A technique to improve the safety of laryngeal mask airway when used in lacrimal duct surgery.
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Anesthesia, General↗
Biomedical subjects
D Galante
Publications and source records attributed to D Galante.
Efficacy of amphotericin B colloidal dispersion in the treatment of Mediterranean visceral leishmaniasis in immunocompetent adult patients.
Twelve immunocompetent adults with Mediterranean visceral leishmaniasis (VL) were treated with amphotericin B colloidal dispersion (ABCD; 2 mg/kg/d for 7 d). All patients showed rapid clinical response without significant adverse events. Two weeks after therapy they were parasitologically cured and no relapses occurred during 6 months. ABCD is a valid alternative in the management of Mediterranean VL in adult patients.
Adult↗
Gross pathologic types of hepatocellular carcinoma in Italy.
The prevalence and independent predictors of the different macroscopic types of hepatocellular carcinoma (HCC) were assessed in 1,073 unselected patients of 14 hospitals in Italy from May 1996 to May 1997. Solitary HCC was the most common cancer type (44.6%), followed by multinodular (44.2%), diffuse (8.4%) and massive (2.8%) types. After adjustment for the influence of confounders by multiple logistic regression analysis, Child-Pugh grades B and C were found to be independent predictors of multinodular (odds ratio, OR, 2.0; 95% confidence interval (CI) = 1.5-2.6) and diffuse (OR 2.6; 95% CI = 1.6-4.4) HCC types. These findings indicate that the majority of HCC cases are not detected at a potentially treatable stage. Delayed detection of HCC is associated with a higher likelihood of the multinodular or diffuse gross pathologic type.
Carcinoma, Hepatocellular↗
Characteristics of hepatocellular carcinoma in Italy.
BACKGROUND/AIMS: This study aimed to assess the main features of hepatocellular carcinoma at the time of diagnosis in Italy, particularly in relation to the presence or absence of underlying cirrhosis, hepatitis virus marker patterns, age of the subjects and alpha-foetoprotein values. METHODS: A total of 1148 patients with hepatocellular carcinoma seen at 14 Italian hospitals in the 1-year period from May 1996 to May 1997 were the subjects of this prevalence study. Both newly diagnosed cases (incident cases) and cases diagnosed before May 1996 but still attending the hospitals during the study period (prevalent cases) were included. RESULTS: We found that 71.1% of cases were positive for hepatitis C virus antibodies but negative for HBsAg; in contrast, 11.5% were negative for anti-HCV but positive for HBsAg; 5.3% were positive for both markers; and 12.1% were negative for both viruses. The mean age of detection was over 60 years, with a younger mean age in HBsAg-positive compared to anti-HCV-positive patients (59.3 years vs. 65.6 years, p<0.01). The male-to-female ratio among HBsAg-positive patients was 10.4:1, in contrast to 2.8:1 among anti-HCV-positive patients (p<0.01). The majority of cases (93.1%) had underlying cirrhosis. Cirrhotic patients were more likely to be anti-HCV positive than non-cirrhotic cases (73.2% vs 43.9%; p<0.01); conversely, absence of hepatitis virus markers was more frequently observed in the non-cirrhotic than in the cirrhotic population (40.9% vs. 10.0%; p<0.01). Overall, the alpha-foetoprotein level was altered (>20 ng/ml) in 57.9% of patients; only 18% of cases presented diagnostic (>400 ng/ml) values. Anti-HCV positivity (O.R. 2.0; CI 95%=1.3-3.1) but not HBsAg positivity (O.R. 1.0; CI 95%=0.6-1.8) was shown to be an independent predictor of the likelihood of altered alpha-foetoprotein values by multivariate analysis. CONCLUSIONS: These findings point to differences in the characteristics of the populations infected by hepatitis B and hepatitis C. Factors other than the hepatitis viruses are important in non-cirrhotic patients. A change in the relative prevalence of hepatitis virus markers among hepatocellular carcinoma cases was demonstrated, reflecting a significant change in the rate of HBV endemicity in the Italian population. Finally, the increased trend in the mortality rate from liver cancer in Italy from 4.8 per 100,000 in 1969 to 10.9 in 1994 may reflect the large cohort of subjects infected with HCV via the iatrogenic route during 1950s and 1960s when glass syringes were commonly used for medical treatment.
Adult↗
[Spontaneous bacterial peritonitis in patients with liver cirrhosis. Differential aspects with portal thrombosis].
