[Chronic meningitis: a crossroads to mark. Analysis of 5 cases and review of the literature].
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Adult↗
Biomedical subjects
S Rampon
Publications and source records attributed to S Rampon.
Rifampicin in the treatment of osteoarticular infections due to staphylococci.
Rifampicin is a suitable drug for treating staphylococcal bone and articular infections, because high levels are obtained in the human tissues. The best oral dose is 600 mg 12 hourly. The serum levels range from 10 to 15 mg/l at the peak concentration and from 0.2 to 0.6 mg/l 8 h after oral administration of 600 mg. The ratio for cancellous bone/serum is 0.41 at 3 h and 0.39 at 12 h, and for cortical bone/serum is 0.20 at 3 h after a dose of 600 mg. In every case, tissue levels paralleled serum levels; cancellous bone levels are greater than the MIC of Staphylococcus aureus strains until 12 h after a dose of 600 mg. Rifampicin is always used in combination with another antibacterial substance. Results are excellent in most cases. The average duration of antibiotic treatment is 3 months for osteo-arthritis, 6 months for spondylitis and osteitis.
Adult↗
[Temporal arteritis with necrotizing angiitis of the muscles].
A 71 year old woman with typical giant-cell arteritis experienced myalgia of the legs immediately at the end of steroid therapy, 3 months after the onset of her illness. Muscle biopsy showed a focal necrotising panarteritis whereas the muscular fibres remained unchanged. The patient is now asymptomatic after 3 years' follow-up on prednisolone therapy (10 mg per day). This case demonstrates that giant cell arteritis can also involve the muscular arteries.
Aged↗
[Assay of plasma xanthine and hypoxanthine by coupled gas chromatography-mass spectrometry and sampling problems].
The differential assay of xanthine and hypoxanthine in plasma, serum and erythrocytes was performed using a combination of GC and MS with chemical ionisation. The influence of sampling conditions was studied, in particular the latency period between the collection of the blood and the separation of the plasma and the cells, the nature of the anticoagulant used and the method of storage of the samples. Firstly, this study confirms that EDTA is the most appropriate anticoagulant. It also showed that an immediate deproteinisation is necessary after separation of the plasma and the cells, in order to prevent any "in vitro" modification of the oxypurines, in particular erythrocyte hypoxanthine.
Anticoagulants↗
[The diagnosis of Gougerot-Sjorgen syndrome in rheumatology. I. Evaul ation of the principal complementary examinations].
The examination of a patient with Sjögren's syndrome includes evaluation of the eye, the buccal cavity, and a search for certain factors in the blood. Schirmer's blotting-paper test is a good test but is not specific. In addition, a decreased amount of tearing is difficult to interpret after the age of 45. Slit-lamp examination (rose bengal and fluorescein) yields lesions which confirm keratoconjunctivitis due to decreased tearing. The buccal component is difficult to evaluate. A biopsy of the buccal mucosa gives the best results with minimum risk and expense. Nucleotide scanning is sensitive, but less specific. Salivary flow decreases with age. After 60 years of age this decrease can not be interpreted. The chemical composition of tears or of saliva is promising, but it is not yet a part of the usual diagnostic work-up. Of the available laboratory tests, anti-SS-A antibodies and/ or anti-SS-B antibodies are of value, but they are not found consistently.
Humans↗
[Double-blind comparative study of slow-release ketoprofen tablets and indomethacin in coxarthrosis and gonarthrosis].
Effectiveness and tolerance of Bi-Profenid 150 mg were investigated in osteoarthritis of the hip and knee in 20 patients. This double blind trial compared Bi-Profenid, given in two daily 150 mg doses, to indomethacin in two daily 50 mg doses. Each patient was given both treatment regimens successively for 7 days each, with the order being determined at random. The effectiveness of Bi-Profenid and indomethacin was statistically comparable on the criteria studied: walking distance, pain upon passive mobilization, and assessment of pain on the pain scale. Tolerance proved satisfactory for both drugs. However, scores demonstrated a superiority for ketoprofen in 8 of 20 patients as compared to 5 of 20 for indomethacin.
Aged↗
[Association of streptococcal spondylitis and endocarditis. 2 new cases].
