[Salmonella typhimurium cerebral abscess: rare complication of HIV infection].
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Biomedical subjects
Publications and source records attributed to J Baillet.
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Biliary tubage, is interesting in the aetiological research of acute pancreatitis, when the origin is unknown after anamnesis, clinical examination, abdominal ultrasonographic studies and retrograde cholangiography. The sludge is the aetiology fond in 40% of the cases. Microscopic crystals are either cholesterol monohydrate, either calcium bilirubinate, or calcium carbonate microspheroliths. Biliary microscopic crystals drive the patients to the cholecystectomy to prevent acute pancreatitis relapses.
With the examples of historical incoherencies in the diagnosis and treatment of myocardial infarction and pulmonary embolism, the author shows that it is not easy to be an objective reader of "good" scientific articles. Our neuropsychological mechanisms do not facilitate an "intelligent" attitude without the aid of affectivity. An unwanted thymotic component places the reader in an ambiguous position with respect to authority and reality. Though one can never know too much, it is difficult, alone, to maintain an intelligent curiosity. Some financial interests may awaken it. During his career, the physician has to navigate between two slightly contradictory necessities: changing his attitude with respect to new information, and according credence to his personal experience.
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In familial adenomatous polyposis coli (APC) it is possible to detect APC carriers either by research of bilateral congenital hypertrophy of the retinal pigment epithelium (CHRPE) or by genetic diagnosis (APC gene is localized in 5q21). These detections were performed in 33 patients of four families with the same positivity for genetic typing (11 patients) or for CHRPE (11 patients) which thus avoided annual coloscopy.
Among the atypical pneumonias observed between March 1990 and March 1991, 6 were diagnosed as being caused by Chlamydia pneumoniae of the TWAR strain. The serological diagnosis was obtained by a microimmunofluorescence test. All 6 patients had anti-TWAR antibody levels higher than 512; they were treated with a macrolide administered by the oral route and were cured without sequelae or recurrences. Four cases received a ten day course of roxithromycin 300 mg/day and one case received erythromycin 2 g/day also for 10 days. The sixth case received a short course of azithromycin 500 mg once daily for three days. In 2 other patients presenting with clinical and radiological signs of pneumonia the diagnosis of C. pneumoniae infection could not be made despite an antibody level equal or higher than 512, since the serological results showed cross-reactions between C. pneumoniae, C. trachomatis and C. psittaci antibody responses.
The pharmacokinetics of piperacillin were evaluated in seven healthy volunteers, eight cirrhotic patients without ascites and 11 cirrhotic patients with sterile ascites after a single 15-min intravenous infusion of 4 g of the drug. In ascitic patients, piperacillin rapidly entered the peritoneal fluid. Peritoneal concentrations were higher than 10 mg/l from 0.5 to 8 h after the infusion. Disappearance rate of piperacillin was slower in the ascitic fluid than in plasma. The plasma half life of piperacillin was more prolonged in cirrhotic patients that in control subjects. This difference was more marked in ascitic patients for whom half life was twice as high as in volunteers (1.95 versus 0.91 h; P less than 0.01).
The authors report a case of cervical abscess due to yersinia enterocolitica. This is a currently exceptional localization of an enteropozoonosis which is little-known, but whose incidence is increasing throughout the world.
Clinical efficacy and safety of piperacillin were evaluated in 30 patients with a severe aspiration pneumonia admitted in our intensive care unit from july 1987 to december 1988. 20 women and 10 men (with a mean SAPS: 14) had a right pneumonia in 17 cases, left in 6, bilateral in 7 cases. A pathogen was isolated in 18 patients by protected distal catheterism, in 3 patients by blood cultures. 25 patients cured. However with a high isolation of Staphylococci it appears reasonable to associate piperacillin with an aminoglycoside before the obtention of bacteriological results.
Considering that butyrate-treated malignant cells can recover in a transitory fashion a non-cancerous phenotype, the authors carried out a pharmacokinetics study of butyric acid injected as sodium or arginine salts for possible antitumor therapies. In the case of 1-14C-labelled butyrate, the appearance of radioactivity in the blood of injected mice is rapid and some of it is maintained for relatively long periods in different organs, mainly the liver. However, no precision can be given about the structure of radioactive compounds in blood and tissues. Using gas-liquid chromatography, the authors studied the metabolism of butyrate in both animals and man. In mice and rabbits, the half-life is less than 5 min. In man, the butyric acid elimination curve can be divided into two parts corresponding to two half-lives: for the first (0.5 min), the slope suggests an accelerated excretion, while for the following (13.7 min), a slow plateau is observed. The rapid elimination of butyrate is a limiting factor for practical applications. However, the lack of toxicity supports its use in human therapy.
