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J J Monsuez

Publications and source records attributed to J J Monsuez.

52 records · Page 3Linked to original sources
PubMed1989

Treatment of AIDS-associated heart disease.

Although the diagnosis of AIDS-associated heart disease is becoming routine, its treatment has not been reported except in anecdote. Also, it has been unclear whether the odds of successful treatment are altered because of the presence of cardiac involvement per se. This communication reports the authors' treatment of 18 patients with AIDS-associated heart disease. Their results are combined with the treatment results of all patients reported in the literature to date with AIDS-associated heart disease. Treatment success, defined as eradication of the organism and no relapse, was achieved in their patients with M. tuberculosis (M. tb), cardiac cryptococcosis, and Salmonella typhimurium. M. tb required emergency pericardiectomy (well tolerated in all patients), then administration of rifampin, isoniazid, and ethambutol. Cryptococcosis was treated acutely with amphotericin B and flucytosine, then with maintenance amphotericin B. The response, which included resolution of congestive heart failure, occurred within a week. Salmonella endocarditis was cured with administration of ampicillin and netilmicin for one month. When the patients' data were combined with those of patients from the literature, the authors found that the odds of successful treatment for tuberculous pericarditis were somewhat lower than if the tuberculosis was extracardiac (50% vs 67%). With cryptococcal heart disease, the odds of successful treatment were actually significantly better than when only extracardiac disease was present. The authors conclude that infectious forms of AIDS-associated heart disease are often treatable. Although some cardiac infections are less likely to respond to treatment if there is cardiac involvement, mostly the response to treatment is similar to the response with only extracardiac involvement.

Acquired Immunodeficiency Syndrome↗
PubMed1989

[Antibiotic prophylaxis in cardiac surgery in France].

Prophylactic administration of antibiotics in patients undergoing cardiac surgery is now an established procedure. The interest of a short prophylaxis (less then 48 h), directed mainly against Gram positive cocci has been demonstrated. However, there is no general agreement as to the agent to be used. We thus conducted a survey of the current practice of antibiotic prophylaxis (ABP) by sending a detailed questionnaire to each of the 51 centers performing cardiac surgery in France. 48 replies (94%) were received. Monotherapy was used in 42 centers, with cephalosporins in 41 (cefamandole: 22, cefazolin: 10, cefuroxime: 4, cephalothin: 3, cefotiam: 2) and with minocycline in one center. Six centers used a combination including aminoglycoside. Mean duration of ABP was 1.8 +/- 1.2 d. First dose of antibiotic was given before cardiopulmonary (C-P) bypass intravenously. In 29 centers, AB was injected into the C-P pump. Mean dosage of cephalosporin before surgery was 25 mg/kg and total dosage was 70 mg/kg/24 h. We conclude that cephalosporins are almost exclusively chosen in France contrasting with other european countries such as the United Kingdom where the most used regimen is a combination of penicillinase-resistant penicillin and an aminoglycoside.

Aminoglycosides↗
PubMed1988

Changes in lipid and lipoprotein levels and Achilles tendon diameters and indices in familial hypercholesterolaemic patients with tendinous xanthomatosis treated by diet and bezafibrate for 2 years.

Thirteen young adult patients suffering from heterozygotic familial hypercholesterolaemia with tendinous xanthomatosis, previously treated with a suitable special diet, were studied to assess the effect of bezafibrate, given for 2 years at a dose of 800 mg/day, on plasma lipid and lipoprotein levels and on changes in size of the Achilles tendon xanthomas. Measurements were made before and at intervals during treatment, the tendinous xanthomas being measured by an echographic procedure to give data on antero-posterior and lateral diameters, thus enabling an Achilles tendon index to be defined. The results confirm the hypolipidaemic activity of bezafibrate, changes in the levels of total cholesterol, triglycerides, lipids and lipoproteins (LDL, VLDL and HDL) being similar in direction and magnitude to those reported previously. A significant regression in the size of the Achilles tendon xanthomas was observed in 11 of the 13 patients, and the regression in the Achilles tendon index correlated significantly with a favourable change in the ratio HDL/LDL + VLDL. It is suggested that, as a result of this objective observation, a favourable effect of bezafibrate treatment would possibly be seen on the anatomical atheromatous lesions which are usual in this type of hyperlipidaemia.

