[Acute hemolysis after early pneumococcal revaccination in a patient splenectomized for autoimmune hemolytic anemia].
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Biomedical subjects
Publications and source records attributed to P Veyssier.
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Following intramuscular injection sisomicine, in common with other aminosides, shows poor intrathecal diffusion (less than 10% of serum levels) even during the initial phase of purulent meningitis. Following the intraspinal or intraventricular injection of 0.5 mg/kg, high levels are obtained which persist up to 48th hour. This dose is very well tolerated and no accumulation phenomena were demonstrated after repeated injections. In cases of meningitis due to organisms resistant to diffusible antibiotics, sisomicine sulphate may be used by lumbar intraspinal or sometimes intraventricular injection in severe forms, in a dose of 0.5 mg/kg every 48 hours (or even 24 hours). In combination with systemic treatment. The duration of treatment cannot be precisely defined.
A hundred cases have been studied and divided into three categories:--60 normal subjects;--30 coronary subjects with a positive exercise test;--10 subjects with defective nervous control of the circulation; using the exercise test, we studied the effects of hyperventilation on repolarisation of the ventricle. In the normal subjects there was no ischaemic depression of the ST segment, but there were minor changes in repolarisation which affected the T wave in 73% of subjects and were essentially posterior in distribution. In the coronary subjects, we found three with ischaemic depression of the ST segment and one with ST elevation of 2.5 mm (6.7% of the coronary subjects). This last finding is evidence against the commonly held hypothesis that reproduction of ST depression by hyperventilation during the exercise test indicates a false positive test. In the patients with defective nervous control of the circulation, 9 had an ischaemic type of ST depression, either as a new feature or as a more severe one compared with that found at rest. The mechanism by which these depressions are produced has not been totally explained:--in the cases with defective nervous control of the circulation, it appears that latent increased sympathetic activity is increased by the hyperventilation;--in the coronary subjects, it may be caused by true ischaemia or by an associated defect in nervous control of the circulation.
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The authors report 5 cases and study the thoracic and abdominal lesions of actinomycosis. This is a rare bacterial disease but not exceptional, discovered usually by chance on operative specimen on autopsy. The clinical and bacteriological diagnosis is very difficult although the lesions are characteristic. Thus it is always necessary to carry out biopsy and seek sulphur granules in the actinomycotic follicle. The differential diagnosis is usually easy with granulomycoses, but it is sometimes more difficult to distinguish the disease from nocardioses.
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A case is reported of subacute carciac failure during the course of a non-obstructive cardiomypathy in an adolescent. When the exacerbation of cardiac failure, which was accompanied by severe arrhythmias, failed to respond to medical treatment, the combination of a veno-arterial bypass and membrane oxygenator with diastolic counter-pressure from an intra-aortic balloon was tried with success. A reasonable remission was obtained by this means, but the young patient died 8 months later from cardiac failure which proved resistant to treatment.