Screening for HIV in necropsies.
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Biomedical subjects
Publications and source records attributed to J Y Lacut.
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The authors report an association of gastric and pulmonary amyloidosis in a 74 year old woman. The patient had had a gastric plasmacytoma for the last 11 years. On autopsy, the stomach was found to contain intramural deposits of amyloid, and was infiltrated by plasma cells secreting monoclonal IgG lambda light chain. In the lungs, the plasma cells in the vicinity of the amyloid deposits proved to be polytypic, suggesting that these deposits originated from circulating precursor proteins.
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One hundred one nosocomial septicemias (NS) were studied among 461 cases of septicemias (22%) collected by French Septicemia Expert System Group during 1985. The mean-age of the patients was 58 +/- 23 years while it was 56 +/- 23 years in the 360 community acquired septicemias (CAS). The source of septicemia was found more frequently in NS than in CAS (79/101 versus 223/360; p less than 0.002): mainly urinary tract and intravenous therapy in NS, urinary tract, gastrointestinal and biliary origin in CAS. Invasive procedures (except surgical procedures) were more frequent in NS than in CAS (13/101 vs 14/360; p less than 0.0001). Underlying diseases were more often associated with NS than with CAS (96/101 vs 276/360; p less than 0.0001). Many pathogens were involved in these NS but the frequency of S. aureus meti-S and meti-R, S. epidermidis, Enterobacter, Klebsiella, Serratia, Proteus indol + and Pseudomonas carbeni-R was significantly greater in NS than in CAS. There was no significant difference between NS and CAS for septic localizations, respiratory distress syndrome and septic shock. Two antibiotics (and possibly 3 antibiotics for polymicrobial septicemias) were more often used in NS than in CAS (61/101 vs 135/360; p = 0.002). If the duration of hospitalization was not significantly greater in NS than in CAS (26 +/- 29 days vs 23 +/- 33 days), the overall mortality was significantly more important (25.6% vs 14.9%; p less than 0.05).
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Thirty patients (17 male, 13 female; age 17 to 84 years; normal renal function in 23 cases) with severe bacterial infections were treated with ceftriaxone. The infections was septicemia in 20 cases, a septicemia-like condition in 2 and a focal infection in 8 (2 abscesses of the lung, 2 pyelonephritis, 1 abscess of the liver, 1 subphrenic abscess, 1 meningitis developed from an abscess of the brain and 1 acute intestinal infection). 25 infections were bacteriologically documented, with recovery of the following pathogens: 20 Gram negative rods (including 10 E. coli) that were all susceptible to ceftriaxone (MIC = 0.02 to 0.5 mg/l) except 2 (1 Pseudomonas and 1 E. cloacae), 5 susceptible Gram positive cocci (3 Pneumococcus, 1 Streptococcus and 1 Staphylococcus epidermidis) and 3 susceptible anaerobes (2 B. fragilis and 1 B. melaninogenicus). Ceftriaxone was given alone in 15 cases and in association with another antibiotic in 15 cases (aminoglycoside in 10 cases, nitroimidazole in 4 and fosfomycin in 1). The dose of ceftriaxone was 1 to 2 g per day in 28 cases, 3 g per day in 1 case (meningitis with abscess of the brain) and 1 g every other day in 1 case (chronic renal failure under hemodialysis). Duration of treatment ranged from 10 to 62 days (average 17 days). The usual routes of administration were IV and IM; the SC route was used on 4 occasions. Pharmacokinetic studies of serum levels were carried out in several patients including two who had ceftriaxone subcutaneously; results were consistent with those previously reported in the literature.(ABSTRACT TRUNCATED AT 250 WORDS)
A moderate increase in transaminases and alkaline phosphatase serum concentrations was observed in 14 of 32 patients with psittacosis (antibodies anti-Chlamydia psittaci greater than or equal to 1/40 with the complement fixation test). Clinical manifestations were present in 4 patients (hepatomegaly in 4 cases; jaundice in one case). In one patient, histological examination of a liver specimen showed granuloma. In 13 patients treated with tetracycline or macrolides, the outcome was favorable. One patient recovered spontaneously. In comparison with the group of 18 patients without hepatic involvement, there was no difference pertaining to epidemiological, clinical, or serological findings. Equally, there was no difference in the course of the disease.
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Twenty-three patients (22 male and 1 female) aged 41 to 70 years (mean age 56.4 years) with cancer of the upper respiratory and digestive tracts were entered into the study prior to a major surgical procedure involving incision of cervical mucous membranes. Participants were randomly assigned either to a control group (10 patients) which received no routine intra or postoperative antibiotics, or to a treatment group (13 patients) given cefoxitin perioperatively. Treated patients were given 30 mg/kg cefoxitin intravenously over 30 mn, one hour before surgery was begun, and 30 mg/kg over one hour, 3 hours and 6 hours after the initial infusion was started. Rate of local infection was 80% (8/10) and 15% (2/10) in the control group and treated group respectively (p less than 0.001). In addition, a significant difference in rates of local complications was found: 7 disjunctions and/or fistulae or pharyngostomes in the control group against one suppuration with disjunction in the treated group. In the treated group, a mean 24.6 day reduction in time lapse to cicatrization was observed. Fever greater than or equal to 39 degrees C occurring or persisting beyond the 48th postoperative hour was also significantly more frequent in the control group (7/10 versus 3/13). In contrast, no significant difference was found between rates of other infectious localizations. Local bacterial flora recovered in both groups before and/or after surgery was unremarkable and prophylactic cefoxitin selected no particular pathogens.