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1.
Eur J Clin Microbiol Infect Dis ; 34(9): 1901-3, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26194692

RESUMO

Ampicillin-resistant Enterococcus faecium (AREfm) has gained increased footholds in many hospital intensive care units (ICUs) and belongs to specific hospital-adapted E. faecium sub-populations. Three AREfm strains survived in an in vitro survival setting for approximately 5.5 years. These findings have important consequences for the epidemiology of AREfm in hospital settings and stress the importance of maintaining a good level of hospital hygiene.


Assuntos
Ampicilina/farmacologia , Antibacterianos/farmacologia , Enterococcus faecium/efeitos dos fármacos , Infecções por Bactérias Gram-Positivas/microbiologia , Vancomicina/farmacologia , Resistência a Ampicilina , Infecção Hospitalar/microbiologia , Farmacorresistência Bacteriana Múltipla , Enterococcus faecium/crescimento & desenvolvimento , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/transmissão , Hospitais , Humanos , Testes de Sensibilidade Microbiana
2.
Neth J Med ; 67(5): 173-6, 2009 May.
Artigo em Inglês | MEDLINE | ID: mdl-19581666

RESUMO

Bacterial resistance to antimicrobial agents is of great concern to clinicians. Patient outcome after infection is mainly dependent on the sensitivity of the bacterium to the agent used. We retrospectively studied 89 postoperative intensive care unit (ICU) patients with proven Escherichia coli peritonitis and investigated the clinical consequences of the E. coli resistance to amoxicillin/clavulanate. Significantly increased mortality, days of ventilation and ICU stay were noted in the co-amoxicillin/clavulanate resistant group. Furthermore, our results demonstrate that the sensitivity of E. coli to amoxicillin/clavulanate in the postoperative ICU setting has decreased in recent years. We can conclude that the current antibiotic regimen for the empirical treatment of ICU patients with peritonitis, as used in our hospital, needs to be changed. A switch, for instance, to ceftriaxone (Rocephin) in combination with metronidazole and gentamicin, instead of the present regimen of amoxicillin/clavulanate in combination with gentamicin, seems preferable.


Assuntos
Combinação Amoxicilina e Clavulanato de Potássio/administração & dosagem , Antibacterianos/administração & dosagem , Infecções por Escherichia coli/tratamento farmacológico , Escherichia coli/efeitos dos fármacos , Peritonite/tratamento farmacológico , Abdome/cirurgia , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/microbiologia , Farmacorresistência Bacteriana , Feminino , Gentamicinas/administração & dosagem , Humanos , Unidades de Terapia Intensiva , Masculino , Peritonite/microbiologia , Resultado do Tratamento
3.
Scand J Immunol ; 59(5): 440-8, 2004 May.
Artigo em Inglês | MEDLINE | ID: mdl-15140053

RESUMO

The relative contribution of the pro-inflammatory cytokines tumour necrosis factor (TNF)-alpha and interleukin (IL)-1 beta and the lipopolysaccharide (LPS)-induced pathways that result in endothelial activation during sepsis are not fully understood. We have examined the effects of plasma obtained from LPS-treated human whole blood on the expression of E-selectin and intercellular adhesion molecule-1 (ICAM-1) on human endothelial cells. Stimulation of blood with 10 pg/ml of LPS is sufficient to produce plasma that induces E-selectin and ICAM-1 expression, while direct induction by LPS alone requires a 100-fold higher concentration. Characteristics for the plasma-induced adhesion molecule expression were similar to the LPS-induced production of TNF-alpha and IL-1 beta in blood. A complete inhibition of E-selectin and ICAM-1 expression was observed when antibodies against TNF-alpha and IL-1 beta were added to plasma prior to the incubation to endothelial cultures. Significant inhibition was even observed if antibodies were added to the cultures up until 3 h after LPS-conditioned plasma. The plasma-induced adhesion molecule response could also be prevented with inhibitors of nuclear factor (NF)-kappaB, such as pyrollidine dithiocarbamate. These findings emphasize the central role of TNF-alpha and IL-1 beta in LPS-induced endothelial activation and suggest that simultaneous neutralization of these cytokines or their common pathways may, even after the initial stimulus, prevent endothelial response during sepsis.


