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  • 1
    ISSN: 1432-2323
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Résumé Bien qu'un seul antibiotique avec un large spectre couvrant les germes aérobies et anaérobies soit reconnu comme efficace dans l'appendicite, beaucoup de chirurgiens continuent d'utiliser une polyantibiothérapie. Dans un essai contrôlé en double aveugle, nous avons testé la corrélation clinique avec la sensibilité in vitro d'une association de plusieurs antibiotiques comme traitement complémentaire chez 114 patients ayant eu une appendicite compliquée. Quatre-vingt pour-cent (36/40) des patients ayant eu du céfotétan et 86% (31/36) des patients ayant eu l'association clindamycine/amikacíne n'ont pas eu de complications infectieuses postopératoires (p=0.11). II a été nécessaire de changer les antibiotiques en raison d'une complication postopératoire plus souvent chez les patients ayant eu l'association clindamycine/amikacine, 5 (12%) comparé à 1 (2%) dans le groupe céfotétan (p=0.07). On a identifié des organismes Bacteroides fragilis résistants au céfotétane mais aucun n'était responsable d'infection postopératoire. II y a eu des effets secondaires non désirables, essentiellement une perturbation des tests de la fonction hépatique, chez 28% et chez 26% des patients ayant pris respectivement du céfotétane et l'assocíation clindamycine/amikacine, respectivement. Une monothérapie avec une céphalosporine de deuxième génération du type céfotétan, donnée deux fois par jour, est ffficace et économique dans le traitement de l'appendicite compliquée mais opéréc. Les aminosides et les autres antibiotiques plus puissants doivent être réservés pour les germes résistants ou les infections nosocomiales.
    Abstract: Resumen Aunque los antibióticos únicos de amplio espectro de cobertura aeróbica y anaeróbica son eficaces en la apendicitis, muchos cirujanos continúan utilizando agentes múltiples. Se diseñó un ensayo clínico prospectivo, doble ciego y aleatorizado con el fin de correlacionar la susceptibilidad in vitro de agentes antimicrobianos múltiples como terapia adyuvante en el manejo de 114 pacientes sometidos a operación por apendicitis complicada. 90% (36/40) de los pacientes en el Grupo de cefotetan y 86% (31/36) en el Grupo que recibió clindamicina/amikacina tuvieron resolución clínica de sus infecciones intraabdominales sin recurrencia de complicaciones sépticas postoperatorias (P=0.11). El número de pacientes que tuvieron cambio en la terapia antibiótica por complicaciones postoperatorias fue más alto en el Grupo clindamicina/amikacina, 5 (12%) comparados con 1 (2%) en el Grupo cefotetan (P=0.07). Aunque se identifícaron microorganismos del Grupo de los Bacteroides fragilis resistentes a cefotetan, ninguno fue responsable de infecciones postoperatorias. Se presentaron reacciones farmacológicas adversas en 28% del Grupo cefotetan y en 26% del Grupo clindamicina/amikacina, las cuales consistieron primordialmente en elevaciones pasajeras de los valores de las pruebas de función hepática. La monoterapia con una cefalosporina de amplio espectro de segunda generación, tal como el cefotetan, administrado en dos dosis diarias constituye un régimen económico y eficaz en la apendicitis complicada en la cual la cirugía representa el tratamiento definitivo. Los aminoglucósidos y otros agentes antimicrobianos más potentes deben ser reservados para el tratamiento de infecciones nosocomiales por microorganismos resistentes.
    Notes: Abstract Although single antimicrobials with broad-spectrum aerobic and anaerobic coverage are effective in patients with appendicitis, many general surgeons continue to use multiple agents. A prospective, doubleblind, randomized trial was designed to detect any clinical correlate of in vitro susceptibility advantage of multiple antimicrobials as adjunctive therapy for 114 patients undergoing operation for complicated appendicitis. There was clinical resolution of intraabdominal infections with no occurrence of postoperative infectious complications in 90% (36 of 40) of the cefotetan group and 86% (31 of 36) of the clindamycin/amikacin group (p=0.11). The number of patients who had changes in antibiotic therapy due to postoperative complications was higher in the clindamycin/amikacin group: five (12.5%), compared to one (2.8%) in the cefotetan group (p=0.07). Although Bacteroides fragilis group organisms resistant to cefotetan were identified, none was responsible for the postoperative infections. Adverse drug events in 28% of the cefotetan group and 26% of the clindamycin/amikacin group consisted primarily of transient elevations of liver function tests. Monotherapy with a second-generation, broad-spectrum cephalosporin, such as cefotetan, given twice a day is an economical and effective adjunctive regimen in patients with complicated appendicitis for which operation is the definitive treatment. Aminoglycosides and other, more potent antimicrobials should be reserved for resistant organisms or nosocomial infections.