In a series of 155 patients with decompensated liver cirrhosis spontaneous bacterial peritonitis (SBP) was diagnosed in 15 cases (9.7%) and portal thrombosis (PT) in 8 (5.1%) by mean of standard criteria. The main clinical and laboratory characteristics were similar in the two groups of patients; fever was more frequently recorded in the SBP patients. Cytological examination of the ascites showed an increase in total cell count and in neutrophils count higher in SBP group than in PT. The diagnosis of PT was confirmed by ultrasonography. The data suggest that a cytological examination of the ascites should be performed in all patients with decompensated cirrhosis and may contribute to the differential diagnosis of SBP or PT.
English Abstract↗
Clinical and histological aspects of chronic HCV infection and cirrhosis.
We studied 608 consecutive cases of anti-HCV-positive chronic liver disease. In 358 patients the diagnosis was established by needle liver biopsy. In 250 patients with liver cirrhosis the diagnosis was made on the basis of the unequivocal clinical signs and the results of imaging procedures. Chronic HCV infection is usually observed in adults or elderly patients; the age of the patients steadily increases with the progression of the illness to the more severe stages. Jaundice was infrequent in patients with chronic hepatitis or early cirrhosis; clinical symptoms and laboratory tests are of little value in differentiating CPH from CAH or in detecting early cirrhosis. Serum aminotransferases were usually only slightly elevated in all stages of the disease. Despite the mildness of the hepatic cytolysis, the progressive reduction in serum cholinesterase and albumin concentrations and the progressive increase in the serum alkaline phosphatase activity indicate progressive failure in the hepatic function in the course of the illness. The histological study showed that steatosis, follicular portal inflammation and eosinophilic changes in the hepatocytes were prominent features of chronic HCV infection. In contrast, severe piecemeal necrosis without bridging was rarely observed.
Adult↗
Seckel's syndrome: a case report.
The authors describe a case similar to the complex syndrome described by Seckel (1960), "dwarf-headed dwarfism." This case differs from others previously reported because of slight hypophyseal hypoplasia with a slight reduction of human chorionic gonadotrophin (HCG) serum levels, and because of the parent's consanguinity (first cousins). A comparative critical examination was carried out on the 44 cases of Seckel's syndrome described in the literature. Only 19 of these cases appear to be comparable with Seckel's description, while the others are dubious, due to incomplete data. Some can be identified as ordinary cases of dwarfism with microcephaly or mental deficit. Until more precise and objective parameters are established, it would be advisable to refer to this particular form of dwarfism as "Virchow-Seckel type dwarf-headed dwarfism," in order to avoid using the more binding term "syndrome" and the misleading term "bird-headed."
Abnormalities, Multiple↗
Cefodizime (HR221) versus norfloxacin for treatment of urinary tract infections.
Cefodizime is a stable new beta-lactamase cephalosporin chemically related to cefotaxime and with a long half-life. Its clinical efficacy and tolerability were compared with those of norfloxacin in patients with intercurrent urinary tract infections plus chronic liver diseases. Cefodizime (2 g, once a day, i.v.) and norfloxacin (400 mg, twice a day, p.o.) were randomly given to two groups of 20 patients each with urinary tract infections caused by organisms sensitive in vitro to these drugs. Cultures of midstream bladder urine, urinalysis and blood biochemical tests were performed before and after each antibiotic treatment. Clinical resolution was observed in 100% of the patients at the end of the treatments, but bacteriological eradication was obtained in 90% of the patients treated with cefodizime and 85% of those treated with norfloxacin, because of the development in five patients of asymptomatic bacteriuria (superinfections).
Adolescent↗
Efficacy and safety of ciprofloxacin in the treatment of UTIs and RTIs in patients affected by liver diseases.
The clinical efficacy and the safety of ciprofloxacin was studied in 92 patients (aged 26 to 83 years; mean 57.5 years) affected by urinary tract infections (UTI) and respiratory tract infections (RTI) suffering also with various liver diseases. Ciprofloxacin was given orally at different dose regimens: 500 mg b.i.d. (22 cases), 250 mg b.i.d. (20 cases), 500 mg s.i.d. (20 cases) for the treatment of UTIs; 500 mg b.i.d. (ten cases) and 250 mg b.i.d. (20 cases) for the treatment of RTIs. The doses were not correlated to the severity of the infections. Patients were treated for five to 15 days. All the bacteria isolated from sputum or urine before treatment were sensitive to ciprofloxacin (MIC range less than or equal to 0.015 mg/l to 8 mg/l). The clinical and bacteriological responses were favourable in a high percentage of patients both for RTIs and UTIs, irrespective of the dose. Side effects were infrequent (7%) and mild (nausea, gastralgia, oral candidosis), never requiring the interruption of the treatment. No change in the blood chemistry tests was observed at any dose.
