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Biomedical subjects

J Barrier

Publications and source records attributed to J Barrier.

At least 19 recordsLinked to original sources
PubMed1992

Polyarteritis nodosa related to hepatitis B virus. A retrospective study of 66 patients.

In an attempt to establish the characteristics, circumstances leading to infection and development of polyarteritis nodosa (PN) related to hepatitis B virus (HBV), prognostic factors and outcome, and to define the most effective treatment, 66 patients observed between 1972 and 1989 were analyzed. Hepatitis was clinically present in 19/66 patients before PN. In most cases, PN occurred less than 6 months after infection. Clinical manifestations of PN were comparable to those observed in patients without HBV infection except for orchitis which was present in 13.6% and for pulmonary signs which were absent. Transaminases were normal in 38 cases for SGOT and 31 for SGPT and twice the normal range or more in the other cases. Antineutrophil cytoplasmic antibodies (ANCA) were tested in 22 patients and present in 2 (9%). Twenty-eight patients were treated with prednisone +/- oral cyclophosphamide +/- plasma exchanges. Thirty-eight patients were given a short-term treatment with prednisone followed by the association of vidarabine, 15 mg/kg bw/d for one week and 7.5 mg/kg bw/d for 2 weeks, and plasma exchanges: 14 sessions during the 3 weeks of vidarabine infusion, then tapered until stopping treatment after 2 to 3 months depending upon the clinical results obtained. The mean duration of follow-up was 50.3 +/- 46.1 months. At the end of follow-up, 13 of the 28 patients (46.4%) treated with steroids +/- cyclophosphamide +/- plasma exchanges died and 7/38 (18.4%) of those treated with vidarabine and plasma exchanges (p < 0.001) died. HBe/anti-HBe seroconversion was observed in 2 patients treated with prednisone +/- cyclophosphamide +/- plasma exchanges who were alive at the time of final analysis and in 16 patients receiving the other regimen. The outcome of patients treated with a few days of prednisone, vidarabine and plasma exchange was good and, therefore, we propose this protocol as the first viable treatment for polyarteritis nodosa related to HBV, surpassing the conventional treatment with steroids and cyclophosphamide, which stimulates viral replication.

Adult↗
PubMed1989

[Antenatal diagnosis of holoprosencephaly and its consequences. Apropos of 2 cases].

Cyclops represents the worst form of a rare malformation of the brain and face: holoprosencephaly. Two cases are reported, including one that was diagnosed at the 23rd week of pregnancy. Now, ultrasonography makes it possible to diagnose early; as soon as the 15th week of gestation. Ultrasound diagnosis is based on hypotelorism and anomalies of the mid-line, with or without facial abnormalities. The outcome is always poor. This malformation is associated with various conditions and a complete assessment, including the karyotype, morphologic studies of the fetus and of his family, and search for related minor facial dysmorphias (median labial or cleft palate with, with a single upper incisor) is mandatory. The condition recurs in 2 to 50% of cases depending on various associated conditions and on the family histories.

Abnormalities, Multiple↗
PubMed1989

Amoxycillin/clavulanic acid ('Augmentin') compared with a combination of aminopenicillin, aminoglycoside and metronidazole in the treatment of pelvic inflammatory disease.

A randomized, multi-centre trial was carried out in 152 hospitalized women with pelvic inflammatory disease to evaluate the efficacy and tolerability of amoxycillin/clavulanic acid compared with that of a standard regimen using three antimicrobial agents (aminopenicillin, an aminoglycoside and metronidazole). Seventy patients initially received 3 to 4 intravenous doses per day of 1 g amoxycillin/200 mg clavulanic acid (mean 7.7 days) and then 4 to 6 tablets per day of 500 mg amoxycillin/125 mg clavulanic acid (mean 11.2 days). The other group of 82 patients initially received parenteral therapy daily (mean 7.7 days) with a combination of 3 to 4 g amoxycillin or ampicillin, 160 mg gentamicin (or 150 mg dibekacin or tobramycin) and 1.5 g metronidazole, and then oral therapy with 2 to 3 g amoxycillin or ampicillin and 1 to 1.5 g metronidazole daily (11.1 days). Clinical results, assessed at discharge from hospital (mean 10 days in both groups), were comparable in both groups, with 96% complete or partial response and no failures in the amoxycillin/clavulanic acid group, and 90% complete or partial successes and 5 failures with the triple therapy regimen. Both treatments were well tolerated and very few side-effects were reported.

Adult↗
PubMed1989

[Drug addiction and pregnancy. Principal obstetrical and pediatric complications].

