Showing papers by "Hospital General Universitario Gregorio Marañón published in 1995"
TL;DR: Results indicate that the High efficacy of CTX in SBP can be maintained by using doses lower than those habitually recommended, and trough serum levels were significantly lower or more frequently undetectable in group II patients than in group I patients.
172 citations
TL;DR: The first analysis of a randomised multicentre, international phase III study was presented in this paper, where 439 patients with previously untreated advanced colorectal cancer were randomised to Tomudex 3.0 mg/m2 given once every 3 weeks or 5-fluorouracil (5-FU) 425 mg /m2 and leucovorin (LV) 20 mg/ m2 for 5 days (the Mayo regimen), given every 4-5 weeks.
132 citations
TL;DR: In cirrhotic patients, continuous prazosin administration reduces portal pressure and improves liver perfusion and function but favors sodium and water retention, suggesting a potential benefit from this combined therapy.
125 citations
TL;DR: It is suggested that mupirocin and co-trimoxazole plus fusidic acid, both used in conjunction with a chlorhexidine soap bath, are equally effective and safe for the eradication of MRSA from nasal and extranasal MRSA carriers.
Abstract: Mupirocin is a topically applied drug that is very active in the eradication of nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA). However, studies designed to compare mupirocin treatment with other antimicrobial regimens are lacking. We therefore conducted an open, prospective, randomized, controlled trial to compare the efficacy and safety of mupirocin versus those of oral co-trimoxazole plus topical fusidic acid (both regimens with a clorhexidine scrub bath) for the eradication of MRSA from nasal and extranasal carriers of MRSA. The eradication rates with mupirocin and co-trimoxazole plus fusidic acid at 2, 7, 14, 21, 28, and 90 days were 93 and of 93, 100 and 100, 97 and 94, 100 and 92, 96 and 95, and 78 and 71%, respectively, for nasal carriage. At 7, 14, and 28 days the eradication rates for extranasal carriage by the two regimens were 23 and 74, 83 and 76, and 45 and 69%, respectively. The efficacies and safety of both regimens were similar. The MRSA isolates were not resistant to the study drugs either at the baseline or at follow-up. These results suggest that mupirocin and co-trimoxazole plus fusidic acid, both used in conjunction with a chlorhexidine soap bath, are equally effective and safe for the eradication of MRSA from nasal and extranasal MRSA carriers. Mupirocin was easier to use but was more expensive.
115 citations
TL;DR: After a first AMI, elderly women experience a more complicated hospital course than men, and the increase in mortality risk seems to be related to the impact of cardiovascular risk factors on left ventricular function more than to sex itself.
Abstract: Background Sex seems to affect the course of acute myocardial infarction (AMI) in the general population. Although the epidemiological importance of female sex among patients with AMI is more important from the sixth decade of life, little is known about the impact of sex on the outcome of AMI in the elderly.
Methods and Results To determine the differences between sexes in the outcome of AMI in the elderly, we compared the clinical history and evolution of 204 consecutive patients (99 men, 105 women) ≥75 years of age admitted with a first AMI. Women had a higher prevalence ( P <.01) of hypertension (60% versus 32%) and diabetes (41% versus 18%), whereas men were more frequently smokers (41% versus 4%, P <.0001); these factors were associated with higher rates of congestive heart failure. Women showed lower ejection fractions and higher rates of congestive heart failure (odds ratio [OR], 2.32; 95% CI, 1.32 to 4.12) and shock (OR, 2.78; 95% CI, 1.29 to 6.40). Mortality rate was higher in women (40% versus 23%, P =.01; OR, 2.29; 95% CI, 1.26 to 4.26); however, sex was excluded as an independent predictor of in-hospital mortality in every regression model tested (OR, 0.75; 95% CI, 0.25 to 2.21).
Conclusions After a first AMI, elderly women experience a more complicated hospital course than men. The increase in mortality risk seems to be related to the impact of cardiovascular risk factors on left ventricular function more than to sex itself.
