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Biomedical subjects

P Tattevin

Publications and source records attributed to P Tattevin.

28 records · Page 2Linked to original sources
PubMed1999

Prosthetic joint infection: when can prosthesis salvage be considered?

Management of prosthetic joint infection (PJI) remains a therapeutic challenge. We retrospectively studied 69 infected total hip or knee arthroplasties managed between 1980 and 1996 in our institution. Treatment failure, defined as relapse of PJI in the first year following the last antimicrobial treatment, occurred for 14 patients (20.3%). None of the potentially contributive parameters analyzed was significantly predictive of treatment failure. Of the subgroup of 34 patients with PJI who initially underwent debridement with retention of the prosthesis, the 13 (38.2%) who did not require further surgical treatment had symptoms for a significantly shorter duration before debridement (4.85 vs. 54.24 days; P < .0001). Because debridement with retention of the prosthesis rarely enables control of PJI, this therapeutic approach should be considered only when the duration of symptoms is very short.

Adult↗
PubMed1999

The validity of medical history, classic symptoms, and chest radiographs in predicting pulmonary tuberculosis: derivation of a pulmonary tuberculosis prediction model.

STUDY OBJECTIVE: To improve the respiratory isolation policy for patients with suspected pulmonary tuberculosis (TB). DESIGN: Prospective, descriptive, French multicenter study. SETTING: Emergence of nosocomial outbreaks of TB. PATIENTS: All consecutive patients admitted with suspicion of pulmonary TB. MEASUREMENTS AND RESULTS: Medical history, social factors, symptoms, and chest radiograph (CXR) pattern (symptoms and CXR both scored as typical of pulmonary TB, compatible, negative, or atypical) were obtained on admission. Serial morning sputa were collected. Of the 211 patients, 47 (22.3%) had culture-proven pulmonary TB, including 31 (14.7%) with a positive smear. Mean age was 46.2 years; 52 patients were HIV positive (24.6%). The sensitivity of the respiratory isolation policy was 71.4%, specificity was 51.7%, negative predictive value (NPV) was 88.2%, and positive predictive value (PPV) was 26.3%. On univariate analysis, predictive factors of culture-proven pulmonary TB were CXR (p < 0.00001), symptoms (p = 0.0004), age (mean, 40.8 years for TB patients vs 47.5 years for non-TB patients; p = 0.04), absence of HIV infection (89.4% vs 71.3%; p = 0.01), immigrant status (72% vs 55%; p = 0.03), and bacillus Calmette-Guérin status (p = 0.025). On multivariate analysis, CXR pattern (p < 0.00001), HIV infection (p = 0.002), and symptoms (p = 0.009) remained independently predictive. Based on these data, a model was proposed using a receiver operating characteristics curve. In the derivation cohort, the sensitivity and NPV of the model in detecting smear-positive pulmonary TB would have been 100%. The specificity and PPV would have been 48.4% and 25%, respectively. The model performed less well when evaluated on two retrospective groups, but its sensitivity remained above that of the current respiratory isolation policy (91.1% and 82.4% for the retrospective groups vs 71.1% for the current policy). CONCLUSIONS: Improved interpretation of clinical and radiologic data available on patient admission could improve adequacy of respiratory isolation. A prediction model is proposed.

BCG Vaccine↗
PubMed1999

[Neuromuscular complications of long-term treatment of inflammatory diseases. 3 cases].

Chloroquine and colchicine, widely used in internal medicine practice for a variety of inflammatory diseases including systemic lupus erythematosus, rheumatoid arthritis, familial Mediterranean fever, and Behçet's disease, may induce neuromuscular complications. Physicians must be familiar with this diagnosis as this iatrogenic neuromuscular pathology may simulate polymyositis, leading thus to inappropriate treatment with prednisone whereas the only effective treatment is to discontinue the drug involved whenever possible. We report three cases of toxic myopathy and/or neuropathy related to chronic chloroquine or colchicine therapy for systemic diseases, and outline the main points to be considered in this situation.

Adult↗
PubMed1998

Gastric lymphoma of the MALT with breast relapse.

The usual features of non-Hodgkin lymphomas (NHL) of the mucosa-associated lymphoid tissue (MALT) include monocytoid B-cell proliferation, and chronic inflammatory precursor lesions. Despite a reputation of being indolent, NHL of the MALT may disseminate to other MALT areas, and raise difficult therapeutic questions. We report a case of gastric NHL of the MALT whose evolution, despite an initial surgical treatment considered radical, was noticeable for a well documented breast relapse.

Adult↗
PubMed1996

[Tuberculosis. Current therapeutics].

Due to the constant decline in incidence up to the mid eighties, eradication of tuberculosis appeared to be an attainable objective in developed countries. Since then multiple factors (HIV epidemic, poor social conditions in certain unfavored areas, population migrations, urbanization) have led to an increased frequency, making an excellent knowledge of tuberculosis a priority for all physicians. Multi-resistant mycobacteria have also made their appearance leading to numerous clinical and experimental studies which provide new insights into the correct management of patients with tuberculosis. Despite these recent changes, the classical treatment for tuberculosis remains the same in most cases, allowing nearly-certain cure when applied correctly in patients infected with a susceptible bacteria, including those with HIV infection or extrapulmonary localizations. On the contrary, the spontaneous aggravation of multi-resistant tuberculosis, even in some cases being treated, emphasizes the need to test the strain's susceptibility to the antituberculous agents used. Certain new antibiotics, including fluoroquinolones, may play an important role in some cases. The contribution of surgery, isolation and strict compliance must also be emphasized. Resistant strains may also led to renewed indications for the Calmette-Guérin vaccine.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

Respiratory manifestations of leptospirosis: a retrospective study.

We retrospectively reviewed 34 consecutive patients with serologically confirmed leptospirosis admitted during years 1992-2002. Nine patients (26.5%) had respiratory symptoms on admission including cough (n = 4), shortness of breath (n = 4), cyanosis (n = 2), and hemoptysis (n = 1). Six patients had pulmonary radiographic findings including (1) diffuse, ill-defined, ground-glass density (n = 3); (2) diffuse alveolar opacities (n = 2); and (3) small nodular density (n = 1). Male/female ratio was 8/1 and mean age was 47 years. Seven patients reported their exposure source including hunting (n = 2), fishing (n = 2), fresh water swimming (n = 2), and canoeing (n = 1). All patients had fever (mean = 40.1 degrees C). Other common symptoms were headache (n = 4), vomiting (n = 3), and myalgia (n = 3). Biological abnormalities included elevated liver enzymes (n = 8), proteinuria (n = 7), lymphopenia (n = 6), hematuria (n = 5), renal failure (n = 4), anemia (n = 4), and elevated neutrophil count (n = 4). PaO(2 )was measured for 3 patients while they were breathing room air (32, 55, and 66 mmHg). Suspected diagnosis on admission included leptospirosis (n = 2), bacterial pneumonia (n = 2), intoxication, influenza, viral hepatitis, biliary tract lithiasis, and rapidly progressive glomerulonephritis (one patient each). The first serologic testing for leptospirosis was positive for 5 patients (55%). Serovar was presumptively identified for 7 patients: Australis (n = 3), Grippotyphosa (n = 2), and Icterohaemorrhagiae (n = 2). Seven patients were treated with penicillin; two patients received no antibiotics. All patients were cured. In conclusion, patients with leptospirosis may present predominantly with nonspecific pulmonary symptoms. In these patients, leptospirosis must be suspected when there is a potential exposure to rats, especially in case of high-grade fever, myalgia, hepatitis, and renal abnormalities.

Female↗