PubMed Health⌕ Search

Biomedical subjects

E Alfonso

Publications and source records attributed to E Alfonso.

At least 19 recordsLinked to original sources
PubMed2001

[13C]linoleic acid oxidation and transfer into milk in stunted lactating women with contrasting body mass indexes.

BACKGROUND: The fat concentration of human milk is associated with maternal adiposity, but there is no clear understanding of the mechanisms controlling milk fat concentration. OBJECTIVE: We evaluated the effect of postpartum body mass index (BMI; in kg/m(2)) on the metabolic distribution of an oral dose of [13C]linoleic acid in lactating women. DESIGN: Ten lactating women stratified by BMI (either <22.5 or >23.5) at 5 mo postpartum received orally 2.5 mg [13C]linoleic acid/kg body wt. Exhaled air, milk, and plasma samples were collected in relation to tracer administration. Linoleic acid was determined by gas chromatography. Dietary intake, serum, milk composition, [13C]linoleic acid enrichment in milk and plasma, and exhaled 13CO2 (by isotope ratio mass spectrometry) were assessed. RESULTS: Women with a higher BMI exhaled more 13CO2 than did women with a lower BMI (22.8 +/- 9.4% compared with 8.6 +/- 3.5% of dose, P < 0.03). Cumulated 72-h transfer of [13C]linoleic acid to milk was not significantly different between groups (14.8 +/- 6.5% compared with 17.7 +/- 6.7% of dose). Within the first 9 h after dose administration, 51.6 +/- 4.9% of the total isotope transfer into milk had passed in women with a higher BMI, but only 24.0 +/- 15.3% had passed in those with a lower BMI (P = 0.02). CONCLUSIONS: Women with a lower BMI, who were reputed as having less body fat, oxidized and secreted into milk less dietary linoleic acid within 12 h after tracer administration than did women with a higher BMI. In both groups, a large proportion of [13C]linoleic was retained in the maternal compartment, most likely fat tissue, in a slow turnover pool, and released slowly in later hours.

Adipose Tissue↗
PubMed2001

Amniotic membrane transplantation after the primary surgical management of band keratopathy.

PURPOSE: To determine the safety and efficacy of amniotic membrane transplantation to restore and maintain a stable corneal epithelium and reduce ocular surface pain after surgical removal of band keratopathy arising from ocular causes. METHODS: Fifteen patients (16 eyes) from two centers with band keratopathy secondary to ocular causes underwent amniotic membrane transplantation as a graft after surgical removal of calcific deposits with or without the use of ethylenediaminetetraacetic acid. In a prospective, consecutive, uncontrolled case series, the rate of corneal epithelialization and resultant surface stability were recorded over a mean follow-up period of 14.6 months. RESULTS: Pain from ocular surface instability was the presenting complaint in 14 of 15 (93.3%) patients and resolved in all cases after the procedure even for those who experienced a recurrence of the calcific deposit. Fifteen of 16 eyes (93.7%) achieved epithelialization with a mean time to epithelial healing of 15.2 days. The only eye that failed to heal was subsequently diagnosed with total limbal stem cell deficiency. Visual acuity improved in five of nine (44%) sighted eyes and remained unchanged in four of nine (56%). No patient experienced any major surgical or medical complication after the procedure. CONCLUSION: Amniotic membrane transplantation represents a safe and effective method to restore a stable corneal epithelium in eyes after primary surgical removal of band keratopathy arising from ocular causes.

Adult↗
PubMed1999

Combined penetrating keratoplasty and trabeculectomy with mitomycin C.

OBJECTIVE: To evaluate corneal graft survival and intraocular pressure control in eyes that have undergone combined penetrating keratoplasty and trabeculectomy with mitomycin C (MMC). DESIGN: Retrospective noncomparative case series. INTERVENTION: Penetrating keratoplasty combined with trabeculectomy with MMC and other surgical procedures. PARTICIPANTS: Twenty-four eyes of 22 patients undergoing combined penetrating keratoplasty and trabeculectomy with mitomycin C. MAIN OUTCOME MEASURES: Corneal graft clarity and intraocular pressure control. RESULTS: The cumulative probability of corneal graft survival was 85% at 1 year and 60% at 2 years. The cumulative probability of adequate pressure control was 67% at 3 months, 55% at 12 months, and 50% at 24 months. The incidence of bleb failure was higher in cases involving additional concomitant procedures, such as anterior vitrectomy, lens implantation or exchange, and drainage tube implantation. CONCLUSIONS: Combined penetrating keratoplasty and trabeculectomy with mitomycin C is associated with good corneal graft survival but also a risk of early failure of intraocular pressure control. Other concomitant procedures during the combined penetrating keratoplasty/trabeculectomy may increase the risk of early bleb failure.

