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J S Gimbrère

Publications and source records attributed to J S Gimbrère.

18 recordsLinked to original sources
PubMed1993

[Postanginal sepsis caused by Fusobacterium necrophorum: Lemierre syndrome].

Postanginal sepsis or Lemierre's syndrome is characterised by septic thrombophlebitis of the jugular vein, metastatic abscesses in the lungs, soft tissues, joints or elsewhere, occurring several days to two weeks after tonsillitis or pharyngitis. The primary pathogen is a Gram-negative anaerobic rod, mostly Fusobacterium necrophorum. Previously healthy, young adults are affected mainly and the syndrome was seen more frequently in the pre-antibiotic era than it is nowadays. In the three young patients described here, a girl aged 15 and two boys aged 18 and 16, F. necrophorum was isolated from blood or pus. Histories and examinations were suggestive of Lemierre's syndrome. Ultrasound and CT scanning of the neck and other localisations proved to be important diagnostic tools in assessing the diagnosis. Response to therapy was slow and depended in at least one case on adequate drainage of abscesses. If the syndrome is suspected, initial antibiotic treatment should provide adequate coverage of anaerobic bacteria. In previously healthy patients with chills and fever occurring several days after a sore throat, Lemierre's syndrome should be considered.

Adolescent↗
PubMed1992

Adrenocortical function: an indicator of severity of disease and survival in chronic critically ill patients.

Plasma cortisol levels and modified Apache II (Apache IIm-stay) severity of disease scores were determined at weekly intervals in 159 patients who were treated for at least 7 days at the Critical Care Unit of our hospital. The mean (+/- SD) plasma cortisol level (0.60 +/- 0.28 mumol/l) was clearly elevated in these patients. The highest plasma cortisol levels were measured in patients treated with vasoactive drugs (0.76 +/- 0.39 mumol/l). Non-survivors (n = 36) had a significantly higher mean plasma cortisol level and Apache IIm-stay score than survivors (respectively 0.78 +/- 0.40 vs. 0.54 +/- 0.21 mumol/l; p less than 0.0003 and 12.6 +/- 4.8 vs. 7.3 +/- 4.1; p less than 0.0001). A significant correlation was found between the individual weekly plasma cortisol levels and the Apache IIm-stay scores (r = 0.41; p less than 0.0001), especially in the subgroup of patients, who never received glucocorticoids during their stay at the ICU (r = 0.51; p less than 0.0001). During the 14-month study period only two patients showed a clinical picture of adrenocortical insufficiency and a blunted response of cortisol to 0.25 mg synthetic ACTH(1-24). In conclusion, our data suggest that a high plasma cortisol level, like a high Apache IIm-stay score, indicates severity of disease and poor survival in critically ill patients. De novo adrenocortical insufficiency is rare and therefore routine screening of adrenocortical function is superfluous.

Adolescent↗
PubMed1988

Maternal survival after acute haemorrhagic pancreatitis complicating late pregnancy.

In the 41st week of her first pregnancy, a 25-year-old woman presented abdominal complaints. After the Caesarean delivery of an healthy child, the mother developed a severe hypoglycaemia and septic shock. Although normal serum and urine amylase values were obtained, an exploratory laparotomy disclosed acute haemorrhagic pancreatitis. Clinical treatment was complicated by repeated sepsis, multiple organ failure and ARDS, requiring the patient to receive intensive care for 3.5 months. To control abdominal sepsis and bleeding complications, an additional ten laparotomies were carried out. During this period the abdomen was kept closed by means of a nylon mesh. Although according to present day criteria the prognosis was fatal, the patient ultimately fully recovered. By exclusion, the cause of the pancreatitis was ascribed to the pregnancy itself. The medical, obstetric and surgical aspects of the management of acute pancreatitis complicating pregnancy and puerperium are reviewed.

Acute Disease↗
PubMed1986

Imipenem as monotherapy in the treatment of intensive care patients with severe infections.

In an open study, 24 intensive care patients were treated with imipenem/cilastatin as monotherapy for serious bacterial infections. Twenty-one patients were treated for bronchopulmonary infection, two patients for septicaemia, and one patient for an empyema. Initially all strains were susceptible to imipenem. Gram-negative bacilli accounted for 80% of these isolates. The most frequently isolated species were Proteus mirabilis, Escherichia coli and Pseudomonas aeruginosa. All 24 patients were considered clinically cured. Sixteen of these patients (67%) were both clinically and microbiologically cured. In eight of the 24 patients (33%), the strains isolated initially persisted. In eight of the 24 patients (33%), colonization of the respiratory tract developed. Two of the five Ps. aeruginosa isolates developed resistance during therapy but in none of these patients was therapy considered to have failed. In 12 patients (50%), transient elevations in hepatic function tests were observed and these were probably drug-related. The present study supports the view that imipenem/cilastatin may be useful as monotherapy in the treatment of severe infections in intensive care patients.

Adolescent↗
PubMed1985

Multiple-organ failure. Generalized autodestructive inflammation?

