Search PubMed⌕ Search

Biomedical subjects

F Marco

Publications and source records attributed to F Marco.

At least 73 records · Page 4Linked to original sources
PubMed1998

Biopsy forceps disinfection technique does not influence Helicobacter pylori culture.

OBJECTIVES: Culturing Helicobacter pylori (Hp) has a low sensitivity rate, and is affected by factors such as the number of biopsies, transport, and culture conditions. Hp detection is also influenced by omeprazole, antibiotics, bismuth salts, or benzocaine use. Disinfection procedures based on glutaraldehyde are highly effective in eliminating any Hp contamination of endoscopic equipment. However, the possibility that some residual glutaraldehyde present in biopsy forceps after decontamination could affect Hp viability has not yet been investigated. METHODS: Antral specimens from 25 patients with active gastric or duodenal ulcer obtained with three forceps (sterilized with ethylene oxide, glutaraldehyde, or glutaraldehyde-phenolate) were streaked on appropriate media, and results of culture evaluated. RESULTS: Helicobacter pylori was isolated in 17 patients. Positivity of culture was independent of the way the forceps were sterilized, and the number of colonies (mean +/- SD) was similar for the three types of forceps (475 +/- 312, 533 +/- 242, and 550 +/- 225 colony-forming units [CFUs] for ethylene oxide, glutaraldehyde, and glutaraldehyde-phenolate, respectively). Moreover, the incubation time since isolation was also similar (6.0 +/- 1.3, 5.8 +/- 1.2, and 5.7 +/- 1.2 days for ethylene oxide, glutaraldehyde, and glutaraldehyde-phenolate disinfected forceps, respectively). CONCLUSION: The use of glutaraldehyde to sterilize biopsy forceps is not responsible for the false-negative results of Hp culture.

Biopsy↗
PubMed1998

In vitro activities of voriconazole (UK-109,496) and four other antifungal agents against 394 clinical isolates of Candida spp.

Voriconazole (formerly UK-109,496) is a new monotriazole antifungal agent which has potent activity against Candida, Cryptococcus, and Aspergillus species. We investigated the in vitro activity of voriconazole compared to those of fluconazole, itraconazole, amphotericin B, and flucytosine (5FC) against 394 bloodstream isolates of Candida (five species) obtained from more than 30 different medical centers. MICs of all antifungal drugs were determined by the method recommended by the National Committee for Clinical Laboratory Standards using RPMI 1640 test medium. Overall, voriconazole was quite active against all the yeast isolates (MIC at which 90% of the isolates are inhibited [MIC90], < or =0.5 microg/ml). Candida albicans was the most susceptible species (MIC90, 0.06 microg/ml) and Candida glabrata and Candida krusei were the least (MIC90, 1 microg/ml). Voriconazole was more active than amphotericin B and 5FC against all species except C. glabrata and was also more active than itraconazole and fluconazole. For isolates of Candida spp. with decreased susceptibility to fluconazole and itraconazole MICs of voriconazole were also higher. Based on these results, voriconazole has promising antifungal activity and further in vitro and in vivo investigations are warranted.

Amphotericin B↗
PubMed1998

Antifungal activity of a new triazole, voriconazole (UK-109,496), compared with three other antifungal agents tested against clinical isolates of filamentous fungi.

Voriconazole is a new triazole antifungal agent with potent activity against yeast and moulds. We investigated the in vitro activity of voriconazole, itraconazole, amphotericin B and 5-flucytosine against 51 clinical isolates of filamentous fungi. Overall, voriconazole was active (MIC50, 0.5 mg l(-1) and MIC90, 8 mg l(-1)) against these mould isolates. Voriconazole was most active against P. boydii (MIC50, 0.12 mg l(-1)) and Aspergillus spp. (MIC90, 0.5 mg l(-1)) and least active against Fusarium spp. (MIC90, 8 mg l(-1)) and Rhizopus spp. (MIC50, 8 mg l(-1)). Voriconazole was more active than amphotericin B against Aspergillus spp. and P. boydii. By comparison with itraconazole, voriconazole was more active against all isolates except Rhizopus spp. Based on these results, voriconazole has promising activity against commonly encountered isolates of filamentous fungi and its clinical usefulness should be established by further studies.

