Search PubMed⌕ Search

Biomedical subjects

P Germaud

Publications and source records attributed to P Germaud.

At least 37 records · Page 2Linked to original sources
PubMed1995

[Epidemiology of malignant pleural mesothelioma in the Nantes-Saint Nazaire region. Course in 1956-1992].

The aim of this study was to estimate the evolution of the incidence of mesothelioma in the Loire-Atlantique department since 1956 and to register all the cases diagnosed between 1985 and 1992 and to complete the data of earlier studies carried out between 1956 and 1984. The cases were indexed from the files of the pathology department and also from demographic and occupational data concerning the patients which had been gathered retrospectively from an inquiry of patients attached either to private physicians or to a hospital service. From 1956 to 1984 there were 125 cases (119 men, 6 women) who had been diagnosed; 92 cases were registered between 1985 and 1992 (79 men and 13 women). An increase in the annual number of cases was significant. The incidence during the period 1985-1992 was 10.9 per million inhabitants (men 19.4, women 3) against 8.7 (men 17.2, women 0.8) for the period 1975 to 1984 and 2.6 (men 5.2, women 0.2) for the period 1956-1974. The mean age of the subjects at the time of diagnosis rose during the period studied (59.2 +/- 9.4 between 1956-1974 to 63.1 +/- 11.9 between 1975-1984 and 67.0 +/- 9.7 between 1985-1992). Occupational exposure to asbestos was certain or probable in 85 per cent of cases with a median duration of exposure of 25 years (range 2 months to 48 years) with a median interval between the first exposure to diagnosis of 44 years (range 10-70 years). The industrial sector most often implicated was naval construction (127 cases).(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1995

[Invasive aspergillosis in intensive care].

Invasive pulmonary aspergilloses occur in patients with antineoplasic chemotherapy, mainly when associated with a prolonged neutropenia, in transplanted patients with continuous corticotherapy and less frequently in immunocompetent surgical patients. The clinical features are those of an acute infective pneumonia, not responding to antibiotherapy. Radiologic signs are often non specific. Diagnosis is obtained with bronchoalveolar lavage in which Aspergillus is found both at direct examination and in culture. Serological tests are of little interest for the diagnosis of invasive aspergillosis. Extrapulmonary locations such as sinusitis, cutaneous or brain abscesses occur in 20% of cases. The gold standard of treatment is intravenous amphotericin B which elicits an acute reaction often followed by a nephrotoxic effect which can be decreased by fluid loading with saline. Oral itraconazole administration can follow the initial treatment with amphotericin B. The mortality rate remains high and an early diagnosis and an appropriate treatment are essential.

Amphotericin B↗
PubMed1995

[Association of sarcoidosis and autoimmune thyroiditis].

The thyroid gland involvement in sarcoidosis is rare but not exceptional. Usually there is little or no clinical expression although hyperthyroidism may be present. The granulomatous infiltration of the thyroid gland cannot be responsible for all the abnormalities observed. In certain cases, there is undoubtedly an autoimmune disease. We report a case of concomitant discovery of sarcoidosis and Hashimoto's thyroiditis. Despite their relative frequency, there could be a relationship between these two pathologies, especially in light of their similar pathophysiology.

Female↗
PubMed1994

[Aspergillosis and malignant hemopathies].

Infections caused by fungi of the genus Aspergillus have become a major and dangerous problem in the modern treatments of blood diseases using cytotoxic drugs. Invasive pulmonary aspergillosis is the usual clinical manifestation of the disease. The clinical signs, not very suggestive, are those of an infective pneumonia and localized radiological forms are initially more frequent in most cases. The extra pulmonary forms are frequent: nose and sinus, skin, bone, digestive, central nervous system are principal localisations; but all organs may be affected by the processus of dissemination. The proximal tracheobronchial localisations may be seen by fibroscopy in 20% of cases, associated to invasive pulmonary aspergillosis. Diagnosis rests on pathological data, but in many cases the only possible examinations are broncho-alveolar lavage and bronchial brushing. The positive results are a major test of diagnosis.

