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A Legras

Publications and source records attributed to A Legras.

At least 37 records · Page 2Linked to original sources
PubMed1998

Septicemia and meningitis due to Streptococcus zooepidemicus.

A case of septicemia and meningitis due to Streptococcus zooepidemicus in an immunocompetent patient is reported. This organism is an uncommon human pathogen that sometimes causes severe infection, usually in immunocompromised patients. In the reported case, the patient required to be mechanically ventilated for one week and was treated with intravenous ampicillin and gentamicin. He recovered and was discharged from hospital three weeks after the initial presentation. Streptococcus zooepidemicus sensitive to all penicillins, was isolated from all blood cultures and the cerebrospinal fluid.

Aged↗
PubMed1998

Nosocomial infections: prospective survey of incidence in five French intensive care units.

OBJECTIVE: To assess the incidence and to evaluate the feasibility of inter-unit continuous surveillance of intensive care unit (ICU)-acquired infections. DESIGN: Prospective multicentre, longitudinal, incidence survey. SETTING: Five ICUs in university hospitals in western France. PATIENTS: All patients admitted to the ICU during two 3-month periods (1994-1995). MEASUREMENTS AND RESULTS: The main clinical characteristics of the patients, ICU-acquired infections, length of exposure to invasive devices and the micro-organisms isolated were analysed. The study included 1589 patients (16970 patient-days) and the infection rate was 21.6 % (13.1 % of patients). The ventilator-associated pneumonia rate was 9.6 %, sinusitis 1.5 %, central venous catheter-associated infection 3.5 %, central venous catheter-associated bacteraemia 4.8 %, catheter-associated urinary tract infection 7.8 % and bacteraemia 4.5 %. The incidence density rate of ICU-acquired infections was 20.3% patient-days. Ventilator-associated pneumonia and sinusitis rates were 9.4 and 1.5% ventilation-days, respectively. Central venous catheter-associated infection and central venous catheter-associated bacteraemia rates were 2.8 and 3.8% catheter-days, respectively. The catheter-associated urinary tract infection rate was 8.5% urinary catheter-days and the bacteraemia rate 4.2% patient-days. Six independent risk factors for ICU-acquired infection were found by stepwise logistic regression analysis: absence of infection on admission, age > 60 years, length of stay, mechanical ventilation, central venous catheter and admission to one particular unit. A total of 410 strains of micro-organisms were isolated, 16.8 % of which were Staphylococcus aureus (58.0% methicillin-resistant). CONCLUSION: This prospective study using standardised collection of data on the ICU-acquired infection rate in five ICUs identified six risk factors. It also emphasized the difficulty of achieving truly standardised definitions and methods of diagnosis of such infections.

Catheters, Indwelling↗
PubMed1998

-Severe self-poisoning with formol-.

We report a case of voluntary poisoning with formalin in a 47-year-old man. The initial status included respiratory failure, metabolic acidosis and coagulopathy. Medical therapy consisted of mechanical ventilation, a single prolonged haemodialysis session, N-acetylcysteine, and folic acid administration. The corrosive damage to the gastrointestinal tract required an oesogastrectomy and three months later a colic transplant.

Acetylcysteine↗
PubMed1998

Acute paraquat poisoning: increased toxicity in one case with high alcohol intake.

Human paraquat poisoning from accidental or intentional ingestion is very often fatal. According to the amount of paraquat involved, death can occur within hours or weeks following ingestion. The inefficacy of the various treatments undertaken have led to determine prognostic factors based upon the evolution of plasma and urine paraquat concentrations or of usual biochemical parameters. We report one case of acute poisoning which, although the ingested dose of paraquat was not massive (< 50 mg/kg-1) and the severity indices were in favour of a delayed fatal outcome, has ended in an early death. The high blood alcohol level of the patient (3.34 g l-1) seems to be the main cause of the precocity of this death (86th hour).

Acetylcysteine↗
PubMed1998

[Paradoxical embolism: a cause of cerebral stroke in the young subject].

We report the case of a 45 year old patient who presented ischemic stroke due to the migration of a sural thrombus through a patient foramen ovale (PFO) during a Valsalva manoeuvre. The presence of PFO should be systematically evoked in case of ischemic events, especially stroke in younger adults. The diagnosis is facilitated by two-dimensional contrast echography with intravenous administration of an echo-detectable contrast agent. The clinical context and the origin of the venous thrombus in a superficial vein which remained during a stripping procedure with migration through the communicating veins of the leg were exceptional.

