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Biomedical subjects

M Rapin

Publications and source records attributed to M Rapin.

At least 37 records · Page 2Linked to original sources
PubMed1983

[Suppurating splenic infarction originating from endocarditis].

Three cases of splenic infarction complicated by abscess formation during bacterial endocarditis are reported. In all three cases there were associated clinical abdominal signs and, in one case, there was persistently positive hemocultures. The diagnosis was made by CAT scanning. The three patients underwent splenectomy and one patient also underwent valve replacement the same day. The methods of early diagnosis of splenic complications during endocarditis and the indications of splenectomy are discussed. Ultrasonography and abdominal CAT scanning are the most sensitive diagnostic methods for splenic lesions. As splenic rupture is associated with a high mortality and this complication may occur at any time during infarction complicated by abscess formation, early splenectomy is justified when abdominal clinical signs are elicited associated with a persistent, infectious syndrome with or without positive blood cultures, under appropriate antibiotic therapy. Splenectomy should also be considered if valve replacement is carried out in the same circumstances to avoid infection of the prosthesis.

Abscess↗
PubMed1982

[Penicillin-induced encephalopathy].

Five cases of encephalopathy due to intravenous penicillin treatment (penicillin G sodium in 4 cases, oxacillin in 1) are reported in 5 uraemic patients. The first abnormalities noted were decreased consciousness and myoclonic jerks (3 cases), followed by seizures and coma (2 cases). Lumbar puncture and cerebral computed tomography gave normal results. Electroencephalograms showed diffuse sharp and slow activities over the brain areas. The diagnosis was confirmed by the high blood levels of the penicillins. Three patients recovered after discontinuation of the drugs; two patients died in status epilepticus and coma resistant to all treatments.

Adult↗
PubMed1982

Computed tomography and post-laparotomy intra-abdominal abscesses.

Thirty-one patients were prospectively studied and had abdominal computed tomography for post laparotomy sepsis. Computed tomography is of particular interest in seriously ill post-operative patients, 15 of our patients were on ventilators, and it enabled diagnosis and localization of abscesses in 15 patients. Drainage could therefore be achieved via a limited surgical approach, and extensive laparotomy was avoided. Of 16 patients without abscess, the abdominal computed tomogram was negative in 14 cases and there were two false positives. The overall accuracy was 0.94 with a sensitivity of 1 and a specificity of 0.88. The ability to screen the whole abdomen and exactly localize the lesion are the advantages of this non-invasive method.

Abdomen↗
PubMed1982

Influence of age, previous health status, and severity of acute illness on outcome from intensive care.

Age, previous health status (HS), and severity of acute illness were assessed prospectively on 228 unselected patients admitted over 1 yr to the multidisciplinary ICU, to determine their influence on outcome. One hundred and fifty patients (66%) were discharged from the ICU, but the survival rate fell to 50% at 6 months, and was similar after 1 yr (49%). Over a 6-month period, there was improved HS in survivors which gradually leveled off. Compared to prior HS, the final HS was worsened in 37% of survivors. Three factors were important predictors of late survival: age under 50, good previous HS, and less than two visceral failures. We conclude that evaluation of ICU outcome should provide information on 6-month survival and HS and include important variables as age, previous HS, and severity of acute illness.

Acute Disease↗
PubMed1982

Cefotaxime therapy of serious infections with multiresistant gram-negative bacilli.

33 patients with serious gram-negative bacillary infections were treated with cefotaxime. In patients with normal renal function the dose varied between 1.5 to 4 g/day. 17 patients had urinary tract infections, 5 respiratory tract infections, 1 combined urinary tract infection and respiratory tract infection, and 10 miscellaneous infections. 16 patients had septicemia. 25 infections were due to pathogens resistant in vitro to ampicillin, cephalothin, gentamicin and/or tobramycin. 15 infections had failed to respond to ampicillin, cefazolin, gentamicin or tobramycin therapy. 32/33 patients responded favourably to cefotaxime (cure or improvement) but 4 patients developed superinfection with cefotaxime-resistant bacteria. No evidence of nephrotoxicity was observed except for a transient moderate rise in creatinine in one patient.

Adult↗
PubMed1982

[Controlled study of pristinamycin versus oxacillin in staphylococcal infections ].

A prospective double-blind study was conducted in patients hospitalized with a staphylococcal infection. The effects of oxacillin (4-6 g/d) and pristinamycin (2-3 g/d) were compared. These were 52 cutaneous infections and 17 other ones. The results of the two antibiotics effects were not different. Tolerance was appreciated in the 82 patients who entered the study: pristinamycin had fewer (but not significantly different) side effects than oxacillin (3/37 vs 9/45). As pristinamycin is active in vitro on at least 95 p. cent of strains, we concluded that it can be the first choice antibiotic in staphylococcal infections when the oral route is possible.

Administration, Oral↗
PubMed1982

A new case of phosphoglycerate kinase deficiency: PGK Creteil associated with rhabdomyolysis and lacking hemolytic anemia.

