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Biomedical subjects

J M Guérin

Publications and source records attributed to J M Guérin.

At least 19 recordsLinked to original sources
PubMed2000

[Fatal lactic acidosis in a patient infected by HIV and treated with stavudine and didanosine].

We report a case of severe lactic acidosis in an human immunodeficiency virus (HIV)-infected patient treated with combination regimen of stavudine, didanosine and nevirapine. Antiretroviral nucleoside analogs are inhibitors of mitochondrial DNA polymerase gamma, resulting in the dysfunction of the mitochondrial respiratory chain. Despite symptomatic treatments and intravenous L-carnitine supplementation, lactic acidosis persisted, leading to multiorgan failure. The patient died 7 days after admission to the intensive care unit. Retrospective analysis of published cases showed neither specific nor predictive signs of outcome that is usually fatal, with no effective therapy to date. We therefore recommend determining blood lactate in patients with onset of unexplained general fatigue or digestive signs and to stop all antiretroviral treatments in the case of lactate increase.

Acidosis, Lactic↗
PubMed1999

[Optimizing antibiotic therapy in a hospital setting].

Optimal use of antibiotics in hospitalized patients raises several problems. i) Does the patient really have an infection treatable with antibiotics? Currently, there are no clinical or biological data which can resolve this question with sufficient sensitivity and specificity. ii) Are microbial samples warranted before starting treatment? All bacteria isolated from cerebrospinal, ascitis, pleural or articular fluids are pathogens whereas a quantitative assessment is required for bacteria isolated from the upper or lower respiratory tract. iii) If an antibiotic is needed should a single drug or a multiple drug regimen be prescribed? Twenty years ago two-drug regimens were necessary. Synergism and better spectrum were the keystones of two-drug therapy. Today, single-drug regimens are sufficient except in case of Staphylococcus, Pseudomonas or some Enterobacteriacae infections. iv) Which administration route is best? In hospitalized patients, the parenteral route is generally used with a rapid switch to oral administration, usually within 48 hours. v) How long should the antibiotics be given? Treatment duration depends on the bacteria, the patient and the organ involved. vi) How can resistance be avoided? Rotating between antibiotics has been proposed to reduce the emergence of multidrug resistant bacteria, although this concept remains to be validated by controlled studies.

Anti-Bacterial Agents↗
PubMed1998

[Neurologic toxicity of methotrexate in a patient with cerebral arteritis. Report of a case].

We report the case of an 18 year-old woman treated for femoral osteogenic sarcoma who presented generalized seizures requiring sedation, tracheal intubation and artificial ventilation. CT brain scan showed diffuse hypodensities. Doppler studies showed an increased cerebral arterial resistance. Regional cerebral blood flow was decreased. A right carotid angiogram showed abnormalities consistent with diffuse cerebral arteritis. The patient slowly recovered and 6 weeks later, magnetic resonance imaging showed disseminated areas of hyposignal on T1 and hypersignal on T2 weighted images. We reviewed the different published cases of acute high dose methotrexate neurotoxicity and the different underlying mechanisms.

Adolescent↗
PubMed1997

[Thrombosis of the basilar trunk in a young woman previously treated by radiotherapy for malignant lymphoma].

We report the case of a 23-year-old-woman, who had received mediastinal radiotherapy for non-Hodgkin lymphoma. Five years later, she presented a basal artery thrombosis. Arteriography showed an ectopic origin of the left vertebral artery on the aortic arch located within the irradiation field. This artery was irregular and narrowed up to 15 cm from its origin. All other cerebral arteries were normal. We reviewed the literature of other observations describing radiation-induced cervical arteritis.

Adult↗
PubMed1996

[Acute respiratory distress syndrome and pancytopenia during miliary tuberculosis in a HIV positive patient].

Acute respiratory distress syndrome (ARDS) is a rare but severe complication of miliary tuberculosis, which may occur even under antituberculous therapy. Even with adequate treatment, its mortality is close to 70%, and if associated with pancytopenia, it may reach 100%. Underlying diseases, delayed diagnosis and additional complications are factors of poor prognosis. We report a case of a patient infected with the human immunodeficiency virus who experienced pancytopenia and ARDS associated with miliary tuberculosis. The patient recovered under antituberculous chemotherapy.

Adult↗
PubMed1995

[Cerebrovascular reactivity to CO2 during general anesthesia maintained with either isoflurane-N2O or propofol-N2O. A comparative study by transcranial Doppler velocimetry].

