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Biomedical subjects

R Polo

Publications and source records attributed to R Polo.

At least 19 recordsLinked to original sources
PubMed2000

Thrice-weekly sulfadiazine-pyrimethamine for maintenance therapy of toxoplasmic encephalitis in HIV-infected patients. Spanish Toxoplasmosis Study Group.

An open, randomised, multicentre trial was conducted to evaluate the efficacy of thrice-weekly versus daily therapy with sulfadiazine-pyrimethamine in the prevention of relapses of toxoplasmic encephalitis in HIV-infected patients. Between February 1994 and July 1997, 124 patients with HIV infection were enrolled after resolution of the first acute episode of toxoplasmic encephalitis treated with sulfadiazine-pyrimethamine. Patients were randomly assigned to receive either a daily regimen consisting of sulfadiazine (1 g) twice a day plus 25 mg pyrimethamine and 15 mg folinic acid daily (n = 58), or a thrice-weekly regimen consisting of the same doses of sulfadiazine and folinic acid plus 50 mg pyrimethamine (n = 66). After a median follow-up period of 11 months (range 1-39 months), no differences were found in the incidence of toxoplasmic encephalitis relapses between the groups, there being 14.9 episodes per 100 patient-years (95% CI: 2.8-20.2) in the daily-regimen group versus 14.1 episodes (95% CI: 2.3-17.2) in the intermittent-regimen group. The estimated cumulative percentages of relapse at 12 months were 17% and 19%, respectively (P = 0.91). In a Cox multivariate analysis, not taking antiretroviral therapy was the only variable independently associated with relapse (adjusted risk ratio: 4.08; 95%CI: 1.32-12.66). Baseline CD4+ cell counts, prior AIDS, mental status, sequelae and allocated maintenance therapy regimen were not independent predictors of relapse. No differences were observed in the survival rate (P = 0.42), or in the incidence of severe adverse effects (P = 0.79). The efficacy of the thrice-weekly regimen was similar to that of the daily regimen in the prevention of relapses of toxoplasmic encephalitis. Administration of antiretroviral therapy was the only factor associated with a lower incidence of relapse.

AIDS-Related Opportunistic Infections↗
PubMed1998

[Efficacy of ritonavir in HIV positive patients pretreated with nucleoside analogues].

The virologic and immunologic efficacy of ritonavir, an HIV protease inhibitor, was examined in 14 HIV-infected patients with a mean CD4+ cell count of 183 x 10(6)/l at baseline. All had been exposed to nucleoside analogs for longer than 6 months; and ritonavir was added to previous ongoing antiretroviral drugs. A mean reduction of 1.5 logs was seen in plasma viral load 4 weeks after began ritonavir, and 9 (64.3%) of 14 patients achieved undetectable levels (< 4,000 HIV-RNA copies/ml). A mean increase of 222 x 10(6) cells was observed in the CD4+ count. Nine (64.3%) individuals reported side effects, although they did not force to stop the medication. In conclusion, the addition of ritonavir seem to be a reasonable alternative strategy in patients with advanced HIV disease and heavy previous exposure to nucleoside analogs.

Adult↗
PubMed1997

Visceral leishmaniasis in patients infected with the human immunodeficiency virus.

The experience with 52 episodes of visceral leishmaniasis diagnosed in 43 patients is reported. The most common symptoms were fever (81%), splenomegaly (65%), hepatomegaly (63%), and pancytopenia (73%). In 79% of the patients, CD4+ cell counts were < 100 cells/mm3. Prior or simultaneous diagnosis of AIDS was made in 29 (67%) patients. Diagnosis was considered fortuitous in 19% of the episodes. In 27% of the episodes, the diagnosis was made on the basis of demonstration of parasites outside the reticuloendothelial system, chiefly blood (7 cases) and gastrointestinal mucosa (5 cases). Parasites were frequently observed or cultured from blood (22/37 episodes) or the digestive tract (8/9 episodes). High antimony doses were more effective than low doses in achieving clinical or parasitological cure (rate of cure, 80% vs. 40%, p = 0.11). Severe toxicity was observed in six (11.7%) of the 51 treated episodes. Severe AIDS-related diseases [odds ratio (OR) 10, p < 0.05] and CD4+ counts (OR 12, p < 0.05) were independent factors for early death. Prophylaxis with monthly pentamidine was not useful in reducing relapses of visceral leishmaniasis.

