 cardiac allograft recipients transplanted between January 1992 and December 1994 were screened for the presence of lymphocytotoxic antibodies in the first year after transplantation. Dithiothreitol was used to differentiate IgG from immunoglobulin M. RESULTS: Nineteen patients (15%) had cytotoxic IgG develop, mainly during the first month after transplantation. The percentage of women was higher in this group (42% vs 15.7%; P <.05). Donor to recipient mismatches for sex, blood typing, cytomegalovirus serology, and human leukocyte antigen typing were comparable between IgG producers and nonproducers. The frequency of acute allograft dysfunction during the first year after transplantation was significantly higher among patients producing IgG (42% vs 5.9; P <.001). Most of these acute allograft dysfunctions were independent of cellular rejection lesions but were associated with a thickening of the posterior wall and the interventricular septum during the acute episode. Finally, all the patients but one recovered. Recurrences were not uncommon and, at 1 year after transplantation, the dose of cyclosporine used in patients producing IgG was significantly greater, as was the left ventricular thickness. CONCLUSION: Posttransplantation cytotoxic IgG is not uncommon and appears to be associated with a high rate of acute allograft dysfunction. Development of these antibodies can be caused by a previous undetected immunization, as suggested by the higher percentage of women in the producer group. Correlation with histologic lesions of humoral rejection are discussed.
Mesenteric ischemia after cardiac surgery is rare but dramatic. We present a patient who had acute mesenteric ischemia following low cardiac output after coronary artery bypass grafting. Our patient was successfully treated with continuous intra-arterial perfusion with papaverine. We think that selective angiography must be performed as early as mesenteric ischemia is suspected, to get earlier diagnosis and treatment of an ischemic patient.
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A proximal pseudofracture of a Medtronic 6936 defibrillating lead adjacent to the ICD pulse generator was found on X ray. At this site, the multifilar metallic connector joins the stimulating lead before coiling around it. Conventional X ray of the abdomen does not visualize this connection. During ICD replacement, lead impedance should be routinely measured.
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The authors report two cases of pulmonary lymphangioleiomyomatosis which were diagnosed by surgical biopsies. Immunohistochemical study showed positive staining of the smooth muscle cells using antibodies directed against smooth muscle actin, specific muscle actin, HMB45 and vimentin. Ultrastructural study showed some smooth muscle differentiation features, with numerous myofilaments and some dense bodies near the plasma membrane. In one case, the patient was treated by a double-lung transplantation. LAM is a non-familial disease occurring exclusively in females. The etiology is unknown. This disease can be complicated by chronic respiratory failure. Extrapulmonary sites are not rare, particularly in the uterus. Anti-estrogen treatment can slow the course of the disease. Lung transplantation is actually the only effective treatment at the present time therapy. The differential diagnosis of this disease is discussed.
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Pulmonary involvement is very rare in giant cell arteritis. The sign that is most often encountered seems to be dry cough which can remain, for a long time, the sole manifestation of this disease. We report a case of giant cell arteritis in a 66 year old woman that expressed for only symptom a dry cough during one year. A rapid regression of clinical symptoms and radiologic signs have been observed with steroid therapy. Presence of isolated cough along with biological marks of inflammation in a elderly patient should lead to temporal biopsy when no other evidence cause has been found.
We developed an enzymatic method using nitrocefin to assay tazobactam in vitro. Tazobactam was incubated with TEM-1 beta-lactamase. Then, residual beta-lactamase activity was assayed by adding nitrocefin. This activity corresponded indirectly to the initial concentration of tazobactam. Within-assay, between-assay and accuracy coefficients of variation were below 15%. The correlation coefficients between enzymatic method and high performance liquid chromatography (the reference method)was 0.98. The enzymatic method is rapid, easy to perform and should be applied to daily clinical practice.
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The in-vitro 50% inhibitory concentrations (IC50s) of latamoxef and imipenem against a set of plasmid-mediated beta-lactamases including TEM-1, TEM-3, TEM-5 and TEM-10 were determined by an enzymatic method using nitrocefin as substrate. The IC50s of both antibiotics against extended-spectrum beta-lactamases were below 0.2 mg/L. The conventional spectrum beta-lactamase TEM-1 was not inhibited by either antibiotic at the highest concentration tested. Except for TEM-10 for which the IC50s of the two antibiotics were the same, imipenem showed significantly greater activity than latamoxef against TEM-3 and TEM-5. Clavulanic acid taken as a control demonstrated greater and wider inhibitory activity, but on the other hand it has no significant antibiotic activity.
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