Low-dose splenic irradiation in the treatment of immune thrombocytopenia in HIV-infected patients.

PURPOSE: To determine the effect of low-dose splenic irradiation on severe Zidovudine-resistant, HIV-1-associated thrombocytopenia (HAT). METHODS AND MATERIALS: Between September 1994 and October 1996, 17 patients were included in a prospective study. The patients met the following criteria for inclusion: hemorrhagic symptoms or a platelet count below or equal to 50 x 10(9)/l and normal numbers of megakaryocytes on bone aspiration. The mean baseline platelet count was 20.3 (+/- 14.4) x 10(9)/l; four patients had a platelet count inferior to 10 x 10(9)/l. Splenic volume was defined by ultrasonography. A total dose of 9 Gy was given using an isocentric parallel pair field technique. RESULTS: One month after the end of treatment six patients had a significant rise in their platelet count. Clinically, hemorrhagic symptoms stopped for all patients that were symptomatic. Unfortunately, duration of response was short because for one patient only the platelet count remains stable with a follow-up of 6 months. All patients are alive and in recent evaluation, with four out of eight patients receiving a combination of antiretroviral therapy had a platelet count above 50 x 10(9)/l. CONCLUSION: Our results are disappointing concerning the duration of response, especially comparatively to those reported in autoimmune thrombocytopenia. Mechanisms of HAT are more complex, and megakaryocytes' infection may play an important role. Splenic irradiation should be considered as palliative treatment for the minority of patients with severe bleeding that does not respond to standard medical treatment.

A 3-week hepatitis B vaccination schedule provides rapid and persistent protective immunity: a multicenter, randomized trial comparing accelerated and classic vaccination schedules.

Hepatitis B (HB) vaccinations given once weekly for 3 weeks can provide early seroprotection. This study compared immune responses induced by the accelerated (A; days 0, 10, 21) and classic (C; days 0, 28, 56) HB vaccination schedules. Two hundred seventy healthy subjects (95 men, 175 women) with a mean age of 23.8 years received 3 doses of GenHevac B, a recombinant vaccine produced in mammalian cells. The subjects were randomly assigned to schedules A or C. A booster dose was given 1 year later. One month after the third dose, 70% (schedule A) and 92% (schedule C) of the subjects were seroprotected and 100% (A) and 99% (C) had developed anti-pre-S2 antibodies. Before booster injections, 93% (A) and 95% (C) of the subjects were seroprotected, and 1 month after the booster, almost all subjects were seroprotected. A 3-week HB vaccination schedule with GenHevac B can confer early protective immunity lasting up to 1 year.

Three-week hepatitis B vaccination provides protective immunity.

To determine whether a 3-week hepatitis B (HB) vaccination could achieve protective immunity, 89 healthy non-immunized young adults received three doses of 20 micrograms each of HBs antigen (GenHevac B, Pasteur) and were randomly assigned to schedule A (n = 44): two doses at day 0, one dose at day 21; or schedule B (n = 45): one dose at days 0, 10 and 21. Seroprotection rates (anti-HBs > or = 10 mIU ml-1) for groups A and B respectively were: 23 and 40% at day 21; and 77 and 91% at day 82 (not significant). Anti-HBs geometric mean titres were higher in group B than in group A (p < 0.05) at days 21 (6.4 versus 3.8) and 82 (77.6 versus 33.5). One year after primary vaccination, the seroprotection rate remained as high as 90% in the vaccinees of group B; after boosting all vaccinees had protective levels of anti-HBs antibodies. Thus 3-week HB vaccination with GenHevac B allowed early and durable protective immunity.

[Clinical aspects of salmonellosis]. / Aspects cliniques des salmonelloses.

Salmonellosis includes two groups of diseases: typhoid fever and non-typhic infections. Epidemiological and clinical features are different in each group. Typhoid fever is a major health problem in developing countries. It realizes septicemia and endotoxinic symptoms, and has not to be forgotten when the patient is back from travelling. Non-typhic infections in most cases produce acute feverish diarrhea, conforming with collective food toxi-infection. Non digestive localizations are usually the fact of underlying diseases, and are able to kill the patient.

[Resistance to antibiotic treatment produced in a model of experimental Pseudomonas aeruginosa peritonitis]. / Emergence de résistance au cours de traitements antibiotiques dans un modèle de péritonite expérimentale à Pseudomonas aeruginosa.