Amphotericin B↗
PubMed1998

Treatment of pathologic fractures of the humerus with Seidel nailing.

A retrospective study is presented of 14 patients with pathologic fractures of the humerus (12 established, two impending) treated with Seidel nailing from 1988 through 1995 in the authors' institution. There were nine women and five men whose average age was 59.5 years. Breast, prostate, and kidney hypernephroma accounted for the majority of the primary lesions. All but one lesion were located in the middle shaft of the humerus. Ten lesions were considered large (> 5 cm long). In five cases an open curettage and allografting were done. Early pain relief was successful in 85% of the patients. The worst complication found was definite nerve palsy in two (14.28%) patients. Ten fractures healed and two failed to heal. Two thirds of the patients had good functional results. The average survival was 12 months. Intramedullary fixation of pathologic fractures improves the quality of life by controlling pain for most patients.

Adult↗
PubMed1998

Hyperammonemic encephalopathy in multiple myeloma.

We report two cases of hyperammonemic encephalopathy in patients with multiple myeloma. This rare complication, whose pathophysiology remains unknown, is associated with disease progression and so with a very bad prognosis. We believe that this complication should be included in the differential diagnosis of encephalopathy occurring in multiple myeloma.

Ammonia↗
PubMed1997

Platelet activation In mice and human Helicobacter pylori infection.

Extracts of Helicobacter pylori (HP) have been shown to induce leukocyte adhesion in mesenteric venules, but the effects of HP infection on gastric microvessels are unknown. Inflammatory cell interactions in the gastric microcirculation were studied by intravital videomicroscopy in mice inoculated with either saline or fresh isolates of HP. Platelet aggregates were detected and quantified in murine portal blood, while endothelial P-selectin expression was determined using the dual radiolabeled mAb technique. Platelet activation and aggregation were studied in HP-infected patients and controls by measuring the platelet-aggregate ratio and platelet P-selectin expression. HP infection induced a marked increase in the flux of rolling leukocytes and the appearance of platelet and leukocyte- platelet aggregates in murine gastric venules. The HP-induced rolling and platelet aggregate formation was abrogated by mAbs against L- or P-, but not E- selectin. Endothelial cell expression of P-selectin was not altered, but platelet P-selectin expression was enhanced in HP-infected mice. Circulating platelet aggregates and activated platelets were also detected in HP-infected patients. These findings indicate that platelet activation and aggregation contribute to the microvascular dysfunction and inflammatory cell recruitment associated with HP infections.

Animals↗
PubMed1997

Prognostic factors in meningococcal disease. Development of a bedside predictive model and scoring system. Barcelona Meningococcal Disease Surveillance Group.

