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1.
Eur J Clin Microbiol Infect Dis ; 34(5): 935-42, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25575950

RESUMO

Methicillin-resistant Staphylococcus aureus (MRSA) formerly colonized and infected only inpatients in hospitals, but have been reported in community settings worldwide over the last 20 years. In France, the prevalence of such MRSA remains low and outbreaks have, until now, been mainly due to the ST80 clone. However, there were two outbreaks of MRSA clone ST-USA300 recently in France, including one involving children. To investigate epidemiological developments, we studied the 77 MRSA isolated from pediatric patients hospitalized between 2008 and 2013 in three French hospitals. The median incidence of MRSA was stable and low (0.137 per 100 admissions). The prevalence of Panton-Valentine leukocidin (PVL)-positive MRSA was high (33.8 %). The 26 PVL-positive MRSA were genetically diverse, with two clones being predominant: ST80 (12 isolates, 46.1 %) and ST8-USA300 (8 isolates, 30.8 %). The incidence of ST8-USA300 increased over the 6-year period. We believe that screening for ST8-USA300 should be improved: medical biologists should be encouraged to search for PVL genes in all MRSA isolates recovered from abscesses, whatever the susceptibility pattern of the isolate, and not only when suggestive of ST80.


Assuntos
Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Genótipo , Staphylococcus aureus Resistente à Meticilina/classificação , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/microbiologia , Adolescente , Toxinas Bacterianas/genética , Criança , Pré-Escolar , Surtos de Doenças , Exotoxinas/genética , Feminino , França/epidemiologia , Variação Genética , Hospitais , Humanos , Incidência , Lactente , Recém-Nascido , Pacientes Internados , Leucocidinas/genética , Masculino , Staphylococcus aureus Resistente à Meticilina/genética , Epidemiologia Molecular
2.
Ann Dermatol Venereol ; 139(11): 717-22, 2012 Nov.
Artigo em Francês | MEDLINE | ID: mdl-23199767

RESUMO

BACKGROUND: Outbreaks of dermatophytosis have been reported more and more frequently in combat sports such as wrestling and judo. Such outbreaks are difficult to treat due to the involvement of numerous actors and structures. The main aim of our study was to determine whether the use of a standardized treatment in a high-level judo team could successfully reduce the outbreak. Our secondary objectives were to study the topography of lesions and ascertain whether consultations for suspected dermatophytosis were significantly more frequent during the 4 weeks following a judo training course. MATERIALS AND METHODS: We conducted a prospective follow-up study from October 2004 to the end of June 2005 (series 1) and then from September 2006 to June 2011 (series 2) during which all new suspected cases of dermatophytosis in a judoka from Pôle France Orléans were examined at the Orléans Dermatology Department. For each consultation, we prepared a map of lesions and mycological samples, and patients received standardized treatment. RESULTS: We compared the two series and a considerable decrease was noted in dermatophytosis outbreaks after the introduction of these measures. The mean number of visits per training season was 97 for series 1 and 21.6 per training season for series 2. The mean numbers of episodes of cutaneous lesions clinically active per training season were 74 for series 1 and 16.8 for series 2. Lesions were localized mainly on the forearms, face and neck (40% for series 1 and 73% for series 2). "Waves" of visits (at least two visits per week) occurred significantly more frequently (68%) during the 4 weeks following a training period than during the rest of the year. CONCLUSION: Standardized management of this outbreak reduced the number of infectious episodes.


Assuntos
Antifúngicos/administração & dosagem , Dermatite Ocupacional/tratamento farmacológico , Dermatite Ocupacional/epidemiologia , Surtos de Doenças , Artes Marciais , Tinha/tratamento farmacológico , Tinha/epidemiologia , Administração Oral , Administração Tópica , Adolescente , Antifúngicos/efeitos adversos , Dermatite Ocupacional/diagnóstico , Esquema de Medicação , Quimioterapia Combinada , Seguimentos , França , Humanos , Imidazóis/administração & dosagem , Imidazóis/efeitos adversos , Cetoconazol/administração & dosagem , Cetoconazol/efeitos adversos , Masculino , Naftalenos/administração & dosagem , Naftalenos/efeitos adversos , Estudos Prospectivos , Prevenção Secundária , Terbinafina , Tinha/diagnóstico , Tinha/transmissão , Resultado do Tratamento , Adulto Jovem
3.
Pathol Biol (Paris) ; 58(1): 62-6, 2010 Feb.
Artigo em Francês | MEDLINE | ID: mdl-19854585

