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1.
2.
Pediatr Dent ; 36(5): 411-6, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-25303509

RESUMEN

PURPOSE: To investigate postdischarge events occurring in children during the 24 hours following sedation for dentistry. METHODS: A convenience sample of 50 children undergoing sedation with combinations of midazolam, hydroxyzine, and meperidine were included. Parents received a standardized timesheet to record child's behavior, alertness, activity level, motor imbalance, emesis, and soft tissue trauma every two hours from discharge until bedtime. A questionnaire asked about transportation, supervision, and return to normal activity. Families were telephoned after 24 hours to collect the information. RESULTS: Sixty-six percent of children slept in the car; of these, 30 percent were supervised by only the driver, and 12 percent were difficult to awaken. Agitation was observed in 22 percent, restlessness in 10 percent, withdrawn behavior in 16 percent, and soft tissue trauma in 18 percent. Motor imbalance was significantly associated with midazolam (P=.002), as was restlessness (P=.004). Eighty-two percent slept between discharge and bedtime, with 16 percent sleeping for greater than four hours. Return to normal activity was greater than four hours in 36 percent, and was inversely correlated with age (P=.02). CONCLUSIONS: Postdischarge sleepiness, drug-specific motor imbalance, sleep during transit, and recovery times greater than four hours were common and warrant vigilant adult supervision.


Asunto(s)
Anestesia Dental/efectos adversos , Conducta Infantil/efectos de los fármacos , Sedación Consciente/efectos adversos , Hipnóticos y Sedantes/efectos adversos , Adolescente , Factores de Edad , Acatisia Inducida por Medicamentos/etiología , Periodo de Recuperación de la Anestesia , Concienciación/efectos de los fármacos , Mordeduras Humanas/etiología , Niño , Preescolar , Discinesia Inducida por Medicamentos/etiología , Femenino , Estudios de Seguimiento , Humanos , Hidroxizina/administración & dosificación , Hidroxizina/efectos adversos , Hipnóticos y Sedantes/administración & dosificación , Masculino , Meperidina/administración & dosificación , Meperidina/efectos adversos , Midazolam/administración & dosificación , Midazolam/efectos adversos , Actividad Motora/efectos de los fármacos , Mucosa Bucal/lesiones , Estudios Prospectivos , Agitación Psicomotora/etiología , Sueño/efectos de los fármacos , Fases del Sueño/efectos de los fármacos , Vómitos/etiología
3.
Biochim Biophys Acta ; 1841(3): 319-22, 2014 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-23994607

RESUMEN

Lauric acid (C12:0) and sapienic acid (C16:1Δ6) derived from human sebaceous triglycerides are potent antimicrobials found at the human skin surface. Long-chain bases (sphingosine, dihydrosphingosine and 6-hydroxysphingosine) are also potent and broad-acting antimicrobials normally present at the skin surface. These antimicrobials are generated through the action of ceramidases on ceramides from the stratum corneum. These natural antimicrobials are thought to be part of the innate immune system of the skin. Exogenously providing these lipids to the skin may provide a new therapeutic option, or could potentially provide prophylaxis in people at risk of infection. This article is part of a Special Issue entitled The Important Role of Lipids in the Epidermis and their Role in the Formation and Maintenance of the Cutaneous Barrier. Guest Editors: Kenneth R. Feingold and Peter Elias.


Asunto(s)
Antiinfecciosos/metabolismo , Infecciones/metabolismo , Metabolismo de los Lípidos , Lípidos , Piel/metabolismo , Animales , Ceramidasas/metabolismo , Humanos , Control de Infecciones
5.
J Urol ; 182(1): 41-5, 2009 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-19450840

