Taponamiento cardíaco tras punción esternal. Utilidad de la ecografía focussed assessment with sonography for trauma / Cardiac tamponade following sternal puncture. Usefulness of ultrasound focussed assessment with sonography for trauma

La detección de las complicaciones de las pruebas y de los tratamientos que se realizan a los pacientes es uno de los objetivos de los médicos. El diagnóstico precoz de dichas complicaciones puede evitar un desenlace letal. Habitualmente nos basamos en la clínica apoyando el diagnóstico en pruebas complementarias. En los últimos años se han desarrollado pruebas diagnósticas de fácil y rápida ejecución, económicas y mínimamente invasivas. La ecografía focussed assessment with sonography for trauma (eco-FAST) se introdujo en los años 90 en el ámbito de la reanimación como prueba de detección rápida de líquido intraabdominal y pericárdico en el paciente politraumatizado, pero su utilización en otros casos de naturaleza no traumática suscita aún hoy dudas y controversia. Se presenta un caso en el que una paciente sometida a una punción esternal para aspirado medular presentó como complicación un taponamiento cardíaco secundario, que fue diagnosticado de forma precoz mediante eco-FAST (AU)

One of the medical profession is to be able to detect complications in patients during diagnostic tests and treatments. The early diagnosis of these complications can prevent a fatal outcome. The diagnosis is often based on clinical symptoms and supported by complementary tests. Diagnosis tests have been developed in the last few years that are rapid and easy to use, as well as being cost effective and minimally invasive. Focussed assessment with sonography for trauma ultrasound (echo-FAST) was introduced in the 1990s in the field of resuscitacion as a test for the rapid detection of intra-abdominal and pericardial fluid in multiple injury patients, but its uses in other cases not involving trauma still raise doubts and controversy. A case is presented of a patient subjected to a sternal puncture for a bone marrow aspirate, who had a complication of a secondary cardiac tamponade, which was diagnosed early using echo-FAST (AU)

[Cardiac tamponade following sternal puncture. Usefulness of ultrasound focussed assessment with sonography for trauma]. / Taponamiento cardíaco tras punción esternal. Utilidad de la ecografía focussed assessment with sonography for trauma.

One of the aims of the medical profession is to be able to detect complications in patients during diagnostic tests and treatments. The early diagnosis of these complications can prevent a fatal outcome. The diagnosis is often based on clinical symptoms and supported by complementary tests. Diagnostic tests have been developed in the last few years that are rapid and easy to use, as well as being cost effective and minimally invasive. Focussed assessment with sonography for trauma ultrasound (echo-FAST) was introduced in the 1990s in the field of resuscitation as a test for the rapid detection of intra-abdominal and pericardial fluid in multiple injury patients, but its uses in other cases not involving trauma still raise doubts and controversy. A case is presented of a patient subjected to a sternal puncture for a bone marrow aspirate, who had a complication of a secondary cardiac tamponade, which was diagnosed early using echo-FAST.

Synthesis, structure, and nuclease properties of several binary and ternary complexes of copper(II) with norfloxacin and 1,10 phenantroline.

Three new binary Cu(II) complexes of norfloxacin have been synthesized and characterized. We also report the synthesis, characterization and X-ray crystallographic structures of a new binary compound, [Cu(HNor)(2)]Cl(2).2H(2)O (2) and two new ternary complexes norfloxacin-copper(II)-phen, [Cu(Nor)(phen)(H(2)O)](NO(3)).3H(2)O (4), and [Cu(HNor)(phen)(NO(3))](NO(3)).3H(2)O (5). The structure of 2 consists of two crystallographically independent cationic monomeric units of [Cu(HNor)(2)](2+), chloride anions, and uncoordinated water molecules. The Cu(II) ion is placed at a center of symmetry and is coordinated to two norfloxacin ligands which are related through the inversion center. The structures of 4 and 5 consist of cationic units ([Cu(Nor)(phen)(H(2)O)](+) for 4 and [Cu(HNor)(phen)(NO(3))](+) for 5), nitrate counteranions, and lattice water molecules that provide crystalline stability through a network of hydrogen-bond interactions. The complexes exhibit a five coordinated motif in a square pyramidal environment around the metal center. The ability of compounds 4 and 5 to cleave DNA has also been studied. Mechanistic studies with different inhibiting reagents reveal that hydroxyl radicals, singlet oxygen, and superoxide radicals are all involved in the DNA scission process mediated by these compounds.

