RESUMO
AIMS: Leucocyte esterase (LE) has been shown to be an accurate marker of prosthetic joint infection (PJI), and has been proposed as an alternative to frozen section (FS) histology for intraoperative diagnosis. In this study, the intraoperative assessment of LE was compared with FS histology for the diagnosis of prosthetic hip infection. PATIENTS AND METHODS: A total of 119 patients undergoing revision total hip arthroplasty (THA) between June 2015 and December 2017 were included in the study. There were 56 men and 63 women with a mean age of 66.2 years (27 to 88). Synovial fluid was collected before arthrotomy for the assessment of LE using enzymatic colourimetric strips. Between five and six samples were stained with haematoxylin and eosin for FS histology, and considered suggestive of infection when at least five polymorphonuclear leucocytes were found in five high-power fields. RESULTS: The sensitivity and specificity of the LE assay were 100% and 93.8%, respectively; the positive (PPV) and the negative (NPV) predictive values were 79.3% and 100%, respectively. The mean time between the collection of the sample and the result being known was 20.1 minutes (sd 4.4). The sensitivity and specificity of FS histology were 78.3% and 96.9%, respectively; the PPV and the NPV were 85.7% and 94.9%, respectively. The mean time between the collection of the sample and the result being known was 27.2 minutes (sd 6.9). CONCLUSION: The sensitivity of LE assay was higher, with similar specificity and diagnostic accuracy, compared with FS histology. The faster turnaround time, its ease of use, and low costs make LE assay a valuable alternative to FS histology. We now use it routinely for the intraoperative diagnosis of PJI. Cite this article: Bone Joint J 2019;101-B:372-377.
Assuntos
Artroplastia de Quadril/efeitos adversos , Hidrolases de Éster Carboxílico/metabolismo , Prótese de Quadril , Infecções Relacionadas à Prótese/terapia , Líquido Sinovial/enzimologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/metabolismo , Feminino , Seguimentos , Secções Congeladas , Humanos , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/metabolismo , Curva ROC , Estudos RetrospectivosRESUMO
Endocannabinoids are a class of lipid mediators involved in a wide range of physiological pathways including pain perception, and immunological defences. In particular, the involvement of endocannabinoids in bone metabolism and bone resorption has recently been studied. Moreover, one study on total knee arthroplasty describes the probable role of endocannabinoids in pain perception after surgery. The aim of the present study was to evaluate variations of endocannabinoid concentrations in patients undergoing total hip or total knee arthroplasty before and after surgery. Sera from 23 patients were collected at three different times: before surgery and at two different times during rehabilitation, and endocannabinoids were quantified by HPLC-MS/MS analysis. Mean values of endocannabinoids in presurgical serum samples were: 6.11±0.5 ng/ml for N-palmitoylethanolamide, 1.39±0.08ng/ml for N-stearoylethanolamide, 4.84±0.04 ng/ml for N-oleoylethanolamide, 0.44±0.03ng/ml for N-arachidonoylethanolamide, 0.84±0.05ng/ml for N-linoleoylethanolamide, 0.17±0.01ng/ml for N-α-linolenoylethanolamide. Statistical analysis showed a significant decrease of all the endocannabinoids after surgery, while there were no remarkable differences between total hip and total knee arthroplasties or between genders. Moreover, the results show no significant correlation between endocannabinoid concentrations and C-reactive protein and Erythrocyte sedimentation rate. The present study shows for the first time a specific and univocal behaviour of six endocannabinoids and N-acylethanolamides in orthopaedic surgery, suggesting the endocannabinoid system as a possible pharmacological target for presurgical therapeutics.
Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Endocanabinoides/sangue , Idoso , Idoso de 80 Anos ou mais , Cromatografia Líquida de Alta Pressão , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/sangue , Dor Pós-Operatória/etiologia , Espectrometria de Massas em TandemRESUMO
Since the optimal incubation period of cultures for diagnosis of bone and joint infections is still a matter of debate, the present study aimed to evaluate the effects of different incubation periods (5 and 15 days) on microbial isolation. Samples from 387 patients with bone and joint infections (including prosthetic ones) were analyzed from March 2012 to February 2014. In 197 patients (51 %) growth was obtained within 48 hrs, while in 124 (32 %) and 66 (17 %) patients cultures yielded positive results within and after 5 days of incubation, respectively. Of 449 microorganisms isolated, 247 grew within 48 hrs, 131 within the first 5 days of incubation while 71 were isolated after 5 days. Staphylococcus aureus was the most frequently isolated pathogen within 48 hrs, while Propionibacteria were prevalently isolated after 5 days of incubation. Interestingly, about 25 % of microorganisms isolated after 5 days of incubation were coagulase-negative staphylococci. Extending incubation period of broth cultures improves isolation rates of pathogens involved in bone and joint infections thus improving management of these infections.