RESUMO

Regional pneumococcal observatories in region Centre, created in 1997, participate with the others pneumococcal observatories alongside the National Reference Center for Pneumococci and the Institut de Veille Sanitaire at the monitoring of the evolution of resistance of pneumococci to antibiotics in France. Between 1997 and 2007, 2427 strains of Streptococcus pneumoniae were isolated in part from cerebrospinal fluids, blood and middle ear fluid, from children and adults. The prevalence of pneumococci with a decreased susceptibility to penicillin (PDSP) decreased strongly in region Centre: 56.8 % in 2001, 39.6 % en 2007. These data are similar to the French national data over the same period.


Assuntos
Resistência Microbiana a Medicamentos , Infecções Pneumocócicas/microbiologia , Vigilância da População , Streptococcus pneumoniae/efeitos dos fármacos , Adulto , Antibacterianos/uso terapêutico , Líquidos Corporais/microbiologia , Criança , Farmacorresistência Bacteriana Múltipla , Feminino , França/epidemiologia , Humanos , Masculino , Testes de Sensibilidade Microbiana , Infecções Pneumocócicas/tratamento farmacológico , Infecções Pneumocócicas/epidemiologia , Estudos Retrospectivos , Streptococcus pneumoniae/isolamento & purificação
4.
Clin Microbiol Infect ; 24(4): 429.e7-429.e12, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28962997

RESUMO

OBJECTIVES: The usefulness of screening for carriage of extended-spectrum ß-lactamase-producing Enterobacteriaceae (ESBL-E) with active surveillance cultures (ASC) remains equivocal in low-endemicity intensive care units (ICUs). Our primary objective was to appraise the impact of ceasing ASC on the incidence of ICU-acquired ESBL-E infections in an ICU with universal contact precautions (CP). Patient outcomes and carbapenem consumption were also investigated. METHODS: A single-ICU, retrospective, uncontrolled before-and-after study including all patients admitted for ≥3 days during two consecutive 1-year periods with and without ASC. RESULTS: A total of 524 and 545 patients were included during the ASC and the no-ASC periods, respectively. Twenty-eight patients (5.3%) from the ASC period were ESBL-E carriers. An ICU-acquired ESBL-E infection (median duration of risk exposure, 4 (range 2-9) days for both periods) occurred in 1.1% and 1.5% of patients admitted during the ASC and the no-ASC periods (p = 0.64), with no inter-period variation in incidence after adjustment on competing risks of death and ICU discharge (standardized hazard ratio (SHR) 2.32, 95% CI 0.80-6.73, p = 0.12). An admission during the no-ASC period exerted no independent impact on the hazards of ESBL-E infections (adjusted OR 1.16, 95% CI 0.38-3.50, p = 0.79), in-ICU death (SHR 1.22, 95% CI 0.93-1.59, p = 0.15) and extended length of stay (SHR for discharge 0.89, 95% CI 0.79-1.01, p = 0.08). Carbapenem exposure in patients without ESBL-E infection decreased between the ASC and no-ASC periods (75 versus 61 carbapenem-days per 1000 patient-days, p = 0.01). CONCLUSIONS: In a low-endemicity ICU with universal CP, the withdrawal of routine screening for ESBL-E carriage had no significant effect on the incidence of ICU-acquired ESBL-E infections and patient outcomes. Carbapenem consumption decreased in patients without ESBL-E infection.


Assuntos
Enterobacteriáceas Resistentes a Carbapenêmicos/isolamento & purificação , Portador Sadio/microbiologia , Infecção Hospitalar/diagnóstico , Infecções por Enterobacteriaceae/diagnóstico , Controle de Infecções/métodos , Programas de Rastreamento/estatística & dados numéricos , Idoso , Portador Sadio/epidemiologia , Portador Sadio/prevenção & controle , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Infecções por Enterobacteriaceae/epidemiologia , Infecções por Enterobacteriaceae/prevenção & controle , Feminino , Humanos , Incidência , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
5.
Ann Dermatol Venereol ; 133(6-7): 525-9, 2006.
Artigo em Francês | MEDLINE | ID: mdl-16885838