Assuntos
Moléculas de Adesão Celular/biossíntese , Moléculas de Adesão Celular/sangue , Células Endoteliais/efeitos dos fármacos , Lipopolissacarídeos/farmacologia , Transdução de Sinais/imunologia , Moléculas de Adesão Celular/efeitos dos fármacos , Células Cultivadas , Selectina E/biossíntese , Selectina E/sangue , Selectina E/efeitos dos fármacos , Células Endoteliais/metabolismo , Humanos , Molécula 1 de Adesão Intercelular/biossíntese , Molécula 1 de Adesão Intercelular/sangue , Molécula 1 de Adesão Intercelular/efeitos dos fármacos , Interleucina-1/biossíntese , Interleucina-1/sangue , Fator de Necrose Tumoral alfa/biossíntese , Fator de Necrose Tumoral alfa/efeitos dos fármacos
5.
Mediators Inflamm ; 9(5): 235-41, 2000.
Artigo em Inglês | MEDLINE | ID: mdl-11200364

RESUMO

OBJECTIVE: To investigate whether endothelial monolayer permeability changes induced by inflammatory mediators are affected by the extracellular matrix protein used for cell seeding. METHODS: Human umbilical venular endothelial cells (HUVEC) were grown to confluent monolayers on membranes coated with either collagen, fibronectin or gelatin. The permeability to albumin and dextran was then assessed, both under normal conditions and after treatment with tumor necrosis factor-alpha (TNF-alpha) and bacterial lipopolysaccharide (LPS). RESULTS: With any of the three protein coatings, tight junctions were formed all over the monolayers. The permeability of the coated membranes to albumin and dextran was reduced strongly by confluent monolayers; the relative reduction was similar for the three matrix proteins used. Pre-incubation of the monolayers with either TNF-alpha or LPS increased permeability dose dependently. However, the relative increase due to either treatment was independent of the protein used for membrane coating. CONCLUSION: The extracellular matrix protein used for initial seeding of endothelial cultures plays a minor role in determining the permeability changes induced in HUVEC monolayers by inflammatory mediators.


Assuntos
Permeabilidade da Membrana Celular/fisiologia , Colágeno/metabolismo , Endotélio Vascular/fisiologia , Proteínas da Matriz Extracelular/metabolismo , Fibronectinas/metabolismo , Gelatina/metabolismo , Permeabilidade da Membrana Celular/efeitos dos fármacos , Células Cultivadas , Endotélio Vascular/citologia , Humanos , Lipopolissacarídeos/farmacologia , Fator de Necrose Tumoral alfa/farmacologia
6.
Am J Nephrol ; 19(5): 571-5, 1999.
Artigo em Inglês | MEDLINE | ID: mdl-10575186

RESUMO

BACKGROUND: Circulating receptors modulate the biological effects of cytokines. Renal insufficiency is known to influence the concentrations of the soluble tumor necrosis factor (TNF) receptors p55 and p75. No data are available on the concentrations of the circulating interleukin 6 (IL-6) receptors gp80 and gp130 during chronic renal insufficiency. METHODS: We compared the serum concentrations of the IL-6 receptors gp80 and gp130 to those of the TNF receptors p55 and p75 in end-stage chronic renal failure, continuous ambulatory peritoneal dialysis, and hemodialysis (HD). RESULTS: In healthy controls the concentrations of gp80, gp130, p55, and p75 in serum were 82.1 +/- 24.3, 87.9 +/- 20.2, 1.1 +/- 0.2, and 1.7 +/- 0.3 ng/ml, respectively. These concentrations were increased to, respectively, 112.2 +/- 18.0, 186.0 +/- 37.7, 10.5 +/- 4.3, and 15.0 +/- 7.5 ng/ml in chronic renal failure, to 138.8 +/- 18.0, 181. 3 +/- 46.1, 25.5 +/- 5.2, and 19.1 +/- 3.4 ng/ml in continuous ambulatory peritoneal dialysis, and to 107.9 +/- 29.4, 146.6 +/- 30. 5, 22.9 +/- 6.3, and 16.8 +/- 6.0 ng/ ml in HD (before dialysis session). The concentrations after HD were higher for p75 only. CONCLUSIONS: The data show that the concentrations of the IL-6 receptors (gp80 and gp130) are elevated in chronic renal insufficiency. The increase is relatively low as compared with the elevation of the TNF receptors in this situation. HD does not result in a consistent change in serum concentrations of the various receptors.