Assuntos
Doenças Ósseas Infecciosas/diagnóstico , Osso e Ossos/microbiologia , Artropatias/diagnóstico , Articulações/microbiologia , Infecções Relacionadas à Prótese/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Ósseas Infecciosas/microbiologia , Feminino , Humanos , Artropatias/microbiologia , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Propionibacteriaceae/isolamento & purificação , Infecções Relacionadas à Prótese/microbiologia , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/isolamento & purificação , Adulto JovemAssuntos
Biofilmes/crescimento & desenvolvimento , Candida/isolamento & purificação , Candida/fisiologia , Candida/patogenicidade , Candida albicans/isolamento & purificação , Candida albicans/patogenicidade , Candida albicans/fisiologia , Candida glabrata/isolamento & purificação , Candida glabrata/patogenicidade , Candida glabrata/fisiologia , Candida tropicalis/isolamento & purificação , Candida tropicalis/patogenicidade , Candida tropicalis/fisiologia , Membrana Celular/fisiologia , Humanos , Interações Hidrofóbicas e Hidrofílicas , Modelos Biológicos , Análise de Regressão , Especificidade da EspécieRESUMO
In order to identify subjects at higher risk for carotid stenosis and to provide insights into mechanisms of disease development at different age-intervals, a color duplex ultrasound of extracranial arteries was performed in 624 consecutive patients (mean age 62.9+/-10.7, 483 males) undergoing coronary angiography. Significant carotid atherosclerosis (> or =50% stenosis) was documented in 87 patients (14%): the disease was moderate (50/69% stenosis) in 51 patients (8%), severe (> or =70% stenosis) in 36 patients (6%). Age (P<0.0001), smoking (P<0.0001), diabetes (P=0.0002), renal dysfunction (P=0.0119) and hypertension (P=0.0202) were independent predictors of significant carotid atherosclerosis; age (P=0.0001), smoking (P=0.0009) and diabetes (P=0.0201) were independent predictors of severe disease. Among 262 candidates for cardiac surgery, significant carotid artery disease was identified in 57 cases (2.63 Relative Risk, 95% Confidence Intervals: 1.32/5.24). Correlation and regression tree analysis demonstrated that diabetes was associated with greater severity of carotid stenosis in younger patients and hypertension in older ones. In conclusion age is the primary determinant of carotid artery disease; diabetes and smoking accelerate progression of atherosclerosis in younger patients, hypertension and smoking in older ones. Among patients undergoing coronary angiography, carotid ultrasonography should be recommended in high risk subgroups of patients.
Assuntos
Doenças das Artérias Carótidas/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Angiografia Coronária , Fatores Etários , Doenças das Artérias Carótidas/complicações , Doenças das Artérias Carótidas/cirurgia , Estenose das Carótidas/complicações , Estenose das Carótidas/cirurgia , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/cirurgia , Complicações do Diabetes , Feminino , Humanos , Hipertensão/complicações , Nefropatias/complicações , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Análise de Regressão , Fatores de Risco , Fumar/efeitos adversos , UltrassonografiaRESUMO
UNLABELLED: In order to evaluate the prevalence of carotid atherosclerosis (CA) in patients with coronary artery disease (CAD) and to identify the differential role of traditional risk factors, we analyzed data concerning 290 patients aged 61.9 +/- 10.8 years who underwent color duplex ultrasound of extracranial arteries before coronary angiography. Significant CA (stenosis > or = 50% in at least one extracranial artery) was disclosed in 44 patients (15%); significant CAD (stenosis > or = 70% at least in a major epicardial vessel) was documented in 238 patients (82%). Age and smoking were significantly associated with both CAD (respectively, p = 0.034 and p = 0.050) and CA (respectively, p = 0.000 and p = 0.000), but a stronger correlation was documented with CA (r = 0.325 vs r = 0.125 for age; r = 0.218 vs r = 0.114 for smoking). Diabetes (p = 0.031) and male gender (p = 0.016) were significantly associated with CAD, and hypertension (p = 0.029) with CA. CONCLUSIONS: Traditional risk factors play different roles in the pathogenesis of atherosclerotic disease of carotid and coronary circulation. Color duplex evaluation of the carotid arteries can be useful in high-risk patients, particularly if candidates for coronary surgery.
