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J B Dureux

Publications and source records attributed to J B Dureux.

At least 19 recordsLinked to original sources
PubMed1994

[Herpetic meningoencephalitis in the elderly. Apropos of 13 cases].

In a retrospective analysis of 13 cases of Herpes simplex encephalitis (mean age: 67.2 +/- 6.4 years; ten women, three men), the authors conclude that this infection is more often due to Herpes simplex virus 1 in the elderly. Diagnosis is difficult at an early stage, and must be suspected in case of confusion (9/13), especially feverish (11/13), associated with neurological signs (10/13), and particularly epilepsy (5/13). It requires a lumbar puncture which collect a clear and lymphocytic fluid. Prognosis of this encephalitis depends on early diagnosis and an presumptive therapy with acyclovir. EEG is helpful showing periodic activity (10/13). CT scan and MRI can show unspecific abnormalities, but often too late. Laboratory findings will secondarily confirm the diagnosis quite frequently, using new Elisa methods. Polymerase chain reaction allows earlier diagnosis. Geriatric cases seem more often due to reinfection or to endogen virus reactivation rather than to primary infection.

Aged↗
PubMed1993

Mortality in pneumococcal meningitis: a multivariate analysis of prognostic factors.

OBJECTIVES: The mortality due to pneumococcal meningitis remains high, ranging from 15 to 60%. The purpose of this study was to analyze the prognosis of pneumococcal meningitis using a multivariate approach. The objectives were to select the most accurate initial mortality risk factors in pneumococcal meningitis and to determine an individual probability of death according to these prognostic factors. METHODS: The records of 105 consecutive cases of proven pneumococcal meningitis were retrospectively reviewed. The following parameters, recorded at presentation were considered for prognostic analysis: age, sex, duration of symptoms and antimicrobial chemotherapy before admission, underlying debilitating conditions, occurrence of seizures, pneumococcal bacteraemia or pneumonia, Glasgow coma scale score, Simplified Acute Physiological Score (SAPS), Cerebral Spinal Fluid (CSF) leucocyte count, CSF protein level, CSF glucose level and CSF/blood glucose ratio. Those parameters having a prognostic value after univariate logistic regression analysis were then entered into a multivariate stepwise logistic regression model. RESULTS: In multivariate analysis, a fatal outcome was best predicted by 4 variables. In descending order, these were the Glasgow coma scale score, age, CSF glucose level and concomitant pneumonia. The risk of dying was ten times higher in patients with Glasgow coma scale score < 7, seven times higher in patients older than 45 or having a CSF glucose level lower than 0.6 mmol/L and 4 times higher in patients with pneumonia. The logistic model provided an equation for the probability of dying that proved to have predictive values greater than 80% in determining the individual prognostic of pneumococcal meningitis. CONCLUSIONS: Our results are in agreement with most of previously published findings. We further demonstrated that the individual prognosis of pneumococcal meningitis could be accurately predicted with only 4 variables and highlighted the preeminent prognostic value of Glasgow coma scale score.

Adolescent↗
PubMed1992

Assessment of the clinical value of urinary trypsin inhibitory activity in elderly people.

To assess the clinical value of urinary trypsin inhibitory activity (UTIA) in elderly people, a prospective study was carried out over 4 months in our internal medicine department. Two hundred and forty-three patients of more than 60 years of age were included. A positive correlation was observed between UTIA and serum creatinine (p < 10(-3)). In the population with serum creatinine of less than 133 mumol/l (200 patients), UTIA was independent of age, sex and serum creatinine. UTIA was compared with seven serum inflammatory proteins titrated on patient admission. The principal interest of UTIA determination appeared in bacterial infections. UTIA was significantly increased in this group (p < 10(-4)). However, a positive correlation was proved only with C-reactive protein (CRP) (p = 9 x 10(-4)). Nevertheless, CRP appeared to be the best marker of bacterial infectious diseases after receiver operating characteristic curves analysis.

Acute-Phase Proteins↗
PubMed1992

Effects of diclofenac on ceftriaxone pharmacokinetics in humans.

The effects of diclofenac, a nonsteroidal antiinflammatory drug, on the biliary and urinary excretion of ceftriaxone were evaluated in subjects with a T drain in the common bile duct. The kinetic study was carried out on the sixth postoperative day of treatment with ceftriaxone alone (2 g intravenously; group 1) or ceftriaxone combined with diclofenac (50 mg every 12 h orally from postoperative days 3 to 6; group 2). A significant increase in the elimination half-life of ceftriaxone was observed in group 2 patients. Diclofenac caused a significant rise in ceftriaxone biliary excretion. This increase was not sufficient to balance the significant deficit of urinary excretion of ceftriaxone.

Aged↗
PubMed1992

Penetration of ofloxacin into heart valves, myocardium, mediastinal fat, and sternal bone marrow in humans.

