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Biomedical subjects

E Cáceres

Publications and source records attributed to E Cáceres.

17 recordsLinked to original sources
PubMed2001

Oral ciprofloxacin in the management of children with cancer with lower risk febrile neutropenia.

BACKGROUND: Recent reports and a previous randomized trial conducted at the authors' institution suggested that a lower risk subset of children with febrile neutropenia under chemotherapy might benefit of an oral antibiotic outpatient approach. METHODS: The objective of this study was to test the efficacy of oral ciprofloxacin in the treatment of lower risk febrile neutropenia (LRFN) in children treated for malignant diseases. From November 1998 to December 1999, 93 episodes of LRFN in 87 children (median age, 5.5 years; range, 0.9-15.8 years) were included in a prospective randomized controlled single institution trial. Inclusion criteria included fever (> 38 degrees C), severe neutropenia (absolute neutrophil count, < 500/mm(3)), and lower risk features (e.g., absence of severe comorbidity factors, good clinical condition, negative blood cultures, control of local infection, prediction of a period of neutropenia less than 10 days after admission, and compliant parents). After 24 hours of a single intravenous ceftriaxone (100 mg/kg) plus amikacin (15 mg/kg) and completed risk assessment workup, patients were discharged and randomly allocated to two groups. Group A (48 episodes) received ciprofloxacin 20 mg/kg/day orally (p.o.) every 12 hours for 6 days. Group B (45 episodes) received intravenous ceftriaxone plus amikacin for 2 days more followed by cefixime (8 mg/kg/day p.o.) every 24 hours for 4 additional days. Failure was defined as the need of a second hospitalization during the same episode. RESULTS: Most of the patients (59% in Group A and 52% in Group B) were treated for malignant solid tumors. Fifteen (31%) children in Group A and 15 (33%) in Group B presented with fever of unknown origin (P value was not significant). No significant differences were found in sites of initial infection between both groups. Overall results in this study were excellent. Only one patient with respiratory failure was detected in Group B, who did well with secondary treatment. CONCLUSIONS: In febrile neutropenic children after anticancer therapy and lower risk features, oral ciprofloxacin for 6 days after 24 hours of intravenous ceftraxione plus amikacin appears to be as efficacious as intravenous ceftriaxone plus amikacin for 2 days more followed by cefixime for 4 additional days. These results contribute to strengthen the concept of LRFN.

Administration, Oral↗
PubMed1999

One-stage decompression and posterolateral and interbody fusion for severe spondylolisthesis. An analysis of 14 patients.

STUDY DESIGN: A retrospective study of 14 patients with high-grade L5-S1 spondylolisthesis surgically treated with one-stage decompression and posterolateral and interbody fusion (technique of Bohlman and Cook). OBJECTIVE: To determine the efficacy of this technique in managing severe lumbosacral spondylolisthesis. SUMMARY OF BACKGROUND DATA: Controversy exists over the most appropriate method for managing high-grade spondylolisthesis. Circumferential in situ fusion from a single-stage posterior approach was described in 1982, but to the current authors' knowledge, there are not many reports on clinical results in the literature. The current authors studied 14 patients (mean age, 21 years) with severe L5-S1 spondylolisthesis. The percentage of slipping averaged 77%; slip angle averaged 36 degrees. The average follow-up period was 30 months. All patients had severe back or radicular symptoms. Two patients had foot drop, and four had minor neurologic dysfunction. Four patients had extremely tight hamstrings. METHODS: Pre- and postoperative radiographic films and computed tomography scans were reviewed. Magnetic resonance imaging was carried out in 11 patients before surgery and at follow-up examination. Patients were evaluated for fusion rate, clinical outcome, and complications. RESULTS: All six patients with motor deficit of the nerve roots showed complete strength recovery at follow-up examination. None of the patients had tightness of hamstrings. Twelve patients demonstrated incorporation of the graft with solid fusion, one patient had a fracture of the fibular graft, and one had graft resorption. All patients but one rated the surgical result as excellent. One patient was not satisfied with the cosmetic result. Transient paresthesias in the leg of the donor graft were documented in two patients. CONCLUSIONS: Posterior decompression of the spinal canal combined with anterior and posterior arthrodesis performed at one stage through a posterior approach is a safe and effective technique for managing severe spondylolisthesis.