CONTEXT: Meningococcal disease is associated with significant morbidity and mortality. Development of a prognostic model based on clinical findings may be useful for identification and management of patients with meningococcal infection. OBJECTIVES: To construct and validate a bedside model and scoring system for prognosis in meningococcal disease. DESIGN: Prospective, population-based study. SETTING: Twenty-four hospitals in the metropolitan area of Barcelona, Spain. PATIENTS: A total of 907 patients with microbiologically proven meningococcal disease. Patients diagnosed with meningococcal disease from 1987 through 1990 were used to develop the prognostic model, and those diagnosed in 1991 and 1992 were used to validate it. OUTCOME MEASURES: Clinical independent prognostic factors for mortality in meningococcal disease. The association between outcome and independent prognostic factors was determined by logistic regression analysis. A scoring system was constructed and tested using receiver operating characteristic curves. RESULTS: Among 624 patients in the derivation set, 287 (46%) were male, the mean age was 12.4 years, and 34 patients (5.4%) died. Among 283 patients in the validation set, 124 (43.8%) were male, the mean age was 12.7 years, and 17 patients (6.0%) died. In multivariate analysis, independent predictors of death were hemorrhagic diathesis (odds ratio [OR], 101; 95% confidence interval [CI], 30-333), focal neurologic signs (OR, 25; 95% CI, 7-83), and age 60 years or older (OR, 10; 95% CI, 3-34), whereas receipt of adequate antibiotic therapy prior to admission was associated with reduced likelihood of death (OR, 0.09; 95% CI, 0.02-0.4). Hemorrhagic diathesis was scored with 2 points, presence of focal neurologic signs with 1 point, age of 60 years or older with 1 point, and preadmission antibiotic therapy was scored as -1. The clinical scores of -1, 0, 1, 2, and 3 or more points were associated with a probability of death of 0%, 2.3%, 27.3%, 73.3%, and 100%, respectively. CONCLUSIONS: Hemorrhagic diathesis, focal neurologic signs, and age of 60 years or older were independent predictors of death in meningococcal disease, whereas receipt of adequate antibiotic therapy was associated with a more favorable prognosis. The scoring system presented is simple, is based on findings readily available at the bedside, and may be useful to help guide aggressive therapy.

Adolescent↗
PubMed1997

[Yield of blood cultures in relation to the cultured blood volume in Bactec 6A bottles].

BACKGROUND: Concentration of microorganisms in blood is low in bacteremia from extravascular sources. The best yield from blood cultures is achieved by culturing a minimum of 10-20 ml, although in some processing blood culture systems such as Bactec NR-860, smaller volume is used. The objectives of the present study were to establish the frequency in which inadequate small blood volumes are employed for culturing and to analyze the relation between the cultured blood volume in Bactec 6A bottles and the yield achieved. MATERIAL AND METHODS: We weighed 2000 Bactec 6A bottles pertaining to consecutive blood cultures obtained from untreated patients with clinical suspicion of Infection. The cultured blood volume was estimated subtracting the mean empty bottle weight. RESULTS: Microorganisms were recovered from 251 bottles (12.5%). One hundred and thirty one (6.8%) isolates were considered as clinically significant and 115 (5.7%) as contaminant. The inoculated blood volume in both significant (5.532 +/- 1.587 ml) and non-significant (5.471 +/- 1.563 ml) recoveries was superior than that of bottles without microbiologic growth (5.209 +/- 1.575 ml, p = 0.016 and p = 0.06, respectively). A linear positive trend was found between the cultivated blood volume and the rate of recoveries (p = 0.008). Within the range of 1 up to 10 ml, the rate of recoveries increased 2.28% for each additional ml of cultivated blood (r = 0.953, p < 0.0001). Out of the 2,000 weighed bottles 127 (6.3%) contained less than 3 ml of blood and 576 (29%) between 3 and 5 ml. CONCLUSIONS: We have proved that the rate of recoveries from Bactec 6A bottles increased with the volume of cultured blood. In untreated patients, this increase is maintained up to volumes of 7 to 10 ml.

Adult↗
PubMed1997

Risk factors for oxacillin/methicillin resistance in coagulase-negative staphylococci.

The clinical variables associated with isolation of oxacillin- and methicillin-resistant, coagulase-negative staphylococci (CNS) from blood cultures of hospitalized patients were studied. One hundred CNS strains (49 oxacillin-susceptible; 51 oxacillin-resistant) isolated consecutively from one of two or more sets of blood cultures were collected. Only two variables were independently associated with recovery of oxacillin/methicillin-resistant strains by a multivariate analysis: length of hospital stay > 10 days (OR 5.2, 95% CI = 1.7-15.7), and administration of antimicrobial agents in the previous 14 days (OR 4.5, 95% CI = 1.7-11.7). Analysis of the antibiotics administered indicated that only beta-lactams were associated with a statistically significant risk of resistance to oxacillin/methicillin (OR of beta-lactams vs no antibiotics = 6.94, 95% CI = 1.9-25.3; OR of non-beta-lactams vs no antibiotics = 2.64, 95% CI = 0.8-8.3). Length of hospital stay (especially > 10 days) and prior administration of antimicrobial agents (mainly beta-lactams) independently predicted the presence of oxacillin/methicillin-resistant CNS in blood cultures.

