Clinical and investigative medicine. Médecine clinique et experimentale
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Comparative Study
Nystatin prophylaxis of fungal colonization and infection in granulocytopenic patients: correlation of colonization and clinical outcome.
Nystatin, one million units every four hours, was prospectively studied as a prophylactic antifungal agent in 164 neutropenic patients who were not initially colonized by fungi: 104 received nystatin and 60 served as controls. Fungal colonization occurred in 68/104 (65%) nystatin recipients and in 43/60 (71%) controls. However, nystatin significantly reduced multiple body site colonization and persistent oropharyngeal colonization. ⋯ Disseminated fungal infections were diagnosed in 19/111 (17%) of colonized patients, as compared to 1/53 (2%) non-colonized patients (p less than 0.02). We conclude that colonized patients are more likely to develop febrile clinical courses, to fail to respond to empiric antibiotic therapy, and to develop disseminated fungal infection. Nystatin altered colonization patterns but did not prevent disseminated fungal infection.
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Considerations for analgesic or anaesthetic intervention during labour and delivery are reviewed. The amelioration of maternal discomfort must be safe for both mother and fetus. ⋯ Maternal stress resulting from pain can adversely affect fetal oxygen supply. The pros and cons of systemic and regional analgesia are discussed.
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Pressure-vol. (PV) curves of the lung were obtained in 2 groups of normal subjects using different esophageal balloon vols. and balloon positions. The PV curves were fitted to the exponential V = A - Be-KP. Transpulmonary pressures at different %S of total lung capacity and specific compliance were calculated. ⋯ With the balloon positioned at 8 or 12 cm from the gastro-esophageal junction there was no change in PV curve parameters but transpulmonary pressures and K were significantly altered at the 4 cm position. We conclude that, for clinical purposes, exact positioning of the esophageal balloon and use of the precise resting balloon vol. are not critical. Highly reproducible measurements of the elastic properties of the lung may be obtained using an esophageal balloon with a vol. of 0.6-1.0 ml and a position 8-12 cm from the gastro-esophageal junction.