[Non-pneumonia lower respiratory infection by Neisseria meningitidis].
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Aged↗
Biomedical subjects
A Corso
Publications and source records attributed to A Corso.
Chronic myelogenous leukemia and exposure to ionizing radiation--a retrospective study of 443 patients.
Exposure to ionizing radiations (Rx) has been implicated as a causative factor of chronic myelogenous leukemia (CML). We performed a retrospective study of 443 consecutive CML patients, looking for a history of significant exposure to Rx, and evaluated the clinical and hematological characteristics in order to find any difference between radiation-related CML patients and those with de novo CML. We identified 406 patients without known exposure to mutagens (group I) and 37 patients with prior significant exposure to Rx (group II). In comparison to patients of group I, those of group II showed particular clinical and hematological features: significantly lower incidence of bulky splenomegaly (p < 0.05) and hyperleukocytosis (WBC > 100 x 10(9)/l; p < 0.05); significantly higher incidence of anemia (Hb < 10 g/dl; p < 0.01). Patients with radiation-related CML had a significantly better survival than those with de novo CML (median survival 61 months vs 42 months; p < 0.05). In conclusion, this study of a large cohort of CML patients indicates that the subgroup of patients with a history of significant exposure to ionizing radiation has particular clinical and hematological features at onset (lower tumor burden, higher frequency of anemia) and a better survival.
Adolescent↗
Modulation of all-trans retinoid acid pharmacokinetics in acute promyelocytic leukaemia by prolonged interferon-alpha therapy.
Continuous treatment with all-trans retinoid acid (ATRA) induces accelerated drug catabolism which is considered responsible for acquired resistance to ATRA. We studied the effect of interferon-alpha 2a (IFN) on ATRA pharmacokinetics in two patients with acute promyelocytic leukaemia (APL) in complete remission maintained by alternating 15 d of IFN and 15 d of ATRA. Day 15 ATRA levels obtained during IFN+ATRA treatment were significantly higher than those observed in patients maintained on ATRA alone. In one patient IFN was discontinued and day 15 ATRA levels decreased to those observed in patients scheduled for maintenance with ATRA alone. In our two patients IFN substantially reduced the induction of ATRA catabolism, indicating a potential role for IFN in modulating ATRA pharmacokinetics.
Drug Interactions↗
[Failure of the treatment with penicillin in a case of Neisseria meningitidis meningitis].
Most Neisseria meningitidis are susceptible to penicillin with a minimal inhibitory concentration (MIC) < or = 0.6 mg/L and mortality related to meningococcal meningitis has been low. In recent years, however, N. meningitidis moderately susceptible to penicillin (MIC 0.12-1 mg/L) has been isolated in South Africa, England, USA, and mainly Spain. We report a case of a 16-year old male patient, who was admitted with a diagnosis of meningitis. Because group C N. meningitidis was isolated from cerebrospinal fluid, the patient received 300,000 Ul/Kg penicillin G. Seventy-two hours later, a new lumbar puncture was performed, and N. meningitidis was again isolated from culture. Beta-lactamase activity of the isolate was negative and MIC measurement showed that it was moderately susceptible to penicillin, probably due to modification of a penicillin binding protein. Penicillin G was then discontinued, and the patient was given 50 mg/Kg ceftriaxone. A third lumbar puncture performed on the eighth day after admission showed a negative bacteriological culture. The patient was discharged without neurological sequelae after 14 days of treatment. This case report shows that small changes in N. meningitidis sensitivity may be of clinical relevance.
Adolescent↗
Unusual multiresistant Vibrio cholerae O1 El Tor in Argentina.
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Anti-Bacterial Agents↗
The role of systemic high-dose cytarabine in the treatment of central nervous system leukemia. Clinical results in 46 patients.