Female↗
PubMed1998

[Cerebrospinal fluid complement and antinuclear antibodies in lupus meningoencephalitis].

Central nervous system involvement in systemic lupus erythematosus (SLE) requires immediate treatment. We report a case in a 30-year-old woman. Clinical features associated asthenia, headache, right nystagmus and coma. A mechanical ventilation was started. The neurologic pattern appeared three months after an initial treatment with pulsed doses of glucocorticoid (500 mg per day for 3 days) and one month after an oral cyclophosphamid regimen (50 mg twice a week). The cerebral involvement was evidenced by MRI and comparative analysis of the antinuclear auto antibodies (ANA) and the complement components in cerebral spinal fluid (CSF), pleural fluid and serum. The MRI slices showed a well-defined meningeal focal lesion. CSF-cell count was normal. CSF-proteins were elevated. ANA were positive, total complement (UI/l) was low, C4 component (g/l) was 0.11, undetectable and 0.25 respectively in plasma, CSF fluid and pleural fluid. The ANA specific pattern was anti-Sm2. We affirmed that specific cerebral injury was present because there were clinical and imaging features and a decrease of the C3 and C4 component in the CSF. The treatment associated in travenous pulsed doses of methylprednisolone (1000 mg per days for 3 days) and cyclophosphamid (500 mg per day for three days). Mechanical ventilation was with drawn one day after the end of the pulse therapy. The diminution of the complement component could help improving cerebral involvement of SLE. More clinical studies are required.

Adult↗
PubMed1998

[Significance of single photon emission computed tomography and akinetic mutism].

Akinetic mutism is a reactive status with permanent opening of the eyes. The accountable lesions are always bilateral. The injured cerebral structures include the frontal gyri, the thalami or the mesencephalic areas. In one case of a 44-year-old patient, magnetic resonance imaging and computed tomography were not contributive. Tc99m brain SPECT imaging was performed and displayed bilateral frontal hypoactivity. This case suggests that this technique could be helpful for diagnosis when clinical features and radiological pattern are opposite.

Adult↗
PubMed1996

[Legionnaires' disease with acute respiratory insufficiency. Clinical and biological characteristics, comparison with pneumococcal pneumonia].

OBJECTIVES: Legionnaires' disease is one of the main etiologies of bacterial pneumonias because of its frequency as well as its potential severity. The therapeutic choice implies the need to look for distinctive clinical, biological or radiological signs, due to the unreliability of rapid immunological criteria. Pneumococcus is the first cause of bacterial pneumopathy. Thus, identifying the distinctive signs between these two etiologies may be necessary. METHODS: In our restrospective study, nine Legionnaires' disease-related pneumonias were compared with nine pneumococcus-related pneumonias with acute respiratory failure and comparable level of severity. Patients were recruited over a two year period in a medical intensive care unit. RESULTS: Four criteria were found more frequently in pneumonia related to Legionnaires' disease: high-grade fever at the time of admission, elevated transminases, presence of Miller's criteria (converging clinical and biological signs) and increasing creatine kinase. CONCLUSION: In patients with severe pneumonia, both Pneumococcus and Legionella should be entertained as possible diagnoses before starting treatment. A prospective analysis of precise diagnostic criteria is needed to distinguish between these two bacterial diseases.

Acute Disease↗
PubMed1996

Buflomedil poisoning: five cases with cardiotoxicity.

OBJECTIVE: To report cardiotoxicity of buflomedil. SETTING: Medical intensive care unit of a university hospital. PATIENTS: Five patients admitted to the hospital since 1985 for buflomedil poisoning. The amount ingested was known for only three patients (3-10.8 g). RESULTS: The five young women were admitted to the hospital because of generalized seizures or myoclonic jerks. Cardiac arrest (asystole) occurred for two of them on admission, 1 and 3 h after ingestion. Electrocardiogram revealed atrio-ventricular and intraventricular conduction abnormalities, increased QT interval and flattened T wave, decreasing after sodium bicarbonate infusion in two cases. The patients received mechanical ventilation, gastric lavage, oral activated charcoal, and clonazepam or valproic acid for convulsions or myoclonic jerks. Epinephrine was administered for cardiac arrest. Sodium bicarbonate was infused in one patient on the basis of slightly prolonged QRS duration and in two patients due to cardiac arrest. Clinical outcome was good and without sequelae for all five patients after a few days in the intensive care unit. CONCLUSION: Clinical and electrocardiographic symptomatology of buflomedil poisoning suggests direct cardiotoxicity, which could be related to possible sodium antagonist properties.

