Evaluation of the efficacy and tolerance of a short 7 day third-generation cephalosporin treatment in the management of acute pyelonephritis in young women in the emergency department.

OBJECTIVES: Urinary tract infections, among the leading causes of antibiotic prescriptions in adult women, are complicated by increasing antibiotic resistance. Current recommendations propose a 7 day treatment with fluoroquinolones or a 10-14 day course of third-generation cephalosporins (3GC). Our aim was to study the efficiency and tolerance of a short 7 day treatment with 3GC in uncomplicated acute pyelonephritis in women aged between 18 and 65 years. PATIENTS AND METHODS: This study was an open, prospective, non-comparative, monocentric pilot study with consecutive patients. We included women between 18 and 65 years old who had been admitted to the emergency department with a diagnosis of acute pyelonephritis. The treatment consisted of 1 g of ceftriaxone injection followed by 6 days of 400 mg of cefixime per day. The primary endpoint was negative urine cultures on day 9. We opted for Fleming's multistage design for this trial. ClinicalTrials.gov number: NCT01390623. RESULTS: Thirty-seven patients were analysed. The bacteriological response consisted of negative urine cultures for all 37 patients on day 9. On day 9, 30 patients were completely asymptomatic, while 7 exhibited clinical improvement though persistence of bladder irritation or flank pain. On day 37, there were no remaining symptoms and no recurrences of urinary tract infection, as noted during the last follow-up visits. CONCLUSIONS: These results suggest that acute pyelonephritis in women could be successfully treated with a short-term course of 1 g of ceftriaxone on the first day followed by 400 mg of cefixime per day for 6 days. These positive results must be confirmed by a non-inferiority study.

[Pseudo-hyperkalaemia and chronical lymphoïd leukaemia: about one observation]. / Pseudo-hyperkaliémie et leucémie lymphoïde chronique: à propos d'un cas.

Mrs D., 82 years old, is addressed to the emergency department for back pain and dyspnea associated with heart failure. This patient had a venous potassium to 7.4 mmol/L (without hemolysis) without clinical repercussions or electrocardiographic signs. A significant gap is found with arterial kaliema (4.3 mmol/L) determined using gazometric apparatus. This gap is explained by the high leukocytosis of this patient (561 G/L) within a context of chronic lymphocytic leukemia as well as by the fragility of these cells revealed by specific rules for samples transport between the clinical departments and the central laboratory. An efficient talk between biologist and clinician identified this phenomenon for this patient and avoid mistakenly initiation of treatment. This event allows us to recall the different causes leading to overestimate the true value of kaliema when samples are managed at the central laboratory, and to describe the care of patients with true hyperkalemia.

The bioavailability of polyphenols is highly governed by the capacity of the intestine and of the liver to secrete conjugated metabolites.

BACKGROUND: After ingestion of a complex meal containing foods and beverages of plant origin, different polyphenols are likely to be simultaneously present in the intestine. However, almost nothing is known about their interactions and possible consequences on their bioavailability. AIM OF THE STUDY: The present study deals with the intestinal absorption and splanchnic metabolism of three polyphenols, genistein, hesperetin and ferulic acid (FA),when perfused in the small intestine alone or in combination, at different doses (15 and 120 microM). METHODS: The fate of polyphenols in the small intestine was studied using a rat in situ intestinal perfusion model. Polyphenols were analysed in perfusate, bile and plasma by HPLC. RESULTS: Whatever the perfused dose, the efficiency of the net transfer towards the enterocyte was similar for the three polyphenols and not significantly modified by any association between these molecules. However, FA largely differed from the two flavonoids by its low intestinal secretion of conjugates. When perfused at 15 microM, the secretion of conjugates back to the lumen represented 6.2% of the net transfer into the enterocytes for FA compared to 25.5 and 20 % for genistein and hesperetin respectively. Intestinal conjugation and secretion of conjugates back to the gut lumen varied with the dose of flavonoids: saturation of conjugation was observed for the highest dose or when a high dose of a second flavonoid was perfused simultaneously. Intensity of the biliary secretion substantially differed among tested polyphenols: 7.7% of the net transfer for FA vs 50% for genistein or hesperetin. The extent of the enterohepatic cycling of these polyphenols was proportional to the perfused dose and unaffected by the simultaneous presence of different compounds in the intestine. CONCLUSION: Genistein and hesperetin appeared less available than FA for peripheral tissues because of a high intestinal and biliary secretion of their conjugates. Moreover, data suggest that a high polyphenol intake may improve their bioavailability due to saturation of the intestinal secretion of conjugates.

[Acute abdominal dilatation, a serious complication in the case of anorexia nervosa]. / Distension abdominale aiguë, une complication à redouter en cas d'anorexie mentale.

INTRODUCTION: The prognosis of anorexia nervosa (AN) is severe (death in 2 to 5% of cases). AN is closely linked to episodes of bulimia. OBSERVATION: A 25 year-old woman suffering from anorexia nervosa was hospitalised for an occlusive syndrome with vomiting, presence of abdominal cramps, absence of hydroaeric sounds and suspension of stools and gas. The biological examinations were normal. The abdominal scan revealed voluminous gastric dilatation. The diagnosis of functional occlusive syndrome was retained. With medical treatment and follow-up in intensive care the gastric dilatation progressively regressed. DISCUSSION: The periods of restricted nourishment during NA are interspaced by episodes of bulimia and at the origin of sometimes severe digestive complications. The abnormalities in gastric motility can lead to major dilatation of the stomach with the risk of perforation. The onset of abdominal pain in the context of AN during an episode of bulimia must evoke the diagnosis of acute gastric dilatation with major risk of perforation.