RESUMEN
Despite a even more frequent use to non-invasive respiratory support, mechanical ventilation is stilloften necessary for supporting premature infants with lung disease. Protracted mechanical ventilation is associatedwith increased morbidity and mortality and thus the earliest weaning from invasive respiratory supportis desirable. Weaning protocols may be helpful in achieving more rapid reduction in support. However,no consensus has been reached on criteria to identify when patients are ready to wean or how to achieve it. Inthis article, available evidence is reviewed and reasonable evidence-based recommendations for weaning andextubation are provided.
Asunto(s)
Enfermedades del Prematuro/terapia , Recien Nacido Prematuro , Guías de Práctica Clínica como Asunto , Respiración Artificial/métodos , Síndrome de Dificultad Respiratoria del Recién Nacido/terapia , Desconexión del Ventilador/normas , Humanos , Recién NacidoRESUMEN
The field of neonatology presents a fascinating context in which hugely important decisions have to be made on the basis of physicians' assessments of the long term consequences of various possible choices. In many cases such assessments cannot be derived from a consensual professional opinion; the situation is characterized by a high level of uncertainty. A sample of neonatologists in different countries received a questionnaire including vignette cases for which no clear consensus exists regarding the (probabilistic) prognosis. They were asked to (I) assess the probability of various outcomes (death, severe impairment) and (II) choose a treatment to be offered to the parents. Information on the physicians' professional and socio-demographic characteristics and their ethical "values" was also collected. The goal of this international survey is to understand the prognosis and to analyze decision making by professionals in the context of life and death in medicine. The availability of an identical technology in different social and institutional contexts should help identifying the convergences and differences under consideration. Seventy percent of those invited responded to the questionnaire (International 60-80%). Italian neonatologists seem to be quite pessimistic about the prognosis of infants at high risk of death or long term disabilities, they show a pro-life attitude, but in a certain proportion are willing to change their minds if requested by parents. Furthermore personal opinions predominate in the decision-making process and the contribution of team meeting and/or ethic consultation seem not significantly modify the decisions.
Asunto(s)
Toma de Decisiones , Neonatología/métodos , Médicos/psicología , Actitud del Personal de Salud , Actitud Frente a la Muerte , Toma de Decisiones/ética , Disentimientos y Disputas , Europa (Continente) , Femenino , Humanos , Recién Nacido , Enfermedades del Recién Nacido/psicología , Enfermedades del Recién Nacido/terapia , Japón , Masculino , Inutilidad Médica , Neonatología/ética , Padres/psicología , Médicos/ética , Relaciones Profesional-Familia , Pronóstico , Encuestas y Cuestionarios , Estados Unidos , Valor de la VidaRESUMEN
BACKGROUND: The role of nasal continuous positive airways pressure (nCPAP) in the management of respiratory distress syndrome in preterm infants is not completely defined. OBJECTIVE: To evaluate the benefits and risks of prophylactic nCPAP in infants of 28-31 weeks gestation. DESIGN: Multicentre randomised controlled clinical trial. SETTING: Seventeen Italian neonatal intensive care units. PATIENTS: A total of 230 newborns of 28-31 weeks gestation, not intubated in the delivery room and without major malformations, were randomly assigned to prophylactic or rescue nCPAP. INTERVENTIONS: Prophylactic nCPAP was started within 30 minutes of birth, irrespective of oxygen requirement and clinical status. Rescue nCPAP was started when Fio2 requirement was > 0.4, for more than 30 minutes, to maintain transcutaneous oxygen saturation between 93% and 96%. Exogenous surfactant was given when Fio2 requirement was > 0.4 in nCPAP in the presence of radiological signs of respiratory distress syndrome. MAIN OUTCOME MEASURES: Primary end point: need for exogenous surfactant. Secondary end points: need for mechanical ventilation and incidence of air leaks. RESULTS: Surfactant was needed by 22.6% in the prophylaxis group and 21.7% in the rescue group. Mechanical ventilation was required by 12.2% in both the prophylaxis and rescue group. The incidence of air leaks was 2.6% in both groups. More than 80% of both groups had received prenatal steroids. CONCLUSIONS: In newborns of 28-31 weeks gestation, there is no greater benefit in giving prophylactic nCPAP than in starting nCPAP when the oxygen requirement increases to a Fio2 > 0.4.
