ABSTRACT
Background: Systemic fungal infections and specifically invasive aspergillosis (IA) are associated with a high morbi-mortality rate in patients with hematologic malignancies. Itraconazole kinetic studies show that plasma levels are not satisfactory, even though there is a reduction of the severity in clinical cases. Aim: To evaluate the results of oral prophylaxis with high dose itraconazole, 400 mg bid, among patients with adult acute leukemia. Material and Methods: Prospective analysis of 93 high risk febrile episodes (with an absolute neutrophil count of less than 500 x mm3 for more 10 days), that occurred in 76 patients. Results: Seventy five percent of episodes occurred in patients with acute myeloid leukemia and 25 percent in patients with acute lymphoblastic leukemia. Fifty two percent occurred during the induction of chemotherapy. Median duration of severe neutropenia was 21 days (range 10-48). Median duration of itraconazole prophylaxis was 17 days (range 6-34). A low frequency of invasive fungal infections was observed (17 percent). According to diagnostic criteria, 5 percent of episodes corresponded to persistent fever , 1 percent and 11 percent of episodes, to probable or possible IA, respectively. No confirmed or proven IA was observed. Mortality of IA was 18 percent. No serious adverse events due to itraconazole were observed. Conclusions: The use of high dose itraconazole prophylaxis in adult patients with acute leukemia and severe neutropenia was associated to low incidence and mortality of invasive mycoses.
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , Antifungal Agents/administration & dosage , Itraconazole/administration & dosage , Leukemia, Myeloid, Acute/drug therapy , Mycoses/prevention & control , Neutropenia/drug therapy , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Acute Disease , Administration, Oral , Antifungal Agents/adverse effects , Aspergillosis/prevention & control , Fever/drug therapy , Itraconazole/adverse effects , Neutropenia/chemically induced , Prospective Studies , Pulmonary Aspergillosis/prevention & controlABSTRACT
T84 is an established cell line expressing an enterocyte phenotype whose permeability properties have been widely explored. Osmotic permeability (P OSM), hydraulic permeability (P HYDR) and transport-associated net water fluxes (J W-transp), as well as short-circuit current (I SC), transepithelial resistance (R T), and potential difference (deltaV T) were measured in T84 monolayers with the following results: P OSM 1.3 ± 0.1 cm.s-1 x 10-3; P HYDR 0.27 ± 0.02 cm.s-1; R T 2426 ± 109 omega.cm², and deltaV T 1.31 ± 0.38 mV. The effect of 50 æM 5,6-dichloro-1-ethyl-1,3-dihydro-2H-benzimidazol-2-one (DCEBIO), a "net Cl- secretory agent", on T84 cells was also studied. We confirm the reported important increase in I SC induced by DCEBIO which was associated here with a modest secretory deltaJ W-transp. The present results were compared with those reported using the same experimental approach applied to established cell lines originating from intestinal and renal epithelial cells (Caco-2, LLC-PK1 and RCCD-1). No clear association between P HYDR and R T could be demonstrated and high P HYDR values were observed in an electrically tight epithelium, supporting the view that a "water leaky" barrier is not necessarily an "electrically leaky" one. Furthermore, the modest secretory deltaJ W-transp was not consistent with previous results obtained with RCCD-1 cells stimulated with vasopressin (absorptive fluxes) or with T84 cells secreting water under the action of Escherichia coli heat stable enterotoxin. We conclude that, while the presence of aquaporins is necessary to dissipate an external osmotic gradient, coupling between water and ion transport cannot be explained by a simple and common underlying mechanism.
