Hepatitis associated with primary HIV infection.
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Biomedical subjects
Publications and source records attributed to J Modaï.
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Thrombotic microangiopathy (TMA) is an anatomical entity which includes haemolytic-uraemic syndrome as well as thrombotic thrombocytopenic purpura. The physiopathology of TMA has not yet been fully elucidated, but it is certainly multifactorial. TMA has been described in numerous viral infections including HIV infection, and this raises the problem of relationship between the virus itself, the immunological phenomena it produces and the vascular walls. Three cases observed over a 2-year period are reported. In HIV infected patients anaemia, thrombocytopenia, renal failure and neurological abnormalities have multiple causes, and clinicians who look after these patients must be warned of the risk of TMA. TMA is difficult to treat, and its prognosis is extremely severe.
To evaluate the efficacy and safety of parenteral ofloxacin in the treatment of septicemia, a multicenter study was carried out in 88 patients, 53 men and 35 women, hospitalized either in intensive care units (41 patients) or in medical wards (47 patients). Ofloxacin was administered at a dose of 200 mg every 12 hours for a mean duration of ten days. Ofloxacin was administered as single agent to 62 patients. A clinical cure was obtained in 81 patients. Death occurred in 3 cases, relapse in 2, superinfection in one, and persistence of the infecting organism in another case (with acquired resistance to ofloxacin). 89 of the 94 isolated organisms (75% Gram negative-bacilli and 20% staphylococci) were eradicated. The adverse effects were rare, mild or moderate in severity, and always reversible. We conclude that I.V. ofloxacin is efficacious and safe in the treatment of septicemia due to Gram-negative bacilli or staphylococci.
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Following a summary of the main bacteriological and pharmacokinetic properties of this new quinolone derivative, the author reviews the results obtained with pefloxacine in the treatment of urinary tract infection, gonococcal urethritis, and bronchopulmonary, surgical, gynaecological, bone, soft tissue, neuromeningeal and ENT infections.
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Animal experimental models are necessary to study a certain number of factors affecting the course and treatment of bone and joint infections: virulence of the bacteria, presence of foreign bodies or blood-stained effusion, administration of corticosteroids, mode of action of antibiotics. Whereas the penetration of antibiotics within the joint is excellent, it is variable during bony infections and the association of two bactericidal antibiotics and prolonged treatment are necessary to sterilise the infected bone. Although the information supplied by experimental models may be fundamental, it cannot be extrapolated to man without certain precautions.
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During bacterial infections, the intensity of the polymorphonuclear leukocytosis depends on the bacterium but also on the mechanism and extent of the infection. Polymorphonuclear leukocytosis is greater during pyogenic and anaerobic infections. It is due to deep suppuration, septicemia of thrombophlebitic origin, acute endocarditis, purulent meningitis and pneumonia. The increase in the number of polymorphonuclear cells is, on the other hand, less marked in sub-acute bacterial endocarditis. Apart from bacterial infections, a polymorphonuclear leukocytosis is common in inflammatory disease, such as tissue necrosis and several malignant diseases. It may also be due to drug allergy.
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