Antibacterial studies, DNA oxidative cleavage, and crystal structures of Cu(II) and Co(II) complexes with two quinolone family members, ciprofloxacin and enoxacin.

Nine coordination compounds of Cu(II) and Co(II) with Ciprofloxacin (HCp) and Enoxacin (HEx) as ligands have been prepared and characterized. Single crystal structural determinations of [Cu(HCp)2(ClO4)2].6H2O (1) and [Co(HEx)2(Ex)]Cl.2CH(3)OH.12H2O (4) are reported. The crystal of 1 is composed of [Cu(HCp)2(ClO4)2] units with the two perchlorate anions semicoordinated, and uncoordinated water molecules. The copper ion, at a crystallographic inversion centre, is in a tetragonally distorted octahedral environment. The structure of 4 consists of cationic monomeric [Co(HEx)2(Ex)]+ units, chloride anions, and uncoordinated methanol and water molecules. The complex is six-coordinate, with a slightly distorted octahedral environment around the metal centre. Some complexes of ciprofloxacin and enoxacin were screened for their activity against several bacteria, showing activity similar to that of the corresponding free ligands. All compounds tested were more active against Gram-negative bacteria than against Gram-positive bacteria. Ciprofloxacin hydrochloride and its complexes were more active than enoxacin and its complexes. In addition, the bactericidal studies against Staphylococcus aureus ATCC 25923 reveal that one complex exhibits the "paradoxical effect" (diminution in the number of bacteria killed at high drug concentration), which has been described and related to the mechanism of action of quinolones, but three other complexes do not, suggesting different mechanisms of bactericidal action. The ability of Cu(HCp)2(NO3)2.6H2O to cleave DNA has been determined. The results show that the complex behaves as an efficient chemical nuclease with ascorbate/hydrogen peroxide activation. Mechanistic studies using different inhibiting reagents reveal that hydroxyl radicals are involved in the DNA scission process mediated by this compound.

Interactions of metal ions with two quinolone antimicrobial agents (cinoxacin and ciprofloxacin). Spectroscopic and X-ray structural characterization. Antibacterial studies.

Several novel metal-quinolone compounds have been synthesized and characterized by analytical, spectroscopic and X-ray diffraction methods. The crystal structure of the four compounds, Na(2)[(Cd(Cx)3)(Cd(Cx)3(H2O))].12H2O, [Co(Cp)2(H2O)2].9H2O, [Zn(Cp)2(H2O)2].8H2O and [Cd(HCp)2(Cl)2].4H2O, is presented and discussed: HCx=1-ethyl-1,4-dihydro-4-oxo(1,3)-dioxolo(4,5-g)cinnoline-3-carboxylic acid and HCp=1-cyclopropyl-6-fluoro-1,4-dihydro-4-oxo-7-(1-piperazinyl)-3-quinoline carboxylic acid. In all these compounds the quinolone acts as a bidentate chelate ligand that binds through one carboxylate oxygen atom and the exocyclic carbonyl oxygen atom. Complexes of ciprofloxacin were screened for their activity against several bacteria, showing activity similar to that of the ligand. In addition, the number of bacteria killed after 3 h of incubation with the ligand, [Co(Cp)2(H2O)2].9H2O, Ni(Cp)2.10H2O and Cu(Cp)2.6H2O, was determined against S. aureus ATCC25923. There is a direct relationship between the growth rate and the lethal rate. Against growing bacteria, the ligand is the most bactericidal and Cu(Cp)2.6H2O is the less bactericidal. On the contrary, against non-dividing bacteria, the complexes were more bactericidal than the ligand, with Cu(Cp)(2).6H(2)O the most bactericidal compound.

Application of high-performance, thin-layer chromatography to quality control of antimetabolite analogue infusion bags.

A global postproduction quality program was developed to secure chemotherapy infusion at the Gustave Roussy Institute. Despite rigorous procedures and computerized prescriptions, an analytical check was necessary to improve the quality of ready-to-use solutions of cytotoxic drugs in our Centralized Antineoplastics Reconstitution Unit. High-performance, thin-layer chromatography was selected as the analytical tool to assay 12 anticancer drugs. One of the analytical methods can separate 4 antimetabolite substances, i.e., fludarabine (FDB), cytarabine (CTB), gemcitabine (GTB), and fluorouracil (5 FU). For all infusion bags manufactured, up to 26 samples could be assayed per series using a double standard calibration (GTB and 5 FU).

