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Biomedical subjects

J Garau

Publications and source records attributed to J Garau.

At least 19 recordsLinked to original sources
PubMed1992

Postoperative complications due to methicillin-resistant Staphylococcus aureus (MRSA) in an elderly patient: management and control of MRSA.

An elderly lady was admitted to hospital for elective resection of an adenocarcinoma of the colon. Following an anastomotic leak she developed intra-abdominal sepsis and underwent abdominal drainage of pus. During recovery from her second operation, she developed pneumonia and a bacteraemia due to methicillin-resistant Staphylococcus aureus (MRSA). She was treated with vancomycin and co-trimoxazole and survived without further sequelae. Details of the development and treatment of this case are discussed. Procedures for the control and eradication of MRSA infections in hospitals are reviewed.

Adenocarcinoma↗
PubMed1991

Intramuscular imipenem/cilastatin in multiple-dose treatment regimens: review of the worldwide clinical experience.

Multicenter noncomparative trials of intramuscular administration of imipenem/cilastatin for the treatment of a variety of infections requiring multiple-dose therapy are reviewed. Fourteen centers in the United States and 18 centers elsewhere participated in these studies. A total of 686 patients (461 evaluable) were treated worldwide. The severity of the infection was rated as moderate in 58.9%, mild in 37.2% and severe in 0.6%. The most common sites of infection were the skin and soft tissue (36.2%) and intra-abdominal (17.6%). Polymicrobial infections were relatively common (27%). Dosing regimens in evaluable patients were 500 mg every 12 h (45.1%), 750 mg every 12 h (36.2%) and 500 mg every 8 h (18.6%). The overall clinical outcome was favorable (clinical cure or improvement) for 95% or more of the evaluable patients with the various body system infections, except in gynecologic infections where 89% of the evaluable patients had a favorable outcome and for sepsis where the favorable outcome was 76%. Where data were available for analysis (skin and soft tissue infections) there was no difference in favorable clinical outcome among patients with moderate infection treated with 1.0 g/day (95% favorable) compared with 1.5 g/day (94% favorable). The overall bacteriologic eradication rate was 91%. Clinical adverse effects were similar in type but less common in frequency than those noted in other studies with the intravenous formulation, with nausea, vomiting and diarrhea being most common; no instances of seizures or confusion were observed. The laboratory adverse effects were similar to those seen in other studies with the intravenous formulation, with increased liver enzyme values the most common. The intramuscular injection was well tolerated in 87% of the patients and moderately well tolerated in 6.6%. The efficacy and low incidence of side effects of the intramuscular formulation of imipenem/cilastatin are significant advantages in the cost-effective treatment of infections.

Adolescent↗
PubMed1991

[Bacteremia caused by vancomycin-resistant Enterococcus faecalis. Report of 2 cases].

The rising concern about nosocomial bacteremia due to vancomycin-resistant E. faecalis in Spanish hospitals. Retrospective review of the medical records of two patients with nosocomial bacteremia due to E. faecalis resistant to vancomycin. Both patients (a 78 years-old male and a 65 years-old female) were admitted in two separate hospital units. None of them had been previously treated with vancomycin, and both patients had severe underlying diseases. The two strains isolated showed high-level vancomycin and teicoplanin resistance, although they were sensitive to daptomycin. No other strain with high level glycopeptide antibiotic resistance was isolated in the hospital during the following 23 months. This occasional resistance to glycopeptides among enterococci has been shown also in other Spanish hospitals. The increasing incidence of penicillin and aminoglycoside resistance among enterococci in our environment could have a practical impact, either for the clinical laboratory and/or for therapeutic decisions in patients with infections due to this microorganism.

Aged↗
PubMed1990

Tolerance and efficacy of parenterally administered penicillin-streptomycin and orally administered amoxicillin or penicillin V for prophylaxis of experimentally induced streptococcal endocarditis.

A regimen of a single intramuscular dose of penicillin G-streptomycin was compared with regimens of three oral doses of amoxicillin and two oral doses of penicillin V to prevent Streptococcus sanguis endocarditis in rabbits with experimentally induced valvular heart lesions. Challenge doses of 10(4), 10(6), and 10(8) CFU of a strain of S. sanguis highly tolerant to penicillin and amoxicillin were used. The combination of penicillin and streptomycin was the only regimen tested that provided full protection even against the highest inoculum concentration. A single oral dose of penicillin V (36 mg/kg) or amoxicillin (50 mg/kg), two oral doses of penicillin V (36 and 18 mg/kg with a 7-h interval between doses), or six oral doses of amoxicillin (50 mg/kg followed by 8.5 mg/kg at 8-h intervals) protected recipients of the lowest inoculum concentration; protection diminished with increasing inocula. In contrast, administration of two high oral doses of amoxicillin (50 mg/kg) with a 10-h interval between doses provided full protection against challenge doses of 10(4) and 10(6) CFU, preventing endocarditis in 10 (66%) of 15 recipients of 10(8) CFU. All regimens evaluated were highly effective in preventing endocarditis when rabbits were challenged with 10(4) CFU. The combination of penicillin and streptomycin was the best regimen tested. Administration of two high oral doses of amoxicillin (50 mg/kg) with a 10-h interval between doses led to significantly fewer infections when compared with the other oral regimens when rabbits were challenged with 10(6) and 10(8) CFU.

Amoxicillin↗
PubMed1990

Intramuscular diclofenac sodium versus intravenous Baralgin in the treatment of renal colic.