Assuntos
Antígenos CD/sangue , Falência Renal Crônica/sangue , Glicoproteínas de Membrana/sangue , Diálise Peritoneal Ambulatorial Contínua , Receptores de Interleucina-6/sangue , Envelhecimento/metabolismo , Biomarcadores/sangue , Creatinina/metabolismo , Receptor gp130 de Citocina , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-Idade , Receptores do Fator de Necrose Tumoral/sangue , Receptores Tipo I de Fatores de Necrose Tumoral , Receptores Tipo II do Fator de Necrose Tumoral
7.
Eur J Cancer ; 34(1): 162-7, 1998 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-9624252

RESUMO

Experimental studies indicate that anastomotic healing in the intestine is compromised by the immediate postoperative administration of 5-fluorouracil and levamisole. Since fibroblast functions are crucial to healing, we investigated the effects of (combinations of) both drugs on proliferation and collagen synthesis of rat skin fibroblasts in vitro. Proliferation was measured in actively dividing cells by cellular [3H]thymidine uptake and collagen synthesis in non-dividing cells by [3H]proline incorporation into collagenase-digestible protein. 5-Fluorouracil strongly and significantly (P < 0.05) reduced DNA synthesis and collagen synthesis at concentrations of 1 microM or more. The latter effect was not specific for collagen since total protein production was affected similarly. Both effects depended on the duration of exposure to the drugs. Levamisole also inhibited fibroblast proliferation dose-dependently, but less effectively than 5-fluorouracil: 50% inhibition was observed at approximately 0.1 mM. Collagen synthesis was unaffected by levamisole. If levamisole was added together with a low (0.1 microM) concentration of 5-fluorouracil, which in itself did not decrease thymidine incorporation, levamisole's antiproliferative effects became apparent at concentrations as low as 1 microM. A similar effect, but at a much higher concentration (1 mM) was noted on fibroblast collagen synthesis. These results indicate that levamisole potentiates 5-fluorouracil effects in fibroblast cultures and that direct effects of these drugs, alone or in combination, on fibroblast proliferation and collagen synthesis may be responsible for their negative influence on wound repair.


Assuntos
Adjuvantes Imunológicos/farmacologia , Antineoplásicos/farmacologia , Colágeno/efeitos dos fármacos , Fluoruracila/farmacologia , Levamisol/farmacologia , Anastomose Cirúrgica , Animais , Divisão Celular , Colágeno/biossíntese , Combinação de Medicamentos , Sinergismo Farmacológico , Fibroblastos/citologia , Fibroblastos/efeitos dos fármacos , Fibroblastos/metabolismo , Masculino , Ratos , Ratos Wistar , Cicatrização
8.
Antimicrob Agents Chemother ; 41(7): 1439-43, 1997 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-9210662

RESUMO

The in vitro production of interleukin-1beta (IL-1beta), IL-6, and the IL-1 receptor antagonist (IL-1ra) in whole blood upon stimulation with different bacterial strains was measured to study the possible relationship between disease severity and the cytokine-inducing capacities of these strains. Escherichia coli, Neisseria meningitidis, Neisseria gonorrhoeae, Bacteroides fragilis, Capnocytophaga canimorsus, Staphylococcus aureus, Enterococcus faecalis, Streptococcus pneumoniae, and Streptococcus pyogenes induced the cytokines IL-1beta, IL-6, and IL-1ra. Gram-negative bacteria induced significantly higher levels of proinflammatory cytokine production than gram-positive bacteria. These differences were less pronounced for the anti-inflammatory cytokine IL-1ra. In addition, blood was stimulated with E. coli killed by different antibiotics to study the effect of the antibiotics on the cytokine-inducing capacity of the bacterial culture. E. coli treated with cefuroxime and gentamicin induced higher levels of IL-1beta and IL-6 production but levels of IL-1ra production similar to that of heat-killed E. coli. In contrast, ciprofloxacin- and imipenem-cilastatin-mediated killing showed a decreased or similar level of induction of cytokine production as compared to that by heat-killed E. coli; polymyxin B decreased the level of production of the cytokines.


