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Biomedical subjects

B Hoen

Publications and source records attributed to B Hoen.

At least 55 records · Page 3Linked to original sources
PubMed1998

Evolution of cytotoxic T lymphocyte responses to human immunodeficiency virus type 1 in patients with symptomatic primary infection receiving antiretroviral triple therapy.

The impact of highly active antiretroviral treatment (HAART) on anti-human immunodeficiency virus (HIV) cytotoxic T lymphocytes (CTL) was studied in 17 patients with recent symptomatic HIV-1 primary infection receiving triple combination therapy. Anti-HIV CTL were initially detected in 15 patients. In 6, CTL disappeared rapidly and persistently after initiation of therapy. Most of them had a rapid and sustained decrease in plasma HIV RNA to undetectable levels. Conversely, in 6 other patients, CTL remained detectable, which was associated with a less efficient control of viral replication. In 3 others, CTL disappeared only transiently, without clear correlation with the virologic profile. Altogether, despite individual variations, there was a positive correlation between viral replication and anti-HIV-1 cytotoxicity in most subjects, suggesting that the persistence of viral antigens is the main determinant for the maintenance of CTL activity. This raises the question of the potential benefit of anti-HIV CTL induction by immunotherapy in acute seroconverters treated by HAART.

Anti-HIV Agents↗
PubMed1998

EPIBACDIAL: a multicenter prospective study of risk factors for bacteremia in chronic hemodialysis patients.

Bacteremic infections are a major cause of mortality and morbidity in chronic hemodialysis patients. New developments in managing these patients (erythropoietin therapy, nasal mupirocin, long-term implanted catheters, and synthetic membranes) may have altered the epidemiologic patterns of bacteremia in dialysis patients. This multicenter prospective cross-sectional study was carried out to determine the current incidence of and risk factors for bacteremia in chronic hemodialysis patients in France. A total of 988 adults on chronic hemodialysis for 1 mo or longer was followed up prospectively for 6 mo in 19 French dialysis units. The factors associated with the development of at least one bacteremic episode over 6 mo were determined using the multivariate Cox proportional hazards model. Staphylococcus aureus (n=20) and coagulase-negative staphylococci (n=15) were responsible for most of the 51 bacteremic episodes recorded. The incidence of bacteremia was 0.93 episode per 100 patient-months. Four risk factors for bacteremia were identified: (1) vascular access (catheter versus fistula: RR=7.6; 95% CI, 3.7 to 15.6); (2) history of bacteremia (> or =2 versus no previous episode: RR=7.3; 95% CI, 3.2 to 16.4); (3) immunosuppressive therapy (current versus no: RR=3.0; 95% CI, 1.0 to 6.1); and (4) corpuscular hemoglobin (per 1 g/dl increment: RR=0.7; 95% CI, 0.6 to 0.9). Catheters, especially long-term implanted catheters, were found to be the leading risk factor of bacteremia in chronic hemodialysis patients. There was a trend toward recurrence of bacteremia that was not associated with chronic staphylococcal nasal carriage. Synthetic membranes were not associated with a lower risk of bacteremia in this population of well dialyzed patients, but anemia linked to resistance to erythropoietin appeared to be a possible risk factor for bacteremia.

Adolescent↗
PubMed1997

A prospective, multicenter, randomized trial comparing steroids and pulse cyclophosphamide versus steroids and oral cyclophosphamide in the treatment of generalized Wegener's granulomatosis.