Asunto(s)
Presión de las Vías Aéreas Positiva Contínua/métodos , Cuidado Intensivo Neonatal/métodos , Síndrome de Dificultad Respiratoria del Recién Nacido/prevención & control , Presión de las Vías Aéreas Positiva Contínua/efectos adversos , Esquema de Medicación , Femenino , Humanos , Recién Nacido , Recien Nacido Prematuro , Masculino , Oxígeno/sangre , Presión Parcial , Surfactantes Pulmonares/administración & dosificación , Análisis de Regresión , Síndrome de Dificultad Respiratoria del Recién Nacido/sangre , Síndrome de Dificultad Respiratoria del Recién Nacido/terapiaRESUMEN
Docetaxel is one of the most active drugs in second-line therapy for non-small-cell-lung-carcinoma (NSCLC). The aim of this multicenter study was to evaluate the safety and efficacy of weekly low-dose docetaxel. Forty-two patients with advanced NSCLC pretreated with cisplatinum-based chemotherapy were enrolled. Docetaxel was administered at a dose of 25 mg/m(2) weekly for 12 consecutive weeks. A total of 386 doses were given with a median number of 10 doses per patient (range: 3-12). Treatment showed low incidence of hematologic toxicity and modest non-hematologic toxicity. An episode of grade 4 thrombocytopenia was reported but no episodes of grade 3 or 4 neutropenia. Most frequent non-hematologic toxicities were asthenia and alopecia. Response rate was 10.5% and median survival time (MST) was 12.8 weeks. Weekly treatment with 25 mg/m(2) docetaxel for 12 consecutive weeks appears to be a feasible and active regimen with mild toxicity in heavily pretreated NSCLC patients.
Asunto(s)
Antineoplásicos Fitogénicos/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Desoxicitidina/análogos & derivados , Neoplasias Pulmonares/tratamiento farmacológico , Taxoides/administración & dosificación , Vinblastina/análogos & derivados , Adulto , Anciano , Alopecia/inducido químicamente , Antineoplásicos Fitogénicos/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Astenia/inducido químicamente , Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Carcinoma de Pulmón de Células no Pequeñas/secundario , Cisplatino/administración & dosificación , Desoxicitidina/administración & dosificación , Docetaxel , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Resistencia a Antineoplásicos , Esofagitis/inducido químicamente , Etopósido/administración & dosificación , Femenino , Estudios de Seguimiento , Enfermedades Hematológicas/inducido químicamente , Humanos , Neoplasias Pulmonares/mortalidad , Masculino , Persona de Mediana Edad , Síndromes de Neurotoxicidad/etiología , Premedicación , Inducción de Remisión , Estomatitis/inducido químicamente , Tasa de Supervivencia , Taxoides/efectos adversos , Resultado del Tratamiento , Vinblastina/administración & dosificación , Vinorelbina , GemcitabinaRESUMEN
The possibility of breast reconstruction after a mastectomy resulting from breast cancer is still not widely exploited, and perhaps because it is relatively uncommon and unknown, is not widely practised. The plastic surgeons who were pioneers in this field know just how hard it has been to reach the stage we are at today. This leads to longer operating times, in the context of over-worked operating theaters in which time was already at a premium, and this is expecially the case in peripheral hospitals lacking in-house resources for surgical reconstruction and dependent on outisde specialist consultants. In order to address this problem, a new single-operation surgical technique, MFF (Muscular Flag Flap) has been developed. The surgical techniques adopted at present are based on immediate reconstruction or successive reconstruction. The MFF technique was developed as a response to demand for intraoperative reconstruction even when "demolition" is extensive and the breast large. This will reduce the need to operate the contralateral breast. Upper and lower pectoralis major muscle flaps are created in order to produce a large enough pocket for the final prothesis. The elasticity of this muscle is such that a large pocket is possible. The pectoralis major muscle will then envelop at least two thirds of the prosthesis. Projection of the reconstructed cone and a more anatomically normal profile are obtained. This method gives excellent esthetic results in a single operation. Thanks to the collaboration of the hospitals of Ivrea, Pinerolo and Alba over a period of approximately one year, about 80 patients have been very successfully treated using this techhnique. Rapid functional and social recovery have been observed, with no particular problems. In view of the above, we confirm that this new surgical technique will be of considerable benefit to patients.
