Pefloxacin: evolution of in vitro activity during 18 months of use in an intensive care unit.

The MIC of pefloxacin against all the strains (3122) isolated in an intensive care unit during 18 months was studied. The MIC of pefloxacin was estimated by standard agar diffusion method in Mueller-Hinton agar. All the strains with a MIC lower than 2 mg/l were considered as sensitive, between 2 and 4 mg/l as "intermediary" and over 4 mg/l as resistant.

Role of the polysaccharide and of the lipopolysaccharide in the immunoprotective capacity of Klebsiella pneumoniae ribosomes.

Ribosomes, ribosomal RNA (r-RNA), capsular polysaccharide (PS-K) and lipopolysaccharide (LPS) were isolated and purified from Klebsiella pneumoniae, type I. The protective capacity of these different fractions was investigated in function of their analytical composition. The results show that ribosomes, and in particular, ribosomal RNA have the greatest protective activity at the lowest concentrations.

[Local low-dose thrombolytic treatment with sequential urokinase-plasminogen in deep central venous thrombosis].

Four patients with recent central deep vein thrombosis (pelvis-superior mediastinum) were treated by local low dose infusions of urokinase (500 to 1000 IU/kg/h for 6 to 9 hours) followed by plasminogen (20 to 30 microkatals/h for 2 to 3 hours) associated with simultaneous anticoagulation with heparin. The treatment was continued for 83 to 160 hours until control phlebography showed dissolution of the thrombus. There were no haemorrhagic complications despite the presence of a number of risk factors which contraindicated treatment by a systemic route.

Static pressure-volume curves and effect of positive end-expiratory pressure on gas exchange in adult respiratory distress syndrome.

Fifteen patients with adult respiratory distress syndrome (ARDS) were studied: 11 in the early stage of ARDS (group 1); 4 in the late stage (group 2). The inspiratory and expiratory static pressure-volume (P-V) curves of the respiratory system were compared to the pulmonary shunt (Qsp/Qt) when PEEP was increased; cardiac output was kept constant. In group 1 patients, we found that a concavity on the P-V curves was associated with an abrupt decrease in Qsp/Qt when PEEP was increased; the concavity on the expiratory curve was correlated with the change in Qsp/Qt but not the concavity on the inspiratory curve.

[Comparison of high-frequency jet ventilation and conventional ventilation in the adult respiratory distress syndrome].

Sixteen adult patients with respiratory distress syndrome requiring mechanical respiratory assistance entered this study, the purpose of which was to obtain the same blood gas values under high frequency jet ventilation as under conventional ventilation. When high frequency jet ventilation without spontaneous breathing was compared to continuous positive pressure ventilation, peak airway pressure was the same, but mean airway pressure, positive end-expiratory pressure and pleural pressure were higher and cardiac index lower. When high frequency jet ventilation with spontaneous breathing was compared to intermittent mandatory ventilation, peak airway pressure was lower, mean airway pressure and positive end-expiratory pressure were higher, and pleural pressure and cardiac index were not different.

Simultaneous variations of PaCO2 and PACO2 in assisted ventilation.

Thirty-two patients receiving artificial ventilation of the lungs were studied to determine if variations in PACO2 could be reflected in variation in PaCO2. Eleven patients had chronic obstructive lung disease, eight had suffered acute respiratory failure, and 13 had neurological disturbances but normal lungs. PaCO2 and PACO2 were measured concurrently as ventilatory patterns, haemodynamic state or inspired gas concentrations changed.

[Permanent mechanical ventilation at home via a tracheotomy in chronic respiratory insufficiency].

This study describes our experience from 1960 onwards of 222 patients suffering from terminal chronic respiratory failure; we report our results of domiciliary mechanical ventilation for 11-17 hours per day using tracheotomy. The method was easy to use at home at a reasonable cost and was far less than in a medical environment. The results were excellent both for length of survival and quality of life for all cases where respiratory failure was due to chest wall problems (neurological, muscular or restrictive syndromes due to chest deformity).

[Dibekacin in bronchopulmonary infectious pathology].

Thirty six patients in an intensive care unit with a bacterial bronchopulmonary infection were treated with intraparenteral dibekacin at a dose of 3 mg/kg/day. Mean age of the patients was 55 years and the mean duration of treatment 14 days. Biological material was obtained by fibro-aspiration or pleural tap.

[Dibekacin in the treatment of septicemia].

During an open multicentric trial (17 centers), we have treated 62 septicemia by dibekacin, alone or associated with other antibacterial drugs. Taking into account the degree of severity of these patients, the results are considered satisfactory in 47 patients. 15 failures were noted (including 9 deaths).

[Sensitivity of 1041 strains of bacteria obtained from an intensive care unit with regard to aminoglycosides].

Antibiotic treatment of infections due to opportunistic organisms often involves an aminoglycoside/bêta lactamine combination. In order to help in the selection of the aminoglycoside used, a statistical study was made of 1041 strains of organisms obtained from an intensive care unit to 4 aminoglycosides: gentamicin, amikacin, tobramycin and dibekacin. These included Gram negative bacilli (enterobacteria, pseudomonas, acinetobacter) and staphylococci.

[Prediction of aminoglycoside nephrotoxicity].

Mechanism of aminoglycoside nephrotoxicity is yet unclear. Reduction of 20 p. cent of glomerular filtration initial value is observed in 10 p.

[Prevision of aminoglycoside nephrotoxicity (author's transl)].

Mechanism of aminoglycoside nephrotoxicity is yet unclear. Reduction of 20 p. cent of glomerular filtration initial value is observed in 10 p.