100 citations
Journal Article•
TL;DR: CNS TB represents a disease that complicates AIDS with an increasing incidence in endemic areas as well as in developed countries in those patients who have some risk factors such as intravenous drug abuse.
55 citations
TL;DR: A review of the twenty-six published cases adding one of their own is presented, finding that a squamous cell carcinoma located in the hidradenitis-affected area is a rare complication.
Abstract: Hidradenitis suppurativa or Verneuil's disease is usually a chronic, recurrent, suppurative and cicatricial disorder. It most often affects the skin of the axillae, groins and perineum, and less commonly the buttocks and upper thighs. A squamous cell carcinoma located in the hidradenitis-affected area is a rare complication. We present a review of the twenty-six published cases adding one of our own.
50 citations
TL;DR: It is suggested that TIPS worsens the hyperdynamic syndrome associated to portal hypertension and in patients with cardiac insufficiency, this procedure should be evaluated.
Abstract: The purpose of this study was to evaluate the short-term splanchnic and systemic hemodynamics and hepatic function after TIPS creation. Fifteen cirrhotics with portal hypertension underwent TIPS placement for treatment of variceal hemorrhage, and extensive hemodynamic studies including right heart catheterization, portal pressure measurement, hepatic blood flow, and indocyanine green (ICG) clearance were performed before and 1 month after the procedure. Self-expandable metal stents (Strecker 11 mm diameter) were placed in all cases. Portasystemic gradient significantly diminished (18.3±4.2 vs 8±2.8; 54%±18 mm Hg) after the technique, mainly due to a decrease in portal pressure, and remained stable in the final study. Cardiac output and mean arterial pressure increased (6.2±1.4 vs 8.2±1.8 liters/min, 80.1±10.1 vs 91±11.2 mm Hg, respectively), and a decrease in systemic vascular resistance was registered (1018±211 vs 872±168 dyne/sec/cm5); the hepatic blood flow and ICG clearance also decreased significantly (1.5±0.7 vs 0.68±0.2 liters/min, 0.4±0.2 vs 0.24 ±0.06 liters/min, respectively). There was an increase in the preload at the final study, as evidenced by a marked increase in right atrial (3.1±1.6 vs 4.35±2.2 mm Hg, +15%,P<0.05), pulmonary arterial (12.2±2.4 vs 15.9±3.2 mm hg, +31.8%,P<0.001), and wedge pulmonary arterial pressures (6.9±2.4 vs 9.8±3.1 mm Hg, +53%,P<0.001). These results suggest that TIPS worsens the hyperdynamic syndrome associated to portal hypertension. Therefore, in patients with cardiac insufficiency, this procedure should be evaluated. TIPS also decreases the hepatic blood flow, inducing a mild worsening in liver function.
50 citations
TL;DR: Double Gianturco stent deployment is a viable option in patients with anastomotic stenosis of the IVC secondary to OLT when initial treatment with PTA fails.
Abstract: Purpose: Evaluate the efficacy of double Gianturco expandable metallic stents for stenosis of the inferior vena cava (IVC) after orthotopic liver transplantation (OLT).
Methods: Three patients developed severe Budd-Chiari syndrome secondary to suprahepatic caval stenosis after OLT. Percutaneous angioplasty (PTA) of the stenoses was unsuccessful. Therefore double Gianturco expandable metallic stents, connected in tandem, were deployed at the site of the stenoses.
Results: One double stent was successfully and definitively deployed in patient 1. Partial dislocation of the upper and lower stents comprising the double stent occurred in patient 2. The double stent initially implanted across the stenosis became displaced in patient 3. The Budd-Chiari syndrome resolved in all three patients who remained asymptomatic during follow-up from 3 to 32 months.
Conclusions: Double Gianturco stent deployment is a viable option in patients with anastomotic stenosis of the IVC secondary to OLT when initial treatment with PTA fails. Certain modifications of the stents employed are suggested for the purpose of avoiding technical complications.
49 citations
Journal Article•
TL;DR: Results of the Spanish Registry for Hemodynamic and Interventional Cardiology are presented, except for a marked reduction in complications of stents procedures (mainly in those implanted in a rescue situation), which are similar to those of 1993.