Adult↗
PubMed1999

Acute colorectal obstruction: treatment with self-expandable metallic stents before scheduled surgery--results of a multicenter study.

PURPOSE: To evaluate the efficacy of treatment with self-expandable metallic stents for acute colonic obstruction before elective surgical resection. MATERIALS AND METHODS: In 71 patients with malignant obstruction seen from October 1993 through December 1996, lesions were located in the transverse colon in one patient, in the descending colon in 22 patients, and in the rectosigmoid region in 48. A total of 72 self-expandable metallic stents were implanted within 24 hours of diagnosis. RESULTS: Technical success was obtained in 64 patients (90%). In two cases (3%), it was not possible to advance across the obstructing mass. In five cases (7%), the prostheses were poorly positioned at the site of obstruction, requiring placement of a new stent in three cases. Clinical improvement and resolution of the obstruction were confirmed in 66 patients (93%) within 96 hours. Minor complications developed in nine cases (13%). One patient (1%) underwent surgery to resolve a colonic perforation caused by wires at the ends of the stent. The mean time between stent placement and surgery was 8.6 days (range, 6-16 days). CONCLUSION: Implantation of colorectal stents is a safe treatment of acute malignant colonic obstruction before resection.

Acute Disease↗
PubMed1998

Acute colorectal obstruction: stent placement for palliative treatment--results of a multicenter study.

PURPOSE: To evaluate the usefulness of stent implantation as a palliative treatment in patients with acute colonic obstruction who are not surgical candidates. MATERIALS AND METHODS: Twenty-four patients (eight women, 16 men; age range, 60-98 years) with acute colonic obstruction underwent colonic stent placement. In nine patients, the procedure was considered a primary palliative treatment; seven patients had a previous diagnosis of disseminated neoplastic disease, and two were not surgical candidates because of their poor general condition. In the remaining 15 patients, stent placement was considered the definitive palliative treatment after tumor staging. The mean time of follow-up was 8.4 months (range, 1-24 months) for patients who lived and 6.3 months (range, 1-12 months) for those who died. RESULTS: Stent placement was successful in all patients. Clinical and radiographic findings of bowel obstruction resolved within 24 hours after stent placement in 23 (96%) patients. None of the patients required colostomy for bowel decompression after immediate stent placement. Complications developed in 10 (42%) patients: Two (8%) patients had mild rectal bleeding; three (12%), abdominal pain; two (8%), malpositioning of the stent; two (8%), pseudo-obstructive episodes due to fecal impaction; and one (4%), occlusive tumor ingrowth into the stent lumen. One (4%) patient underwent surgery to resolve stent malfunction due to poor positioning. Two (8.3%) patients--one with malpositioning of the prosthesis and the other with stent occlusion--required a new stent. The remaining complications required no further treatment. The mortality rate at 6 months was 24%. Eight patients were alive at the time this article was written. CONCLUSION: Colorectal stent placement resulted in successful palliation of acute colonic obstruction in patients with disseminated neoplastic disease.

Acute Disease↗
PubMed1995

Efficacy of ofloxacin vs cefazolin and tobramycin in the therapy for bacterial keratitis. Report from the Bacterial Keratitis Study Research Group.

