Combination of caspofungin and an azole or an amphotericin B formulation in invasive fungal infections.

OBJECTIVES: Combination of caspofungin and another anti-fungal agent raise expectation of improved efficacy in severe fungal infections including failures to first line therapy. METHODS: We assessed the efficacy and safety of a combination therapy including caspofungin in 17 immunosuppressed or postoperative patients progressive despite standard anti-fungal therapy. RESULTS: The infections included aspergillosis (6), invasive candidiasis (9), mucormycosis (1) and Scedosporium pneumonia (1). Infections had failed one to four prior lines of treatment. The anti-fungal agent combined to caspofungin was either an amphotericin B formulation or an azole. There were 12 favourable responses (71%) and five failures. The survival rate at 3 months was 47%. Eleven patients died within 2-533 days. The causes of death included the initial fungal infection (4), relapse of the infection after switching to oral monotherapy (2), breakthrough aspergillosis (1), and the underlying condition (4). Clinical and renal tolerance were good. Significant hepatic abnormalities were recorded in eight (50%) of the 16 patients evaluable for biological tolerance. CONCLUSION: Caspofungin combined with an azole or with amphotericin B may be of interest in the treatment of serious fungal infections after failure of conventional therapy. Close monitoring of hepatic function is required. These approach should be evaluated in prospective trials.

Hemodilution is an effective treatment for reperfusion edema after lung transplantation.

A 38-year-old patient underwent left single-lung transplantation for end-stage histiocytosis with secondary pulmonary hypertension and polycythemia. Despite use of an optimal lung graft and a total ischemia limited to 250 minutes, major pulmonary edema developed postoperatively. Hemodilution resulted in a quick recovery of lung function. We speculate that blood hyperviscosity was a major factor of pulmonary edema in this patient.

[Local fibrinolytic treatment in occlusions of the central retinal artery]. / Traitement fibrinolytique local dans les occlusions de l'artère centrale de la rétine.

The effectiveness of thrombolytic agents used in local infusion has been demonstrated in the treatment of acute myocardial infarctions by several randomized trials. Thrombolytic therapy seems also to improve the prognosis of certain acute life-threatening brain stem strokes. Two cases of central retinal artery occlusion were treated with intracarotid urokinase injections. Visual acuity was improved in both cases in less than 24 hours, repermeation of the occluded vessels was observed 48 hours after the beginning of treatment. The limits of this kind of therapy are emphasized: there must be no contra-indication to the fibrinolytic agents, a delay shorter than 6 hours after the beginning of symptoms, a lack of arguments in favour of an embolism, and integrity of the carotid bifurcation. Surveillance in an intensive cares unit during the first days is required.

[Moxalactam in complications of abdominal surgery]. / Moxalactam en chirurgie abdominale compliquée.

The authors have used Moxalactam as single antibiotic therapy in a series of 20 patients with primary or secondary peritonitis in order to test its efficiency on aerobic and anaerobic bacteria. Four early deaths and one late death not directly related to the peritoneal infectious process were recorded. In 95% of cases, the peritoneal infection was controlled by the association of Moxalactam and adequate surgery.

[Haemodynamic investigation in pre-eclampsia or eclampsia. Consequences of therapy (author's transl)]. / Exploration hémodynamique dans la pré-éclampsie et l'éclampsie. Implication thérapeutique.

Haemodynamic function was assessed in twenty patients with severe pre-eclampsia or eclampsia. In front of the earlier well-known data hypercinetic circulatory status was found with vascular resistance almost unchanged. As some investigators found two levels placental blood flow, haemodynamic status may be different in some cases. Consequences on therapy are discussed especially beta-bloquers and potential deleterious effects of anti-hypertensive treatments.

[Comparative study about the analgesic effect of buprenorphine (author's transl)]. / Etude sur l'efficacité analgésique de la buprénorphine.

In that study we compared the analgesic effects of equianalgesic doses of buprenorphine and morphine taken as the narcotic of reference. The experiment has been undertaken in ten adults having severe cancer pain. The results have been analysed by statistical non parametric tests. We found that buprenorphine and morphine have the same pattern of action despite the fact that intramuscular buprenorphine has a clinical duration of approximately 9 hours.