RESUMEN
Aims Burkitt Lymphoma (BL) accounts for approximately 40% of childhood non-Hodgkin Lymphoma (NHL) in the developed world. Survival rates have improved dramatically in recent years, a success attributed to better use of poly-chemotherapy and targeted immunotherapy. Nevertheless, relapse is unpredictable and carries a dismal prognosis. We report on event-free survival (EFS) and overall survival (OS) rates in the Republic of Ireland (ROI) during 2000-2017, and evaluate novel predictors of outcome. Methods Data was collected by retrospective review of patient medical records. Results Thirty-three patients were identified (twenty-five [76%] males, eight [24%] females), fourteen [42%] having stage III disease at presentation. Six [18%] had stage IV disease. Five [15%] had refractory disease; one salvaged with allogeneic stem cell transplantation. Of the four [12%] who died; two [50%] had weights >99th centile, one [25%] >90th centile. One died during induction from refractory lactic acidosis, one from early relapse. Discussion EFS and OS was 85% and 89% respectively; in keeping with the best international standards. Obesity appears to be a poor predictor of outcome in our cohort.
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Linfoma de Burkitt , Adolescente , Linfoma de Burkitt/tratamiento farmacológico , Linfoma de Burkitt/epidemiología , Linfoma de Burkitt/terapia , Niño , Estudios de Cohortes , Femenino , Humanos , Inmunoterapia , Masculino , Obesidad , Estudios RetrospectivosAsunto(s)
Enfermedades del Ciego/diagnóstico por imagen , Perforación Intestinal/diagnóstico por imagen , Neumoperitoneo/diagnóstico por imagen , Anciano , Antiinflamatorios no Esteroideos/efectos adversos , Enfermedades del Ciego/inducido químicamente , Humanos , Perforación Intestinal/inducido químicamente , Masculino , Neumoperitoneo/etiología , Radiografía , Fracturas de la Columna Vertebral/terapiaRESUMEN
Surgical site infections (SSIs) are a serious problem worldwide. Little is known about the epidemiology of SSI in the former Soviet Union. In order to determine the prevalence and predictors of SSI in the Republic of Georgia, we undertook a multicentre observational study of SSIs in three urban hospitals in the capital, Tbilisi. Point prevalence studies (PPS) were performed every 3-5 weeks from September 2000 to January 2002 using the National Nosocomial Infections Surveillance (NNIS) System definitions. All patients who had undergone surgery and were present in participating departments at study hospitals on the day of PPS were included. Of 872 surgical procedures, 146 (16.7%) were complicated by SSI. The prevalence of SSI varied by procedure and risk category. On multivariate regression analysis, age, wound class, one hospital (B) and urological surgery were predictive of SSI. In a separate model, NNIS risk index was highly predictive of SSI. Antibiotic prophylaxis was rare (29.5% of operations), while postoperative antibiotic use was common. SSI is an important problem in the Republic of Georgia. Potential areas for intervention include antibiotic prophylaxis and shaving practices for skin preparation.
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Infección Hospitalaria/epidemiología , Infección de la Herida Quirúrgica/epidemiología , Factores de Edad , Antibacterianos/uso terapéutico , Profilaxis Antibiótica/estadística & datos numéricos , Femenino , Georgia (República)/epidemiología , Hospitales Urbanos , Humanos , Masculino , Análisis Multivariante , Prevalencia , Medición de Riesgo , Factores de Riesgo , Procedimientos Quirúrgicos UrológicosRESUMEN
Medical advances are often technology driven. One of the new technologies used in imaging is the positron emission tomography (PET)-computed tomography (CT) scanner, which combines the advantages of the functional imaging of PET with CT. This enables both functional and anatomical data to be acquired at the same time. However, such technology is expensive and not always widely available. In the assessment of patients suffering from non-small-cell lung cancer the only curative treatment is surgery or radical radiotherapy, but this is only possible if disease is limited to the affected lung and local nodes. Imaging with CT has not been reliable in determining disease load and many patients undergo futile thoracotomies, which are both expensive and also carry a significant morbidity. In this clinical scenario there is evidence that (18)F fluorodeoxyglucose PET-CT is the best discriminator of disease load and, if used in the correct clinical setting, will not only reduce the number of futile operations but also reduce costs.