PURPOSE: To compare ofloxacin solution with a combination of fortified antibiotic cefazolin sodium and tobramycin sulfate solutions in the treatment of bacterial keratitis. METHODS: Patients under care at any one of 28 participating clinical centers who had an eye with suspected bacterial keratitis were randomly allocated in a double-masked manner to treatment with 0.3% ofloxacin solution or a combination of the fortified antibiotics (1.5% tobramycin and 10.0% cefazolin solutions). MAIN OUTCOME MEASURES: Time to healing defined as complete re-epithelization, accompanied by a nonprogressive stromal infiltrate for two consecutive visits. Secondary outcome measures included patient symptoms and signs of infection and adverse reactions to study medications. Only patients with a positive bacterial corneal culture were included in most analyses. RESULTS: A positive bacterial corneal culture was obtained in 140 (56%) of the 248 enrolled patients. The time to healing was similar among the 73 patients receiving ofloxacin and the 67 patients receiving fortified antibiotics (P = .70). By 7 days after study entry, the keratitis in 37% of the ofloxacin group and 38% of the fortified antibiotics group had healed. By 28 days, keratitis in 89% of the ofloxacin group and 86% of the fortified antibiotics group had healed. Two patients receiving ofloxacin and one receiving fortified antibiotics discontinued study medication because of lack of efficacy. Patients receiving ofloxacin reported substantially less burning and stinging on instillation than the patients receiving fortified antibiotics (P < .001). Five of six patients among the 140 with positive bacterial cultures who had study medications discontinued because of ocular side effects were in the fortified antibiotics group; an additional three patients, all in the fortified antibiotics group, among the remaining 108 receiving study medications had ocular side effects. CONCLUSIONS: The efficacy of ofloxacin solution in treating bacterial keratitis is equivalent to that of the fortified cefazolin and tobramycin solutions. The reduced frequency of ocular toxic effects and the relative ease of preparation of ofloxacin are additional considerations.

Adult↗
PubMed1995

Surgical management of dislocated intraocular lenses.

Intraocular lens (IOL) malpositions range from simple IOL decentration to luxation into the posterior segment. Many surgical techniques and approaches have been devised to treat visually significant IOL dislocation. In this series, 78 eyes with IOL dislocation were managed by anterior segment and vitreous surgeons with a variety of surgical techniques using a limbal, pars plana, or combined limbal-pars plana approach. Most of the dislocated lenses were posterior chamber IOLs. In 39 of 78 eyes (50%), final visual acuity was 20/50 or better. Neither surgical approach nor management technique appeared to be related to outcome. The timing of surgery did not appear to affect visual outcome but was not examined in a randomized fashion. Guidelines for determining optimal management are presented.

Adult↗
PubMed1991

Treatment of infectious scleritis and keratoscleritis.

We reviewed 28 cases of culture-proven infectious scleritis and keratoscleritis to clarify the role of an operation in this disorder. Surgical management in 11 patients with keratoscleritis included cryotherapy, five; penetrating corneal-scleral graft, two; lamellar corneoscleral graft, two; and tectonic penetrating keratoplasty, two; in addition to intensive fortified antibiotic eyedrops. Eight patients with keratoscleritis were treated medically only with intensive fortified frequent antibiotic eyedrops, one; intensive instilled plus intravenous antibiotics, three; and instilled, intravenous, and subconjunctival antibiotics, four. Seven of eight patients treated with antibiotics alone and two of 11 patients who received surgical intervention in addition to antibiotics eventually required evisceration or enucleation of the eye. These results suggest that cryotherapy, lamellar or penetrating corneoscleral graft, in addition to intensive antibiotic therapy, may improve the outcome of patients with infectious keratoscleritis. Five eyes with isolated scleritis without corneal involvement were treated with conjunctival recession and cryotherapy in addition to aggressive antibiotics, and four were treated with antibiotics alone. The infections of these nine patients resolved.

Adrenal Cortex Hormones↗
PubMed1991

Biofilm and scleral buckle-associated infections. A mechanism for persistence.

Scleral buckle infections tend to be persistent as well as resistant to antimicrobial treatment. Often, scleral buckle infections require removal of the buckling elements for resolution. To determine if bacteria are able to persist on scleral buckles by elaborating a glycocalyx matrix or biofilm that offers protection against host defenses and antimicrobial treatment, the authors cultured 28 scleral buckle elements removed for infection and extrusion. Bacteria were isolated from 18 elements (64%). The most frequently isolated bacteria were Staphylococcus epidermidis and other coagulase-negative staphylococci (8), Staphylococcus aureus (3), corynebacteria (3), Mycobacterium chelonei (3), and Proteus mirabilis (3). Eleven (65%) of 17 buckles evaluated with scanning electron microscopy demonstrated the presence of bacteria encased in biofilm. Biofilm was demonstrated on the surfaces and ends of solid silicon elements. In the silicon sponges, biofilm also extended into the matrix of the sponges. The authors believe that bacterial production of biofilm offers an explanation for the persistence of scleral buckle infections and their ability to withstand antimicrobial treatment.

Adult↗
PubMed1990

Antibiotic therapy for Bacillus species infections.

