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At least 19 recordsLinked to original sources
PubMed2026

The Next Step: The Role of Metagenomic Next-Generation Sequencing in Microbial Detection of Culture-Negative Cardiovascular Infections.

Cardiovascular infections, including those that involve native and prosthetic heart valves, implantable cardiac devices, mechanical circulatory assist devices, and vascular grafts, are associated with significant morbidity and mortality risks. Optimal management of these complex infections requires pathogen-directed antimicrobial therapy. However, standard culture-based methods often fail to identify causative organisms due to prior antimicrobial use, infections due to fastidious organisms, or biofilm-associated infections. Emerging evidence suggests that microbial cell-free DNA (mcfDNA) and metagenomic testing can enhance pathogen detection, particularly in culture-negative cases. However, their results require careful clinical interpretation, often necessitating input from infectious diseases specialists. In this review, we examine published evidence regarding metagenomic testing for cardiovascular infections and its impact on patient care. We propose a framework for microbiological adjudication of mcfDNA results, introduce standardized definitions for clinical impact assessment, and provide guidance on integrating mcfDNA testing into diagnostic evaluation of patients with culture-negative cardiovascular infections.

Humans↗
PubMed1977

Hazards of mechanical ventilation--therapeutic implications.

The side effects and adverse reactions associated with the use of positive pressure volume cycle ventilators are described with a focus on information the pharmacist needs to know to monitor patient drug therapy. Mechanical ventilation is discussed with regard to pulmonary and blood gases, infections, cardiovascular effects, renal-fluid status, metabolic considerations, central nervous system effects, gastrointestinal effects, musculo-skeletal reactions, discontinuance of mechanical ventilation and the use of inhalation drugs.

Blood Gas Analysis↗
PubMed1976

Results obtained with fractionated ifosfamide massive-dose treatment in generalized malignant tumours.

In 409 sufferers from various malignant tumours, we used the cytostatic Ifosfamide (ASTAZ4942) in fractionated doses. The total i.v. dose averaging 300 mg/kg bodyweight, was either spread over 5 consecutive days (5 X 60 mg/kg i.v.) or over 10 consecutive days (10 X 30 mg/kg). At the same time, most patients were irradiated, the radiation dose usually being only one tenth the antitumour dose. Infections and electrolyte imbalance were first treated before Ifosfamide therapy was instituted. Cases of advanced cerebral sclerosis, thrombopenia below 75,000/cmm, cerebral metastases, impaired renal function and inadequate cooperation of the patient were excluded from the studies. To prevent and control side effects, various premedications and adjuvants are required: Antiemetics, prevention of cystitis and infections, cardiovascular agents etc. Corticosteroids are contraindicated. Out of 360 assessable patients 101 had a full remission, 150 a partial remission, 79 were failures; 30 cases were not evaluated. Good results were seen especially in ovarian carcinoma, mammary carcinoma and microcellular bronchial carcinoma. Particularly striking is the drug's effectiveness in testicular tumours including teratomas, osteosarcomas, chondrosarcomas and myosarcomas as well as in some adenocarcinomas of the gastro-intestinal tract, particularly pancreatic carcinoma. In lymphoreticular tumours and haemoblastoses, its potency is less pronounced. The side effects of Ifosfamide are the same as those of other alkylating agents. They are reversible and can usually be controlled or even avoided by adequate preventive measures. In the order of incidence we observed: Alopecia, leukopenia, fall in haemoglobin, cystitis, intercurrent infections, nausea and vomiting as well as cerebral disorders. Since haemorrhagic cystitis considerably interferes with Ifosfamide treatment, its prevention is of essential importance. Because of possible complications and specific premedication and adjuvant measures for their control, this type of treatment should for the present only be carried out by oncologists or special cancer centres.

Adolescent↗
PubMed1992

Role of metabolism and pharmacokinetic studies in the discovery of new drugs--present and future perspectives.

1. The impact which pharmacokinetics and drug metabolism studies have made to drug discovery programmes is reviewed with examples from the anti-infective, cardiovascular, anti-inflammatory and CNS therapeutic areas. 2. Contributions that advances in analytical technology have made to the early application of pharmacokinetics and drug metabolism are discussed. 3. Some future perspectives are given on the advances being made in basic science and technology and how this will provide the basis for further growth in the contribution to the drug discovery process.

Animals↗
PubMed1979

A collaborative study of infective endocarditis in the 1970s. Emphasis on infections in patients who have undergone cardiovascular surgery.

Twenty-six major cardiovascular centers participated in a cooperative study of all cases of infective endocarditis occurring during a single calendar year to obtain an overview of infective endocarditis. The study was designed to learn which patients appear to be at highest risk to develop this infection after palliative or reparative cardiovascular surgery. Of 278 patients developing infective endocarditis during the year at these medical centers, 63 (23%) had had previous cardiovascular surgery and 215 had not. Seventy percent of the 278 patients had recognized congenital or acquired heart disease before developing the infection. Rheumatic heart disease accounted for over half of the patients with underlying structural heart disease. A majority (55%) of the 63 patients who had been operated on before developing endocarditis had prosthetic valves inserted. Of those who did not require prosthetic valves, the majority had congenital heart disease with systemic artery-to-pulmonary artery shunts. Although these data were obtained from a selected group of patients, they confirm a significant risk of endocarditis in patients with prosthetic valves and suggest that in postoperative patients with non-valvular congenital heart disease, the highest risk appears to be in cyanotic patients with palliative pulmonary artery-to-systemic artery shunts.

