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Biomedical subjects

C León

Publications and source records attributed to C León.

At least 37 records · Page 2Linked to original sources
PubMed1998

[Intestinal trichobezoar: report of a case].

Trichobezoars are rare medical entities that must be considered in the differential diagnosis of patients with abdominal mass. We describe a case of an unsuspected intestinal trichobezoar in a nine years old girl. The patient presented an acute lower abdominal pain. We found an echogenic abdominal mass in the pelvic sonography. A double contrast barium enema was scheduled and a rapid relief of symptoms during the preparation of it was accomplished with the expulsion of a mass of hair.

Bezoars↗
PubMed1998

[Diagnostic value of Gram staining of peri-catheter skin and the connection in the prediction of intravascular-catheter-related bacteremia].

BACKGROUND: To evaluate the diagnostic value of Gram stain of pericatheter skin swabs and the intravascular device hub in detecting catheter-related bacteremia (CRB) in critically-ill patients. METHODS: Over a 12-month period, 170 intravascular catheters (> 7 days in place) suspected as being the primary source of CRB were prospectively examined in adult patients admitted to 10 intensive care units of different hospitals in Spain. Blood cultures, Gram staining and culture of swabs obtained from skin entry side and catheter hub were performed before catheter removal. A semiquantitative culture of the catheter tip was carried out. Catheter-associated bacteremia was considered to be present if the same organism was isolated from the catheter tip, skin and/or hub, and blood cultures. RESULTS: The incidence rate of CRB was 15%. Staphylococcus epidermidis was the most frequently isolated microorganism. Considered together, the sensitivity, specificity, positive predictive value and negative predictive value for Gram staining of the skin and hub were 80, 81.9, 35.3 and 97.1%, respectively. CONCLUSIONS: The Gram stain of skin and hub swabs has a great utility in predicting CRB, specially in the absence of microorganisms. Gram stains of the above mentioned sites could be recommended as an easy and fast method to rule out the presence of CRB.

Adult↗
PubMed1997

Umchs5, a gene coding for a class IV chitin synthase in Ustilago maydis.

A fragment corresponding to a conserved region of a fifth gene coding for chitin synthase in the plant pathogenic fungus Ustilago maydis was amplified by means of the polymerase chain reaction (PCR). The amplified fragment was utilized as a probe for the identification of the whole gene in a genomic library of the fungus. The predicted gene product of Umchs5 has highest similarity with class IV chitin synthases encoded by the CHS3 genes from Saccharomyces cerevisiae and Candida albicans, chs-4 from Neurospora crassa, and chsE from Aspergillus nidulans. Umchs5 null mutants were constructed by substitution of most of the coding sequence with the hygromycin B resistance cassette. Mutants displayed significant reduction in growth rate, chitin content, and chitin synthase activity, specially in the mycelial form. Virulence to corn plantules was also reduced in the mutants. PCR was also used to obtain a fragment of a sixth chitin synthase, Umchs6. It is suggested that multigenic control of chitin synthesis in U. maydis operates as a protection mechanism for fungal viability in which the loss of one activity is partially compensated by the remaining enzymes.

Amino Acid Sequence↗
PubMed1997

Prospective, randomised, multicentre study of meropenem versus imipenem/cilastatin as empiric monotherapy in severe nosocomial infections.

The clinical and bacteriological efficacy and the tolerability of meropenem versus imipenem/cilastatin (both 1 g t.i.d.) in severe nosocomial infections were compared in a multicentre, randomised, nonblinded study. A total of 151 patients were recruited; 133 (66 meropenem, 67 imipenem/cilastatin) were clinically evaluable and 84 (42 meropenem, 42 imipenem/cilastatin) bacteriologically evaluable. Most clinically evaluable patients (90%) were in intensive care units, required mechanical ventilation (72%), and had received previous antibiotic therapy (62%). The mean (+/- SD) APACHE II score was 15.2 (+/- 6.6) in the meropenem group and 17.8 (+/- 6.8) in the imipenem/cilastatin group. The primary infections were nosocomial lower respiratory tract infections (56% of patients), intra-abdominal infections (15%), septicaemia (21%), skin/skin structure infections (5%), and complicated urinary tract infections (3%); 35% of the patients had two or more infections. There was no significant difference between the meropenem and imipenem/cilastatin groups in the rates of satisfactory clinical (weighted percentage 87% vs. 74%) or bacteriological (weighted percentage 79% vs. 71%) response. There was a slightly higher rate of clinical success with meropenem against primary or secondary lower respiratory tract infection (89% vs. 76%). Drug-related adverse events occurred in 17% and 15% of meropenem and imipenem/cilastatin patients, respectively. Meropenem (1 g t.i.d.) was as efficacious as the same dose of imipenem/cilastatin in this setting, and both drugs were well tolerated.

