[Eikenella corrodens infections].
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Adult↗
Biomedical subjects
J Vargas
Publications and source records attributed to J Vargas.
Synthesis, activity and toxicity of novel macrocyclic ligands against HIV-1 in Jurkat and CEM-SS cell lines.
We have developed versatile synthetic routes that afford metal-free macrocycles containing different functionalities in their framework. Novel oxaziridine and amide containing macrocycles were synthesized, and the metal complexes of the latter were also prepared. A series of theophilline and thymidine side-arm containing podands as well as macrocycles were obtained employing the same methodology. The primary anti-viral tests of these synthetic compounds for anti-HIV-1 activity was carried out using the XTT-based cytopathicity assay (CEM-SS cells) with AZT as positive control. It was found that the nature of the macrocyclic headgroups affected the anti-HIV-1 activity. Heteroatom containing macrocyclic headgroups displayed activity in the micromolar range. Metal complexation did not enhance the activity and side-arm substitution resulted in inactive compounds. Cell viability determined in both Jurkat and CEM-SS cells was strongly dependent on the structure of the macrocyclic framework. The oxaziridine moieties in the macrocycle were highly toxic to CEM-SS and less toxic to Jurkat cell lines, while amide containing macrocycles were toxic to neither.
Antiviral Agents↗
230 patient years of experience with home long-term parenteral nutrition in childhood: natural history and life of central venous catheters.
The records of 27 pediatric patients who required parenteral nutrition (PN) for 5 to 14.5 years (mean +/- SD, 8.5 +/- 3.8) were analyzed to determine the frequency of complications with their central venous catheters (CVC). This represents a 230 patient-year experience. Patients with short bowel syndrome and chronic intestinal pseudoobstruction syndrome (CIPS) accounted for all but two of the patients. Unsuccessful medical management of the exit site or CVC infection was responsible for removal of 62% of the 123 CVCs. Ninety-five episodes of line infection occurred in 24 patients. Fifty (52%) were successfully treated without catheter removal. The organisms responsible for catheter removal were fungal (14), mycobacterium species (5), gram-positive cocci (22), or gram-negative bacilli (19). The CVCs were infected an average of once every 884 days. The life of the second CVC (23.5 +/- 17.9 months) was significantly longer than that of the first (P < .05). Clotting of the CVC with unsuccessful lysis of the clot was responsible for removal of 24%, and breakage or unsuccessful repair was responsible for 14%. In no patient were all possible venous sites for CVC placement exhausted. Patients with CIPS had substantially fewer catheter complications (P < .05) than did those with short bowel syndrome. In conclusion, CVCs can "survive" without major complications for more than a decade. Numerous factors contribute to the increased rate of CVC survival over time, including improvement in PN self-care with greater experience, improvement in teaching, regular follow-up of patients, better management of infection, and better ability to treat CVC thrombosis or breakage.
Adolescent↗
Copper deficiency secondary to a copper transport defect: a new copper metabolic disturbance.
We describe a 21-year-old man who developed copper deficiency manifested as a demyelinating neuropathy, chronic intestinal pseudo-obstruction, osteoporosis, testicular failure, retinal degeneration, and cardiomyopathy with a tortuous aorta. His serum copper was low and did not increase despite administration of large doses of intravenous copper sulfate. The ceruloplasmin level as measured by an antibody technique was normal, yet ceruloplasmin (Cp) oxidase activity was very low. The Cp amino acid sequence was normal. This suggests that the copper deficiency was caused by a defect in hepatic processing of copper for incorporation into Cp.
Adult↗
[Duffy blood group in malformed newborns and their mothers].
The aim of this work is to analyze the distribution of Duffy blood group and the reproductive history of 148 malformed newborns and their mothers compared to 131 control pairs. The mother-child segregation of the system is analyzed using ITO matrixes. A higher frequency of heterozygote mothers for the system was found among the malformed group compared to controls. No differences in the reproductive history was found between Duffy system homozygote or heterozygote mothers.
Case-Control Studies↗
[Prolonged fever and Mycoplasma pneumoniae infection].
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Female↗
Diagnosis and treatment of bowel perforation following pediatric orthotopic liver transplantation.
