ABSTRACT
OBJETIVO: Relatar a experiência no uso do OK-432 para tratamento de linfangiomas em crianças. MÉTODOS: Estudo retrospectivo de 19 crianças com linfangioma tratadas com OK-432 no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - USP, durante o período de 1999 a 2003. RESULTADOS: Todos os pacientes apresentaram alguma resposta ao OK-432, 12 pacientes apresentaram regressão total, sete apresentaram regressão parcial variando de 50 por cento a 80 por cento. Os pacientes apresentaram febre após a aplicação da droga com duração de 2 a 10 dias. Não se observaram cicatrizes após a aplicação do OK-432. CONCLUSÕES: A droga OK-432 é segura, eficaz e pode ser utilizada como primeira escolha no tratamento de pacientes com linfangiomas devido à excelente resposta, podendo tornar desnecessária a realização de cirurgia. Em pacientes com resposta parcial, podem ser realizadas novas aplicações de OK-432 ou cirurgia menos mutilante, devido à redução das dimensões da lesão.
Subject(s)
Humans , Female , Infant, Newborn , Infant , Child, Preschool , Child , Antineoplastic Agents/therapeutic use , Head and Neck Neoplasms/drug therapy , Lymphangioma/drug therapy , Picibanil/therapeutic use , Follow-Up Studies , Retrospective StudiesABSTRACT
Thirty one infective endocarditis (IE) fatal cases whose diagnosis was first obtained at autopsy were studied. The clinical data of these patients (Group 1) showed significant differences compared to other 141 IE cases (Group 2). The average age of 53 years in Group 1 patients was 18 years higher than that of Group 2. The Group 1 patients had a low frequency of IE predisposing heart disease. Both patient groups presented fever (about 87 percent), but a significant low frequency of cardiac murmur (25.8 percent) was observed in Group 1 patients and echocardiography tests were performed in only 16.1 percent, suggesting that IE diagnosis was not suspected. Likewise, although most Group 1 patients appeared with severe acute illness, they did not present the classic IE clinical presentation. Blood cultures were performed in only 64.5 percent of the Group 1 patients. However, bacteria were isolated in 70 percent of these blood cultures and Staphylococcus aureus was isolated in 71.4 percent. The bacteria attacked mitral and aortic valves. Complications such as embolizations and cardiac failure occurred in almost half of the cases and they also presented with infections of the lungs, urinary tract, and central nervous system. Medical procedures were performed in practically all fatal cases whose diagnosis was first obtained at autopsy. Sepsis occurred in about half of the patients and it was followed by shock in more than 25 percent. This form of IE must be suspected in mature and in old febrile hospitalized patients having infection predisposing diseases, embolization, and suffering medical procedures
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Endocarditis, Bacterial/diagnosis , Autopsy , Brazil/epidemiology , Chi-Square Distribution , Confidence Intervals , Endocarditis, Bacterial/mortalityABSTRACT
Neste trabalho, analisaram-se bactérias isoladas em 180 episódios de endocardite infecciosa, ocorridos em Ribeirão Preto, entre 1992 e 1997, e suas susceptibilidades a antimicrobianos. Hemoculturas foram realizadas em 93,8 por cento dos casos, sendo que, em 60,7 por cento deles, foi identificado, pelo menos, um agente etiológico. As bactérias mais comumente isoladas no pacientes com EI foram Staphylococcus aureus, 31,0 por cento (52/168), Streptococcus viridans, 15,9 por cento (27/168), Streptococcus do Grupo D, 6,6 por cento (11/168), Gram negativas, 5,3 por cento (9/168) e Staphylococcus epidermidis, 4,2 por cento (7/168). Dos Staphylococcus aureus, todos os testados mostraram-se sensíveis à vancomicina e à teicoplanina, 86,5 por cento, mostraram-se sensíveis a aminoglicosídios (gentamicina e amicacina), 85 por cento à cefalosporina de primeira geração (cefalotina) e 79 por cento à oxacilina. Streptococcus viridans isolados, todos foram sensíveis ao cloranfenicol, à vancomicina e apenas dois foram resistentes à ampicilina e à penicilina G. Quanto aos Streptococcus do Grupo D, todos mostraram-se sensíveis à penicilina G, à ampicilina, ao cloranfenicol e à vancomicina
Subject(s)
Humans , Bacterial Infections , Brazil , Endocarditis, Bacterial , Bacteriological Techniques , Endocarditis, BacterialABSTRACT
OBJECTIVE: To analyze the epidemiology, diagnosis, clinical aspects causes and evolution of infectious endocarditis. METHODS: The patients analyzed were treated at the University Hospital of the Faculdade de Medicina of Ribeirão Preto-USP and had a diagnosis of infectious endocarditis defined by Duke's criteria, which classifies infectious endocarditis as native, prosthetic valve or that occurring in intravenous drug users. RESULTS: One hundred and eighty episodes of infectious endocarditis in 168 patients were observed. Echocardiograms in 132 (73.3 per cent) provided a diagnosis of infectious endocarditis in 111 (84 per cent) patients; mitral valves were affected in 55 (30.5 per cent), tricuspid valves in 30 (16.6 per cent) and the aortic valve in 28 (15.5 per cent) patients. Hemocultures were performed in 148 (93.8 per cent) episodes of IE. The most commonly isolated infectious organisms were Staphylococcus aureus in 46 (27.2 per cent) patients and Streptococcus viridans in 27 (15.9 per cent). Complications occurred in 116 (64.4 per cent) patients and 73 (40.5 per cent) of the patients died. CONCLUSION: The general profile of the observed infectious endocarditis was similar to that reported in studies performed in other countries and included users of intravenous drugs. The high degree of mortality observed is not compatible with progress in diagnosis and treatment of infectious endocarditis and is probably due to the absence of diagnostic suspicion. The high frequency of fatal cases of septicemia (45.1 per cent of deaths) in the patients studied indicates that unnoticed cases of infectious endocarditis had only been diagnosed at necropsy.