RESUMEN
BACKGROUND: Pancreatic fistula (PF) is a significant cause of morbidity in patients undergoing distal pancreatectomy (DP), with an incidence of 15-40%. It remains unclear if the location of pancreatic transection affects the rate of PF occurrence. This study examines the correlation between the transection site of the pancreas during DP and the incidence of PF. METHODS: All cases of DP from October 2005 to January 2012 were reviewed retrospectively from an institutional review board-approved database at the Thomas Jefferson University Hospital. Patient demographics and perioperative outcomes were analyzed. The pancreatic transection location was determined by review of operative reports, and then dichotomized into 2 groups: neck/body or tail. PF were graded following the International Study Group on Pancreatic Fistula guidelines. RESULTS: During the study period, 294 DP were performed with 244 pancreas transections at the neck/body and 50 at the tail. Of the 294 patients, 52 (17.7%) developed a postoperative PF. The incidence of PF after transection at the tail of the pancreas was higher (28%) when compared with transection at the neck/body (15.6%; P = .04). When stratified by PF grade, grade A PF occurred more commonly when transection of the gland was at the tail (22% tail vs 8.2% neck/body; P = .007); however, no difference was found for grade B/C PF (6% tail vs 7.4% neck/body; P = 1). CONCLUSION: Our data suggest that PF occurs more often when the tail is transected during DP, although the majority are low grade and of minimal clinical significance. More severe PF occurred equally between the transection sites.
Asunto(s)
Páncreas/cirugía , Pancreatectomía/efectos adversos , Fístula Pancreática/etiología , Neoplasias Pancreáticas/cirugía , Centros Médicos Académicos , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Páncreas/anatomía & histología , Pancreatectomía/métodos , Fístula Pancreática/epidemiología , Fístula Pancreática/cirugía , Neoplasias Pancreáticas/patología , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/cirugía , Reoperación , Estudios Retrospectivos , Medición de Riesgo , Distribución por Sexo , Tasa de Supervivencia , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Due to the emergency of multidrug-resistant strains of Mycobacterium tuberculosis, is necessary the evaluation of new compounds. FINDINGS: Tedizolid, a novel oxazolidinone, and ACH-702, a new isothiazoloquinolone, were tested against M. tuberculosis infected THP-1 macrophages. These two compounds significantly decreased the number of intracellular mycobacteria at 0.25X, 1X, 4X and 16X the MIC value. The drugs were tested either in nanoparticules or in free solution. CONCLUSION: Tedizolid and ACH-702 have a good intracellular killing activity comparable to that of rifampin or moxifloxacin.
Asunto(s)
Antituberculosos/farmacología , Macrófagos/microbiología , Mycobacterium tuberculosis/efectos de los fármacos , Organofosfatos/farmacología , Oxazoles/farmacología , Quinolonas/farmacología , Tiazoles/farmacología , Carga Bacteriana , Línea Celular , Humanos , Mycobacterium tuberculosis/crecimiento & desarrolloRESUMEN
The in vitro activities of ACH-702 and other antimicrobials against 30 Nocardia brasiliensis isolates were tested. The MIC(50) (MIC for 50% of the strains tested) and MIC(90) values of ACH-702 were 0.125 and 0.5 microg/ml. The same values for econazole were 2 and 4 microg/ml. The MIC(50) and MIC(90) values of imipenem and meropenem were 64 and >64 microg/ml and 2 and 8 microg/ml, respectively; the addition of clavulanic acid to the carbapenems had no effect.