OBJECTIVE: To investigate the effectiveness and side effects of oral versus pulse cyclophosphamide (CYC) in combination with corticosteroids (CS) in the treatment of systemic Wegener's granulomatosis (WG). METHODS: Patients with newly diagnosed systemic WG were enrolled in a prospective, randomized trial. At the time of diagnosis, prior to randomization, every patient received a daily injection of methylprednisolone for 3 days, followed by daily oral prednisone (1 mg/kg/day) and a 0.7-gm/m2 pulse of CYC. Patients were then randomly assigned to receive either prednisone plus intravenous pulse CYC (group A) or prednisone plus oral CYC (group B) as first-line treatment. CYC was given for at least 1 year and was then progressively tapered and discontinued. RESULTS: Fifty patients were included in the study: 27 in group A and 23 in group B. At 6 months, 24 group A patients (88.9%) were in remission, versus 18 group B patients (78.3%). At the end of the trial, 18 group A patients (66.7%) and 13 group B patients (56.5%) were in remission. In group A, 66.7% of the patients experienced side effects, versus 69.6% in group B. Infectious side effects were significantly more frequent in group B (69.6%) than in group A (40.7%) (P < 0.05). The incidence of Pneumocystis carinii pneumonia was higher in oral CYC-treated patients (30.4%) than in pulse CYC-treated patients (11.1%). Nine group A patients (33.3%) and 10 group B patients (43.5%) died. Actuarial curves showed that relapses were significantly more frequent in group A (59.2%) than in group B (13%) (P = 0.02). CONCLUSION: Our results indicate that pulse CYC is as effective as oral CYC in achieving initial remission of WG and is associated with fewer side effects and lower mortality. However, in the long term, treatment with pulse CYC does not maintain remission or prevent relapses as well as oral CYC.

Administration, Oral↗
PubMed1997

Clinical and bacteriological characteristics of infective endocarditis in the elderly.

OBJECTIVE: To determine the clinical and bacteriological features of infective endocarditis in the elderly. DESIGN: Prospective case series. SETTING: A university hospital that is both a referral and a primary care centre. PATIENTS: 114 consecutive patients treated for infective endocarditis from November 1990 to December 1993: 25 were > 70 years of age (group 1) and 89 were < 70 years old (group 2). RESULTS: Location of infective endocarditis, clinical signs, and symptoms were similar in the two groups, except for a lower occurrence of embolic episodes in the elderly (group 1:8%, group 2: 28%; P < 0.04). A higher rate of infective endocarditis on intracardiac prosthetic devices was noted in group 1 (group 1: 52%, group 2: 25%; P < 0.05). The distribution of causative micro-organisms showed a higher proportion of bacteria from the gastrointestinal tract in the elderly (group D streptococci and enterococci: 48% in group 1 v 20% in group 2) and the presumed portal of entry was more often digestive (group 1: 50%, group 2: 17%; P = 0.01). Elderly patients were less often operated on (group 1: 24%, group 2: 43%; P = 0.07) and their mortality rate was higher (group 1: 28%, group 2: 13%; P = 0.08). CONCLUSIONS: Infective endocarditis in patients over 70 often occurs in those with intracardiac prosthetic devices and is more often due to bacteria from the gastrointestinal tract. Its prognosis appears to be worse than in younger subjects.

Adult↗
PubMed1997

Relapsing congestive cardiomyopathy in Wegener's granulomatosis.

Congestive cardiomyopathy is a highly unusual complication of Wegener's granulomatosis. In this report, we describe a 37-year-old man with histologically proven Wegener's granulomatosis who had two episodes of severe hypokinetic cardiomyopathy that responded well to cyclophosphamide. The theory that cardiomyopathy might be related to cardiac involvement in Wegener's granulomatosis and the beneficial effect of cyclophosphamide in this condition are discussed.

Adult↗
PubMed1997

Tuberculosis in Lorraine, France: study of prognostic factors.

AIM: To identify factors predicting short-term mortality in patients with tuberculosis in the Lorraine region of France. METHOD: Retrospective survey in nine voluntarily participating hospitals between January 1990 and December 1994. RESULTS: In total 351 files were analyzed. The average age of patients was 49 +/- 19 years; 77% were of French origin, 60% were male; 35% were in paid employment at the time of the diagnosis, 42% were unemployed and 23% were retired. Twenty-three patients were infected by the human immunodeficiency virus (HIV), and 34 patients had a prior history of tuberculosis; 79% of all cases were exclusively pulmonary, 14% were exclusively extra-pulmonary (more frequent in women) and 7% were mixed. Extra-pulmonary sites of involvement were more frequent in HIV-infected patients. Chest X-ray was suggestive of tuberculosis in 158 patients with pulmonary involvement, and non-suggestive in 145 (more frequently in HIV-infected patients). In univariate analysis, HIV co-infection, increasing age and unemployment were linked to death during treatment. In multivariate analysis (logistic regression), HIV co-infection, old age, unemployment, pulmonary involvement and French origin were significantly linked to the risk of death during treatment.