Assuntos
Doenças das Artérias Carótidas/diagnóstico , Doença das Coronárias/diagnóstico , Distribuição por Idade , Idoso , Doenças das Artérias Carótidas/epidemiologia , Angiografia Coronária/métodos , Angiografia Coronária/estatística & dados numéricos , Doença das Coronárias/epidemiologia , Ecocardiografia Doppler em Cores/métodos , Ecocardiografia Doppler em Cores/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/epidemiologia , Prevalência , Fatores de Risco , Distribuição por Sexo , Estatísticas não ParamétricasRESUMO
This case report illustrates the clinical and angiographic findings of 2 patients undergoing coronary angiography for ischemic heart disease and with the unexpected presence of anomalous origin of the left coronary artery from the right aortic sinus. The angiographic classification of the different subgroups of single coronary artery is reviewed and the 2 cases are identified as type R-II with septal and anterior course of the left main stem.
Assuntos
Anomalias dos Vasos Coronários/diagnóstico por imagem , Idoso , Angiografia Coronária , Anomalias dos Vasos Coronários/patologia , Humanos , MasculinoRESUMO
BACKGROUND: The presence of extracranial artery disease has been used as a predictor of coronary artery disease (CAD). The present study was conducted to test the prevalence of extracranial artery disease among patients with suspected CAD. METHODS: Among candidates for coronary arteriography, 400 consecutive patients (mean age 63 +/- 11 years, 78% males, 22% females) underwent color duplex ultrasound of carotid arteries. RESULTS: Extracranial artery disease was documented in 60 patients (15%), CAD in 309 patients (77%). Patients with extracranial artery disease were significantly older (p < 0.001), smoked a higher amount of pack-years (p < 0.001), showed a higher incidence of diabetes (p < 0.01), hypertension (p < 0.05) and CAD (p < 0.05) when compared to extracranial artery disease-free subjects. Plotting age against extracranial artery disease and CAD distribution, extracranial artery disease occurred later in life than CAD (p < 0.001). The best cut-off point of age for predicting extracranial artery disease was 68 years. Carotid angiography was performed in 114 patients after cardiac catheterization (k = 0.8044 with color duplex scanning). CONCLUSIONS: Extracranial artery disease is frequent among patients undergoing coronary arteriography. Carotid ultrasound screening is useful in older patients.
Assuntos
Artérias Carótidas/diagnóstico por imagem , Doenças das Artérias Carótidas/diagnóstico por imagem , Doença das Coronárias/diagnóstico por imagem , Idoso , Angiografia/métodos , Distribuição de Qui-Quadrado , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Sensibilidade e Especificidade , Ultrassonografia Doppler em Cores/métodos , Ultrassonografia Doppler em Cores/estatística & dados numéricos , Ultrassonografia Doppler Dupla/métodos , Ultrassonografia Doppler Dupla/estatística & dados numéricosRESUMO
The higher long-term patency of internal mammary artery grafts has stimulated the search for alternative conduits in order to achieve a complete arterial myocardial revascularization. Percutaneous angioplasty is often the preferred strategy for the treatment of recurrent ischemia in patients who previously underwent bypass surgery, but there is limited experience in the treatment of arterial grafts. We describe two cases of percutaneous treatment of diseased radial artery (RA) grafts. In the first case, two disarticulated stents were deployed through an RA graft: half stent inside the anastomosis to the left anterior descending (LAD) artery, and half stent in the distal LAD artery. Diffuse spasm of the RA graft, resistant to ic nitrates, was successfully reversed after ic calcium antagonists. Absence of restenosis was confirmed two years later. In the second case, after simultaneous catheterization of both the left coronary artery and RA graft, two long stents were implanted in the LAD artery and a final "reversed" kissing-balloon dilation through the stent struts was performed; four months later the patient showed proximal occlusion of the LAD artery and the stenotic RA distal anastomosis was successfully dilated.
Assuntos
Angioplastia Coronária com Balão , Idoso , Angioplastia Coronária com Balão/instrumentação , Angioplastia Coronária com Balão/métodos , Angiografia Coronária , Doença das Coronárias/diagnóstico por imagem , Doença das Coronárias/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Radial/diagnóstico por imagem , RecidivaRESUMO
An 83-year-old woman with previous closed transventricular commissurotomy was admitted for congestive heart failure. Echocardiogram and angiography demonstrated a mitral restenosis and a large-mouthed false aneurysm of the left ventricle.