As multiple-organ failure (MOF) has been generally associated with sepsis, the importance of bacterial sepsis was evaluated retrospectively in 55 trauma and 37 intra-abdominal-sepsis patients with MOF. The severity of MOF was graded, and an analysis was made of day of onset, incidence, severity, sequence, and mortality of organ failures. No difference was found between groups in sequence, severity, or mortality of organ failures. In contrast, bacterial sepsis was found in 65% of intra-abdominal-sepsis patients but only in 33% of trauma patients. It is concluded that sepsis is probably not the essential cause of MOF. Instead, an alternative hypothesis is presented involving massive activation of inflammatory mediators by severe tissue trauma or intra-abdominal sepsis, resulting in systemic damage to vascular endothelia, permeability edema, and impaired oxygen availability to the mitochondria despite adequate arterial oxygen transport.

Adolescent↗
PubMed1983

Ceftazidime treatment in intensive care patients.

In the intensive care unit 39 patients were treated with ceftazidime for 52 infections (38 broncho-pulmonary infections, 4 intra-abdominal abscesses, 6 septicaemia, 3 urinary tract infections and 1 mediastinitis). All patients were ventilated mechanically. Three patients (6 infections) were not evaluable. In all cases except one, ceftazidime was administered after clinical failure of other antibiotics, including aminoglycosides. Ceftazidime was successful in 32 out of 46 evaluable infections (70%), while its success rate in infections previously treated with aminoglycosides (alone or in combination with cephalothin or cefotaxime) was 78% (21 out of 27 infections). In the higher dosage group (2000 mg tds) the drug was successful in 20 out of 23 infections compared with 12 out of 21 infections in the lower dosage group (1000 mg tds). Altogether 69 bacterial strains were cultured including 30 strains of Pseudomonas aeruginosa. Ceftazidime was clinically successful against 49 and 25 strains, respectively (71 and 83%, respectively). Bacterial overgrowth was present in 13 patients (14 strains) with broncho-pulmonary infections, but in only 7 was a change to another antibiotic required. Elevation of liver function enzymes was recorded in 4 patients, but it was not necessary to stop ceftazidime prematurely. This drug is an effective and relatively safe agent for the treatment of serious infections caused by Gram-negative bacilli including Pseudomonas aeruginosa in critically ill patients.

Abscess↗
PubMed1982

Emergency laparotomy in multiply injured patients.

The records of 146 consecutive multiply injured patients treated between 1976 and 1981 have been studied. Thirty-five patients underwent emergency laparotomy and in 24 patients the laparotomy was done 4 or more hours after admission. Eight of the 35 patients of the third group died, in 4 of whom the cause was head injury. The other 4 patients were extremely severely injured (Injury Severity Scores from 66 to 75). In the second group, 6 patients died, 5 from multi-organ failure due to sepsis and 1 patient from hypovolaemic shock. The more aggressive approach--to prevent multi-organ failure--is advised. The laparotomy, if indicated, must be done as an emergency procedure. During the same procedure fractures can be stabilized. In the postoperative period, mechanical ventilation should be instituted. Fresh blood should be given when more than 4000 ml stored blood is transfused, to prevent any tendency to bleed.

Abdominal Injuries↗
PubMed1982

Early osteosynthesis and prophylactic mechanical ventilation in the multitrauma patient.

Prophylactic mechanical ventilation with PEEP of patients with severe injuries prevents or attenuates the clinical manifestations of ARDS. Also, operative stabilization of all major fractures appears to be beneficial in reducing the incidence of ARDS. Primary external or internal fixation of all unstable long-bone fractures combined with prophylactic ventilation is safe and well tolerated, and allows for optimal nursing of the patient. In a group of 58 severely injured patients, treated accordingly to these principles, late death from remote organ failure due to sepsis--which is the main cause of death in multitrauma patients treated with delayed osteosynthesis or conservative fracture treatment--did not occur. Prophylactic mechanical ventilation with PEEP resulted in a significantly lower incidence of ARDS.

Adolescent↗
PubMed1980

Maternal morbidity due to beta-adrenergic therapy. Pre-existing cardiomyopathy aggravated by fenoterol.

In the 32nd wk, fenoterol was administered to a patient during her first pregnancy because of premature rupture of the membranes and uterine contractions after 2 wk of medication. At 8 microgram/min of fenoterol, total irregularity of the maternal pulse occurred. In the 35th wk, cesarean section had to be performed because of fetal asphyxia at 5 cm of cervical dilatation. Intensive care treatment of the mother was necessary during the postoperative phase. The diagnosis of pre-existing congestive cardiomyopathy was made. Non-invasive examination of the heart is advised before beta-adrenergic drugs are given.

Adult↗
PubMed1979

Maternal mortality due to the hepatorenal syndrome of pre-eclampsia. A case report.

A maternal death in the 23rd wk of pregnancy is described. The patient was gravida 8, with 6 previous abortions and one growth-retarded term infant. The clinical symptoms and biochemical findings strongly suggest that the mode of death was septic shock, with the hepatorenal syndrome due to pre-eclampsia as the underlying cause.

Adult↗
PubMed1979

An unusual case of carbamazepine poisoning with a near-fatal relapse after two days.

A severe case of carbamazepine is described in which the drug and its major metabolite were monitored by means of HPLC. After 2 days of treatment a dramatic rise in plasma concentration of carbamazepine and its metabolite was observed, accompanied by a relapse into deep coma, then followed by a rapid elimination of the drugs and complete recovery within 4 days. The possible mechanisms underlying these phenomena and potential therapeutic measures are discussed.

Adult↗
PubMed1977

Septic shock.

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Anti-Bacterial Agents↗