[Recurrent meningitis revealing a Bing-Neel syndrome]. / Méningite récidivante révélant un syndrome de Bing-Neel.

INTRODUCTION: Bing-Neel syndrome is a rare complication of Waldenström macroglobulinemia, defined by monoclonal lymphoplasmocytic cells in the cerebrospinal fluid or in central nervous system biopsy. CASE REPORT: We report a 47-year-old man, with no prior history, who presented a recurrent aseptic lymphocytic meningitis with central nervous manifestations. The presence of a monoclonal lymphoplasmacytic proliferation in cerebrospinal fluid, blood and bone marrow biopsy results was compatible with a diagnosis of Bing-Neel syndrome. Despite the absence of any specific treatment, there was no recurrence of symptoms at 4-month follow-up, and the MRI lesions remained stable. CONCLUSION: We report a case of Bing-Neel syndrome revealed by a recurrent meningitis. Outcome without treatment was favorable at 4-month follow-up.

[Monotherapy using amoxicillin/clavulanic acid as treatment of first choice in community-acquired lung abscess. Apropos of 57 cases]. / Monothérapie par amoxicilline/acide clavulanique (AM-AC) en traitement de première intention dans les abcès pulmonaires communautaires. A propos de 57 cas.

In a multicentre open prospective trial the effectiveness of AM-CA as first-line treatment of community-acquired lung abscess was evaluated in immunocompetent adult patients. AM-CA was administered intravenously in doses of 4 g/day for at least 7 days, then orally in doses of 2 g/day for at least 14 days. Radio-clinical and laboratory evaluations were made during treatment, and 30 and 60 days after it was discontinued. The results of this trial concerned 57 patients (48 men, 9 women; mean age 52 years). The facilitating factors were those usually found in lung abscess. Twenty-seven patients had previously received an antibiotic treatment which had failed. The clinical picture, built up gradually in 42/37 patients, consisted of infectious syndrome (52 cases), altered general condition (39 cases), purulent expectoration (47 cases), sometimes foetid (10 cases), and thoracic clinical abnormalities (57 cases. X-ray films of the chest showed round abscess images (44 cases) or looked like necrotizing pneumonia (13 cases) with pleural reaction (8 cases). Protecting bacteriological sampling by BFW brushing and transtracheal or transparietal sample collecting was performed in 41 of the 57 patients. The pathogens, isolated in 31 cases, were: S. pneumoniae 5; Streptococcus spp. 12; Staph. aureus 4; H. influenzae 7; Enterobacteriaceae 6; anaerobes 7. These organisms were associated in 8 cases. With the exception of Enterobacter cloacae, all were sensitive to AM-CA in-vitro. The outcome was satisfactory in 52 patients.

[Massive hemoptysis ten days after bronchial extraction of an accidentally inhaled tablet of ferrous sulfate]. / Hémoptysie massive dix jours après extraction bronchique d'un comprimé de sulfate ferreux inhalé accidentellement.

Fatale haemoptysis occurred as a result of circumferential caustic erosion to the right intermediate bronchus caused by a tablet of ferrous sulphate which remained in contact for 4 days. The necrotic process continued, after removal of the foreign body, in the bronchial wall and its vessels. We suggest local bronchial lavage with 1% bicarbonate saline during extraction of the tablet and subsequent follow-up fibroscopies. The discovery of a necrotic ulceration of the bronchus requires strict medico-surgical surveillance in order to rapidly intervene under cover of selective intubation when necessary.

[Amoxicillin as a 1st choice: 275 acute focal pneumopathies treated on an outpatient basis]. / Amoxicilline en première intention: 275 pneumopathies aiguës en foyer traitées en ville.