Assuntos
Falso Aneurisma/fisiopatologia , Disfunção Ventricular Esquerda/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Falso Aneurisma/diagnóstico por imagem , Angiografia Coronária , Ecocardiografia , Feminino , Humanos , Estenose da Valva Mitral/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/fisiopatologia , Disfunção Ventricular Esquerda/diagnóstico por imagemRESUMO
The aim of our study was to compare the short-term efficacy of three different chest physiotherapy (CPT) regimens (PD, postural drainage; PEP, positive expiratory pressure physiotherapy; HFCC, high-frequency chest compression physiotherapy) on patients with cystic fibrosis (CF) hospitalized for an acute pulmonary exacerbation. Sixteen patients with CF, 8 males, 8 females, aged 15-27 years (mean, 20.3 +/- 4), met the inclusion criteria: 1) age over 14 years; 2) mild or moderate airway obstruction; 3) sputum volume > 30 mL/day; 4) being proficient in PD and PEP CPT. Patients at admission had (mean +/- SD) forced volume in 1 second (FEV1) 52.2 +/- 21.9 percent predicted; Shwachman-Kulczycki clinical score 65.1 +/- 11 points; Chrispin-Norman chest radiography score 18.6 +/- 4.3 points. The three CPT regimens and a control-treatment (CONT) were administered in a random sequence, each patient receiving each treatment twice a day (in 50 minute sessions) for 2 consecutive days. During CONT and for 30 minutes after each session only spontaneous coughing was allowed. Wet and dry weight of sputum were recorded during the 50-minute sessions and 30 minutes afterward. Lung function was measured before and 30 minutes after each session. For each treatment a score was given by the patient for efficacy, and by both the patient and the physiotherapist for tolerance. Wet and dry weights of sputum collected during the sessions were greater for all CPT regimens than for CONT (P < 0.001, P < 0.0001). No significant differences between the three CPT regimens for both wet and dry weights were found when the number of coughs was taken into account.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Fibrose Cística/terapia , Drenagem Postural/métodos , Modalidades de Fisioterapia/métodos , Pneumonia/terapia , Adolescente , Adulto , Análise de Variância , Antibacterianos/uso terapêutico , Estudos Cross-Over , Fibrose Cística/complicações , Fibrose Cística/fisiopatologia , Feminino , Humanos , Modelos Lineares , Masculino , Pneumonia/etiologia , Pneumonia/microbiologia , Respiração com Pressão Positiva , Recidiva , Testes de Função Respiratória , Escarro , Resultado do TratamentoRESUMO
The Authors evaluate the influence of illness behaviour (measured by IBQ) on patients' delay in seeking dental treatment for caries or periodontal pathology, and the relationship with anxiety (measured by STAI) and with social--demographic and clinical data. One hundred patients were studied. Delay in coming for a dental visit is influenced by family habit, level of education and fear experienced. The 'late' patients present significantly higher scores for denial on the IBQ. More serious pathology is in relation with greater denial. Anxiety is positively correlated with the IBQ scales dysphoria, hypochondria, disease conviction, irritability and inversely with denial.
Assuntos
Ansiedade ao Tratamento Odontológico/psicologia , Papel do Doente , Adolescente , Adulto , Idoso , Ansiedade ao Tratamento Odontológico/diagnóstico , Assistência Odontológica/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Inventário de Personalidade/estatística & dados numéricos , PsicometriaRESUMO
The activities of glutathione peroxidase (GSH-px), glutathione reductase (GSSG-rx) and glutathione transferase (GST) were measured in myocardial specimens obtained from right atria of patients subjected to different period of ischaemic arrest (aortic clamping ranging from 10 min to 90 min) followed by 60 min. of reperfusion, during open heart surgery 41-90 min. period of aortic clamping induced a significant increase of GSH-px activity with both H2O2 (p less than 0.05) and cumene hydroperoxide (p less than 0.025) as substrates when compared with baseline levels. Aortic clamping and reperfusion, however did not significantly change the myocardial activities of glutathione transferase and glutathione reductase. It is suggested that the increase of GSH-px in ischaemic-reperfused human hearts may render the myocardium less susceptible to oxidative attack particularly during the reoxygenation period when the level of active oxygen species is greatly elevated.
