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SCOPUS: ar.j, info:eu-repo/semantics/published

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In this paper, we present a review of the intra-aortic balloon pump, as well as the usage of it in the medical field today. An intra-aortic balloon pump (IABP) is a biomedical device that can assist the heart during unstable angina or after a heart attack. This pump is typically used in patients who suffer from ischemia of the heart tissue, due to an unbalanced level of myocardial oxygen supply or demand. Through counterpulsation, which is a technique to synchronize the external pumping of blood with the heart’s cycle, the device can balance the supply and demand of blood that is necessary for the heart to pump properly. The IABP is comprised of the following four components: a polyurethane balloon, a polyethylene or fiber-optic catheter, a transducer, and the intra-aortic balloon pump console. In the past, researchers have used other materials that have low biocompatibility and can cause complications within the body. This analysis will explain the complications and state changes that occurred due to them. Limitations of past designs and advantages of current designs will be acknowledged, for they can be used by researchers to enhance designs for the future. Consequently, the analysis of this device may lead to improved designs and treatment in the future for patients with cardiac conditions.

Multiple gastrointestinal stromal tumors (GISTs) caused by germline KIT gene mutations are an extremely rare autosomal dominant disorder. We report a case of a 21-year-old woman who presented to the emergency department with a 2-week history of asthenia, palpitations and upper gastrointestinal bleeding. After further clinical evaluation one gastric and two small bowel GISTs were diagnosed, which were surgically resected after neoadjuvant therapy with Imatinib. Diffuse hyperplasia of the interstitial cells of Cajal was also seen in the background gastric and small intestinal walls. Somatic mutational analysis of the KIT gene revealed a substitution at codon 576 in exon 11 (p.Leu576Pro) in all tumors and normal ileal mucosa. The germline nature of this mutation was confirmed by mutation analysis in peripheral blood leukocytes. However, she had no familial history of GISTs and her parents did not carry the respective germline mutation.

BACKGROUND The incidence of rectal cancer increases with age, and older patients are more likely to have other chronic conditions that can affect outcome and tolerability of treatment. OBJECTIVE The incidence of rectal cancer increases with age, and older patients are more likely to have other chronic conditions that can affect outcome and tolerability of treatment. METHODS 59 patients aged 75 years and older with stage II-III rectal cancer who were treated during a 3-year period were included in the study. Comorbidities were assessed using the Charlson Comorbidity Index (CCI) and the patients were divided into 2 groups based on their CCI scores: Fit (score of 0-1 points) and Vulnerable (score of greater than or = 2). Primary endpoint was survival at 1 and 3 years. RESULTS The sample included 43 patients (72.9%) in the Fit group and 16 patients (27.1%) in the Vulnerable group. The most common comorbidities were myocardial infarction, diabetes, and chronic lung disease. One-year survival the same between the groups (P = .330), but 3-year survival was lower in the Vulnerable group patients (83.7% vs 56.3%, respectively; P = .040). The rates of neoadjuvant chemo- and radiotherapy use and low anterior resection performance were the same between the groups. Colostomy closure was achieved more frequently in the Fit group compared with the Vulnerable group (83.3% vs 55.6%; P = .083). There was no difference in mean disease-free survival, grade 3-4 toxicity, and dose reduction between the groups. CONCLUSIONS Comorbidity assessment should always be included in standard oncological management of elderly patients. Fit patients can be managed with standard treatment and may bene¦t from a conventional, more aggressive approach in their therapy.

Ofloxacin, its optical isomers levofloxacin (HR 355, DR-3355) and D-ofloxacin (DR-3354) and ciprofloxacin were administered orally to mice and rats which had systemic and localized infections. Both levofloxacin and ciprofloxacin were equally effective in treating systemic murine infections caused by staphylococci, Enterobacteriaceae or Pseudomonas aeruginosa with ED 50 s ranging from 0.18 to 15.8 mg/kg and 0.42 to 16.3 mg/kg respectively and both these agents were twice as effective as ofloxacin which had an ED 50 0.41 to 39.7 mg/kg. In contrast, D-ofloxacin was either inactive or exhibited only modest chemotherapeutic activity against the staphylococci and the Gram-negative organisms tested. When given to mice to treat staphylococcal abscesses and lung infections due to Klebsiella pneumoniae DT-S levofloxacin was up to four times more effective and produced a more pronounced bactericidal effect against the pathogens in vivo than the reference compounds. Despite possessing a similar, if not lesser, in-vitro activity against the infecting pathogens, levofloxacin was more effective than ofloxacin and ciprofloxacin in rats with localized infections caused by Enterobacteriaceae and P. aeruginosa.