A comparative, randomized, double-blind study of diclofenac sodium 75 mg im versus Baralgin (a combination drug composed of dipyrone and two spasmolytics) 5 mL iv was performed on 57 patients with renal colic. Both groups were comparable as to age, sex, pain evolution time before treatment, and no treatment for renal colic in the six hours preceding trial drug administration. No significant differences were found between the two groups with respect to the evolution of pain after the first dose or in the frequency of administration of a second dose. Tolerability was good in both groups, but sweating and pain throughout the vein were observed in one patient in the Baralgin group. We concluded that diclofenac sodium constitutes an excellent alternative to pyrazolone analgesics, with the advantages of being monotherapy and having good tolerability, when used as intramuscular injection in ambulatory patients.

Adult↗
PubMed1990

Single-dose antibiotic prophylaxis in patients at high risk for infection in biliary surgery: a prospective and randomized study comparing cefonicid with mezlocillin.

The usefulness of antibiotic prophylaxis in biliary surgery is well established. When antibiotic prophylaxis is not used, wound infection rates after biliary surgery range from 10% to 25%. With antibiotic prophylaxis, the rates can be reduced to less than 5%. Three questions are still controversial: Do all patients undergoing biliary surgery require antibiotic prophylaxis? What is the ideal antibiotic for use in biliary surgery? What should be the duration of antibiotic prophylaxis? In this study we prospectively evaluated the efficacy of a single dose of antibiotic prophylaxis in biliary surgery, administered to patients at high risk for infection, in a trial comparing cefonicid (a cephalosporin with a long half-life) with mezlocillin (a broad-spectrum ureidopenicillin).

Adult↗
PubMed1989

[Gastric ulcer as a unique and symptomatic manifestation of infection by cytomegalovirus in a healthy adult].

A previously healthy female without risk factors had cytomegalic inclusion disease with symptomatic gastric involvement and without evidence of systemic cytomegalovirus (CMV) infection. Multiple ulcerations with a fibrinous bottom were discovered by fibrogastroscopy in the gastric body and antrum. Histological study showed cells with intranuclear inclusions and basophilic nuclear cytoplasm. The detection of specific IgM and its subsequent negativization suggest an active CMV infection. Gastric infection may be the isolated and symptomatic feature of the disease in the healthy adult.

Aged↗
PubMed1989

[Heparin-induced skin necrosis, thrombocytopenia and pulmonary thromboembolism. Presentation of 2 cases].

Two patients with skin necrosis in the injection points after subcutaneous prophylactic porcine calcium heparin administration are reported. In addition, both patients had thrombopenia, deep venous thrombosis and pulmonary thromboembolism. The review of similar cases suggests that skin necrosis is another feature of the thrombopenia and multiple vascular thrombosis syndrome associated with heparin administration. Data from the literature suggest that there is a common immunologically-mediated pathogenetic mechanism responsible for these phenomena through the production of platelet aggregates and immune reaction in endothelial cells. Paradoxically, the continuation of therapy with intravenous sodium heparin was not followed in our patients by new complications despite the theoretical risk.

Adult↗
PubMed1987

Controlled trial of endoscopic sclerosis in bleeding peptic ulcers.

Of 113 patients in whom endoscopy revealed a bleeding gastric or duodenal ulcer 55 were randomly allocated to receive endoscopic sclerosis (ES) (injections of adrenaline/polidocanol) plus cimetidine while 58 received cimetidine alone as controls. 3 patients treated with ES (5.5%) compared with 25 controls (43.1%) had a major recurrent haemorrhage during their hospital stay. ES also led to significant reductions in the need for emergency surgery (3 vs 20 patients), transfusion requirements (mean 0.42 [SD 1.1] vs 2.7 (3.19) U), and the length of hospital stay (11.6 [5.1] vs 16.2 [11.3] days). ES as an adjunct to conventional medical treatment is an effective and safe emergency therapy for gastrointestinal bleeding due to peptic ulcer.

Adult↗
PubMed1987

Efficacy of orally administered penicillin V for prophylaxis of experimentally induced streptococcal endocarditis.

Four oral penicillin V regimens were compared for the ability to prevent Streptococcus sanguis infection of experimentally induced valvular heart lesions in rabbits. Challenge doses of 10(4), 10(6), and 10(8) CFU of a penicillin-susceptible strain of S. sanguis were used in this study. Measured by recovery of test organisms from endocardial lesions, the lowest-concentration inoculum was infective for 53% of the recipients; the higher-concentration inocula were infective for all recipients. A single-oral-dose penicillin V regimen (36 mg/kg of body weight) prevented endocarditis when rabbits were challenged with 10(4) CFU, but protection diminished with increasing inoculum concentrations. In contrast, addition of a second penicillin V dose (18 mg/kg of body weight) administered with a 7-h interval between doses achieved fully effective prophylaxis against even the highest inoculum tested (10(8) CFU). A repeated set of experiments in which half the dose of penicillin V was administered showed significantly reduced protection against S. sanguis endocarditis.

Adult↗
PubMed1987

Cytomegalovirus mononucleosis-associated antral gastritis simulating malignancy.

A 44-year-old man with epigastric pain, fever, and atypical lymphocytosis was found to have severe antral gastritis with radiologic and endoscopic features suggestive of malignancy. Histopathologic and serologic findings were diagnostic of cytomegalovirus gastric infection. Clinical involvement of the stomach in the course of cytomegalovirus mononucleosis is unique, and this case expands further the spectrum of clinical disease in the otherwise healthy adult.

Adult↗