RESUMO

BACKGROUND: High contact sports regularly allow transmission of infectious agents, including fungi such as dermatophytes. The occurrence of dermatophytosis outbreaks among wrestlers has been extensively described since the 90s. The emergence of such outbreaks among judokas was described for the first time in December 2004. We report here an outbreak which occurred in a high level judo team and is, to our knowledge, the largest ever published. PATIENTS AND METHODS: From October 2004 to June 2005, every judokas of the Pôle France Orléans who were suspect of dermatophytosis were addressed to one single dermatologist. Lesions were sampled for fungal culture and their anatomical cartography was extensively raised. Two protocols of treatment were defined. RESULTS: 97 medical appointments occurred over the period, leading to 74 clinically-defined episodes of dermatophytosis, distributed as 51 primo-contaminations and 23 re-contaminations (new episode in an individual who was considered cured). The distribution of the lesions on the body was: forearms > anterior trunk > neck and face > scalp. Among the 74 episodes, 53 could grow Trichophyton tonsurans. Infected athletes received oral and topical antifungal treatments. No adverse effects were noticed. DISCUSSION: This series among judokas is the largest ever published. It allowed the description of the specific clinical and anatomical presentation of tinea corporis gladiatorum, emphasising that contamination takes place through direct skin to skin contacts during practice. T. tonsurans is regularly the responsible fungus in recently published series. Caring for such an outbreak raises specific problems because of the numerous structures involved and of the nature of these structures and of the sportive goals they aim at. CONCLUSION: This outbreak is probably part of a wider one diffusing among high level judo teams. Stopping it requires the cooperation of several distinct actors, among which sports federations as well as sports-related physicians and dermatologists should play a major role.


Assuntos
Dermatomicoses/epidemiologia , Surtos de Doenças , Artes Marciais , Adolescente , Adulto , Antifúngicos/uso terapêutico , Dermatomicoses/tratamento farmacológico , Feminino , França/epidemiologia , Humanos , Masculino
6.
Euro Surveill ; 10(9): 187-90, 2005 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-16280611

RESUMO

An outbreak of 49 cases of tinea corporis gladiatorum due to Trichophyton tonsurans infection occurred in a high level judo team of 131 members in Orleans, central France, between October 2004 and April 2005. The team was divided into 5 groups: cadet-junior boys (n=44), cadet-junior girls (n=33), male university students (n= 15), female university students (n=21), and a group called 'pole technique' made up of high level judokas who have finished academic study (n=18). The outbreak involved 86% of the cadet-junior boys, but only 6 men in the 'pole technique' (33%) and only 5 of the 69 other team members (7%) (cadet-junior girls and university students). We describe the outbreak and the results of a survey that found a known risk factor for the 'pole technique': sharing an electric hair shaver. Personal hygiene practices were found to be very good among the cadet-junior boys. The high attack rate in this group may be linked to the poor shower facilities in the gymnasium where they practiced that led them to have their showers several hours after the end of daily practice.


Assuntos
Surtos de Doenças , Artes Marciais , Tinha/epidemiologia , Adolescente , Adulto , Contaminação de Equipamentos , Face , Feminino , Remoção de Cabelo/efeitos adversos , Remoção de Cabelo/métodos , Humanos , Higiene , Masculino , Equipamentos Esportivos/efeitos adversos , Tinha/etiologia , Tinha/transmissão , Trichophyton/isolamento & purificação
7.
Diabetes Care ; 22(5): 667-73, 1999 May.
Artigo em Inglês | MEDLINE | ID: mdl-10332663