[Role and functional spectrum of HPTLC in a hospital pharmaceutical quality control program]. / Place et spectre fonctionnel de l'HPTLC dans un programme d'assurance qualité pharmaceutique hospitalier.

As part of the development of a quality assurance program (QAP), a high performance thin layer chromatography (HPTLC) analysis unit was installed in the pharmacy department at Gustave-Roussy. The HPTLC-CAMAG consists of: 1) an HPTLC-Vario development chamber for optimization of the mobile phases; 2) TLC Sampler III automated sample applicators; 3) solid teflon migration chambers, i.e., horizontal tanks that enable separation to be carried out either in sandwich or in saturation mode; 4) a TLC Scanner 3 densitometer controlled by CATS 4 software; and 5) a Pentium MMX 233 MHz personal computer with an external backup unit. HPTLC quantitative and qualitative analysis has now reached a remarkably high level of development and performance. The samples (aqueous or non-aqueous solutions) that are to be processed are automatically applied by spraying (50-300 nl) in calibrated bands of a few mm (with up to 64 3-mm bands per 10 x 20 cm plate) on high-performance stationary phases and of wide technological diversity. The chromatogram is obtained in 10 min, and run over a migration pathway of 5-6 cm. The plates are read by absorption-reflection or fluorescence-reflection at an ad hoc wavelength (190-800 nm), then the peak areas which have been scanned are calculated by the trapezoid method. The calibration curves are generated by Michaelis-Menten non-linear regression, and validated by internal quality control. The analytical yield is high, i.e., up to 50 assays and 250 determinations per day. HPTLC analysis covers a wide functional range, and can be used in the following ways: 1) as a teaching tool for separative analysis and GLP; 2) it is an invaluable method for the optimization of mobile phases and for the determination of absorption spectra and absorption maxima, with a view to developing HPLC methods in complex matrices; 3) it provides major support for post-production quality control of prescribed hospital preparations of all types, e.g., those connected with parenteral nutrition, chemotherapy, synthetic narcotic analgesia; and it can also be used for dry dosage analysis; 4) it is useful in pharmaceutical assessment, e.g., in studies on the physico-chemical characteristics of various substances, such as their identity, purity, concentration, stability and compatibility, particularly with regard to generic products; 5) it can contribute to monitoring the safety of medical apparatus and equipment via the analysis of container-content interactions; 6) it provides a qualification system for personnel and procedures for within- and between-center validation of GMP. Setting up such an HPTLC quality control unit requires a basic investment of about 0.9 MF or 70,000 US dollars for a cost of no more than 10 F or 1.5 US dollars (including tax) per routine assay. After 18 months in operation and 16,500 assays, the HPTLC analysis unit has become one of the mainstays of the Gustave-Roussy QAP.

Interactions of metal ions with a 2,4-diaminopyrimidine derivative (trimethoprim). Antibacterial studies.

The interaction of copper (II), zinc(II) and cadmium(II) with Trimethoprim (2,4-diamino-5-(3',4',5'-trimethoxybenzyl) pyrimidine) has been studied. The crystal structures of [Zn(Trim)2Cl2] (2) and [Cd(Trim)Cl2(CH3OH)]n (4) are reported. Compound (2) exhibits a distorted tetrahedral environment around the metal center and crystallizes in the triclinic space group P1 with a=10.2397(6), b=10.4500(6), c=16.3336(16) A, alpha=96.141(8), beta=106.085(5), gamma=96.551(5) degrees and Z=2. In complex (4), the Cd(II) centers are bridged sequentially by two chlorine ions to form infinite chains and present a six-coordinated environment; the compound crystallizes in the monoclinic P2(1)/C space group with a=13.958(5), b=7.532(2), c=18.390(2) A, alpha=90, beta=97.32(5), gamma=90 degrees and Z=4. In both structures the Trimethoprim acts as a monodentate ligand through the pyrimidinic nitrogen N(1) atom. The characterization of the Cu(Trim)2(CH3O)(ClO4) complex through EPR and magnetic measurements suggests a binuclear or polinuclear nature, with bridging methoxo groups. The complexes were screened for their activity against several bacteria, showing activity similar to that of trimethoprim.

