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J Delmont

Publications and source records attributed to J Delmont.

At least 37 records · Page 2Linked to original sources
PubMed1999

[Neurocysticercosis in the South-East of France 1988-1998].

OBJECTIVE: Neurocysticercosis is commonly observed in developing countries but can also occur in industrialized countries. The aim of this work was to analyze diagnostic and therapeutic data on cases of neurocysticercosis diagnosed in southeastern France over the last 10 years. METHODS: We collected data from patient files and compared them with those reported in the literature. RESULTS: We collected 29 cases of neurocysticercosis diagnosed in southeastern France between 1988 and 1999. None of the patients had acquired the disease in France. Seizures were the most common inaugural sign. Four patients had skin lesions and very few had radiologically identifiable muscle calcifications. CT scan and MRI provided the diagnosis of neurocysticercosis and contributed to follow-up. Brain imaging showed cyst formation and calcifications. Cysticercosis serology was positive in only 52% of our patients. Antiparasite treatments with albendazole provided improvement in most patients although aggravation was observed in 4 despite a well-conducted regimen. There was one death. CONCLUSION: Neurological manifestations, particularly seizures, in a patient returning from an endemic zone should prompt search for neurocysticercosis with brain CT and MRI. Regression of clinical and radiological signs with treatment confirms the diagnosis.

Female↗
PubMed1999

Vaccination and HIV: a review of the literature.

People with HIV are at risk for a variety of infections both at home and abroad. Recent studies have reported conflicting data concerning potential harmful effects following several inactivated vaccines. Antigenic stimulation by vaccines designed to prevent secondary infections may promote HIV-1 replication in certain patients. In HIV-positive subjects, immune response worsens with progression of the HIV infection. When vaccination is considered, administration of the vaccine must be performed as early as possible in the course of HIV infection because an HIV-infected patient's response to inactivated vaccines is closely related to HIV infection stage. A minority of subjects have a protective antibody response to vaccination. Consequently, specific antibody titers should be measured after vaccination to ensure immune protection. Immune response is improved by highly active antiretroviral therapy. Some live attenuated vaccines are considered as beneficial in some specific indications and if administered in the early stages of AIDS. However, viral load variations following administration of live attenuated vaccines have not been studied yet.

AIDS Vaccines↗
PubMed1999

The comparative efficacy and tolerability of CGP 56697 (artemether + lumefantrine) versus halofantrine in the treatment of uncomplicated falciparum malaria in travellers returning from the Tropics to The Netherlands and France.

CGP 56697 (Riamet) is a new oral anti-malarial drug composed of artemether and lumefantrine (benflumetol) which combines the fast, short-acting artemether for rapid parasite clearance with the prolonged action of lumefantrine for intended radical cure. In this double-blind, comparative trial, the efficacy and tolerability of CGP 56697, given as a course of 4 x 4 tablets over 48 h, was compared to halofantrine, given as 3 x 2 tablets over 12 h with a second course 1 week later. Patients (mostly non-immune) with acute, uncomplicated Plasmodium falciparum infection were randomly assigned to either CGP 56697 (n = 51) or halofantrine (n = 52). CGP 56697 proved superior with respect to parasite clearance time (median 32 vs. 48 h, P < 0.001) and parasite reduction at 24 h (median 99.7 vs. 89.6%, P < 0.001) with a non-significant difference in resolution of fever (median 24 vs. 32 h, P = 0.835). However, a 28-day cure rate of 82% was observed for CGP 56697 and 100% for halofantrine. Significant QTc prolongations (> 30 ms) were seen 6-12 h after halofantrine intake but not after CGP 56697 intake. CGP 56697 is an effective, well-tolerated treatment for uncomplicated falciparum malaria but for this dosing regimen the recrudescence rate is unacceptablyhigh (18%). For travellers contracting malaria abroad, we propose a six-dose regimen of CGP 56697 over 3 days.

Adolescent↗
PubMed1999

Long term treatment of biliary stricture due to chronic pancreatitis with a metallic stent.

The exact role of endoprostheses in the management of chronic pancreatitis-associated biliary strictures has not yet been clearly established. We report an unusual case of a patient with this condition who was treated for an unexpectedly long term with a self-expanding metallic endoprosthesis. There has only been one previous report of the use of metallic stents in this situation. It appears that metallic endoprostheses may have a role to play in the management of selected patients who have chronic pancreatitis-associated bile duct stricture.

Cholestasis, Extrahepatic↗
PubMed1999

[Imported dengue: study of 44 cases observed from 1994 to 1997 in 9 university hospital centers. Infectio-Sud-France group].