From December 1986 to January 1988, 100 General Practitioners and Pneumologists working outside hospital included in open unmatched series 275 patients who were diagnosed as having pneumonia at home. The study consisted of 53.2% men with an average age of 49.3 plus or minus 19.3. Their temperature on the first day (J1) was in 72.7% of cases greater than 38.5 degrees Centigrade. The doctors felt that the general state was good in 66.5% of the cases. Cough was present in 83.5% of cases but was dry in one out of every two. The patients received Amoxycillin in a dose of 2 grams per day orally (66.9%), or by injection (33.1%). On the third day (J3) 90% of the patients had a temperature below 38.5 degrees Centigrade. Their general state was improved in 94.6% of cases. The diagnosis of pneumonia at home was confirmed radiologically on 219 of the films available, confirming the good specificity of the clinical diagnosis of pneumonia at home. Ten patients were hospitalised. The apparent treatment of Amoxycillin was given in 247 cases (89.8% of cases). In 28 cases (10.2%) the treatment was changed by the addition or substitution of a Macrolide (15), or another antibiotic (5), and in 80 cases a change of treatment was not specified. 25 of these 28 cases were reviewed on the 14th day (J14) and no failures were observed after the change of treatment. In 247 patients in whom the treatment with Amoxycillin was followed 336 were reviewed on the 15th day and there had been four failures. Three were intolerant to the drug and there was one relapse.(ABSTRACT TRUNCATED AT 250 WORDS)

[Diffusion, in the bronchial mucus, of enoxacin administered by oral route in man]. / Diffusion dans le mucus bronchique de l'énoxacine administrée par voie orale chez l'homme.

The diffusion of Enoxacin into the bronchial mucus was studied in 34 patients admitted because of an acute infectious episode over chronic bronchopathy. They received via the oral route 400 mg of Enoxacin twice daily. The antibiotic concentrations were measured in sputum and serum by microbiological assay and HPLC. The patients were divided into 5 groups according with the timing of sampling: 1, 3, 6, 12 hours after dosing at day 3 (group I, II, III, IV), 3 hours after dosing at day 1, 2 and 3 (group V). Serum concentrations of Enoxacin were low (2.46 mg/l at 3rd hour). Bronchial concentrations exceed blood levels (mean 3.06 mg/l at 3rd hour). The bronchial levels of Enoxacin were above the mean MIC of many respiratory bacterial pathogens.

[Diffusion of an orally administered single dose of ofloxacin into human bronchial mucus]. / Diffusion de l'ofloxacine administrée à une dose unique par voie orale dans le mucus bronchique chez l'homme.

As part of a systematic investigation of the penetration of antibiotics into human bronchial mucus, we assayed ofloxacin concentrations following ingestion of a single dose. 25 patients with acute superinfection of a chronic lower respiratory tract disease were studied. Each patient had single drug therapy with ofloxacin in a daily dosage of 200 mg taken in the morning on an empty stomach. Patients were divided into five groups according to the time interval between ingestion of ofloxacin and collection of samples (bronchial mucus and serum): 1 hour, 3 hours, 6 hours, 12 hours or 24 hours. Duplicate determinations of ofloxacin on individual samples were done using a microbiologic method. Mean serum concentrations were 1.85, 1.64, 1.32, 0.75 and 0.20 mg/l respectively, with a half-life of 6.7 hours; the corresponding concentrations in mucus were 1.83, 1.51, 1.20, 0.66 and 0.19. These results demonstrate ofloxacin's outstanding penetration into bronchial mucus.

[Pefloxacine: diffusion into bronchial mucus]. / Péfloxacine: diffusion dans le mucus bronchique.

Pefloxacin is a new quinolone with significant in vitro antibacterial activity and a broad spectrum. It was included in an extensive study of antibiotic diffusion into bronchial mucus. Pefloxacin was given to 35 patients divided into five groups according to the timing of sputum sampling. Plasma specimens were taken simultaneously. Pefloxacin was measured by microbiological assay. Mean pefloxacin concentrations in bronchial mucus was high, exceeding 5 mg/l. Concentrations on the first and third days were similar. The ratio of mucus concentrations to plasma concentrations was high in each case, around or often above 1. These findings show that diffusion of pefloxacin into bronchial mucus is outstanding.

[Haemophilus influenzae in respiratory pathology in adults]. / Haemophilus influenzae en pathologie respiratoire chez l'adulte.

