Etiology of candidemia in patients with solid tumors - 7 years of experience of one oncology center.

Although the candidemia still remains a serious health problem, the study of candidemia in cancer patients is limited. We conducted a retrospective analysis of candidemia among 31 adult patients hospitalized in one oncological center. The mean annual incidence of candidemia was 0.14±0.05/1000 patient-days (range 0.04-0.91). In 10 patients (32.3%), the catheter-related infection was diagnosed; in the remaining 21 patients (67.7%), it was a secondary infection. From 31 patients of candidemia, 15 died (48.4% 30-day mortality), but an overall mortality rate during hospital stay was 61.3% (19 cases). Patients with secondary candidemia, ASA=IV and complicated postoperative course, had poorer 1-year survival probability compared with patients with catheter-related infection (p=0.004), ASA

The role of genetic factors in the pathogenesis of neonatal intraventricular hemorrhage.

Intraventricular hemorrhage (IVH) affects 15-20% of babies born before 32 weeks of pregnancy. Besides gestational age (below 32 weeks) there are a number of IVH risk factors. Increasing attention is being paid to genetic factors in the development of IVH. The authors discuss genetic factors (mutations of coagulation factors, gene polymorphisms in pro-inflammatory cytokines, mutation of type IV collagen gene, polymorphisms of genes responsible for the regulation of systemic blood pressure and cerebral blood flows) whose involvement in IVH pathogenesis has been confirmed in the highest number of reports and for which being a carrier plays an important role in their pathophysiology. The role of genetic factors in IVH remains unclear. Further analysis of the role of genetic factors in the pathophysiology of IVH will make it possible to determine the group of newborns who are specifically at risk of developing IVH in the perinatal period.

Cushing's syndrome in pregnancy: a case report and mini review of the literature.

Adrenal diseases in pregnant women are diagnosed relatively rarely. The main cause of hypercortisolemia during pregnancy is Cushing's syndrome related to adrenal adenoma. It is important to diagnose Cushing's syndrome in pregnant women because it can lead to significant maternal and foetal complications and morbidity. However, due to physiological endocrine changes and symptoms in pregnant women the diagnosis of this disorder can be a challenge. One current case describes a 38-year-old pregnant woman with hypertension, oedema and an adrenal tumour. At the beginning, Conn syndrome was suspected, but after careful analysis Cushing's syndrome (with an adenoma of the right adrenal gland) was diagnosed. After delivery and 5 weeks of pharmacological treatment the patient underwent right side adrenalectomy by laparoscopy.

Pulmonary function after surfactant lung lavage followed by surfactant administration in infants with severe meconium aspiration syndrome.

OBJECTIVE: The effect of surfactant lung lavage (SLL) on pulmonary function was examined in neonates with severe form of meconium aspiration syndrome (MAS) (mean +/- standard deviation: birth weight, 3178.1 +/- 237.6 g; gestational age, 37.7 +/- 1.8 weeks). METHODS: The infants were on mechanical ventilation and were subjected to SLL with Survanta. Dynamic compliance (Cdyn), airway resistance (Raw) and mean airway pressure (MAP) were obtained with use of the pneumotachometric method. Measurements of Cdyn, Raw, MAP and time constant (Tc) were compared in the study and control groups and between the groups before SLL and 24 and 48 h after SLL. RESULTS: A significant increase in Cdyn (from 1.06 +/- 0.23 to 2.12 +/- 0.99 (ml/cmH(2)O)/kg) (p < 0.05) and a drop in both Raw (from 264.7 +/- 41.5 to 146.6 +/- 39.4 (cmH(2)O/l)/s) and MAP (from 12.4 +/- 3.6 to 5.4 +/- 2.1 cmH(2)O) were observed 48 hours after SLL. CONCLUSIONS: These data suggest that SLL is associated with a rapid and significant improvement in pulmonary mechanics, together with an improvement in oxygenation, in newborns with severe MAS. We found that the beneficial effects of SLL on pulmonary mechanics persisted for at least 48 h after introduction of the procedure.

[Monitoring of bacteremia in oncological patients]. / Monitorowanie bakteriemii u pacjentów nowotworowych.

The aim of the present study was analysis of bacteremia occurring among oncological patients treated in 3 departments of Regional Center of Oncology, in period 1997-2000. A total number of 255 blood cultures from 89 patients were tested using the automatic system to early detection of positive blood-cultures Bactec 9050 (Becton Dickinson). The strains were identified in the automatic VITEK system using commercial strips with biochemical tests and in manual system API (bioMerieux). The total number of positive blood cultures was 70 (27.45%). The most frequently isolated causal agents were the Gram-positive microorganisms (65.79%). Among 28 examined patients with positive blood cultures 10 were with lymphoma and 9 with cancer of the gastrointestinal tract. 9 patients (32.14%) had sepsis, 4 patients with sepsis died. Constant monitoring of bacteremia in oncological patients should be fundamental element in control of hospital infection program.