Two new cases of spondylitis associated with endocarditis are reported. Approximately 30 cases have already been published in the medical literature. Although this association is infrequent, the possibility of its occurrence calls for repeated auscultation in patients with spondylitis and focal roentgenograms in patient with bacterial endocarditis who develop vertebral pain.
Aortic Valve Insufficiency↗
[Treatment of rheumatoid arthritis by a single daily dose of levamisole. A comparative trial with gold salts].
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Arthritis, Rheumatoid↗
[Diffusion of fosfomycin into bone tissue in man].
Fosfomycine diffusion into spongious and cortical bone was studied in 20 patients undergoing total replacement of the hip after an intravenous infusion of 4 g (1 g/h). The serum and bone samples were collected 1 h and 3 h after administration of the drug. Concentrations at 1 h were 105.0 +/- 12.4 micrograms/ml, 19.6 +/- 4.8 micrograms/g and 13.3 +/- 3.7 micrograms/g in serum, spongious bone and cortical bone respectively; at 3 h these concentrations had become respectively 67.8 +/- 15.9 micrograms/ml, 10.0 +/- 4.2 micrograms/g and 8.2 +/- 3.6 micrograms/g. Antibiotic levels in bone tissue decreased in direct ratio to corresponding serum values, the mean tissue/serum ratio remaining at 15 +/- 4%.
Adult↗
[Rifampicin in the treatment of Staphylococcus arthritis].
Rifampicin is used for treating 20 Staphylococcus septic arthritis, in combination with another antibiotic. The former is chosen for its striking bone diffusion. The average duration of the whole antibiotic treatment is 3 months. Rifampicin is usually prescribed, in daily doses of 1 200 mg for 60 days, after one month of parenteral antibiotherapy. The bactericidal activity is controlled regularly by measuring serum inhibitory titre. For 2 patients, the administration of rifampicin is suspended after 12 and 25 days respectively, due to digestive disorders. Results are evaluated at the end of a period averaging 18 months. Articular infection has been cured in all patients. Taking these results into account, we are able to emphasize that the inclusion of rifampicin in the antibiotic scheme is of great value in treating bone and articular infections.
Adult↗
[Bone and phosphoro-calcium metabolism in reflex sympathetic dystrophy].
A combined study organised by the French Society of Rheumatology was devoted to the investigation of bone and phosphoro-calcium metabolism in cases of reflex sympathetic dystrophy. The following observations were made: the usual phosphoro-calcium parameters are not altered, apart from a slight elevation of the urinary calcium in multifocal forms of the disease, during the 3rd and 4th months; the level of PTH, studied in 11 patients, was normal in each case; the examination of 8 bone biopsies, one performed in the 7th week and six others performed during the 3rd and 4th months of the disease, showed, initially, invasion of the spongy tissue by oedema, signs of marrow stress and bone stress, with a reduction in the number of osteoblasts, without any marked alteration of bone remodelling. At a later stage, the biopsy shows intense bone remodelling with hyperosteoclastosis and hyperosteoblastosis and the formation of irregular bone tissue which later becomes lamellar. Electron microscopic study of two biopsies revealed signs of acellular demineralisation with normal appearance of the osteoblasts and osteoclasts.
Bone and Bones↗
Histological and immunological study in patients with rheumatoid arthritis showing isolated abnormalities of salivary scintigraphy.
We report the histological and immunological findings in 20 rheumatoid arthritis (RA) patients with impaired salivary scintigraphy but without sicca complex. This condition was stable over 2-5 years and associated with mild infiltrates on lip biopsies. Increased levels of IgG, immune complexes, and antinuclear antibodies were found in seven patients (35 vs 69% in secondary Sjögren's syndrome). Two of the seven patients later developed xerostomia. The above-mentioned immunological abnormalities may increase the likelihood of developing a clinical impairment of salivary function in patients with an abnormal salivary scintiscan, the latter being a frequent, yet often isolated, finding in RA. Antisalivary duct antibodies were not related to any other parameter of salivary gland involvement.
Arthritis, Rheumatoid↗
[Penetration of cloxacillin into human bone tissue after oral administration (author's transl)].