AIDS-Related Opportunistic Infections↗
PubMed1996

Comparison of infective endocarditis in patients with and without previously recognized heart disease.

In a consecutive series of patients with infective endocarditis, we compared the charts of 123 nonaddicted patients without previously known heart disease with those of 174 patients with native valve disease. The 2 groups were similar in age, sex, clinical findings, and mortality rates, but infective endocarditis was more often located on the aortic valve, more often due to Streptococcus bovis and enterococci in patients without previously known heart disease.

Aged↗
PubMed1996

[Isolated invasive sphenoid aspergillosis].

Isolated aspergillosis of the sphenoid sinus is a difficult diagnosis because the often misleading clinical manifestations of this rare disease develop late. We report a case of invasive aspergillosis uniquely involving the sphenoid sinus revealed by clinical features suggesting pseudotumor of the pituitary in an immunocompetent man. A 71-year-old man presented sudden onset palsy of the abductor nerve of the left eye. Neuroimaging suggested a pseudotumor of the pituitary. Sphenoid sinusitis was discovered at surgery. The diagnosis of aspergillosis was provided by the histology examination of the sphenoid mucosa. Despite medical treatment with itraconazol alone then in combination with amphotericine B, the infectious process progressed to the pituitary, the cavernous sinus, the upper orbital fissue and the optic canal. Cure was finally achieved after a second surgical procedure to drain and aerate the sphenoid sinus. Aspergillosis of the sphenoid sinus is usually discovered due to neurological signs such as a cavernous sinus syndrome, pseudotumor of the pituitary or the orbit. Diagnosis is often made intraoperatively or at histology examination. Invasive forms almost always are seen in immunosuppressed subjects. In our case, the patient was immunocompetent and had no past history of sinusitis. The invasive sphenoid aspergillosis invaded bone tissue, the cavernous sinus and the meninges.

Aged↗
PubMed1996

[Prognostic factors of Pneumocystis carinii pneumonia in AIDS].

OBJECTIVES: Identify prognosis factors in Pneumocystis carinii pneumonia at diagnosis and construct a model to predict mortality according to these prognosis factors. METHODS: Seventy-seven consecutive cases of proven AIDS-related Pneumocystis carinii pneumonia (67 men, 10 women, mean age 37.2 years) were reviewed to determine the most accurate initial prognostic factors and estimate an individual prediction of death. A stepwise logistic regression analysis was performed. Three kinds of data were entered into the logistic model: historical data, clinical and laboratory data obtained within the first 24 hours of diagnosis, and specific data related to chest X-ray and bronchoalveolar lavage results. RESULTS: The sum of arterial partial pressure of oxygen and carbon dioxide (PaO2 + PaCO2) and serum albumin level best predicted a fatal outcome in multivariate analysis. CONCLUSION: The logistic equation provided by the model might be used to accurately and quickly identify the patients with severe Pneumocystis carinii pneumonia who might benefit from supportive intensive care.

AIDS-Related Opportunistic Infections↗
PubMed1996

The Duke criteria for diagnosing infective endocarditis are specific: analysis of 100 patients with acute fever or fever of unknown origin.

