[Sequential prescriptions: Arguments for a change of therapeutic patterns in treatment resistant depressions]. / Prescriptions séquentielles : arguments en faveur d'une modification des schémas thérapeutiques dans les dépressions résistantes.

Among the therapeutic strategies in treatment of resistant depression, the use of sequential prescriptions is discussed here. A number of observations, initially quite isolated and few controlled studies, some large-scale, have been reported, which showed a definite therapeutic effect of certain requirements in sequential treatment of depression. The Sequenced Treatment Alternatives to Relieve Depression Study (STAR*D) is up to now the largest clinical trial exploring treatment strategies in non psychotic resistant depression in real-life conditions with an algorithm of sequential decision. The main conclusions of this study are the following: after two unsuccessful attempts, the chance of remission decreases considerably. A 12-months follow-up showed that the higher the use of the processing steps were high, the more common the relapses were during this period. The pharmacological differences between psychotropic did not cause clinically significant difference. The positive effect of lithium in combination with antidepressants has been known since the work of De Montigny. Antidepressants allow readjustment of physiological sequence involving different monoaminergic systems together. Studies with tricyclic antidepressant-thyroid hormone T3: in depression, decreased norepinephrine at the synaptic receptors believed to cause hypersensitivity of these receptors. Thyroid hormones modulate the activity of adrenergic receptors. There would be a balance of activity between alpha and beta-adrenergic receptors, depending on the bioavailability of thyroid hormones. ECT may in some cases promote pharmacological response in case of previous resistance, or be effective in preventing relapse. Cognitive therapy and antidepressant medications likely have an effect on different types of depression. We can consider the interest of cognitive therapy in a sequential pattern after effective treatment with an antidepressant effect for treatment of residual symptoms, preventing relapses and recurrences, in antidepressant maintenance. These data support the interest of therapeutic strategies based on evolutionary criteria. Sequential models inspired by statistical methods may incorporate the effects of a future treatment by measuring the current one.

Laser ion source with a double pulse laser system.

To extend an ion beam pulse of a laser ion source, multiple laser shots could be used. To check the feasibility of this idea, we tested double laser irradiations on an iron target. When the interval of the two laser shots is longer than 10 µs, the obtained ion current profile was expressed as a sum of two individual expanded laser plasmas. However, if the interval is too close, a current reduction was observed. This technique can be effectively applied to low charge state ion production.

[Sequence in prescribing neuroleptics: a therapeutic alternative in refractory schizophrenia?]. / Séquence de prescription de neuroleptiques: une alternative thérapeutique dans les schizophrénies résistantes?

Although clozapine (CLZ) is effective in resistant schizophrenia, it fails in some cases leading to a therapeutic problem. Authors report a case of schizophrenia which resists several neuroleptic trials (including haloperidol, chlorpromazine and thioproperazine) and responds to a sequence of CLZ and amisulpride. These two atypical neuroleptics have the same main target (mesolimbic system) but have different and complementary affinities to neuromediator receptors: CLZ has strong serotoninergic and anticholinergic action, noradrenergic alpha 1 affinity and moderately active dopaminergic antagonism; amisulpride has a high and specific dopaminergic D2 antagonism when used at high posology. This clinical improvement can be related to "second treatment effect", described by Goldman in 1966: his study included two groups of refractory schizophrenic patients who received successively during two 6 months periods, 2 neuroleptics (fluphenazine and trifluperazine). Without initial therapeutic response, he noted a significant improvement only after change of neuroleptic medication. Tricyclic antidepressants may turn to be effective, after an initial failure, when they are given after an uneffective ECT trial. The same model may be applied and the clozapine-amisulpride sequence is proposed as an alternative treatment in resistant schizophrenia: even if CLZ is uneffective, it may produce carryover effects which ease the action of amisulpride. The hypothesis of an action on 5HT2-D2 antagonism is advanced. It leads to the general question of the opportunity of neuroleptic sequential prescription in resistant schizophrenia as a therapeutic option.