Cloxacillin diffusion into spongious and cortical bone was studied in 20 patients undergoing total replacement of the hip, after an oral single-dose of 1 g (10 patients) or an oral dose of 1 g every 8 hours (10 patients). Serum and bone samples were collected 2 and 3 hours after the last dose and assayed for antibiotic concentration by a microbiological method. Bone levels were similar in any group of patients, but significantly higher in spongious bone than in cortical bone. The bone/serum concentration ratios were 0.15 for spongious bone and 0.10 for cortical bone. Calculations from these data showed that adequate local levels inhibitory to Staphylococcus aureus, would be achieved by cloxacillin administration of 1 g dose every 4 hours orally.
Administration, Oral↗
[Osteoarticular infections due to Gram-negative bacilli].
An enquiry carried out on 20 French rheumatology units led us to find, out of a total of 1,202 cases of non-tuberculous osteo-arthritis of the adult, 137 gram negative bacillary infections. These were 64 cases of spondylodiscitis and 73 cases of septic arthritis, due mainly to Escherichia Coli, Pseudomonas and other enterobacteria. The frequency of gram-negative bacilli was 11.4% i.e. 9.2% in the case of arthritis and 15.6% in the case of spondylodiscitis. It is higher than in the middle of this century but does not seem to be progressing now. However, the seventy of this type of infection, which may cause important functional sequelae and numerous deaths (8 patients) justifies the routine search for these bacilli in appropriate culture media, in order to test their sensitivity to antibiotics.
Adult↗
[Stimulation of T-lymphocytes by autologous monocytes. Decrease in the proliferative response in Gougerot-Sjögren syndrome].
A mixed autologous culture enables the measurement of the proliferative response of T lymphocytes which have been stimulated by preparations of autologous mononucleated cells. The role of the monocytes present in the preparation was examined in this study which sought to determine if the autologous response induced by these monocytes was modified during Sjögren's syndrome. Purified monocytes are a powerful stimulant of autologous response in normal subjects. However, high concentrations of monocytes were found to have an inhibiting effect. In patients with Sjögren syndrome, the autologous response induced by monocytes in significantly decreased. This decrease parallels a reduction on "non-T" lymphocytes observed in these same patients. The anomaly provoking these two modifications does not appear to be caused by a seric factor or by a deficit of the proliferation of responding T lymphocytes. It is more likely due to a blockage of lymphocyte T/monocyte interactions where the markers of the HLA-D system intervene.
Cell Division↗
[Non-tuberculous infectious coxitis in adults].
A multicentric study permitted us to report 94 cases of non-tuberculous infections of the hip joint in the adult (13.4% of the cases of septic arthritis observed over the same period). A local predisposing factor (37.2%) and/or general predisposing factors (22.6%) were frequently noted. The routine search for bacteria permits identification of the latter in 71.3% of cases; the germ was usually a staphylococcus, arthritis due to Gram negative bacilli were found in 12% of the cases. The authors emphasize the interest of daily joint aspiration and traction on the lower limb associated with bactericidal antibiotic therapy which are the only means able, in their view, to improve the poor functional prognosis in these cases of hip joint infections.
Adult↗
[Role of the bacteriology laboratory in the diagnosis and treatment of osteoarthritis].
The etiological diagnosis of bone and joint infections, the choice of antibiotics adapted to the responsible bacteria and the supervision of their efficacy depend mainly on the bacteriology laboratory. A routine search for the causal bacteria in various samples, e.g. synovial fluid, blood cultures, synovial biopsy, inter-vertebral disc puncture, permit etiological diagnosis in about 80% of cases. The choice of antibiotics, limited to those whose synovial and bony diffusion is known, depends on the results of in vitro studies of sensitivity of the isolated bacteria (CMI and CMB) and of the bactericidal power of the associations. The measurement of the inhibitory power or concentrations of antibiotic in synovial fluid and serum give an indication of the efficacy of the treatment.
Adult↗
[The use of antibiotic treatment in osteoarticular infections].
The authors emphasise the interest of identification of the germ during bone and joint infections, and recall the main data, often fragmentary, one the diffusion of antibiotics into bone. Concerning the practical use of antibiotics, they emphasise the necessity of basing their treatment on bacteriological examinations before choosing an association of two antibiotics, the effect of which will be regularly assessed by a study of the bactericidal power of the serum.
Aminoglycosides↗