A mouse model of experimental Pseudomonas aeruginosa peritonitis was used to evaluate the emergence of resistant mutants during antimicrobial therapy. Mice were infected intraperitoneally with a large inoculum (10(8) CFU + 125 mg talcum) of one of eight strains of Pseudomonas aeruginosa and treated for eight hours with imipenem (IPM) (2 mg/kg/60 min), ciprofloxacin (CIP) (5 mg/kg/45 min), ceftazidime (CAZ) (2 mg/kg/45 min), and amikacin (AN) (2 mg/kg/45 min), alone or in combination. Dosages were selected to achieve and maintain for 8 hours intraperitoneal concentrations similar to those seen in human bronchial secretions. Emergence of resistant strains occurred in 88% of mice after IPM, 29% after CIP, and 31% after CAZ. MICs for resistant strains were increased 8-fold to 512-fold above baseline. Given in combination, IPM and CIP use was followed with lower rates of resistance to each drug (6% and 2% respectively) than use of each antimicrobial alone (p less than 0.001). Combination with amikacin reduced resistance rates for all the antimicrobials studied. No resistant strains occurred with the CIP-CAZ combination. Under the experimental conditions used, the CIP-CAZ combination provided the best results, although the difference with the CIP-IPM combination was not statistically significant.

Comparison of different antibiotic regimens for therapy of 32 cases of Q fever endocarditis.

We studied 32 cases of Q fever endocarditis diagnosed in France between January 1985 and December 1989 to evaluate the efficacies of the different regimens of antibiotics used for treatment. Each patient was monitored during the treatment (range, 12 to 60 months), and clinical and biological information was computerized. Various treatments were prescribed, including doxycycline alone (9 cases) or in association with rifampin (4 cases), quinolones (16 cases), or sulfamethoxazole-trimethoprim (1 case). Two patients died before the beginning of the treatment. Nineteen patients had hemodynamic failure and subsequently underwent valve replacement. Nine valve tissue cultures were positive despite previous antibiotic treatment. In terms of their effects on mortality, the difference between doxycycline alone and doxycycline plus quinolones is statistically significant. We conclude that the addition of quinolones to doxycycline is beneficial. On the basis of clinical, serological, and valve tissue culture results, no treatment was able to cure Q fever endocarditis within 2 years, even with a combination of antibiotics. We advise a minimum duration of treatment of 3 years with therapy combining quinolones and doxycycline.

[Shortened antibiotic therapy of meningococcal meningitis: 5-day administration of ceftriaxone]. / Antibiothérapie raccourcie de méningites à méningocoque: cinq jours de ceftriaxone.

In an open study, twenty cases of meningococcal meningitis have been treated by ceftriaxone for five days. Therapeutic results presented in this study are consistent with findings reported in similar conditions, and agree for shortened treatment of meningococcal meningitis with ceftriaxone.

[Lymphatic and lymph node diffusion of ceftriaxone. Incidence in the treatment of typhoid fever]. / Diffusion lymphatique et ganglionnaire de la ceftriaxone. Incidence dans le traitement des fièvres typhoïdes.

Following intravenous administration of 2 g ceftriaxone, concentrations of the drug were assayed in serum, in thoracic duct lymph from dogs, and in mesenteric lymph nodes in patients. Antibacterial activity of lymph against S. typhi was also studied. Results show that ceftriaxone concentrations in serum and lymph are comparable; with a satisfactory antibacterial activity of both fluids against S. typhi. In mesenteric lymph nodes, mean ceftriaxone concentration was approximately 1000 times the MIC for S. typhi. Our data contribute to explain the successful clinical results achieved with ceftriaxone in patients with typhoid fever.

[Evaluation and perspectives of a new cephalosporin: ceftriaxone]. / Bilan et perspectives d'une nouvelle céphalosporine: la ceftriaxone.

Following a brief review of the main bacteriological and pharmacokinetic properties of ceftriaxone, the authors present a therapeutic evaluation of this new cephalosporin antibiotic. The effects of ceftriaxone in severe infections, such as septicaemia, bacterial meningitis, urinary tract infections, typhoid, bone infections and sexually transmitted diseases, are described on the basis of recent publications. Mention is also made of the adverse reactions to, and benign side-effects of the drug. Finally, the advantages of ceftriaxone in the treatment of some infections are envisaged: the single daily dose and short therapeutic courses may modify therapeutic habits and exert a beneficial effect on costs in some cases.

[Bacterial endocarditis on mitral prolapse revealed by cutaneous and neurological disorders. Usefulness of immunological investigations (author's transl)]. / Endocardite bactérienne sur prolapsus mitral: manifestations cutanées et neurologiques révélatrices.

In a 32-year-old woman with mitral prolapse, bacterial endocarditis was preceded by a long period of neuralgias and skin lesions. Thrombosis of the Sylvian artery heralded the onset of the disease which remained for a long time apyretic and was marked by several cerebral vascular accidents. After failure of antibiotic therapy the mitral valve was replaced by a Starr valve and the patient recovered. In view of the presence of immunological abnormalities in this patient, the mechanisms of the vascular lesions is discussed. Many authors are new giving a large place to "immunoallergic" theories in their attempts to explain the occurrence of non-specific arteritis in bacterial endocarditis.