The recently proposed Duke criteria were confirmed to be more sensitive than the former Beth Israel criteria for the diagnosis of infective endocarditis (IE). To assess the specificity of the Duke criteria, we reviewed the records of 100 patients admitted to two internal medicine wards because of acute fever or fever of unknown origin (FUO). IE was considered a possible diagnosis for all patients who had had at least two blood cultures performed and one transthoracic echocardiogram obtained. The diagnosis of IE was rejected in all cases in accordance with the Duke criteria (i.e., a firm alternate diagnosis [n = 23], resolution of symptoms with no antibiotics [n = 39], or both reasons [n = 38]). To calculate the specificity of the Duke criteria, all 100 cases were then reclassified according to these criteria as if the diagnosis of IE had not been rejected. Only one patient, who probably did not have IE, was reclassified as having clinically definite IE. The specificity of the Duke criteria could therefore be calculated to 0.99 (95% confidence interval, 0.97-1). Although the design of the study may have resulted in a slight overestimation of the specificity rate, we conclude that the Duke criteria are highly specific for ruling out IE in patients with acute fever or FUO who are at low risk for IE.

Adult↗
PubMed1995

A controlled trial of zidovudine in primary human immunodeficiency virus infection.

BACKGROUND: It is possible that antiretroviral treatment given early during primary infection with the human immunodeficiency virus (HIV) may reduce acute symptoms, help preserve immune function, and improve the long-term prognosis. METHODS: To assess the effect of early antiviral treatment, we conducted a multicenter, double-blind, placebo-controlled trial in which 77 patients with primary HIV infection were randomly assigned to receive either zidovudine (250 mg twice daily; n = 39) or placebo (n = 38) for six months. RESULTS: The mean time from the onset of symptoms until enrollment in the study was 25.1 days. Among the 43 patients who were still symptomatic at the time of enrollment, there was no appreciable difference in the mean (+/- SE) duration of the retroviral syndrome between the zidovudine group (15.0 +/- 4.1 days) and the placebo group (15.8 +/- 3.6 days). During a mean follow-up period of 15 months, minor opportunistic infections developed in eight patients: oral candidiasis in four, herpes zoster in two, and oral hairy leukoplakia in two. Disease progression was significantly less frequent in the zidovudine group (one opportunistic infection) than in the placebo group (seven opportunistic infections; P = 0.009 by the log-rank test). After adjustment for the base-line CD4 cell count, the patients treated with zidovudine had an average gain of 8.9 CD4 cells per cubic millimeter per month (95 percent confidence interval, -1.4 to 19.1) during the first six months of the study, whereas those receiving placebo had an average loss of 12.0 CD4 cells per cubic millimeter per month (95 percent confidence interval, 5.2 to 18.7), for a between-group difference of 20.9 CD4 cells per cubic millimeter per month (95 percent confidence interval, 8.5 to 33.2; P = 0.001). CONCLUSIONS: Antiretroviral therapy administered during primary HIV infection may improve the subsequent clinical course and increase the CD4 cell count.

AIDS-Related Opportunistic Infections↗
PubMed1995

Multivariate approach to differential diagnosis of acute meningitis.

A previously reported statistical model based on a combination of four parameters (total polymorphonuclear cell count in cerebrospinal fluid (CSF), CSF/blood glucose ratio, age and month of onset) appeared effective in differentiating acute viral meningitis (AVM) from acute bacterial meningitis (ABM). The objectives of this study were to validate this model on a large independent sample of patients with acute meningitis and to build and validate a new model based on this sample. Of 500 consecutive cases of community-acquired meningitis reviewed retrospectively, 115 were ABM, 283 were AVM and 102 were of uncertain etiology. For each of the ABM and AVM cases, the probability of ABM versus AVM (pABM) was calculated for both models. Sensitivity, specificity and predictive values as well as areas under the receiver operating characteristic (ROC) curves were calculated for both models. The original model proved an accurate and reliable diagnostic test. Its area under the ROC curve was 0.981. For pABM = 0.1, its negative and positive predictive values were 0.99 and 0.68, respectively. The new model retained four slightly different independent variables: CSF protein level, total CSF polymorphonuclear cell count, blood glucose level and leukocyte count. Its area under the ROC curve was 0.991 and, for pABM = 0.1, its negative and positive predictive values were 0.99 and 0.85, respectively. In conclusion, both models provide a valuable aid in differentiating AVM from ABM. They should be further evaluated in a prospective appraisal of their contribution to therapeutic decision making.

Acute Disease↗