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  • 2
    ISSN: 1476-4687
    Source: Nature Archives 1869 - 2009
    Topics: Biology , Chemistry and Pharmacology , Medicine , Natural Sciences in General , Physics
    Notes: [Auszug] We used a 1.5-kilobase (kb) complementary DNA fragment to map the p45 NF-E2 gene in the mouse by Southern blot analysis of DNA from the C57BL/6J x DBA/2J (B x D) recom-binant inbred (RI) strain set and an interspecific backcross. Analysis of BxD RI lines localized Nfe2 to within one map unit of the ...
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  • 3
    ISSN: 1476-4687
    Source: Nature Archives 1869 - 2009
    Topics: Biology , Chemistry and Pharmacology , Medicine , Natural Sciences in General , Physics
    Notes: [Auszug] Analysis of complementary DNA for human erythroid ankyrin indicates that the mature protein contains 1,880 amino acids comprising an N-terminal domain binding integral membrane proteins and tubulin, a central domain binding spectrin and vimentin, and an acidic C-terminal 'regulatory' domain ...
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  • 4
    ISSN: 1615-5947
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
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  • 5
    ISSN: 1615-5947
    Keywords: Percutaneous balloon angioplasty ; combined iliac angioplasty and distal bypass ; Veterans Administration Cooperative Study No. 199
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Multiple sites of atherosclerotic occlusion in high risk patients may be treated by angioplasty of the iliac obstruction and distal reconstruction. We report 18 male patients with symptomatic peripheral vascular disease in whom proximal iliac percutaneous transluminal angioplasty was combined with femoropopliteal bypass (11), femorotibial bypass (2), or femorofemoral bypass (5). There were no operative deaths. The pretreatment ankle brachial index of 0.40 ± 0.04 was increased to 0.64 ± 0.04 by discharge (p=0.0001), and remained significantly increased through 27 months (0.65 ± 0.07) (p=0.0001). During the follow-up period of 2–57 (mean 27 months) one dilated iliac artery required repeated percutaneous transluminal angioplasty and revision of the femoropopliteal bypass at three months. Two late amputations of study limbs occurred at two years and three years due to progression of distal disease in the infrapopliteal segment. Four patients died during the follow-up period of ischemic heart disease (3) and lung carcinoma (1). Life table analysis shows a 76% success rate for the combined procedures at two years. In selected, high risk patients, proximal iliac dilatation and distal bypass is an acceptable alternative reconstruction for multilevel occlusion.
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  • 6
    ISSN: 1615-5947
    Keywords: Chylous ascites ; ascites ; abdominal aortic operations
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Three patients, two women, one man (mean age 74 years), who had abdominal aortic aneurysms (2) or aortobifemoral surgery (1), developed chylous ascites postoperatively. They were studied to determine their clinical course and develop a plan for management of this complication. In each patient, the ascites was not manifest until abdominal swelling developed two weeks after operation, and the problem was confirmed by the finding of milky fluid on paracentesis. A low serum albumin (mean 2.6 gm) was also characteristic. The ascites was not altered by parenteral nutrition or reduction of dietary fat and ingestion of medium chain triglycerides. In one patient (man, age 93) the ascites resolved spontaneously two months after abdominal aortic aneurysm surgery. Another (woman, age 70) was cured following operative ligation of a lymphatic fistula identified at operation five weeks after abdominal aortic aneurysm repair. In the third (woman, age 60), the ascites resolved immediately following placement of a peritoneal venous shunt six weeks after an aortobifemoral bypass. Chylous ascites is rare after aortic surgery and manifests itself about two weeks after operation, at times after discharge from hospital. It has an indolent course, but may resolve spontaneously up to two months after operation. Its course appears not to be foreshortened by diet, including omission of fat, but can be successfully treated surgically with a shunt or fistula ligation. If done early a protracted hospital course may be avoided.