AIDS-Related Opportunistic Infections↗
PubMed1997

Patterns of fluconazole susceptibility in isolates from human immunodeficiency virus-infected patients with oropharyngeal candidiasis due to Candida albicans.

We evaluated 119 episodes of oropharyngeal candidiasis due to C. albicans to study the patterns of fluconazole susceptibility of the isolates and the characteristics of the patients and to confirm the correlation between fluconazole susceptibility of isolates and therapeutic outcome. Sixty-one isolates were considered susceptible to fluconazole (MICs, < or = 0.5 microg/mL), 33 were intermediate (MICs, 1.0-8.0 microg/mL), and 25 were resistant (MICs, > or = 16.0 microg/mL). Patients infected with resistant strains had significantly lower CD4+ cell counts and a less recent AIDS diagnosis than patients infected with intermediate or susceptible strains. Previous fluconazole therapy and prophylaxis were significantly more frequent for patients infected with resistant and intermediate strains (P < .001). Decreased susceptibility to ketoconazole and itraconazole was observed in resistant and intermediate strains. Fluconazole treatment was ineffective for patients infected with resistant isolates; however, high doses of ketoconazole or itraconazole were successful for nine (81%) of them. Different patterns of fluconazole susceptibility among C. albicans strains are correlated with patients' characteristics and with therapeutic outcomes.

AIDS-Related Opportunistic Infections↗
PubMed1997

[Prosthetic bilateral laparoscopic hernioplasty. Extra-peritoneal approach].

The use of prosthetic mesh in inguinal hernia repairs is becoming increasingly popular. In recent years different laparoscopic procedures for prosthetic repair of inguinal hernias have been developed. The authors describe their initial experience with a totally extra-peritoneal prosthetic approach in laparoscopic repair of bilateral inguinal hernias. From November 1993 to May 1994, ten consecutive patients with bilateral primary inguinal hernias underwent laparoscopic repair under general anesthesia. A totally extra-peritoneal approach has been performed beginning through a 2 centimeter vertical midline sub-umbilical incision. Two additional trocars have been inserted on the midline: a 10/12 mm one halfway between the umbilicus and the pubis and 5 mm one 2 cm above the pubis. Average operative time was 141 minutes. Two cases were converted to traditional open Stoppa procedure because of holes made in the peritoneum during blunt dissection of the hernia sac. In the remaining 8 cases a polypropylene mesh of about 8 cm in height and 13 cm in length have been placed on each hernia site. No major complications have been observed and recovery was quick in all cases. In conclusion we think that laparoscopic hernia repair through a totally extra-peritoneal approach is technically feasible for general surgeons trained in laparoscopic surgery. Nevertheless the operation in costly and the patient's benefit in terms of rapid recovery, complications and recurrences has not yet been demonstrated in controlled prospective trials.

Adult↗
PubMed1997

[Quantification of viremia in patients infected with human immunodeficiency virus with different degrees of immunosuppression].

BACKGROUND: Many of the therapeutical decisions related to patients infected with human immunodeficiency virus (HIV) are taken considering the CD4+ lymphocyte count. The recent availability of procedures which quantitate the number of viral particles in peripheral blood has disclosed that viremia degree is the best predictor of HIV disease progression. Nevertheless, the proportion of subjects who despite a normal CD4+ lymphocyte count, have a high viremia and a high risk of short term progression to AIDS is not well known. PATIENTS AND METHODS: Plasma viremia was investigated in 120 adults subjects with a known time of HIV infection. Fifty-two patients had a CD4+ lymphocyte count > 500 x 10(6)/l (CDC group 1), 42 had a number of CD4+ lymphocytes ranging from 200 and 500 x 10(6)/l (CDC group 2), and 26 had a count < 200 x 10(6)/l (CDC group 3). None of the patients was receiving antiretroviral treatment or had intercurrent infections at the time of the study. RESULTS: Mean values of viremia showed an inverse significant relationship with the CD4+ lymphocyte count. In CDC group 1 subjects the distribution of viremia was as follows: low (< 3,000 copies of HIV RNA/ml) in 16 (30.8%), intermediate in 20 (38.4%), and high (> 30,000 copies of HIV RNA/ml) in 16 (30.8%). In eight subjects from CDC group 1, the duration of HIV infection was less than 5 years. In contrast, in patients from CDC group 3, viremia was high in 17 (65.4%), intermediate in 9 (34.6%), and none of them had a low degree viremia. In CDC group 2 patients, viremia was high in 14 (33.3%), intermediate in 20 (47.6%), and low in 8 (19.1%). CONCLUSION: There is an inverse correlation between the viremia degree and the CD4+ lymphocyte count among HIV-positive patients. Nevertheless, there can be a high viremia in absence of low CD4+ lymphocyte count, particularly among subjects with HIV infection for less than 5 years, in whom an early therapeutical intervention might be warranted.

