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Biomedical subjects

N Clumeck

Publications and source records attributed to N Clumeck.

At least 163 records · Page 9Linked to original sources
PubMed1979

Clinical and pharmacological evaluation of different preparations of oral erythromycin.

The activity of erythromycin stearate in respiratory tract infections was evaluated. This study involved 269 out-patients. Of these, 76 satisfied the strict criteria for detailed bacteriological study with positive cultures of a known pathogen before treatment and bacteriological follow-up after treatment. The results of erythromycin stearate were good against the haemolytic streptococcal infections. The activity of this antibiotic was shown to be insufficient against Haemophilus influenzae. A second clinical trial with 20 patients with acute exacerbations of chronic bronchitis demonstrated quite good activity from erythromycin ethylsuccinate and no intolerance when administered in a dose of 1 g q.i.d. The administration of 1 g of the ethylsuccinate immediately after a meal gave a peak serum concentration after 60 min of 3.36 micrograms/ml. Blood levels on the fourth day of this treatment showed some accumulation, concentrations of greater than 4 micrograms/ml being found at 30, 60 and 90 min after the dose. With its good absorption, its lack of toxicity and its reputation for good diffusion into bronchial secretions, we consider that erythromycin ethylsuccinate should have a major place in the treatment of respiratory tract infections.

Administration, Oral↗
PubMed1978

Is nasogastric suction necessary in acute pancreatitis?

Fifty-eight patients with mild to moderately severe acute pancreatitis were randomly allocated to treatment with or without nasogastric suction (27 and 31 patients respectively). Intravenous fluids and pethidine hydrochloride were also given. The two groups were comparable clinically at the start of the study. There were no differences between the two groups in the mean duration of the following features: abdominal pain or tenderness; absence of bowel movements; raised serum amylase concentration; time to resumption of oral feeding; and days in hospital. Prolonged hyperamylasaemia (serum amylase greater than 0.33 mU/l) occurred in one patient in the suction group and in three patients in the non-suction group. A mild recurrence of abdominal pain after resumption of oral feeding occurred in three patients in the suction group and in two patients in the non-suction group. Two patients in the suction group developed overt consumption coagulopathy and two others pulmonary complications. No patient in the non-suction group had complications. The findings suggest that most patients with mild to moderately severe acute pancreatitis do not benefit from nasogastric suction. The procedure should be elective rather than mandatory in treating this condition.

Acute Disease↗
PubMed1978

A low T3 syndrome in diabetic ketoacidosis.

The pituitary-thyroid axis was investigated in nineteen euthyroid patients with severe diabetic ketoacidosis. A 'low T3 syndrome' was found, with the following characteristics: lowered serum concentrations of triiodothyronine (T3), increased reverse triiodothyronine (rT3), slightly low thyroxine (T4), normal thyrotrophin (TSH), slightly increased triiodothyronine uptake (RT3U) values, and a blunted TSH response to thyrotrophin-releasing hormone (TRH). These disturbances in thyroid-function tests required several days good control of the diabetes to be corrected, at least partially. The data suggest the presence of an abnormal extrathyroidal T4 metabolism as well as a pituitary defect. Caution is recommended in the interpretation of thyroid-function tests during and several days after the treatment of diabetic ketoacidosis.

Adult↗
PubMed1978

Amoxicillin entry into human cerebrospinal fluid: comparison with ampicillin.

The entry of amoxicillin and ampicillin into cerebrospinal fluid (CSF) of humans was studied in the absence of meningeal inflammation. Twelve volunteers received 33 mg of amoxicillin per kg intravenously over 30 min and nine volunteers received 33 mg of ampicillin per kg. The CSF specimens were sampled at 1, 2, and 4 h after the beginning of the infusion. Blood samples were obtained at the end of the infusion and at 45, 60, 90, 120, 180, and 240 min after the beginning of the infusion. Amoxicillin and ampicillin were both detected in the CSF. Ampicillin tended to give higher CSF levels than amoxicillin, although the difference was small. Serum concentrations of ampicillin equaled those of amoxicillin.

Adult↗
PubMed1977

Lactic acidosis complicating diabetic ketosis in a patient with hyperthyroidism.

The present report describes a patient with insulin-dependent diabetes who developed simultaneously lactic acidosis and ketoacidosis following insulin deprivation. Administration of insulin at low doses rapidly corrected both ketosis and lactic acidosis. There had been neither circulatory collapse, nor phenformin intake, and hepatic function was normal. The development of lactic acidosis in this case was possibly precipitated by hyperthyroidism. A review of the literature indicates that lactic acidosis is a very rare complication of diabetic ketosis per se.

Acidosis↗
PubMed1976

Treatment of diabetic coma with small intravenous insulin boluses.

