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Biomedical subjects

O Leroy

Publications and source records attributed to O Leroy.

At least 91 records · Page 5Linked to original sources
PubMed1989

[Nosocomial pneumopathies].

The criterion used for the diagnosis of nosocomial pneumonia is an infiltrate on X-ray of the chest, not present on admission, associated with new sputum production. The main causative pathogens are Staphylococcus spp. and Gram-negative bacilli. The most common pattern in the development of pneumonia is colonization of the oropharynx followed by aspiration into the lungs in patients with impaired normal defences. The factors which significantly predispose to nosocomial pneumonia are tracheal intubation, low level of consciousness, chronic lung disease, thoracic or upper abdominal surgery, large volume aspiration and age over 70 years. The fatality rate is high (32 p. 100 to 55 p. 100). In most cases the curative treatment requires a combination of antimicrobial agents. At the moment, preventive measures remain an elusive goal.

Cross Infection↗
PubMed1989

[Nosocomial infections caused by intravascular catheters].

In intensive care units nosocomial infections associated with intravascular catheters are an important cause of morbidity. Infection is essentially due to the implantation of cutaneous pathogens and to the contamination of infusion line components by manipulations. The risk of infection therefore mainly depends on the way the catheter is handled and on the duration of catheterization. The diagnosis of infection rests on clinical observation of the patient and on a semi-quantitative study of the catheter. Preventing such infections requires strict asepsis of the skin when the catheters is introduced and while it is maintained in situ and changes of infusions lines and of the catheter itself. These changes must be particularly frequent when the catheter is manipulated and when the patient is already infected prior to catheterization.

Asepsis↗
PubMed1989

[Can nosocomial infections be prevented?].

Nosocomial infections constitute an important problem in terms of morbidity, wHich can be measured as excess hospital stay, mortality and extra-cost. A third of these infections can be prevented by an effective control programme, as shown by the results of the SENIC Project, but this requires a close co-operation between infection control nurses, physicians interested in infection control and practising epidemiological supervision and hospital personnel. Data concerning the four main sites of nosocomial infections (surgical wounds, urinary tract, lower respiratory tract and bloodstream) are reviewed, and the main guidelines regarding their prevention are summarized.

Cross Infection↗
PubMed1989

Nosocomial infections associated with long-term radial artery cannulation.

From January 1987 to December 1987, 193 radial artery cannulations were performed in 112 patients (87 males, 25 females; mean age = 57.5 years). The mean duration of cannulation was 6.45 days. After removal, the tip of the catheter was cultured using a semiquantitative culture technique: 164 catheters were cultured and positive results were seen in 37 cases (22.5%); 98 samples of infusate were cultured. Positive results were observed in 23 cases (23.5%). No bacteriological correlation was found between these two culture results. During the study, no catheter-related or infusate-related bacteraemia was detected. It is concluded that nosocomial infections associated with long-term radial artery cannulation are not commonly seen, in particular no catheter or infusate-related bacteraemia occurs even if the duration exceeds 4 days.

Catheterization, Peripheral↗
PubMed1989

[Enterobacter, Serratia, Acinetobacter or Pseudomonas septicemias].

During 1985 and 1986, 48 bacteremias due to Enterobacter spp, Acinetobacter spp, Serratia spp or Pseudomonas spp were collected by the SES Group. The mortality rate of those infections due to multiresistant organisms appeared high (27.9%). Among all factors influencing the prognosis, the following, age over 75 years, hospital-acquired infections, occurrence of shock and single antimicrobial therapy, are those associated with a high fatality rate. Given that clinical signs are not specific, nosocomial bacteremias should be treated by antimicrobial agents having wide spectrum, rapid onset of action and most often in combination.

Acinetobacter Infections↗
PubMed1989

[Prospective randomized controlled study of a ceftazidime and pefloxacin combination versus a ceftazidime and amikacin combination in the empirical treatment of pneumonia and nosocomial septicemia at intensive care units].

Three hundred fifty-two patients from 20 intensive care units, suffering from pneumonia or nosocomial septicemia were treated at random with either ceftazidime + pefloxacin (CP) or ceftazidime + amikacin (CA). After exclusion of patients who did not comply with the protocol and of cases where no organism was isolated, 108 assessable patients received CP and 114 received CA. The cure rates achieved in infections due to a single organism were 82 per cent in the CA group and 62 per cent in the CP group. In infections due to multiple organisms, the cure rate was 67 per cent with both antibiotic regimens.

