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1.
Breast ; 19(3): 219-25, 2010 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-20167490

RESUMEN

The purpose of this study was to determine the safety and efficacy of percutaneous ultrasound (US) guided preferential radiofrequency ablation (PRFA) of unifocal human invasive breast carcinoma with largest radiological diameters of up to 16 mm. Thirty-three patients were enrolled in a study to be treated prior to scheduled partial mastectomy. A needle-shaped treatment electrode, successively developed in two different sizes, was placed into the center of the lesions using ultrasound guidance. A temperature of 85 degrees C was maintained for 10 min. The analysis of the resected specimen was performed using conventional histopathological methods with the aim to determine the size of the lesion as well as the potential viability of tumor cells. Of the 33 patients enrolled 31 were treated. In 26 (84%) patients a complete ablation of the tumor was achieved. Ultrasound guided preferential radiofrequency ablation of small breast carcinoma is feasible and patient friendly. The success rate depends on accurate preoperative diagnostic imaging as well as an exact position of the needle electrode.


Asunto(s)
Neoplasias de la Mama/cirugía , Carcinoma/cirugía , Ablación por Catéter/métodos , Cirugía Asistida por Computador , Ultrasonografía Intervencional , Ultrasonografía Mamaria , Anciano , Anciano de 80 o más Años , Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/patología , Carcinoma/diagnóstico por imagen , Carcinoma/patología , Estudios de Factibilidad , Femenino , Humanos , Mastectomía , Persona de Mediana Edad , Proyectos Piloto , Resultado del Tratamiento
2.
BMC Microbiol ; 8: 103, 2008 Jun 25.
Artículo en Inglés | MEDLINE | ID: mdl-18578864

RESUMEN

BACKGROUND: Among tuberculosis (TB) high incidence regions, Sub-Saharan Africa is particularly affected with approx. 1.6 million new cases every year. Besides this dramatic situation, data on the diversity of Mycobacterium tuberculosis complex (MTBC) strains causing this epidemic in this area are only sparsely available. Here we analyzed the population structure of strains from Sierra Leone with a special focus on the prevalence of M. africanum. RESULTS: A total of 97 strains isolated from smear positive cases registered for re-treatment in the Western Area and Kenema districts in years 2003/2004 were investigated by susceptibility testing (first line drugs) and molecular typing (IS6110 fingerprinting, spoligotyping, and MIRU-VNTR typing). Among the strains analyzed, 32 were resistant to isoniazid, and 11 were multidrug resistant (at least resistant to isoniazid and rifampin). The population diversity was high with two previously described M. africanum lineages (West African-1, n = 6; West African-2, n = 17) and seven M. tuberculosis lineages (Haarlem, n = 14; LAM, n = 15; EAI, n = 4; Beijing, n = 4; S-type, n = 4, X-type, n = 1; Cameroon, n = 4). Furthermore, two new M. tuberculosis genotypes Sierra Leone-1 (n = 7) and -2 (n = 10) were found. Strain classification according to a 7 bp deletion in pks1/15 revealed that the majority of M. tuberculosis strains belonged to the Euro American lineage (66 out of 74). CONCLUSION: Resistance rates in Sierra Leone have reached an alarming level. The population structure of MTBC strains shows an intriguing diversity raising the question of possible consequences for TB epidemic and for the introduction of new diagnostic tests or treatment strategies in West Africa.


Asunto(s)
Variación Genética , Mycobacterium/clasificación , Mycobacterium/aislamiento & purificación , Tuberculosis Resistente a Múltiples Medicamentos/microbiología , Tuberculosis Pulmonar/microbiología , Antituberculosos/farmacología , Dermatoglifia del ADN , ADN Intergénico/genética , Farmacorresistencia Bacteriana Múltiple , Humanos , Repeticiones de Minisatélite , Mycobacterium/efectos de los fármacos , Mycobacterium/genética , Estudios Retrospectivos , Sierra Leona/epidemiología , Tuberculosis Resistente a Múltiples Medicamentos/epidemiología , Tuberculosis Pulmonar/epidemiología
3.
Anesth Analg ; 102(1): 104-9, 2006 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-16368813

RESUMEN

Frakefamide (FF), is a new peripherally acting mu-opioid receptor agonist. The aim of this double-blind, randomized, double-dummy, four-way, crossover study was to investigate FF effects on hypercarbic and hypoxic ventilation at steady-state after a 6-h infusion. We compared the effect with 2 clinical doses of morphine (M-small and M-large) and placebo in 12 healthy men. The subjects received 1.22 mg/kg of FF, 0.44 mg/kg of M-large, and 0.11 mg/kg of M-small. Sodium chloride 9 mg/mL was used as placebo. Ventilation was studied by pneumotachography and in-line capnography. There were no ventilatory effects caused by FF or placebo. As expected, large doses of morphine influenced both hypercarbic and hypoxic ventilatory responses. We conclude that there were no signs of central respiratory depression caused by FF after 6 h of constant infusion, which supports a peripheral action of the compound. However, morphine caused a dose-dependent central depression during the hypercarbic ventilatory response and a mild depression of hypoxic ventilatory response.


