摘要:

BackgroundLong-term suppressive antimicrobial therapy is an alternative treatment choice in patients with medical device-related infection who are not eligible for surgical device removal for attempted cure. There is a paucity of data published that examines this treatment option.MethodsMembers of the Infectious Diseases Society of America’s Emerging Infections Network were polled to identify patients with intravascular device-related infections who were not candidates for surgery and were given long-term antimicrobial therapy to suppress clinical manifestations of infection.ResultsClinical and microbiologic data were collected retrospectively for 51 patients. Sixty-nine percent of patients were men; vascular grafts were the most common type of medical device infected [30 (58.8%) patients]. Sixty-three percent (32 of 51) of cases involved Gram-positive cocci. A variety of antimicrobials were administered as chronic suppressive therapy, with &bgr;-lactams used most frequently (39.2%). Therapy ranged from 3 months to 10 years. Three (7.32%) of 41 patients in whom follow-up data were available developed relapsing infection while on long-term suppressive therapy. Three other patients suffered drug adverse events.ConclusionsOverall, long-term suppressive therapy was well-tolerated and efficacious in preventing signs of infection relapse.

ISSN:0002-9629    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Fibroproliferative lung disease is prevalent and associated with high mortality. The pathogenesis of fibrotic lung disease involves inflammation, mesenchymal cell proliferation, and deposition of interstitial matrix components, such as collagen and fibronectin. Corticosteroids and other immunosuppressive medications have been routinely employed, but have demonstrated only marginal efficacy. Even though this information has been known for some time, the optimal medical regimen for treating pulmonary fibrosis remains largely undefined. This article addresses the rationale for, and efficacy of, antifibrotic regimens used to treat humans with fibrotic lung diseases.

ISSN:0002-9629    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

ObjectiveTo introduce a new concept in the etiology and treatment of traumatic and septic shock. It describes 3 types of shock: (1) hypovolemic shock, (2) traumatic shock, and (3) septic shock.BackgroundThe mortality of septic shock in both total number and mortality rate has been increasing over the past 40 years despite major advances in diagnosis and treatment, including a number of “magic bullets.” Trauma is the No. 1 cause of death in persons under the age of 44 and the No. 3 cause of all deaths. Traumatic shock has been assumed to be caused by hypovolemia; however, many traumatic shock patients die with a normal blood volume, usually after several days. Septic shock in pigs using an injection of killedEscherichia coliorganisms produced disseminated intravascular coagulation (DIC). Control pigs treated with plasminogen activator survived. Septic shock in humans also treated with plasminogen activator showed excellent results. Traumatic shock studied in pigs showed excellent results with plasminogen activator. A normal blood volume was maintained with the use of intravenous fluids. Traumatic shock in humans also treated by plasminogen activator showed excellent results. The improvement in Pao2and other parameters demonstrated in these studies provides a new possibility in the treatment of trauma and/or sepsis induced acute respiratory distress syndrome (ARDS). DIC is almost always present in traumatic and septic shock and probably in the course of ARDS and multiple organ failure. The DIC is probably initiated by tissue cell or bacterial cell destruction, which liberates a thrombogenic aminophospholipid that forms the inner layer of all cell walls.

ISSN:0002-9629    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Prosthetic valve thrombosis is a rare but serious complication of implanted mechanical valves. Thrombolysis has emerged as an alternative to surgical therapy in the management of these patients. The indications for such therapy and appropriate patient selection are evolving. Our report describes management of a patient we encountered with this complication and reviews the current status of thrombolysis in such patients.

ISSN:0002-9629    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Hepatitis C is a common infection with worldwide prevalence. It has a variable course and can lead to chronic hepatitis, cirrhosis and hepatocellular carcinoma. Until recently &agr;-interferon (IFN-&agr;) was the only effective treatment available. Combination therapy with IFN-&agr; and ribavirin has been found to be more efficacious than IFN-&agr; alone. Various side effects have been ascribed to interferon, such as arthralgias, myalgias, fatigue, and gastrointestinal and neuropsychiatric symptoms. Interstitial pneumonitis is a rare but known complication of IFN-&agr; when given at a high dosage of 6 to 10 million units per day. Ribavirin is associated with dose-dependent hemolytic anemia, cough, dyspnea, rash, depression, and dyspepsia, although a potential role in interferon-induced interstitial pneumonitis has not been described. We describe a patient with an excellent clinical response of chronic hepatitis C to combination therapy with IFN-&agr; at a dosage of 3 million units per day and ribavirin. The patient developed interstitial pneumonitis that resolved after discontinuation of IFN-&agr; and ribavirin. Given that interstitial pneumonitis has previously been reported with high-dose IFN-&agr;, this case suggests that this complication may occur with lower dosages of IFN-&agr;, although a potential role for ribavirin in this disorder at present remains speculative.

ISSN:0002-9629    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Two elderly patients, treated with captopril for left ventricular dysfunction and diabetes, developed severe cholestatic jaundice for which no alternative explanation could be found. The jaundice resolved completely after discontinuation of the drug. A review of the literature identifies a highly similar and distinctive clinical pattern in another 13 cases reported and suggests that hepatotoxicity is a well-established yet rare adverse effect of captopril. However, the very common use of this drug, together with the severity of the liver injury it may cause, calls for a high index of suspicion and increased awareness of this phenomenon.

ISSN:0002-9629    

出版商:OVID    

年代:2001

数据来源: OVID