Asunto(s)
Implantación de Mama/métodos , Mamoplastia/métodos , Mastectomía Radical , Músculos Pectorales/cirugía , Colgajos Quirúrgicos , Neoplasias de la Mama/cirugía , Carcinoma/cirugía , Estética , Femenino , Humanos , Mastectomía Segmentaria , Persona de Mediana EdadRESUMEN
Computerised tomography (CT) is being used with increasing frequency in acute respiratory distress syndrome (ARDS) patients. This brief review will discuss some of the clinical insights that a CT scan can offer. A large number of CT scan studies have provided new insights into the pathophysiology of ARDS and of mechanical ventilation, and are particularly focused on the recruitment-derecruitment phenomenon. To this end, newer fast CT scan technology promises a dynamic, rather than a static view of lung ventilation.
Asunto(s)
Síndrome de Dificultad Respiratoria/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto , Preescolar , Femenino , Humanos , Pulmón/diagnóstico por imagen , Pulmón/fisiopatología , Masculino , Respiración Artificial , Síndrome de Dificultad Respiratoria/fisiopatología , Síndrome de Dificultad Respiratoria/terapiaRESUMEN
BACKGROUND: Gemcitabine (G) and vinorelbine (V) have favorable safety profile and antitumor activity in metastatic breast cancer. To exploit their different mechanism of action and lack of overlapping toxicity, we performed a phase I and II study of G and V in combination. PATIENTS AND METHODS: Fifty-three patients with metastatic breast cancer were treated. In the dose-finding phase, seven cohorts of patients (22 women) received increasing doses to determine the dose limiting toxicity (DLT) and maximum tolerated dose (MTD) of the combination. Patients recruited in the phase II portion of the study (31 women) received the dose level immediately below the one defined as MTD (i.e., G 1200 mg/m2, V 30 mg/m2, on day 1 and day 8, every 3 weeks). RESULTS: Dose escalation was discontinued at G 1400mg/m2 and V 30 mg/m2 because of toxic death due to thrombocytopenia and CNS hemorrage. No other limiting toxicities were observed, and tolerability was similar at all dose levels studied in the escalation portion of the study. The main toxicity was granulocytopenia of grade 3/4 in 36 and 48% of the patients on phase I and II respectively, without episodes of neutropenic fever. Thrombocytopenia was uncommon. Other side effects were usually mild to moderate. In 46 evaluable patients, the response rate was 24% (complete response 7%, partial response 17%). Disease stabilization was observed in further 17%. The median duration of response was 12 months (range 5-14) and the median survival was 20 months (range 1 to 45+). CONCLUSIONS: G and V, on day 1 and 8 of 3-weekly cycles, can safely be administered to patients with metastatic breast cancer at the dose of 1200 and 30 mg/m2, respectively. The antitumor activity of G and V in combination was similar to that reported when using either drug as single agent.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Desoxicitidina/análogos & derivados , Vinblastina/análogos & derivados , Adulto , Anciano , Agranulocitosis/inducido químicamente , Agranulocitosis/tratamiento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Desoxicitidina/administración & dosificación , Desoxicitidina/efectos adversos , Esquema de Medicación , Femenino , Humanos , Dosis Máxima Tolerada , Menopausia , Persona de Mediana Edad , Vinblastina/administración & dosificación , Vinblastina/efectos adversos , Vinorelbina , GemcitabinaRESUMEN
PURPOSE: To assess the differences in CT appearance between adult respiratory distress syndrome due to pulmonary disease (ARDSP) and that due to extrapulmonary disease (ARDSEXP) and determine whether the variable appearances of ARDS are due, in part, to the initial pulmonary and systemic causes. MATERIALS AND METHODS: Thirty-three patients, 22 with ARDSP and 11 with ARDSEXP, underwent helical CT shortly after intubation. Two readers evaluated images for the type, extent, and distribution of pulmonary opacities; secondary findings; and correlation with survival and physiologic parameters. RESULTS: In both ARDSP and ARDSEXP, approximately 80% of the lung was abnormal. In ARDSP, ground-glass opacification and consolidation were equally