Asunto(s)
Analgésicos Opioides , Hipercapnia/fisiopatología , Hipoxia/fisiopatología , Morfina , Oligopéptidos , Ventilación Pulmonar/efectos de los fármacos , Adolescente , Adulto , Analgésicos Opioides/efectos adversos , Estudios Cruzados , Método Doble Ciego , Humanos , Hipercapnia/inducido químicamente , Hipoxia/inducido químicamente , Masculino , Persona de Mediana Edad , Morfina/efectos adversos , Oligopéptidos/efectos adversos , Placebos , Ventilación Pulmonar/fisiología
4.
Lakartidningen ; 102(34): 2296-9, 2301, 2302-3, 2005.
Artículo en Sueco | MEDLINE | ID: mdl-16167628

RESUMEN

We followed 300 Stockholm women, aged 30 to 65, for ten years to examine their health at the end of their working life and adaptation to retirement. Less than half of the initially healthy women were working until the retirement age of 65. More women left their working lives due to work related causes, than because of illness. Baseline assessments of stress at work and stress in the family were more important determinants of ill health than were life style (smoking, alcohol intake, exercise) and standard risk factors (lipid and hemostatic profile, blood pressure and obesity). The distribution of deaths and sickness pensions followed an expected social gradient with a higher frequency in women of lower social class, whereas the reverse was true for long-term sick leave (over 28 days). To stop working before the age of 65, with or without economic compensation, may be interpreted as an effective "coping-mechanism" available to well educated women, in order to avoid life-threatening illness.


Asunto(s)
Estado de Salud , Jubilación , Ausencia por Enfermedad , Salud de la Mujer , Mujeres Trabajadoras , Adaptación Psicológica , Adulto , Anciano , Femenino , Humanos , Estilo de Vida , Persona de Mediana Edad , Jubilación/psicología , Jubilación/estadística & datos numéricos , Factores de Riesgo , Ausencia por Enfermedad/estadística & datos numéricos , Factores Socioeconómicos , Estrés Psicológico , Suecia/epidemiología , Mujeres Trabajadoras/psicología , Mujeres Trabajadoras/estadística & datos numéricos , Carga de Trabajo
5.
Anesth Analg ; 100(3): 713-717, 2005 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-15728057

RESUMEN

In animal models frakefamide (FF) is a potent analgesic that acts as a peripheral active mu-selective receptor agonist. In this double-blind, randomized, double dummy four-way crossover study in 12 healthy male subjects, we investigated the effects on resting ventilation of FF and 2 dose levels of morphine compared with placebo. Each drug was infused for 6 h. The subjects received 1.22 mg/kg FF, 0.43 mg/kg morphine (M-large), and 0.11 mg/kg morphine (M-small). Sodium chloride 9 mg/mL was used as placebo. Ventilation was measured by pneumotachography and inline capnography. Blood was collected and plasma concentrations of FF and morphine and its metabolites were analyzed. Within 15 min after administration of FF all subjects complained of a transient myalgia, which disappeared within 30 min. At target measurement (335 min), there were no differences in tidal volume among the groups. Respiratory rates were, however, slower in the two M-groups (P < 0.05 in M-small and P < 0.001 in M-large) compared with FF and placebo. Minute volume was significantly less in the M-large group compared with the FF (P < 0.01) and placebo (P < 0.01) groups. This difference was reflected by an elevated ETco(2) in the M-large group (P < 0.01). We conclude that, during resting ventilation, FF, unlike morphine, did not cause central respiratory depression. This suggests that FF has only peripheral mu-opioid agonist activity in humans.


Asunto(s)
Analgésicos Opioides/farmacología , Morfina/farmacología , Oligopéptidos/farmacología , Receptores Opioides mu/agonistas , Respiración/efectos de los fármacos , Adolescente , Adulto , Analgésicos Opioides/sangre , Método Doble Ciego , Humanos , Masculino , Persona de Mediana Edad , Morfina/sangre , Oligopéptidos/sangre
6.
Acta Orthop Scand ; 75(6): 756-61, 2004 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-15762268

