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Biomedical subjects

J M Sainty

Publications and source records attributed to J M Sainty.

At least 37 records · Page 2Linked to original sources
PubMed1993

Fatal pneumonia due to Serratia proteamaculans subsp. quinovora.

Serratia proteamaculans subsp. quinovora was isolated from several samples (blood cultures, tracheal aspirates, pleural effusion) from a patient with pneumonia. This is the first clinical isolate and the first documented human infection caused by this organism.

Adult↗
PubMed1992

[Non-malignant esophagotracheal fistulas in adults. Experience with 35 cases].

Esophagotracheal fistula always constitutes a serious, life-threatening complication. Fistulae occurring during medical intensive care with mechanical ventilation are currently the most frequent. Their diagnosis was strongly suspected by clinical examination of the patient, but was always confirmed by endoscopy which revealed their exact site in relation to the vocal cords or carina, essential information for the choice of incision when it is decided to perform surgery. Twenty-five patients were treated medically. Treatment was always combined with gastrointestinal resting, control of gastro-oesophageal reflux and broad-spectrum systemic antibiotics. There were 19 deaths and 6 fistulae closed spontaneously. Three of these 6 patients developed a secondary tracheal stenosis, 2 of which were treated surgically by resection-anastomosis. Ten fistulae were closed surgically with a good long-term result. The indication for surgery was essentially based on the patients general and infectious status and on his or her respiratory autonomy. Technically, we always combined direct suture of the two organs with interposition of muscular or pleural tissue.

Adult↗
PubMed1992

[Gangrene of the perineum. Plea for a standardized therapeutic management apropos of 50 cases].

From 1988 to 1992, 50 cases of perineal gangrene were treated with a therapeutic protocol combining: a) repeated extensive excisions, b) hyperbaric oxygen therapy, even before surgery if this was possible, and c) intensive care. The mortality rate was 24% (12/50). It was even higher in patients admitted more than 6 hours after diagnosis. The average stay in hospital was of 20 (+/- 2) days. Four patients presented with residual signs. Twenty-eight (56%) had had colostomy for lesions originating in the rectum or threatening the anal margin; 9 of these patients died, while gastrointestinal continuity was restored in another 17 cases. There were three predictive factors of survival in this series: a) early diagnosis and treatment, b) severity index on admission, c) some associations of bacteria.

Adult↗
PubMed1991

Comparison of different antibiotic regimens for therapy of 32 cases of Q fever endocarditis.

We studied 32 cases of Q fever endocarditis diagnosed in France between January 1985 and December 1989 to evaluate the efficacies of the different regimens of antibiotics used for treatment. Each patient was monitored during the treatment (range, 12 to 60 months), and clinical and biological information was computerized. Various treatments were prescribed, including doxycycline alone (9 cases) or in association with rifampin (4 cases), quinolones (16 cases), or sulfamethoxazole-trimethoprim (1 case). Two patients died before the beginning of the treatment. Nineteen patients had hemodynamic failure and subsequently underwent valve replacement. Nine valve tissue cultures were positive despite previous antibiotic treatment. In terms of their effects on mortality, the difference between doxycycline alone and doxycycline plus quinolones is statistically significant. We conclude that the addition of quinolones to doxycycline is beneficial. On the basis of clinical, serological, and valve tissue culture results, no treatment was able to cure Q fever endocarditis within 2 years, even with a combination of antibiotics. We advise a minimum duration of treatment of 3 years with therapy combining quinolones and doxycycline.

4-Quinolones↗
PubMed1988

[Treatment of nosocomial pneumopathies caused by Pseudomonas aeruginosa with ceftazidime. 50 cases in pulmonary resuscitation].

Fifty patients under prolonged mechanical ventilation who developed nosocomial lung infections caused by Pseudomonas aeruginosa were treated with ceftazidime. This cephalosporin was used alone in 18 cases and combined with another antibiotic (usually an aminoglycoside) in 32 cases. Favourable results were obtained in 40 cases, with regression of the clinical signs and eradication of the organism between the 5th and 10th days of treatment. Eight of the 10 failures occurred in patients with impaired ventilation due to chronic obstructive lung disease. Secondary superinfection was observed in 12 cases. Among the 257 strains of P. aeruginosa isolated in our respiratory intensive care unit over an 18-month period, 88 per cent were sensitive to ceftazidime, and this figure remained stable after the period when ceftazidime was given. These in vitro findings probably account for the remarkable results obtained in infections which up to now had mortality rates of 30 to 60 per cent, depending on the patient's underlaying condition.

Adult↗
PubMed1988

[Antibiotherapy in gangrene of the perineum].

Fifty cases of extensive and necrotizing perineal cellulitis ("perineal gangrene") are reported. The disease, remarkable for its many anatomical and bacteriological varieties, is regarded as a therapeutic requiring multidisciplinary management. Bacteriological samples were polymicrobial in 40 cases. Streptococcus D and aerobic Gram-negative bacilli were isolated in 21 patients. The initial antibiotic treatment had to be modified on ten occasions in 36 patients who were given penicillin G in high doses and on five occasions in 14 patients who received a beta-lactam antibiotic active against anaerobes. Nineteen patients (38 p. 100) died; death was directly related to the sepsis in 16 cases. The death rate was the same in the two treatment groups (11/36 and 5/14) and similar to that found in the literature. The authors advocate an ureidopenicillin, fosfomycin and imidazole combination as a substitute for the conventional penicillin G, aminoglycoside, imidazole combination, since the former is active against Streptococcus D and has better tissue penetration.

Adult↗
PubMed1983

[Digitalis poisoning and severe respiratory insufficiency].

After seeing 9 cases of digitalis intoxication in patients with acute respiratory decompensation of chronic respiratory failure in one year in an intensive care unit, the authors decided to review the literature on the subject. They set out to: --determine the clinical, laboratory and electrical features of digitalis intoxication in patients with chronic respiratory failure, accounting for the frequency of supraventricular arrhythmias; --evaluate the frequency of this intoxication (20% in this study), introducing a definite risk factor, given the poor haemodynamic effectiveness of digitaloids in this indication; --establish a therapeutic management based on the use of anti-arrhythmics and especially on the prevention of predisposing factors (hypoxaemia--functional renal failure and abuse of diuretics).

Adult↗
PubMed1978

[Haemodynamic data, blood gas measurements and coagulation disorders in acute respiratory failure of patients with chronic lung disease (author's transl)].

24 subjects with chronic obstructive pulmonary disease were investigated in the course of acute respiratory failure defined by hypoxaemia, hypercapnia and respiratory acidosis. Haemodynamic data of right heart catheterization and coagulation tests were particularly studied. 12 of these subjects had right heart failure defined by a rise of right ventricular end-diastolic pressure above 10 Torr. Coagulation tests brought evidence of consumption coagulopathy in 8 patients, 7 of whom had right heart failure. Data suggest a significant correlation between right heart failure and coagulation disorders in patients with acute exacerbation of chronic obstructive pulmonary disease. These disturbances, accompanied by reduction of pulmonary vascular area, could be in part related to the presence of microthrombi in pulmonary arterial vessels.

Aged↗