[Role of electroshock therapy in puerperal mental disorders]. / Place de l'électrochocthérapie dans les troubles psychiatriques de la puerpéralité.

Ten cases of psychotic patients requiring electroconvulsivotherapy (ECT) are reported during pregnancy and puerperium. The interest and the safety of ECT are confirmed. ECT is principally indicated in severe cases and in typical or atypical mood disorders.

[Use of ceftazidime combined with netilmicin in the treatment of febrile episodes occurring after bone marrow transplantation in children]. / Utilisation de la ceftazidime associée à la nétilmicine dans le traitement des épisodes fébriles survenant après des greffes de moelle osseuse chez l'enfant.

Thirteen episodes of fever in bone marrow transplantation recipients (23 months to 11 years old children) were treated by ceftazidime (100-200 mg/kg/j) and netilmicin (7 mg/kg/j). Vancomycin was added at the 24th hour in 10 cases of persistent fever. 6 presumed agents of infection were isolated before antibiotic treatment: blood cultures (streptococci 2, staphylococcus 1, proteus 1), fecal sample (E. coli 1), urine (E. coli 1). Modifications of aerobic fecal flora were studied under this treatment. E. coli, staphylococci and enterococci were the mainly strains isolated. There were no third generation cephalosporins resistant Gram-negative bacteria. High level resistance to aminoglycosides was observed in enterococcal strains, isolated during and after treatment. Ceftazidime-netilmicin (+/- vancomycin) was an effective and safe combination for the management of febrile neutropenic episodes.

[Pharmacokinetics of ceftazidime injected peritoneally in continuous ambulatory peritoneal dialysis]. / Pharmacocinétique de la ceftazidime par voie intrapéritonéale en dialyse péritonéale continue ambulatoire.

Peritonitis is the most frequent complication in patients under continuous ambulatory peritoneal dialysis. Intraperitoneal administration of ceftazidime in a dose of 125 mg per liter dialysate achieved serum concentrations higher than the minimal inhibitory concentrations of most organisms in spite of low peritoneal clearance. Serum concentration was stable up to the 120th hour. Dialysate osmolarity had no influence on serum concentration, peritoneal absorption or clearance of ceftazidime. Peritoneal inflammation did not cause changes in ceftazidime pharmacokinetics. Ceftazidime used alone as the first choice treatment was successful in 85%, of cases.

[Multicenter clinical study and pharmacokinetics of ceftazidime in children and newborn infants]. / Etude clinique multicentrique et pharmacocinétique de la ceftazidime chez l'enfant et le nouveau-né.

The pharmacokinetics and clinical efficacy of ceftazidime, a new cephalosporin with activity against Pseudomonas aeruginosa, were studied in children and neonates. Our studies suggest that ceftazidime should be considered for the treatment of sever infections in pediatric patients (neonatal septicemia and meningitis, urinary tract infections due to multiresistant bacteria) and for the empirical therapy of febrile episodes in immunocompromised children. Ceftazidime appears to be effective and safe, alone or associated with an aminoglycoside, in the treatment of acute exacerbation in cystic fibrosis. The dosage recommended on the basis of our pharmacokinetic studies is 30 to 50 mg/kg intravenously every eight hours for infants and children and 30 mg/kg every 12 hours for neonates. Larger doses should be used in cystic fibrosis patients, immunosuppressed children, meningitis, and bacterial infections due to organisms with high MICs.

[Study of prostaglandin synthesis during anaphylactic shock in guinea pigs]. / Etude de la synthèse de prostaglandines au cours du choc anaphylactique chez le Cobaye

In guinea pigs actively sensitized with ovalbumin and shocked, we have measured blood histamine and histaminase, pulmonary content in cycli AMP and prostaglandins (PG) E1, E2 and F2alpha. In pulmonary efferent blood, both PGE and PGF are increased. In lung tissue, only PGF2alpha, which are bronchoconstructive mediators, are increased. Th increased level in PG seems to have two origins: first a specific increase, then an increased synthesis secondary to histamine release.