The clinical efficacy of small intravenous boluses of insulin in treating diabetic decompensation was tested in 23 patients presenting in either a ketoacidotic or a nonketotic diabetic coma. In addition to the usual ionic and fluid replacement, the patients received hourly intravenous injections of insulin 5 IU. This dose lowered blood glucose levels in all but two patients. In the patients who responded the percentage decrease in glycaemia was similar whatever the initial glucose concentration and averaged (+/-SE of mean) 50+/-3% in five hours. Close monitoring of insulin and glucose concentrations after intravenous insulin in three patients showed that despite the short half life of insulin the effect of the intravenous bolus lasted for about 60 minutes. The overall clinical effectiveness of this type of treatment is comparable to that of the other low-dose regimens. Owing to its simplicity, this technique of insulin administration seems most suitable for the routine treatment of diabetic coma.

Blood Glucose↗
PubMed1976

[Contribution of the "limulus test" to the diagnosis of endotoxemias and meningitis due to gram negative bacteria].

The "limulus test" may be used to detect the endotoxins of Gram negative organisms. Applied to the cerebrospinal fluid (79 specimens from 64 patients) it proved itself to be a very important contribution to the differential diagnosis of purulent meningitis (95% positive results, no false positives). However it can be used on the plasma only in patients with shock of suspected endotoxic origin.

Adult↗
PubMedDate not supplied

Moxalactam therapy of serious infections.

Twenty-four patients were treated with moxalactam for 25 serious infections. Nineteen patients were septicemic and 18 presented severe underlying diseases considered to impair the normal response to bacterial pathogens. All of the pathogens had MICs of less than 12 mg/l except one Pseudomonas aeruginosa strain with an MIC of 32 mg/l. The dosage ranged from 3 to 12 g/day; the route of administration was either i.v. or i.m. The duration of treatment was six to 26 days. Six patients had urinary tract infections (three bacteremia), four had pulmonary abscesses (two bacteremia), five had septic thrombophlebitis (five bacteremia) and ten had miscellaneous infections (nine bacteremia). Twenty-two (92%) patients responded favourably. Four patients (16.6%) developed superinfections due to organisms highly resistant to moxalactam: three Streptococcus faecalis, one Bacteroides fragilis and one Aspergillus flavus. Tolerance was good. Nine moderate adverse reactions were observed: three cases of transient eosinophilia, two of phlebitis, three hepatic enzyme alterations and one rash. Moxalactam kinetics were measured in serum from 15 patients with normal renal function after receiving 1 g i.v. over 30 min. The mean peak level after the infusion was 82.8 +/- 12.1 (SE) mg/l; the mean trough level 8 h later was 6.2 +/- 1.7 (SE) mg/l. The serum half-life was 2.6 +/- 0.6 (SE) h for the beta phase. Plasma clearance was 76.8 +/- 8.2 ml/min. Moxalactam was found to be highly effective in the therapy of life-threatening infections.

Adult↗
PubMedDate not supplied

Safety and efficacy of single-dose fluconazole compared with a 7-day regimen of itraconazole in the treatment of AIDS-related oropharyngeal candidiasis.

The primary aim of this study was to compare the efficacy and safety of single-dose fluconazole and a 7-day regimen of itraconazole for the treatment of oropharyngeal candidiasis in human immunodeficiency virus (HIV)-positive patients. In this open-label trial, 40 HIV-positive patients with oropharyngeal candidiasis were randomized to receive either one dose of fluconazole 150 mg or seven daily doses of itraconazole 100 mg. Clinical condition was assessed at baseline, day 8, and day 30 (follow-up). In the fluconazole group, 15 of 20 (75%) patients were clinically cured on day 8, three (15%) were clinically improved, and two (10%) were treatment failures. At follow-up, six (30%) patients experienced relapse. In the itraconazole group, four of 17 (24%) patients were clinically cured at 8 days, and two (12%) were clinically improved; two patients relapsed by day 30. Ten (50%) patients in the itraconazole group were taking concomitant medications that could potentially affect the bioavailability of itraconazole. After excluding the results from these patients, clinical response rates remained significantly higher in the fluconazole treatment arm. These results suggest that a single 150-mg dose of fluconazole may be a safe, effective, and convenient therapy for acquired immune deficiency syndrome-related oropharyngeal candidiasis. The lower response rate in the patients who received itraconazole 100 mg daily for 7 days could be explained by drug interactions and the unpredictable absorption of itraconazole.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

Efficacy and safety of trazodone versus clorazepate in the treatment of HIV-positive subjects with adjustment disorders: a pilot study.