A new case of phosphoglycerate kinase (PGK) deficiency is described. The propositus displayed episodes of rhabdomyolysis crises and acute renal failure but did not exhibit any sign of hemolysis. A severe deficiency in phosphoglycerate kinase was revealed in muscle and was also found in erythrocytes, white cells and platelets. A partial defect in the same enzyme was present in the mother's and the two daughters' erythrocytes, indicating a X-linked recessive genetic transmission of the enzyme defect. In the propositus, erythrocyte ATP concentration was normal, although 2,3-diphosphoglycerate and triose phosphate levels were moderately increased. Lactate production from glucose, in vitro, was close to normal in intact red cells. The partial PGK was characterized by an increased Km for ADP and more especially for ATP, reduced thermostability, and diminished electrophoretic mobility. Lack of this enzyme, which is a key step in the glycolytic process (generation of one molecule of ATP), is thought to be responsible for rhabdomyolysis, a fact that has not been reported previously.

Acute Kidney Injury↗
PubMed1981

[A rare cause of acute respiratory distress syndrome in adults: acute disseminated pulmonary tuberculosis. Four cases (author's transl)].

Four cases of acute respiratory distress syndrome due to miliary tuberculosis are reported. All four patients had tuberculin anergy; three developed disseminated intravascular coagulation. All were treated early with anti-tuberculous drugs. Three patients were intubated and ventilated with positive end expiratory pressure, but they died shortly afterwards. The fourth patient was treated with continuous positive airway pressure and corticosteroids and survived. In view of such reports, the possibility of tuberculosis should be considered systematically in all adult patients with unexplained acute respiratory distress syndrome. The extremely rapid course of the disease and the inconsistent results of standard examinations for tuberculosis justify an "aggressive" diagnostic approach. Extra-pulmonary biopsies, notably of the bone marrow, are very helpful.

Acute Disease↗
PubMed1981

[Toxic-shock syndrome. Three cases (author's transl)].

Several cases of toxic shock syndrome (T.S.S) have been recently reported from the U.S.A. Clinical features of this new syndrome include fever, desquamative scarlatiniform rash, hypotension and involvement of central nervous system, liver, kidney and muscles. More than 90% of cases are women with staphylococcic vaginitis using tampons during menstruations. A toxin produced by staphylococcus aureus is thought to be the causative agent, because the germ has been isolated in local (vaginal, pharyngeal, subcutaneous or other sites) but not systemic (blood, cerebrospinal fluid) cultures. The mortality rate is 3-10%, and relapse can occur. We report the first three french cases of T.S.S.: a 17 year old girl with typical tampon-associated vaginitis, a 36 year old woman with a postoperative peritonitis and a 20 year old man with a popliteal abscess. Staphylococcus aureus of type I or IV was identified at the site of infection in all cases, but never in blood cultures. These three patients recovered with antistaphylococcic antibiotics and supportive therapy, but local treatment of infections seems to have been of utmost importance. These cases suggest that T.S.S. can occur with several staphylococcus serotypes and confirm that this syndrome is not always associated with tampons and vaginitis.

Adolescent↗
PubMed1981

[Cefotaxime in the treatment of severe infections due to multiresistant Gram-negative bacilli (author's transl)].

Cefotaxime was used to treat 33 patients with serious Gram-negative bacillary infections. The dosage varied between 1.5 g and 4 g/day in patients without renal failure. Eighteen patients had urinary tract infections, 6 had pulmonary infections and 10 had miscellaneous infections. Sixteen patients were also bacteremic. Twenty-five infections were due to pathogens resistant to ampicillin, cephalothin, gentamicin and/or tobramycin, in vitro. Fifteen infections had failed to resolve during ampicillin, cefazolin, gentamicin or tobramycin therapy. Thirty-two patients responded favourably (cure or improvement). Four patients developed superinfection with cefotaxime-resistant bacteria. One patient developed mild reversible renal insufficiency. Cefotaxime is a very active cephalosporin with potential use in serious multi-resistant enterobacteria infections.

Acinetobacter Infections↗
PubMed1980

The role of iatrogenic disease in admissions to intensive care.

We prospectively studied all patients admitted to a multidisciplinary intensive care unit to determine how many of their diseases were iatrogenic and, of these, what number were potentially avoidable. Of 325 patients admitted in the course of one year, 41 (12.6%) were hospitalized because of iatrogenic disease. Many of these patients had concomitant serious illnesses. Nevertheless, 19 patients (46.3%) were admitted with iatrogenic disease resulting from therapeutic or technical errors that were potentially avoidable. Iatrogenic disease was fatal in eight cases, life-threatening in 13, moderate in 20.

Adolescent↗
PubMed1980

Nov Presse Med.

Explore the source record for details and available documents.

Acute Kidney Injury↗
PubMed1980

Circulating immune complexes in patients with gram negative septic shock.

In order to explain complement components abnormalities observed during septic shock, circulating immune complexes (C.I.C.) were searched for in sera from 34 patients with gram negative sepsis by two different methods: polyethylene glycol precipitation test based on physical properties of C.I.C. and C1q deviation test based on the property of radiolabelled C1q to react with C.I.C. Serum immunoglobulins (IgG, IgA, IgM) and complement components (C1q, C3, C4) levels were simultaneously determined. Seventeen patients with minimal haemodynamic abnormalities had normal or increased levels (except C4 at 62% of normal) and in eleven cases both tests for C.I.C. were simultaneously positive. Seventeen patients with severe septic shock had a decrease in IgG, IgM C1q, C3 and C4 and none had both tests for C.I.C. simultaneously positive (P less than 10(-4)). The disappearence of C.I.C. in patients with severe septic shock associated with evidence of complement activation suggests their involvement in the pathogenesis of septic shock in man.

Antigen-Antibody Complex↗