Adolescent↗
PubMed1976

[Physiopathology and clinical aspects of respiratory tract infections. Review].

A topographical account is given of the (mostly viral) infections that strike the upper airways and the lung parenchyma sites caused by bacteria, Mycoplasma, Rickettsiae and fungi. The different features of the three main syndromes that ensue: obstructive and restrictive ventilatory insufficiency, and alveolo-capillary block, are examined. The need for care in the administration of antibiotics is stressed, since germ resistance must be restricted as far as possible. In the case of chronic forms of lung disease, careful clinical surveillance and active therapeutic management are mandatory to prevent the establishment of irreversible, incapacitating consequences.

Anti-Bacterial Agents↗
PubMed2026

Non-Cancer Causes of Death in Patients With Metastatic Hormone-Sensitive Prostate Cancer: A Real-World Analysis.

BACKGROUND: As overall survival improves in metastatic hormone-sensitive prostate cancer (mHSPC), non-cancer causes of death are increasingly relevant. METHODS: We conducted a real-world multicenter study of patients diagnosed with mHSPC treated with ADT alone or in combination. Causes of death before progression to castration-resistant prostate cancer (CRPC) were classified as cancer- or non-cancer-related. Deaths were classified as non-cancer-related if they occurred in the absence of cancer progression. RESULTS: Among 565 patients, 35 (6.2%) died from non-cancer-related causes without disease progression, mainly infections (34%) and cardiovascular events (20%). CONCLUSIONS: Non-cancer mortality represents a meaningful proportion of deaths in mHSPC, supporting systematic cardiovascular risk evaluation and infection-prevention strategies.

Humans↗
PubMedDate not supplied

[Imipenem in the treatment of patients with severe surgical infection].

The clinical efficacy and safety of intravenously administered imipenem/cilastatin in the treatment of 45 patients with severe bacterial septicemia due to intra-abdominal abscesses, respiratory and urinary tract as well as skin, soft tissue and bone infections was studied in the prospective and open trial. The in vitro antimicrobial activity of imipenem has been assessed on the basis of 909 bacterial strains isolated from patients treated and non-treated with imipenem/cilastatin. Among them were 526 Gram-negative, 370 Gram-positive aerobic bacteria and 13 Gram-negative anaerobic bacteria (Bacteroides sp.). Pathogen susceptibility to imipenem was determined with a disc-diffusion technique using Merck, Sharp Dohme sensitive discs containing 10 mcg of imipenem. Highly sensitive to imipenem were 96.8% of Gram-negative 82.7% of Gram-positive aerobic bacteria and 100% of Bacteroides sp. All patients, in whom evident foci of infection e.g. intra-abdominal abscesses were discovered, were operated on. The dosage of imipenem/cilastatin ranged from 1.5 to 2.0 g/24 h. Clinical cure and bacteriological elimination was achieved in 39 (86.7%) of patients while 6 (13.3%) showed marked clinical improvement. Before and during therapy, aerobic and anaerobic cultures were taken from accessible sites. All specimens were worked up using conventional bacteriological techniques. Before during and after therapy, samples for hematology, biochemistry and urinanalysis were obtained. Adverse clinical effects were noted in 2 (4.4%) patients. One had nausea and vomiting which were probably related to rapid infusion and disappeared after increasing the administration time, and one had transient diarrhea. In conclusion, imipenem/cilastatin was a well tolerated and effective drug in the treatment of life-threatening surgical infections.

Adolescent↗
PubMed1976

Syndrome of intrahepatic biliary dysgenesis and cardiovascular malformations.

Peripheral pulmonary stenosis with or without intracardiac disease is described in 14 patients with intrahepatic biliary dysgenesis. Cardiovascular malformations were not present among a large group of patients with extrahepatic biliary dysgenesis. This association of intrahepatic biliary dysgenesis and vascular malformations is postulated to be a specific malformation syndrome resulting most probably from intrauterine infection. The cardiovascular disease is usually mild. The liver dysfunction varies in severity, and is accompanied by a notable hyperlipoproteinemia with secondary xanthomata which can be ameliorated by long-term treatment with cholestyramine resin and/or vegetable oil supplements.

Child, Preschool↗
PubMed1975

[Complications following colon surgery].

615 transperitoneal operations on the colon and rectum produced the following results. 377 abdominoperineal resections, anterior resections, partial and subtotal colectomies and proctocolectomies, 87 closures of colostomies and 151 operations with resection. 66% of the operations were required due to tumors. The death rate with 545 preopreratively prepared and scheduled operations was 8.1% whereas with the 70 emergency operations it was 25.7%. In 254 or 41.3% of the cases there were postoperative complications. Severe postoperative complications due to infection were the most frequent, followed by cardiopulmonary, haemorrhagic, urological and complications due to ileus. The quotient of insufficiency with the 356 anastomoses was 16%, the death rate 1.4%.