Abstract: Results of the Spanish Registry for Hemodynamic and Interventional Cardiology are presented. As previous years, has been done by the Chapter of Hemodyamics and Interventional Cardiology of the Spanish Society of Cardiology. Seventy seven cardiac catheterization laboratories have collaborated, which represents 100% of those who had any activity in 1994. Sixty nine performed cardiac catheterization in adults, in 90% of the cases performing coronary intervention, and 22 performed both adult and pediatric studies. Eight laboratories exclusively performed pediatric cardiac catheterizations. Fifty five thousand one hundred sixty nine diagnostic procedures were performed, the majority of them being coronariographies (41,887), representing an increase of 10% from 1993. Ten thousand four hundred thirty three angioplasty procedures were performed in 1994. This represents 274 PTCA per million people (an increase of 21% compared to 1993). Eighty seven per cent of these procedures were done with conventional balloon, 1,361 stents were implanted (724 electivily), and 308 directional and 305 rotational atherectomies were performed. The overall results are similar to those of 1993, except for a marked reduction in complications of stents procedures (mainly in those implanted in a rescue situation). PTCA success was 91% with a complication rate of 3.4% and a mortality of 0.69%. The number of mitral valvuloplasties decreased 16% (694 vs 825 in 1993), and the pediatric interventional procedures were 7% less than those of 1993.
42 citations
TL;DR: In toto endoatriectomy of a massively calcified atrium is an easy to perform technique that helps to replace the mitral valve and close the atrial wall.
TL;DR: The first known case of an intravascular catheter-related primary cutaneous mucormycosis in a heart transplant patient is reported, and the organism was identified as aMucor species.
Abstract: The first known case of an intravascular catheter-related primary cutaneous mucormycosis in a heart transplant patient is reported. The patient had corticosteroid-induced hyperglycemia and experienced an acute tissue rejection episode. A necrotic lesion appeared around the insertion site of a peripheral venous catheter. A biopsy revealed typical mucorales hyphae. The lesion continued to spread during the following 24 hours and necessitated amputation of the forearm. The organism was identified as aMucor species.
TL;DR: It has been recently demonstrated that ventricular arrhythmias influence mortality in patients with left ventricular hypertrophy secondary to systemic hypertension, however, whether asymptomatic ventricular arranged are specific markers for more severe sustained arrh rhythmias, or just markers for a more severe stage of the disease, remains to be determined.
Abstract: In the present review 6 lines of evidence will be discussed that suggest a prognostic significance for ventricular arrhythmias in patients with systemic hypertension and left ventricular hypertrophy: (1) in patients with systemic hypertension there is a statistical relation between asymptomatic ventricular arrhythmias and left ventricular hypertrophy; (2) in nonhypertensive left ventricular hypertrophy the prognostic value of ventricular arrhythmias is well known; (3) left ventricular hypertrophy is related to sudden death in patients with systemic hypertension; (4) it is generally acknowledged that ventricular arrhythmias are a frequent cause of sudden death; (5) there is experimental evidence to support the arrhythmic risk of left ventricular hypertrophy; and (6) it has been recently demonstrated that ventricular arrhythmias influence mortality in patients with left ventricular hypertrophy secondary to systemic hypertension. However, whether asymptomatic ventricular arrhythmias are specific markers for more severe sustained arrhythmias, or just markers for a more severe stage of the disease, remains to be determined.
TL;DR: Two cases of piroxicam‐caused FDE are described and cross‐sensitivity among piroXicam, tenoxicam, and droxicAM in both of them are demonstrated and the patch test was useful for diagnosis and cross-sensitization studies.
Abstract: Fixed drug eruption (FDE) caused by oxicams is very rare. There are few reports of FDE induced by piroxicam, and this explains why cross-sensitivity among oxicams (piroxicam, tenoxicam, and droxicam) has been studied in only one patient. The patch test on residual lesions has lately been used by some authors in FDE diagnosis with variable results. We describe two cases of piroxicam-caused FDE and demonstrate cross-sensitivity among piroxicam, tenoxicam, and droxicam in both of them. One patient had residual lesions and the patch test was useful for diagnosis and cross-sensitization studies. The second patient had no residual lesions, and the patch test was negative on normal but previously affected skin; therefore, the study was performed by single-blind controlled oral challenge.