Assuntos
Antibacterianos/farmacologia , Bactérias/efeitos dos fármacos , Interleucina-1/biossíntese , Interleucina-6/biossíntese , Receptores de Interleucina-1/antagonistas & inibidores , Sialoglicoproteínas/biossíntese , Bactérias/metabolismo , Escherichia coli/efeitos dos fármacos , Bactérias Gram-Negativas/efeitos dos fármacos , Bactérias Gram-Negativas/metabolismo , Bactérias Gram-Positivas/efeitos dos fármacos , Bactérias Gram-Positivas/metabolismo , Humanos , Proteína Antagonista do Receptor de Interleucina 1 , Interleucina-1/sangue , Interleucina-6/sangue , Lipopolissacarídeos/farmacologia , Sialoglicoproteínas/sangue , Resultado do Tratamento
9.
Eur J Surg ; 163(4): 245-54, 1997 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-9161821

RESUMO

OBJECTIVES: To assess the potential benefit of a protocol for the diagnostic work-up and management of patients with obstructive jaundice, by comparing its recommendations with the policies actually followed in patients and to compare local expertise with diagnostic and therapeutic procedures with that described in published reports. DESIGN: A retrospective analysis of patients' records. SETTING: University hospital, The Netherlands. SUBJECTS: 49 consecutive patients who presented to the departments of internal medicine and surgery between June 1990 and June 1992 with serum alkaline phosphatase activities > 125 mumol/L, and serum bilirubin concentrations > 17 mumol/L. MAIN OUTCOME MEASURES: The proportions of diagnostic and therapeutic decisions that deviated from the recommendations, and the success rates of diagnostic and therapeutic procedures. RESULTS: In patients with bile duct stones the treatment strategies did not deviate from those recommended in the protocol. In patients with cancer 38 (30%) of the 128 diagnostic decisions and 4 (11%) of the 37 therapeutic decisions deviated from the protocol. Success rates of all diagnostic investigations were comparable with those reported, and success rates of endoscopic biliary drainage tended to be lower than those reported. CONCLUSIONS: The introduction of a protocol for the diagnostic work-up of patients with obstructive jaundice may reduce unnecessary investigations and diagnostic omissions by half. Because local expertise of some of the procedures seems to be significantly less than reported elsewhere it may be necessary to modify the protocol to better fit local circumstances.


Assuntos
Colestase/diagnóstico , Colestase/cirurgia , Tomada de Decisões Assistida por Computador , Idoso , Neoplasias dos Ductos Biliares/diagnóstico , Neoplasias dos Ductos Biliares/cirurgia , Neoplasias do Sistema Biliar/complicações , Colangiografia/métodos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Colelitíase/complicações , Colestase/etiologia , Protocolos Clínicos/normas , Intervalos de Confiança , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
10.
Crit Care Med ; 24(11): 1801-5, 1996 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-8917028

RESUMO

OBJECTIVES: To determine the pattern of the soluble interleukin (IL)-6 receptor during acute meningococcal infections and recovery phase, and to measure the effect of plasma or whole blood exchange on the plasma concentrations of these mediators. DESIGN: Prospective, descriptive patient study. SETTING: University hospital intensive care unit. PATIENTS: Patients with bacteriologically proven meningococcal infections were entered in the study. Three group were formed: a) patients with meningitis without shock (group A); b) patients with meningitis and shock (group B); and c) patients with shock only (group C). INTERVENTIONS: Part (n = 9) of the patients with shock underwent plasma or whole blood exchange. MEASUREMENTS AND MAIN RESULTS: Serum concentrations of interleukin-6 and soluble IL-6 receptors were determined sequentially during the acute and recovery phases. Peak concentrations of IL-6 were highest in group C, followed by group B and group A. Soluble IL-6 receptor concentrations showed an opposite pattern and were all below normal. Soluble IL-6 receptor concentrations were negatively correlated with the IL-6 concentrations. During recovery, IL-6 rapidly decreased and soluble IL-6 receptors increased to supranormal concentrations, after which concentrations returned to normal. Plasma or whole blood exchange did not significantly influence IL-6 concentrations but did increase the soluble IL-6 receptor concentration directly after an exchange session followed by a rapid decrease. CONCLUSIONS: Soluble IL-6 receptor concentrations are low in acute meningococcal infections. Plasma or whole blood exchange temporarily increases these concentrations. It needs to be determined whether the effect of this therapy is beneficial to the patient.


