[Results of valvular replacement in chronic or paucisymptomatic aortic insufficiency. Apropos of 79 patients].

The aim of this study was to assess the outcome of 79 patients operated for chronic, pure, severe aortic incompetence with little or no symptoms (Grades I or II of the NYHA Classification). The average age of the patients was 42 years (range 14 to 76 years) and the average follow-up period was 59.4 months (range 3 to 190 months).

[Piperacillin in in vitro-in vivo combination].

Launched two years ago, piperacillin is administered either alone or combined with other antibiotics. Broadening the antibacterial spectrum, looking for synergism and preventing the emergence of resistant mutants constitute a major preoccupation, especially in immunodepressed patients, and an indication for combined antibiotic therapy. The most effective combination, justified by in vitro tests, consists of a beta-lactam antibiotic and an aminoglycoside.

Involvement of penicillin-binding protein 2 with other penicillin-binding proteins in lysis of Escherichia coli by some beta-lactam antibiotics alone and in synergistic lytic effect of amdinocillin (mecillinam).

Compared with cefotaxime, ceftazidime, moxalactam, and aztreonam, ceftriaxone produced the best lytic and bactericidal effects when each was added at about 10 times the MIC to Escherichia coli W7. When each of these antibiotics was added at its MIC, only bacteriostasis occurred, but the simultaneous addition of amdinocillin (mecillinam) was synergistic in causing rapid lysis and bactericidal effects. Induction of lysis of two E.

[Percutaneous mitral valvuloplasty in the adult. Apropos of 5 cases].

The results of percutaneous mitral valvuloplasty in 5 adult patients with mitral stenosis are presented. The average age was 55 years (37-72 years); 4 patients were in functional Class III and 1 in Class IV. The three oldest patients were in atrial fibrillation, and 2 of them had severe valvular and subvalvular lesions.

Role of beta-lactamases in the resistance of gram-negative bacilli to beta-lactam antibiotics.

Few studies in animal models or humans have been performed to prove that the mechanism of resistance to beta-lactam antibiotics in the presence of beta-lactamases is similar in vivo and in vitro. In vivo, it seems likely that different parameters will influence each other: the penetration of the antibiotic into the site of infection; the stability of the drug; and the organism responsible for the infection, which affects the type and amount of beta-lactamase released into the environment. In vitro, the different enzymatic parameters responsible for the inactivation of various compounds have been well defined.

[Tissue plasminogen activator (t-PA) in myocardial infarction. Biological aspects].

A group of 37 patients with myocardial infarction less than 6 hours old was given 5,000 IU of heparin and 0.75 mg/kg of tissue plasminogen activator (rt-PA) (Group A, N = 18) or placebo (Group B, N = 19) intravenously over 90 minutes in a double blind study. Blood sampling was performed before, during and after treatment.

Antimicrobial therapy of experimental endocarditis caused by nutritionally variant viridans group streptococci.

Rabbits with nutritionally variant viridans group streptococcal experimental endocarditis were treated three times daily for 3 days with procaine penicillin (1.2 X 10(6) U) alone or together with low-dose streptomycin (2 mg/kg), high-dose streptomycin (8 mg/kg), low-dose gentamicin (0.32 mg/kg), or high-dose gentamicin (1.

[Potential course of lesions of the ascending aorta in dystrophic aortic insufficiency].

Dystrophic aortic insufficiencies represent at present time an important etiology of operated on pure and voluminous aortic regurgitations (n = 95, i.e. 28.

The changing pattern of trimethoprim resistance in Paris, with a review of worldwide experience.

From 1972 to 1984, all Enterobacteriaceae isolated from clinical specimens at St. Joseph Hospital in Paris were tested for susceptibility to trimethoprim. During this period, resistance to trimethoprim increased from 17.

Use of penicillin-binding proteins for the identification of enterococci.

The results of 20 physiological and fermentation tests and examination of the penicillin-binding proteins (PBPs) of 85 enterococcal strains demonstrated that the genus Enterococcus could be divided into at least nine distinct species: E. faecalis, E. faecium, E.

Strategies in aminoglycoside use and impact upon resistance.

Assessment of amikacin resistance over a 10-year period at our institution revealed that the number of resistant strains remained stable. Qualitatively, amikacin-resistant Enterobacteriaceae and Pseudomonas were fairly stable. There was a slight increase in amikacin-resistant Acinetobacter and staphylococci.

[Midpoint follow-up results of aortic valve replacement with the Ionescu-Shiley pericardial bioprosthesis. Apropos of 109 patients].

Between March 1980 and May 1985, 109 adults with an average age of 59 years underwent aortic valve replacement with a pericardial Ionescu-Shiley xenograft. Twenty six of the prostheses were of small size (N 19 and 21). In 20 patients, the operation was associated with another procedure (15 aorto coronary bypass grafts and 5 conservative mitral valve procedures).

Synergism and antagonism in double beta-lactam antibiotic combinations.