Antineoplastic Agents↗
PubMed1993

Localized invasive pulmonary aspergillosis in patients with neutropenia. Effectiveness of surgical resection.

BACKGROUND: Invasive pulmonary aspergillosis (IPA) is a major cause of morbidity and mortality in patients with neutropenia. Two severe complications with poor outcome can be observed after apparently successful IPA medical treatment: severe hemoptysis and IPA relapse during subsequent cytotoxic treatments. Early surgical therapy has not been considered routinely in the management of localized IPA. METHODS: Six consecutive patients (four women, two men; median age, 52 years) with localized cavitating IPA diagnosed during chemotherapy-induced aplasia were treated with early surgical resection after hematologic recovery. RESULTS: All patients received a lobectomy. Surgery was uneventful. This procedures allows patients to proceed with further intensive chemotherapy and/or bone marrow transplantation without IPA reactivation. CONCLUSIONS: For selected patients, surgical resection of localized IPA with unique cavitating lesion, which prevents hemoptysis and IPA recurrence and allows for subsequent cytotoxic treatment, may be recommended.

Adult↗
PubMed1993

[Invasive aspergillosis in surgical intensive care patients].

Aspergillosis is a rare event in intensive care patients. Three cases of invasive aspergillosis due to Aspergillus fumigatus were diagnosed in a surgical critical care unit. Risk factors for aspergillosis were found in two liver transplanted patients. One of them had a primitive cutaneous aspergillosis, and the other, treatment difficulties due to the unavailability of an injectable preparation of itraconazole, a new triazole antifungal agent efficient against Aspergillus species. The third case occurred in a patient who had had surgery for gastric carcinoma with liver metastasis. The mycological examination of the air and workbench in the patients' rooms disclosed between 2 and 13 CFU.mm-3 of different Aspergillus species. Plasma itraconazole concentrations were measured in one patient only. They were below the therapeutic range, probably because of intestinal disturbances. The oral administration of itraconazole capsules through gastro-intestinal feeding tubes results in a poor availability of the drug. Such a technique of administration should therefore be undertaken with larger doses than those commonly recommended. Moreover, itraconazole plasma concentrations should be monitored. The association with amphotericin B is recommended until normal intestinal absorption has been obtained.

Adult↗
PubMed1993

[Monotherapy using amoxicillin/clavulanic acid as treatment of first choice in community-acquired lung abscess. Apropos of 57 cases].

In a multicentre open prospective trial the effectiveness of AM-CA as first-line treatment of community-acquired lung abscess was evaluated in immunocompetent adult patients. AM-CA was administered intravenously in doses of 4 g/day for at least 7 days, then orally in doses of 2 g/day for at least 14 days. Radio-clinical and laboratory evaluations were made during treatment, and 30 and 60 days after it was discontinued. The results of this trial concerned 57 patients (48 men, 9 women; mean age 52 years). The facilitating factors were those usually found in lung abscess. Twenty-seven patients had previously received an antibiotic treatment which had failed. The clinical picture, built up gradually in 42/37 patients, consisted of infectious syndrome (52 cases), altered general condition (39 cases), purulent expectoration (47 cases), sometimes foetid (10 cases), and thoracic clinical abnormalities (57 cases. X-ray films of the chest showed round abscess images (44 cases) or looked like necrotizing pneumonia (13 cases) with pleural reaction (8 cases). Protecting bacteriological sampling by BFW brushing and transtracheal or transparietal sample collecting was performed in 41 of the 57 patients. The pathogens, isolated in 31 cases, were: S. pneumoniae 5; Streptococcus spp. 12; Staph. aureus 4; H. influenzae 7; Enterobacteriaceae 6; anaerobes 7. These organisms were associated in 8 cases. With the exception of Enterobacter cloacae, all were sensitive to AM-CA in-vitro. The outcome was satisfactory in 52 patients.

Adolescent↗
PubMed1990

[Amoxicillin as a 1st choice: 275 acute focal pneumopathies treated on an outpatient basis].