prevalent, whereas in ARDSEXP ground-glass opacification was dominant. Ground-glass opacification was evenly distributed, whereas consolidation tended to be dorsal and caudal. ARDSP often caused asymmetric consolidation, whereas ARDSEXP caused symmetric ground-glass opacification. Air bronchograms were almost universal. Pleural effusions were present in one-half of the patients, and Kerley B lines and pneumatoceles were uncommon. Lung consolidation correlated with the ratio of mean partial pressure of arterial oxygen to fraction of inspired oxygen, shunt fraction, and pulmonary arterial pressure. The patients who died tended to have more consolidation and asymmetric disease. CONCLUSION: ARDSP tends to be asymmetric, with a mix of consolidation and ground-glass opacification, whereas ARDSEXP has predominantly symmetric ground-glass opacification. In both groups, pleural effusions and air bronchograms are common, and Kerley B lines and pneumatoceles are uncommon.
Asunto(s)
Síndrome de Dificultad Respiratoria/diagnóstico por imagen , Síndrome de Dificultad Respiratoria/etiología , Tomografía Computarizada por Rayos X , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Síndrome de Dificultad Respiratoria/mortalidad , Síndrome de Dificultad Respiratoria/fisiopatología , Tasa de SupervivenciaRESUMEN
During the last few years, advances in the care of low-birth-weight and preterm neonates has stimulated research on the best dietetic program to improve survival and to reduce handicap incidence. At present, fortification of human milk with artificial formulas is the most usual dietetic solution. As yet, however, little is known about the composition of milk from mothers giving birth prematurely. The aim of this study was the quantification of different proteins in human milk during the lactation period. By use of an electrophoretic method, lactoferrin (LF), alpha-lactalbumin, beta-casein, and lysozyme concentrations were measured in milk from mothers delivering normally (TM) or prematurely (PM). LF concentration in milk from TM presented higher values in the very first days and a fast decrease to d 10. After d 10, the concentration reached a plateau. In milk from PM, the LF concentration in the first days was lower than for TM. Similar profiles of alpha-lactalbumin, beta-casein, and lysozyme concentrations were found in milk from TM and PM. A general higher variability in PM samples was observed both between different mothers and for the same woman during the lactation period. Lactation profiles for four human milk proteins are described here. No significant difference was observed (apart from LF in the very first days) between preterm and term milk samples, confirming the unsuitability of unfortified breast milk for preterm neonates.
Asunto(s)
Calostro/química , Lactancia/fisiología , Proteínas de la Leche/análisis , Leche Humana/química , Peso al Nacer , Caseínas/análisis , Calostro/enzimología , Dieta , Electroforesis en Gel de Poliacrilamida , Femenino , Humanos , Recién Nacido , Recien Nacido Prematuro , Lactalbúmina/análisis , Lactoferrina/análisis , Leche Humana/enzimología , Muramidasa/análisis , Trabajo de Parto Prematuro , Embarazo , Factores de TiempoRESUMEN
OBJECTIVE: Research was undertaken to test two hypotheses. First, during the early neonatal period, thyroid function of very low birth weight (VLBW) infants is suppressed by exposure to iodine-containing antiseptic solutions and/or iodized contrast media. Second, this suppression is more pronounced in small for gestational age (SGA) infants. METHODS: Urinary iodine concentration and thyroid function measurements were obtained prospectively from 44 VLBW infants with gestational ages at birth of 30 +/- 2.3 weeks and weights of 1223 +/- 231 g. Eleven of these infants were SGA. The infants were grouped according to iodine exposure: 18 infants had no increased exposure and served as control infants; 9 infants were exposed to an iodine-containing antiseptic (povidone iodine); 12 infants were exposed to an iodized contrast medium (iopamidol); and 5 infants were exposed to both agents. Urinary iodine and serum free triiodothyronine, free thyroxine, and thyrotropin were measured on days 1, 7, 14, 21, and 28 of life. RESULTS: