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Biomedical subjects

G Mombelli

Publications and source records attributed to G Mombelli.

At least 55 records · Page 3Linked to original sources
PubMed1984

[Problems of heparin dosage].

Administration of heparin by continuous intravenous infusion is, so far as bleeding complications are concerned, safer than intermittent injection. Recurrence of venous thromboembolism during infusion is rare if the APTT is prolonged to 1 1/2-2 1/2 times the control value. The efficacy of low-dose heparin in the primary prevention of venous thromboembolism in medical patients remains unproven. On the other hand, adjusted-dose subcutaneous heparin treatment provides an effective alternative to oral anticoagulants in the long-term treatment of venous thrombosis.

Dose-Response Relationship, Drug↗
PubMed1984

[Endocarditis prevention and therapy].

The use of antibiotics to prevent infective endocarditis is accepted medical practice in risk patients. The author discusses some basic problems surrounding the development of endocarditis following interventions likely to produce bacteremia, and indicates guidelines for the prevention of this infection. Antibiotic regimens for the usual forms of endocarditis are summarized, and the role of surgery in active infection is discussed.

Anti-Bacterial Agents↗
PubMed1984

Effect of heparin on plasma fibrinopeptide A in patients with acute myocardial infarction.

The plasma level of fibrinopeptide A (fpA) was used as an index of thrombin action on fibrinogen in order to investigate the rates of fibrin formation and the effect of heparin on thrombin in patients with acute myocardial infarction. The fpA levels measured on admission in 19 patients with acute myocardial infarction ranged from 1.7 to 12.4 ng/ml and were elevated (greater than 2.5 ng/ml) in 16 patients. A loading dose of 5000 IU of heparin resulted in a significant decrease within 20 min of the mean fpA level (from 5.1 to 2.2 ng/ml; p less than .001) and in an fpA normalization in five of 16 patients. During the following continuous infusion of 20,000 IU of heparin per day, the mean fpA levels measured on day 0, 1, and 2 were 3.0, 3.2, and 3.4 ng/ml, respectively, with 16 of 46 fpA values within the normal range. In 10 additional patients, the effect of higher concentrations of heparin and the consequences of stopping heparin infusion were studied. An additional 5000 IU of heparin injected intravenously during continuous infusion of 20,000 IU of heparin per day resulted in a substantial decrease of the plasma fpA level in three of 10 measurements. The stopping of heparin infusion led to an impressive increase of the mean fpA level (from 3.1 to 12.9 ng/ml; p less than .001) within 2 hr. These data demonstrate increased fibrin formation in patients with acute myocardial infarction and neutralization of thrombin in vivo by heparin.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1983

Gram-negative bacillary meningitis in neurosurgical patients.

The authors report 34 cases of Gram-negative bacillary meningitis related to traumatic cranial lesions or neurosurgery observed between 1973 and 1980 at two neurosurgical units (Institut J. Bordet, Brussels, and Inselspital, Bern). As a typical nosocomial infection, meningitis developed after prolonged hospitalization in most patients, and was mainly due to highly resistant organisms, such as P. aeruginosa and Klebsiella sp. At least 65% of the patients were colonized with the pathogen responsible for the meningitis before the onset of the infection. Ventriculitis, including four cases of ventricular empyema, complicated meningitis in all the 17 patients in whom a ventricular tap was performed. The results of treatment were unsatisfactory. Fifty percent of the patients were cured of their infection, but only 30% survived; 15% of the patients died within 48 hours following diagnosis. The optimum treatment of postsurgical Gram-negative meningitis remains in doubt. The choice of initial antibiotics should take into account the sensitivity patterns of colonizing microorganisms. Chloramphenicol is ineffective against most pathogens commonly involved in this infection. Intrathecal aminoglycosides may fail in the presence of ventriculitis. Intraventricular aminoglycosides are probably justified in critically ill patients. The role of the newer cephalosporins and of co-trimoxazole remains to be defined.

Adolescent↗
PubMed1982

[Useful and superfluous measures in the treatment of respiratory infections].

A safe and inexpensive approach to respiratory infections requires: 1. an accurate diagnosis, 2. a critical attitude towards drugs whose clinical efficacy is unproven, 3. to avoid antibiotics where they are not strictly indicated, 4. to use penicillin instead of more expensive (and often less active) antibiotics in the treatment of infections due to streptococci or pneumococci.