BACKGROUND: Given the good penetration of systemic high-dose cytarabine (HDara-C) into the cerebrospinal fluid (CSF), this approach was used to treat patients with central nervous system (CNS) leukemia, either isolated or with concurrent extraneurologic disease (END). METHODS: From 1983 to 1991, 46 adults with CNS involvement were treated with systemic HDara-C: 25 had acute lymphoblastic leukemia (ALL), 15 had high-grade non-Hodgkin lymphoma (NHL), 5 had acute myelogenous leukemia (AML), and 1 had lymphoid blast crisis of chronic myelogenous leukemia. Induction consisted of HDara-C 3 g/m2 every 12 hours, by 3-hour infusion, for 8 doses (30 patients), or 6 doses (16 patients), followed by 4 doses at day 21. RESULTS: Of 46 patients, 29 (63%) achieved complete remission (CR): 15/15 with isolated CNS leukemia, and 14/31 (45%) with CNS and concurrent marrow or lymph node disease. Of 17 patients not meeting CR criteria because of persistent END, 11 showed complete CNS response. The first 10 remitters were consolidated with monthly 4-dose courses of HDara-C. The remaining 19 received postinduction multidrug chemotherapy (including vincristine, doxorubicin, cyclophosphamide, L-asparaginase, etoposide plus intermediate-dose ara-C, mitoxantrone plus HDara-C) and intrathecal methotrexate (MTX) +/- cranial radiation therapy. One patient underwent autologous and one allogeneic bone marrow transplant. Median CR duration was 7 months (range, 2-56+): 8 months for patients with isolated CNS leukemia, and 4 months for those with concurrent END: In only two patients was CNS the primary site of relapse. Three patients with isolated CNS leukemia are disease-free at 23, 40, and 56 months. The main toxicity was myelosuppression. No patient showed dose-limiting neurologic toxicity. CONCLUSIONS: Systemic HDara-C appears effective therapy for CNS leukemia, maximally in cases with isolated CNS involvement. HDara-C may be combined safely with cranial radiation therapy and intrathecal MTX. This approach for CNS leukemia, however, needs to be combined with additional treatments to eradicate residual disease in extraneurologic compartments.
Adolescent↗
["Indirect" radioisotope cystography after the furosemide test: its diagnostic efficacy compared to "direct" study].
The diagnostic efficacy was investigated of "indirect" radionuclide cystography after a furosemide test in the detection of vesicoureteral reflux. A single i.v. injection of 99mTc-diethylenetriaminepentacetic acid (DTPA) was administered during sequential renal scintigraphy. "Direct" radionuclide cystography with 99mTc-DTPA was assumed as the "golden standard". Thirty-three patients, 24 of whom in pediatric age, were examined with "indirect" radionuclide cystography after a furosemide test: the method had 32% sensitivity according to restrictive positivity criteria versus 59% according to less restrictive ones. In conclusion, "indirect" radionuclide cystography, in spite of the advantages coming from the use of the diuretic, cannot be considered as an efficient technique to recognize vesicoureteral reflux, especially when the latter is present at a low degree.
Adolescent↗
[Dietary calcium deficiency and degree of enamel mineralization in suckling rats].
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Animals↗
Thyrotropin and prolactin response to intraspinal TRH administration in man.
The effect of intraspinal (i.s.) TRH administration of Prolactin (Prl) and thyrotropin stimulating hormone (TSH) serum levels was studied in order to verify the existence of a ventricular route in man for releasing factor delivery to the anterior pituitary, which has been previously reported in rats. Ten young male subjects were given 200 microgram thyrotropin releasing hormone (TRH) i.s. injections and Prl and TSH were measured by radioimmunoassay (RIA) before and at various times after TRH administration. In the same subjects, an i.v. TRH test was also performed. After i.s. TRH, a prompt Prl increase (peak values at 10-30 min and return to baseline within 150 min) and a delayed increase (3-5 h following TRH injection) were observed in 7 and 5 subjects respectively, while an early elevation in serum TSH occurred in 6 subjects and a late one in other 6. In two subjects, a biphasic response of both tropins was present. Prl and TSH response to i.v. TRH was within the normal range in all cases; no late rise of the 2 hormones was observed. A kinetic experiment with 125I-TRH was also carried out to elucidate the mode of i.s. vs i.v. TRH action. These results confirm in man data reported in animals which suggest that TRH can be transported from the cerebrospinal fluid (CSF) to the portal system and the hypophysis.
Humans↗
[Consensus on antimicrobial sensitivity tests in gram-positive cocci. Subcommittee on Antimicrobials, SADEBAC (Argentinian Society of Clinical Bacteriology), Argentinian Association of Microbiology].
Antimicrobial susceptibility testing is mainly performed in Argentina by disk diffusion method, following National Committee for Clinical Laboratory Standards (NCCLS) recommendations. We worked out new recommendations for the reporting and interpretation of this test when dealing with gram-positive cocci, in accordance to local trends and epidemiology. General considerations for performing the diffusion assay, quality control, and an update on susceptibility testing for gram-positive cocci are reported in this first document. The present update should be considered as a group of recommendations summarized by Argentinean experts and as the result of a consensus meeting coordinated by the Subcomisión de Antimicrobianos of the Sociedad Argentina de Bacteriología Clínica (Asociación Argentina de Microbiología). Experts in antimicrobial agents were convened in order to prepare this final document. These recommendations take into account local needs, affordability and availability to be used in current practice, tending to contribute to the correct antimicrobial treatment election, according to the particular microorganism and the infection sites.
Algorithms↗
[1st isolation of vancomycin-resistant Enterococcus faecium with the vanB genotype in Argentina: presentation of 2 cases].