We reviewed 36 cases of culture-proven Bacillus species ocular infections occurring between September 1974 and December 1989. Kirby-Bauer disk sensitivities were available in 34 of the 36 cases (95%). All Bacillus species isolates were sensitive to the aminoglycoside antibiotics (N = 34) and to vancomycin hydrochloride (N = 32); resistance to clindamycin was found in four of 18 (22%) of tested isolates. Although B. cereus was uniformly sensitive to these antibiotics, resistance to clindamycin occurred in four cases in the non-B. cereus group. The microbroth dilution technique confirmed the Kirby-Bauer data. The aminoglycosides were uniformly effective, but the cephalosporins (first, second, and third generation drugs) were consistently ineffective against B. cereus and varied from sensitive to moderately sensitive for the non-B. cereus isolates. Our microbiologic laboratory findings suggest that vancomycin hydrochloride in combination with an aminoglycoside ensures more consistent antibiotic coverage of Bacillus species ocular infections.

Anti-Bacterial Agents↗
PubMed1989

Ulcerative keratitis associated with contact lens wear.

From October 1982 through June 1986, 658 patients developed ulcerative keratitis. In 196 of these patients it was contact lens-related. Fifty-nine patients wore extended-wear contact lenses for cosmetic purposes. On culture, Pseudomonas species was the organism most frequently isolated from the ulcers associated with contact lens wear. No cases of fungal keratitis were found in the contact lens group as compared to 40 cases (17%) in the noncontact lens group. Compared to results of a similar study covering January 1977 through September 1982, current results showed a larger number of patients using extended-wear lenses for cosmetic reasons (59 vs one) and overall younger age.

Adolescent↗
PubMed1989

Gentamicin-resistant pseudomonal infection. Rationale for a redefinition of ophthalmic antimicrobial sensitivities.

Eight pseudomonal species were involved in 106 invasive infections of the eye; all were community acquired. Eighteen percent of the total and 9% of the Pseudomonas aeruginosa strains were gentamicin resistant, as defined using conventional criteria. All 10 cases of "resistant" pseudomonal (nine P. aeruginosa) keratitis responded satisfactorily to treatment with gentamicin. The resistance breakpoint (defined by safe serum levels in parenteral therapy) for most P. aeruginosa is much lower than ocular gentamicin levels achievable by optimal local application. We argue for a specific ophthalmologic definition of antibiotic resistance in infections of the cornea and external eye. MIC quantitative determinations of ocular isolates would provide more useful information to ophthalmologists than conventional qualitative disc sensitivity testing.

Adult↗
PubMed1989

Microbiology of contact lens-related keratitis.

We reviewed 397 cases of microbial keratitis examined at the Massachusetts Eye and Ear Infirmary, Boston, MA, U.S.A., from January 1982 through December 1985. Of these, 136 cases (34%) were related to contact lens use. Extended-wear contact lenses were used by 107 (79%) of these patients. Cosmetic contact lenses accounted for 59 (44%) of lens-related cases, aphakic contact lenses 44 (32%), and therapeutic (bandage) contact lenses 33 (24%). Fifty-three microbial keratitis cases associated with contact lens wear were culture-positive: 28 (52%) were gram-positive, and 19 (36%) were gram-negative. Mixed cultures, fungi, and Acanthamoeba accounted for two cases (4%) each. Pseudomonas aeruginosa was specifically associated with cosmetic soft contact lens use.

Adult↗
PubMed1988

Effects of gentamicin on healing of transdifferentiating conjunctival epithelium in rabbit eyes.

We examined the effects of commercially prepared gentamicin, a wide-spectrum topical antibiotic, on the healing of epithelial defects of the rabbit cornea. Abrasions were created by: (1) removing the corneal epithelium and 3 mm of the conjunctival epithelium (Group 1); and (2) producing the same initial trauma and subsequently removing the central 8 mm of epithelium 28 days after initial healing (Group 2). The complete healing of the large corneal and conjunctival epithelial defects was not delayed when gentamicin solution was used four times a day (Group 1). When the healed epithelium was reinjured while transdifferentiating from conjunctival to corneal epithelium (day 28, Group 2), treatment with the gentamicin solution and its vehicle, both containing benzalkonium chloride, delayed epithelial healing significantly compared with treatment with saline (P less than .01).

Administration, Topical↗