RESUMEN

BACKGROUND: Subchondral bone necrosis is important in osteonecrosis, Mb Kienboeck, intraarticular fractures or osteochondral grafting. As revascularization follows, bone resorption may lead to collapse in load bearing areas during the remodeling. Bisphosphonates are potent osteoclast inhibitors. Our hypothesis was that local bisphosphonate treatment of an osteochondral graft, in a high load environment, would protect the subchondral bone from collapse and maintain the joint architecture during remodeling. To investigate this, we used a rat bone chamber model to subject a necrotic osteochondral graft to a large mechanical load during remodeling. METHOD: Cylindrical osteochondral grafts were taken from the patellar groove of rats, one end of the cylinder being the joint surface. The grafts were frozen, thawed and treated with alendronate. The length of the cylinder was measured and the grafts were placed in the chambers, which were inserted into the proximal tibia of rats. The chambers were left to heal in for two weeks to allow establishment of a vascular supply, and then the transplanted osteochondral plugs were mechanically loaded for 4 weeks, once a day with 10 cycles of 2 MPa pressure at 0.16 Hz. RESULTS: At harvest, the graft length had decreased during remodeling in 5 of the 6 untreated controls, but only in 2 out of 8 alendronate-treated rats (p = 0.05). Histologically, the bone graft in the non-treated controls was resorbed in the remodeled part of the graft, whereas in the alendronate-treated rats a dense trabecular bone was found consisting of both new bone and graft. INTERPRETATION: Local treatment of the graft with bisphosphonate diminishes the risk of collapse during revascularization and bone remodeling in a mechanically loaded osteochondral graft. This could be useful in a variety of situations when bone remodeling occurs after a necrosis close to a joint, either spontaneously after osteonecrosis or a fracture, or after surgical procedures such as mosaic-plasty or other osteochondral grafting.


Asunto(s)
Alendronato/farmacología , Remodelación Ósea/efectos de los fármacos , Resorción Ósea/prevención & control , Trasplante Óseo , Osteonecrosis/prevención & control , Animales , Fenómenos Biomecánicos , Trasplante Óseo/patología , Rechazo de Injerto/prevención & control , Ratas , Ratas Sprague-Dawley , Factores de Riesgo
7.
Anesth Analg ; 96(2): 570-5, table of contents, 2003 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-12538214

RESUMEN

Sameridine is a new compound with both local anesthetic and opioid properties (partial micro -opioid receptor agonist). It was intended for intrathecal administration to provide anesthesia for surgery and extended postoperative analgesia. In this double-blinded pharmacodynamic study with a two-parallel-group design, we investigated, during a 24-h period, the effects of intrathecal sameridine and bupivacaine on ventilation at rest and at ventilatory challenges during hypercarbia and hypoxia. Twenty-four healthy volunteers received either 25 mg of sameridine or 15 mg of bupivacaine intrathecally. Ventilation was measured by pneumotachography and in-line capnography. Sedation was rated by a visual analog scale. Segmental spread and development of motor and sensory block were similar in both groups. There was a decrease in tidal volume 2.5 to 6 h after injection in the bupivacaine group. This was seen only at 4 h in the sameridine group. There were no other major ventilatory differences between sameridine and bupivacaine during resting ventilation. Hypercarbic (tidal volume, mean inspiratory flow) and hypoxic (mean inspiratory flow) ventilatory responses were slightly decreased in the sameridine group, but not in the bupivacaine group. We conclude that intrathecal administration of sameridine or bupivacaine in healthy volunteers produces similar, minor effects on ventilatory responses over a 24-h observation period.


Asunto(s)
Anestésicos Locales/efectos adversos , Bupivacaína/efectos adversos , Dióxido de Carbono/metabolismo , Hipoxia/metabolismo , Piperidinas/efectos adversos , Adulto , Algoritmos , Anestésicos Locales/farmacocinética , Bupivacaína/farmacología , Sedación Consciente , Método Doble Ciego , Electrocardiografía/efectos de los fármacos , Femenino , Humanos , Inyecciones Espinales , Masculino , Monitoreo Intraoperatorio , Neuronas Motoras/efectos de los fármacos , Bloqueo Nervioso , Neuronas Aferentes/efectos de los fármacos , Piperidinas/farmacología , Receptores Opioides mu/agonistas , Mecánica Respiratoria/efectos de los fármacos
8.
Anesthesiology ; 98(1): 143-50, 2003 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-12502990