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Fluorodesoxiglucosa F18/economía , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/economía , Tomografía de Emisión de Positrones/economía , Tomografía Computarizada por Rayos X/economía , Análisis Costo-Beneficio , Humanos , Tomografía de Emisión de Positrones/instrumentación , Tomografía Computarizada por Rayos X/instrumentaciónRESUMEN
BACKGROUND AND AIM: Selective internal radiation therapy with 90Y microspheres (SIR spheres) is increasingly used in the treatment of extensive liver tumours. Careful selection and preparation of patients are necessary to avoid possible adverse effects. We aimed to evaluate the incidence and severity of adverse effects resulting from the administration of SIR spheres during therapy. MATERIALS AND METHODS: Between June 2004 and August 2006, 21 patients (11 women and 10 men; age range 40-75 years; mean, 58 years) with a wide range of extensive liver tumours were treated with SIR spheres. The mean administered dose was 1.87 GBq (range 1.2-2.5 GBq). During the follow-up period of 26 months, all adverse effects were monitored and classified according to the National Cancer Institute criteria. RESULTS: Four patients had adverse effects: one case of cholecystitis followed by fibrosis and portal hypertension, one case of peptic ulceration and two cases of radiation hepatitis. All cases responded to appropriate therapy. CONCLUSION: Proper selection of patients and accurate interpretation of pre-treatment investigations are vital for minimizing adverse effects following therapy with SIR spheres. In our experience, all adverse effects were moderate with no life-threatening consequences.
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Carcinoma Hepatocelular/patología , Carcinoma Hepatocelular/radioterapia , Neoplasias Hepáticas/patología , Neoplasias Hepáticas/radioterapia , Microesferas , Radioisótopos de Itrio/efectos adversos , Radioisótopos de Itrio/uso terapéutico , Adulto , Anciano , Colecistitis/etiología , Femenino , Fibrosis/etiología , Humanos , Hipertensión Portal/etiología , Masculino , Persona de Mediana Edad , Úlcera Péptica/etiología , Tomografía Computarizada por Rayos XAsunto(s)
Fluorodesoxiglucosa F18 , Tomografía de Emisión de Positrones/métodos , Fístula Rectal/diagnóstico por imagen , Fístula de la Vejiga Urinaria/diagnóstico por imagen , Reflujo Vesicoureteral/diagnóstico por imagen , Anciano , Humanos , Masculino , Radiofármacos , Fístula Rectal/complicaciones , Fístula de la Vejiga Urinaria/complicaciones , Reflujo Vesicoureteral/etiologíaAsunto(s)
Hemorragia/etiología , Arteria Hepática/lesiones , Hígado/lesiones , Traumatismo Múltiple/diagnóstico , Heridas por Arma de Fuego/diagnóstico , Adulto , Implantación de Prótesis Vascular , Colangiopancreatografia Retrógrada Endoscópica , Conducto Colédoco/lesiones , Conducto Colédoco/cirugía , Embolización Terapéutica , Urgencias Médicas , Extravasación de Materiales Terapéuticos y Diagnósticos , Hemorragia/diagnóstico , Hemorragia/terapia , Arteria Hepática/cirugía , Humanos , Masculino , Traumatismo Múltiple/terapia , Intensificación de Imagen Radiográfica , Stents , Tomografía Computarizada por Rayos X , Heridas por Arma de Fuego/terapiaAsunto(s)
Infecciones por Citomegalovirus/prevención & control , Ganciclovir/uso terapéutico , Inmunización Pasiva , Inmunoglobulinas/uso terapéutico , Trasplante de Hígado , Adulto , Antivirales/uso terapéutico , Terapia Combinada , Ciclosporina/uso terapéutico , Citomegalovirus/inmunología , Infecciones por Citomegalovirus/inmunología , Infecciones por Citomegalovirus/transmisión , Femenino , Humanos , Inmunización Pasiva/efectos adversos , Inmunoglobulinas/efectos adversos , Inmunoglobulinas Intravenosas , Inmunosupresores/uso terapéutico , Masculino , Persona de Mediana Edad , Muromonab-CD3/uso terapéutico , Placebos , Donantes de TejidosRESUMEN
Enzyme replacement therapy for the lysosomal storage disorders derives its impetus from the successes achieved in the treatment of Gaucher disease. After nearly two decades of persistent but unsuccessful efforts, the promise of therapy through enzyme replacement was losing credibility. Then, the fortunate intersection of two different lines of scientific research produced the necessary breakthrough. The dramatic responses to enzyme replacement therapy in patients with Gaucher disease made it immediately clear that this treatment approach was a success. Furthermore, the large number of patients with the disorder guaranteed commercial involvement. The lessons learned from the development of enzyme replacement therapy for Gaucher disease are broadly applicable to other lysosomal storage diseases and will be reviewed in this paper.