Assuntos
Antígenos CD/sangue , Interleucina-6/sangue , Infecções Meningocócicas/sangue , Infecções Meningocócicas/complicações , Troca Plasmática , Receptores de Interleucina/sangue , Choque/sangue , Choque/complicações , Doença Aguda , Adolescente , Adulto , Criança , Pré-Escolar , Cuidados Críticos , Feminino , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva , Masculino , Infecções Meningocócicas/terapia , Pessoa de Meia-Idade , Estudos Prospectivos , Receptores de Interleucina-6 , Choque/terapia
11.
Br J Cancer ; 74(5): 711-6, 1996 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-8795572

RESUMO

The continuing search for effective adjuvant therapy after resection of intestinal malignancies has prompted a growing interest in both immediate post-operative regional chemotherapy and the combination of 5-fluorouracil (5-FU) and interferon-alpha as drugs of choice. We have compared the effects of both compounds, alone and together, on early healing of intestinal anastomoses. Four groups (n = 26 each) of rats underwent resection and anastomosis of both ileum and colon: a control group and three groups receiving intraperitoneal 5-FU, interferon-alpha or both on the day of surgery and the next 2 days. Animals were killed 3 or 7 days (n = 10 each) after operation in order to measure anastomotic strength and hydroxyproline content. The remaining six animals in each group were used to study anastomotic collagen synthetic capacity at day 3. Three days after operation, ileal anastomotic bursting pressure was lowered by 37% in the 5-FU/interferon-alpha group (P = 0.0104). At day 7, anastomotic breaking strength was reduced significantly in ileum (P = 0.0221) and colon (P = 0.0054) of the 5-FU/interferon-alpha group and in colon of the interferon-alpha group (P = 0.0221). Collagen synthetic capacity was strongly suppressed by 5-FU but not by interferon-alpha. However, no differences in anastomotic hydroxyproline content were observed between groups at both days 3 and 7. Thus, post-operative use of interferon-alpha, in particular in combination with 5-FU, may be detrimental to anastomotic repair in the intestine.


Assuntos
Fluoruracila/uso terapêutico , Interferon-alfa/uso terapêutico , Intestinos/cirurgia , Cicatrização/efeitos dos fármacos , Anastomose Cirúrgica , Animais , Peso Corporal/efeitos dos fármacos , Colágeno/biossíntese , Colágeno/efeitos dos fármacos , Quimioterapia Combinada , Hidroxiprolina/análise , Intestinos/efeitos dos fármacos , Masculino , Técnicas de Cultura de Órgãos , Ratos , Ratos Wistar , Estatísticas não Paramétricas , Resistência à Tração
13.
Int J Biomed Comput ; 42(1-2): 143-50, 1996 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-8880281

RESUMO

A protocol processing system (ProtoVIEW), containing therapeutic trauma protocols, was used in the Accident and Emergency (A and E) department for a period of 7 months to investigate the impact of automated protocols on firstly, medical decision making of physicians and secondly, on quality of treatments eventually received by the patients. A randomized controlled trial showed that mandatory use of the system led to a more uniform working strategy while fracture treatment only seemed to improve in a subgroup of patient for whom residents established a correct diagnosis.