Achilles Tendon↗
PubMed1988

[Cutaneous localizations of disseminated Histoplasma capsulatum histoplasmosis in a case of acquired immunodeficiency].

A widespread maculo-papular cutaneous rash appeared on a HIV-positive young bisexual Cambodian man. He was treated for Mycobacterium tuberculosis and Pneumocystis carinii infections. He had been residing in France for seven years. Histology showed, within the dermis, abundant extracellular and intramacrophagic yeast-like organisms suggestive of histoplasmosis. Cultured specimens produced a growth of colonies after three weeks on Sabouraud 4 p. 100 dextrose agar at 25 degrees C. Numerous macroconidia were found which made the species diagnosis of Histoplasma capsulatum possible. Despite initiation of therapy with amphotericin B the patient died. Cutaneous involvement with or without specific features is uncommon in disseminated histoplasmosis. The specific cutaneous lesions are protean. They rarely are the presenting sign of initial infection. Disseminated histoplasmosis has a poor prognosis in acquired immunodeficiency syndrome: amphotericin B is not curative. Maintenance suppressive therapy with ketoconazole has been recommended following amphotericin B completion, although break-through has been reported.

Acquired Immunodeficiency Syndrome↗
PubMed1986

[Phlebitis of the arm. Apropos of 45 cases].

We report in this retrospective study the data of 45 patients presenting with deep venous thrombosis of the upper extremities. This includes: 22 phlebitis due to strains, 3 traumatic phlebitis, 3 phlebitis combined with an adjacent injury, 7 phlebitis following endovenous therapeutic procedures and 10 spontaneous phlebitis (4 during adjacent medical pathologies), 3 pulmonary embolisms, including a septic one are thus demonstrated. No patient died. The follow-up date of 12 patients out of 32 exhibiting a spontaneous phlebitis or phlebitis due to a thoracic outlet syndrome have been documented: 25 p. 100 of them still presented with severe injuries. All patients underwent heparin therapy, but no fibrinolytic. A surgical procedure of the thoracic outlet syndrome was performed, when liable to the disease. Data of this series was then compared with those of previous reports on the subject.

Adult↗
PubMed1986

[Pseudophlebitis of the lower limbs. A critical study from 102 suspected cases of deep venous thrombosis].

Clinical diagnosis of deep venous thrombosis appears as uneasy, because of inconstant and non-specific symptoms. When studying a phlebitis, the risk to diagnose venous thrombosis is over 50 p. 100. This review of 102 patients, supposed to present with phlebitis, confirms such data. The diagnosis reliability depends mainly on the physician's experience. Examination and clinical research, combined with Doppler data make possible to perform a good diagnosis in 4 cases out of 5. However, in 20 p. 100, phlebography is strongly required, appearing as an essential examination. Analysis of epidemiologic and clinical data demonstrates the importance of certain data as for the diagnosis: female sex, age superior to 60 years, existence of two antecedents and/or a cardiopathy, a complex clinical picture might demonstrate a diagnosis of deep venous thrombosis. Post-phlebitic syndrome and skin infectious pathologies are the main pseudophlebitis etiologies. Popliteal cyst (often mentioned in English literature as a pseudophlebitis factor) is diagnosed in 11 p. 100 of cases.

Adult↗
PubMed1985

[Prospective study of the prevalence of coronary involvement in isolated aortic stenosis].