TL;DR: In this paper, the efficacy and safety of Zidovudine (ZDV) and lymphoblastoid interferon (IFN)-alpha combination therapy compared with ZDV monotherapy in HIV-infected subjects with CD4+ cell counts between 150 and 500 x 10(6)/l.
Abstract: OBJECTIVE To evaluate the efficacy and safety of zidovudine (ZDV) and lymphoblastoid interferon (IFN)-alpha combination therapy compared with ZDV monotherapy in HIV-infected subjects with CD4+ cell counts between 150 and 500 x 10(6)/l. DESIGN Open, randomized controlled trial with subjects stratified by the Centers for Disease Control and Prevention (CDC) 1986 classification of HIV disease (group II/III or IV). The study was amended to a sequential design in February 1992 to allow interim analyses to be conducted. SETTING Outpatient clinics in 45 hospitals in Europe, Australia and Canada. PARTICIPANTS A total of 402 previously untreated subjects with symptomatic HIV infection (CDC group IV) and CD4+ count 150-500 x 10(6)/l or asymptomatic HIV infection (CDC group II/III) with CD4+ count 150-350 x 10(6)/l. INTERVENTIONS ZDV 250 mg twice daily with or without 3 MU subcutaneous injections of lymphoblastoid IFN-alpha three times per week. MAIN OUTCOME MEASURES Time to development of a study endpoint defined as: progression from CDC group II/III to group IV, group IV non-AIDS to AIDS, or group IV AIDS to a second AIDS-defining condition; also CD4+ count to < 50 x 10(6)/l on two occasions at least 1 month apart or HIV-related death irrespective of CDC group on entry. RESULTS There was no reduction in the rate of disease progression for patients receiving ZDV plus IFN-alpha compared with patients receiving ZDV alone. No major differences between the groups were seen for CD4+ counts or percentages, or p24 antigenaemia. In a subset of 70 patients, a similar proportion from both dose groups showed evidence of ZDV resistance after 48 weeks of treatment. More adverse experiences were seen in the ZDV/IFN-alpha group. CONCLUSIONS Combination therapy with low dose lymphoblastoid IFN-alpha and ZDV revealed no clinical benefit compared with ZDV monotherapy.
TL;DR: It is concluded that a 6-8 mm graft can be successfully used for dialysis in the brachioaxillary position and expressed the efficiency of rescue surgery.
Abstract: Eight millimeter expanded polytetrafluoroeth-ylene (e-PTFE) grafts, tapered to 6 mm at the arterial site, are used by our group in the upper arm in order to avoid midgraft stenosis observed with other graft sizes. Long-term results (1–12 years) on 157 6–8 mm brachioaxillary e-PTFE grafts (Gore-Tex) are analyzed. Early failure was found in 4 grafts (2.5%). The rate of late complications was 0.37 episodes per graft-year. Steal syndrome, found in 4 cases (2.5%), was successfully treated in 3 cases by graft banding. Neither midgraft nor arterial anastomotic stenosis was observed in the 63 grafts requiring surgical thrombectomy or fistulography. The primary patency rates were 73%, 53%, and 41% at 1, 3, and 5 years, respectively. The secondary patency rates were 91%, 80%, and 72% at 1, 3, and 5 years, respectively. Comparison between both curves by the log rank test was significant (p < 0.001) expressing the efficiency of rescue surgery. We conclude that a 6–8 mm graft can be successfully used for dialysis in the brachioaxillary position
TL;DR: The present study verification of the basic metrical characteristics of the ISAPD found it to be an easy to apply, reliable, and valid scale that fulfills the aim for which it was designed.
TL;DR: Tumor progression and survival were strongly associated with T-category, and use of fashioned blocks, age and T- category were the most important factors influencing survival in a multivariate analysis.