Cross Infection↗
PubMed1997

Anti-Legionella activity of trovafloxacin compared with seven other antimicrobial agents including an intermethod evaluation.

The activity of trovafloxacin, a new fluorinated naphtheridone, was tested against 61 Legionella spp. isolates and compared with that of 4 fluoroquinolones, 2 macrolides, and rifampin. Trovafloxacin MICs were determined by a reference agar dilution method and E-test (Solna, Sweden) strips on buffered charcoal yeast extract agar. Among the fluoroquinolone compounds, the rank order of activity (on the basis of MIC90 results) determined with E-test strips was as follows: levofloxacin (MIC90, 0.094 microgram/ml) > trovafloxacin = sparfloxacin = ofloxacin (MIC90, 0.19 microgram/ml). Rifampin (MIC90, 0.008 microgram/ ml) and clarithromycin (MIC90, 0.032 microgram/ml) were the most potent of all drugs tested, and erythromycin and ciprofloxacin were the least active. In this study, the E-test strips with trovafloxacin were validated (100% of results +/- one log2 dilution compared to the reference value) for susceptibility testing with Legionella isolates.

4-Quinolones↗
PubMed1996

Epidemiology and outcome of Pseudomonas aeruginosa bacteremia, with special emphasis on the influence of antibiotic treatment. Analysis of 189 episodes.

OBJECTIVE: To evaluate the trend in incidence of Pseudomonas aeruginosa bacteremia, underlying conditions of patients, mortality rate, and factors associated with poor outcome. PATIENTS AND METHODS: Medical charts of 189 consecutive episodes of P aeruginosa bacteremia, detected between January 1, 1991, and December 31, 1994, were prospectively evaluated. Associated risk factors, treatment, and outcome were recorded. RESULTS: Pseudomonas aeruginosa bacteremia represented 5.7% of the total number of bacteremias, 6.9% of nosocomial bacteremias, and 23.6% of nosocomial gram-negative bacteremias. There were 1.5 episodes per 1000 discharges. These numbers were slightly lower than those recorded at our hospital 10 years earlier. Human immunodeficiency virus infection was the most frequent underlying disease (28/189 [15%]). Overall mortality was 18% (34/189). The presence of fatal underlying disease (P < .001), surgery (P = .001), pneumonia (P = .02), and severe sepsis (P < .001) were associated with poor prognosis, the mortality of the patients with these variables being 28%, 28%, 47%, and 62%, respectively. The presence of inappropriate definitive antimicrobial treatment became an independent factor predictive of death (P = .04) only when the subset of patients with intravenous catheter-associated bacteremia was excluded from the analysis. The survival rate was no greater in patients who received 2 or more antibiotics active in vitro against P aeruginosa than in those who received only 1. Neutropenia was not associated with increased mortality. The use of colony-stimulating factors did not affect the outcome of the neutropenic patients. CONCLUSIONS: The rate of P aeruginosa bacteremia is falling slightly at our hospital. The emergence of the human immunodeficiency virus epidemic has had a considerable impact on both epidemiology and mortality. The presence of severe underlying disease, surgery, pneumonia, and, especially, severe sepsis are associated with a poor outcome. With the exclusion of patients with intravenous catheter-associated P aeruginosa bacteremia, the administration of an appropriate antimicrobial therapy is essential to a good outcome. Treatment with 1 active antibiotic seems to be sufficient.

Aged↗
PubMed1996

European multicentre evaluation of a commercial system for identification of methicillin-resistant Staphylococcus aureus.