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Enfermedad de Gaucher/enzimología , Enfermedad de Gaucher/terapia , Glucosilceramidasa/uso terapéutico , Enfermedad de Gaucher/genética , Enfermedad de Gaucher/patología , Glucosilceramidasa/efectos adversos , Hemoglobinas/metabolismo , Humanos , FenotipoAsunto(s)
Absceso/complicaciones , Neoplasias de la Mama/complicaciones , Neoplasias del Ciego/complicaciones , Infecciones por Clostridium/complicaciones , Clostridium/aislamiento & purificación , Absceso/microbiología , Adenocarcinoma/complicaciones , Adenocarcinoma/microbiología , Anciano , Anciano de 80 o más Años , Enfermedades de la Mama/microbiología , Neoplasias de la Mama/microbiología , Neoplasias del Ciego/microbiología , Femenino , Humanos , Neoplasias Primarias MúltiplesRESUMEN
BACKGROUND/PURPOSE: Controversy persists in the management of perforated appendicitis with regard to antibiotic choice and duration, operative timing, drain utilization, and wound closure. For 2 decades at the authors' institution, patients were treated with ampicillin, gentamicin, and clindamycin for 10 inpatient days, with drains in the abdomen, resulting in lower complication rates than most other published series. Managed care pressures have led to less aggressive medical management regimens with length of stay and financial factors viewed as principal outcome measures with little emphasis on clinical outcomes. In addition, there are little prospective data on clinical outcomes. The authors sought to determine whether our previously documented excellent quality outcomes could be maintained when modifications aimed at decreasing cost and length of stay in our protocol were instituted. METHODS: The authors monitored prospectively clinical outcomes in patients with perforated appendicitis treated according to their clinical practice guidelines over a 43-month period. Patients received a single antibiotic, piperacillin-tazobactam, intravenously for 10 days. They were permitted to go home with a percutaneous intravenous catheter for the final 5 days if medical and social criteria were met. Other practices from our earlier protocol were continued, including immediate operation, placement of Penrose drains, and primary wound closure. RESULTS: Of 150 patients treated on our protocol, major complications included intraabdominal abscess in 5 (3.3%), cecal fistula in 2 (1.3%), phlegmon in 3 (2.0%), wound infection in 4 (2.7%), and no small bowel obstructions requiring operation. None of these complications, nor their aggregate, were significantly more common than those reported in 373 patients treated over 11 years on the authors' prior protocol (chi2, P > .05). CONCLUSIONS: Prospective outcome analysis of our protocol shows that a single broad-spectrum antibiotic (allowing portions of therapy to be delivered less expensively on an outpatient basis) effectively can treat postoperative appendicitis with very few infectious complications. These outcome data provide baseline against which future protocols can be compared. All treatment modifications aimed at decreasing costs must be analyzed to ensure quality of care is not unduly compromised.
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Apendicitis/cirugía , Perforación Intestinal/cirugía , Adolescente , Antibacterianos/administración & dosificación , Apendicitis/complicaciones , Apendicitis/economía , Niño , Preescolar , Drenaje , Terapia de Infusión a Domicilio , Precios de Hospital , Humanos , Lactante , Perforación Intestinal/complicaciones , Perforación Intestinal/economía , Tiempo de Internación , Evaluación de Resultado en la Atención de Salud , Complicaciones Posoperatorias , Estudios Prospectivos , Rotura EspontáneaRESUMEN
The cloning, purification, and characterization of MagIII, a 3-methyladenine DNA glycosylase from Helicobacter pylori, is presented in this paper. Sequence analysis of the genome of this pathogen failed to identify open reading frames potentially coding for proteins with a 3-methyladenine DNA glycosylase activity. The putative product of the HP602 open reading frame, reported as an endonuclease III, shares extensive amino acid sequence homology with some bacterial members of this family and has the canonic active site helix-hairpin-helix-GPD motif. Surprisingly, this predicted H. pylori endonuclease III encodes a 25,220-Da protein able to release 3-methyladenine, but not oxidized bases, from modified DNA. MagIII has no abasic site lyase activity and displays the substrate specificity of the 3-methyladenine-DNA glycosylase type I of Escherichia coli (Tag) because it is not able to recognize 7-methylguanine or hypoxanthine as substrates. The expression of the magIII open reading frame in null 3-methyladenine glycosylase E. coli (tag alkA) restores to this mutant partial resistance to alkylating agents. MagIII-deficient H. pylori cells show an alkylation-sensitive phenotype. H. pylori wild type cells exposed to alkylating agents present an adaptive response by inducing the expression of magIII. MagIII is thus a novel bacterial member of the endonuclease III family, which displays biochemical properties not described for any of the members of this group until now.