RESUMO

OBJECTIVE: In this study, we evaluated the effects of high-(55%) and low-(40%) carbohydrate diets on insulin requirements in nine type 1 diabetic subjects treated intensively with ultralente as basal insulin and regular insulin as premeal insulin adjusted to the carbohydrate content of meals. RESEARCH DESIGN AND METHODS: Nine subjects were randomized in a crossover design to follow two diets consecutively for a period of 14 days each. A 3-day food diary was completed for each diet with the amount of carbohydrate in the mixed meals ranging from 21 to 188 g. Preprandial (5.9 vs. 6.1 mmol/l) and postprandial (8 vs. 8.9 mmol/l) capillary glucose and fructosamine (310 vs. 316 mumol/l) were comparable on both the low- and high-carbohydrate diets. RESULTS: The assessment of meal carbohydrate content by the patients was excellent, with > 85% of cases falling within 15% of computer-assisted evaluation. When premeal regular insulin was prescribed in U/10 g of carbohydrate, the postprandial glycemic rise remained constant (2.4 +/- 2.8 mmol/l) over a wide range of carbohydrate ingested (21-188 g) and was not affected by the glycemic index, fiber, and caloric and lipidic content of the meals. This tight control was maintained during the low- and high-carbohydrate diet without any change in insulin requirements (breakfast, 1.5 vs. 1.5 U/10 g of carbohydrate; lunch, 1.0 vs. 1.0; supper, 1.1 vs. 1.2) and in basal ultralente insulin requirements (22.5 vs. 21.4 U/day). CONCLUSIONS: These results indicate that in type 1 diabetic subjects 1) increasing the amount of carbohydrate intake does not influence glycemic control if premeal regular insulin is adjusted to the carbohydrate content of the meals; 2) algorithms based on U/10 g of carbohydrate are effective and safe, whatever the amount of carbohydrate in the meal; 3) the glycemic index, fiber, and lipidic and caloric content of the meals do not affect premeal regular insulin requirements; 4) wide variations in carbohydrate intake do not modify basal (ultralente) insulin requirements; and, finally 5) the ultralente-regular insulin regimen allows dissection between basal and prandial insulin requirements, so that each can be adjusted accurately and independently.


Assuntos
Glicemia/metabolismo , Diabetes Mellitus Tipo 1/tratamento farmacológico , Carboidratos da Dieta , Hipoglicemiantes/uso terapêutico , Insulina de Ação Prolongada/uso terapêutico , Insulina/uso terapêutico , Adulto , Estudos Cross-Over , Diabetes Mellitus Tipo 1/sangue , Quimioterapia Combinada , Ingestão de Alimentos , Ingestão de Energia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Prandial , Análise de Regressão
8.
Res Microbiol ; 143(2): 211-6, 1992 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-1410796

RESUMO

We describe a medium, novobiocin, brilliant green, glycerol, lactose (NBGL) agar, for the routine isolation of Salmonella strains from stool samples. The NBGL agar principle involved the use of the antisaprophytic effect of brilliant green and novobiocin. Glycerol and lactose were added in order to distinguish between Citrobacter and Salmonella. NBGL was used in parallel with salmonella-shigella (SS) and Hektoen (H) agar for culturing 2,853 stool samples, of which 184 were confirmed to be salmonellae. NBGL showed a high sensitivity: 94% in direct plating compared to 74% (p < 10(-3)) and 65% (p < 10(-5)) for H and SS, respectively, and 96% in enrichment broth plating vs. 83% (p < 10(-4)) and 86% (p < 10(-3)), respectively, for H and SS. In direct plating using NBGL, 95% of black-centred colonies were confirmed to be salmonellae (vs. 31% and 36%, H and SS). In enrichment plating using NBGL, this figure was 82% (vs. 26% and 28%). The results suggest that NBGL agar is advantageous for the isolation of non-Typhi H2S+ salmonellae.


Assuntos
Glicerol , Lactose , Novobiocina , Compostos de Amônio Quaternário , Salmonella/crescimento & desenvolvimento , Anti-Infecciosos Locais , Contagem de Colônia Microbiana , Meios de Cultura , Fezes/microbiologia , Humanos , Técnicas In Vitro , Salmonella/isolamento & purificação , Infecções por Salmonella/diagnóstico , Infecções por Salmonella/microbiologia
9.
Res Microbiol ; 142(9): 1019-27, 1991.
Artigo em Inglês | MEDLINE | ID: mdl-1805304

RESUMO

Fourteen neonates intubated at birth for 1-16 days had a microbiological follow up. After removal, tubes were examined using electron microscopy. Tubes became covered with a slimy accretion from the third day in place, independently of bacterial colonization, which was, in all but one cases, restricted to the rough areas of the tubes. Only Candida albicans and the corresponding slimy coat were found on smooth areas of tube. Cocci were noticed on 3 tubes. They were associated with the slimy accretion. Transmission micrographs elicited a thick material that was lying between cocci and polymer. These results showed that, on neonates' endotracheal tubes, accretion occurred independently of microbial colonization and that when colonization occurred, cocci adhered preferentially to a biological coat of human origin rather than the medical devices.


