[Surgical treatment of complex periodontitis].
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Biomedical subjects
Publications and source records attributed to M Brion.
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The equilibria of the complexes formed separately by calcium and magnesium with tetracycline, oxytetracycline, doxycycline and minocycline were studied in the previous parts of this series. Computer simulations run on this occasion showed that the stoichiometry of these species do actually condition the bioavailability of the antibiotics in blood plasma during treatment, the fraction of free base being quite negligible with regard to the metal-bound one. The present paper completes this study with the investigation of the mixed-metal complexes given rise to by calcium and magnesium with the same antibiotics. Such ternary species have been proved to exist for tetracycline, oxytetracycline, and minocycline. Their involvement in the plasma distribution of these drugs is discussed, in relation with the potential abilities of the four tetracyclines to diffuse from plasma into tissue membranes.
The formation constants of the various complexes formed by magnesium with four tetracycline derivatives, namely, tetracycline itself, oxytetracycline, doxycycline, and minocycline, were determined by potentiometry over large pH ranges under experimental conditions pertaining to blood plasma (37 degrees C, NaCl 0.15 mol dm-3). The results were used, together with those previously obtained on the complexation of these tetracyclines with proton and calcium, to assess the influence of the two alkali earth metal ions on the bioavailability of these drugs in blood plasma. Accordingly, simulations of the distribution of the four tetracyclines into their different proton and metal complex species were calculated. The distributions confirm that, in combination with the protein-bound fraction of the tetracyclines, the metal-bound fraction represents more than 99% of these drugs in plasma, the extent of their free fraction commonly being less than 1%.
One thousand one hundred and seventy refugees from Cambodia, Laos and Vietnam were examined in the north of France from 1976 to 1980. 58% of them carried digestive parasites, 22% had anti-Plasmodium antibodies and 2% showed circulating Plasmodium. The most frequent parasites were hookworms (28%), Opisthorchiidae (15%) and Giardia intestinalis (12%). Strongyloides stercoralis (5,7%), Entamoeba histolytica (4,5%), tapeworms (3,3%), human coccidia (1,3%) and Trichostrongylus sp. (1%) were less frequent. Four cases of japonicum schistosomiasis were diagnosed by rectal biopsy. Three species of Plasmodium were identified: P. falciparum (10 cases), P. vivax (3 cases) and P. malariae (2 cases). 16% of the refugees displayed E haemoglobin (Hb E). The occurrence of parasitic infestation and Hb E were more frequent in Cambodians and Laotians than in Vietnameses. Specific anti-P. falciparum antibodies were observed with a significant higher frequency in patients carrying Hb E.
The authors report a case of endocarditis due to Corynebacterium diphtheriae. THe bacteriological study is difficult since this micro-organism can be undistinguishable from a saprophytic diphtheroid. The observed case is compared to previously published observations. All have in common the great severity of the illness, and the high mortality rate. Despite the clinical symptoms and the cerebrospinal fluid (CSF) abnormalities, meningitic involvement could not be demonstrated.
Over a six year period, 145 pneumococcal septicemias were seen at the Tourcoing Hospital. This represents 0.39% of all hospitalized patients and 19.8% of all septicemias seen over the same period. A mortality rate of 38.6% was recorded. Prognostic factors were analyzed. The mortality rate was significantly higher in women (46.5%), in patients admitted for a reason unrelated to the septicemia (50.8%), and in patients with septic shock (81.5%) which was frequent (22.8%). An underlying poor general condition was present in 88.2% of the patients. This confirms the high risk of pneumococcal infections in some patients who should be protected by vaccination.
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A fast diagnosis (6h) of clinically latent pyonephrosis by combined use of 99mTc-MDP and 67Ga-citrate is reported. This technique combines the potential early detection of focal infectious processes by 67Ga and the "high-pulse" separation possibility of multiple isotopes. A brief prospective study (6 months) showed the interest of this technique: in six cases focal bone and/or joint infections were found three of which were absolutely latent clinically.
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The second generation cephalosporins are those drugs that are totally or partially resistant to betalactamases (cefamandole, cefuroxime) or the cephamycins (cefoxitine). This property allows them to destroy the enterobacteria resistant to cefalotine and they may have a place in the treatment of certain post-operative infections (abdominal, gynaecological, urinary) on their own or in combination with an aminoglycoside. They also may be of use in combination with an aminoglycoside in the management of secondary septicaemia infections. Outside of these indications which are dependent on the bacteriological findings, their use should be limited even when there is an absence of organisms that are Cefalotine sensitive on the antibiogram. This careful approach (which applies particularly for cefotaxine) may be abandoned once a certain quantity of resistant strains have emerged. For the time being, the second generation cephalosporins ought to be used only for specific indications, and as a general rule should not be first line antibiotic treatment.
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