Assuntos
Glutationa Peroxidase/metabolismo , Glutationa Redutase/metabolismo , Glutationa Transferase/metabolismo , Parada Cardíaca Induzida , Reperfusão Miocárdica , Miocárdio/enzimologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de TempoAssuntos
Aspirina/uso terapêutico , Perda Sanguínea Cirúrgica/prevenção & controle , Ponte de Artéria Coronária , Dipiridamol/uso terapêutico , Administração Oral , Aspirina/administração & dosagem , Fatores de Coagulação Sanguínea/análise , Transfusão de Sangue , Dipiridamol/administração & dosagem , Hematócrito , Humanos , Contagem de Plaquetas/efeitos dos fármacos , Estudos ProspectivosRESUMO
The changes in thrombocythemia in patients subjected to extracorporeal circulation (ECC) and pretreated with dipyridamole per os have been examined and compared with a control group in whom the drug was not used; in all patients a circuit with bubble oxygenator was employed. Measurements were carried out before sternotomy, 10' and 60' after ECG, 1 h after the start of intensive therapy and on the 1st surgical day. The variations in thrombocythemia were assessed in consideration of the thrombocythemia/Ht ratio, so as to eliminate the dilution variable. On the basis of the results obtained, it is considered that preoperative treatment with dipyridamole is effective in limiting the fall in thrombocythemia during ECC. The effect of the drug is prevalent in the initial stage of ECC, probably reducing platelet aggregation to non-biological surfaces of the circuit.
Assuntos
Plaquetas/efeitos dos fármacos , Dipiridamol/farmacologia , Oxigenação por Membrana Extracorpórea/efeitos adversos , Administração Oral , Idoso , Ponte de Artéria Coronária , Dipiridamol/administração & dosagem , Feminino , Próteses Valvulares Cardíacas , Humanos , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas/efeitos dos fármacosRESUMO
The aim of this study was to evaluate the problems found in performing chest physiotherapy (PKT) by patients with Cystic Fibrosis (CF) and by their families. The research has been based upon processing 389 questionnaires (46 items) that were compiled by the families. Thirteen CF centers all over the nation have participated in this study. Patients' mean age was 7.4 years (range 2 months to 14 years). Data about the socio-economic status and illness severity were available for every patient. Many graphs (line connects points with a line = n. 8; bar charts = n. 17; pie charts = n. 13) show the results and their statistical processing. Our purpose was to solve the following problems: 1) What is the extent of the compliance? 2) Who perform, or should perform, PKT in the family environment? 3) What is the kind and extent of the help request? 4) What are the mistakes made in executing PKT? 5) What is the usefulness of precursors and aerosol therapy? 6) What is the link between physical activity and PKT? 7) What are the main difficulties in performing PKT? 8) How effective is PKT? 9) What is the extent of the parents' faith in their capabilities? 10) Are there any prejudices against PKT? Three major findings emerge from this study: 1) the compliance appeared good; 2) the average family understood the meaning of PKT correctly and 3) PKT is usually executed properly. As for negative results are concerned, it is to be noted that the burden of performing PKT is usually up to the mother. This finding is linked both to the socio-economics status of the family and to the severity of the illness. On the other hand, a home PKT service is only asked in very extreme situations such as sudden worsening of the patient's illness. The difficulties met in performing PKT range from the patient's refusal to logistical and organization problems, which are correlated with the socio-economic status of the family. The relationship between PKT and sport is understood well and there is a high percentage of patients doing regular physical activity, even if it is often hindered by the severity of the disease. In conclusion, although there are many problems, there are also many methods to use in order to improve the acceptance and the effectiveness of the PKT.
Assuntos
Atitude Frente a Saúde , Fibrose Cística/terapia , Terapia por Exercício , Pais , Adolescente , Adulto , Criança , Pré-Escolar , Terapia por Exercício/métodos , Feminino , Humanos , Lactente , Masculino , Idade Paterna , Cooperação do Paciente , Terapia Respiratória , Inquéritos e QuestionáriosRESUMO
Following the previously described semisynthetic preparation of new aglycones (8S)-8-fluoroerythronolide A (I), (8S)-8-fluoroerythronolide B (II) and the monoglycoside 3-O-mycarosyl-(8S)-8-fluoroerythronolide B (III), their conversion into new fluoroerythromycins was attempted by mutational biosynthesis. The strain Streptomyces erythraeus ATCC 31772, a mutant blocked in the biosynthesis of erythromycin, was employed in the present investigation. Four new antibiotics, (8S)-8-fluoroerythromycin A (IV), (8S)-8-fluoroerythromycin B (V), (8S)-8-fluoroerythromycin C (VI) and (8S)-8-fluoroerythromycin D (VII) were successfully derived by such an approach. The result is also discussed in terms of the substrate specificity of the enzymes involved in the biosynthesis of erythromycins. The new antibiotics exhibited promising biological properties.