Adolescent↗
PubMed1997

T-Fix anchor sutures for arthroscopic meniscal repair.

The results of arthroscopically repaired meniscal tears with the T-Fix system in a short-term follow-up of 6 months was assessed in a non-comparative, prospective study. The T-Fix device consists of a short, rigid Delrin T attached to a braided, non-absorbable, polyester suture which is preloaded inside and deployed through a delivery (spinal) needle. The T grabs inside the tissue and provides an anchor for the suture. Twenty menisci in 20 patients (mean age 29 years) were repaired. Sports-related injuries were documented in 18 patients. In 15 patients, meniscus tears were repaired 6 months or more after injury. Half of the patients had isolated meniscus injuries. Associated injuries included anterior cruciate ligament (ACL), medial or lateral collateral ligament ruptures. These were not treated at the time of meniscal surgery except for an ACL reconstruction. All tears were longitudinal and positioned mainly in the posterior horn of the medial meniscus. A total of 70 T-Fixes were used with an average of 3 per patient (range 2-7). Only 4 T-Fixes (6%) were unsuccessfully placed, and this occurred early on in the series in 4 patients. In 90% of the patients, the postoperative activity levels returned to preoperative levels, and the clinical symptoms had either resolved or were experienced at a higher level of activity. The T-Fix device was relatively easy to use and could be reliably placed in the meniscus. Postoperatively, there were no complications directly associated with the device. However, further studies are needed to confirmed these results in a long-term follow-up in a larger patient population.

Adolescent↗
PubMed1993

The results of surgical treatment of lumbar arachnoiditis.

Forty patients with lumbar arachnoiditis, following previous operations, were classified into 4 myelographic types. Most patients with type I images had herniated disc symptoms with unilateral leg pain and limited straight-leg raising. Patients with types II and III myelographic appearances had bilateral leg pain, absent ankle jerks, weakness, cramps and signs of diffuse sensory deficit; some also had neurogenic claudication and urinary sphincter dysfunction. All patients with type IV had dysesthesia. Twenty-three of the 40 patients underwent reoperation and those with types I and II had acceptable results, but poor results occurred in those with types III and IV myelograms.

Adult↗
PubMed1992

The empty sella: results of treatment in 76 successive cases and high frequency of endocrine and neurological disturbances.

OBJECTIVE: We assessed the frequency of endocrine or neurological disturbances and the results of surgery in patients with empty sella, diagnosed with cisternography and/or computerized tomography scanning. DESIGN AND PATIENTS: Analysis of hospital records of 76 successive patients (73 primary, three secondary empty sella) from a single institution. MEASUREMENTS: Clinical and neuro-ophthalmological evaluation. Serum PRL, GH, TSH, LH, FSH, T4, T3 by radioimmunoassay. Diagnosis of empty sella with cisternography and/or computerized tomography scanning (n = 69), or discovered at surgery (n = 7). RESULTS: Patients with empty sella had: headache (69.7%), visual disturbances (34.2%), cerebrospinal fluid rhinorrhoea (11.8%), endocrine disturbances (51.4%, including hyperprolactinaemia, acromegaly, Cushing's syndrome). A pituitary tumour was discovered in two patients, in seven other ones it was suspected but not found at surgery. Transsphenoidal packing of empty sellas was done in 56 cases, with 7.1% post-operative complications. With surgery there was improvement of headache in 71%, of visual disturbances in 46%. Cerebrospinal fluid rhinorrhoea (discovered at surgery in four other patients) was not resolved by the first operation in six out of 13 patients. In 20 patients without surgery, headache improved in 64.6%. CONCLUSIONS: The empty sella is frequently associated with a variety of neurological and endocrine disturbances, which is contrary to conventional belief. Cerebrospinal fluid rhinorrhoea is not a rare complication and it may be difficult to treat. Some cases of empty sella may be due to partial pituitary apoplexy. Autoimmunity may have existed in other cases. Surgery may be useful in many patients, but a judicious selection is needed because it entails complications and non-operated patients may improve spontaneously.

Adolescent↗
PubMed1976

Evaluation of dissection of the axilla in modified radical mastectomy.

