Biomedical subjects
R M Rouquet
Publications and source records attributed to R M Rouquet.
[Legionellosis: definition, diagnosis, treatment].
Explore the source record for details and available documents.
[A rare cause of asthma exacerbation: systemic anguilluliasis].
Strongyloides is an helminthic infection that may induce bronchospasm during systemic migration of larvae. We report a case of a 60 years old man originating from Caribbean who had corti-codependent asthma since 30 years. He was hospitalized for severe exacerbation that worsen when steroid dosage was increase. Sputum examination revealed the presence in great number of Larvae of Strongyloides stercoralis. A good clinical evolution was achieved after specific anti-helminthic treatment. Later on, it was even possible to stop completely steroid treatment. This clinical case demonstrates the interest to look for Strongyloides superinfection in asthmatic patients that worsen when receiving increasing dose of steroids. This is particularly important for patients who have resided, even many years earlier, in areas where intestinal helminthic infection are endemic.
Idiopathic esophageal ulceration associated with human immunodeficiency virus infection: efficacy of thalidomide treatment.
Explore the source record for details and available documents.
[Nocardia respiratory infection in patients with chronic obstructive lung disease].
Pulmonary nocardiosis is a respiratory infection which is usually described in the immunocompromised. We report three cases in patients suffering from chronic airflow obstruction. In two cases there was a parenchymal disorder and in one case bronchial suppuration without involvement of the alveolar region. The diagnosis was made in all cases by bacteriological examination from specimens obtained at fiberoptic bronchoscopy. The outcome was favourable in all three cases after appropriate treatment. These observations underline the diversity of the clinical forms of respiratory nocardiosis. Furthermore, it demonstrates their possible occurrence in non-immunocompromised patients and the need to look for this germ specifically in long drawn infections. A bacteriological diagnosis is vital to start early and appropriate antibiotic therapy which should be prolonged because of the risk of recurrence and disseminated infection.
[Invasive pulmonary aspergillosis in 4 patients with acute decompensation of chronic respiratory insufficiency].
Invasive pulmonary aspergillosis (API) is a necrotising pneumonia generally occurring in profoundly immunodepressed subjects. These observations were based on four patients in the intensive care unit, suffering from chronic respiratory failure (IRC), without profound immunodepression. After a pathophysiological and clinical review, a focus on the diagnostic methods permits one to stress on the reliability, in this type of patient, of the evidence from direct examination of aspergillus filaments in the bronchoalveolar lavage (LBA) or protected bronchial brushings, taking account of the weak value of routine culture of spit or bronchial aspiration in IRC in whom patients are frequently colonised. These four cases permit one to discuss the factors which predispose to the development of API outside the usual immune suppression: IRC itself, by the disorder of mucociliary function, which it leads to; repeated antibiotic therapy which destabilises the saprophytic flora; viral infections which would be responsible for transitory immunodepression. But it is above all steroid therapy which seems to be the major factor favouring the development of API without producing profound immunodepression but probably because it inhibits phagocytosis of aspergillus spores. In these circumstances it is necessary to make an early diagnosis and to use fibre optic bronchoscopy with protected sampling and bronchoalveolar lavage with a complete microbiological. Only early treatment allows one to contemplate a cure.
Immunostimulant effects on granulocyte functions during an acute respiratory infection.
Treatment of healthy volunteers by Ribomunyl, whether or not in association with in vitro antibiotics (amoxicillin or josamycin), has been earlier demonstrated to be an efficient stimulant of PMN functions (adhesion and migration). This second double-blind study versus placebo was performed on 17 patients with acute respiratory infections (placebo group: eight subjects; Ribomunyl group: nine subjects). Ribomunyl treatment (four days) associated with antibiotherapy (amoxicillin) induced a significant increase of PMN adhesion (p = 0.014) with no significant effect of the placebo (p = 0.30) and no significant difference between the initial level of PMN adhesion of the two groups (placebo-Ribomunyl).
[Idiopathic subacute pulmonary eosinophilia].
We report a case of pneumonia with hypoxaemia and a swinging fever which was resistant to antibiotics, but was associated with a hypereosinophilia (44%) noted in the bronchoalveolar lavage. Investigations as to the cause of the eosinophilic pneumonia were negative; a lung biopsy confirmed the eosinophilic infiltration and the absence of any angiitis. There was a rapid and favourable clinical outcome following steroid therapy, which was maintained for three months. No relapse has been noted in the ten months of follow up since ceasing the cortico-steroids. The diagnosis appears to be that of a sub-acute, idiopathic eosinophilic pneumonia. The similarities and differences between this case and the chronic idiopathic eosinophilic pneumonia of Carrington were discussed.
