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J J Cocheton

Publications and source records attributed to J J Cocheton.

At least 19 recordsLinked to original sources
PubMed2000

Nocardia infection of a joint prosthesis complicating systemic lupus erythematosus.

The authors report the case of a 43-year-old woman suffering from severe systemic lupus erythematosus treated with long-term prednisone, who developed Nocardia nova infection on a hip prosthesis. Sepsis occurred about two years after an episode of pulmonary nocardiosis with the same Nocardia species, that was successfully treated by 12 months of antibiotics. A good outcome of the joint infection was observed in response to antibiotics and removal of the prosthesis. Nocardiosis is a rare infection, acting as an opportunistic infection, facilitated in the present case by systemic lupus erythematosus and chronic corticosteroid therapy. Nocardia infections mainly affect the lungs, skin and central nervous system; these last two sites are mostly due to haematogenous spread, a frequent event. Treatment is based on antibiotics, usually continued for 3-12 months, especially because of the risk of relapse. The imipenem-amikacin combination appears to be more effective than trimethoprim sulfamethoxazole. To our knowledge, this is the first case report of Nocardia nova joint prosthesis infection also presenting as late septic spread of pulmonary nocardiosis, complicating corticosteroid-treated systemic lupus erythematosus.

Adrenal Cortex Hormones↗
PubMed2000

[Infective endocarditis following incomplete ablation of a pacemaker].

Pacemaker lead-related infective endocarditis is uncommon but mortality remains high. We report the case of a 63-year-old man who presented with a history of intermittent low-grade fever and no other sign for 15 months. Fever had developed after incomplete removal of a pacemaker with the ventricular lead left in situ followed by a new implantation of cardiac stimulation material. Positive blood cultures and transesophageal echocardiography showing a vegetation on a pacemaker lead gave the diagnosis. Initial antibiotic therapy was insufficient and complete surgical extraction of the pacemaker and leads was required. A huge vegetation was seen on the old ventricular lead. The other leads were not affected. Outcome was good. The paucity of symptoms in pacemaker lead-related infective endocarditis makes diagnosis difficult. It must however be suspected in pacemaker patients with low-grade intermittent fever. Transesophageal echocardiography is required. Treatment must combine antibiotic therapy with material extraction.

Endocarditis, Bacterial↗
PubMed2000

Ursodeoxycholic acid in intrahepatic cholestasis of pregnancy. A retrospective study of 19 cases.

OBJECTIVE: We studied the clinical and biological effects and safety of ursodeoxycholic acid in patients with intrahepatic cholestasis of pregnancy (ICP). METHODS: All cases of ICP treated with ursodeoxycholic acid in our department from January 1st, 1991 to May 31st, 1997 were reviewed. RESULTS: Forty-three patients had ICP, of whom 19 received ursodeoxycholic acid. The first symptoms appeared after a mean of 29.7 weeks of pregnancy (WP). Treatment was started after a mean of 32 WP, and lasted a mean of 28.5 days. Fourteen patients showed a clinical improvement on UDCA, and 11 showed a biological improvement. Two had a biological deterioration with increased liver enzyme concentrations. CONCLUSIONS: Ursodeoxycholic acid appears to be an effective treatment for ICP, but further studies are needed to confirm its safety in pregnancy.

Adult↗
PubMed2000

[Infective endocarditis related to pacemaker leads. A review].

Infective endocarditis is a rare but serious complication of permanent cardiac pacing with high mortality ranging from 10 to 30%. Clinical symptoms are sometimes acute but more often poor and aspecific in subacute and chronic forms causing prolonged diagnostic delay. In order to make endocarditis on pacemaker leads clearer, we conducted a medline search of all published literature. Analysis of this literature shows that the initial infective source is often local and that Staphylococcus species are the most often pathogens isolated. Clinicians have to search carefully for local inflammatory signs, past or ongoing, and pulmonary embolism because their presence will be helpful for diagnosis. Transoesophageal echocardiography is essential; it shows vegetations in more than 90% and must be repeated when the examination is negative. Treatment has a double goal: a prophylactic treatment in order to reduce risk factors of infection related to implantation of the pacemaker and a curative treatment associating prolonged antibiotic therapy with extraction of the material.

Aged↗