RESUMEN

PURPOSE: Recent evidence suggests significantly discordant findings regarding tumor size and the metastasis risk in renal cell carcinoma cases. We present our experience with renal cell carcinoma. We evaluated the association between tumor size and the metastasis risk in a large patient cohort. MATERIALS AND METHODS: Using our prospectively maintained nephrectomy database we identified 2,691 patients who were treated surgically for a sporadic renal cortical tumor between 1989 and 2008. Associations between tumor size and synchronous metastasis at presentation (M1 renal cell carcinoma) were evaluated with logistic regression models. Metastasis-free survival after surgery was estimated using the Kaplan-Meier method in 2,367 patients who did not present with M1 renal cell carcinoma and were followed postoperatively. RESULTS: Of the 2,691 patients 162 presented with metastatic renal cell carcinoma. Only 1 of 781 patients with a tumor less than 3 cm had M1 renal cell carcinoma at presentation and tumor size was significantly associated with metastasis at presentation (for each 1 cm increase OR 1.25, p <0.001). Of the 2,367 patients who did not present with metastasis metastatic disease developed in 171 during a median 2.8-year followup. In this group only 1 of the 720 patients with renal cell carcinoma less than 3 cm showed de novo metastasis during followup. Metastasis-free survival was significantly associated with tumor size (for each 1 cm increase HR 1.24, p <0.001). CONCLUSIONS: In our experience tumor size is significantly associated with synchronous and asynchronous metastases after nephrectomy. Our results suggest that the risk of metastatic disease is negligible in patients with tumors less than 3 cm.


Asunto(s)
Carcinoma de Células Renales/patología , Carcinoma de Células Renales/secundario , Neoplasias Renales/mortalidad , Neoplasias Renales/patología , Carga Tumoral , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Carcinoma de Células Renales/mortalidad , Carcinoma de Células Renales/terapia , Quimioterapia Adyuvante , Terapia Combinada , Intervalos de Confianza , Bases de Datos Factuales , Femenino , Humanos , Estimación de Kaplan-Meier , Neoplasias Renales/terapia , Masculino , Persona de Mediana Edad , Invasividad Neoplásica/patología , Metástasis de la Neoplasia , Estadificación de Neoplasias , Nefrectomía , Ciudad de Nueva York , Oportunidad Relativa , Pronóstico , Estudios Prospectivos , Medición de Riesgo , Sensibilidad y Especificidad , Factores Sexuales , Análisis de Supervivencia , Resultado del Tratamiento , Adulto Joven
6.
Lipids ; 44(3): 291-5, 2009 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-19184160

RESUMEN

Ceramides are the major type of lipid found in stratum corneum from the skin, gingiva and hard palate. The present study examined the ceramides of the stratum corneum from the hard palate. Six fractions of ceramides were isolated by preparative thin-layer chromatography. The least polar fraction contained an unusual acyl ceramide (EOS) consisting of long omega-hydroxy acids amide-linked to sphingosine with mostly saturated fatty acids ester-linked to the omega-hydroxyl group. The second and third fractions contained normal fatty acids amide-linked to sphingosine (NS) and phytosphingosine (NP), respectively. In each of these ceramides, the fatty acids consisted of a mixture of saturated and monoenoic species. The three most polar fractions all contain amide-linked alpha-hydroxy acids. The fourth fraction contained long alpha-hydroxy acids amide-linked to sphingosine (ASl), while the fifth fraction contained short alpha-hydroxy acids amide-linked to sphingosine (ASs). The most polar ceramide contained alpha-hydroxy acids amide-linked to phytosphingosine (AP). EOS, NS and NP differed from their epidermal counterparts in terms of the compositions of the normal fatty acids. ASl, ASs and AP from palatal stratum corneum were essentially identical to their epidermal counterparts. The differences between palatal and epidermal EOS, NS and NP contribute to the differences in permeability of palate compared to skin.


Asunto(s)
Ceramidas/química , Epidermis/química , Paladar Duro/química , Animales , Cromatografía de Gases , Cromatografía en Capa Delgada , Estructura Molecular , Porcinos
7.
Urology ; 72(2): 461.e11-3, 2008 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-18336889

RESUMEN

Xanthogranulomatous orchitis (XGO) is a rare histological finding that is generally diagnosed at orchiectomy. To date, fewer than 10 reports of XGO exist in the literature. The exact pathogenesis of XGO is unknown and patients may present with a rapid onset of symptoms or a longer, more indolent course. We report a patient who presented with symptoms of epididymoorchitis, leukocytosis, and fever after an instillation of bacillus Calmette-Guérin therapy for bladder cancer.