Ofloxacin penetration into heart tissue (valve and myocardium), mediastinal fat, and sternal bone marrow was the object of a prospective nonrandomized study. Thirty-six patients undergoing mitral and/or aortic valve replacement were included. Patients were divided into two groups of 18 patients each. Group 1 patients were administered a single 400-mg intravenous dose of ofloxacin over a 30-min period upon anesthesia (n = 6) or at 1 h (n = 6) or 6 h (n = 6) prior to surgery. Group 2 patients received a 200-mg oral dose of ofloxacin every 12 h during the 48 h preceding surgery. In this group, the final dose of ofloxacin was administered 3 h (n = 9) or 8 h (n = 9) before anesthesia. Plasma and tissue ofloxacin concentrations were assayed by high-pressure liquid chromatography. In group 1 patients, the peak level in plasma was 15.9 +/- 2.5 micrograms/ml. Peak ofloxacin levels in tissue were reached by hour 1 and were 8.89 +/- 2.16 micrograms/g in myocardium and 5 +/- 0.75 micrograms/g in heart valves. A significant decrease in ofloxacin levels in heart valve tissue and sternal bone marrow was observed after hour 3. Nevertheless, ofloxacin myocardial, heart valve, and sternal bone marrow levels remained higher than the MICs for the usually susceptible pathogens for at least 3 h. In group 2 patients, myocardial levels were long lasting (6.46 +/- 1.92 micrograms/g [4 to 8 h] and 5.92 +/- 0.95 micrograms/g [8 to 12 h]) and remained higher than those observed in the other tissues over the entire study period. A progressive but insignificant decrease in ofloxacin heart valve levels was observed (from 2.46 +/- 0.40 micrograms/g [4 to 8 h] to 1.57 +/- 0.22 micrograms/g [8 to 12 h]). In both groups, concentration in mediastinal fat were lower and tended to decrease with time. These were 1.83 +/- 0.61 micrograms/g with the first hour and 0.85 +/- 0.43 micrograms/g between hours 8 and 12 in group 1 and 1.74 +/- 0.52 micrograms/g between hours 4 and 8 and 0.67 +/- 0.11 micrograms/g between hours 8 and 12 in group 2. In conclusion, satisfactory diffusion of ofloxacin into heart tissue seems to favor use of the drug in the treatment of bacterial endocarditis due to susceptible pathogens. Furthermore, the progressively decreasing concentrations observed in heart valve and sternal bone marrow and the poor levels achieved in mediastinal fat suggest the need for renewing injection 3 h following initial infusion if the drug is used as an antibiotic prophylactic agent during cardiovascular surgery.

Adipose Tissue↗
PubMed1992

[Endocarditis caused by heart valve prosthesis. Apropos of 35 cases].

35 cases of prosthetic valve endocarditis are reported. The diagnostic is based on clinical, echocardiographic, bacteriological and anatomical aspects. Heart failure, neurologic complications, positive culture of prosthesis, Staphylococcus aureus infection and perivalvular abscess are factors of a bad prognosis. The current therapeutic trends associate antibiotic treatment and infected prosthetic valve replacement rather for hemodynamic indications than bacteriological factors. General prognosis has a mortality of 40 p. cent. Prophylaxis of infection, although simple is necessary.

Adult↗
PubMed1991

[Hyponatremia in AIDS. Etiology and diagnosis].

Hyponatremia is a common electrolyte abnormality in AIDS patients. In this study, hyponatremia was defined as natremia less than 130 mmol/l at two different samplings. Medical records of 160 hospitalized AIDS patients were exhaustively reviewed in search for hyponatremia and, if present, of its etiology. 45 cases of hyponatremia were identified in 43 AIDS patients. Two causes were predominant: hypovolemic hyponatremia, due to water and salt losses (11 cases) and the syndrome of inappropriate antidiuretic hormone secretion (10 cases). These results are consistent with those of the literature and were used to develop a simple diagnosis schedule based on the analysis of limited clinical and biological data: hydration status, serum and urinary osmolality, natriuria and creatininemia.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Effect of plasma exchange on flumequine pharmacokinetics: comparison with control kinetics.

The effect of plasma exchange (PE) on the pharmacokinetics of flumequine (Apurone) was studied in eight patients receiving a single oral dose of 800 mg. The maximum concentration (38 micrograms/ml) and time to maximum concentration (2.6 h) values were not significantly altered by PE beginning 3 h after administration of flumequine. There was no change in the terminal elimination half-lives (6.6 h), in the steady-state volume of distribution (29 L), or in the apparent plasma clearance (2.5 L/h). By contrast, PE decreased the mean residence time by 30% (14.3 +/- 4.1 h without PE; 9.88 +/- 1.36 h with PE; p less than 0.05). The amount of flumequine extracted by PE (72 mg) was proportional to the plasma concentration at the beginning of the exchange. The elimination half-life during PE (3.15 +/- 1.23 h) decreased by 40%. Renal clearance (0.3 L/h) was not affected. PE only partially modifies the pharmacokinetics of flumequine administered in a single oral dose before PE.