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Proteínas Bacterianas , Desoxirribonucleasa (Dímero de Pirimidina) , Endodesoxirribonucleasas/química , Proteínas de Escherichia coli , Helicobacter pylori/enzimología , N-Glicosil Hidrolasas/química , N-Glicosil Hidrolasas/clasificación , Secuencias de Aminoácidos , Secuencia de Aminoácidos , Sitios de Unión , Western Blotting , Cromatografía Líquida de Alta Presión , Aductos de ADN/metabolismo , ADN Glicosilasas , Relación Dosis-Respuesta a Droga , Electroforesis en Gel de Poliacrilamida , Endodesoxirribonucleasas/clasificación , Inducción Enzimática , Lisina/química , Metilmetanosulfonato/farmacología , Metilnitronitrosoguanidina/farmacología , Datos de Secuencia Molecular , Mutagénesis , N-Glicosil Hidrolasas/genética , Sistemas de Lectura Abierta , Plásmidos , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Homología de Secuencia de Aminoácido , Especificidad por Sustrato , Transcripción GenéticaRESUMEN
OBJECTIVE: To compare a surveillance definition of noso comial bloodstream infections requiring only microbiology data to the Centers for Disease Control and Prevention's (CDC) current definition. SETTING: Six teaching hospitals. METHODS: We classified a representative sample of 73 positive blood cultures from six hospitals growing common skin contaminant isolates using a definition for bacteremia requiring only microbiology data and the CDC definition for primary bloodstream infection (National Nosocomial Infections Surveillance [NNIS] System review method). The classifications assigned during routine prospective surveillance also were noted, and the time required to classify isolates by the two methods was compared. RESULTS: Among 65 blood cultures growing common skin contaminant isolates obtained from adults, the agreement rate between the microbiology data method and the NNIS review method was 91%. Agreement was significantly poorer for the eight blood cultures growing common skin contaminant isolates obtained from pediatric patients. The microbiology data method requires approximately 20 minutes less time per isolate than does routine surveillance. CONCLUSIONS: A definition based on microbiology data alone yields the same result as the CDC's definition in the large majority of instances. It is more resource-efficient than the CDC's current definition.
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Infección Hospitalaria/microbiología , Control de Infecciones/métodos , Técnicas Microbiológicas/normas , Vigilancia de la Población/métodos , Sepsis/microbiología , Adulto , Centers for Disease Control and Prevention, U.S. , Niño , Hospitales , Humanos , Estudios Prospectivos , Reproducibilidad de los Resultados , Estudios Retrospectivos , Sensibilidad y Especificidad , Factores de Tiempo , Estados UnidosRESUMEN
Continuous quality improvement (CQI) is a powerful methodology for improving clinical outcomes and patient satisfaction while reducing inefficiency and costs. However, most hospitals in low- and middle-income countries have little experience with CQI methods. Hospital infection prevention is an ideal model for nascent efforts to improve the quality of hospital care because of its proven efficacy in reducing the occurrence of infections that compromise patient outcomes and increase costs. This article describes the design and implementation of a demonstration project to reduce the incidence of surgical-site infections (SSIs) for hospitals with little experience with quality-improvement methods. The project has a high likelihood of producing measurable reductions in SSI rates and hospital costs related to inefficient use of perioperative antimicrobial prophylaxis. Moreover, participating staff will gain experience that can be applied to efforts to improve the quality of other aspects of hospital care.
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Países en Desarrollo , Administración Hospitalaria/normas , Control de Infecciones/organización & administración , Modelos Organizacionales , Infección de la Herida Quirúrgica/prevención & control , Gestión de la Calidad Total/organización & administración , Investigación sobre Servicios de Salud/organización & administración , Humanos , Incidencia , Evaluación de Procesos y Resultados en Atención de Salud , Satisfacción del Paciente , Pobreza , Proyectos de InvestigaciónAsunto(s)
Clozapina/farmacología , Dopamina/metabolismo , Núcleo Accumbens/fisiología , Antagonistas de la Serotonina/farmacología , Administración Oral , Animales , Clozapina/administración & dosificación , Cuerpo Estriado/efectos de los fármacos , Cuerpo Estriado/fisiología , Estimulación Eléctrica , Técnicas In Vitro , Núcleo Accumbens/efectos de los fármacos , Potasio/farmacología , Ratas , Antagonistas de la Serotonina/administración & dosificación , Factores de TiempoRESUMEN
The authors overview tibialis posterior dysfunction (TPD) with emphasis on a criteria-oriented surgical protocol for management of the various clinical and pathologic stages of TPD. Subluxation of the peroneal tendons is also detailed with respect to diagnosis and treatment.