During the period of maximum exposure (days 1 to 7), the concentration of iodine in the urine of study infants was 2 to 4 orders of magnitude greater than that in the urine of control infants (123 +/- 141 micrograms/L). During the subsequent 3 weeks, levels of urinary iodine in study infants returned to levels that were not significantly different from controls. On day 7 of life, iodine-exposed infants had a significantly higher mean thyrotropin level than control infants, whereas on day 28, free triiodothyronine and thyroxine levels were lower. Of the 26 iodine-exposed infants, 6 had transient hyperthyrotropinemia and 2 had transient hypothyroidism. When exposed to iodine, SGA infants had more labile thyroid function than normally grown iodine-exposed or control infants. These SGA infants had significantly lower levels of thyroid hormones in umbilical cord blood, increased production of thyroid hormones on day 14 of life, and lower levels again at 1 month. CONCLUSION: In VLBW infants, the use of iodine-containing antiseptic solutions and iodized contrast media results in massive uptake of iodine that is associated with alterations in thyroid function. It is reasonable to suggest that, whenever possible, iodized products should be avoided in VLBW infants, because their routine use results in exposure to excessive loads of iodine, which can be associated with hyperthyrotropinemia and hypothyroidism.
Asunto(s)
Recién Nacido de muy Bajo Peso/fisiología , Yodo/orina , Glándula Tiroides/efectos de los fármacos , Antiinfecciosos Locales/efectos adversos , Medios de Contraste/efectos adversos , Humanos , Alimentos Infantiles/análisis , Recién Nacido , Yopamidol/efectos adversos , Análisis de los Mínimos Cuadrados , Leche Humana/química , Povidona Yodada/efectos adversos , Estudios Prospectivos , Glándula Tiroides/fisiología , Hormonas Tiroideas/sangre , Factores de TiempoRESUMEN
OBJECTIVE: We reviewed our experience with six consecutive cases of fetal intracranial hemorrhage and the cases published in the English literature in an attempt to devise an original prognostic scoring system for antenatal intracranial hemorrhage. STUDY DESIGN: The series included the cases of fetal intracranial hemorrhage detected at our institution between 1992 and 1994 by transabdominal ultrasonography. In addition, we performed an English literature search (Medline computer search, National Library of Medicine) of all reported cases of a prenatal diagnosis of intracranial hemorrhage. The prenatal ultrasonographic findings were correlated with the clinical outcome, which was divided into (1) normal outcome or mild neurologic sequelae and (2) poor outcome (severe neurologic impairment and fetal or neonatal death). RESULTS: Six cases of intracranial hemorrhage were detected in a population of 6641 pregnancies (0.9/1000) at our institution. Parenchymal involvement was present in three cases. Review of the English literature revealed 35 additional cases with prenatal ultrasonographic findings and postnatal follow-up. The total cases (n = 41) were divided into three groups: (1) isolated intraventricular hemorrhage (n = 20), (2) parenchymal hemorrhage (n = 13), and (3) subdural or subarachnoid hemorrhage (n = 8). Overall, poor outcome was present in 68% of cases, including 45% (9/20) of intraventricular hemorrhage, 92% (12/13) of parenchymal hemorrhage, and 88% (7/8) of subdural or subarachnoid hemorrhage. The heterogeneity of the intraventricular hemorrhage group in both severity of antenatal findings and outcome prompted us to devise a prognostic scoring system based on prenatal ultrasonographic lesions, grouping cohorts with similar outcomes. Outcome was favorable in 100% (5/5) of grade 1 intraventricular hemorrhage cases, in 50% (6/12) of grade 2 cases, and in 0% (0/3) of grade 3 cases. CONCLUSIONS: Fetal intracranial hemorrhage can be classified on the basis of the anatomic location of the intracranial bleeding. The prognosis is poor in nearly 90% of parenchymal and subdural hemorrhages, whereas it is better in the subgroup with intraventricular hemorrhage. The prognostic scoring system we propose for intraventricular hemorrhage may assist the physician in providing patients with prognostic information.