Development of Novel DNA Cleavage Systems Based on Copper Complexes. Synthesis and Characterisation of Cu(II) Complexes of Hydroxyflavones.

Copper(II) complexes of several hydroxyflavones were prepared and characterised through their physico-chemical properties. The nuclease activity of three synthesised complexes is reported. These copper(II) complexes present more nuclease activity than the ligands and the copper(II) ion.

Cinoxacin complexes with divalent metal ions. Spectroscopic characterization. Crystal structure of a new dinuclear Cd(II) complex having two chelate-bridging carboxylate groups. Antibacterial studies.

Several cinoxacin (HCx) complexes with divalent metal ions have been prepared and characterized by spectroscopic techniques. The crystal structure of [Cd2(Cx)4(H2O)2].10H2O has been determined by X-ray diffraction. The complex is triclinic, space group P1 with unit-cell dimensions: a = 10.412(2), b = 11.119(2), c = 13.143(6)A, chi== 76.78(4) degrees, beta = 74.59(3) degrees, gamma = 77.12(3) degrees, V = 1406.0(8) A3. In this complex each cadmium atom is heptacoordinated: the metal environment is formed by two Oketo and two Ocarbox atoms from two different cinoxacinate monoanions, two carboxylate oxygen atoms from a third cinoxacinate ligand and by one water oxygen atom on the seventh position. Two of the cinoxacinate ions act as tridentate chelate and bridging ligands and the other one as a bidentate chelate ligand. In the bridging monoanions the carboxylate group is behaving as a chelate ligand. All the complexes were screened for their activity against several bacteria, showing activity similar to that of cinoxacin. Additionally, the number of bacteria killed after 3 h of incubation with cinoxacin, [Cu(Cx)2].2H2O and [Co(Cx)3]Na.10H2O complexes was determined against E. coli ATCC 25922; the copper compound presents paradoxical effect which has been described and related to the mechanism of action of quinolones.

Cobalt(II), nickel(II), and copper(II) complexes of sulfanilamide derivatives: synthesis, spectroscopic studies, and antibacterial activity. Crystal structure of [Co(sulfacetamide)2(NCS)2].

The synthesis and characterization of new coordination compounds of Co(II), Ni(II), and Cu(II) with sulfacetamide (N-[4-(amino-fenil)sulfonil]acetamide) is reported. The complex [Co(sulfacetamide)2(NCS)2] crystallizes in the triclinic space group P-1. The cell dimensions are a = 7.80(2) A, b = 8.327(9) A, c = 9.568(3) A, alpha = 90.5(1) degrees, beta = 90.5(1) degrees, gamma = 97.8(2) degrees, V = 616(1) A3, Z = 2, and Dx = 1.689 g/cm3. The final conventional R-factor = 0.039 (Rw = 0.039) for 3535 "observed" reflections and 173 variables. The Co(II) is surrounded in a regular octahedral arrangement by two Nthyocianato from the NCS, two Namino and two Oacetamido atoms from the sulfacetamide. Each sulfacetamide, acting as a bidentate ligand, chelates two Co(II) ions as a bridge through the Namino and the Oacetamido atoms. IR, Reflectance Diffuse, EPR, and magnetic properties of the obtained complexes are discussed. The complexes were screened for their activity against E. Coli and S. aureus, showing an appreciable antimicrobial activity compared with the ligands.

Synthesis, characterization, and crystal structure of [Cu(cinoxacinate)2].2H2O complex: a square-planar CuO4 chromophore. Antibacterial studies.

The structural and spectroscopic properties of a new copper (II) complex of cinoxacin (HCx) have been investigated. The complex [Cu(Cx)2].2H2O crystallizes in the monoclinic system, space group P2(1)/c. The cell dimensions are: a = 7.998(2), b = 7.622(1), c = 18.955(6) A, beta = 94.38(2) degree, V = 1154.6(6) A3, Z = 2. The structure was refined to R = 0.051. The crystal is composed of [Cu(Cx)2] units and uncoordinated water molecules. The Cu(II) ion, at a center of symmetry, is coordinated to two cinoxacinate (Cx) ligands related by the inversion center. Each cinoxacinate acts as bidentate ligand bonded to the cation through its carboxylate oxygen atom and through its exocyclic carbonyl oxygen atom, resulting in a CuO4 chromophore in a crystallographically planar configuration. The complex was screened for its activity against several bacteria, showing the same antimicrobial activity as the corresponding ligand.