Assuntos
Protocolos Clínicos , Tomada de Decisões Assistida por Computador , Serviço Hospitalar de Emergência/organização & administração , Sistemas de Informação Hospitalar , Internato e Residência , Adolescente , Adulto , Algoritmos , Distribuição de Qui-Quadrado , Gráficos por Computador , Sistemas de Apoio a Decisões Administrativas , Seguimentos , Fraturas Ósseas/diagnóstico , Fraturas Ósseas/terapia , Humanos , Países Baixos , Avaliação de Resultados em Cuidados de Saúde , Qualidade da Assistência à Saúde , Interface Usuário-Computador
14.
Shock ; 5(5): 313-9, 1996 May.
Artigo em Inglês | MEDLINE | ID: mdl-9156785

RESUMO

In a prospective randomized, double-blind, placebo-controlled clinical study, the safety and efficacy of the platelet-activating factor antagonist TCV-309 in the treatment of systemic inflammatory response syndrome was studied. In total 29 patients were treated with 1.0 mg/kg TCV-309 twice daily during 7 days or with placebo. Study parameters were as follows: adverse events, 28 and 56 day all cause mortality, multi-organ failure scores, and the inflammatory mediators tumor necrosis factor, interleukin 6, interleukin 8, and soluble E-selectin. There was no difference in number and severity of adverse events between TCV-309- and placebo-treated patients. Day 28 and day 56 mortality was similar in both groups (day 56: 7/12 TCV-309 vs. 9/16 placebo, NS). Pulmonary and hematological failure scores improved significantly in TCV-309-treated patients (p < .05). There was no difference in inflammatory mediator levels between TCV-309- and placebo-treated patients. Treatment with TCV-309 appears to be safe in patients with systemic inflammatory response syndrome and does improve organ failure significantly.


Assuntos
Isoquinolinas/administração & dosagem , Fator de Ativação de Plaquetas/antagonistas & inibidores , Inibidores da Agregação Plaquetária/administração & dosagem , Compostos de Piridínio/administração & dosagem , Síndrome de Resposta Inflamatória Sistêmica/tratamento farmacológico , Tetra-Hidroisoquinolinas , Adulto , Idoso , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Síndrome de Resposta Inflamatória Sistêmica/fisiopatologia , Resultado do Tratamento
15.
Eur J Surg ; 162(4): 287-96, 1996 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-8739415

RESUMO

OBJECTIVE: To evaluate the association between inflammatory mediators and clinical outcome in patients after repair of abdominal aortic aneurysms. DESIGN: Prospective study. SETTING: University hospital, The Netherlands. PATIENTS: 30 Consecutive patients who had undergone elective or acute repair of abdominal aortic aneurysms. MAIN OUTCOME MEASURES: Plasma concentrations of the cytokines tumour necrosis factor (TNF), interleukin-6 (IL-6) and interleukin-8 (IL-8) as well as soluble TNF receptors and the soluble (s) adhesion molecules E-selectin and intercellular adhesion molecule 1 (ICAM-1) were measured and correlated with the degree of systemic hypotension (shock: hypotension more than 15 minutes) and clinical outcome. RESULTS: Peak plasma concentrations of TNF and IL-6 were significantly higher in shocked patients (p < 0.005 and p < 0.0005, respectively) and those who died (both p < 0.01), whereas concentrations of IL-8 increased only when shock complicated rupture of the aneurysm (p < 0.01). Increases in the concentrations of TNF receptors reflected impaired renal function. In contrast to sE-selectin concentrations, peak sICAM-1 concentrations were significantly higher in shocked patients (p < 0.01) and those that died (p < 0.01). CONCLUSIONS: These results strongly suggest that increased concentrations of sICAM-1 and IL-6 reflect the inflammatory response induced by ischaemia after repair of an abdominal aortic aneurysm, and indicate that the postoperative course is likely to be complicated.