Asunto(s)
Hemorragia Cerebral/diagnóstico por imagen , Enfermedades Fetales/diagnóstico por imagen , Ultrasonografía Prenatal , Hemorragia Cerebral/complicaciones , Hemorragia Cerebral/etiología , Femenino , Edad Gestacional , Hematoma Subdural/diagnóstico por imagen , Humanos , Recién Nacido , Imagen por Resonancia Magnética , Enfermedades del Sistema Nervioso/etiología , Embarazo , Pronóstico , Hemorragia Subaracnoidea/diagnóstico por imagenRESUMEN
The authors describe a new method of medicating disepidermised areas from which a dermo-epidermic graft has been removed to cover burn areas or following post-traumatic loss of substance. This method consists of the use of a thin microfibrillar film of a polysaccharidic type, which serves as a temporary substitute for the skin, offering selective permeability, the possibility of transpiration and gaseous exchange, but at the same time being impermeable to liquids and microorganisms. A study was performed to evaluate the efficacy and tolerability of this new dressing, involving 30 patients of both sexes aged between 9 and 87 years old. The site, dimensions, and type of graft were assessed in each patient together with the duration of pain and the time taken for the lesion to heal. This study has highlighted the positive function performed by medication with microfibrillar film in facilitating the cicatricial process, achieving complete re-epithelisation within an average of 8-9 days, with a considerable reduction in pain and satisfactory esthetic and functional result. No collateral effects or complications relating to the use of this material are reported in any of the cases studied.
Asunto(s)
Procedimientos Quirúrgicos Dermatologicos , Apósitos Oclusivos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trasplante de PielRESUMEN
Few data are available for ranitidine pharmacokinetics in the first few days of life. Twenty seven newborn infants were treated with intravenous ranitidine because they were vomiting blood, although they had a negative Apt's test. Each infant provided two blood samples at randomly selected times 30-360 minutes after a 2.4 mg/kg intravenous bolus of ranitidine. A single exponential equation for the concentration-time graph was fitted to the mean serum concentrations at different times. From this model the following mean (SD) measurements wer derived: elimination half life, 207.1 (19.1) minutes; total volume of distribution, 1.52 (0.91) l/kg; and total plasma clearance, 5.02 (0.46) ml/kg/min. Assuming that these measurements do not change with different administered doses, regimens can be derived to assist in planning ranitidine treatment in newborn infants.
Asunto(s)
Ranitidina/farmacocinética , Hemorragia Gastrointestinal/sangre , Hemorragia Gastrointestinal/tratamiento farmacológico , Humanos , Recién Nacido , Ranitidina/uso terapéutico , Factores de TiempoRESUMEN
We report on 3 new cases of C trigonocephaly syndrome. In addition to the findings characteristic of this condition, one of the patients also had a large omphalocele. This patient was referred from a suburban hospital with a diagnosis of Down syndrome, stressing the fact that C syndrome is still under-recognized and underdiagnosed. Another patient was diagnosed at birth and immediately submitted to craniosynostectomy. A second operation was performed 7 months later resulting in normal brain growth and close to normal psychomotor development at 3 years, in contrast to the third patient, who was not treated surgically and was severely retarded at 4 years.
Asunto(s)
Anomalías Múltiples , Craneosinostosis/cirugía , Discapacidad Intelectual/prevención & control , Cráneo/anomalías , Preescolar , Femenino , Hernia Umbilical , Humanos , Recién Nacido , Italia , Masculino , SíndromeRESUMEN
Seventy cases of ureteropelvic junction obstruction, bilateral or unilateral, were followed prospectively throughout gestation and postnatally for an average of 2.3 years. Cases of ureteropelvic junction obstruction with a renal pelvis dilated less than 1 cm uniformly did well; those with a pyelectasis more than 2 cm, both bilateral and unilateral, had a favorable outcome in approximately three-quarters. Surprisingly, pelvis dilatation between 1-2 cm had a better outcome if bilateral than if unilateral.
