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Biomedical subjects

F Leibinger

Publications and source records attributed to F Leibinger.

At least 19 recordsLinked to original sources

[Treatment with intravenous rt-PA in a general hospital context: A review of the Saint-Jean Hospital experience from Perpignan, France].

INTRODUCTION: Intravenous recombinant tissue plasminogen activator (rt-PA) has approval for use despite of its authorization for treatment of ischemic stroke within the 3-hour time window in 2003, is rarely used in community hospital (CH). It therefore remains questionable if the positive results of the key studies conducted in specialized centers may be extended to community hospitals less specialized in the management of stroke. METHODS: We report the results of an observational cohort study including 39 patients treated with intravenous rt-Pa (according to the NINDS rt-PA stroke trail treatment protocol) at St Jean Hospital (Perpignan, France) between March 1, 2002 and August 31, 2005. Results are compared to those of the treated arm of the NINDS study. RESULTS: 1.2p.cent of ischemic stroke were treated with intravenous rt-Pa. Results are similar to those of the NINDS study: The outcome was favorable (modified Rankin score (mRS) with 0 or 1) for 44p.cent of the patients (as compared to 39p.cent in the NINDS study (X2 = 0.34; p = 0.5)) and there was no significant difference in term of death or outcome as assessed by mRS at 3 months (X2 = 0.09; p = 0.75 and X2 = 0.77; p = 0.75, respectively). No symptomatic hemmorrhagic transformation related to the use of rt-Pa was observed. CONCLUSION: Our results indicate that rt-PA therapy for ischemic stroke may be as safe and effective in the setting of a community hospital as it is in specialized centers.

Adult↗

Polymicrobial meningitis revealing an anterior sacral meningocele in a 23-year-old woman.

Polymicrobial meningitis has become increasingly rare during recent decades. Historically, it has mainly been reported as being associated with disorders of the ENT-sphere. The treatment of these infections being optimized, polymicrobial meningitis nowadays is essentially a complication of gastrointestinal or gynaecological disorders and trauma. We present a case of polymicrobial meningitis following puncture of a unrecognized pre-sacral meningocele in a patient with Currarino syndrome and review of the relevant literature.

Adult↗

Spontaneous Escherichia coli meningitis in an adult.

Spontaneous meningitis due to gram-negative bacilli (excluding Hemophilus influenzae) is an infrequent infection in adult patients. It usually occurs in patients with underlying immunosuppressive conditions. Most of the cases are due to Escherichia coli and represent a complication of bacteraemia. The infection has a high mortality rate which may be as high as 90%, especially if associated with septicaemia. We report the case of a 53-y-old man with spontaneous, community-acquired Escherichia coli meningitis who was admitted with an unusual presentation. Blood and urine cultures were negative.

Alcoholism↗

Primary sternal osteomyelitis and septicaemia due to Staphylococcus aureus.

Primary sternal osteomyelitis is rare in these recent decades. Only scattered cases have been reported, most of them in intravenous drug users. We report the case of an 88-y-old woman who presented a primary sternal infection due to Staphylococcus aureus associated with secondary septicaemia. The only predisposing factor was radiotherapy for a malignant tumour of the right mammary gland 20 y ago. Diagnostic evaluation and therapeutic management are briefly discussed.

Aged↗

[Tuberculosis of the central nervous system. MRI features and clinical course in 12 cases].

OBJECTIVE: The aim of this study was to characterize the MR findings of various intracranial lesions in the central nervous system (CNS) tuberculosis. MATERIALS AND METHODS: The MRI findings (T1, T2 and T1 sequence after contrast) of 12 proved cases (10 males, 2 females, 24 to 64 years old, average: 35) of CNS tuberculosis were reviewed; 4 patients were seropositive for HIV. RESULTS: Several types of lesions were identified: tuberculomas called miliary lesions if they were smaller than 2 mm in diameter (7 cases), in 1 case the tuberculoma was revealed by two large lesions and bi-hemispheric localisations, leptomeningitis (5 cases), infarction (4 cases), abscesses (3 cases with solitary lesions in 2/3 cases), hydrocephalus (3 cases), pachymeningitis (2 cases). A tuberculomas-leptomeningitis association was found in 4 patients. The pachymeningitis form had an unusual aspect in one case. Patients with leptomeningitis showed thick meningeal contrast enhancement involving all basal cisterns, expanding to the sylvian fissures level, and causing narrowing of the sylvian arteries. Massive infarctions resulted from arterial englobement or embols. In three out of five patients, leptomeningitis was the initial presentation. In seropositive patients, tuberculosis was severe with high mortality (3/4 patients), and associated with other multiple lesions. CONCLUSION: Central nervous system tuberculosis has different appearances, mostly tuberculomas and leptomeningitis. MR with contrast is necessary for follow-up during treatment.

Adult↗

[Neurologic toxicity of methotrexate in a patient with cerebral arteritis. Report of a case].

We report the case of an 18 year-old woman treated for femoral osteogenic sarcoma who presented generalized seizures requiring sedation, tracheal intubation and artificial ventilation. CT brain scan showed diffuse hypodensities. Doppler studies showed an increased cerebral arterial resistance. Regional cerebral blood flow was decreased. A right carotid angiogram showed abnormalities consistent with diffuse cerebral arteritis. The patient slowly recovered and 6 weeks later, magnetic resonance imaging showed disseminated areas of hyposignal on T1 and hypersignal on T2 weighted images. We reviewed the different published cases of acute high dose methotrexate neurotoxicity and the different underlying mechanisms.

Adolescent↗

Streptococcus B meningitis in post-partum.

We report a case of post-partum meningitis due to group B-streptococcus developing 24 h after vaginal delivery. Diagnosis was established by latex agglutination of streptococcus B-antigenes and confirmed by cerebrospinal fluid-culture later on. Clinical and haematological signs of meningitis disappeared after treatment with ampicillin. In a review of the literature we found eight other cases of streptococcal post-partum meningitis. In all of these cases, delivery was vaginal and no antibioprophylaxis was given.

Adult↗

[Thrombosis of the basilar trunk in a young woman previously treated by radiotherapy for malignant lymphoma].

We report the case of a 23-year-old-woman, who had received mediastinal radiotherapy for non-Hodgkin lymphoma. Five years later, she presented a basal artery thrombosis. Arteriography showed an ectopic origin of the left vertebral artery on the aortic arch located within the irradiation field. This artery was irregular and narrowed up to 15 cm from its origin. All other cerebral arteries were normal. We reviewed the literature of other observations describing radiation-induced cervical arteritis.

Adult↗

Adult respiratory distress syndrome and pancytopenia associated with miliary tuberculosis in a HIV-infected patient.

Adult respiratory distress syndrome (ARDS) is a rare but severe complication of miliary tuberculosis, which may appear even after introduction of antituberculosis therapy. Mortality has been reported to be as high as 100% if there is associated pancytopenia. We report a case of a patient infected with the human immunodeficiency virus who presented with miliary tuberculosis associated with pancytopenia and adult respiratory distress syndrome.

AIDS-Related Opportunistic Infections↗