OBJECTIVE: Bowel perforation is a frequent cause of mortality after pediatric orthotopic liver transplantation. The aims of this study were to identify the cause of this phenomenon and to examine current methods of treatment. DESIGN: This is a retrospective analysis of 246 pediatric patients who underwent orthotopic liver transplantation at a large, urban, tertiary care medical center between 1984 and 1992. We examined the frequency of bowel perforations after transplantation and identified predisposing factors and signs. In this series, bowel perforations occurred in 24 of 246 recipients and were common in those who had previous liver-related surgery (22 patients). Clinical signs included fever (13 patients), leukocytosis (14 patients), and free air on abdominal roentgenograms (11 patients). RESULTS: Perforation occurred at the Roux-en-Y limb in 15 of 24 recipients as well as in the right transverse colon (five patients), terminal ileum (three patients), and duodenum (one patient). The repair was resection and/or primary closure (18 patients), or diversion (six patients). Recurrent perforations (nine patients) could not be attributed to the method of the repair. Perforation-related sepsis was the primary cause of death in 12 patients (50%) and was more common among patients who developed recurrent perforation (seven [78%] of nine patients). CONCLUSIONS: The occurrence and location of bowel perforation after pediatric orthotopic liver transplantation suggests that the cause is related to bowel injury during difficult hepatectomy. Mortality may be reduced by early second-look operations in high-risk patients.
Child↗
Arterial ketone body ratio in pediatric liver transplantation.
Arterial ketone body ratio (AKBR) was measured serially in 49 pediatric orthotopic liver transplantations. The AKBR pattern correlated with hepatic synthetic function, as well as with short-term graft and patient survival. A rapid recovery pattern of AKBR to above 1.0 within 40 hr after reperfusion was associated with 94% graft and patient survival. Pediatric liver grafts were found to have better tolerance to low energy levels when compared with previously published data for adult OLT. The salvage rate of pediatric grafts exhibiting a slow recovery pattern (AKBR 0.7-1.0) was 71%. No recovery pattern (AKBR < 0.7) was seen in all 6 cases of primary nonfunction, and in 3 of 4 cases of early hepatic artery thrombosis (HAT). All these grafts were lost; however, 56% of the children in this group survived retransplantation. Unlike the PNF grafts, the no recovery pattern after HAT was characterized by gradual improvement of the synthetic function, despite the low energy state.
Arterial Occlusive Diseases↗
Differences in oral FK506 dose requirements between adult and pediatric liver transplant patients.
The oral dose recommendation for FK506 (Fujisawa Pharmaceutical, Deerfield, IL) after liver transplantation has, to date, made no distinction between adult and pediatric patients. Sixteen pediatric and 33 adult liver transplant patients treated long term with oral FK506 were studied. Initial FK506 doses were 0.3 mg/kg/day p.o. or 0.15 mg/kg/day i.v. Thereafter, doses were adjusted to achieve therapeutic FK506 serum levels (0.5-3.0 ng/ml, ELISA liquid/liquid separation) and to maintain an acceptable serum creatinine. FK506 (in mg/kg/day), FK506 levels, and liver function were assessed at monthly intervals on outpatient visits. The mean age of 16 pediatric patients was 5.3 +/- 3.5 years and of 33 adult patients was 49 +/- 12 years. Mean days of FK506 therapy were 284 +/- 136 for pediatric patients and 239 +/- 112 for adult patients. For each time period, pediatric patients required a significantly higher dose of FK506 compared to adult patients (P < 0.001). The overall mean pediatric dose for the first year was 0.46 +/- 0.4 mg/kg/day compared to the mean adult dose of 0.13 +/- 0.01 mg/kg/day. The ratio of pediatric to adult oral FK506 dose requirements ranged from 2.7 to 4.4 over the 1 year of followup. FK506 levels monitored at the same time points showed no significant differences at any month between pediatric and adult patients. We conclude that the oral dose per kilogram per day of FK506 required to maintain similar FK506 levels is significantly greater in pediatric patients compared to adult recipients during the first year of follow-up. Pediatric recipients require substantially more, and adult recipients substantially less, than the recommended oral FK506 dose to achieve a therapeutic effect.
Administration, Oral↗
Ross operation using a bovine bioprosthetic valve with autologous pericardial conduit in the pulmonary position.
Between 1 February 1992 and 1 March 1993, we performed Ross's aortic replacement in 7 men and 4 women with rheumatic heart disease. The patients' ages ranged from 22 to 60 years (mean, 41 years). All 11 patients had aortic valve disease; 2 also had mitral valve disease. In all patients, the right ventricular outflow tract was reconstructed using an autologous pericardial conduit containing a bovine cardiac valve bioprosthesis manufactured at our institution. The 2 patients who had mitral valve disease underwent a concomitant mitral valvuloplasty. In 1 patient, minimal aortic regurgitation was documented by means of transesophageal echocardiography immediately after the cessation of cardiopulmonary bypass, but no hemodynamic compromise was noted. In another patient, mediastinal exploration was required for bleeding, 3.5 hours postoperatively. The follow-up period ranged from 6 to 16 months (mean, 11.3 months). Results were assessed by means of clinical and transesophageal echocardiographic studies. No infection or technical failure was encountered. No patient died. All patients remain asymptomatic, and follow-up echocardiography has revealed no transaortic or transpulmonary gradient. The Ross operation was chosen for this group of patients because it avoids the use of mechanical valves and subsequent anticoagulant therapy. Most of our patients have a low income and a history of noncompliance with the strict postoperative drug regimen. Although the short-term results have been excellent with the Ross operation and our combination bioprosthesis, long-term evaluation is needed.