Adolescent↗
PubMed1996

Development of listeriosis during vancomycin therapy in a neutropenic patient.

Vancomycin and aminoglycosides are widely used for fever in neutropenic patients. This combination of antibiotics has also been proposed for the treatment of Listeria monocytogenes bacteremia. We report a case of fatal listeriosis in a 33-year-old man during acute lymphoblastic leukemia induction therapy in a total protective environment despite him having been on vancomycin for 8 days for treatment of staphylococcus bacteremia. Vancomycin and aminoglycoside cannot be proposed for the treatment of L. monocytogenes bacteria in neutropenic patients. Neutropenia might be a risk factor for listeriosis in cancer patients.

Adult↗
PubMed1996

Herbicide: fatal ammonium thiocyanate and aminotriazole poisoning.

OBJECTIVE: To describe fatal herbicide poisoning with Radoxone TL composed of aminotriazole and ammonium thiocyanate. CASE REPORT: A 54-year-old man was hospitalized because of unexplained coma with myoclonic jerks and vascular collapse. Despite symptomatic treatment with mechanical ventilation and vascular filling, life-threatening shock occurred with oliguria, profound metabolic acidosis and cardiac arrest. Hyperchloremia (141 mmol/L) with reversed anion gap (-19) suggested interference with chloride measurement caused by halogens (Br,F,I) or other anions such as thiocyanate. Eventually a weed killer, Radoxone TL containing ammonium thiocyanate, was found at the patient's house. Thiocyanate and aminotriazole blood levels were 750 mg/L and 138 mg/L respectively more than 12 hours after ingestion. After prolonged cardiopulmonary resuscitation, continuous venovenous hemodiafiltration was performed. Despite hemodynamic recovery the patient died 48 hours later of postanoxic coma. CONCLUSION: Aminotriazole, a systemic nonselective herbicide, is often associated with ammonium thiocyanate which enhances its activity. Experimental studies and previous fatal cases suggest a predominant toxicity of thiocyanate. Early diagnosis is important.

Amitrole↗
PubMed1994

[State of shock during acute meprobamate poisoning. 6 cases].

The prognosis of acute meprobamate poisoning is related to shock whose haemodynamic mechanism remains obscure. We report the results of a retrospective study of six patients with meprobamate poisoning associated with shock and explored by a right heart catheterization. The age of the patients, five women and one man, ranged from 36 to 57 years. Five patients had also ingested other psychotropic drugs. A haemodynamic investigation was performed at admission to the ICU and three hours later, under treatment. Vasoplegia was the predominant feature. A myocardial dysfunction was sometimes associated, which can be explained by a moderate hypothermia. According to these results, we suggest that prior to right heart catheterization, the treatment should include inotropic and alphamimetic agents and that vascular filling should be cautious.

Adult↗
PubMed1994

Tamponade due to Rhodococcus equi in acquired immunodeficiency syndrome.

Infection with Rhodococcus equi has been described as a cause of cavitary pneumonia in AIDS patients. We report such a case, complicated by bacteremia, tamponade, and possible brain and liver abscesses. Medical treatment was successful with pericardiocentesis and antibiotherapy with teicoplanin, gentamicin, clarithromycin, rifampicin, supplemented by empirical treatment of cerebral toxoplasmosis. Antibiotherapy was terminated after 6 months, without relapse 2 months later.

AIDS-Related Opportunistic Infections↗
PubMed1993

Efficacy of epinephrine therapy in shock complicating pulmonary embolism.

A case of shock and pulmonary embolism in a 57-year-old woman is described in which hemodynamics were unresponsive both to usual therapy (volume loading, dobutamine, thrombolysis) and then to norepinephrine. Epinephrine proved to be effective, above all by strong beta 1-inotropic effect.

Cardiac Output, Low↗