The efficacy of trazodone and clorazepate to relieve anxiety and depressive symptoms in 21 HIV-positive subjects with adjustment disorders was determined in a 28-day single-centre, randomized, double-blind study. Subjects were evaluated using the Hospital Anxiety and Depression Scale, the Revised Symptom Checklist, the European Organization for Research and the Treatment of Cancer Quality of Life Questionnaire, and a binary criterion based on the Clinical Global Impression. The incidence of successful treatment was 80% for trazodone compared with 64% for clorazepate; the sample number was too small to establish a significant difference. Bayesian analysis revealed the probability of making a wrong decision in prescribing trazodone rather than clorazepate reduced from 35% to 18% in this small sample. Clinical evaluations using the different scales suggest some benefit from trazodone, although this was not significant. Safety of both treatments was similar. Trazodone is devoid of the risk of abuse and dependence, and may be a valuable alternative to benzodiazepines for the treatment of HIV-related adjustment disorders.

Adjustment Disorders↗
PubMedDate not supplied

AIDS-related Kaposi's sarcoma patients with visceral manifestations. Response to human chorionic gonadotropin preparations.

OBJECTIVE: In vitro cell culture studies and a murine model for human Kaposi's sarcoma (KS) have shown that human chorionic gonadotropin (hCG)-associated factor (HAF) isolated from commercial hCG preparations has antiproliferative and cell killing effects on neoplastic KS cells, without toxic effects on normal endothelial cells and lymphocytes. These findings prompted preliminary study of hCG preparations for patients with early-stage KS with skin lesions only and no known visceral involvement. Complete or partial regression of the skin lesions occurred after intralesional injections of hCG (hCG-Pregnyl, hCG-APL). The current study sought to extend these early observations to evaluation of the safety of hCG in acquired immunodeficiency syndrome (AIDS) KS patients with aggressive disease and visceral involvement. These patients present in a more advanced stage of the disease that is coupled with serious immunodeficiency. They commonly respond poorly to conventional chemotherapy and have a reduced median life expectancy of only 4 to 9 months. STUDY DESIGN/METHODS: After approval by the local institutional review boards, 13 patients with advanced AIDS-KS gave informed consent and were treated with hCG preparations. These hCG preparations are known to have antiproliferative activity in laboratory tests. Patients were monitored for tumor size by clinical evaluation, ultrasonography, radiography, respiratory functions, and endoscopic examination. Histologic examinations of biopsied tissues were used for studies of apoptosis using in situ hybridization techniques. The patients were also monitored for CD4+ T-cell numbers and human immunodeficiency virus type 1 (HIV-1) plasma viral load according to common clinical practice. RESULTS: Thirteen patients with advanced AIDS-KS and visceral KS were treated with hCG. Five of 13 (38%) patients had dramatic responses to therapy, and overall tolerance to the drug was excellent for all patients. Some hCG preparations also showed beneficial effects against HIV-associated markers. An accompanying decrease in viral load (plasma HIV-1 RNA) was observed in one patient, a dramatic increase in CD4+ cells occurred in another, and significant weight gain was seen in seven patients. CONCLUSIONS: These clinical observations suggest that patients with aggressive visceral forms of KS, usually indicative of an extremely poor prognosis and poor response to combined chemotherapy, can benefit from this new therapeutic approach. In some patients, these preparations also induce several other beneficial effects, such as weight gain, reduction in HIV-1 RNA load, or increase in the CD4+ T-cell count. Additional controlled clinical trials comparing this new therapeutic option with standard cytotoxic chemotherapy are needed. These trials should be extended to patients with KS not related to HIV-1 infection. Because we showed elsewhere that pure hCG had no effect on KS, identification and subsequent clinical use of the active molecules in hCG preparations is urgently needed.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

[Septicaemia and spontaneous peritonitis in the cirrhotic (author's transl)].

During a five year period 36 episodes of septicaemia in 32 patients with hepatic cirrhosis were documented. This represents 20% of the patients hospitalized with a decompensated cirrhosis and 1.1% of the patients with non decompensated cirrhosis. In patients with decompensated cirrhosis, enteric Gram-negative organisms were most frequently isolated (91% of the cases) and ascitis was infected in one third of the cases. No primary foci of infection were documented. On the contrary patients with a non decompensated cirrhosis had infection mostly with Gram-positive organisms (82%) and foci of infection (skin, throat) were documented in 38% of the cases. Infection by enteric organisms was associated with higher mortality than infection by non enteric organisms (68% vs 28%). Five patients with inappropriate antibiotic treatment died from septic shock. Spontaneous septicaemia and peritonitis are frequent complications if cirrhosis. There are potentially treatable causes of deterioration in the cirrhotic patient, necessitating prompt recognition and treatment.

Adult↗