Bronchitis↗
PubMed1982

[Vaccine poliomyelitis in an adult undergoing chemotherapy for non-Hodgkin lymphoma].

Paralytic disease was observed in a 68-year-old man with non-Hodgkin lymphoma following administration of oral live poliomyelitis vaccine. The vaccine had been administered during a vaccination campaign just before the patient underwent chemotherapy with cyclophosphamide. The dangers intrinsic in vaccination campaigns, i.e. of failure to individualize risks and benefit of the vaccination, are discussed.

Aged↗
PubMed1982

Comparison of 125I-fibrinogen kinetics and fibrinopeptide A in patients with disseminated neoplasias.

To provide more information on the pathways of fibrinogen catabolism in generalized cancer, the effect of heparin on fibrinopeptide A (fpA) and on 125I-fibrinogen kinetics was studied in 15 patients with disseminated neoplasia. Three patients had evidence of venous thrombosis and in 2 additional patients a low fibrinogen level together with increased amounts of FDP/fdp and a positive ethanol test indicated disseminated intravascular coagulation (DIC). The plasma levels of fpA were grossly elevated (4.6--20, mean 11.4 ng/ml, normal values 1.01 +/- 0.45 ng/ml) in patients with thrombosis or DIC, and normal to grossly elevated (0.4--10.4, mean 6.1 ng/ml) in the other patients. Intravenous heparin bolus lowered the fpA level in 11/11 patients, and continuous heparin treatment led to an impressive suppression or complete normalization of the plasma fpA in 5/6 patients. This finding is thought to reflect heparin suppression of thrombin activity on fibrinogen. In some cases, the fpA fall after heparin bolus was slow and/or incomplete, suggesting fpA generation at sites not easily accessible to heparin or insufficient heparin dosage. The 125I-fibrinogen kinetics were characterized by a significantly shorter half-life (t1/2: 2.5 days), increased catabolic rate constant (j: 0.44 days-1), and increased absolute turnover (68.9 mg fibrinogen/kg/day) as compared to 4 normal subjects (t1/2: 4.2 days; j: 0.26 days-1; turnover 21.7 mg fibrinogen/kg/day). As estimated from the fpA generation rates, intravascular thrombin action on fibrinogen contributed only in minor part to increase the turnover of 125I-fibrinogen. In particular, the turnover was greatly accelerated in heparin-treated patients despite impressive suppression or normalization of the fpA levels in 5/6 cases.

Adult↗
PubMed1981

[Aminopenicillin: when, how, what kind?].

The antibacterial activity of aminopenicillins is similar and includes penicillin-sensitive microorganisms and certain gram-negative species, particularly E. coli, P. mirabilis, Salmonellae, Shigellae and H. influenzae. Since penicillin G is less expensive, often more active and less likely to produce skin rashes than aminopenicillins, there is no reason to substitute aminopenicillins, there is no reason to substitute aminopenicillins for penicillin in situations where the latter would suffice. Of the various oral drugs of this class, amoxycillin and the esters of ampicillin (bacampicillin, pivampicillin) are better absorbed than ampicillin and epicillin and are thus effective at lower dosages. Amoxycillin has the advantage of having undergone extensive clinical investigation. For parenteral treatment amoxycillin and epicillin do not offer therapeutic advantages over ampicillin, which remains the best documented drug.

Acute Disease↗
PubMed1981

[Bactericidal activity against P. aeruginosa in serum and bronchial secretion in patients under continuous infusion of azlocillin].

The azlocillin level and killing activity in serum and bronchial secretions against 10 strains of P. aeruginosa were studied in 7 intubated or tracheotomized patients with severe bronchial infection who were receiving the drug as continuous i.v. infusion. In 5 out of 7 patients azlocillin was absent or present only in traces in bronchial secretions in spite of plasma levels ranging between 170 to 340 micrograms/ml. In the other 3 patients azlocillin levels of 23 and 39 micrograms/ml and moderate bactericidal activity against P. aeruginosa could be detected in bronchial secretions. Penicillinase producing strains of Staph. aureus were isolated from the sputum of the 5 patients with extremely low azlocillin level in bronchial secretions. The strain of Staph. aureus isolated from one patient was shown to destroy azlocillin rapidly. In bronchopulmonary infections, Staph. aureus may not only be directly pathogenic but also interfere with the action of beta-lactamase unstable drugs against other microorganisms.