Imipenem/vancomycin for Rhodococcus equi pulmonary infection in HIV-positive patient.
Explore the source record for details and available documents.
[In vitro activity of twenty antibiotics against Rhodococcus equi].
The in vitro susceptibility of nine Rhodococcus equi strains (seven isolates from immunocompromised patients mainly HIV positive and two reference strains) to twenty various antibiotics were assessed for bacteriostatic effects by an agar dilution method. Imipenem and ceftriaxone were the most effective of the beta-lactams studied. The lowest MIC were noted with vancomycin, teicoplanin, erythromycin, clarithromycin, rifampicin, gentamicin and doxycycline. A longitudinal survey, including three strains isolated from the same patient, showed the emergence of rifampicin resistance and a marked increase of the MIC to imipenem.
[Therapeutic modalities in pulmonary tuberculosis].
In 1990, specific antituberculous chemotherapy can cure almost 100 p. cent of patients with pulmonary tuberculosis in France, provided practitioners follow strict therapeutic rules and patients' compliance with treatment is perfect. A single standard treatment is proposed for those patients whose tuberculosis has never previously been treated; it consists of a six months' course of isoniazid (5 mg/kg/day) and rifampicin (10 mg/kg/day); combined with ethambutol (20 mg/kg/day) and pyrazinamide (30 mg/kg/day) during the first two months. This treatment must be administered under regular medical supervision, and it must be prolonged for some time after cure has been obtained. In case of relapse or in some special situations (e.g. pregnant women, HIV positive patients, serofibrinous pleurisy, complex anatomico-clinical forms of the disease) treatment is more difficult, but it should always give favourable results.
[Community-acquired pneumonia].
Community-acquired pneumonia accounts for about 1 p. 100 of all lower respiratory infections, i.e. 1 to 10 cases per 1,000 adults annually, depending on the country and the year. The causative organism is seldom identified since there is no simple, specific, non-invasive and cheap laboratory diagnostic method. Treatment therefore is empirical. It rests upon epidemiological and clinical data as well as upon a set of criteria concerning the acceptability of antibiotics and variations in bacterial resistance. The four principal antibiotic-sensitive microorganisms to be taken into account are pneumococci, Haemophilus influenzae, Mycoplasma pneumoniae and Legionella pneumophila. In practice, focal lung infections should initially be treated with penicillin A which is active against pneumococci and H. influenzae. In case of atypical pneumonia, preference should be given to macrolides since these drugs are active against M. pneumoniae and L. pneumophila. In initially severe or worsening pneumonia occurring in debilitated patients penicillins and macrolides should be given concomitantly from the start.
[The value of Doppler echocardiography in the diagnosis of pulmonary artery hypertension in chronic obstructive bronchopneumopathies].
We report a study using Doppler echocardiography looking for pulmonary arterial hypertension (HTAP) in 36 patients presenting with chronic airflow obstruction (BPCO) who are in a stable state. 18 of these (group 1) had confirmed HTAP by right heart catheterisation which had been done the day before and was defined as a mean pulmonary arterial pressure (PAPm) of greater than 20 mm of mercury. The other 18 patients (group 2) did not have HTAP at rest. The systolic ejection flow and the duration of the peak (expressed in msec) was analysed at the time of each examination. The Doppler data was compared between the two groups of patients and also with the results obtained in ten healthy subjects. The Doppler examination was successfully performed in 35 patients in spite of a poor echographic window in 86% of cases. When there was HTAP, the systolic ejection flow had a triangular aspect which contrasted with the dome shaped appearance of the normals. In group 1 the peak time was significantly shortened (p less than 0.01) compared to group 2 and to the healthy subjects. On the other hand there was no linear correlation between the value of the peak time and the level of HTAP measured by the catheter. Thus the severity of HTAP could not be precisely measured using these parameters. In considering that the peak time is normally greater than 100 msec, the sensitivity and specificity of the Doppler examination for the detection of HTAP during the course of BPCO are 90 and 88% respectively, which appears to be superior to the values obtained using other non invasive methods in the diagnosis of HTAP.
[Acute primary infectious pneumopathies. Which antibiotherapy?].
Explore the source record for details and available documents.
[Electromyographic monitoring during desensitization to Hymenoptera venoms].
Explore the source record for details and available documents.
[Current modalities for the treatment of tuberculosis].
Explore the source record for details and available documents.