Adult↗
PubMed1996

[Colony-stimulating factors and HIV-related neoplasms].

OBJECTIVE: it is analyzed a group of patients with HIV related malignancy treated with myelosuppressive therapy with granulocyte colony stimulating factor (G-CSF) to study the efficacy of hematopoietic growth factors in these subjects. PATIENTS AND METHODS: it was studied the clinical and hematological evolution of 20 patients with HIV related malignancy treated with standard dose of chemotherapy and 5 micrograms/Kg/day of G-CSF starting 24 hours after the completion of chemotherapy administration. It was done an epidemiological study and was determined haemoglobin level, and the number of leukocytes, monocytes, neutrophils, lymphocytes, CD4+ lymphocytes and platelets before and after the chemotherapy administration. RESULTS: all of the patients were men with mean age of 37 +/- 2 years. The mean of lymphocyte CD4+ count was 17 x 10(6)/l and the tumor was the first aids manifestation in 50% of the subjects. The mean days of hospitalization was 14 +/- 3 days. As the result of the G-CSF administration, the leucocyte and the neutrophil count was statistically elevated (p < 0.01) and the platelets, the lymphocytes and the monocytes were not statistically elevated. Only one patient had a severe adverse reaction. Seventeen patients (85%) are dead, but only in 3 the cause was an infectious disease. CONCLUSION: the use of G-CSF prophylactically can elevate the neutrophil count and avoid the apparition of febrile neutropenia in patients with HIV related malignancies.

Adult↗
PubMed1995

[Initial locoregional chemotherapy in recurrent and locoregional advanced or inoperable stages of pelvic uterine and anorectal cancers].

The authors report their 12 years of experience of intra arterial chemotherapy in pelvic recurrences and inoperable advanced stages of uterine carcinoma, rectal cancer and anal cancer. In squamous cell cancers the drug associations were mitomycin C, bleomycin, fluorouracil and folinic acid and cisplatin. In adenocarcinoma the same protocol contained no bleomycin. Drugs were infused for a 48 hours period in continuous infusion. The dosages were the same than in the intravenous regimens. Twenty patients with pelvic recurrences were included in this retrospective study: six were uterine cancers, fourteen were colo rectal cancers and two had advanced stage uterine cancer. Pain decreased in 10/14 patients with ano-rectal cancer pre sacral recurrence. Partial response was observed in 12 patients. Complete secondary surgical resection was possible in 4/14 rectal cancers and 6/6 uterine cancer recurrences. Chemotherapy induced a pathological complete response in 4/6 uterine cervix carcinoma recurrences. These observations led to perform pelvic intra arterial chemotherapy as first line treatment of locally-advanced inoperable pelvic tumors: 11 uterine cancers and five ano-rectal cancers. The objective were: tumor reduction before radiotherapy or surgery, tumor sterilization, decrease tumor volume for better radiation dosimetry, increase the chance of organ-preservation. The observation of tumor reduction in this small number of patients does not allow to draw definite conclusions. However the introduction of intra arterial pelvic chemotherapy as first line treatment of inoperable pelvic cancer warrants further studies.

Adult↗
PubMed1995

Excessive competence of the lower oesophageal sphincter after Nissen fundoplication: evaluation by three-dimensional computerised imaging.