OBJECTIVES: To compare, using transcranial doppler velocimetry (TDV), the cerebral blood flow velocity and CO2 reactivity during general anaesthesia maintained with either isoflurane-N2O-O2(IF) or propofol-N2O-O2 (PF) in adults with a normal brain. STUDY DESIGN: Nonrandomized controlled trial. PATIENTS: Forty ASA I patients (mean age 41 +/- 13 yrs, 15 F/35 M) undergoing surgery of the lumbar spine in prone position. The first 20 were allocated into the IF group and the subsequent 20 into the PF group. METHODS: General anaesthesia was induced with midazolam (0.05 mg.kg-1), phenoperidine (0.03 mg.kg-1), thiopentone (5 mg.kg-1), vecuronium (0.1 mg.kg-1) and maintained with N2O (50 vol %) and O2 (50 vol %) and either isoflurane (0.8 < Fet < 1 vol %) in IF group or propofol (6 mg.kg-1.h-1) in PF group. The vascular reactivity was assessed with velocimetry measurements (Angiodine DMS, with a probe transmitting a 2-MHz pulsed wave) of flow in the middle cerebral artery at a given PetCO2 (obtained by adjustments of VT) during systole (SV) and diastole (DV). Three measurements were made: at T1 (PetCO2 = 30 +/- 2 mmHg), at T2 (PetCO2 = 40 +/- 2) and at T3 (PetCO2 = 30 +/- 2 mmHg). RESULTS: In the IF group, VS increased by +32% at T2 (P = 0.006) with an increase of + 3.4 %/1 mmHg of PetCO2. Similarly, in the PF group VS increased by + 31 % at T2 (P < 0.0001) with an increase of 2.9 %/1 mmHg of PetCO2. In both groups the VS returned to baseline values at T3. In the IF group, VD increased by + 66% at T2 (P < 0.0001), with an increase of + 7%/1 mmHg of PetCO2. Similarly in the PF group, VD increased by + 61% (P < 0.0001) with an increase of + 5.7%/1 mmHg of PetCO2. In both groups the VD returned to baseline values at T3. CONCLUSIONS: During anaesthesia maintained with either isoflurane-N2O-O2 or propofol-N2O-O2, a change in PetCO2 results in similar changes in VS and VD. These anaesthetic agents preserve the cerebrovascular reactivity of the normal brain. The results of this study are in accordance with those obtained with other reference techniques in healthy volunteers. Transcranial doppler velocimetry can be a useful noninvasive tool of clinical research in neuroanaesthesia.

Adult↗
PubMed1994

[Cutaneous diphtheria].

Cutaneous diphtheria, frequently seen in tropical areas, is uncommon in developed countries. As seen in the recent epidemics in western countries, where it turned out to be an important factor of dissemination, there is a persisting risk of diphtheria. A perfect knowledge of the clinical manifestations and factors of risk and consequent vaccination is necessary to eradicate diphtheria.

Diphtheria↗
PubMed1989

[Nosocomial sinusitis and nasotracheal intubation. Prospective study of 53 patients].

The authors studied the frequency of sinusitis in nasotracheally intubated patients in an Intensive Care Unit. All patients intubated nasotracheally during an 8 day period were included in a prospective study which included CT scanning with views of all the paranasal sinuses. Sinusitis was defined as opacification of the sinus with an air-fluid level. Transantral punctures were performed in cases of maxillary sinusitis. Fifty-three patients were included. Local symptoms and/or unexplained fever were present in 22% of cases. CT scanning showed sinusitis in 49 of the 53 cases (pansinusitis 42 cases, maxillary alone 5 cases, sphenoidal 16 cases). Bacteriological cultures of sinus punctures were positive in 39 cases, monomicrobial in 21 and polymicrobial in 18 cases. Twenty of the 53 patients developed a lower respiratory tract infection with the same germ and 10 developed septicemia (3 with isolated sinusitis and 7 with pneumonia). Eighteen patients died (6 of their infection and 12 of the underlying disease). This study shows the high frequency of bacterial sinusitis and the necessity of sinus puncture for bacteriological identification of the causal organism to adapt antibiotic therapy.

Aged↗
PubMed1988

[Secondary lung diseases in patients with nasotracheal intubation. Role of nosocomial sinusitis].

Nosocomial pneumonia is a frequent infectious complication in ICU patients. All the patients with prolonged nasotracheal intubation presenting with nosocomial pneumonia according to Salata's criteria were examined for sinusitis in the prospective study. Diagnosis was confirmed via CT-scan views and transnasal sinus puncture. In eleven nasally intubated patients, CT-scan views showed air fluid levels and multiple sinus involvement. Bacteriological studies isolated the same gram negative bacilli in both sinus and bronchial aspirates. In four cases, a polymicrobial sinusitis was found with a single organism predominant. This predominant germ was always found in bronchial aspirate. Recovery from pneumonia was obtained only after sinus drainage. Treatment included removing the nasal tubes, or performing tracheostomy and systemic antibiotics. One patient required surgical maxillary sinus drainage after failure of medical management. The occurrence of nosocomial pneumonia in nasotracheally intubated patients should lead physicians to explore the paranasal sinuses. Sinus CT-scan views should be routinely obtained in the assessment of pulmonary sepsis in patients with prolonged nasotracheal intubation. Persistent or ignored nosocomial sinusitis in such circumstances could be a major source of treatment failure.

Adult↗
PubMed1988

[Nosocomial sinusitis in an intensive care unit. Role of nasotracheal intubation].

Hospital infectious sinusitis resulting from nasotracheal intubation is common. A prospective study was undertaken between October 1986 and January 1988 of 46 patients who had undergone nasotracheal intubation. CT scan revealed sinusitis in 43 cases with sinus puncture proving the existence of bacterial sinusitis in 36 cases. Gram negative bacilli predominated. In 21 cases the existence of a complication (chest infection and/or septicemia) raised the possibility of the role played by sinusitis in their etiology. The prevalence of gram negative bacilli sinusitis in patients with a nasotracheal tube is felt to require the following from the 8th day onwards: a CT scan to detect the existence of sinusitis, sinus puncture for bacteriological identification of the organism.

Adult↗