RESUMEN

BACKGROUND: In this open, randomized study, the pharmacokinetics, clinical efficacy, and safety of a 48-h continuous interscalene infusion of 2 mg/ml ropivacaine for postoperative pain relief were investigated in patients undergoing open major shoulder surgery. METHODS: An initial interscalene block with 30 ml ropivacaine, 7.5 mg/ml (225 mg), was performed. After completion of interscalene block, all patients (n = 24) received general anesthesia, and 6 h after interscalene block, a 48-h continuous interscalene infusion of 12 or 18 mg/h using 2 mg/ml ropivacaine was started. Total and unbound plasma concentrations of ropivacaine and 2.6-pipecoloxylidide (PPX; a major active metabolite) were determined during and up to 6 h after the interscalene infusion. Postoperative pain at rest was assessed by a visual analog scale. Supplementary analgesics and adverse events were recorded. RESULTS: Plasma concentrations of total and unbound ropivacaine were proportional to the total dose. At the end of the interscalene infusion of 9 ml/h, the mean +/- SD plasma concentrations of total and unbound ropivacaine were 1.40 +/- 0.54 and 0.03 +/- 0.01 mg/l, respectively, and of total and unbound PPX were 0.70 +/- 0.38 and 0.30 +/- 0.20 mg/l, respectively. Plasma concentrations of unbound ropivacaine and unbound PPX, added together, remained well below threshold levels for systemic central nervous system toxicity. There were no significant differences between the groups for postoperative pain (median maximum of about 20 mm on the visual analog scale in both groups), analgesic consumption, or quality of pain relief assessed by the patient. No signs or symptoms of systemic local anesthetic toxicity were observed. CONCLUSION: A 48-h continuous interscalene infusion of 6 or 9 ml/h ropivacaine, 2 mg/ml, started 6 h after an initial interscalene block of 30 ml ropivacaine, 7.5 mg/ml, provided satisfactory postoperative pain relief after major shoulder surgery and was well tolerated. Unbound plasma concentrations of ropivacaine and PPX remained well below threshold levels for systemic central nervous toxicity.


Asunto(s)
Amidas , Analgesia , Anestésicos Locales , Bloqueo Nervioso , Dolor Postoperatorio/tratamiento farmacológico , Dolor de Hombro/tratamiento farmacológico , Hombro/cirugía , Adolescente , Adulto , Anciano , Amidas/farmacocinética , Anestésicos Locales/farmacocinética , Biotransformación , Plexo Braquial , Relación Dosis-Respuesta a Droga , Femenino , Semivida , Hemodinámica/efectos de los fármacos , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Ortopédicos , Dimensión del Dolor , Ropivacaína , Dolor de Hombro/etiología
9.
J Cardiothorac Vasc Anesth ; 16(3): 294-9, 2002 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-12073199

RESUMEN

OBJECTIVE: To evaluate if the calcium channel blocker diltiazem protects postoperatively renal function in cardiac surgical patients with preexisting mild-to-moderate renal dysfunction. DESIGN: Prospective, randomized, placebo-controlled, double-blind, clinical study. SETTING: Cardiothoracic anesthesia department at a university hospital. PARTICIPANTS: Adult patients undergoing elective cardiac surgery using cardiopulmonary bypass, with a preoperatively elevated serum creatinine level (n = 24). INTERVENTIONS: Randomized infusions of diltiazem (bolus 0.25 mg/kg followed by a continuous infusion of 1.7 microg/kg/min) (DTZ, n = 12) or placebo (C, n = 12) were started 30 minutes before induction of anesthesia and continued for 24 hours. MEASUREMENTS AND MAIN RESULTS: Median plasma concentrations of diltiazem (DTZ group) were 79 microg/L before cardiopulmonary bypass, 67 microg/L at the end of cardiopulmonary bypass, and 164 microg/L at 24 hours postoperatively. Serum creatinine levels; on postoperative days 1, 3, and 5; and 3 weeks postoperatively were similar between groups. Iohexol clearance did not differ between the groups on day 5 but was higher in the DTZ group than in the placebo group 3 weeks after surgery (median, 51 v 40 mL/min/1.73 m(2); p < 0.05). Urinary N-acetyl-beta-glucosamidase concentrations were similar between the groups during the study but were increased from baseline on days 2 and 4 and 3 weeks postoperatively. CONCLUSION: Diltiazem can be safely used in patients who have mild-to-moderate renal dysfunction and undergo cardiac surgery using cardiopulmonary bypass. Within the limits of this study, the data suggest that addition of prophylactic diltiazem may prevent further glomerular damage resulting from cardiopulmonary bypass and may improve glomerular function 3 weeks after cardiac surgery.


Asunto(s)
Bloqueadores de los Canales de Calcio/administración & dosificación , Procedimientos Quirúrgicos Cardíacos , Diltiazem/administración & dosificación , Riñón/fisiopatología , Sustancias Protectoras/administración & dosificación , Acetilglucosaminidasa/orina , Anciano , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Puente Cardiopulmonar , Creatinina/sangre , Método Doble Ciego , Femenino , Tasa de Filtración Glomerular , Humanos , Infusiones Intravenosas , Yohexol/farmacocinética , Riñón/efectos de los fármacos , Pruebas de Función Renal , Masculino , Complicaciones Posoperatorias/prevención & control , Cuidados Preoperatorios , Estudios Prospectivos
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