Assuntos
Eritromicina/análogos & derivados , Mutação , Antibacterianos/biossíntese , Antibacterianos/toxicidade , Bactérias/efeitos dos fármacos , Eritromicina/biossíntese , Eritromicina/toxicidade , Fluoretos , Testes de Sensibilidade Microbiana , Streptomyces/genética , Streptomyces/metabolismo , Relação Estrutura-AtividadeRESUMO
We have investigated the effectiveness of seven new beta-lactam antibiotics, azlocillin, piperacillin, ceftazidime, cefsulodin, cefoperazone, latamoxef (moxalactam), and cefotaxime, against acute pulmonary exacerbations caused by Pseudomonas aeruginosa in cystic fibrosis. Three hundred and fifty-five strains of Ps aeruginosa isolated from 310 sputum cultures (190 cystic fibrosis patients) were tested for susceptibility to the drugs by determination of minimal inhibitory concentrations (MIC). The highest activity was shown by ceftazidime (6% resistant strains) followed by cefsulodin and piperacillin (15 and 16% resistant strains); very low activity was found for cefotaxime and latamoxef (moxalactam). Ceftazidime was the most active drug against 32 pseudomonas isolates that were resistant to both carbenicillin and aminoglycosides (78% susceptible). A randomized, double-blind trial of azlocillin, piperacillin, ceftazidime, cefsulodin or cefoperazone was performed in 111 cystic fibrosis patients with predominant and susceptible pseudomonas in their sputum. Results were evaluated by a clinical, radiological and bacteriological scoring system: the best results were obtained with ceftazidime, followed by cefsulodin and piperacillin. However, pseudomonas was eradicated in only 22 (23%) of the cases with the most active drugs and persisted or reappeared in all the cases 1 to 3 months later. Ceftazidime always eradicated Staph. aureus and Haemophilus influenzae associated with pseudomonas. Similar eradication occurred nearly always with cefsulodin but rarely with the other drugs. No serious drug reaction occurred but a later fever and rash with piperacillin, transient diarrhoea with cefoperazone, vomiting with cefsulodin, and very frequent eosinophilia with ceftazidime should be mentioned. These five drugs offer, in varying degree, alternatives to traditional anti pseudomonas antibiotics in cystic fibrosis pulmonary infections, but they should be used only against well-proven resistant strains. Ceftazidime is best and cefotaxime and latamoxef (moxalactam) least useful.
Assuntos
Antibacterianos/uso terapêutico , Fibrose Cística/complicações , Infecções por Pseudomonas/tratamento farmacológico , Infecções Respiratórias/tratamento farmacológico , Adolescente , Dissuasores de Álcool/uso terapêutico , Azlocilina , Cefoperazona/uso terapêutico , Cefotaxima/uso terapêutico , Cefsulodina , Ceftazidima , Cefalosporinas/efeitos adversos , Cefalosporinas/uso terapêutico , Criança , Ensaios Clínicos como Assunto , Método Duplo-Cego , Eosinofilia/induzido quimicamente , Humanos , Moxalactam/uso terapêutico , Penicilinas/uso terapêutico , Piperacilina/uso terapêutico , Infecções por Pseudomonas/complicações , Distribuição Aleatória , Infecções Respiratórias/complicaçõesRESUMO
Transformation of erythronolide B to new antibiotics was attempted by feeding this compound during the fermentation of Streptomyces antibioticus ATCC31771, a blocked mutant of an oleandomycin producing strain. As a result, four new active compounds were obtained with hybrid structures between erythromycin and oleandomycin. They were identified as 3-O-oleandrosyl-5-O-desosaminyl-15-hydroxyerythronolide B (I), 3-O-oleandrosyl-5-O-desosaminylerythronolide B (II), 3-O-oleandrosyl-5-O-desosaminyl-(8S)-8-hydroxyerythronolide B (III) and 3-O-oleandrosyl-5-O-desosaminyl-(8R)-8,19-epoxyerythronolide B (IV). They were found to be less active, but more stable to acid, than erythromycin A. From their relative biogenetical relationship together with the structure elucidated some hypotheses about late stages of oleandomycin biosynthesis are inferred too.