Amikacin↗
PubMed1989

[Treatment of pneumonia caused by Legionella, Mycoplasma, Chlamydiae and Rickettsia using ofloxacin].

To asses the efficacy and the safety of ofloxacin as therapy of pneumonia caused by intracellular pathogens, 35 patients were studied (26 male, 9 female, mean age: 52.5 +/- 16.6 years). Causative pathogens were Chlamydia psittaci (n = 13), Legionella pneumophila (n = 10), Mycoplasma pneumoniae (n = 7) and Coxiella burnetii (n = 5). Ofloxacin was administered orally in 32 cases (200 mg b.i.d. in 80% of cases) and by I.V. route in 3 cases. All patients were cured without any side effects. In conclusion, ofloxacin appears, in our study, as an efficient therapy for these pneumonias. It could be considered as a valuable alternative to other antimicrobial agents with intra-cellular activity.

Adult↗
PubMed1988

[Controlled randomized prospective study of a ceftazidime-pefloxacin combination versus a ceftazidime-amikacin combination in the empirical treatment of nosocomial pneumonias and septicemias of resuscitation. Preliminary results].

The preliminary results obtained in 212 patients from 20 intensive care units, suffering from pneumonia or nosocomial septicemia and treated at random with either ceftazidime + pefloxacin (CP) or ceftazidime + amikacin (CA) were analyzed. After exclusion of patients who did not comply with the protocol and of cases where no organism was isolated, 57 assessable patients received CP and 72 received CA. The cure rates achieved in infections due to a single organism were 85 per cent in the CA group and 63 per cent in the CP group. In infections due to multiple organisms, the cure rate was 74 +/- 2 per cent with both antibiotic regimens.

Amikacin↗
PubMed1988

[Pulmonary valve endocarditis caused by Streptococcus D bovis in a patient with a colorectal adenocarcinoma].

A case of pulmonary endocarditis caused by Streptococcus D bovis in a female patient with colorectal adenocarcinoma is reported. The M-mode and two-dimensional echocardiographic and pulsed doppler ultrasound findings are described. A review of the literature shows that Streptococcus D bovis pulmonary endocarditis is rare. Any septicaemia or endocarditis caused by this organism calls for invasive exploration of the digestive tract, and especially the colon.

Adenocarcinoma↗
PubMed1987

[Coxsackie B virus infections in cardiology. Apropos of 66 cases].

Coxsackie B virus infections are common and frequently asymptomatic. However in young people, they can cause primary congestive cardiomyopathy and complicate previous cardiovascular illnesses. Virus diagnosis is difficult and based mainly on the detection of significant rising or stating high neutralizing antibody titers. A clinical and epidemiological five years study investigated 3,856 sera. 30.2% of the patients had evidence of a significant antibody titer (greater than or equal to 64) to one of the group B Coxsackie viruses; this percentage reaches 34.6% in cardiology and fluctuates from year to year; Coxsackie B2 is predominant (55.9%) in cardiology; coxsackie B1 and B2 antibody responses were detected more frequently than B3, B4 and B5. Coxsackie B6 appears to be uncommon. From these, 66 patients have evidence of coxsackie B virus infections with 60.2% for Coxsackie B2; they include pericarditis (30.3%), acute and chronic congestive cardiomyopathies (19.7%). Moreover it has been suggested that Coxsackie B virus might be responsible for electrocardiographic abnormalities (9.1%), ischemic heart disease and myocardial infarction. Enzyme linked immunosorbent assay (ELISA) and radioimmunoassay with purified antigens (VP1 and VP4) did not appear better than microneutralisation for evaluation of IgM and IgG antibodies. To elucidate the mechanisms of cardiac injury it is refer to viral replication, virus specific and auto-reactive T cells cytotoxic activities.

Coxsackievirus Infections↗
PubMed1987

[Gallium-67 scintigraphic evaluation of primary dilated myocardiopathies in adults].