Assuntos
Aderência Bacteriana/fisiologia , Candidíase/etiologia , Intubação Intratraqueal/efeitos adversos , Infecções Estafilocócicas/etiologia , Infecções Estreptocócicas/etiologia , Humanos , Técnicas In Vitro , Recém-Nascido , Microscopia Eletrônica , Infecções Estafilocócicas/microbiologia , Staphylococcus epidermidis/isolamento & purificação , Infecções Estreptocócicas/microbiologia , Streptococcus agalactiae/isolamento & purificação
10.
Psychopharmacology (Berl) ; 156(4): 417-26, 2001 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-11498719

RESUMO

RATIONALE: The role of melatonin (MLT) in mediating the sleep-wake cycle has been previously suspected of indicating that this substance could be a candidate for a new generation of hypnotics. OBJECTIVES: We investigated whether MLT acted as a sleep promoter or a modulator of sleep temporal timing related to cardiovascular and body temperature (Tb) adaptations to sleep induction. The pharmacological effects of MLT on sleep were compared with zolpidem (ZP) and diazepam (DZ). METHODS: The radiotelemetry system was used to record the electrocorticogram [slow wave sleep (SWS), paradoxical sleep (PS)], Tb, blood pressure and heart rate in six Wistar rats. DZ (3 mg/kg and 6 mg/kg), ZP (1, 3, 5 and 10 mg/kg) and MLT (2.5 and 5 mg/kg) were delivered intraperitoneally during light (L) and dark (D) periods. RESULTS: MLT increased the number of sleep cycles (L: 30%, D: 110%) and total duration (P<0.05) of PS (L: 70%, D: 150%). In return, ZP (10 mg/kg) presented no effect during L but increased total (40%) and mean duration (37%) of SWS during the D period. DZ modified mean duration of SWS (L: -27%, D: +26%) and increased total duration of SWS (+47%). ZP and DZ induced a more pronounced decrease in Tb than MLT but only DZ induced tachycardia and hypertension. CONCLUSIONS: We showed that MLT could not promote sleep and its cardiovascular adaptations despite hypothermia, but modulated the period of ultradian sleep cycles. DZ and ZP promoted sleep and induced hypothermia during the D period. Only DZ disrupted sleep architecture and induced adverse effects on cardiovascular parameters.


Assuntos
Antioxidantes/farmacologia , Pressão Sanguínea/efeitos dos fármacos , Temperatura Corporal/efeitos dos fármacos , Frequência Cardíaca/efeitos dos fármacos , Hipnóticos e Sedativos/farmacologia , Melatonina/farmacologia , Fases do Sono/efeitos dos fármacos , Animais , Pressão Sanguínea/fisiologia , Temperatura Corporal/fisiologia , Diazepam/farmacologia , Frequência Cardíaca/fisiologia , Masculino , Piridinas/farmacologia , Ratos , Ratos Wistar , Fases do Sono/fisiologia , Telemetria/métodos , Zolpidem
11.
J Clin Pathol ; 57(6): 665-6, 2004 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-15166280

RESUMO

Rhombencephalitis is not a rare presentation of listerial central nervous system infections in healthy adults. This report describes a case with several management difficulties linked to antibiotic related adverse events, pointing to alternative solutions to aminopenicillins. In addition, the role of dexamethasone in the management of inflammation and neurological symptoms is discussed.


Assuntos
Amoxicilina/efeitos adversos , Antibacterianos/uso terapêutico , Hipersensibilidade a Drogas/etiologia , Encefalite/tratamento farmacológico , Listeriose/tratamento farmacológico , Adulto , Dexametasona/uso terapêutico , Quimioterapia Combinada , Humanos , Masculino , Rombencéfalo/microbiologia
12.
Intensive Care Med ; 18(8): 464-8, 1992.
Artigo em Inglês | MEDLINE | ID: mdl-1289370

RESUMO

OBJECTIVE: The purpose of the study was do describe the architecture of accretions occurring on the tips of central venous catheters (CVC). DESIGN: A conservative procedure was used followed by two different techniques of electron microscopy. SETTING AND PATIENTS: the study included 19 catheters which have been used on intensive cared adults, and which were chosen among those of parallel 300 CVC study. MEASUREMENTS AND RESULTS: CVC were considered sterile, contaminated, colonized or infected according to microbiological and clinical criteria. CVC were found to remain much cleaner than in past descriptions. When present, accretions were located on the olive-shaped end, and displayed stratified structures with three types of material: amorphous material, thrombus components and inflammatory cells. Bacteria were not seen, even on culture positive CVC. Candida albicans was found on one CVC in the cytoplasm of granulocytes, and made no direct contact with the plastic surface. CONCLUSION: This technique should contribute to the understanding of the pathobiology of CVC infection and provide information proving or precluding the involvement of microbial adherence to polymers in vivo.