A controlled trial of the tolerance of amphotericin B infused in dextrose or in Intralipid in patients with haematological malignancies.

Patients with haematological malignancies requiring an antifungal therapy were randomly assigned to receive amphotericin B diluted in either 5% dextrose or in fat emulsion (Intralipid). Twenty-one patients were included in each group. Mean duration of amphotericin B therapy was 8.4 days in the dextrose group and 12.8 days in the Intralipid group. Amphotericin B infusion induced chills in 16 of 21 patients in the dextrose group and in 5 of 21 in the Intralipid group (P = 0.0008). Serum creatinine increased > 75% from baseline in ten patients in the dextrose group compared with only two in the Intralipid group (P = 0.007). A > or = 50% decrease of creatinine clearance was observed in 14 of 21 patients in the dextrose group compared with seven of 21 patients in the Intralipid group (P = 0.025). No difference was found between the two groups with regard to potassium and sodium requirement. Among patients who did not receive magnesium before antifungal therapy, magnesium supplementation was required more frequently in the dextrose group (8/12 vs 2/11; P = 0.02). Concomitant amikacin dosage reduction was more frequent in the dextrose group due to nephrotoxicity (7/19 vs 2/20; P = 0.045). A similar difference in vancomycin dosage reduction was observed between the two groups (12/20 vs 5/19; P = 0.03).

Synthesis and spectroscopy studies of copper(II) nitrate of sulfacetamide drug. Crystal structure of [Cu(sulfacetamide)2(NO3)2]. Antibacterial studies.

The structural spectroscopic, and thermal properties of a complex of sulfacetamide (Hsacm) with Cu(II) have been investigated. The complex [Cu(Hsacm)2(NO3)2] crystallizes in the monoclinic system, space group P2(1)/n. The cell dimensions are a = 7.696(7) A, b = 8.017(7) A, c = 19.230(10), beta = 110.80(1) degree, V = 1109(1) A3, Z = 2, and Dx = 1.84 g/cm3. The structure was refined to R = 0.0776. Cu(Hsacm)2(NO3)2 molecules form a long polymeric chain extended along the b-axis. The copper(II) coordinated geometry is tetragonally distorted octahedral with two amino nitrogens from Hsacm and two oxygens from nitrato anions in the basal plane and two acetamido oxygens from neighbor Hsacm molecules in the apical position. Each sulfacetamide, acting as a bidentate ligand, links two Cu(II) ions as a bridge through the Namino and the Oacetamido atoms. The complex proved to possess higher bacteriostatic activity than the corresponding ligand.

Metal complexes of phenobarbituric acid. Chelating behavior of the phenobarbiturate ring. Anticonvulsant properties of the K2[Cu(N-methylphenobarbiturato)]4.8H2O.

Na2Ni(phenobarbiturato)4.3H2O, Na2Ni3(phenobarbiturato)2(OH)6.4H2O, and NaZn(phenobarbiturato)2(OH).H2O derivatives were prepared from Ni(II) and Zn(II) and phenobarbital. The Na2Ni(phenobarbiturato)4.3H2O complex is diamagnetic and isostructural with the complex previously reported, Na2Cu(phenobarbiturato)4, suggesting a square-planar environment around the Ni(II) ion. The DMF solutions of this complex show the existence of two species. The EPR spectra of the Cu(II) doped complex show the hyperfine and superhyperfine structures. The covalence parameters Alpha2, Beta2, and Delta2 show a strong bonding in the equatorial plane and suggests the formation of a [CuN4] chromophore. The anticonvulsant properties of the K2Cu(N-methylphenobarbiturato)4.8H2O are reported.

Ternary complexes of Cu(II) ion with cimetidine and L-alanine.

(Cu(CM)A)B(C6H5)4 and Cu(CM)A(OH) X H2O (CM = cimetidine and HA = L-alanine) were prepared and characterized by elemental analysis, TG-DTA, IR, and electronic spectral data and magnetic susceptibility measurements. The EPR spectrum of (Cu(CM)A)B(C6H5)4 shows a distorted octahedral environment for the Cu(II) ion.