Myocardiopathy (MCP) is diagnosed by exclusion in patients with congestive heart failure in the absence of lesions of the coronary vessels or cardiac valves. Endo-myocardial biopsies and several cases of clinical improvement under immunosuppressive therapy suggest that it may be due due to an immune mechanism. Gallium-67 is taken up by the myocardium and may be regarded as a scintigraphic marker of myocardial inflammation. It may therefore be used to determine which patients would benefit from immunosuppressants. Our study involved 47 patients (mean age 40.1 +/- 10.2 years) with MCP evidenced by angiography and coronary arteriography. Isotopic ejection fraction (EF) and Ga-67 uptake by the myocardium were evaluated in all cases. A significant Ga-67 uptake was observed in 22 patients, 20 of whom could be divided into two groups: group I received an immunosuppressive treatment (azathioprine plus prednisone); group II did not receive such treatment. A new radionuclide cardiac examination was carried out 5 months after the beginning of treatment. No significant Ga-67 uptake could be detected in either group. Significant improvement of EF was observed in 6 patients of group I and in 2 patients of group II. Four patients had died: 1 in group I and 3 in group II. Thus, a decrease in Ga-67 uptake was noted in all patients 5 months after the initial examination, irrespective of the treatment received, which suggests that this decrease belongs to the natural history of the disease. The effect of immunosuppressive therapy on MCP, therefore, ought to be re-evaluated.

Adult↗
PubMed1986

[Aneurysm of the sinus of Valsalva in children and young adults. Apropos of 9 cases].

Nine cases (7 boys and 2 girls) of aneurysm of the sinus of Valsalva (SVA) diagnosed before 19 years of age are reported. Group 1 comprised 5 children aged 5 to 14 years without rupture of the aneurysm; 3 had an associated ventricular septal defect (VSD). The diseased sinus was the right anterior sinus in 4 cases and the posterior sinus in one case. The diagnosis was made by 2D echocardiography, performed in 3 patients for follow-up of a VSD and in 2 patients to investigate a systolic murmur. Group 2 comprised 4 patients under 19 years of age with SVA which ruptured into in the right heart cavities. One of these patients had a known right anterior SVA diagnosed at angiography performed to investigate a VSD when the child was 4 years old. The rupture occurred suddenly when the child was 14. These cases of SVA involved the right anterior sinus with rupture into the right ventricle (3 cases) and the posterior non-coronary sinus with rupture into the right atrium (1 case). A rupture syndrome was observed in 3 of the 4 patients with pulmonary oedema in 2 cases. The authors emphasise the rarity of SVA diagnosed before rupture and the low frequency of rupture before adulthood. Echocardiography is certainly the best method for diagnosing the condition and for following up these patients.

Adolescent↗
PubMed1986

[Anti-Coxsackie antibodies and congestive cardiomyopathies].

During a 4-years period 122 patients admitted to the cardiologic hospital in Lille presented a significative positivity of serological reaction against Coxsackievirus B. Among these patients 19 suffered from acute pericarditis, 4 from cardiac arrhythmias, 3 from Bornholm syndrome and 14 from apparently primary congestive cardiomyopathy. In most of these 14 patients representing 18.4% of congestive cardiomyopathies investigated at the same time, hemodynamic studies and heart scanning with radioactive gallium were performed. 7 of these patients had a chronic (group A) and 7 an acute evolution (group B). In group A the scans were negative 4 times out of 5, whereas in group B they were positive in 5 out of 5 examinations. The control group including 3247 patients coming from the Institut Pasteur exhibited serological positivity in 4.6% of cases. Comparison of this group with that of cardiomyopathies shows a significant difference (p less than 0.001). The authors draw the attention to the frequency of positive serodiagnosis in congestive cardiomyopathy and stress the importance of gallium scintiscanning.

Adult↗
PubMed1986

[Difficult diagnosis of the plasmodial species].

We reported a case of malaria in a 37 years-old French woman. The first crisis occurred 8 months after coming back from an endemic area. Plasmodium falciparum was the responsible species. After 3 months' clinical latence, the patient had a new malarial crisis, but P. vivax malaria. Pictures of polyparasitism and the almost total absence of Schüffner granulations were noted. This double malaria infection and the involvement of atypical plasmodial strains are discussed.

Adult↗