[Comparison of mortality and morbidity in newborns treated with ambroxol prenatally and postnatally]. / Porównanie smiertelnosci i zachorowalnosci noworodków leczonych Ambroksolem prenatalnie i pourodzeniowo.

The effect of Ambroksol given pre- and postnatal on infant mortality and morbidity was performed. In particular we found a statistically significant differences in reduction of mortality in the group A treated with Ambroksol pre- and postnatal vs. group B treated only postnatal. The other parameters of morbidity had no significantly importance but sepsis, which was more often diagnosed in group A than in group B (17.5% vs. 11.1%). We connect this fact with higher frequency of PROM in the group A.

[Evaluation of ambroxol given prenatally and postnatally on gas exchange in the newborn with respiratory distress syndrome]. / Ocena wplywu ambroksolu podawanego prenatalnie i pourodzeniowo na wymiane gazowa u noworodka z zespolem zaburzen oddychania.

160 newborns were observed to compare the influence of combine treatment with ambroxol (Lasolvan-Boehringer Ingelheim) (antenatal and postnatal) versus postnatal administration of this drug on gas exchange and reduction of ventilatory settings in newborns with RDS. In 53% of cases the preparation was given both: pre- and postnatal and 47% of newborns were treated only postnatal. The results of stimulation of lung maturity "before and after" versus "after" delivery were better in the first group, however in some parameters we did not found statistical differences.

[Predictive value of absent or reverse end-diastolic blood flow in the umbilical artery in the diagnosis of fetal distress]. / Wartosc prognostyczna zaniku lub odwrócenia koncowo-rozkurczowego przeplywu krwi w tetnicy pepowinowej w diagnostyce zagrozenia plodu.

To examine the significance of the absence of reverse of end-diastolic (ARED) velocity in umbilical artery, outcome of pregnancy in 24 women with this complication was evaluated. Acute or chronic hypoxia was evident in 87.5% fetuses with ARED. Such situation is a definable high-risk state that demands intensive surveillance.

[Evaluation of surfactant administration in neonates with respiratory distress syndrome. III. The role of intra-uterine stimulation on lung maturity]. / Ocena leczenia surfaktantem noworodków z zespolem zaburzen oddychania. III. Rola wewnatrzmacicznej stymulacji dojrzalosci pluc.

Prenatal corticosteroids and exogenous surfactant therapy independently reduce the adds of neonatal death by about 40%. It is not clear however if babies who develop RDS despite prenatal corticosteroid therapy behave differently when later given exogenous surfactant. This paper presents an evaluation of the outcome of babies treated with Curosurf (a porcine surfactant) for RDS depending upon whether they received prenatal corticosteroids (16 babies) or not (11 babies). Although not randomised these two groups of babies appear to be similar in respect of gestational age. However, lower mortality was found in the group treated with prenatal corticosteroids (12.5% vs. 27.2%).

[Effects of surfactant administration in neonates with respiratory distress syndrome. II. Radiographic changes]. / Ocena leczenia surfaktantem noworodków z zespolem zaburzen oddychania. II. Obraz radiologiczny.

The effect of treatment of severe respiratory distress syndrome with a natural porcine surfactant (Curosurf) on the radiographic appearances and degree of aeration is described. Separate assessment of each lung of 22 preterm babies was made before and after surfactant administration. The beneficial effect of Curosurf treatment on the aeration of the lungs was seen in 19 (86%) of the babies.

[Evaluation of treating neonates with surfactants for respiratory distress syndrome. I. Importance of gas exchange]. / Ocena leczenia surfaktantem noworodków z zespolem zaburzen oddychania. I. Wplyw na wymiane gazowa.

Twenty seven preterm babies enrolled in a European Multicentre Trial (Curosurf 4) were treated with surfactant Curosurf (Chiesi Farmaceutici, Italy). Mean gestational age was 30.7 weeks (range 26-36), and mean birthweight 1617 g (960-2790 g). Curosurf was given as a rescue therapy in babies with severe RDS between 2-72 hours after birth. Indications for treatment were: clinical and radiological diagnosis of RDS, need for mechanical ventilation and arterial to alveolar oxygen tension ratio < 0.22. Umbilical arterial catheterisation and written parental consent were obtained before trial entry. The results are given for all treated babies and have not been analysed according to the dose of Curosurf. In the first hour after treatment there were mean increases in PaO2 of 27.4 mm Hg (3.6 kPa), and oxygen saturation of 8.2%, a mean decrease in PaCO2 of 15.0 mm Hg (3.3 kPa) and mean increases a/A ratio of 0.1. It was possible to reduce mechanical ventilation one hour after Curosurf instillation: inspired oxygen concentration was decreased by a mean of 12.3%, peak inspiratory pressure by 4.3 cm H2O, and frequency by a mean of 5.6 per minute. It is concluded that there are immediate beneficial effects of Curosurf in preterm babies with severe RDS.