TL;DR: It is concluded that this HAV vaccine is safe and immunogenic in healthy children and the routine vaccination against hepatitis A in pre-school children attending day-care centres should be seriously considered.
Abstract: The reactogenicity and immunogenicity of an inactivated hepatitis A vaccine were assessed. Seventy healthy children aged between 2 and 5 years old, who lacked antibodies against the hepatitis A virus, were enrolled in this study. With a 0-, 1-, and 6-month vaccination schedule, the children received three doses of 360 enzyme-linked immunosorbent assay (ELISA) units of hepatitis A vaccine intramuscularly (deltoid). Safety parameters were recorded in standardized diary cards by the parents on the day of injection and the three following days. Blood tests for liver enzymes and anti-hepatitis A virus antibody analyses were performed the day of screening and 1, 2, 6 and 7 months after the first dose. Anti-hepatitis A virus antibody was tested by ELISA. Titres < 20 mIU/ml were considered negative. For the three hepatitis A vaccine doses administered, 22% (46/210) of the diary cards reported any kinds of signs or symptoms. Soreness at the injection site (9%, 18/210) and malaise (6%, 12/210) were the most common local and systemic reactions reported, respectively. The seroconversion rates were 83, 99 and 100% one month after the 1st, 2nd, and 3rd doses, respectively. The corresponding geometric mean titres were 124, 352, and 2,778 mIU/ml. We conclude that this HAV vaccine is safe and immunogenic in healthy children. As the hepatitis A epidemiology pattern is rapidly changing in our country (and other regions), resulting in an increasing population of susceptible adolescents and young adults, we suggest that the routine vaccination against hepatitis A in pre-school children attending day-care centres should be seriously considered.
Journal Article•
TL;DR: It is not possible to recommend the use of a single fibrinolytic and, due to its lowest cost, streptokinase could be considered the first choice, however, in patients with previous thrombolysis, as well as in those with right ventricular infarction, the drug of choice should be tPA or urokinase.
Abstract: In patients with acute myocardial infarction (AMI) thrombolysis reduces the infarct area, preserves ventricular function and improves survival. This effect is more significant in men with age between 65 and 75 years, anterior ST segment elevation or branch block, during the first 6 hours of evolution. In this review the comparative studies with placebo and between different fibrinolytic agents, in different doses or in combination are reviewed, and the drug selection, the actual impact or fibrinolysis and future directions of thrombolysis in patients with AMI are discussed. Reperfusion is highest with the use of double bolus tPA of front-loaded rapid tPA infusion. Reocclusion is more frequent after tPA and minimal after urokinase or the combination of tPA and urokinase. In the GISSI-2 and ISIS-3 studies, the mortality of patients treated with streptokinase, tPA or APSAC was similar. However, in the GUSTO study, with front loaded, rapid infusion of tPA, mortality was lower than with streptokinase, although this effect was only statistically significant in patients with anterior infarction or age < 75 years. Bleeding is more common with tPA, and allergic reactions are more frequent after streptokinase and APSAC than after tPA or urokinase. Symptomatic hypotension and bradycardia are also more frequent after streptokinase or APSAC, specially in patients with right ventricular infarction. Streptokinase and APSAC generate antibodies that may neutralize the effect of a second administration even years after the first dose. On the basis of the current clinical evidence it is not possible to recommend the use of a single fibrinolytic and, due to its lowest cost, streptokinase could be considered the first choice. However, in patients with previous thrombolysis, as well as in those with right ventricular infarction, the drug of choice should be tPA or urokinase; in young patients with anterior infarction tPA is more effective and in patients with difficult controls (mobile CCU, emergency wards, etc.) APSAC or urokinase may be considered the agent of choice because their easier administration. In spite of clear evidence of the efficacy of the thrombolytic therapy, it is only used in 20%-30% of the patients with AMI, and probably there is a selection of low risk patients. For these reasons, the impact of thrombolysis in the whole population of AMI is probably lower than it could be. Future directions for the use of thrombolytic agents include a better selection of the candidates and the drug to be used as well as the early administration of thrombolytics, even before the admission to the CCU.