OBJECTIVE: To compare the competence of the lower oesophageal sphincter after Nissen fundoplication with that in a control group of healthy volunteers using a new computerized manometric device that integrates the pressure and length of the entire sphincter into one measurement, called the vector volume. DESIGN: Open study. SETTING: University hospital, Italy. SUBJECTS: 18 patients, 6-52 months (mean 10 months) after they had undergone Nissen fundoplication for gastro-oesophageal reflux, and 14 healthy volunteers. INTERVENTIONS: Oesophageal computerised manometric system comprising a catheter with eight side holes radially oriented to each other at 45 degrees on one level and 24-hour oesophageal pH monitoring. MAIN OUTCOME MEASURES: Differences in percentage time of oesophageal acid exposure, number of episodes of gastro-oesophageal reflux, and lower oesophageal sphincter vector volume. RESULTS: The pH of the oesophagus was returned to the normal range in all patients after the Nissen fundoplication. There was a significant reduction in both the percentage time of acid exposure and the number of episodes of gastro-oesophageal reflux compared with the control group (p < 0.001). The vector volume of the intra-abdominal part of the lower oesophageal sphincter was significantly increased compared with the control group (p < 0.04). Lower oesophageal sphincter pressure measured at the respiratory inversion point, and lower oesophageal length, both increased after fundoplication to become similar to control values. When sphincter pressure was measured as a mean of the sphincter pressure curve there was a clear difference postoperatively compared with controls (p < 0.02). CONCLUSIONS: Nissen fundoplication corrects abnormal gastro-oesophageal reflux but abolishes normal physiological postprandial reflux; this is caused by the gastric fundus that encircling the intra-abdominal oesophagus, restores sphincter pressure and length, and modifies its shape.

Adult↗
PubMed1994

[Limited surgery in cancer of the hypopharynx and cervical esophagus: role of autotransplants of the intestinal loop and skin flaps].

The cervical esophageal region can be involved by several cancer types as primary malignancies of the hypopharynx and cervical esophagus, locally advanced tumors of the larynx and thyroid, and neoplastic recurrence after laryngectomy for cancer. These situations often require complex surgical procedures, and the integrated use of multiple surgical techniques or multistage operations. It is often a limit-type surgery that requires free loop intestinal autotransplants, local and regional skin flaps, and peduncle myocutaneous flaps, and therefore requires specific skill not only in general and thoracic surgery but also in head and neck surgery, plastic surgery and microsurgery. This paper summarizes the experience in the field of cervical esophagus replacement with jejunal free loop autotransplant (23 cases) and cutaneous or myocutaneous flaps (23 cases) at the "Centro Regionale Veneto per le Malattie dell'Esofago" from 1980 to 1993.

Esophageal Neoplasms↗
PubMed1993

Altered esophageal pain threshold in irritable bowel syndrome.

Gut motility disorders and altered pain perception were reported in patients with irritable bowel syndrome (IBS). To verify foregut involvement in IBS, we studied 30 patients using esophageal manometry and 24-hr pH monitoring of the distal esophagus. Two subgroups of patients underwent esophageal provocative tests (bethanechol 50 micrograms/kg subcutaneously and esophageal balloon distension test). Twelve healthy volunteers formed a control group. A pain threshold on esophageal distension significantly lower than in healthy subjects (11.5 +/- 1 ml vs 22.2 +/- 1.7 ml, P < 0.01) was found in IBS patients. On the other hand, no differences between patients and controls were detected in lower esophageal sphincter pressure and length, esophageal body motility, or GER pattern; furthermore, bethanechol stimulation elicited similar esophageal body motility changes. Our study could confirm no detectable basal or bethanechol-induced esophageal motility disorders in IBS patients, nor enhanced GER. Esophageal involvement in IBS consists of a lower pain threshold on esophageal distension, possibly reflecting an altered visceral receptor sensitivity or modulation throughout the gut.

Adult↗
PubMed1991

[Esophageal manometry and pH-monitoring: cost-benefit analysis].

Functional tests of the esophagus have become increasingly popular over the last 10 years. Here we present a cost/benefit analysis model to evaluate the real contribution to diagnosis with reference to the cost of these tests. All of the patients referred to the digestive physiopathology laboratory at the Institute of Surgical Semiotics, from 1988 to 1990, were evaluated for gastroesophageal reflux disease (152 cases), dysphagia (27 cases) and chest pain (12 cases). The cost of each modified diagnosis was L. 508,250 in the first case, L. 315,772 in the second case and L. 262,446 in the third case. Additionally, concerning gastroesophageal reflux disease, the cost of medical therapy based on endoscopic diagnosis alone was compared to that of medical therapy guided by these functional tests. Hence it was demonstrated that it is economically advantageous to study functionally all of the symptomatic patients, except the cases of esophagitis, and patients with atypical symptoms or with mild symptoms and endoscopic esophagitis of the first degree. It is not worthwhile investigating patients with second, third or fourth degree esophagitis, regardless of the symptoms, and patients with typical severe symptoms and first degree esophagitis. These functional tests are economically practical in all cases in which morphologic alterations are either absent or minimal.

Adolescent↗