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  • 7
    ISSN: 1619-7089
    Keywords: Indium-111 ; monoclonal Fab′ ; In vivo stability human ; 111-In Fab′ excretion pattern ; Electrophoresis ; Animal distribution
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract This study was conducted to investigate alterations that occur in an indium/111 Fab′ of a monoclonal antibody following its in vivo administration. Patients were infused with 111 In-Fab′ of the monoclonal antibody ZCE-025. Serum and urine specimens were collected from these patients. Starting materials, serum, urine and controls samples were studied by electrophoresis. Animal distribution studies were performed in normal Balb/c mice and, in some cases, nude mice bearing a carcinoembryonic antigen (CEA)/producing human colon tumour since the antibody targets CEA. The studies indicated that the molecule circulated almost totally intact for at least 4 h and to a considerable extent for 24 h, with some evidence for in vivo fragmentation by 24 h. Evidence was also obtained suggesting the formation of a high molecular weight species in some patients. Shortly after infusion, some of the 111In in the urine appeared as the intact Fab′, but within hours the majority migrated electro-phoretically as low molecular weight species. We conclude that while the majority of the 111In-Fab′ of this particular antibody remains intact and immunoreactive following its administration, the molecule is structurally changed to some degree shortly after its infusion into humans. Since each monoclonal antibody is unique, the degree and rapidity of degradation of its Fab′ in vivo could vary markedly from the above and possibly adversely effect its utility as a radiopharmaceutical.
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  • 8
    ISSN: 1615-5947
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Construction of a vascular access site for hemodialysis has traditionally been done on an inpatient basis or more recently in a hospital operating room as a 1-day admission. Over 18 months we performed 49 vascular access procedures on 45 patients in a freestanding ambulatory surgical center. Four patients had an arteriovenous radiocephalic autogenous fistula constructed, 30 patients had a polytetrafluoroethylene (PTFE) prosthesis inserted as an arteriovenous bridge graft, 11 patients had a planned reconstruction of a previously placed graft, 1 patient had a false aneurysm corrected, 1 patient had a chronically infected graft removed, and 2 patients had a thrombectomy. All procedures were in the upper extremities except for one femorosaphenous PTFE graft and one excision of a false aneurysm in a thigh prosthesis. Only one patient, an 84-year-old woman, required hospitalization following the outpatient procedure because she was unable to care for herself. No postoperative infection had occurred at 1 month follow-up. A left upper extremity graft performed at another inpatient facility was removed because of infection. The protocol for outpatient vascular access surgery includes preoperative evaluation of the patient for determination of the access site within a week of operation; duplex scan of subclavian veins if central venous lines have been in place for more than 2 weeks; scheduling surgery for the afternoon or morning following routine hemodialysis; obtaining a hemoglobin level, serum/electrolyte study, and an ECG following the last hemodialysis; parenteral antimicrobial prophylaxis; local infiltration anesthesia with standby; a minimum of 1 hour of observation in the recovery room; and a repeat hematocrit study prior to discharge. Vascular access surgery can be performed safely and efficiently in a freestanding outpatient surgery center with a postoperative hospital admission rate of approximately 2%. Hemodialysis patients who have frequent revisions of access sites much prefer the convenience and shortened total time (approximately 4 hours) for surgery performed on an ambulatory basis. Providers realize significant cost savings.
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  • 9
    ISSN: 1476-4687
    Source: Nature Archives 1869 - 2009
    Topics: Biology , Chemistry and Pharmacology , Medicine , Natural Sciences in General , Physics
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  • 10
    ISSN: 1546-1718
    Source: Nature Archives 1869 - 2009
    Topics: Biology , Medicine
    Notes: [Auszug] Pallid is one of 12 independent murine mutations with a prolonged bleeding time that are models for human platelet storage pool deficiencies in which several intracellular organelles are abnormal. We have mapped the murine gene for protein 4.2 (Epb4.2) to chromosome 2 where it co–localizes ...
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