TL;DR: The primary objective of this study was to compare the single‐biochemical modulation of 5‐fluo‐rouracil (5‐FU) and leucovorin with that of the double‐biochemistry modulation of methotrexate andLeucovOrin.
Abstract: Background. The primary objective of this study was to compare the single-biochemical modulation of 5-fluo-rouracil (5-FU) and leucovorin with that of the double-biochemical modulation of methotrexate and leucovorin. Because of the Martin et al. study in which an experimental model showed similar effects of 5-FU at maximum tolerated doses to the modulation with leucovorin at standard doses, a third treatment arm of 5-FU alone was also studied.
Methods. A randomized trial was performed using a 500-mg/m2 intravenous (i.v.) 1-hour infusion of methotrexate, and 12 hours later, a 600-mg/m2 i.v. bolus of 5-FU plus a 200-mg/m2 i.v. 1-hour infusion of leucovorin (MFL) every 2 weeks versus 5-FU plus leucovorin at an equal dose and schedule (FL), versus a 1200-mg/m2 i.v dose of 5-FU every 2 weeks. Of 186 patients included in the study, 178 were evaluable.
Results. In a preliminary analysis with 94 evaluable patients, two significant statistical differences were shown. First, the toxicity rate of the 5-FU—alone (F) treatment arm was higher than that of the other arms (MFL vs. F, P = 0.0002; FL vs. F, P = 0.00001). Second, the median survival was worse in the F treatment arm with a rate of 12.6 months for the MFL and FL arms and 7.5 months for the F arm (P < 0.05). Considering these results, the F treatment arm was discontinued. The Final results included 70 evaluable patients for MFL and 74 patients for FL. No difference was found in the distribution of prognostic factors. The response rates were 25.7% for MFL (95% CI, 16-37.5) and 14.8% for FL (95% CI, 7.6-25), (P = 0.1). The median survival was 14.3 months for patients treated with MFL and 12.3 months for those treated with FL. The hematologic toxicity was mild, with no grade 3/4 leukopenia in either treatment arm. The major nonhematologic toxicity in the MFL and FL treatment arms was ocular; nongrade 3/4 diarrhea also was observed.
Conclusions. The results of MFL double-biochemical modulation failed to show a significant statistical difference from that of single-biochemical modulation for this dose and schedule. Cancer 1995;75:1238-44.
TL;DR: A case of central hyperventilation syndrome associated with a neural crest tumor, which revealed a ganglioneuroblastoma in a girl who had several apneic spells at the age of three years.
Abstract: Nous presentons l'observation d'une fille de 3 ans admise dans notre Unite de Soins Intensifs pour des pauses respiratoire associees au sommeil qui nous ont obliges a une tracheotomie avec ventilation assistee a la demande. Les etudes radiologiques et biologiques etaient normales mais, a la recherche d'une tumeur neurale, nous avons fait une tomodensitometrie et une resonance magnetique qui ont demontre, l'existence d'une tumeur para-vertebrale infra-diaphragmatique qui a put etre extirpee. L'etude anatomo-pathologique a precise qu'il s'agissait d'un ganglio-neuroblastome.
TL;DR: An early and adequate assessment of the candidates, when possible avoiding emergency surgery and acute left ventricular dysfunction, as well as careful management during cardiopulmonary bypass procedures (CPB) and the immediate post-surgical period will certainly improve the result of cardiac surgery in these patients, making it similar to those who are not in chronic renal failure.
Abstract: A total of 15 chronic renal failure patients on hemodialysis therapy underwent some kind of cardiovascular surgery between August 1984 and March 1993. Ten had a valve abnormality, and the remaining five had coronary artery disease. All of them were hemodialyzed the day before surgery and 24-48 h after the operation. Eleven recovered well after surgery, four died of septic shock: two of these were in septic shock prior to surgery; one was in acute congestive heart failure, and one was operated during an acute myocardial infarction. All operative deaths occurred in the patients who underwent non-elective surgery or were preoperatively in New Heart Association (NYHA) class IV. The factors having an impact on morbidity and mortality seem to be more related to the previous clinical situation and to the urgency of the operation than to the status of chronic renal failure. An early and adequate assessment of the candidates, when possible avoiding emergency surgery and acute left ventricular dysfunction, as well as careful management during cardiopulmonary bypass procedures (CPB) and the immediate post-surgical period will certainly improve the result of cardiac surgery in these patients, making it similar to those who are not in chronic renal failure.