Administration, Oral↗
PubMed1990

Penetration of ciprofloxacin into heart valves, myocardium, mediastinal fat, and sternal bone marrow in humans.

The penetration of ciprofloxacin into heart tissue (valve and myocardium), mediastinal fat, and sternal bone marrow was the object of a prospective nonrandomized study involving 36 patients undergoing mitral and/or aortic valve replacement. Patients were divided into two groups of 18. Group 1 patients were administered a single 400-mg intravenous dose of ciprofloxacin over a 1-h period. Group 2 patients received a 750-mg dose of ciprofloxacin orally every 12 h over the 48-h period preceding surgery. In this group, the last dose of ciprofloxacin consisted of an intravenous infusion of 400 mg. Concentrations of ciprofloxacin in plasma and tissue were assayed by high-performance liquid chromatography. Peak and trough levels in plasma were, respectively, 6.19 +/- 1.73 and 0.54 +/- 0.25 micrograms/ml in group 1 patients and 11.59 +/- 3.95 and 0.89 +/- 0.57 micrograms/ml in group 2 patients. Levels of ciprofloxacin in plasma remained significantly higher in group 2 than in group 1 until 12 h postinfusion (P less than 0.05). Concentrations of ciprofloxacin in heart valves and myocardia rose rapidly by 1 h postinfusion and remained greater than the MICs for usually susceptible pathogens for at least 5 h. Peak concentrations in myocardia were achieved by hour 1 and were 31.6 +/- 25.0 micrograms/g for group 1 and 21.8 +/- 13.0 micrograms/g for group 2. Peak concentrations in heart valves, achieved between hours 1 and 3, were 5.8 +/- 3.2 and 8.3 +/- 3.1 micrograms/g for groups 1 and 2, respectively. In both groups, peak concentrations in mediastinal fat were lower and achieved later. These were 3.1 +/- 3.8 micrograms/g in group 1 and 2.0 +/- 1.8 micrograms/gram in group 2 and were achieved between hours 3 and 5 and hours 1 and 3, respectively. In conclusion, the good diffusion of ciprofloxacin into heart tissue warrants its use for the treatment of bacterial endocarditis. On the other hand, low and delayed concentrations in mediastinal fat could limit its value as an antibiotic prophylactic agent in a cardiovascular surgical setting when administered immediately (less than 3 h) before surgery.

Adipose Tissue↗
PubMed1990

[The combination of penicillin G and ofloxacin: a response to the empirical treatment of community acquired pneumonia].

The aim of this study was to assess the clinical efficacy of a combination of penicillin G and ofloxacin in the treatment of community acquired pneumonia. Thirty eight patients (23 males, 15 females, mean age 62.8 years +/- 19.6) were included. They presented a CAP with the following criteria: fever, abnormal chest X-ray pattern. They received the combination of IV penicillin 12 x 10(6) U daily and IV ofloxacin 200 mg bid. After 48 hours of apyrexia, this treatment was followed by oral ofloxacin alone 200 mg bid. In six cases, the etiologic agent was identified: 2 S. pneumoniae, 1 Chlamydiae psittaci, 2 Staphylococcus aureus, 1 Mycoplasma. In 32 cases, the bacteriological investigation was negative. Five patients were excluded: 2 deaths due to heart failure, 3 alterations of treatment. Twenty eight patients recovered: apyrexia was obtained in 3.5 days. Penicillin G was prescribed for 7.5 days +/- 2.65, followed by ofloxacin alone for 11.43 +/- 3 days. Five patients were considered as clinical failures: 2 deaths due to extensive pneumonia, 3 recoveries after alteration of treatment. Side effects were rare: 1 confusion, 2 skin rashes. As a conclusion: penicillin G and ofloxacin in combination for the initial therapy of CAP, rapidly relayed by ofloxacin alone, permitted 84.3% of recovery in our patients.

Acute Disease↗
PubMed1989

Mitral valve prolapse as a risk factor for infective endocarditis.

The frequency of mitral valve prolapse was assessed in 48 patients with mitral valve endocarditis and in 96 controls matched for age and sex, attending a routine family screening clinic or having surgery of the limbs. The frequency of mitral valve prolapse in cases with endocarditis (9 of 48 patients) was more than three times that in controls (6 of 96) (odds ratio 3.5; 95% confidence interval [CI] 1.1-10.5). When patients with rheumatic heart disease, an established risk factor for infective endocarditis, were excluded from the study group, patients were nearly six times more likely to have infective endocarditis than were controls (odds radio 5.7; 95% CI 1.8-18.4). However, a higher risk of infective endocarditis was seen only in the subjects with mitral valve prolapse and a previously known systolic murmur (odds ratio 14.5; 95% CI 1.7-125). The results indicate that mitral valve prolapse constitutes a true risk factor for infective endocarditis only when associated with the presence of a precordial systolic murmur.

Adult↗