We describe the first isolate of van B vancomycin-resistant Enterococcus faecium in Argentina. The strains were recovered from ambulatory patients admitted to a hospital of Buenos Aires city in July 2000. They were not high-risk patients, they had not received previous antibiotic therapy, and they were assisted in different services. MICs for vancomycin were 32 micrograms/ml for both strains, whereas MICs for teicoplanin were 0.12 microgram/ml in case 1 and 0.25 microgram/ml in case 2. PCR was performed to confirm the vanB genotype. The molecular fingerprints of the isolations by PFGE revealed that they were identical. No further VanB strains were isolated in the hospital.
Adult↗
[Bacteremia caused by Enterococcus gallinarum with a high level of glycopeptide resistance: 1st documented cases in Argentina].
A case of bacteremia due to high-level-vancomycin- (MIC = 64 micrograms/ml) and high-level-teicoplanin- (MIC = 32 micrograms/ml) resistant Enterococcus gallinarum is described. Both genes, van C1 and van A, respectively conferring natural low-level resistance and acquired high-level resistance to vancomycin, were found in the enterococcal genoma. The present is the first report of an E. gallinarum isolate showing the van A genotype in Argentina.
Anti-Bacterial Agents↗
[Methicillin resistance detection in Staphylococcus aureus: comparison between conventional methods and MRSA-Screen latex agglutination technique].
Methicillin-resistant Staphylococcus aureus (MRSA) is a significant pathogen that has emerged over the last four decades, causing both nosocomial and community-acquired infections. Rapid and accurate detection of methicillin resistance in S. aureus is important for the use of appropriate antimicrobial therapy and for the control of nosocomial spread of MRSA strains. We evaluated the efficiency of conventional methods for detection of methicillin resistance such as the disk diffusion, agar dilution, oxacillin agar screen test, and the latex agglutination test MRSA-Screen latex, in 100 isolates of S. aureus, 79 mecA positive and 21 mecA negative. The MRSA-Screen latex (Denka Seiken, Niigata, Japón), is a latex agglutination method that detects the presence of PLP-2a, product of mecA gene in S. aureus. The PCR of the mecA gene was used as the "gold standard" for the evaluation of the different methods tested. The percentages of sensitivity and specificity were as follows: disk difusión 97 and 100%, agar dilution 97 and 95%, oxacillin agar screen test 100 and 100%, and MRSA-Screen latex, 100 and 100 %. All methods presented high sensitivity and specificity, but MRSA-Screen latex had the advantage of giving a reliable result, equivalent to PCR, in only 15 minutes.
Bacterial Proteins↗
[Clinical and epidemiologic analysis of intestinal tract colonization with vancomycin-resistant enterococci in an intensive care unit].
Intestinal tract colonization with vancomycin resistant enterococci (VRE) was studied during five months and 25 days. Out of 171 patients hospitalized in the intensive care unit, 124 (73%) were included in this study. Thirty five of them (28%) were recognized as colonized with VRE. VRE isolates (n = 35) were identified as Enterococcus faecium (n = 18), Enterococcus gallinarum (n = 16), and Enterococcus raffinosus (n = 1). All of them were resistant to vancomycin (MIC90 = 512 microg/ml) and to teicoplanin (MIC90 = 32 microg/ml), having the vanA gene. By means of molecular methods a high homology was found among E. faecium and E. gallinarum isolates, respectively, suggesting their spread as a kind of outbreak. No significant differences in age or sex were found among colonized and non-colonized patients (p > 0.05). On the other hand, the hospitalization time and the use of broad-spectrum antibiotics were associated with colonization. From this study we highlight the importance of enhancing all measures of control and prevention of hospital infections, carefully analyzing the empiric antimicrobial schemes, trying to reduce the hospital stage, and following the surveillance to evaluate the efficacy of such procedures.
Adolescent↗
A protocol for the enrichment of different types of CFU-S from fetal mouse liver.
A method is described for purifying hemopoietic stem cells from fetal mouse liver. It entails three steps. First, fetal liver cell obtained from 14- and 15- days-old fetuses are centrifuged on a discontinuous metrizamide gradient and the low density fraction is removed. These cells are then incubated with monoclonal antibodies directed against late differentiation antigens, and the positive cells are removed by immunomagnetic beads. The negative cells are labelled with fluorescein-conjugated pokeweed mitogen (FITC-PWM) and sorted by a fluorescence- activated cell sorter (FACS) on the basis of differences in fluorescence intensity. The number of stem cells is determined by spleen colony assay (CFU-S) for the various sorted fractions. We observed that, as shown for the bone marrow, the different cell fractions are responsible for CFU-S heterogeneity in the kinetics of spleen colony formation. The PWM dull day-12 CFU-S, which originate from cells with a high enrichment factor, would probably be a closer measure of pluripotent hemopoietic stem cells (PHSC), while the PWM bright day-8 and day-12 CFU-S likely originate from committed stem cells. Furthermore, the PWM dull sorted cells had a better capacity for protecting lethally irradiated mice than did the bright cells, although the latter yielded good numbers of day-8 and day-12 CFU-S that displayed, as in the bone marrow, a discrepancy between the enrichment for day-12 CFU-S and radioprotection.