Adolescent↗
PubMed1997

Nosocomial bacteremia in critically ill patients: a multicenter study evaluating epidemiology and prognosis. Spanish Collaborative Group for Infections in Intensive Care Units of Sociedad Espanola de Medicina Intensiva y Unidades Coronarias (SEMIUC).

A total of 590 consecutive episodes of nosocomial bacteremia were prospectively followed in 30 intensive care units (ICUs) over a 9-month period. The crude and directly related mortality rates were 41.6% and 19%, respectively. The predominant pathogens were coagulase-negative staphylococci (24.4%) and coagulase-positive staphylococci (17.5%). The most frequent sources of infection were intravenous catheters (37.1%). Multivariate analysis defined seven variables as independently influencing crude mortality: adult respiratory distress syndrome (ARDS), septic shock, multiorgan failure (MOF), mechanical ventilation, chronic hepatic failure, acute renal failure, and APACHE II score of > or = 15 at diagnosis. Variables associated with a higher directly related mortality were septic shock, ARDS, acute renal failure, MOF, gram-negative or candidal bacteremia, source of bacteremia other than intravascular catheter, and severe sepsis. We conclude that preventing catheter colonization is crucial in reducing the incidence of bacteremia in an ICU, while improving outcome depends on better management of septic shock and associated complications.

Adult↗
PubMed1997

[Catheter infections: before and after the Consensus Conference].

The use of intravascular devices in the usual and daily clinical practice, used as diagnostic or as therapeutic means, is a reality nowadays, present in all hospitals of our medium, and it is increasing. In the area of intensive care, it constitutes a routine and prolonged procedure, and its contribution within the hospitality area, in the context of complications derived from its use, is important. The most frequent complication derived from the use of intravascular catheters or devices, is infection, which manifests itself either locally or systemically. At present it is considered that the bacteremia associated with a catheter, is by far the most common nosocomial cause of bacteremia in our environment, along with the associated morbido-mortality which this implies, the prolonged hospitalization, and the increased cost of health care. The connection of these catheters is an entry site which should be considered, and it is taking on greater significance in these past years. As always, the prophylaxis measures which are applied rigorously and on a daily manner, are the corner stone on which the possibility of minimizing these complications rests.

Bacteremia↗
PubMed1996

Candida endophthalmitis in non-neutropenic critically ill patients.

Six non-neutropenic critically ill patients who developed hematogenous endophthalmitis due to Candida spp. were studied prospectively. In all cases the yeast was isolated in blood cultures. The incidence of endophthalmitis in patients with candidemia was 13%, the predominant species being Candida albicans. Four patients were treated with fluconazole, but its efficacy could not be evaluated because three of the patients died. In patients at risk of candidemia, regular ophthalmoscopic examinations are recommended in order to enable early initiation of systemic antifungal therapy in those who develop endophthalmitis.

Aged↗
PubMed1995

[Malignant pleural mesothelioma: clinical characteristics, prognostic factors and treatment].