Asunto(s)
Vacuna BCG/efectos adversos , Granuloma/inducido químicamente , Orquitis/inducido químicamente , Xantomatosis/inducido químicamente , Anciano , Vacuna BCG/uso terapéutico , Humanos , Masculino , Resultado del Tratamiento , Neoplasias de la Vejiga Urinaria/tratamiento farmacológico
8.
Urology ; 71(1): 62-6, 2008 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-18242366

RESUMEN

OBJECTIVES: Interstitial cystitis (IC) is a challenging disease complex. Patients' perception of their outcomes after different treatment modalities may be the best measure of therapeutic efficacy. Our study focused on a large group of women with a diagnosis of IC who reported on perceived outcomes after undergoing invasive and pharmaceutical treatments for their disease. METHODS: Seven hundred fifty patients with a diagnosis of IC completed a computerized survey that queried each patient about their demographics, symptoms, concomitant diagnoses, treatments, and their perceived treatment outcomes. The patients were surveyed on therapies used to treat IC and whether they perceived their condition to be improved, not affected or having deteriorated at a mean follow-up of 6 months. Pearson chi-squared tests were used in the statistical analyses. RESULTS: Invasive and medical therapies were surveyed. The most commonly performed procedures were hydrodistention (61.9%), intravesical therapy (40.1%), and urethral dilatation (26.5%). Of these procedures, 24.4% to 45.3% of patients were improved by these procedures; whereas 27.0% to 49.8% felt no effect and 25.9% to 30.7% worsened. A comparison of the number of patients who improved with those who deteriorated while on medical therapy was found to be significant for all drugs (P <0.001). The majority of patients reported that medications improved their condition, perceptively. CONCLUSIONS: Medical therapy is perceived to be superior to invasive therapy in the treatment of IC. Medication should be considered the first line therapy for IC. Several medications showed a large percentage of patients with improvement in symptoms. These medications were calcium glycerophosphate (Prelief, AkPharma Inc, Pleasantville, NJ), phenazopyridine, and pentosan polysulfate sodium.


Asunto(s)
Cistitis Intersticial/terapia , Satisfacción del Paciente , Administración Intravesical , Adulto , Terapia Combinada , Cistitis Intersticial/tratamiento farmacológico , Dilatación , Dimetilsulfóxido/uso terapéutico , Femenino , Glicerofosfatos/uso terapéutico , Heparina/uso terapéutico , Humanos , Persona de Mediana Edad , Resultado del Tratamiento
10.
Nat Clin Pract Urol ; 4(8): 451-4, 2007 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-17673916

RESUMEN

BACKGROUND: A 61-year-old male presented with a history of gradually rising PSA over several years. His PSA had increased from 3.3 to 7 ng/ml over 3 years. INVESTIGATIONS: Digital rectal examination, prostate biopsy, bone scan, and endorectal MRI were carried out to confirm the diagnosis and evaluate the extent of the cancer, with subsequent histopathologic examination of the radical prostatectomy specimen. DIAGNOSIS: Preoperative clinical stage (based on the digital rectal examination alone) was cT3a. Biopsy demonstrated extraprostatic extension in one core (Gleason 9 [4 + 5]). Endorectal MRI suggested a large volume cancer with probable extraprostatic extension in the posterior midline at the apex. Examination of the radical prostatectomy specimen demonstrated a pT3aN0 prostate cancer (Gleason 4 + 3 = 7 with a minor component of Gleason pattern 5). Extraprostatic extension was seen in the right posterior apex in the area of the dominant tumor mass. Surgical margins and seminal vesicles were negative for cancer. MANAGEMENT: Radical retropubic prostatectomy with preservation of both neurovascular bundles plus bilateral pelvic lymph node dissection was performed. Postoperative PSA has been nondetectable. The patient is continent and, with the aid of vardenafil HCl, has erections sufficient for intercourse.


Asunto(s)
Prostatectomía/métodos , Neoplasias de la Próstata/cirugía , Calidad de Vida , Humanos , Masculino , Persona de Mediana Edad , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/sangre , Neoplasias de la Próstata/psicología , Calidad de Vida/psicología
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