Assuntos
Aneurisma da Aorta Abdominal/sangue , Aneurisma da Aorta Abdominal/cirurgia , Citocinas/sangue , Selectina E/sangue , Molécula 1 de Adesão Intercelular/sangue , Choque Hemorrágico/sangue , Choque Cirúrgico/sangue , Idoso , Aneurisma da Aorta Abdominal/mortalidade , Ruptura Aórtica/sangue , Ruptura Aórtica/mortalidade , Ruptura Aórtica/cirurgia , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Choque Hemorrágico/mortalidade , Choque Cirúrgico/mortalidade , Taxa de Sobrevida , Fatores de Tempo
16.
Comput Methods Programs Biomed ; 49(2): 177-84, 1996 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-8735024

RESUMO

A randomized two period crossover trial was performed at the Accident and Emergency (A & E) department of the University Hospital in Nijmegen (The Netherlands). We assessed what the impact was of (mandatory) consultation of a protocol for the management of isolated traumas on treatment decisions of residents. All eight surgical residents who regularly worked in the A & E department participated in the trial. All patients who entered the A & E department between October 13, 1992 and June 9, 1993, of age 16 years or older with an isolated fracture without concomitant lesions were admitted to the study. During the experimental periods, the management protocol was available on computer (using ProtoVIEW) and during the control periods on paper. Main measurements were treatment adjustments made by residents (after consulting different information sources), and their opinion about ProtoVIEW as an information source assessed by means of a questionnaire. When protocol consultation was mandatory, residents changed their treatments almost four times more often towards the protocol than during the control periods (P = 0.01 Chi-square test). Most residents found ProtoVIEW easy to use, liked it as a useful training source while half of them said they would use the system in daily clinical practice. We conclude that mandatory protocol consultation using ProtoVIEW influenced protocol adherence positively.


Assuntos
Protocolos Clínicos , Tomada de Decisões Assistida por Computador , Técnicas de Apoio para a Decisão , Serviço Hospitalar de Emergência , Internato e Residência , Atitude , Sistemas Computacionais , Hospitais Universitários , Humanos , Países Baixos , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/terapia
17.
Arch Surg ; 130(9): 959-65, 1995 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-7661680

RESUMO

OBJECTIVES: To examine the effects of perioperative administration of fluorouracil on healing variables of internal anastomoses and to explore ways to promote repair under these conditions. DESIGN: Seven-day, prospective randomized experimental trial. SETTING: Animal research laboratory. ANIMALS: Male young-adult Wistar rats after resection and anastomosis of both ileum and colon. INTERVENTIONS: Random assignment to groups receiving placebo, daily fluorouracil (20 mg/kg per day, intraperitoneally), daily fluorouracil plus retinol palmitate (5000 IU/kg per day, orally), daily fluorouracil plus interleukin-2 (2 x 10(6) IU/kg per day, subcutaneously), or daily fluorouracil plus granulocyte macrophage colony-stimulating factor on the first 4 days after operation (20 micrograms/kg per day, intraperitoneally. MAIN OUTCOME MEASURES: Anastomotic bursting pressure, breaking strength, hydroxyproline content, and ex vivo collagen synthetic capacity. RESULTS: Administration of fluorouracil decreased anastomotic breaking strength by more than 40% and caused a shift in bursting site from outside to within the suture line. It also lowered anastomotic hydroxyproline content. The capacity for collagen synthesis, which was greatly enhanced in 4-day-old anastomoses from the control group, was significantly (P < .05) and specifically reduced. Concomitant administration of retinol resulted in restoration of strength and hydroxyproline content, particularly in the ileum. Interleukin-2 and granulocyte macrophage colony-stimulating factor did not improve fluorouracil-suppressed repair: both wound strength and collagen content were similar in the fluorouracil, fluorouracil/interleukin-2, and fluorouracil/granulocyte macrophage colony-stimulating factor groups. CONCLUSION: Intraperitoneal administration of fluorouracil, delivered from the day of operation onward, severely reduces anastomotic strength at the end of the first postoperative week. This negative effect may be prevented by oral administration of retinol.


