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Biomedical subjects

J F Moskovtchenko

Publications and source records attributed to J F Moskovtchenko.

At least 37 records · Page 2Linked to original sources
PubMed1991

[Cerebral aspergillosis in immunocompromised patients].

Three cases of central nervous system (CNS) aspergillosis in immunocompromised patients are reported. All three had neurological symptoms with normal cerebrospinal fluid (CSF). The CT scan showed poorly defined low density lesions which were not enhanced by contrast medium. They also had pulmonary signs and fever despite antibiotic treatment. Aspergillus fumigatus was isolated from bronchoalveolar lavage fluid. Antifungal therapy was started promptly, associating amphotericin B, itraconazole and flucytosine. Unfortunately, they died within 2 days to 2 weeks after admission in the intensive care unit. Postmortem examinations revealed disseminated aspergillosis with colonization of brain, lung, heart and kidney. The CT scan signs were quite different from those seen with the more usual bacterial ring lesions. In immunocompromised patients, the agents responsible for producing these findings are Aspergillus, Nocardia, Cryptococcus, Toxoplasma and Mycobacterium tuberculosis. Signs involving organs other than the CNS, and an examination of the CSF, should provide elements for establishing a differential diagnosis. Early antifungal treatment is the only chance of survival. Recrudescent fever and pulmonary signs occurring in neutropenic patients after antibacterial antibiotic treatment has been started are sufficient criteria for empirically starting amphotericin B administration unless clinical judgement dictates otherwise.

Adult↗
PubMed1991

Acute renal failure with preserved renal plasma flow induced by cancer immunotherapy.

Adoptive immunotherapy in patients with advanced cancer produces significant regression of metastatic disease in selected patients, but it is complicated by severe side effects. Prevention of these complications is still limited because their precise mechanisms remain unknown. For this reason we have investigated renal function and hemodynamic parameters in 16 patients with renal cell carcinoma before and during treatment with a combination of high doses of both recombinant interleukin-2 (rIL2) and recombinant alpha-interferon. After patients had received three injections of combined immunotherapy, there was a decrease in mean blood pressure (-20%), glomerular filtration rate (-25%), urine output (-50%), and fractional sodium excretion (-0.8%). This was associated with an increase in heart rate (+30%), plasma creatinine level (+30%), fractional potassium excretion (+14%) and microalbuminuria (+130%). However, renal plasma flow remained constant. The increment in microalbuminuria may reflect an alteration of glomerular capillary permeability. The reduction in GFR may be accounted either for a decrease in efferent to afferent arteriolar resistance ratio, leading to a decrease in glomerular capillary pressure, or for a decrease in ultrafiltration coefficient, or both. Nonsteroidal antiinflammatory drugs, such as ketoprofen, used to minimize side effects, could considerably worsen renal function and should be avoided in patients treated by rIL2. Our results bring new insights into the pathogenesis of functional acute renal failure and provide a rational basis for the use of vasopressors in the treatment of cytokine-induced acute renal failure.

Acute Kidney Injury↗
PubMed1991

Microalbuminuria is acutely increased during anesthesia and surgery.

Microalbuminuria is known to increase in various diseases with potential repercussion on the kidneys and indicates an increase in glomerular intracapillary pressure or changes in permeability characteristics. In this study, we measured whether albumin excretion is affected in patients undergoing anesthesia and surgery, which are both known to induce dramatic changes in renal function and in the release of vasoactive substances such as catecholamines, vasopressin, angiotensin, and prostaglandins. Seven patients with normal renal function and physiological microalbuminuria prior to surgery were studied. Urine samples were collected before anesthesia, just before the beginning of surgery, and thereafter 30 min following incision, and 30 min after the end of surgery. Anesthesia induced a significant increase in microalbuminuria, which further increased during surgery. After the end of surgical procedure, microalbuminuria decreased but remained significantly higher than control. This phenomenon may be due to an increase in intracapillary glomerular pressure and/or an alteration in glomerular permeability induced by a direct effect of drugs, or to the action of vasoactive substances on the glomerular structure.

Adult↗
PubMed1991

[Organization of organ transplantation in France].

France was in tenth position in the field of kidney transplant in Europe in 1982, and is currently at the top of western countries for all transplant activities (per million inhabitants). Cyclosporin A was certainly a favourable factor for liver, heart and lung transplantations. Nevertheless the transplantation activity in France is twice than of Great Britain or Germany for those transplant specialties and the percentage of renal transplantations from living related donors is very low in France: 2.7% versus 30% in others. These data depend on a specific French organization which involves: a presume consent law; an emergency policy with mobile medical rescue teams and polyvalent intensive care units; a three level France Transplant organization: national, regional and local; hospital physicians as regional transplant coordinators who are independent from transplant teams; waiting list telematic computer system which promotes priorities: high emergencies, high-sensitized and pediatric recipients.

Child↗
PubMed1991

[Postoperative analgesia for nephrectomy].

The aim of this study of post-nephrectomy acute pain in 30 patients was to compare three methods of postoperative analgesia and determine which one could be the most satisfactory. Ten patients received epidural analgesia with pethidine (400 mg.24 h-1 for 48 hrs). Ten other patients received intrapleural analgesia with bupivacaine (0.2 mg.kg-1.h-1 of 0.5% bupivacaine with 1/200,000 epinephrine). The ten remaining patients received systemic IV analgesia (2 g of propacetamol every 6 hrs and 0.15 mg of buprenorphine every 6 hrs). According to results of pain evaluation score (VAS) epidural analgesia with pethidine (VAS less than 2.5) appeared to be the best tested analgesic method. IV systemic analgesia (VAS less than 5) was less effective. Intrapleural bupivacaine (VAS greater than 5) was ineffective but apparently not toxic (serum concentration less than 1,200 ng.ml-1).

Acetaminophen↗
PubMed1990

[Antibiotic prophylaxis with cefotiam in transurethral resection of the prostate].

UNLABELLED: Over a period of 7 months, 50 patients underwent a trans-urethral resection of the prostate (TURP), this intervention is classified as "clear-contamined". The antibiotic prophylactic protocol, the subject of this study, was the following: cefotiam 2 g IV with the induction of anesthesia, 1 g 3 hours later and 1 g IV with the removal of the urethral catheter. RESULTS: there were 3 early post-operative urinary tract infections, one of these patients was symptomatic, at the time of removal of the urethral catheter. Most of these infections were due to Enterococcus faecalis bacteria. There was 4 late post-operative symptomatic urinary tract infections at days 15, 20, 50, and 120 respectively. All these late infections were due to Streptococcus faecalis. In total, there was a 10% rate of urinary tract infections in the critical 30 days period following the TURP. All the blood cultures were negative. These results lead us to conclude that the short term preventive treatment using the cefotiam, cephalosporin which has a strong prostatic tissue penetration, reduces the rate of post TURP urinary tract infections.

Aged↗
PubMed1988

Myocardiotoxicity of 5 fluorouracil.

We report a case of specific myocardiotoxicity due to 5 F.U. not previously described in man. A 41-year-old man was admitted to the ICU for heart and renal failure, appearing 24 h after 5 days treatment with 5 F.U. and cis-platinum. Dopamine was necessary to maintain blood pressure. Two-D echocardiography and a right heart catheterisation confirmed the alteration of myocardial contractility. After 2 weeks a complete cardiac recovery occurred.

Adult↗