Biomedical subjects

J D Bernard

Publications and source records attributed to J D Bernard.

16 recordsLinked to original sources

PubMed1996

Antibiotic efficacy against Staphylococcus epidermidis adherent to vascular grafts.

Antibiotic bonded grafts may improve the treatment results of vascular graft infections. The purpose of this study was to determine the antibiotic and antibiotic concentration needed to be effective against Staphylococcus epidermidis-infected vascular grafts. The efficacy of four antibiotics (minocycline, cefazolin, vancomycin, and rifampin) against S. epidermidis adherent to Dacron or Teflon vascular grafts was studied in vitro. Kill kinetic studies were performed with 18 and 42 hr of exposure of Dacron-adherent and Teflon-adherent S. epidermidis at 1, 4, 16, and 64 times the minimum inhibitory concentration (MIC) of each antibiotic. Antibiotic efficacy against graft-adherent S. epidermidis at 42 hr was best at concentrations 64x MIC for minocycline, cefazolin, and vancomycin and 4x MIC for rifampin. None of the antibiotics totally eradicated the graft-adherent bacteria. Antibiotics were equally effective for S. epidermidis adherent to Dacron and Teflon grafts. Antibiotic concentrations several times that predicted by the MIC were needed for all antibiotics to achieve significant killing of graft-adherent bacteria, with rifampin the most effective at the lowest concentration.

Anti-Bacterial Agents↗

PubMed1995

Coarctation of the abdominal aorta.

Four patients with suprarenal coarctation of the abdominal aorta were managed from 1978 to 1993 (mean follow-up 8.75 years). Ages at the time of diagnosis were 2 months, 8 months, 4.5 years, and 15 years, respectively. Three children presented with severe hypertension, two of whom were in congestive heart failure, and the fourth child presented with a cold, ischemic leg. The 8-month-old patient had Williams syndrome (supravalvular aortic and pulmonic stenosis, bilateral renal artery stenosis and celiac artery occlusion, "elfin" facies, and mental retardation) and was treated nonoperatively. After 12 years of follow-up, he was given five medications to control hypertension, cardiac arrhythmias, and heart failure. Three patients with abdominal aortic coarctation were treated operatively and none died. Two patients underwent bypass grafting from the supraceliac aorta to the infrarenal aorta, with bilateral renal artery reconstruction in one. Postoperative arteriograms obtained 1 year or more after operation were normal in both cases. The 2-month-old patient underwent patch aortoplasty, with subsequent reoperation 1.5 years later for recurrent hypertension and heart failure with a bypass graft to the left kidney and removal of an infarcted right kidney. In all three patients, operative repair of the suprarenal aortic coarctation has resulted in long-term control of blood pressure and cardiac and renal function.

Adolescent↗

PubMed1994

[Surgical treatment of hidradenitis and Fox-Fordyce disease of the nipples].

Hidradenitis suppurativa and Fox-Fordyce disease are apocrine sweat gland diseases, characterized by chronic and recurrent forms, with frequently unsatisfactory management and physical discomfort. The localisation to the breast areola is well known but infrequent. A new surgical treatment of areolar involvement is presented. This technique includes: dermal detachment of the areola safeguarding the nipple, excision of the underlying apocrine sweat glands, areola fixation like a flap-total skin graft. This very simple procedure allows definitive treatment without aesthetic impairment. Two cases of areolar involvement are presented.

Adult↗

PubMed1993

[Anterolateral hysteropexy via abdominal approach. Results and indications. Apropos of a series of 92 patients].

Of the possible surgical techniques for the treatment of genito-urinary prolapses, abdominal suspension is reserved for young patients in whom retention of sexual function is desirable. Fixation to the sacral promontory is the reference method but has some contraindications. Anterolateral suspension of the uterine isthmus to the anterior superior iliac spines by a strip of non-absorbable mesh, as described by Kapandji, is then a good alternative. We report our results with this technique over an 8-year period in 92 patients. Mean follow-up was 5 years. There was no intraoperative mortality nor major complications. Anatomical results were satisfactory in 87% of cases at 5 years, with however 4 reoperations for total recurrent prolapse, of which one was posterior. Functional results showed two cases of deep dyspareunia and 12% post-operative stress urinary incontinence, of gradual onset. In conclusion, anterolateral hysteropexy associated with removal of the pouch of Douglas is a reliable procedure with no particular danger. It can be a good alternative to fixation to the sacram promontory when the latter is contraindicated or dangerous.

Adult↗

PubMed1992

Hypercalcemia and breast cancer related to parathormone-like secretion by liver metastases.

A premenopausal woman developed hypercalcemia 30 months after treatment for infiltrating breast cancer. After bone metastases had been excluded, primary hyperparathyroidism was suspected. A parathyroid adenoma was removed and histologically confirmed. Hypercalcemia, associated with low plasma phosphate and severely depressed plasma parathormone (PTH) levels, persisted. Further investigations showed liver metastases from the primary breast cancer and also secretion of a PTH-like substance. Antitumoral treatment was effective on the liver metastases and also normalized calcemia and the PTH-like substance, demonstrating the existence of a paraneoplastic syndrome related to the secretion of a PTH-like substance by disseminated liver metastases of primary breast cancer.