Assuntos
Cateterismo Venoso Central/efeitos adversos , Cateteres de Demora/normas , Infecção Hospitalar/epidemiologia , Contaminação de Equipamentos/estatística & dados numéricos , Microscopia Eletrônica de Transmissão e Varredura , Microscopia Eletrônica de Varredura , Antibacterianos/administração & dosagem , Aderência Bacteriana , Candida albicans/crescimento & desenvolvimento , Candida albicans/ultraestrutura , Cateteres de Demora/classificação , Contagem de Colônia Microbiana , Infecção Hospitalar/etiologia , Infecção Hospitalar/microbiologia , Desenho de Equipamento/normas , Estudos de Avaliação como Assunto , Fibrina/ultraestrutura , França/epidemiologia , Humanos , Infusões Intravenosas , Unidades de Terapia Intensiva , Fatores de Tempo
13.
Leuk Lymphoma ; 35(5-6): 555-65, 1999 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-10609793

RESUMO

Between March 1992 and August 1993, thirty patients with hairy cell leukemia (HCL) were treated in a single institution with 2-chlorodeoxyadenosine (2-CdA) for one course (N=27) or two courses at six month interval (N=3). Sixteen patients were previously untreated, 14 had been treated with alpha interferon (alpha IFN) (N=5), alpha IFN and splenectomy (N=8) and splenectomy, alpha IFN and Deoxycoformycin (N=1). Overall results in 29 evaluable patients were: 25 CR (86%), 3 PR (10%), one failure. The three PR patients relapsed after 18, 24 months and five years. Two were retreated successfully. Two CR patients relapsed after five years. Careful clinical survey, sequential bone marrow biopsies (BMB) with DBA44 immunostaining for assessment of response and detection of residual disease and serially evaluation of lymphocyte subsets counts were performed. Results of bone marrow biopsies study show 1) a progressive reduction in hairy cell infiltration during the first six months after therapy and not after that indicating that the best moment for the evaluation of response may be the sixth month, 2) the persistence of a very small number of DBA44+ cells (80% of BMB). There was a correlation between the presence of > 5% DBA44 positive cells on 6th month BMB and relapse. 60% had an absolute CD4+ lymphocyte count less than 0.2 10(9)/l at least on one examination after treatment. CD4+ lymphocyte level persisted less than baseline level in 8/18 patients tested after four and/or five years. Lymphopenia was less marked in splenectomized patients: 7/7 splenectomized patients tested have recovered a CD4+ lymphocyte count equal to pretherapy level compared to 3/11 non splenectomized patients (p: 0.004). Three opportunistic infections were observed early (first 6 months) after 2CdA therapy: pneumocystis pneumonia, retinitis due to toxoplasma in the patient who failed and legionella pneumonia in a patient retreated after relapse. Two patients developed a second carcinoma 6 and 12 months after therapy. Five patients died, three from a cause unrelated to HCL, one from HCL and one from infection while in second CR. At five years, overall survival is 83% and progression free survival is 66%. Our study shows 1) long-lasting response in the majority of patients after 2-CdA, 2) a correlation between persistent minimal residual disease detected with DBA44 immunostaining and occurrence of relapse and 3) a profound and persistent CD4+ lymphopenia more marked in non splenectomized patients.