TL;DR: A 37-year-old man who had suffered a thoracic trauma presented night release of whitish urine 2 years later and has remained asymptomatic.
Journal Article•
TL;DR: Data indicate that intraoperative TEE is useful in formulating the surgical plan and assessing immediate operative results as well as a guide to anesthetic procedures.
Abstract: Purpose To assess the value of routine intraoperative transesophageal echocardiography (TEE) in unselected patients (P) undergoing cardiac surgery. Design Routine intraoperative TEE in unselected patients undergoing cardiac surgery and evaluation of its usefulness and contribute to a successful surgery. Patients In-hospital patients from cardiology, cardiac surgery and intensive care departments of a general hospital classified as a reference medical centre in cardiovascular pathology. Material and methods From February 1994 to May 1994 an intraoperative TEE was routinely performed in patients undergoing cardiac surgery. A total of 130 TEE studies were made corresponding to 128 patients, 69 males and 61 females, with a mean age of 49.4 +/- 12.1 years. Indications for surgery were as following: a) Coronary artery bypass grafting (C.A.B.G.)-39; b) Valvular surgery-76; c) C.A.B.G. and valvular surgery-5; d) Thoracic aorta pathology associated or not to aortic valve surgery and/or coronary arteries re-implantation-6; e) Other-4. TEE performed using either a monoplane, biplane or multiplane probe and the images acquisition was made before thoracotomy and cardiopulmonary bypass (CPB) and after CPB with hemodynamic stabilization. Results Pre CPB imaging yielded unsuspected findings in 11 P (8.5%) that changed the planned surgery in 7 cases (5.4%). Post CPB echo study, which was performed after hemodynamic stabilization, modified the surgical strategy in 13 cases (10.9%) avoiding 1 predetermined surgical procedure (tricuspid ring annuloplasty) and a new surgery in another case, leading to a 3 non-predetermined surgical procedures (by showing significative tricuspid regurgitation), to a further surgery in the same valve in 6 patients (mitral paravalvular leak with significative regurgitation in 1P, another mitral prosthesis dysfunction in 1P, residual mitral valve insufficiency after mitral valve repair in 3 P and aortic prosthesis dysfunction in 1 P), to a intraaortic counterpulsation balloon device in 1 P and to new CPB due to an insufficient extraction of calcified pericardium in one case of constrictive pericarditis. In 23 cases (17.7%) TEE has modified the anesthetic procedure by demonstrating signs of hemodynamic changes before Swan-Ganz catheter, thus prompting changes in the administrations of fluids and either in inotropic or vasodilator agents. In total, intraoperative TEE has changed the surgical and/or anesthetic plan in 43 cases (33.0%). There was no difficulties or complications related to the procedure. Conclusion These data indicate that intraoperative TEE is useful in formulating the surgical plan and assessing immediate operative results as well as a guide to anesthetic procedures. Its high rentabillity in modifying the surgical and/or anesthetic plans lead us to believe that it must be used as a routine procedure in patients undergoing cardiac surgery.
TL;DR: In vitro activity of amphotericin B, flucytosine and fluconazole against 95 yeasts causing fungemia in a single institution over the last eight years was determined by a broth macromethod recommended by the National Committee for Clinical Laboratory Standards.