Asunto(s)
Enfermedades Fetales/diagnóstico , Pelvis Renal/patología , Obstrucción Ureteral/diagnóstico , Femenino , Enfermedades Fetales/patología , Estudios de Seguimiento , Humanos , Hidronefrosis/diagnóstico , Hidronefrosis/etiología , Recién Nacido , Masculino , Ultrasonografía , Obstrucción Ureteral/complicaciones , Obstrucción Ureteral/patología , Obstrucción Ureteral/cirugíaRESUMEN
Six emblematic cases of neonatal thrombocytopenic purpura (NTP) due to different etiologic factors are described. Various methods for the detection of platelet and leukocyte antibodies are considered: platelet suspension and lymphocyte immunofluorescence tests (PSIFT and LIFT), solid-phase platelet antibody detection test (Capture-P), immune-enzymatic assay on platelet suspension (ELISA) and on solid-phase platelets (Capture-P-ELISA), lymphocytotoxicity (Lctx). Furthermore, chloroquine stripping of HLA antigens and monoclonal antibody (MoAb) treatment of target platelets specific antigens are described. The technical characteristics and advantages of each method are discussed. The authors stress that a step-by-step investigation employing an integrated system that includes various methods can correctly supply the pathogenetic information necessary for the physician to undertake the best therapeutical approach.
Asunto(s)
Púrpura Trombocitopénica/inmunología , Sistema del Grupo Sanguíneo ABO , Ensayo de Inmunoadsorción Enzimática , Femenino , Técnica del Anticuerpo Fluorescente , Antígenos HLA/inmunología , Humanos , Inmunoglobulinas/análisis , Recién Nacido , Isoanticuerpos/análisis , MasculinoRESUMEN
Radiation treatment using low power laser beams is recommended for chronic or recurring lesions. Personal experience is reported with emphasis on the fact that He-Ne laser treatment should be employed when topical or surgical therapy fails.
Asunto(s)
Terapia por Láser , Cirugía Plástica , Quemaduras/cirugía , Cicatriz/cirugía , Edema/cirugía , Hematoma/cirugía , Humanos , Úlcera de la Pierna/cirugía , Úlcera por Presión/cirugía , Trasplante de Piel , Ultrasonido/instrumentación , Cicatrización de Heridas , Heridas y Lesiones/cirugíaRESUMEN
An assessment was made of the determination of carcinoembryonic antigen (CEA) in patients with tumours and non-neoplastic diseases. Positivity in relation to hepatic cirrhosis and stasis was noted in only 3.9% of non-oncological patients, whereas this figure rose to 28.8% in those with tumors, with higher frequencies in forms involving the intestine, lung, liver, and stomach. Variations in the result of the examination were noted in relation to the progress of the disease, and also in relation to chemotherapy in some cases. The results of the investigation indicate that CEA is of little use as an early diagnosis test. Its importance lies in its indication of the effectiveness of treatment, and as an early sign of the approach of recurrences.
Asunto(s)
Antígeno Carcinoembrionario/análisis , Neoplasias/diagnóstico , Neoplasias Gastrointestinales/diagnóstico , Humanos , Cirrosis Hepática/diagnóstico , Neoplasias Hepáticas/diagnóstico , Neoplasias Pulmonares/diagnóstico , Recurrencia Local de Neoplasia/diagnóstico , Neoplasias/inmunología , Neoplasias Gástricas/diagnósticoRESUMEN
21 children with recurrent urinary tract infections (UTI) due to bacteria resistant to the usual antiinfectious drugs were examined to evaluate whether their UTI could be effectively treated with a single daily administration of gentamicin (2.5 mg/kg i.m.) for ten days. From the data obtained it may be concluded that such a scheme of therapy is effective in all cases as far as urine sterilization is concerned during therapy, regardless of the site of infection. However, urine culture controls, 10 and 30 days after therapy was discontinued, showed a further infection in 3 out of 7 children with upper UTI, Since in urine of all our patients the antibiotic level was well above the minimal inhibitory concentration for the infective bacteria, the different therapeutic response could be related to an inadequate antibiotic concentration at the renal interstitial site.