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Circulating immune complexes are thought to play an essential part in the pathogenesis of necrosing angiitis. This theory also allows a role to be attributed to certain infectious agents (viral, bacterial, parasitic) in the development of periarteritis nodosa (PAN). An infectious syndrome was found in all our 9 patients, aged 26 to 69 years, with histologically confirmed PAN: previous infection (over 15 days before hospital admission): otitis, hepatitis B, tonsillitis, ascaris (Case n.7), pulmonary tuberculosis, brucellosis, seropositivity for Chlamydia trachomatis (Case n.9), paratyphoid (Case n.5), seropositivity for Yersiniosis pseudo-tuberculosis (Case n.2), seropositivity for Chlamydia trachomatis (Cases 3 and 4), seropositivity for toxoplasmosis (Cases 4 and 6), seropositivity for rubella (Case n.8). Recent infection (less than 15 days before hospital admission): staphylococcus aureus septicaemia (Case n.1); Group A betahemolytic streptococcal urinary infection (Case n.2); Group A betahemolytic streptococcal otitis media; pseudomonas aeruginosa and Klebsiella septicaemia; enterococcal cystitis (Case n.4); progressive pulmonary tuberculosis (Case n.6), acinetobacter pneumonia (Case n.9). The HBs antigen was only found in one patient (Case n.6), who had an active hepatitis.
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A clinical study and dosages of ceftriaxone were performed during the treatment of 14 ascitic fluid infections. Fourteen cases of ascitic fluid infection were treated with ceftriaxone at doses of 2 grams daily. The isolation of the causative organisms was obtained in 11 out of 14 cases by systematic culture of the ascitic fluid in hemoculture bottles with aerobic and anaerobic medium. Of 11 evaluable infectious episodes ten were cured. Ceftriaxone diffuses rapidly in the ascitic fluid because, within the first hour; mean concentrations were already of 18.6 micrograms/ml largely exceeding the usual MIC for these organisms. A good tolerance for the drug, the well spaced rythm of infections preventing unnecessary parenteral treatment in cirrhotic patients, and its effectiveness against Enterobacteriaceae justify its choice in the treatment of ascitic fluid infections with sensitive organism.
Several authors have studied variations in myocardial thickness on short-axis sections cut through healthy postmortem hearts. The circumferential profiles showed a series of minima and maxima, with a minimum at the septum, a maximum at the anterior interventricular junction and another at the anterolateral papillary muscle, a minimum at the inferior wall followed by a maximum at the posterior papillary muscle, then at the posterior interventricular junction, after which came a septal minimum again. When examined by short-axis thallium 201 tomography, the left ventricle does not look like a ring of even density. The purpose of this study was to try and explain the changes in density observed by variations in thickness and to devise a quantification method that would take anatomical features into account. 23 patients with normal coronary angiography underwent thallium 201 scanning after exercise. Circumferential profiles were drawn from short-axis sections with the angle on the abscissa and the number of sections on the ordinate. 29 other patients with a more than 75 p. 100 stenosis of coronary vessels (anterior interventricular artery 15, right coronary artery 10, circumflex artery 8, diagonal artery 4) had the same examination. The circumferential profiles of normal subjects closely resembled those of anatomical sections, with a minimum at the upper and anterior septal wall (the limit between the two areas being undefinable), a maximum at the anterolateral papillary muscle and adjacent myocardium, a minimum at the inferior wall and a maximum at the posterior papillary muscle and adjacent septum. These curves enabled us to determine the relative perfusion values of one area compared with another, which will serve as reference.(ABSTRACT TRUNCATED AT 250 WORDS)
Fifteen observations of perihepatitis due to Chlamydia trachomatis were studied. Occurring in young women (M: 29, 3 years), genital infection is seldom simultaneous, sometimes not even found in the case history (5 times out of 15). Women consult for a biliary type of pain (11 cases out of 15), associated with pelvic pain (2 cases). The diagnosis of perihepatitis is suspected on the normality of usual further investigations, and confirmed by laboratory tests: rarely by direct sighting (2 cases out of 8) but each time with a positive serology and a titer of antibodies higher than 1/64 by the micro immunofluorescence method. Treatment by Cyclins (13 cases) or Macrolids (2 cases) leads to the regression of the painful symptoms during the first week.
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