From December 1986 to January 1988, 100 General Practitioners and Pneumologists working outside hospital included in open unmatched series 275 patients who were diagnosed as having pneumonia at home. The study consisted of 53.2% men with an average age of 49.3 plus or minus 19.3. Their temperature on the first day (J1) was in 72.7% of cases greater than 38.5 degrees Centigrade. The doctors felt that the general state was good in 66.5% of the cases. Cough was present in 83.5% of cases but was dry in one out of every two. The patients received Amoxycillin in a dose of 2 grams per day orally (66.9%), or by injection (33.1%). On the third day (J3) 90% of the patients had a temperature below 38.5 degrees Centigrade. Their general state was improved in 94.6% of cases. The diagnosis of pneumonia at home was confirmed radiologically on 219 of the films available, confirming the good specificity of the clinical diagnosis of pneumonia at home. Ten patients were hospitalised. The apparent treatment of Amoxycillin was given in 247 cases (89.8% of cases). In 28 cases (10.2%) the treatment was changed by the addition or substitution of a Macrolide (15), or another antibiotic (5), and in 80 cases a change of treatment was not specified. 25 of these 28 cases were reviewed on the 14th day (J14) and no failures were observed after the change of treatment. In 247 patients in whom the treatment with Amoxycillin was followed 336 were reviewed on the 15th day and there had been four failures. Three were intolerant to the drug and there was one relapse.(ABSTRACT TRUNCATED AT 250 WORDS)

Ambulatory Care↗
PubMed1989

[Invasive pulmonary aspergillosis].

Infections caused by fungi of the genus Aspergillus have become a major and dangerous problem in the modern treatments of blood diseases using cytotoxic drugs. Invasive pulmonary aspergillosis, generally caused by A. fumigans and A. flavius, is the usual clinical manifestation of the disease, but subacute forms have been described in patients with little immunodeficiency. The clinical signs, not very suggestive, are those of an infective pneumonia, and localized radiological forms are initially more frequent in most cases. Diagnosis rests on pathological data, but in many cases the only possible examinations are broncho-alveolar lavage and bronchial brushing which give both sensitive and specific results. Treatment is basically medical and consists of intravenous infusions of amphotericin B. The earlier the treatment the better the outcome which seems to be more favourable in patients with localized infection.

Amphotericin B↗
PubMed1988

Prognostic factors in diffuse malignant pleural mesothelioma. A study of 167 patients.

The existence of large shipyards accounts for the particular frequency of pleural mesothelioma in the Nantes-St. Nazaire region of France. From 1955 to 1985, 167 cases were diagnosed. Occupational exposure to asbestos was involved in 131 cases (88 percent). There was a great predominance of epithelial types (135) over mixed (25) and fibrosarcomatous (7) types. Survival, estimated by the actuarial method, was 54 percent at one year from first symptoms and 39 percent from histologic diagnosis. No subject was alive four years after diagnosis. Histologic type and asbestos exposure had no predictive value in our series. Survival was longer in patients under 60 years of age and when mesothelioma originated on the left side. Overall, treated patients had significantly longer survival than untreated patients. However, there was no significant difference in survival with respect to the type of treatment given: surgery, chemotherapy, talc poudrage or their combination.

Adult↗
PubMed1987

[Disseminated invasive aspergillosis associated with Mycoplasma pneumoniae infection].

Disseminated aspergillosis is rare in patients not suffering from haematological disorders and myelo-suppression. We report a case of pulmonary cardiac and renal aspergillosis diagnosed at autopsy in a patient with chronic respiratory failure dying in the intensive care unit during an acute exacerbation. The role of risk factors associated with invasive aspergillosis in patients not suffering from myelosuppression is discussed (steroid therapy, chronic respiratory disease, concomitant viral or bacterial infection). The discovery in this patient of a pulmonary infection associated with mycoplasma pneumonia (the micro-organisms were found in necropsy specimens of pulmonary tissue) does not seem to have been reported before in the literature.

Aspergillosis↗