Imported dengue is increasingly observed in non endemic countries. We report a retrospective study of 44 cases of dengue fever diagnosed in nine french university hospitals between 1994 and 1997. The patients were aged between 13 and 67 years. Most of them were tourists and had been traveling for a few weeks, in French West Indies and French Guyana (18), South-East Asia (10), India (7) or Polynesia (4). Only, two contracted the disease in Africa. The onset of symptoms preceded the return or followed it within 7 days. The most frequent clinical presentation was a febrile and painful syndrome. Cutaneous manifestations (rash or macular exanthem) were observed in 59% of cases, digestive symptoms in 50%, pharyngitis and/or cough in 25%, microadenopathy in 20%, moderate mucous haemorrhagic manifestations in 16% and neuropsychiatric manifestations in 14%. The common biological abnormalities were thrombocytopenia (84%), leukopenia (59%), and elevated transminases (57%). The diagnosis, orientated by negativity of malaria smears, the knowledge of an epidemic in the visited country, or occurrence of similar cases in the entourage, were argued by serological results: presence of anti-DEN IgM in 25 cases, serological conversion (anti- DEN IgG) in 7 cases or very high seropositivity (anti-DEN IgG > 1/1280) in 12 cases. No virus isolation was obtained.

Adolescent↗
PubMed1998

First report of association of chronic pancreatitis, primary biliary cirrhosis, and systemic sclerosis.

We report an original observation of chronic pancreatitis associated with primary biliary cirrhosis and systemic sclerosis. The diagnosis of each of these conditions was unequivocally confirmed. Pancreatic involvement in this case was asymptomatic. The association of chronic pancreatitis with primary biliary cirrhosis has been previously reported and pancreatitis has been associated with other autoimmune disorders. We hypothesize about the underlying pathogenic mechanisms of chronic pancreatitis in our case.

Aged↗
PubMed1998

The natural history of hereditary chronic pancreatitis: a study of 12 cases compared to chronic alcoholic pancreatitis.

The aim of this study was to document the natural history of chronic hereditary pancreatitis and to compare its evolution to that of chronic alcoholic pancreatitis. Twelve subjects with chronic hereditary pancreatitis were followed up for a mean duration of 15.8 years (range, 1-23) and compared to subjects with chronic alcoholic pancreatitis who were followed up from 1972 to 1980. The subjects with chronic hereditary pancreatitis, when compared to those with chronic alcoholic pancreatitis, were found to have an earlier onset of symptoms (10.5 vs. 46.0 years, p < 0.05); a significant delay in diagnosis (14.3 vs. 3 years); a similar prevalence of pancreatic calcification (58 vs. 57%); a similar amount of pancreatic insufficiency; both endocrine (50 vs. 70%) and exocrine 42 vs. 38%); and a higher prevalence of pseudocysts (33 vs. 10%, p < 0.05). Only one pancreatic adenocarcinoma was diagnosed in a patient with chronic alcoholic pancreatitis. Apart from the earlier onset and the delay in diagnosis, chronic hereditary pancreatitis has a natural history similar to that of chronic alcoholic pancreatitis. The disease is progressive with a high incidence of complications, but all subjects were alive after follow-up.

Adolescent↗
PubMed1998

[The proper use of antimalarial drugs currently available].

French medical practitioners have at their disposal several antimalarial drugs for giving chemoprophylaxis to people travelling to a malaria endemic country or treating an imported malaria case in a patient. The choice depends on the contre-indications and indications of each drug, essentially subordinated to the presence and level of Plasmodium falciparum chemosensitivity in the visited area. For prevention, chloroquine alone can be taken in the areas where P. falciparum is absent or not chloroquine resistant; elsewhere, the choice between chloroquine/proguanil or mefloquine depends on knowing the prevalence and level of falciparum chloroquine resistance in these areas. For treatment, the only indications of chloroquine are imported malaria cases either due to P. vivax, P. ovale or P. malariae, or caused by P. falciparum contracted in one of the rare countries where the species is still sensitive to chloroquine. For uncomplicated falciparum malaria cases acquired in a chemoresistance area, mefloquine, halofantrine, sulfadoxine-pyrimethamine or oral quinine is selected, depending on the observed chemoprophylaxis, the contra-indications and the suspicion of chemoresistance type. Whatever the provenance area, P. falciparum in a patient with one or several serious symptoms or possibly profuse vomiting is treated by intravenous quinine, associated with tetracycline if the patient comes from an area known for a low quinine sensitivity of this species. The spectrum of falciparum malaria treatment has recently broadened to include new drugs such as artemisinin, artemether or atovaquone/proguanil, the latter being as yet unauthorized in France.