The principal obstetrical and paediatric sequelae were studied in 22 heroin addicts who were followed up at Lariboisière Hospital in Paris between 1980 and 1984. The main effects were on the fetus with 45% showing growth retardation below the 10th percentile, 65% fetal distress, 9% prematurity; 33% had infections and 66% had the withdrawal syndrome. Because of this pathology a high number had to be transferred. Considering the period of study, HIV infection could not be evaluated. The most dramatic result seems to be the long-term effect on these children because only a third apparently live with their families and several suffer from abnormalities in psychomotor development.

Adult↗
PubMed1988

HLA class II genes polymorphism in DR4 giant cell arteritis patients.

We have previously reported a significant increase of HLA-DR4 antigen frequency in giant cell arteritis (GCA). This finding suggested an important role of immunogenetic factors in this syndrome. Recent data suggest that inherited susceptibility to several autoimmune diseases was associated with specific DR4 associated DQ beta alleles. DNAs from 27 DR4 positive patients with GCA were digested with Taq I and Bam HI, analysed on 0.7% agarose gel and hybridized with DR beta, DQ alpha and DQ beta probes. DR beta hybridization produced no variant detectable within DR4. DQ beta probe confirmed two clusters among DR4 associated DQW3 alleles: DQW 3.1 (Bam HI 360 Kb) and DQw 3.2 (Taq I 1.9 Kb and Bam HI 11 Kb). Among our 27 DR4 positive patients, 34% were DQW 3.1 and 66% were DQW 3.2. These frequencies are the same as those observed in healthy controls.

DNA↗
PubMed1988

[Prognosis and treatment of glomerulonephritis of periarteritis nodosa. The role of plasma exchange].

Fourteen patients with polyarteritis nodosa complicated by histologically confirmed glomerulopathies were included in a prospective multi-center study comparing corticotherapy (group 1, n = 8) with combined cyclophosphamide and steroids (group 2, n = 6). Plasma exchanges were associated on a routine basis. The two groups were comparable apart from initially more severe renal impairment in group 1 (p less than 0.05). Initial control of the disease was obtained in 11 patients (7 from group 1, 4 from group 2) including the patients with oligoanuria. Six patients recovered, 3 had recurrence requiring chronic hemodialysis and 5 patients died from group 1 (p less than 0.05). These preliminary findings suggest that plasma exchange can contribute to control of polyarteritis nodosa with renal complications.

Adrenal Cortex Hormones↗
PubMed1988

[Prenatal diagnosis and treatment of auricular flutter. Apropos of a case and review of the literature].

In newborns, atrial flutter is a rare, but severe condition. Late diagnosis was usual and based on fetal ECG. Now, fetal ultrasonography can differentiate in utero atrial flutter and other supra ventricular tachycardias; so it can be treated before development of cardiac failure. Among numerous and various available drugs, digoxin is universally recommended, but the delayed effect and the maternal serum levels to obtain effective fetal concentration of digoxin are not well known. Furthermore, endogenous "digoxin-like" substances have been found in maternal blood in late pregnancy; this finding raises the problem of the validity of monitoring the treatment only by serum digoxin levels. A case of atrial flutter, diagnosed in utero by ultrasonography and treated by digoxin before development of cardiac failure is reported. Neonatal echocardiography showed an aneurysm of the atrial septum, which needed simple monitoring. Its responsibility in the pathogenesis of the arrhythmia is unclear. Numerous cases of aneurysm of the atrial septum have been reported in healthy adults without atrial arrhythmias.

Adult↗
PubMed1987

[Neuromeningeal listeriosis in adults, excluding pregnancy. Prognosis and development of neurologic manifestations. Retrospective study of 63 cases].

Patients' constitutional background, treatment and neurological manifestations were analyzed in a retrospective study of 63 cases of neuromeningeal listeriosis in adults. Age over 60 and coma at the onset were of poor prognosis, but immunodepression (present in only 38% of the cases) did not seem to affect the outcome. The ampicillin-aminoglycoside combination did not appear to improve the vital and functional prognoses more than ampicillin alone. The neurological manifestations observed at the end of hospitalization in 16 of the 42 patients who were cured were not necessarily permanent: among the 13 patients who could be followed up for a mean period of 6.5 years, 5 recovered completely, 5 recovered partially and 3 remained unchanged at neurological examination.

Adult↗
PubMed1987

Pasteurella multocida bacteremia: report of thirteen cases over twelve years and review of the literature.