Adult↗
[Comparison of ATB STREP, AMS-Vitek GPS-TA, and disk diffusion for the detection of a high level of aminoglycoside resistance in Enterococcus spp].
BACKGROUND: The absence of the synergic effect between beta-lactam and aminoglucoside versus Enterococcus is predicted by the presence of a high level of resistance to aminoglucoside. There are several commercial systems which include wells for the performance of this determination for streptomycin and gentamicin. METHODS: A comparative study of two commercial systems, Vitek GPS-TA and ATB STREP (Biomérieux) and disk diffusion versus the Mueller-Hinton agar dilution method used as a method of reference. Two hundred ninety strains of Enterococcus spp. from blood, wounds, pus, fluids from paracentesis and urine were studied. RESULTS: By the reference method, 17 presented high level of resistance only to gentamicin, 45 only to streptomycin, 46 to both and 182 were sensitive to the two antibiotics. The sensitivity of ATB STREP, Vitek GPS-TA and disk diffusion was respectively for high level of resistance to gentamicin of 96.8, 100 and 100% and specificity of 99.5, 99.1 and 96.5%. For high level of resistance to streptomycin sensitivity was 78.2, 100 and 100% and specificity 96, 79.4 and 72.4% respectively. CONCLUSIONS: The authors consider the three methods valid for the determination of high level of resistance to gentamicin, presenting excellent correlation between the results of the reference methods. However, for high level of resistance to streptomycin with ATB STREP 1/5 of the resistant strains would not be detected due to low sensitivity. With Vitek GPS-TA and disk diffusion, although excellent sensitivity was presented, a high percentage of false positives were obtained due to low specificity, thus the authors recommend that before a results of resistance be decided the same should be confirmed by another alternative method (agar dilution, macrodilution in tubes or death-time curve).
Diffusion↗
[Serum aminoterminal procollagen type-III peptide in the diagnosis of chronic hepatopathies].
BACKGROUND: The aims of the present study were to 1) compare the serum levels of the aminoterminal peptide of procollagen type III (PIIIP) in patients with different chronic liver diseases, 2) correlate their concentrations with histologic features in liver biopsy and 3) evaluate their use in the diagnosis of liver diseases and in recognition of fibrosis. METHODS: With these aims PIIIP was determined in 57 patients with different chronic liver diseases and in 50 healthy donors. RESULTS: PIIIP was significantly elevated in patients with chronic active hepatitis (18.3 +/- 5.5 ng/ml; p less than 0.01) and with liver cirrhosis (27.8 +/- 11.7 ng/ml; p less than 0.001). The serum levels of this peptide related significantly with the severity of liver disease (p less than 0.001) in addition to the degree of morphometric liver fibrosis (Rs: 0.736; p less than 0.001) and with the degree of histologic activity (Rs: 0.78; p less than 0.001). The correlation between PIIIP and fibrosis was due to the relation between the same and inflammation. The levels of this peptide which were higher than 15 ng/ml were a sensitive test for the diagnosis of active liver disease (0.80) and cirrhosis (0.87) permitting differentiation between chronic and persistent active hepatitis. The differentiation between chronic active hepatitis and cirrhosis was only possible when 24 ng/ml were taken as a discriminative level. CONCLUSIONS: The comparison of serum levels of the aminoterminal peptide of procollagen type III (PIIIP) in patients with different chronic liver diseases can predict moderate or high degrees of inflammatory activity when PIIIP are higher than 15 ng/ml. This test is of use for evaluating chronic hepatopathies although the levels reflect the activity of inflammation better than the degree of hepatic fibrosis.
Adult↗
Excessive chromium intake in children receiving total parenteral nutrition.