A commercial system for the rapid detection of methicillin-resistant Staphylococcus aureus, the BBL Crystal MRSA test (C-MRSA ID; Becton Dickinson, USA), was evaluated prospectively and compared with a polymerase chain reaction test for the presence of the mecA gene. Ten European centres tested a total of 676 isolates of Staphylococcus aureus from blood cultures. The system correctly identified 661 (97.8%) isolates within 4 h. All but three mecA gene-negative isolates (99.4% specificity) yielded a negative C-MRSA ID reaction, and 158 of 170 mecA gene-positive isolates were accurately detected (92.9% sensitivity). After repeated testing of discrepant results, sensitivity and specificity increased to 99% and 100%, respectively.

Bacteriological Techniques↗
PubMed1996

Randomized, comparative study of oral ofloxacin versus intravenous cefotaxime in spontaneous bacterial peritonitis.

BACKGROUND & AIMS: Treatment of spontaneous bacterial peritonitis currently involves intravenous antibiotic administration. To test the possibility of treating spontaneous bacterial peritonitis with oral antibiotics, oral ofloxacin was compared with intravenous cefotaxime in this infection. METHODS: One hundred twenty-three cirrhotics with uncomplicated spontaneous bacterial peritonitis (no septic shock, grade II-IV hepatic encephalopathy, serum creatinine level of > 3 mg/dL, and gastrointestinal hemorrhage or ileus) were randomly given oral ofloxacin (64 patients) or intravenous cefotaxime (59 patients). RESULTS: Infection resolution rate was 84% in the ofloxacin group and 85% in the cefotaxime group. Peak serum levels and trough serum and ascitic fluid levels of ofloxacin and cefotaxime measured on days 3 (23 patients) and 6 (11 patients) of therapy were greater than the minimal inhibitory concentration of isolated organisms. Hospital survival rate was 81% in each group of patients. Blood urea nitrogen and hepatic encephalopathy at diagnosis were associated with prognosis. None of the 36 nonazotemic patients with community-acquired spontaneous bacterial peritonitis and without hepatic encephalopathy developed complications during hospitalization, and all were alive at time of discharge. CONCLUSIONS: Oral ofloxacin is as effective as intravenous cefotaxime in uncomplicated spontaneous bacterial peritonitis. Nonazotemic cirrhotic patients with uncomplicated community-acquired spontaneous bacterial peritonitis and without hepatic encephalopathy have an excellent prognosis and may be treated with oral ofloxacin without requiring hospitalization.

Administration, Oral↗
PubMed1996

Prevention and control of nosocomial infections in Spain: current problems and future trends.

Spain is a state member of the European Union, with more than 180,000 hospital beds and 800 public and private institutions. Only 6.9% of our gross national product is devoted to health expenditures. All citizens receive free health care through the National Health System. This system has given increasing attention to the prevention and control of nosocomial infections since 1986. In this article, results of serial prevalence surveys of antibiotic use and resistance patterns of microorganisms isolated from nosocomial infections are discussed. The needs for future development of infection control and quality assurance training programs in Spain also are discussed. Overall, a clinically and epidemiologically oriented approach to infection control is preferred, with greater emphasis in the role of infection control practitioners and infection control committees.

Anti-Bacterial Agents↗
PubMed1996

[Transesophageal cardiac echography and paracardiac tumor masses. Apropos of a case].

Computed tomography is currently the reference examination in the investigation of mediastinal tumours. We report a case of pericardial tumour revealed by transoesophageal echocardiography. This investigation immediately defined the limits of this mass and its relations with cardiac cavities and large vessels and suggested the main features of its tissue structure. However, the aetiological diagnosis is still based on CT-guided needle biopsy or investigation by mediastinoscopy or thoracotomy. Our case consisted of a non-Hodgkin lymphoma. Transoesophageal echocardiography is a non-irradiating technique, which can be performed at the patient's bed and which allows a precise assessment of the pericardial regions, especially the right pericardial regions.

Adult↗