13 episodes of bacteremia caused by Pasteurella multocida were seen in a general hospital during a 12-year period. All the patients had an underlying disease (77% had cirrhosis) and 2 were receiving chemotherapy for hematologic malignancy. There was a numerical preponderance of male patients (69%). In 5/13 cases a recent animal-derived trauma could be found. In the other cases the source of the infecting organism was thought to be endogenous (from patients' own pharyngeal commensal flora) or secondary to contact with secretions of a pet animal. The clinical presentation of sepsis caused by this organism was nonspecific. Hypotension was seen in 5 cases. Localized sites of infection were certain in 6 and only clinically suspected in 4 other cases. The overall mortality rate was 31%. The administration of ampicillin seems the appropriate therapy for Pasteurella multocida bacteremia.

Anti-Bacterial Agents↗
PubMed1987

[Value of initial chemotherapy in the treatment of advanced cancers of the uterine cervix].

Eleven patients who had advanced cancer of the cervix were treated with combination chemotherapy containing Cisplatin as a primary treatment. The cases were: 3 stage II B N+, 2 stage III not involving the bladder, 3 stage III involving the bladder and 3 stage IV. The response rate was 40% with 6 patients responding. The response was better than 50% in 3 and there were 5 failures. In the 6 patients where the treatment was helpful, 2 could have extended surgery whereas the others had follow-up radiotherapy without developing urinary fistulae. Just as it to be found in the literature, it was not possible to pick out prognostic criteria for sensitivity to chemotherapy. A protocol for treatment is suggested, starting with a therapeutic test of chemotherapy. If this is successful it should be followed by extended surgery or radiotherapy. It if is not successful, conventional treatment with radiotherapy will be undertaken. It is essential to carry out multicentre studies in future to find out whether this attitude is going to be successful.

Adult↗
PubMed1987

[Primary Gougerot-Sjögren syndrome with necrotizing polymyositis: favorable effect of hydroxychloroquine].

A 61-year-old woman was admitted for acute arthralgias and proximal weakness in all four limbs. Clinical examination found xerostomia, xerophthalmia, enlarged parotid glands. The Schirmer test was positive and the salivary gland biopsy showed a mononuclear, lymphoid, sometimes nodular infiltrate. A muscle biopsy showed necrotizing myopathy with perifascicular atrophy. The patient refused steroids and was given hydroxychloroquine (600 mg daily). She improved gradually, and one year later there were no further complications. The favorable course both of Sjögren's syndrome and polymyositis with hydroxychloroquine treatment is unexpected. This led us to suppose that both could have had a common cause.

Female↗
PubMed1986

[The drug combination amoxicillin-clavulanic acid compared to the triple combination ampicillin-gentamicin-metronidazole in the treatment of severe adnexal infections].

Forty-four patients with severe pelvic inflammatory disease were randomly divided into two groups. Single drug therapy with the amoxicillin-clavulanic acid was used in 22 patients (group A). The other 22 patients (group B) were given a combination of ampicillin, gentamicin and metronidazole. Clinical results were comparable in both groups with 91% successes and 9% improvements in group A, against 86% successes, 9% failures, and 5% non-interpretable results in group B. The difference between the two groups was not statistically significant (p = 11.6%). 30% of patients in each group had positive serologic tests for Chlamydiae. This had no influence on therapeutic results but led to secondary prescription of a cycline. Because amoxicillin-clavulanic acid is active against aerobic and anaerobic pathogens, including beta-lactamase-producing microorganisms, it is a satisfactory alternative to the ampicillin-gentamicin-metronidazole combination, especially as it is simpler to use, less toxic and less expensive.

Amoxicillin↗
PubMed1986

[Value of the echography of the maternal kidney during pregnancy].

Routine ultrasonographic detection of renal tract dilatations in pregnant women is used to define a high risk population for urinary tract infections. In a first group of 96 patients with symptomatic urinary tract infection, 34% of the cases of uncomplicated infection were accompanied by ultrasonographic abnormalities, while 73% of cases of pyelonephritis presented such signs. Antibody coated bacteria were only found in 12% of uncomplicated urinary tract infections and in 30% of cases of pyelonephritis. In a second group of 273 patients, routine ultrasonography revealed abnormalities in 11.5% of cases. 7.5% of patients had dilatations of the upper renal tract, 2% had renal stones and 2% had occult renal malformations. Dilatations of the upper renal tract were associated with asymptomatic urinary tract infections in 30% of cases. Screening for upper renal tract dilatations is recommended between the 17th and 20th weeks of pregnancy. The presence of such lesions constitutes a risk factor for urinary tract infection and appropriate prophylactic treatment should be prescribed.

Acute Disease↗