Malignant pleural mesothelioma soon leads to death no matter what type of treatment is provided. We discuss the clinical signs, prognostic factors and treatment given in 41 cases managed over the past 13 years in our oncology department. 32% had been exposed to asbestos, 61% were 60 years old or younger, 71% had a Karnofsky's index > or = 80% and 63% were stage I (Butchart). The first symptom leading to diagnosis was pain in 66% and mean time between first symptom and diagnosis was 3 months. Thirty patients never experienced full remission of disease: 15 were treated with palliative chemotherapy (CHT), 1 with palliative radiotherapy (RT), 5 with partial pleurectomy (PP) plus RT and/or CHT. Nine were given symptomatic treatment only. Only 11 (27%) patients experienced full remission after treatment: 7 had had extrapleural pneumonectomy, 2 had been given CHT and RT series and 4 had undergone PP with or without RT and/or CHT follow-up. Only 3 of these patients were still alive with no relapse more than 1 year later. Mean survival was 8 months. Univariate analysis revealed that the prognostic factors influencing survival were age and Karnofsky's index. Patients initially treated with surgery had a higher rate of survival. In conclusion, only Karnofsky's index and age were prognostic factors in our series. The better survival of patients initially treated surgically is probably related to prior screening.

Adolescent↗
PubMed1995

[Compliance with nasal continuous positive airway pressure (CPAP) treatment in sleep apnea-hypopnea syndrome].

Ever since Sullivan introduced nighttime nasal continuous pressure on the upper airway (CPAP) in 1981 it has been the standard treatment for sleep-hypopnea syndrome (SAHS). However, CPAP is carried out at great expense and is not tolerated by all patients. Moreover, its efficacy is dependent on the degree of compliance. In this study we set out to analyze the degree of compliance with CPAP over the first 3 months of treatment in a group of 142 consecutive patients with moderate to severe SAHS (apnea-hypopnea index: 48.9 +/- 20). Diagnosis and measurement of the level of CPAP needed (9.6 +/- 2.5 cm H2O) were based on polysomnography. Eighteen (13%) patients did not return for follow-up evaluation. In the remaining 124 patients (age 54 +/- 11 years) compliance with treatment was evaluated by way of a sleep diary in which the patient recorded the hours CPAP was used at night; this record was compared with readings from the CPAP generator's counter. All subjects were asked about their degree of sleepiness before treatment by way of a standard questionnaire. Although most patients reported regular use of CPAP in diaries, only about 60% actually used it for longer than a mean 4.5 hours daily. The most compliant patients could not be differentiated from the least compliant with respect to degree of initial sleepiness, apnea-hypopnea-per-hour index or level of CPAP required.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Treatment of candidemia in critically ill surgical patients with intravenous fluconazole.

Six nonneutropenic, critically ill patients with candidemia who underwent surgery were treated with intravenous fluconazole, a new, nontoxic triazole derivative. The portal of entry for Candida species could be demonstrated for four patients (the peritoneal cavity in two and a central venous catheter in two). There were three cases of fungemia due to Candida albicans; two cases were due to Candida tropicalis, and one case was due to Candida parapsilosis. Fluconazole was administered to these patients for a mean of 20 days at doses ranging from 100 to 200 mg/d. All patients survived and Candida species were eradicated from all sites. The decision to treat patients with proven or suspected systemic candidiasis has been made easier by the development of new, nontoxic antifungal agents.

Adolescent↗
PubMed1992

Gastroparesis: medical or surgical therapy?

It is presented the case of a 63-year-old female patient, who was admitted to the hospital for the first time, because of clinical picture compatible with acute cholecystitis and choledocholithiasis. She underwent cholecystectomy common bile duct (cbd) exploration, and duodenotomy, with the extraction of two stones located in the distal cbd. During her postoperative course, she had been under a great emotional tension, and ten days after her surgical intervention, she developed symptoms and signs of acute gastric dilatation, requiring a second admission. A barium meal and an upper endoscopy revealed gastric dilation, with marked pyloric spasm. Her complaints improved after conservative therapy was instituted. No surgical intervention was necessary. We concluded that the cause of her gastric retention was due to the emotional stress present during her postoperative course, which produced marked pyloric spasm, and not from an organic cause.

Cholecystectomy↗
PubMed1991

[Multiple primary pulmonary carcinomas].

Three cases of multiple simultaneous primary lung carcinomas are presented, in which diagnosis was established by post-surgery pathological exam. In all three cases, chest X-ray showed pulmonary masses suggestive or clinical malignancy, and pre-surgery pathological diagnosis or squamous lung carcinoma. During thoracotomy or in the resected segment, a second lesion we confirmed which made resection necessary being this second lesion classified as lung adenocarcinoma.

Adenocarcinoma↗