ABSTRACT
BACKGROUND: Intravenous administration of a third-generation cephalosporin is optimal antibiotic treatment for spontaneous bacterial peritonitis. AIMS: To compare an intravenous-oral step-down schedule with ciprofloxacin (switch therapy) to intravenous ceftazidime in the treatment of spontaneous bacterial peritonitis, and to evaluate the impact of terlipressin and albumin in the treatment of type 1 hepatorenal syndrome on mortality. METHODS: A total of 116 cirrhotic patients with spontaneous bacterial peritonitis, were randomly given switch therapy with ciprofloxacin (61 patients) or intravenous ceftazidime (55 patients). All patients who developed type 1 hepatorenal syndrome were treated with terlipressin (2-12 mg/day) and albumin (20-40 g/day). RESULTS: Resolution of infection was achieved in 46/55 patients treated with ceftazidime (84%) and in 49/61 patients treated with ciprofloxacin (80%, P = N.S.). An intravenous-oral step-down schedule was possible in 50/61 patients (82%) who received ciprofloxacin; 45/61 patients (74%) were discharged before the end of antibiotic treatment and completed it at home. The mean saving per patient due to the reduction of hospital stay in the ciprofloxacin group was 1150 . Type 1 hepatorenal syndrome was treated successfully in 12/19 patients (63%). As a consequence, the in-hospital mortality rate due to infection was 10%. CONCLUSIONS: Switch therapy with cephalosporin is more cost-effective than intravenous ceftazidime in the treatment of spontaneous bacterial peritonitis in cirrhotic patients who are not on prophylaxis with quinolones.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Ceftazidime/administration & dosage , Ciprofloxacin/administration & dosage , Hepatorenal Syndrome/drug therapy , Liver Cirrhosis/complications , Peritonitis/drug therapy , Administration, Oral , Albumins/therapeutic use , Antihypertensive Agents/therapeutic use , Female , Health Care Costs , Hepatorenal Syndrome/mortality , Humans , Infusions, Intravenous , Length of Stay , Lypressin/analogs & derivatives , Lypressin/therapeutic use , Male , Middle Aged , Peritonitis/economics , TerlipressinABSTRACT
BACKGROUND: Radiofrequency thermal ablation is the first therapeutic option in percutaneous treatment of hepatocellular carcinoma but data on its long-term efficacy and safety are not conclusive. AIM: This study reports a prospective survey on radiofrequency thermal ablation in north-east Italy. METHODS: Data were collected on 401 patients with hepatocellular carcinoma (males 301, mean age: 68 years) treated by radiofrequency thermal ablation in 13 centres. Indication to treatment was: single nodule not eligible for surgery in 77% of patients, 2-3 nodes in 18% and multiple lesions in 5%. Mean size was 3 cm (1-8 cm). Treatment response was assessed at 1 month by spiral computerized tomography and then with ultrasound examination and new spiral computerized tomography. RESULTS: Complete response was obtained in 67% of patients and in 27% response was 75-99%. Complete response raised to 77% in lesions smaller than 3 cm. The morbidity rate was 34%; the mortality was 0.5%, seeding was observed in four patients. Ten patients presented an unexpected rapid disease progression. CONCLUSION: The above data show that by radiofrequency thermal ablation, complete response can be achieved only in about two-third of the cases, clearly less than expected, and that, beyond seeding, unexpected progression can be observed.
Subject(s)
Carcinoma, Hepatocellular/surgery , Liver Neoplasms/surgery , Aged , Carcinoma, Hepatocellular/diagnostic imaging , Disease-Free Survival , Female , Humans , Italy , Liver Neoplasms/diagnostic imaging , Male , Prospective Studies , Tomography, X-Ray Computed/methods , Treatment OutcomeABSTRACT
Adolescents are at risk for a wide range of problems necessitating creative approaches to the delivery of health care. Baltimore City has responded to this challenge by opening seven school-based clinics (SBCs) that provide comprehensive health and social services to adolescents. This article summarizes the history of SBCs, the range of services, and the role of community involvement. A major focus of this article is the independent role of the nurse practitioner as clinical expert and educator.
Subject(s)
Adolescent Health Services/organization & administration , School Health Services/organization & administration , Social Work/organization & administration , Adolescent , Adolescent Health Services/standards , Baltimore , Humans , Nurse Practitioners , Pediatric Nursing/methods , Role , School Health Services/standards , Social Work/standardsABSTRACT
The changing face of health care is requiring all consumers to be more responsible for their own care. At the same time, opportunities to lay the foundations for self-advocacy with adolescents are becoming more limited. Pediatric nurses are in an ideal position to help adolescents develop skills in self-advocacy that they will need throughout their lives.
Subject(s)
Patient Advocacy , Patient Education as Topic , Psychology, Adolescent , Self Care , Adolescent , Adult , Child , Humans , Pediatric Nursing/methodsABSTRACT
As one element of Baltimore's effort to combat its high rate of teenage pregnancy, the Baltimore City Health Department added the implantable contraceptive Norplant to the array of services offered at one of its school-based health centers in early 1993. The initial findings with the adolescents who received this contraceptive at the school were favorable, particularly regarding condom use, parental involvement, and patient acceptance of the contraceptive. This new policy garnered a significant amount of attention, both nationally and locally. It attempts to address problems that have complicated etiologies as well as diverse clinical, social, and ethical ramifications, all complicated by political realities. The Norplant experience offers useful lessons regarding controversial health initiatives that address problems facing public health practitioners today.
Subject(s)
Family Planning Services , Levonorgestrel , Pregnancy in Adolescence , School Health Services , Adolescent , Baltimore , Community Participation , Female , Health Policy , Humans , Outcome Assessment, Health Care , Pilot Projects , PregnancyABSTRACT
Laparoscopy was systematically employed for the study of 143 cases of primary ovarian tumor in the various phases of staging, treatment, follow-up, and restaging. We found that laparoscopy allowed a more precise staging if used before laparotomy. Verification of response at any time in the course of therapy was readily achieved by laparoscopy.
Subject(s)
Laparoscopy , Ovarian Neoplasms/pathology , Adolescent , Adult , Aged , Biopsy/methods , Child , Female , Follow-Up Studies , Humans , Middle Aged , Neoplasm Metastasis , Neoplasm StagingABSTRACT
Through the use of echography after establishing the pneumoperitoneum, it is possible to recognize the presence of intra-abdominal adhesions and the distribution of gas. Using this method, the laparoscopist is able to form a picture of the intra-abdominal situation with regard to the site of the adhesions and the pneumoperitoneal chambers. This enables him to choose the best site for the insertion of the trocar both for the avoidance of possible incidents, and for optimal inspection. This method has been successfully employed in 39 patients with large abdominal surgical scars. Laparoscopy confirmed the echographic findings in almost all the cases. Thus, in 38% of cases the laparoscopic "inspection site" chosen was atypical with respect to the usual sites for the insertion of the laparoscope, but always proved to be the most suitable.