Cefpirome, cefoperazone and ceftazidime were tested for their in-vitro activity against Enterococcus faecalis and methicillin-resistant Staphylococcus aureus (MRSA) isolates. Cefpirome was the most active cephalosporin followed by cefoperazone. Ceftazidime had only very limited activity against these strains. In experiments with cefpirome/vancomycin and cefoperazone/vancomycin combinations, synergy was detected against most MRSA strains and some enterococci. Antagonism did not occur.

The in-vitro activity of cefpirome was compared with other antibiotics against organisms causing sexually transmitted diseases (STD). The excellent activity of cefpirome against Neisseria gonorrhoeae (MIC90 1.0 mg/L), Haemophilus ducreyi (MIC90 0.5 mg/L), and Gardnerella vaginalis (MIC90 1.0 mg/L) suggests that this agent might be useful in the empirical treatment of a variety of venereal diseases.

The pharmacokinetic profile of cefpirome was evaluated in rats and dogs after a single intravenous or intramuscular dose. A two-compartment open model was used for the calculation of the pharmacokinetic parameters for both routes of administration. The elimination half-lives after intravenous and intramuscular administration of 20 mg/kg cefpirome did not differ significantly and ranged from 0.4 h in rats to 1.1 h in dogs. Cefpirome was mainly excreted via the kidneys. After iv or im dosing of the compound, between 80% (dogs) and 90% (rats) was recovered in urine within 24 h. The bioavailability of cefpirome in rats and dogs after both routes of administration was almost identical when calculated either by the AUC or the urinary recovery rates.

Laparoscopic anterior resection with total mesorectal excision for middle and lower third rectal cancer remains a difficult operation, in particular, in male patients with a narrow pelvis and bulky mesentery. In this type of patient, the available staplers do not allow an easy transection of the rectum close to the pelvic floor. A new approach that uses instruments (dilator, obturator, and pursestring anoscope) specifically designed for the technique of stapled hemorrhoidopexy and a common circular stapler can overcome all these issues.

Cefquinome is a new injectable aminothiazolyl cephalosporin derivative. It is stable against chromosomally and plasmid-encoded beta-lactamases and has a broad antibacterial spectrum. Staphylococcus aureus, streptococci, Pseudomonas aeruginosa, and members of the family Enterobacteriaceae (Escherichia coli, Salmonella spp., Klebsiella spp., Enterobacter spp., Citrobacter spp., and Serratia marcescens) are inhibited at low concentrations. Cefquinome is also active against many strains of methicillin-resistant staphylococci and enterococci. Its in vitro activity against gram-negative anaerobes is very limited. The high in vitro activity of cefquinome is reflected by its high in vivo efficacy against experimental septicemia due to different gram-positive and gram-negative bacteria. We studied the pharmacokinetic properties of cefquinome in mice, dogs, pigs, and calves. After single parenteral administrations, cefquinome displayed high peak levels, declining with half-lives of about 0.5, 0.9, 1.2, and 1.3 h, respectively. The areas under the concentration-time curve determined for dogs and mice showed linear correlations to the given doses. In dogs the urinary recovery was more than 70% within 24 h of dosing.

Introduction Breast cancer with metastatic sentinel lymph nodes (SLN) may have clinico-pathologic factors associated with the presence of positive nonsentinel axillary nodes (NSLN). The aim of the present study was to determine factors that predict in-volvement of NSLN in breast cancer patients with positive SLN.

Cefodizime was evaluated for its effect on a number of parameters of leukocyte function in humans. Four healthy volunteers received 2 g i.v. b.i.d. for seven days. Leukocyte activity was measured before, during and after treatment. Using opsonized zymosan as a stimulant, no effect on the respiratory burst of granulocytes was observed. It was found, however, that the lymphocytes in three of the four subjects showed significantly more marked proliferation rates in the mixed lymphocyte reaction after administration of cefodizime than at baseline. The stimulation indices subsequently returned to normal. This pilot study therefore demonstrated that cefodizime has biological response modifying properties in healthy humans.