Animals↗
[The diagnosis of non-Hodgkin's lymphoma in a patient with Marfan's syndrome].
The Marfan syndrome is classified as a heritable disorder of connective tissue whose pathogenetic mechanism has not yet been defined. An inborn error of protein metabolism, particularly in collagen has long been hypothesized, but conclusive evidence on the matter is not available. It is usually diagnosed in young patients and can be associated with other disease. We report a case of an unusual association with a malignant non-Hodgkin lymphoma in a 55-year-old patient, never described before.
Biopsy↗
[Determination of serum aminoglycoside and vancomycin concentrations by the microbiological method in the presence of other antimicrobials].
The determination of serum concentrations of antimicrobials with a narrow therapeutic range by microbiological method requires some modifications when the patient is under combined antimicrobial therapy. The methodological conditions for the appraisal of aminoglycosides and vancomycin in the presence of other drugs were evaluated by using strains with selective sensitivity to the antimicrobial to be tested or by the adding crude extracts of beta-lactamases for the inactivation of the beta-lactam antimicrobials. These beta-lactamases were obtained from Enterobacter cloacae P99 (derepressed mutant) cultures for the inactivation of penicillins and first, second and third generation cephalosporins, as well as from Stenotrophomonas (Xanthomonas) maltophilia M 1484 cultures for the hydrolysis of imipenem. The strains allowing vancomycin appraisal and indifferent to the synergic activity of other drugs in the mixture were S. aureus M 2120, when the accompanying antimicrobials were gentamicin, ciprofloxacin or rifampicin, and E. faecalis M 2113, E. avium M 2091 and S. aureus M 2101 when the drugs in the mixture were amikacin, lincomycin or trimethoprim-sulfamethoxazole, respectively. For the appraisal of gentamicin in the presence of vancomycin or fluoroquinolones (ciprofloxacin or norfloxacin), E. coli M 1376 was the most suitable strain, while the use of K. pneumoniae ATCC 10031 was required for the appraisal of amikacin or netilmicin. When rifampicin was the accompanying antimicrobial, E. coli M 1495 turned out more adequate. E. coli M 1462 proved to be more satisfactory for gentamicin, amikacin and netilmicin dosages in samples also containing chloramphenicol, trimethoprim-sulfamethoxazole or tetracycline.
Aminoglycosides↗
Bone marrow T-cell subsets in patients with monoclonal gammopathies: correlation with clinical stage and disease status.
BACKGROUND AND OBJECTIVE: The existence of an imbalance in T-cell subpopulations in patients (pts) affected by monoclonal gammopathies (MG) has been well established. This imbalance might be correlated with different control of plasma cell growth and, particularly in MM, with the severity of the disease. The aim of this study was to verify whether the alteration of the T lymphocyte subsets in bone marrow correlates with the diagnosis, clinical status and disease phase in patients with monoclonal gammopathies. METHODS: We performed a study on bone marrow (BM) T-cell subsets in 49 multiple myelomas (MM) and in 17 monoclonal gammopathies of uncertain significance (MGUS), using as controls 20 BM aspirates from normal subjects. RESULTS: The percentages of BM CD4 cells in MM pts at onset were slightly lower than in controls and in MGUS pts, who showed normal percentages of CD4. The percentages of CD8 cells were lower than in controls in both MM and MGUS (p = 0.02 and p = 0.007, respectively), and consequently the CD4/CD8 ratios were significantly higher than in normal subjects (p = 0.01 and 0.008, respectively). Analysis of BM T-cell subpopulations in MM pts showed a progressive decrease in the percentage of CD4 cells from stage I to stage III (I vs III p = 0.008) and an increase in CD8 cells, although not statistically significant. The same trend was observed when the different phases of MM (onset, plateau, progression) were analyzed: a lower percentage of CD4 cells and an increase of CD8 cells characterized the advanced phases. Treatment did not seem to alter significantly the distribution of T-cell subsets in MM patients. INTERPRETATION AND CONCLUSIONS: The imbalance in T-cell involving the bone marrow lymphocytic populations that exist in MG is somewhat different in MGUS and MM. In MM patients this disturbance is related to the disease stages and phases, reflecting an important role for T-cell subsets in tumor cell control.
Adult↗