From 1980 to 1982, 148 consecutive patients with isolated aortic stenosis (AS) were studied prospectively with coronary angiography. Significant coronary artery disease was discovered in 27 patients (18.4 percent of cases), with involvement of the left main coronary artery 4 times (15 percent of cases), three-vessel involvement 10 times (37 percent of cases), two-vessel involvement 8 times (30 percent of cases), and single-vessel involvement 9 times (33 percent of cases). Clinical information such as age, sex, the existence of angina (present in 81 out of 148 patients, or 54.7 percent of cases), or electrocardiographic findings could not accurately predict coronary artery involvement except for the previous history of a myocardial infarction. Five patients with coronary artery lesions had no manifestations of angina, comprising 18.5 percent of patients with coronary artery disease, 3.4 percent of the entire group of 148 patients with AS, and 7 percent of patients without angina. This study's originality resides in the fact that it is a prospective study which demonstrates that coronary artery lesions associated with AS can often be severe and can not be predicted without coronary angiography. No other examination can reliably identify the association of these two conditions, making coronary angiography a routine part of the preoperative evaluation of AS if these lesions are to be discovered.

Adult↗
PubMed1984

[Skin manifestations of sarcoidosis. Review of the literature and 53 personal cases].

The authors review the literature and 53 personal cases, and describe the very variable appearances of the skin lesions in sarcoidosis: these may be divided into two main groups: non-specific "vasculitis" mainly represented by acute lesions of the erythema nodosum type, and specific polymorphic lesions often difficult to diagnose clinically and requiring skin biopsy. As in previous reports, the personal cases bring out a number of special features: silicotic granulomatous sarcoid like lesions may be observed in authentic cases of sarcoidosis; lesions identical to those described in systemic sarcoidosis may appear in isolation without other localisations. Is this cutaneous sarcoid? or sarcoid-like granulomata of unknown origin? The treatment of sarcoid skin lesions is described briefly.

Adrenal Cortex Hormones↗
PubMed1983

[Pneumopathies in drug addicts].

Drug-addicts frequently suffer from pulmonary diseases, particularly those who practice self-injection of the drugs intravenously. Emphasis is at present laid on the various excipients which are thought to induce acute alveolitis with subsequent acute pulmonary oedema in heroin-addicts. It has also been suggested that the deep ventilatory depression that precedes pulmonary oedema may play a part and this is interesting since the depression can now be prevented with naloxone. Infectious lesions, such as septic pulmonary embolism or endocarditis, are easier to explain. The ever increasing use of tablets crushed for injection is responsible for peri-arteriolar granulomas of the lung with possibly severe sequelae. Finally, the almost generalized consumption of marihuana in the United-States has led to the discovery of new properties of this drug, including ventilatory stimulation and broncho-dilatation. However, this is mostly of theoretical interest. The psychotropic effects of marihuana and its irritant effect on the bronchi when inhaled make it unlikely that it will be ever be used for therapeutic purposes.

Bacterial Infections↗
PubMedDate not supplied

Early social intervention in the emergency department.

OBJECTIVES: To assess the usefulness of an early medical social intervention conducted by a specially oriented medical social workers stationed in the Emergency Department. METHODS: Prospective study during a 2-month reference period, in a 900-bed inner-city teaching hospital that has approximatively 30,000 emergency department visits annually, providing health care facilities for a metropolitan area with a population of 230,000. RESULTS: Among 6,000 patients presenting to the emergency department during the study, 72 were found to require social intervention (1.2% of all emergency department visits, 6.85% of admissions to the hospital). Social intervention consisted of telephone calls (89%), correspondence by letters (26.5%), counsel and advice (23.5%), out-hospital intervention (14%) and resulted in: house-keeping help (34.5%) or transferal to nursing homes or nursing hospitals (28%) of elderly patients; aid to homeless and socially disadvantaged people, such as transferal to homing city shelters, clothing supply, etc., allowing extra hospital maintenance (23.5%); regularization of health insurance affiliation (10%); aid in various other social situations (22%). CONCLUSION: An early medical social intervention in the emergency department resulted in alternatives to hospital admission for a high proportion of patients (82%).

Adolescent↗