Assuntos
Fluoruracila/farmacologia , Intestinos/cirurgia , Vitamina A/farmacologia , Cicatrização/efeitos dos fármacos , Anastomose Cirúrgica , Animais , Colágeno/biossíntese , Fluoruracila/antagonistas & inibidores , Mucosa Intestinal/metabolismo , Intestinos/efeitos dos fármacos , Masculino , Distribuição Aleatória , Ratos , Ratos Wistar , Deiscência da Ferida Operatória/prevenção & controle , Vitamina A/uso terapêutico
18.
Comput Methods Programs Biomed ; 48(1-2): 53-8, 1995.
Artigo em Inglês | MEDLINE | ID: mdl-8846712

RESUMO

This paper describes the design, implementation and evaluation of a prototype protocol processing system (ProtoVIEW). ProtoVIEW provides protocol information for diagnostic and therapeutic purposes. The developed system described here is used as a research instrument to investigate the impact of automated protocols on the medical decision making of physicians. A first evaluation indicates that residents like to use the system and that usage of the system leads to a more uniform working strategy.


Assuntos
Protocolos Clínicos , Tomada de Decisões Assistida por Computador , Serviço Hospitalar de Emergência , Internato e Residência , Atitude do Pessoal de Saúde , Competência Clínica , Instrução por Computador , Humanos , Corpo Clínico Hospitalar/educação
19.
Br J Cancer ; 72(2): 456-60, 1995 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-7640232

RESUMO

There exists growing interest in immediate post-operative local adjuvant therapy after resection of intestinal malignancies. It is therefore necessary to assess it potential effect on the healing of intestinal anastomoses. Five groups (n = 20) of rats underwent resection and anastomosis of both ileum and colon: a control group and four experimental groups receiving intraperitoneal 5-fluorouracil (5-FU), 5-FU plus leucovorin, 5-FU plus levamisole or levamisole alone, on the day of surgery and the next 2 days. Animals were killed 3 or 7 days after operation. Another three groups (n = 6) of animals were used to compare anastomotic collagen synthetic capacity in control rats or rats receiving 5-FU or 5-FU plus levamisole. On the third post-operative day, the average anastomotic bursting pressure in the 5-FU/levamisole group was reduced by 36% as compared with the control group, both in ileum (P = 0.02) and in colon (P = 0.01). Values in the other groups were similar to those in the control group. Anastomotic breaking strength was significantly (P < 0.025) lowered in the ileum from the levamisole group at both days 3 and 7. Anastomotic collagen synthetic capacity was strongly reduced in the 5-FU and 5-FU/levamisole groups. However, there was no significant difference between the control group and the four experimental groups with regard to anastomotic hydroxyproline concentration and content, either 3 or 7 days after operation. Thus, limited use of levamisole, alone or in combination with intraperitoneal 5-FU, may compromise intestinal healing.


Assuntos
Intestinos/cirurgia , Levamisol/efeitos adversos , Cuidados Pós-Operatórios/efeitos adversos , Cicatrização/efeitos dos fármacos , Anastomose Cirúrgica , Animais , Colágeno/biossíntese , Fluoruracila/efeitos adversos , Fluoruracila/farmacologia , Hidroxiprolina/análise , Leucovorina/efeitos adversos , Masculino , Pressão , Ratos , Ratos Wistar
20.
J Infect Dis ; 171(2): 469-72, 1995 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-7661926

RESUMO

Concentrations of interleukin (IL)-6, soluble IL-6 receptor (sIL-6R), and soluble tumor necrosis factor receptor (sTNFR) p55 and p75 were measured in 25 patients with sepsis syndrome. Sequential blood samples were drawn from patients during a 7-h period. IL-6 concentrations were 34-763,000 pg/mL; they were higher in nonsurvivors than survivors, but the difference was not statistically significant. In septic patients, the median sIL-6R concentration was significantly lower than in 19 healthy volunteers (43 vs. 80 ng/mL). sIL-6R concentrations in survivors were not significantly different than those in nonsurvivors. There was a negative correlation between IL-6 and sIL-6R in septic patients (r = -.72). In patients with moderately impaired renal function, sIL-6R levels were not affected, but the concentrations of sTNFRs were significantly higher.


Assuntos
Antígenos CD , Interleucina-6/sangue , Receptores de Interleucina/análise , Receptores do Fator de Necrose Tumoral/análise , Síndrome de Resposta Inflamatória Sistêmica/sangue , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Receptores de Interleucina-6 , Receptores Tipo I de Fatores de Necrose Tumoral , Receptores Tipo II do Fator de Necrose Tumoral
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