Abstract: The in vitro activity of amphotericin B, flucytosine and fluconazole against 95 yeasts causing fungemia in a single institution over the last eight years was determined by a broth macromethod recommended by the National Committee for Clinical Laboratory Standards. All strains were inhibited by amphotericin B concentrations of ≤ 1 µg/ml. With flucytosine in most species the MIC50 was between 0.12 and 0.25 µg/ml and the MIC90 was between 0.25 and 1 µg/ml. One exception with flucytosine wasCandida krusei, with an MIC50 and MIC90 of 16 µg/ml and 32 µg/ml, respectively. Overall, 12 % of the isolates needed at least 8 µg/ml of fluconazole to be inhibited. Fluconazole was very active againstCandida albicans, Candida tropicalis andCryptococcus neoformans, with MIC50 ranging from 0.12 to 0.5 µg/ml and MIC90 of 1 µg/ml, and somewhat less active againstCandida parapsilosis (MIC50 of 1 µg/ml and MIC90 of 4 µg/ml). Fluconazole exhibited poor in vitro activity againstCandida krusei (MIC50 and MIC90 of 64 µg/ml) andTorulopsis glabrata (MIC50 of 4 µg/ml and MIC90 of 16 µg/ml). High MICs of fluconazole were found for four strains ofCandida albicans, one with an MIC of 4 µg/ml and three (5.7 %) with MICs of ≥ 16 µg/ml. Previous exposure to fluconazole could be demonstrated in two of these strains. Further work must be done in order to determine appropriate breakpoints of antifungal agents, to assess the clinical relevance of azole resistance in yeasts causing bloodstream infections and to identify risk factors for infections with azole-resistant yeasts.
TL;DR: It is concluded that intraoperative radiotherapy (IORT) is feasible to be integrated in multidisciplinary programs as a local intensification treatment technique and peripheral nerves are dose-limiting structures for IORT trials.
Abstract: The results of intense therapy for soft tissue sarcomas located in central anatomic sites using an intraoperative electron boost (10–20 Gy) during surgery, integrated in a multimodal approach including external beam irradiation with or without chemotherapy, are analyzed. The relevant clinical data include a total of 30 patients treated, 13 recurrent tumors, 11 primary locally advanced stages, 15 high grade lesions, common location in the trunk (10 cases) and retroperitoneum (8 cases), and macroscopic residual disease after surgery in 9 cases. The median follow-up time for the entire series is 25 months (range 4–98+ months).
Severe toxicity related to the combined therapy includes peripheral neuropathy in 3 patients, 1 myelopathy, 1 chronic enteritis, 1 rectovaginal fistula, and 1 lethal sepsis. Overall local control rate is 53% (65% in cases with microscopic residual disease and 35% in confirmed macrotumor residue). Subgroup analysis of local control shows a value of 72% (13/18) in patients with lesions of 10 cm (4/12). Actuarial survival rates are 36% for the entire series and 53% and 20% for patients with primary and recurrent disease, respectively. It is concluded that intraoperative radiotherapy (IORT) is feasible to be integrated in multidisciplinary programs as a local intensification treatment technique. Peripheral nerves are dose-limiting structures for IORT trials. Local tumor control rates in central sarcomas appear to be related to the status of postsurgical margins and tumor size. Long-term survivors are followed with no evidence of disease both in primary (81+ months) and recurrent disease (98+ months) patients. © 1995 Wiley-Liss, Inc.
TL;DR: Infusional therapy with EPOCH is an active regimen in these heavily pretreated patients, particularly in relapsed Hodgkin's disease, and seems a useful protocol to prove chemosensitivity before bone marrow transplantation.
Abstract: Seventeen patients with refractory (7 cases) or relapsed (10 cases) lymphoma were treated with a continuous infusion of etoposide, vincristine, and doxorubicin, in addition to cyclophosphamide (bolus) and prednisone (regimen EPOCH). Six patients (4 with Hodgkin's disease) achieved a complete response (CR) (35%; 95% CI: 14-62%). However, 5 of 6 patients had achieved a CR with their initial therapy. Myelosuppression was the most serious effect (29% of patients with grade IV leukopenia after the first course). There were two treatment-related deaths. Doses were lower than originally reported (median: 68%). Infusional therapy with EPOCH is an active regimen in these heavily pretreated patients, particularly in relapsed Hodgkin's disease. It seems a useful protocol to prove chemosensitivity before bone marrow transplantation. However, the true role of infusional treatment has to be determined in clinical trials.