Combinations of two beta-lactam antibiotics may be advantageous in certain clinical situations, providing a synergistic activity against specific organisms or a broad spectrum of antibiotic coverage. Depending on the combination and the bacteria, synergism, indifference, or antagonism can be observed. Synergism may occur when two beta-lactam antibiotics, acting on different penicillin-binding proteins, are combined or when a penicillinase-susceptible beta-lactam antibiotic is protected by another beta-lactam antibiotic acting as a beta-lactamase inhibitor in strains producing a penicillinase (chromosomal or plasmidic).

[Ofloxacin (RU 43280): clinical evaluation in urinary and prostatic infections].

Ofloxacin, a new fluoroquinolone, was given to fifty patients (29 females and 21 males) aged 25 to 86 years with urinary tract infection or prostatitis. Urinary tract infections usually chronic and associated with urologic anomalies, included 17 cases of cystitis and 19 cases of pyelonephritis. 14 patients had prostatitis.

[Multicenter study of ofloxacin activity on bacteria isolated from a hospital environment].

Minimal inhibitory concentrations (MICs) of ofloxacin were evaluated by agar dilution for 1508 bacterial strains isolated in five hospitals. For Enterobacteriaceae sensitive to nalidixic acid, MICs ranged from 0.008 to 1 microgram/ml (mode MIC: 0.

Molecular epidemiology of resistance to trimethoprim in enterobacteria isolated in a Parisian hospital.

Between January, 1981 and December, 1984, 419 strains of enterobacteria isolated from patients at the Hôpital Saint-Joseph were studied for (1) the level of resistance to trimethoprim (Tp) by determination of minimal inhibitory concentration (MIC), (2) transferability of this resistance by conjugation into Escherichia coli, (3) plasmid content of wild-type strains and transconjugants by agarose gel electrophoresis of crude bacterial lysates and by incompatibility grouping, and (4) type of dihydrofolate reductase (DHFR) by colony hybridization with probes specific for DHFR types I and II. Tp resistance was defined as MIC greater than or equal to 4 micrograms/ml and high-level resistance by MIC greater than or equal to 1000 micrograms/ml. Amongst the strains studied, 90% were resistant to high levels of Tp, while 10% had low-level resistance to Tp was detected in 180 strains corresponding to 185 plasmids.

Comparative evaluation of a new beta-lactamase inhibitor, YTR 830, combined with different beta-lactam antibiotics against bacteria harboring known beta-lactamases.

YTR 830, a new beta-lactamase inhibitor, combined with amoxicillin or carbenicillin, showed a synergistic effect similar to that observed with clavulanic acid, and generally better than that with sulbactam, against strains harboring chromosome-encoded penicillinases and broad-spectrum beta-lactamases or plasmid-determined beta-lactamases. With ampicillin, YTR 830 showed the best synergistic activity of the inhibitors against Proteus morganii, Citrobacter freundii, and Enterobacter cloacae and their mutants with a derepressed chromosome-encoded cephalosporinase.

Transfer of amikacin resistance by closely related plasmids in members of the family Enterobacteriaceae isolated in Chile.

During a 9-month period when amikacin was the sole aminoglycoside used clinically in a hospital in Santiago, Chile, resistance to amikacin and other antibiotics was encountered in 42 strains of the family Enterobacteriaceae, including Escherichia coli, Klebsiella pneumoniae, Citrobacter freundii, Enterobacter cloacae, Serratia marcescens, and Serratia liquefaciens. Amikacin resistance was transferable by conjugation and carried by IncM plasmids ranging in size from ca. 48.

[Traumatic aorto-right ventricular fistula. Apropos of a case].

The authors report the case of a 19 year old young man with an aorto-right ventricular fistula caused by a stab wound. The diagnosis was not made initially during surgery to control haemorrhage (left hemothorax due to a damaged internal mammary artery). However, three weeks later, a continuous murmur was detected and the diagnosis established by echocardiography and cardiac catheterisation.

[Multicenter study of the activity of pefloxacin on bacteria isolated in a hospital milieu].

Minimal inhibitory concentrations (MICs) of pefloxacin were evaluated by agar dilution for 3422 bacterial strains isolated in nine hospitals. Enterobacteriaceae proved very sensitive to pefloxacin: 62 p. 100 of 1743 strains tested had MIC less than or equal to 0.

The new quinolones and their combinations with other agents for therapy of severe infections.

New quinolones are very potent compounds against Gram-negative bacteria, including Pseudomonas, and staphylococci. They are particularly interesting because of their oral availability and their pharmacokinetic properties. When combined with other common antibiotics they appear to have mostly indifferent effects in vitro.

Plasmid-mediated resistance to multiple antibiotics in Salmonella typhi.

Two hundred forty-one strains of Salmonella typhii isolated in Lima, Peru, from October 1981 through February 1983 were tested for susceptibility to antimicrobial agents. Seventy-two strains (29.9%) were resistant to chloramphenicol and other antibiotics, including ampicillin, sulfonamides, and trimethoprim.