Fifty patients were diagnosed bronchopulmonary Haemophilus infections, because of the production of a purulent sputum, containing at least 10(8) Haemophilus influenzae per ml. Among them were 36 males (average 52 years old) and 14 females (average 58 years old). There was a high percentage (64%) of smokers (over 30 packs/year) within this population, which also included heavy drinkers. The top incidence occurred in winter and spring. Most cases were related to an acute infection in a chronic bronchitis (26 cases). The other cases included 6 cancers, 6 sequelae of tuberculosis, 4 bronchiectasis, 4 asthma, and only 3 pulmonary consolidations. There usually was a low grade fever (only 8 cases reached or went beyond 38 degrees, while in 29 cases the body temperature kept below 38 degrees). The return to a normal temperature was obtained after 4 to 10 days of ampicillin therapy, with no fatal case within this series. The 50 strains were studied by the microbiology laboratory. The minimum inhibitory concentrations showed an elective response to ampicillin and erythromycin, and a less dramatic response to chloramphenicol and tetracyclin. Some strains were proved resistant (MIC over 4 micrograms per ml) to cefoxitin and cefamandole.

[Haemophilus influenzae in respiratory pathology in adults]. / Haemophilus influenzae en pathologie respiratoire chez l'adulte.

Fifty patients were diagnosed bronchopulmonary Haemophilus infections, because of the production of a purulent sputum, containing at least 10(8) Haemophilus influenzae per ml. Among them were 36 males (average 52 years old) and 14 females (average 58 years old). There was a high percentage (64%) of smokers (over 30 packs/year) within this population, which also included heavy drinkers. The top incidence occurred in winter and spring. Most cases were related to an acute infection in a chronic bronchitis (26 cases). The other cases included 6 cancers, 6 sequelae of tuberculosis, 4 bronchiectasis, 4 asthma, and only 3 pulmonary consolidations. There usually was a low grade fever (only 8 cases reached or went beyond 38 degrees, while in 29 cases the body temperature kept below 38 degrees). The return to a normal temperature was obtained after 4 to 10 days of ampicillin therapy, with no fatal case within this series. The 50 strains were studied by the microbiology laboratory. The minimum inhibitory concentrations showed a peculiar response to ampicillin and erythromycin, and a less dramatic response to chloramphenicol and tetracyclin. Some strains were proved resistant (MIC over 4 micrograms per ml) to cefoxitine and cefamandole.

Penetration of cefotaxime into bronchial secretions.

The penetration into bronchial secretions of cefotaxime, a new, highly active cephalosporin, was studied in 45 patients with respiratory infections. Ten patients received 0.75 g and 25 received 1 g of cefotaxime intramuscularly; 10 patients received a 30-min intravenous infusion of 2 g of cefotaxime. Samples of bronchial secretions were obtained by means of fiber-optic bronchoscopy after a single dose in all patients and after three and seven days of treatment in 30 and 15 patients, respectively. Simultaneous serum samples were collected for determination of the relationship between the levels of drug in bronchial secretions and those in serum. Assays were performed by microbiologic agar diffusion. In 30 cases bacteriologic analysis determined the minimal inhibitory concentrations of cefotaxime for the bacteria isolated from sputum. Mean peaks in bronchial secretions reached 1.5-2.5 microgram/ml (according to the groups) after 3 hr; individual concentrations varied according to the dose, the route of administration, and the duration of the treatment. Ratios between the levels in bronchial secretions and the corresponding levels in serum were approximately 8%-25% after 3 hr, as is usual for other cephalosporins. Cefotaxime reached significant concentrations in bronchial secretions, exceeding the minimal inhibitory concentrations for microorganisms responsible for respiratory infections.

[Penetration of cefotaxime into bronchial secretions]. / Pénétration du céfotaxime dans les sécrétions bronchiques.

The objective of this study was to evaluate the penetration into bronchial secretions, of cefotaxime, a new highly-active cephalosporin. The study was performed in 45 patients with respiratory infections. The doses and the route of administration of the drug were different in 3 groups of patients: 10 patients received 0.750 g and 20 received 1 g intramuscularly; 10 patients received a 30 min IV Infusion of 2 g of cefotaxime. Bronchial samples were taken by means of fiberoptic bronchoscopy, after a single dose in all patients, and, respectively, after 3 and 7 days treatment in 30 and 15 patients. Simultaneous serum samples were collected in order to determine relationship between bronchial and corresponding serum levels. Assays were performed by means of the microbiological agar diffusion technique. In 30 cases bacteriological analysis was performed in order to determine the MICs for cefotaxime of the bacteria isolated in sputum. The results of the study showed a mean bronchial peak reaching about 2 microgram/ml at the 3d h. Individual concentrations were varying according to doses, route of administration and underlying pathology; the ratios between bronchial and corresponding serum levels were about 15 to 23 p. cent as usual for other cephalosporins. This study indicates that cefotaxime realizes significant bronchial amounts superior to MICs of microorganisms responsible for respiratory infections.

