[Subacute infectious endocarditis in the elderly. Retrospective study of 33 cases]. / L'endocardite infectieuse subaiguë du sujet âgé. Etude rétrospective de 33 cas.

The authors reviewed 33 cases of infectious endocarditis in patients over 65 years of age and classified according to Von Reyn's diagnostic criteria. Twenty-four patients had organic valvular disease, 4 had a prosthetic valve, and in 4 cases the diagnosis of the murmur was uncertain. Positive blood cultures were obtained in 79 p. 100 of cases. The commonest infecting organism was the streptococcus (21 out of 26). In 11 patients, it was a Group D streptococcus and a recto-sigmoid colonic tumour was found in 3 cases. A dental portal of entry was suspected in 55 p. 100 of patients and this should guide the choice of prophylactic antibiotic therapy. The initial choice of antibiotic had to be changed in 19 patients, usually because of poor tolerance. Eight patients died and one underwent valve replacement within two months of hospital admission.

A phase I, double-blind, placebo-controlled study of the tolerance and pharmacokinetic behaviour of RP 59500.

The tolerance and pharmacokinetic behaviour of a new injectable streptogramin antibiotic, RP 59500 were evaluated on 26 healthy male volunteers in a double-blind, placebo-controlled, phase I study. The doses used were 1.4, 2.8, 4.6, 7.0, 9.8, 12.6, 16.8, 22.4 and 29.4 mg/kg; each dose was administered as a 1 h infusion to eight subjects, two of them receiving placebo. Blood levels of RP 59500 were measured by both microbiological and HPLC assays. At the end of the infusion, Cmax for RP 59500 ranged from 0.95 +/- 0.22 to 24.20 +/- 8.82 mg/L. The apparent elimination half-life of the compound ranged from 1.27 to 1.53 h. RP 59500 did not significantly affect any of the laboratory or clinical assessments (blood pressure, pulse rate, ECG, peak expiratory flow rate). Reported adverse effects were of mild intensity; the most frequent event was mild pain or burning at the infusion site with doses of 7 mg/kg or higher. These results support further studies of RP 59500 in phase II clinical trials.

[Pharmacokinetic parameters of prednisone and prednisolone in healthy volunteers]. / Paramètres pharmacocinétiques de la prednisone et de la prednisolone chez le volontaire sain.

A cross-over, double-blind, randomized trial with 8 healthy volunteers was undertaken to compare prednisolone and prednisone pharmacokinetics after a single oral dose (1 mg/kg) of prednisone (Cortancyl) and prednisolone sodium metasulfobenzoate (Solupred). Maximum prednisolone concentrations measured after ingestion of prednisone are higher (535 +/- 32 ng/ml) and occur earlier than after taking prednisolone sodium metasulfobenzoate (198 +/- 114 ng/ml) (p less than 0.001). The areas under the curve are significantly larger after prednisone than after prednisolone sodium metasulfobenzoate (p less than 0.02). These findings suggest a decreased systemic availability of prednisolone after prednisolone sodium metasulfobenzoate (Solupred) administration and show, from a strictly pharmacokinetic point of view, that equimolar doses of prednisone and prednisolone sodium metasulfobenzoate are not equivalent therapies.

[Plasma exchange in dermatomyositis and polymyositis. Retrospective study of 38 cases of plasma exchange]. / Echanges plasmatiques au cours des dermatomyosites et polymyosites. Etude rétrospective de 38 séries d'échanges.

In order to evaluate the efficacity of plasma exchanges (PE) in dermatomyositis and polymyositis, the case histories of 38 patients, who had undergone plasma exchanges between 1980 and 1986 in 10 French plasmapheresis centers, were studied. Large volume PE were performed in 34 patients after failure of conventional therapy and were part of the initial regimen for the 4 others. The initial activity of the muscle disease was acute in 27 patients and subacute or chronic in 11 cases. Clinical results were evaluated on a functional scale based on changes in muscle force: 24 patients improved (10 appreciably and 14 moderately) and 14 remained unchanged. PE were well tolerated in 23 patients. But side effects occurred in 15 patients, necessitating treatment withdrawal in 4 cases. PE seem to be more effective when the dermatomyositis is acute and evolutive than when it is chronic and insidious. The encouraging results of this exhaustive retrospective study prompt us to set up a prospective randomized trial.

Pharmacokinetics of prednisone and prednisolone in bullous pemphigoid patients.

The purpose of this prospective study was to attempt to evaluate a possible relationship between corticosteroids pharmacokinetics parameters and clinical efficacy in bullous pemphigoid (BP) patients. Sixteen BP patients took part in the study. Prednisone (Cortancyl, Laboratoire Roussel) was given orally (1 mg/kg/day) in a single morning dose. Eleven blood samples were collected over 24 h for the pharmacokinetic studies on day 1 (first day of treatment) and on day Y (after the clinical evaluation). Efficacy was evaluated as the number of new skin blisters on day 1 and on day X which was either the day of cure, i.e. no blisters (responders), or the day of treatment failure, i.e. persistence of blisters (non-responders). Prednisolone (PO) was assayed using high-performance liquid chromatography (HPLC). Areas under the plasma concentration time curves (AUC) and plasma half-lives were estimated using a model independent approach. In responder patients, PO AUC values were 6,225.5 +/- 575.5 ngh/ml, range 3,933-9,080.5 on day 1 and 5,687 +/- 535 ngh/ml, range 4,513.5-9,828.5 on day Y. There was a significant correlation (0.87) between the number of skin blisters on day 1 and the time required for their resolution. The pharmacokinetics and clinical data suggest that a "therapeutic" AUC value was necessary to achieve clinical efficacy and that the duration of treatment depended on the number of blisters on day 1.(ABSTRACT TRUNCATED AT 250 WORDS)

[Long-term development of eosinophilic fasciitis. Study of 11 cases]. / Evolution à long terme des fasciites avec éosinophilie. Etude de 11 cas.

The long-term outcome of eosinophilic fasciitis (EF) described for the first time by Shulman in 1974 remains unclear. Its exact pathological classification is still contested. We reviewed 11 cases selected exclusively on their initial symptoms being compatible with EF. The outcome of the cutaneous lesions, the investigations of possible visceral involvement were analysed with a follow-up of 1 to 9.5 years (average 4.8 years). Regression of the cutaneous infiltration was complete in 5 cases and partial in 3 cases. No regression was observed in 3 cases. Steroid therapy was given in 10 patients: objective improvement was observed in 5 patients. There was no improvement in the other 5 cases. Ungual capillaroscopy was performed in 9 patients and showed none of the characteristic capillary changes of scleroderma. These results suggest that the prognosis and outcome of EF justify its distinction from systemic scleroderma. The effects of steroid therapy on the cutaneous lesions are very variable.