Azlocillin↗
PubMed1981

Post neurosurgery Gram-negative bacillary meningitis.

The findings of a retrospective analysis of 20 patients who developed Gram-negative bacillary meningitis (GNBM) following neurosurgery are reported. The predisposing causes included surgery for skull fracture or cerebral contusion (9 patients), neoplasm (6) and vascular disease (2). Nine of the patients (45 per cent) had a cerebrospinal fluid (CSF) leak from a fistula. The organisms isolated, which included Pseudomonas aeruginosa (6), Klebsiella spp. (5) and Escherichia coli (4), had, in 75 per cent of cases, been isolated from other sites prior to the onset of GNBM. Initial diagnosis was achieved by Gram-stain of CSF in 15 of 19 cases (78 per cent). Culture of lumbar CSF was positive in 19 of the patients (95 per cent) and concommittant ventriculitis was confirmed by positive culture of ventricular CSF in 10 of 11 cases (91 per cent) from whom it was obtained. The overall mortality was 80 per cent, 11 patients dying of causes directly related to GNBM. Eradication of the infecting organism from CSF was achieved in 79 per cent of patients receiving intraventricular aminoglycoside therapy, but in only 40 per cent of those receiving intralumbar therapy. Deaths in the latter group were associated with ventriculitis whereas those in patients receiving intraventricular therapy resulted from intracranial abscess formation. These findings, plus the observation of chloramphenicol resistance in 80 per cent of the isolates, suggest that systemic and intraventricular aminoglycoside administration is indicated in patients with post-neurosurgical GNBM.

Adolescent↗
PubMed1981

Anti-Pseudomonas activity in bronchial secretions of patients receiving amikacin or tobramycin as a continuous infusion.

The penetration of amikacin and tobramycin into bronchial secretions and the resulting anti-Pseudomonas activity were assessed in two groups of tracheostomized or intubated patients with tracheobronchial infection and purulent bronchial secretions. The aminoglycosides were administered as continuous, high-dose intravenous infusions. The mean drug concentrations in serum and bronchial secretions were 12.8 and 2.0 microgram/ml for amikacin and 3.6 and 0.7 microgram/ml for tobramycin. The bronchial secretion/serum ratios varied over a wide range: from 9.6 to 22.8% (average, 14.9%) for amikacin and from 3 to 39.3% (average, 17.5%) for tobramycin. Sustained anti-Pseudomonas activities in bronchial secretions were achieved only in patients with very high aminoglycoside levels in serum. In most patients, however, no anti-Pseudomonas activity could be detected within bronchial secretions despite therapeutic levels of amikacin and tobramycin and adequate bactericidal activities in serum.

Amikacin↗
PubMed1980

[Ineffectiveness of preventive low-dose heparin administration in pacemaker implantation].

In a prospective controlled trial the prophylactic efficacy of low-dose heparin was investigated in 41 patients undergoing transvenous pacemaker implantation. 20 of these patients were randomly selected to receive heparin (2 x 5000 units subcutaneously/day, first dose 1--2 hours before surgery). 21 did not receive prophylaxis and acted as a control group. The frequency of deep-vein thrombosis, determined by the 125I-fibrinogen test, was 14.3% in the control group and 25% in the treatment group. Independently of heparin administration, the incidence of thrombosis was significantly higher among the 20 patients with multiple factors known to predispose to deep venous thrombosis (39% versus 4.3%; p < 0.05). It is concluded that in patients undergoing transvernous pacemaker implantation low-dose heparin does not reduce the frequency of 125I-fibrinogen thrombosis. Conventional anticoagulation of patients selected on the grounds of risk factors is probably more appropriate.

Anticoagulants↗
PubMed1979

[Fibrinogen metabolism and plasma fibrinopeptide A in disseminated neoplasms].

FPA immunoreactivity was elevated in 14 out of 15 patients with disseminated neoplasia. Two of the patients showed signs of DIC, two had clinically evident thrombosis and one a positive 125I-fibrinogen uptake test suggesting thrombosis. Infusion of heparin produced a prompt fall in FPA levels. FPA immunoreactivity correlated well with the turnover of intravasal 125I-fibrinogen. The results confirm that the RIA of FPA provides a specific and quantitative index of the conversion of fibrinogen into fibrin and indirectly of the thrombin action in vivo.

Disseminated Intravascular Coagulation↗