Subject(s)
Humans , Epithelial Cells/metabolism , Hydrostatic Pressure , Osmosis/physiology , Water/metabolism , Cell Line/metabolism , Electrophysiology , Epithelial Cells/physiology , Membrane Potentials/physiology , Osmolar Concentration , PermeabilityABSTRACT
El adecuado control de la hidatidosis en general, requiere conocer algunos aspectos relacionados con la supervivencia de los agentes infectantes, especialmente de los escólices. El objetivo de este trabajo, es evaluar la viabilidad de los escólices de quistes hidatídicos humanos de localización hepática. Estudiar la asociación entre las características clínicas al momento de la cirugía y el porcentaje de viabilidad de los escólices. Los criterios de viabilidad utilizados fueron: forma ovoide, invaginados, ganchos rostrales y corpúsculos calcáreos intactos, movimientos vibratorios presentes y ausencia de tinción con colorantes vitales. Los criterios para certificar mortalidad de los escólices fueron dos o más de los siguientes hechos: inmovilidad, alteración de los ganchos rostrales y de los corpúsculos calcáreos, rotura de membrana y pérdida de la forma ovoide y fácil tinción con el colorante vital (azul de tripan al 1,5 por ciento). Se estudiaron de esta forma 16 quistes, con un diámetro promedio de 16,2 cm. Siete lesiones (44 por ciento) de tipo univesicular, 5 (31 por ciento) multivesiculares y 4 (25 por ciento) quistes abscedados. En 7 oportunidades (44 por ciento), se evidenció comunicación a la vía biliar; y se constató viabilidad en 9 de los 16 quistes (56 por ciento). Las muestras con mayor porcentaje de escólices viables fueron los quistes multivesiculares, principalmente a expensas de las vesículas hijas. Se constató que los quistes multivesiculares eran viables en el 100 por ciento de los casos, a diferencia de los univesiculares con un 57 pir ciento y los abscedados con 0 por ciento (p= 0,01)
Subject(s)
Humans , Echinococcus/isolation & purification , Echinococcosis, Hepatic/parasitology , In Vitro Techniques , Bile Ducts/parasitology , Echinococcus/drug effects , Echinococcus/growth & development , Echinococcus/pathogenicity , Liver/parasitology , Histological Techniques , Tissue SurvivalABSTRACT
Background: One of the most important factors involved in the pathophysiology of gastroesophageal reflux disease (GERD) is the lower esophageal sphincter rest pressure (LESRP), but these patients can have esophageal motor disorders (EMD). Aim: To assess an association between LESRP and the appearance of EMD in patients with GERD. Subjects and methods: A cross-sectional study was conducted in 229 patients with GERD and 49 healthy controls. Forty five patients with LESRP < 6 mmHg and a mean age of 49 years were assigned to group 1, 128 patients with a LESRP between 6 and 12 mmHg and mean age of 47 years were assigned to group 2, 56 patients with a a LESRP >12 mmHg and a mean age of 47 years were assigned to group 3 and group 4 was conformed by 49 healthy subjects aged 40 years old. Esophageal manometry was performed using previously published techniques. Results: There was a significant association between LESRP, waves amplitude and the frequency of tertiary waves. Conclusions: Resting lower esophageal sphincter pressure is inversely proportional to the presence of esophageal motor disorders in patients with gastroesophageal reflux disease
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Gastroesophageal Reflux/etiology , Esophageal Motility Disorders/complications , Basal Metabolism , Manometry , Muscle Hypotonia/physiopathology , Esophageal Motility Disorders/physiopathology , Esophagogastric Junction/physiopathologyABSTRACT
Se midió a minuto el movimiento neto de agua transepitelial (Jw) en el ciego de ratas Wistar adaptadas a una dieta con alto potasio (HKD). También se midió la diferencia de potencial (PD), la corriente de cortocircuito (SCC) y los flujos unidireccionales de 22Na, 36Cl 89Rb. Cuando se utilizó un buffer bicarbonato, las permeabilidades hidrostática y osmótica no se modificaron con la adaptación al potasio. La adaptación al potasio implicó el desarrollo de un Jw secretorio asociado al transporte (Jw), relacionado con un incremento en la PD transepitelial, la SCC y el transporte neto de sodio. Contrariamente al caso de las ratas controles, no se observó ningún transporte neto de cloruro en las ratas HKD. En la presencia de sodio, cloruro y bicarbonato, el Jwt secretorio compensó un Jwt absortivo. La secreción de agua se acopló a una secreción neta de potasio. El reemplazo de iones cloruro por iones sulfato estuvo acompañado por el desarrollo de un Jw neto absortivo y por incrementos en la PD transepitelial y la permeabilidad hidrostática. El reemplazo del buffer bicarbonato por un buffer tris-hepes hizo decaer el Jw absortivo observado y la PD. Por último, se observó el cambio de una reabsorción de NaCI no electrogénica a una entrada electrogénica de Na+ sensible al amiloride