[Serum and bronchial concentrations of netilmicin during its continuous intratracheal administration]. / Etude des concentrations sériques et bronchiques au cours de l'administration continue de nétilmicine intratrachéale.

Respiratory tract infections in intensive care units have a high fatality rate, perhaps as a result of the poor diffusion into bronchial secretions of aminoglucosides given by a systemic route. Endotracheal administration of aminoglycosides has been advocated but the optimal dosage remains to be determined. To investigate this problem we studied 13 patients free of renal failure and 6 patients with renal failure. Netilmicin was given by continuous endotracheal infusion in a daily dosage of 3 to 30 mg/kg. A good correlation was found between infused doses and serum concentrations; very high bronchial secretion concentrations were consistently found. There is a significant risk of accumulation in patients with renal failure. The characteristics of the respiratory tract secretions had no influence on the passage of netilmicin into the bloodstream. The dosages we advocate on the basis of our results are 8 mg/kg/day in patients free of renal failure and 4 mg/kg/day in patients with renal failure; serum netilmicin concentrations should not exceed 1 microgram/ml.

Factors affecting outcome of sarcoidosis. Influence of race, extrathoracic involvement, and initial radiologic lung lesions.

Chest roentgenograms of 152 patients with type 2/3 disease observed 3 or more years were reviewed using modified ILO/UC nomenclature. After a mean length of observation of 9.3 years, clinical recovery was observed in 71.7% and radiologic recovery in 48.0% of the patients. Age; duration of observation; mediastinal adenopathy; and character (xyz, pgr, stu), size, extent, and profusion of pulmonary densities were similar in the 53 white and 99 black patients, who differed significantly only in sex distribution. White patients achieved clinical recovery (84.9%) more often than black patients (64.7%) (p = .05). Factors influencing clinical recovery were analyzed by means of stepwise logistic linear regression. The initial roentgenographic features were unrelated to outcome; only race and extrathoracic disease proved to have significant predictive value. The probability of clinical recovery is estimated to be .894 in white patients with disease limited to the chest, .697 in white patients with extrathoracic disease, and .760 in black patients without and .454 in black patients with extrathoracic sarcoidosis. Recovery appears to be related not to the severity of the initial pulmonary reaction but to racially associated factors that influence extrathoracic dissemination as well as lung damage.