Various expert bodies have recommended that the daily parental intake of chromium in children receiving total parenteral nutrition (TPN) should be 0.20 micrograms/kg. To test whether this recommendation is appropriate, we assessed chromium intake, serum chromium concentrations, and renal function in 15 children receiving TPN. The median duration of TPN use was 9.5 (range 1.3-14) years. The children's glomerular filtration rate (GFR), measured by plasma clearance of indium-111-DTPA was lower than that of non-TPN controls (70 [SD 17] vs 110 [10] ml/min per 1.73 m2). The daily chromium intake averaged 0.15 (0.09) micrograms/kg daily but the serum chromium concentration was 20 (4 to 42) times higher than that of the controls (2.1 [1.2] vs 0.10 [0.03] micrograms/l; p less than 0.0001). GFR was significantly inversely correlated with serum chromium concentration (r = -0.60, p less than 0.02), daily chromium intake (r = -0.69, p less than 0.01), cumulative parenteral chromium intake (r = -0.72, p less than 0.01), and TPN duration (r = -0.52, p less than 0.05). We discontinued chromium supplementation of TPN solutions and reassessed the children a year later. Contaminating chromium concentrations were 1.0-1.8 micrograms/l in TPN solutions and 0.9 micrograms/l in fat emulsions. Drinking water contained 4.3-5.7 micrograms/l. Thus, the chromium intake without supplementation was only 0.05 (0.01) micrograms/kg daily. The mean serum chromium concentration fell to 0.50 (0.30) micrograms/l but was still significantly higher than that in the controls (p less than 0.01). The GFR did not change significantly (65 [14] ml/min per 1.73 m2). No patient has shown signs of chromium deficiency. Although our patients were receiving less than the recommended chromium intake during supplementation, their high serum concentrations suggested excessive intake. The recommended parenteral chromium intake for children should be lowered.
Adolescent↗
Gastric antroplasty for the treatment of delayed gastric emptying and gastroesophageal reflux in children.
Operative correction of symptomatic gastroesophageal reflux (GER) was undertaken in 530 children during a 21-year period. Gastroesophageal fundoplication (GEF) alone was performed in 415 children; 83 had simultaneous GEF and pyloroplasty; 13 had pyloroplasty alone; and 19 had GEF with later pyloroplasty. Of the last 355 children with reflux, 110 (31%) had pyloroplasty. Pyloroplasty was performed for persistent symptoms despite medical therapy when more than 60% of the isotope meal was retained in the stomach at 90 minutes. Children with central nervous system disorders and GER often had delayed gastric emptying (DGE). A modified Heineke-Mikulicz pyloroplasty was used for the first 59 children; the last 56 patients had a more simplified antroplasty with a 2.5- to 3.5-cm vertical incision through the antral muscularis down to the duodenum without mucosal incision; the muscularis was reapproximated in a transverse direction with sutures. With a mean follow-up of 5.8 years, only three patients experienced mild transient dumping. None had pyloroplasty leak or clinical evidence of alkaline reflux. Antroplasty is a helpful, simple adjunct to GEF with low morbidity in children with GER and DGE.
Adolescent↗
Iodine supplementation in children receiving long-term parenteral nutrition.
In 18 children receiving long-term total parenteral nutrition (TPN) without iodide supplements, thyroid function test results were normal but serum iodide levels were greater than in control subjects (p less than 0.01). Iodine contamination of TPN solutions and fat emulsions accounted for only half of the recommended parenteral intake. Skin absorption of topical iodinated disinfectant may explain the adequate, if not excessive, iodine intake. We conclude that iodine is an unnecessary supplement in TPN solutions.
Adolescent↗
[Paternity study in Chilean families using DNA fingerprints and erythrocyte blood markers].
In the last decade, the electromorphic phenotype corresponding to extremely polymorphic zones of DNA, that include variable number of tandem repeat loci (VNTR) of oligonucleotide sequences, have been added to classical markers to elucidate the problems of parenthood identification and ascription in human beings. Using VNTR of several loci, a band profile practically unique for each individual is obtained (DNA-fingerprints). Since the pattern of VNTR electrophoretic bands is inherited from parents in a proportion of 50% from each one, this system is extremely useful for paternity ascription or exclusion. Nine nuclear families were studied, randomly selected from a group of 170 families that were analyzed using 5 erythrocyte genetic markers and with VNTRs detected using the multi locus probe (CAC)5, aiming to explore the concordance of both methods. Results were similar for both methods; however for VNTR, there is no information available on population frequency of polymorphisms.
Blood Group Antigens↗
[Transvaginal echography in the diagnosis of placenta previa].
To illustrate the usefulness of transvaginal sonography in diagnosing placenta previa, a case managed in our unit is presented. The literature available shows that this method has more sensibility and specificity than the transabdominal technique.
Adult↗
[Cervical and abdominal microbiology in infertile patients].
The microbiology of twenty-nine asymptomatic infertile women was evaluated prospectively. Samples were taken from the cervix and the endosalpinx during laparoscopy. Cultures for aerobes, anaerobes, Neisseria gonorrhoeae, Mycoplasma, Ureaplasma urealyticum and Chlamydia trachomatis were performed. No association was found between the presence of germs in the abdomen or cervix and tubal abnormalities. History of previous IUD use was associated with tubal disease.
Abdomen↗