AimsTo determine the eventual advantage of the new 1997 TNM as prognosis predictor for gastric cancer patients submitted to an R0 resection and to compare it with two other lymph-node involvement classifications, the 1990 TNM and the Okusa system.MethodsFrom January 1980 to December 1995, an R0 resection was performed as primary therapy in 275 cases of gastric cancer. These operations consisted of a total or sub-total gastrectomy and of a D2 type lymph-node dissection. Tumour classification was performed according to 1990 and 1997 TNM systems, and to the Okusa lymph node classification. The statistical methods used to evaluate prognostic value were: Kaplan–Meier survival estimates; the log-rank test for univariate analysis; and Cox's model for multivariate analysis.Results.The 1990 TNM showed the best stratification power in univariate analysis. In multivariate analysis, the Okusa classification was identified as the best prognostic index (P

In vitro gamma irradiation of virus-induced (Gross) mouse leukemia cells at doses of 350-1600 rads (1 rad = 0.01 gray) had no effect on their ability to induce leukemia, usually within 2 weeks, after transplantation into syngeneic mice. However, when cells irradiated at doses of 2000-20,000 rads were transplanted, they induced leukemia after a latency period exceeding 2.5 months, similar to the results observed in mice inoculated with filtered mouse leukemia extracts. Similar results were also obtained after irradiation of leukemic cells derived from rats in which leukemia had been induced by rat-adapted mouse leukemia virus. Apparently, gamma irradiation at a dose of, or exceeding, 2000 rads, inhibits the ability of mouse and rat leukemic cells to induce leukemia after transplantation into syngeneic hosts; however, it does not inactivate the virus carried by such cells nor prevent it from inducing leukemia. [In previous experiments, doses of more than 4,500,000 rads were needed to inactivate the passage A (Gross) leukemia virus carried in either mouse or rat leukemic cells.] In vitro gamma irradiation of L2C guinea pig leukemic cells at doses of 750-2500 rads had no apparent effect on their ability to induce leukemia after transplantation effect on their ability to induce leukemia after transplantation into strain 2 guinea pigs. However, irradiation at doses of 3250-20,000 rads inactivated their ability to do so. The morphology of mouse, rat, and guinea pig leukemic cells and the virus particles present in such cells was not affected by irradiation at doses of 20,000 rads.

A protein was isolated from guinea-pig serum which enabled cobra venom factor (VF), in combination with purified C3 proactivator (C3PA) and Mg ++ , to induce turnover of isolated C3. To parallel the terminology for human serum, the protein was designated as factor D of the alternate pathway of complement activation. Purified factor D has a mol. wt of 22, 000 and an s-rate of 2·6. The isoelectric point was determined to be at pH 9·5. Factor D, although resistant to trypsin and hydrazine treatment, was relatively heat labile. It was found that the enzymatic activity directed against C3 was exerted by a trimolecular complex consisting of VF, C3PA and factor D. The existence of such a complex was demonstrated by gel filtration; additional evidence was provided by assembling an active complex on Sepharose-VF. Anti factor D serum blocked the C3 cleaving activity of the complex. Factor D itself was required for the C3 shunt activation induced by inulin, Dextran sulfate, Zymosan or endotoxin.

Desacetyl-cefotaxime, the main metabolite of cefotaxime, possesses a broad antibacterial spectrum. Its activity is lower than that of cefotaxime, but significantly surpasses that of cefazolin against gram-negative bacteria. The beta-lactamase stability of desacetyl-cefotaxime is higher than that of the parent compound. This beta-lactamase stability might be responsible for the synergistic effects of cefotaxime and desacetyl-cefotaxime occasionally seen in in vitro combination studies.

The antibacterial activity of the cephalosporin antibiotic HR 810 was evaluated in comparison with cefoperazone, cefotaxime, ceftazidime, ceftriaxone, latamoxef, gentamicin and amikacin against 1500 clinical isolates. HR 810 is the antibiotic with the broadest antimicrobial spectrum. It is also highly active against isolates of the genera Pseudomonas, Enterobacter, Staphylococcus and enterococci. HR 810 is very stable against hydrolysis by plasmid-coded and chromosomally coded beta-lactamases.

HE movement toward the development of a code of ethics for the nursing profession seems to be at a standstill. A suggested code was presented to the American Nurses' Association in 1926 with the expectation that after further study there might be official approval. This code was never formally adopted, nor is there any evidence that it has been widely discussed among nurses. A Committee on Ethical Standards exists but has found no marked enthusiasm for the code. There is so

3-[(2,3-Cyclopenteno-1-pyridinium)-methyl]-7-[2-syn-methoximino-2-(2-aminothiazol-4-yl)-acetamido]-ceph-3-em-4-carboxylate (HR 810) is a new cephalosporin derivative with an extremely broad antimicrobial spectrum. It is active against all bacterial species of clinical relevance, including strains which are frequently resistant towards cephalosporins of the third generation.