Abscess↗
PubMed1979

[Kidney transplantation in children].

Ten years' experience of renal transplantation in 40 children (aged 5--18 years) is reviewed. Including 3 second transplantations 40 cadaver grafts and 3 living donor grafts were transplanted. Mean graft survival was found to be 19 months, the longest being 8 years. At the time of last examination 24 children were alive wtith a functioning graft (mean serum creatinine level 1.5 mg/dl). After graft failure 9 children were again on intermittent hemodialysis. 7 children had died mainly because of infections or cardiovascular complications. Cumulative survival rate of patients and cadaver grafts after 2 years was 84 and 53% respectively. Growth velocity was variable but improved in the majority of patients compared to the previous dialysis period. Full social rehabilitation could be achieved in every case. Main complications were acute rejections (irreversible in 7 of 67), chronic rejections (irreversible in 6 of 10), side effects of immunosuppressive drugs (infections; hematologic, metabolic, and bone disorders), hypertension (60%), recurrence of primary renal disease (in 5 of 9 patients with focal segmental glomerulosclerosis) and surgical complications (28%). Therapeutic guide-lines are given emphasizing the role of specialized children's centres and the cooperation between pediatric nephrologists, immunologists, urologists and psychologists including the time before, during and after transplantation.

Adolescent↗
PubMed1975

[The acute vestibular paralysis (author's transl)].

Acute vestibular paralysis may not be considered as a nosologic entity but as a syndrome. Symptomatology (vertigo, spontaneous and provoked vestibular nystagmus, absence of cochlear signs) shows an uniform picture. The results of the caloric test as well as the nystagmic responses induced by galvanic stimulation and the development of central vestibular compensation however indicate that the site of the lesion is not only confined to the labyrinth but may also occur at the level of the peripheral neuron or even the vestibular nuclei. Etiology and pathology are still vague. Our own clinical observations as well as the scarce data in literature about morphological and experimental studies suggest in a way that vascular and infectious disorders are of importance as primary releasing factors. Hypothetically, vestibular loss of function may either be caused by a disturbance of labyrinthine microcirculation, initiated in a great majority of cases by infection, or by a direct lesion of the peripheral neuron as well as the vestibular nuclei. Retrolabyrinthine lesions may be due to menigoencephalitis, caused by a neurotropic virus or other infectious agents such as Toxoplasma gondii. Acute vestibular paralysis should be strictly distinguished from vestibular neuronitis. While vestibular paralysis is a syndrome, vestibular neuronitis must be considered as a nosologic entity, including a lesion of the peripheral neuron as well as evidence of an infectious event.

Adolescent↗
PubMedDate not supplied

Fundus hemorrhages in infancy.

The anatomical location and appearance of retinal hemorrhages in the infant provide important clues in the diagnosis of underlying disorders. While neonatal retinal hemorrhages related to birth trauma are common, benign, and self-limited, other retinal hemorrhages in infancy may signify intracranial aneurysms, accidental or non-accidental injury, and a variety of ocular (e.g., Coats' disease, PHPV, ROP, retinal dysplasia, hypertension, myopia) or systemic disease (e.g., hematologic or cardiovascular disorders, infection, protein C deficiency). In this review, retinal hemorrhages are illustrated and classified according to location, appearance, and etiology. Prompt diagnosis of retinal hemorrhages in infants is crucial, because treatment may be required to prevent early deprivation amblyopia and blindness. Ophthalmological findings may also be a valuable contribution to the overall medical evaluation of the infant.

Choroid Hemorrhage↗
PubMed1992

[Etiology of pneumonia and host defense].

To investigate the relationship of efficacy of chemotherapy to host defense, we reviewed the clinical features, treatment and outcome in 648 patients with acute pneumonia (424 males and 224 females; mean age, 65 years) treated between 1984 and 1989. Pneumonia complicated pulmonary disease in 336 patients (52%) and complicated systemic disease in 258 (40%). Pneumonia pathogens were diagnosed in 346 patients (53%); the five major pathogens were S. pneumoniae (19%), H. influenzae (16%), S. aureus (14%), K. pneumoniae (14%) and P. aeruginosa (11%). The incidence of K. pneumoniae infection were decreased from 18% to 3.5% and that of S. aureus increased from 10.9% to 26.3% during the study period. The incidence of S. aureus and of P. aeruginosa infection was much higher in patients with nosocomial pneumonia, systemic disease, or serum protein concentration under 6.5 g/dl. beta-lactamase antibiotics were administered to 70% of all patients, with an efficacy rate of 74.9% of after the first course of antibiotics therapy. The efficacy rate was decreased in patients with nosocomial pneumonia, systemic or pulmonary disease, or malnutrition. The data presented in this study indicate that the risk of pneumonia must be taken into careful consideration in patients with compromising complications.

Acute Disease↗