Adult↗
Efficacy and safety of oral ciprofloxacin in the treatment of respiratory tract infections associated with chronic hepatitis.
Twenty patients with lower respiratory tract infections presumably caused by ciprofloxacin-susceptible bacteria were admitted to a non-comparative, prospective clinical study. All patients were hospitalized for chronic hepatitis at various stages of the disease. Ciprofloxacin was given orally at a dose of 250 mg every 12 hours for five to 10 days. Patients had either acute bronchitis, chronic bronchitis in the acute phase, or acute tracheobronchitis. In 19 of 20 patients treated, there was a favorable outcome (15 cures and four improvements). In 17 patients, the presumably causative pathogen was eradicated. No side effect was observed except for oral candidiasis, which occurred in two patients. This study demonstrates the clinical and bacteriologic efficacy of ciprofloxacin in pulmonary infection in patients with severe impairment of liver function.
Administration, Oral↗
Rapid improvement of hepatic encephalopathy associated with oral ciprofloxacin treatment.
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Ciprofloxacin↗
Clinical efficacy and safety of sulbactam/ampicillin in patients suffering from chronic liver disease.
Sulbactam is a new beta-lactamase inhibitor with pharmacokinetic characteristics in humans similar to those of ampicillin. A total of 41 patients hospitalized in the Clinic of Infectious Diseases, University of Naples, for chronic liver diseases, were treated with sulbactam/ampicillin (ratio 1:2) for urinary, respiratory, biliary tract or soft tissue infections. Sulbactam/ampicillin was administered im or iv at a dosage of 3-9 g/day depending on the site and severity of the infection. All the patients treated with sulbactam/ampicillin had clinical signs and symptoms of infection, and all the organisms isolated were sensitive to sulbactam/ampicillin (MIC less than 16 mg/l). For both Gram-positive and Gram-negative bacteria the sulbactam/ampicillin MICs were much lower than the ampicillin MICs. In agreement with the favourable in-vitro results, we observed good therapeutic efficacy. 85% of the patients recovered or improved within a few days of therapy, with no clinical relapses, and in 81% of the infections the responsible bacteria were completely eradicated. We observed a low number of side effects (3/41 oral candidosis; 3/41 pain at the im injection site) and no change in the blood chemistry tests.
Adult↗
Microbiological properties of sulbactam combined with ampicillin.
Several in vitro parameters of sulbactam combined with ampicillin (Sbt/Amp) were studied in order to evaluate and compare its microbiological properties with those of beta-lactamase stable beta-lactams (ceftriaxone, cefamandole, cefoxitin). The intrinsic activity of Sbt/Amp was satisfactory and comparable to that of other beta-lactams and no significant difference was observed against beta-lactamase producing or non-producing bacteria. Besides, it was determined that sulbactam, when combined with ampicillin at different ratios (1:2, 5:1), with and without preincubation (60 min) reduces the hydrolysis of ampicillin determined by ten different standard beta-lactamases. The hydrolysis rates of ampicillin become as low as those of cefoxitin, cefamandole and ceftriaxone, which are beta-lactamase stable cephalosporins. In fact, all the antibiotics under examination were slightly hydrolyzed by several beta-lactamases, but such slight hydrolysis did not affect the antibacterial activity against beta-lactamase producing bacteria. About 50% of non-beta-lactamase producing bacteria (18 strains of different bacterial species) produced an inducible beta-lactamase after ten daily subcultures with sub-inhibitory concentrations of each antibiotic, but minimum inhibitory concentrations (MICs) of Sbt/Amp never increased after stimulation in contrast with other drugs whose MICs were much higher in consequence of this procedure. Finally, no spontaneous resistant mutant to Sbt/Amp was detected, but several mutants appeared in response to the other drugs. Sulbactam makes ampicillin as effective as beta-lactamase stable cephalosporins and its use does not determine an increase of resistance or selection of resistant mutants.
Ampicillin↗
[Profile of a new antibiotic: the combination sulbactam/ampicillin].
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Ampicillin↗
Intestinal microflora changes induced by ciprofloxacin and treatment of portal-systemic encephalopathy (PSE).
The modifications of colon microflora in 14 patients under oral ciprofloxacin therapy for intercurrent UTIs or RTIs, at the dose of 250 mg b.i.d. or 500 mg o.d. were examined. All patients were affected by liver cirrhosis. A marked decrease in enterobacteria with both doses was noticed in the first few days, with a complete disappearance from days 3-6 of therapy and a return to normal within 2 weeks after interruption of treatment. Gram-positive and Gram-negative aerobic and anaerobic flora were not affected significantly. As a consequence of these results, the treatment of six patients affected by PSE (grade 2-3) was studied, testing the colon microflora changes, the presence of circulating endotoxins and blood ammonium levels before, during and after 12 days of therapy. A marked reduction or suppression of enterobacteria was observed, and a prompt normalization of blood ammonium levels, the disappearance of circulating endotoxins and a clear clinical improvement in 5 out of 6 patients.