The chemotherapeutic activity of ofloxacin (HOE 280), a new pyridone-carboxylic acid derivative, was compared with that of other drugs in the same group, including norfloxacin, ciprofloxacin, enoxacin and in some cases pipemidic acid and nalidixic acid. The test model used was experimental pneumonia caused by Klebsiella pneumoniae DT-S in mice. In the treatment of pneumonic mice, ofloxacin was 4 to 18 times more effective than norfloxacin and enoxacin and in most cases slightly more effective than ciprofloxacin. Pipemidic acid and nalidixic acid showed only low activity or proved to be inactive. In studies on the bactericidal activity of the compounds in vivo, ofloxacin produced a more pronounced effect than ciprofloxacin. With norfloxacin and enoxacin, a bactericidal effect in the infected tissue of the animals was only observed during the first hours after treatment.

At least under experimental conditions, various antibiotics modulate the immune system in different ways [9]. Chloramphenicol, tetracyclines, certain penicillins and cephalosporins, and other substances interfere in vitro, at least in high concentrations, with the mitogen-induced lymphocyte proliferation. Cephalothin and chloramphenicol trigger the synthesis of lymphokines [5, 6, 7, 15].

The in vitro and in vivo activity of ofloxacin (DL 8280, HOE 280) was compared with that of other antibacterial compounds. Ofloxacin was found to have a broad antibacterial spectrum which includes both gram-positive and gram-negative aerobic and anaerobic species. Its activity is generally higher than that of pipemidic acid and nalidixic acid. Against staphylococci and streptococci, ofloxacin proved to be more active than norfloxacin. In the case of Enterobacteriaceae and Pseudomonadaceae, ofloxacin and norfloxacin possess comparable activities. Ofloxacin was the most active compound against a number of aerobic isolates which are resistant to cefotaxime and ceftriaxone. Of the compounds compared, ofloxacin was the only one which exhibited reasonable activity against anaerobes. It inhibited all strains of Bacteroides fragilis at a concentration of 3.125 mg/l and the gram-positive anaerobes at 0.5 mg/l. In mice experimentally infected with various gram-positive and gram-negative bacteria, ofloxacin was more active than norfloxacin and pipemidic acid. With the gram-negative pathogens, orally administered ofloxacin was as active as gentamicin used parenterally. We conclude from our studies that ofloxacin could be a valuable therapeutic agent with a variety of indications.

Dextran sulfate (DS) consumed C3 in C4 deficient guinea pig serum. This temperature-dependent reaction required Mg++ ions and could therefore be blocked by EDTA. Isolated C3 was not influenced by DS, but serum factors were required for C3 consumption. The C3 proactivator as well as C3 were converted to their activated state by DS in guinea pig and human serum, as revealed by immunoelectrophoretical analysis. DS generated anaphylatoxin activity in serum. It is concluded that DS activates C3 via the alternate pathway of complement activation. This potency of the polyanion might serve as a tentative explanation for its T cell-replacing effect in an antibody-forming system, which was reported by Diamantstein and his coworkers.

lems in the nursing profession is that of discipline," recently declared a well-known professor of nursing education. Although the writer is a mere layman, too healthy to have more than a passing acquaintance with nursing technic, he believes that the problem of discipline in the nursing profession is not only of current interest but offers a fruitful approach to an understanding of certain issues of basic concern. One who views this question from outside the professional nursing group may lay claim to a freedom from bias in controversial areas as partial compensation for his lack of technical knowledge. The concept of discipline is commonly associated with two types of situations: (a) in relations between a "superior" and an "inferior "-in age, experience, or professional statuswhere regulations or conventions are involved; (b) in cases where an infraction of rules has occurred and some form of punishment is to be meted out to the offender. One may enumerate at least five varieties of situations within the nursing profession where problems of discipline are likely to arise: in relation to patients, in relation to the supervisor, in relation to the attending physician, in relation to fellow-students or professional colleagues, in personal conduct off duty. Further distinction could be made between student nurses and graduate nurses. Although the five categories just mentioned hold for both groups, student nurses are likely to be subjected to more strict supervision because of their immaturity. In each of these five areas there are regulations and standards more or less explicitly formulated. The problem of the development and administration of a professional ethical code is closely related to the question of discipline, but this warrants separate consideration and will not be included in the present discussion. Any analysis of problems of discipline in the nursing profession involves an understanding of certain important elements in the tradition of the profession. A very brief sketch of three of these factors will suffice for those who are familiar with the history of nursing. Because of the important place which nursing came to hold since the time of Florence Nightingale in softening the horrors of war, the ethics of the profession have been strongly influenced by the military ideal. Military discipline rests upon two basic assumptions: (a) a definite gradation of rank and authority, with clearly marked distinctions of superiority and inferiority; (b) an unquestioning obedience on the part of subordinates.