Animals↗
PubMed1998

Eosinophilic pancreatitis mimicking pancreatic neoplasia: EUS and ERCP findings--is nonsurgical diagnosis possible?

Eosinophilic pancreatitis is a rare disease with, to date, only 10 reported cases. We report two patients whose presentation was suggestive of a pancreatic tumor. An 18-year-old man presented with a short history of obstructive jaundice, epigastric pain, and weight loss. Endoscopic ultrasonography revealed a 12-mm round, hypoechoic lesion in the head of the pancreas, suggestive of a pancreatic endocrine tumor. A duo-denopancreatectomy was performed, and the patient made an uneventful recovery. A 64-year-old man was referred with weight loss and obstructive jaundice due to a stricture of the common bile duct. Retrograde pancreatography demonstrated a very narrow, regular main pancreatic duct and early parenchymography. Endoscopic retrograde cholangiopancreatography revealed a tight, regular stenosis of the intrahepatic portion of the common bile duct. A gastrojejunal anastomosis and biliary-digestive bypass were performed without postoperative complications. In both cases, the diagnosis of eosinophilic pancreatitis was revealed after surgical resection. The features of eosinophilic pancreatitis, including eosinophilic infiltration of the digestive wall, a history of atopy, and the radiological characteristics are described. If these are of sufficient discriminatory value, unnecessary surgery may be avoided.

Adolescent↗
PubMed1997

African tick-bite fever. An imported spotless rickettsiosis.

OBJECTIVES: To characterize the clinical presentation and course of African tick-bite fever, a recently rediscovered rickettsiosis caused by Rickettsia africae (a new species within the spotted fever group of rickettsiae), to establish its relationship with Amblyomma tick species, and to discuss its role in the etiology of fever in patients who are returning from the tropics. PATIENTS: Seven patients who returned from Zimbabwe of the Republic of South Africa and presented with fever. METHODS: Cases were recognized clinically by the presence of multiple taches noire and were diagnosed as having a rickettsial infection by identification of the organisms in circulating endothelial cells. The causative role of R africae was further demonstrated using cross-absorption and immunoblotting of patients' serum samples and isolation of the agent from blood and skin biopsy specimens. Isolates were characterized using the restriction fragment length polymorphism-polymerase chain reaction and sequence analysis of the gene that encodes for the 190-kd Rickettsia-specific antigen. RESULTS: All 7 patients presented with fever and multiple taches noire. Further physical examination of patients revealed lymphadenopathy, lymphangitis, and edema, but there were virtually no signs of a rash. These findings are characteristic of R africae-infected patients and are distinct from those observed in patients with Rickettsia conorii-induced Mediterranean spotted fever. All 7 patients were infected with R africae as demonstrated by immunoblotting or isolation of the agent, and all were cured. CONCLUSIONS: With increasing international travel, a need for the recognition of rickettsial diseases by physicians is becoming more important. Tick-bite fever, a disease caused by R africae and transmitted by Amblyomma ticks, is characterized by multiple taches noire, lymphadenopathy, lymphangitis, and edema, but no rash or a discrete rash. It is a frequent but benign disease that physicians should consider when presented with febrile patients returning from southern Africa.

Adult↗
PubMed1997

[Immunocompromised travelers].

More and more immunocompromised people travel abroad especially in tropical countries where infectious risks are high. Before leaving, these subjects must consult their general practitioner who will determine their fitness in function of type of immunodeficiency, travel destination, availability of medical care at the destination, and possibility of medical evacuation. Counseling should also be provided concerning the precautions necessary to avoid the hazards of exposure to fecal material, venereal disease, insect bites, and sun. Antimalarial drug prophylaxis is the same as for uncompromised subjects. Advising immunocompromised subjects about vaccinations is difficult since there is no consensus on the subject. Administration of inert vaccines is usually recommended but their effectiveness is often diminished and harmful effects have been observed in HIV-infected subjects. Administration of live vaccines is always contraindicated in severely immunocompromised subjects but some live vaccines can be used in moderately immunocompromised subjects. The guidelines for vaccination differ depending on the underlying cause of immunodeficiency: congenital defects, cancer, hemopathy, treatment with immunosuppressors or corticosteroids (transplant patients and patients with systemic disease), HIV-infection, or spleen dysfunction. If there is a high risk of contracting a disease for which vaccination is contraindicated, drug prophylaxis or administration of immunoglobulins can be an alternative. If not, travel should either be postponed or the destination should be changed.

Counseling↗