Aged↗
Ciprofloxacin concentrations in human fluids and tissues following a single oral dose.
Ciprofloxacin is a new quinolone carboxylic acid derivative which exerts its antibacterial activity at very low concentrations against a wide spectrum of microorganisms. Ciprofloxacin serum and urine concentrations were studied in 10 healthy volunteers after a single 250 and 500 mg oral dose. The concentration in ascitic fluid was determined in four male patients undergoing paracentesis after a single oral 250 mg dose (two patients) and 500 mg dose (two other patients). The penetration of ciprofloxacin into the human tonsils and turbinate bones was also determined in eight patients undergoing tonsillectomy or turbinectomy 3 h after a single oral 250 mg administration. Ciprofloxacin concentrations were determined by an agar diffusion test utilizing E. coli as reference strain. Ciprofloxacin is rapidly absorbed after oral administration (Ka = 2.67 and 1.93 mcg/ml) and its serum concentration does not vary significantly with sex and dosage (Cmax = 2.61 and 1.99 mcg/ml after a single 500 mg and 250 mg oral dose). Urinary concentrations of ciprofloxacin are twice higher after a single 500 mg dose than after a 250 mg one and are still high after 24 h (37.2 and 25.3 mcg/ml). The concentrations of ciprofloxacin in ascites, tonsils and turbinate bones are several times higher than its MICs against the majority of Gram+ and Gram- aerobic bacteria. The in vitro activity of ciprofloxacin and its human pharmacology suggest a twice daily 250 of 500 mg dosing for infections caused by multiple antibiotic-resistant bacteria, and a once a day dose in the treatment of urinary tract infections.
Administration, Oral↗
In vitro microbiological properties of mezlocillin compared with four cephalosporins.
The intrinsic activity, antibacterial spectrum and beta-lactamase stability of mezlocillin were determined and compared with that of four other beta-lactams: ceftriaxone, ceftizoxime, cefotaxime, cefuroxime. These parameters were studied by determining the minimum inhibitory concentrations (MICs) and minimum bactericidal concentrations (MBCs) against 397 gram-negative bacteria including Pseudomonas sp. and 124 gram-positive cocci, utilizing 10(5) and 10(7) CFU/ml bacterial concentrations. The sensitivity to ten different standard beta-lactamases was determined by a spectrophotometric method that utilizes the velocity of cytochrome c reduction. Mezlocillin was hydrolyzed, at different degrees, by all the beta-lactamases under examination (TEM 1, TEM 2, OXA1, OXA2, OXA3, S + A, P99, STH4, SHV1, K1) but such hydrolysis did not affect its bactericidal activity which was similar to that of the other beta-lactamase-stable beta-lactams. In addition MBC/MIC ratios were very low and the differences of MIC values at different bacterial inocula were not significant. We also studied the stimulation of inducible beta-lactamases by subinhibitory doses of antibiotics, the eventual changes of antibiotic susceptibility after these stimulations and, finally, the frequency of spontaneous resistant mutants. Mezlocillin stimulated the production of inducible beta-lactamases in 50% of the bacteria examined, but in contrast with the other drugs tested, no increase of MICs occurred nor did mezlocillin select resistant mutants.
Bacteria↗
Inhibitory and bactericidal activity of cefmetazole and seven other beta-lactams against different bacterial inocula.
The determination of the minimal inhibitory concentrations (MICs) at different bacterial inocula represents an important factor in determining the potential effectiveness of new antibiotics. MICs at different inocula (10(5) and 10(7) CFU/ml) and minimal bactericidal concentrations (MBC) of cefmetazole and seven other new cephalosporins (ceftazidime, ceftizoxime, cefamandole, ceftriaxone, cefotaxime, cefuroxime, cefoxitin) were determined by a miniaturized dilution broth method against a wide range of gram-positive, gram-negative and non-fermentative bacteria. The results of the present investigation confirm that all the beta-lactams under examination including cefmetazole exert a good or satisfactory antibacterial activity against gram-positive and gram-negative bacteria; and that only ceftazidime possesses antipseudomonas activity. MBCs and MICs at heavy inoculum are two times higher than MICs at light inoculum. These results could explain the spread by different mechanisms of bacteria resistant to beta-lactam antibiotics.
Bacteria↗