Fifty consecutive unselected patients with infiltrating carcinoma of the breast underwent radical mastectomy in two consecutive stages. The initial operation was a modified radical mastectomy, with preservation of the pectoral muscles, and the second stage, a procedure to transform the initial operation into a standard radical mastectomy. An analysis of the location and the number of the lymph nodes recovered in the two stage operation shows that a so-called modified radical mastectomy is inadequate to ensure the clearing of the axilla. Lymph nodes were recovered at the second stage of the operation in 36 patients, and seven of these patients had metastasis. Modified radical mastectomy was effective in erradicating the lymph nodes of the lower part of the axilla but inadequate for lymph nodes at levels II and III and, especially, the interpectoral lymph nodes.

Adult↗
PubMedDate not supplied

Lung function of young Aymara highlanders.

The patterns of development of FVC, FEV and %FEV are examined in 217 male and 195 female youths of Aymara ancestry residing in La Paz, Bolivia (altitude 3600 m). The data provide some evidence of an acceleration in the development of lung function relative to stature in Aymara children, beginning during early adolescence, and also indicate that there is a strong relationship between lung function and chest dimensions in Aymara children. Similar patterns have been observed among Quechua youth. However, despite the general similarity between Quechua and Aymara youths in the development of lung function, there are potentially important differences between them. In particular, the magnitude of the acceleration of lung volumes relative to stature among Aymara children appears to be considerably less than is exhibited by highland Quechua children. In addition, shorter Quechua boys have FVC values similar to those of shorter Aymara boys, despite having significantly larger chests, while taller Quechua boys have considerably larger FVC values than taller Aymara boys, without a corresponding increase in chest size relative to stature. Thus, although lung volumes and chest dimensions are closely related in both groups, the development of lung function to chest size of Quechua boys appears to be somewhat different from that of Aymara boys and, in particular, to be amplified during adolescence in response to factors other than simply an increase in chest size.

Adaptation, Physiological↗
PubMedDate not supplied

Prevalence of Trypanosoma cruzi and Leishmania chagasi infection and risk factors in a Colombian indigenous population.

This study was carried out in order to obtain base-line data concerning the epidemiology of American Visceral Leishmaniasis and Chagas' Disease in an indigenous population with whom the government is starting a dwelling improvement programme. Information was collected from 242 dwellings (1,440 people), by means of house to house interviews about socio-economic and environmental factors associated with Leishmania chagasi and Trypanosoma cruzi transmission risk. A leishmanin skin test was applied to 385 people and 454 blood samples were collected on filter paper in order to detect L. chagasi antibodies by ELISA and IFAT and T. cruzi antibodies by ELISA. T. cruzi seroprevalence was 8.7% by ELISA, L. chagasi was 4.6% and 5.1% by IFAT and ELISA, respectively. ELISA sensitivity and specificity for L. chagasi antibodies were 57% and 97.5% respectively, as compared to the IFAT. Leishmanin skin test positivity was 19%. L. chagasi infection prevalence, being defined as a positive result in the three-immunodiagnostic tests, was 17.1%. Additionally, 2.7% of the population studied was positive to both L. chagasi and T. cruzi, showing a possible cross-reaction. L. chagasi and T. cruzi seropositivity increased with age, while no association with gender was observed. Age (p<0.007), number of inhabitants (p<0. 05), floor material (p<0.03) and recognition of vector (p<0.01) were associated with T. cruzi infection, whilst age ( p<0.007) and dwelling improvement (p<0.02) were associated with L. chagasi infection. It is necessary to evaluate the long-term impact of the dwelling improvement programme on these parasitic infections in this community.

Adult↗
PubMedDate not supplied

Human and dogs Toxocara canis infection in a poor neighborhood in Bogota.

Prevalence of Toxocara canis antibodies was studied in a poor community of Bogotá, Colombia. Two-hundred-seven patients, from both sexes and all age groups, were studied. Positive ELISA titers were found in 47.5% of the population, a high prevalence compared with reports from developed countries. T. canis ova were positive in 43.6% of fecal samples from dog puppies. An endemic pattern of the disease is described: socioeconomic status, weather, pollution, poor hygiene and a significant population of infected dogs. Neither the physical examination nor ELISA titers could detect any case of T. canis disease.

Adolescent↗