[Penetration of mezlocillin into bronchial secretions (author's transl)]. / Diffusion de la mezlocilline dans le mucus bronchique.

The penetration of mezlocillin into bronchial secretions collected by fiberoscopy was determined in 18 hospital patients with acute-on-chronic bronchial infection. Samples of blood and bronchial mucus were collected simultaneously 3 hours after each 12-hourly intramuscular injection of 1 g mezlocillin. Antibiotic concentrations were measured by the microbiological method. Mezlocillin concentrations in bronchial secretions averaged 50 % of concomitant serum concentrations. The rate of penetration of the drug was higher than that observed with ampicillin in similar conditions. The mean bronchial level of 3 micrograms/ml was indicative of a high therapeutic index in relation to the MICs of the pathogens isolated in these patients. It is concluded that intramuscular mezlocillin is indicated for the treatment of acute exacerbations of chronic bronchial infections due to highly sensitive organisms.

[Pharmacokinetic study of antibiotics in human respiratory tract (author's transl)]. / Pharmacocinétique des antibiotiques dans les voies respiratoires.

We report the results of the study of the bronchial concentrations of several antibiotics. The experiment included 280 patients and the concentrations achieved in bronchial secretions were measured for 11 antibiotics. The samples of bronchial secretions were taken in situ by fibroscopy or through the tracheostomy cannula. The results of the study show that the rate of penetration is variable according to the different drugs; even in the same antibiotic family such as beta-lactam antibiotics the rate of penetration is variable. The bronchial levels of aminoglycosides, macrolides and tetracyclines are worthwhile, and are often superior to the MIC of the infecting organisms; the penetration is also dependant of the inflammatory conditions of the bronchi. Otherwise the sampling conditions were the best possible since samples taken by fibroscopy or by tracheostomy are not contaminated by saliva which is a factor of dilutional error. The methodology used in this study is an approach of pharmacokinetics of antibiotics in respiratory tract.

[The treatment of relapsing polychondritis using sulfones. One case (author's transl)]. / Traitement de la polychondrite chronique atrophiante par les sulfones. Une observation.

A case of relapsing polychondritis was successfully treated with a daily dose of 120 mg of diaminodiphenylsulfone. Clinical signs (fever, fatigue, conjunctivitis, chondritis and hoarseness of the voice) rapidly regressed and remain so 8 months later, despite a decrease in the dose. Biological parameters returned to normal (sedimentation rate, plasma perchlorosoluble seromucoids, urinary acid mucopolysaccharides), and histological and ultrastructural lesions of the auricular cartilage disappeared. The pathogenic role of a herpes infection at the beginning of the disease is discussed.

Pharmacokinetic study of beta-lactam antibiotics in bronchial secretions.

The objective of the study was to evaluate the concentrations obtained in serum and bronchial secretions after administration of five beta-lactam antibiotics: cephradin (1 g per os) and cefoxitin (2 g i.v. infusion), amoxycillin (1.0 g per os), bacampicillin (0.4 g and 0.8 g per os) and ampicillin (1.0 g per os). 123 adult patients were included in the study and received a single dose of the tested drug. Serum and mucus samples were collected simultaneously 30 minutes, 1, 2 or 4 hours after administration of the drugs. Mucus samples were taken by fibroscopy but in some patients the samples were collected through a tracheostomy cannula which allowed sampling at different time intervals. The results show that the concentrations of penicillins in bronchial secretions increase progressively between one and four hours after administration of the drugs. Bronchial levels obtained after oral administration of ampicillin are low, not more than 5 to 10% of serum levels. The other antibiotics tested show worthwhile concentrations in bronchial secretions, especially with cephalosporins and bacampicillin which exhibits higher serum and bronchial concentrations than ampicillin.