Breast Neoplasms↗

PubMed1992

[Malignant hypercalcemia after treatment of breast cancer].

A premenopausal woman developed hypercalcemia 30 months after treatment for infiltrating breast cancer. After bone metastases had been excluded, primary hyper parathyroidism was suspected. A parathyroid adenoma was removed and histologically confirmed. Hypercalcemia persisted, associated with low plasma phosphate and severely depressed plasma parathormone (PTH) levels. Further investigations showed liver metastases from the primary breast cancer and also secretion of a PTH-like substance. Anti-tumoral treatment was effective on the liver metastases and also normalized calcemia and the PTH-like substance, demonstrating the existence of a paraneoplastic syndrome related to the secretion of a PTH-like substance by disseminated liver metastases of primary breast cancer.

Breast Neoplasms↗

PubMed1992

[The treatment of severe dysplasias by CO2 laser: the respective indications for vaporization and conization. 84 cases].

Fifty-nine conisations and 25 vaporizations were carried out using laser CO2 in order to treat a series of 84 cases of severe dysplasias (CIN III). After a follow-up of 4 and 12 months (median period of observation 25 months) it was found that out of 74 patients that were followed up in this way 72 had benefitted from the use of the treatment. There were 5 cases however of recurrence of dysplasia (1 CIN I, 2 CIN II, 2 CIN III). These had further treatment with laser. Four of those were controlled properly, the fifth had to have surgery. Complications of treatment did not occur when vaporization was used and only rarely when conisation was used. With vaporisation it is not possible to obtain a piece for histological examination, but if it is done according to precise criteria it is safe (7 mm depth at least and vaporisation carried out to 3 mm beyond the lesions). It can be used particularly in young patients who have never been pregnant. If these have been examined carefully with directed biopsies taken colposcopically and where the lesion is strictly limited to the exocervix and the transformation zone has been seen and the lesion is small (2 cm of less), 84% were controlled therapeutically and using Bruhat's criteria the success rate was 96%. Conisation was effective for every one of the other cases. Laser CO2 probably lessens local complications of the procedure and if vaporization is carried out on the rim of the cervix better control of the condition is obtained (98% controlled in the period under review).

Adult↗

PubMed1991

[Maternofetal infection with human parvovirus B19. Apropos of 2 cases].

Two cases of maternal-fetal human parvovirus B19 infection are reported. The first case involved a feto-placental anasarca occurring during the third trimester and complicated by in-utero death with expulsion of a fetus with multiple malformations. The second case involved meconial peritonitis during the second trimester with favourable outcome after cesarean section and resolution of the digestive syndrome. Proof of PV B19 infection was obtained by identifying M specific immunoglobulins and viral DNA. After a review of the clinical situations most often encountered and the particular features of these two cases, therapeutic attitudes are proposed for this infection of major gravity during pregnancy.

Adult↗

PubMed1980

Effects of castration and chronic morphine administration on liver alcohol dehydrogenase and the metabolism of ethanol in the male Sprague-Dawley rat.

The effects of castration on liver alcohol dehydrogenase (ADH) activity and the in vivo metabolism of ethanol were examined in the male Sprague-Dawley-derived rat. It was found that castration led to immediate (24 hr) increases in the ADH-dependent metabolism of ethanol which persisted for at least 6 weeks postcastration. Testosterone completely reversed the effects of castration. Moreover, when increases in liver ADH activity and the metabolism of ethanol were allowed to develop to maximal levels (2 weeks), a single s.c. injection of testosterone promptly reversed the effects of castration, such that by 24 hr castrated animals were indistinguishable from controls. Thus, it appears that in the male Sprague-Dawley-derived rat liver ADH activity and the in vivo metabolism of ethanol are under the control of testosterone. Because narcotics have also been shown to depress serum testosterone levels, and there is good evidence of significant pharmacological and biochemical interactions between the narcotics and ethanol, we examined whether chronic administration of morphine led to testosterone-reversible increases in the ADH-dependent metabolic disposition of ethanol. We found that chronic morphine administration, at doses sufficient to markedly depress serum testosterone levels (> 85%), produced large increases in liver ADH activity and the clearance of ethanol. Concurrent administration of testosterone completely abolished this effect. These data may, therefore, provide the first evidence of a biochemical mechanism involved in the interactions between morphine and ethanol. Furthermore, our results suggest that drug-induced reductions in serum testosterone may serve as an important mechanism involved in the cross-tolerance observed between ethanol and many abused, sedative-hypnotic drugs which share the common ability to decrease serum testosterone.

Alcohol Oxidoreductases↗

PubMed1975

Licorice-induced pseudoaldosteronism.

Licorice ingestion as a cause of pseudoaldosteronism is discussed. The mechanism whereby licorice, when consumed in large quantities, exhibits the physiologic properties of aldosterone, is reviewed. A case report of a 51-year-old male hospitalized with hypertension and hypokalemia is presented with reports of laboratory findings which lead to the diagnosis of pseudoaldosteronism.

Glycyrrhiza↗

PubMed1974