Assuntos
Antimetabólitos Antineoplásicos/uso terapêutico , Cladribina/uso terapêutico , Leucemia de Células Pilosas/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Medula Óssea/patologia , Contagem de Linfócito CD4 , Terapia Combinada , Progressão da Doença , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Infecções/epidemiologia , Infecções/etiologia , Interferon-alfa/uso terapêutico , Leucemia de Células Pilosas/mortalidade , Leucemia de Células Pilosas/patologia , Leucemia de Células Pilosas/cirurgia , Leucemia de Células Pilosas/terapia , Masculino , Pessoa de Meia-Idade , Neoplasia Residual , Segunda Neoplasia Primária/epidemiologia , Infecções Oportunistas/epidemiologia , Infecções Oportunistas/etiologia , Pentostatina/uso terapêutico , Indução de Remissão , Esplenectomia , Taxa de Sobrevida
14.
Neurosci Lett ; 250(1): 57-60, 1998 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-9696065

RESUMO

No experimental studies looked at the disturbances appearing after a neonatal focal cerebral hypoxia-ischemia (HI) when animals become adults. Using radiotelemetry, we examined the effects of neonatal focal cerebral HI on blood pressure (BP), heart rate (HR), locomotor activity (LA), body temperature (BT) levels and circadian rhythm parameters of unrestrained adult Wistar rats. At 15 weeks of age, we continuously recorded the cardiovascular and neurobehavioral parameters of HI (n = 6) and sham-operated (n = 6) rats. In adult rats, HI induced persistent hypertensive effects associated with alteration in BP circadian rhythms and pronounced decreases in mesor and percent rhythm of LA. HR and BT parameters were not significantly modified. Therefore, our results suggest that the rat cardiovascular and behavioural circadian control systems may involve several structures which present selective vulnerability to early cerebral HI.


Assuntos
Isquemia Encefálica/fisiopatologia , Sistema Cardiovascular/fisiopatologia , Sistema Nervoso/fisiopatologia , Ratos Wistar/crescimento & desenvolvimento , Animais , Animais Recém-Nascidos , Pressão Sanguínea/fisiologia , Ritmo Circadiano/fisiologia , Frequência Cardíaca/fisiologia , Masculino , Atividade Motora/fisiologia , Ratos , Ratos Wistar/lesões , Temperatura
15.
J Pharm Pharmacol ; 49(1): 40-2, 1997 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-9120768

RESUMO

The effect of tamoxifen on the pharmacokinetics of theophylline was investigated in male Sprague-Dawley rats. The oral administration of tamoxifen at a dose equal to 40 mg kg-1 48 h before the intravenous injection of theophylline 10 mg kg-1, significantly (P < 0.05) increased the clearance of theophylline by 39%, with no apparent effect on the volume of distribution. As a consequence, the elimination half-life of theophylline was significantly (P < 0.05) shortened in the tamoxifen-treated rats (3.56 +/- 0.39 h vs 5.25 +/- 0.48 h) as well as its mean residence time (5.04 +/- 0.60 h vs 7.50 +/- 0.75 h). Although these data cannot be directly extrapolated to the clinical situation, they provide experimental support to suggest that more attention should be paid to the potential risk of pharmacokinetic interactions in the presence of tamoxifen.


Assuntos
Broncodilatadores/farmacocinética , Antagonistas de Estrogênios/farmacologia , Tamoxifeno/farmacologia , Teofilina/farmacocinética , Animais , Interações Medicamentosas , Masculino , Ratos , Ratos Sprague-Dawley
16.
Presse Med ; 21(32): 1513-5, 1992 Oct 03.
Artigo em Francês | MEDLINE | ID: mdl-1465373

RESUMO

The results of annual parasitological coprology in 56 members of the kitchen staff of a hospital over a 6-year period have been studied. Among these subjects, 27 had at least one positive examination. The results were compared with those from other hospitals. Among the parasites found were 2 Strongyloides stercoralis, 4 Schistosoma mansoni and 31 protozoa with direct transmission. The value of this examination is discussed, taking into account the increasing number of immunodepressed patients.


Assuntos
Fezes/parasitologia , Serviço Hospitalar de Nutrição , Doenças Parasitárias/prevenção & controle , Recursos Humanos em Hospital , França/epidemiologia , Mãos/parasitologia , Humanos , Doenças Parasitárias/epidemiologia , Doenças Parasitárias/transmissão
17.
Presse Med ; 19(3): 111-5, 1990 Jan 27.
Artigo em Francês | MEDLINE | ID: mdl-2137586

RESUMO

Twenty men and 23 women aged from 18 to 65 years, who had been under maintenance haemodialysis for 2 to 16 years and whose haematocrit had been below 30 percent for at least 3 months received recombinant human erythropoietin intravenously at the end of each session for one year. Anaemia was corrected in all patients, the delay in response to each dosage variation being about 4 weeks. The necessary maintenance dosage ranged from 96 to 240 u/kg/week. The number of leucocytes increased significantly until the 4th month, from 5880 +/- 1760 to 6600 +/- 1920 per cubic mm (P less than 0.01). During treatment, pre-dialysis blood creatinine concentrations and potassium and phosphate levels rose, while blood calcium levels fell significantly from 2.45 +/- 0.16 to 2.36 +/- 0.19 mmol/l (P less than 0.01). A nonsignificant increase in systolic and diastolic pressures was also observed, from 129 +/- 16 to 134 +/- 18 mmHg (P = 0.06) and from 75 +/- 9 to 78 +/- 10 mmHg (P = 0.07) respectively. Eight patients (18 percent) required antihypertensive drugs or a higher dose of those previously prescribed. There were 7 cases of vascular thrombosis on pre-existing stenosis, and the dosage of heparin during dialysis had to be increased in most patients. This study confirms that erythropoietin plays a major role in the genesis of the anaemia associated with renal failure. The absence of severe complications in this series was probably due to the criteria of inclusion in the study.


Assuntos
Anemia/tratamento farmacológico , Eritropoetina/uso terapêutico , Falência Renal Crônica/terapia , Diálise Renal/métodos , Adolescente , Adulto , Idoso , Anemia/complicações , Esquema de Medicação , Eritropoetina/administração & dosagem , Eritropoetina/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Uremia/etiologia , Uremia/terapia
18.
Ann Dermatol Venereol ; 129(10 Pt 1): 1156-8, 2002 Oct.
Artigo em Francês | MEDLINE | ID: mdl-12442129

RESUMO

INTRODUCTION: Infection with Streptobacillus moniliformis is an uncommon illness which can lead to death if untreated. We report the case in which initially cutaneous signs permitted diagnosis and further identification of the organism. CASE REPORT: A 42 year-old woman presented with a three-day history of acrally distributed purpuric macules on her fingers. Two days later, she was admitted for arthritis of the knees and wrists. There were two large pustules on the left elbow and the right knee. Laboratory studies showed inflammatory changes. The diagnosis of streptobacillary rat-bite fever was made after isolation of Gram-negative bacilli from a blood-culture and from cutaneous lesions. Finally identification of the organism was made by molecular biology analysis. The patient received intravenous ofloxacin and imipenem with complete resolution of arthritis and the cutaneous lesions. DISCUSSION: Streptobacillary rat-bite fever is a systemic infectious disease. It is caused by Streptobacillus moniliformis, organism found in the oropharyngeal flora of small rodents, especially rats. The illness is uncommon in urban settings. It starts by fever, followed by arthritis and rash. Septicaemical rat-bite fever may start only with cutaneous involvement such as acral purpura, like in our case. This clinical manifestation must be recognized by the dermatologist, because the illness can lead to death if untreated.


Assuntos
Antibacterianos/uso terapêutico , Artrite Infecciosa/etiologia , Púrpura/etiologia , Febre por Mordedura de Rato/complicações , Febre por Mordedura de Rato/tratamento farmacológico , Sepse/etiologia , Streptobacillus/patogenicidade , Adulto , Anti-Infecciosos/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Diagnóstico Diferencial , Feminino , Dedos/patologia , Humanos , Imipenem/uso terapêutico , Ofloxacino/uso terapêutico , Febre por Mordedura de Rato/diagnóstico , Sepse/tratamento farmacológico , Streptobacillus/isolamento & purificação , Resultado do Tratamento
20.
Ann Pharm Fr ; 53(5): 215-9, 1995.
Artigo em Francês | MEDLINE | ID: mdl-7503510

RESUMO

The pharmacological study of 3-(4-chlorophenylsulfonyl) 4-hydroxy-7-methoxy- coumarine and 3-(4-methylphenylsulfonyl) 4-hydroxy-7-methoxy-coumarine shows that these derivatives present low sedative effects on the central nervous system, particularly due to their actions upon temperature and motility, more accentuated for the chloro-substituted derivative.


Assuntos
4-Hidroxicumarinas/farmacologia , Vitamina K/antagonistas & inibidores , Vitamina K/farmacologia , Animais , Comportamento Animal/efeitos dos fármacos , Cumarínicos/farmacologia , Interações Medicamentosas , Masculino , Camundongos , Camundongos Endogâmicos , Psicofarmacologia , Psicotrópicos/farmacologia
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