Low-dose cidofovir for the treatment of polyomavirus-associated nephropathy: two case reports and review of the literature.

BACKGROUND: Polyomavirus-associated nephropathy (PVAN) is a serious complication and cause of graft loss in kidney transplant recipients. In the absence of specific antiviral drugs, early detection of the disease and reduction of immunosuppressive regimen is the cornerstone of therapy. Cidofovir, a nucleoside analogue, has been found to inhibit BK virus (BKV) replication in vitro and has been proposed as treatment of refractory PVAN at low doses; however, its efficacy has never been demonstrated in randomized controlled trials. METHODS: Cidofovir therapy (0.5 mg/kg at a 2-week interval for eight consecutive doses) was initiated in two patients with biopsy-proven PVAN and persistent BKV DNA viraemia (> or = 10,000 copies/ml despite sustained reduction of the immunosuppressive regimen). In addition to these two case reports, we performed a critical review of the literature on the use of cidofovir in PVAN. RESULTS: No significant decrease of BKV viral load in blood was observed during cidofovir therapy and in follow-up of the two patients treated with cidofovir. Our literature review identified 21 publications reporting the use of cidofovir for the treatment of PVAN. All were case reports or small series. The efficacy of cidofovir therapy could not be assessed in 17 of these publications because of lack of data or concomitant reduction of immunosuppressive regimen. The four remaining publications were case reports. CONCLUSIONS: In vitro and clinical data to support the efficacy of cidofovir in the treatment of PVAN are currently lacking. More promising compounds should be identified for further clinical studies.

Acquisitions de la littérature en médecine interne générale ambulatoire en 2010 [2010 findings from literature on general internal ambulatory medicine].

From our reading over the current year 2010 we have singled out 8 items which seem to us significant for the practice of medicine. Small doses of colchicine are useful in the treatment of gout. No efficacious treatment for muscular cramps can be recommended. A cervical collar can be usefully prescribed for the treatment of cervical radiculopathy. A single dose of azithromycin can be envisaged as a third line treatment of syphilis. High doses of vitamin D should not be prescribed for the prevention of fractures in elderly women because of the risks of falling. The wearing of bifocals can be associated with these risks. A clinical score is available to help with the diagnosis of thoracic pain. The NT-pro BNP is of limited use for the follow-up of patients suffering from heart failure.

Cultured epithelial autografts in the management of burn injuries: a review of the literature

Introduction. The management of large burn victims has significantly improved in the last decades. Specifically autologous cultured keratinocytes (CEA) overcame the problem of limited donor sites in severely burned patients. Several studies testing CEA's in their burn centers give mixed results on the general outcomes of burn patients. Methods. A review of publications with a minimum of 15 patients per study using CEA for the management of severe burn injury from 1989 until 2011 were recruited by using an online database including Medline, Pub Med and the archives of the medical library of the CHUV in Lausanne. Results. 18 studies with a total of 977 patients were included into this review. Most of the studies did not specify if CEA's were grafted alone or in combination with split thickness skin grafts (STSG) although most of the patients seemed to have received both methodologies in reviewed studies. The mean TBSA per study ranged from 33% to 78% in patients that were grafted with CEA's. Here no common minimum TBSA making a patient eligible for CEA grafting could be found. The definition of the "take rate" is not standardized and varied largely from 26% to 73%. Mortality and hospitalization time could not be shown to correlate with CEA use in all of the studies. As late complications, some authors described the fragility of the CEA regenerated skin. Conclusion. Since the healing of large burn victims demands for a variety of different surgical and non-surgical treatment strategies and the final outcome mainly depends on the burned surface as well as the general health condition of the patient, no definitive conclusion could be drawn from the use of CEA's of reviewed studies. From our own experience, we know that selected patients significantly profit from CEA grafts although cost efficiency or the reduction of mortality cannot be demonstrated on this particular cases.

EZ-IO(®) intraosseous device implementation in a pre-hospital emergency service: A prospective study and review of the literature.

INTRODUCTION: Intraosseous access is increasingly recognised as an effective alternative vascular access to peripheral venous access. We aimed to prospectively study the patients receiving prehospital intraosseous access with the EZ-IO(®), and to compare our results with those of the available literature. METHODS: Every patient who required an intraosseous access with the EZ-IO from January 1st, 2009 to December 31st, 2011 was included. The main data collected were: age, sex, indication for intraosseous access, localisation of insertion, success rate, drugs and fluids administered, and complications. All published studies concerning the EZ-IO device were systematically searched and reviewed for comparison. RESULTS: Fifty-eight patients representing 60 EZ-IO procedures were included. Mean age was 47 years (range 0.5-91), and the success rate was 90%. The main indications were cardiorespiratory arrest (74%), major trauma (12%), and shock (5%). The anterior tibia was the main route. The main drugs administered were adrenaline (epinephrine), atropine and amiodarone. No complications were reported. We identified 30 heterogeneous studies representing 1603 EZ-IO insertions. The patients' characteristics and success rate were similar to our study. Complications were reported in 13 cases (1.3%). CONCLUSION: The EZ-IO provides an effective way to achieve vascular access in the pre-hospital setting. Our results were similar to the cumulative results of all studies involving the use of the EZ-IO, and that can be used for comparison for further studies.

Mitologia i literatura a "Suddenly Last Summer" de Tennessee Williams: tot lluitant contra Venus i Èdip

The aim of this article is to analyze accurately the role played by two classical references, Venus and Oedipus, in Tennessee Williams¿s Suddenly Last Summer, in accordance with the usual nature of studies on Classical Tradition ¿Greek and Roman- and focusing in this case on the relationship between literature and mythology. It is thanks to Venus and Oedipus that the playwright succeeds in showing the magnitude of men¿s and women¿s tragedy, which from his point of view is simply that they have failed to see either kindness in the face of God or to feel his loving and fatherly providence.

Muerte en Venecia de Thomas Mann o la via plutarquea hacia Eros

En Muerte en Venecia Thomas Mann se refiere explícitamente al Simposio y al Fedro de Platón para explicar la relación entre Gustav von Aschenbach y Tadzio, pero oculta que su novela se inspira también en el Erótico de Plutarco. ¿Por qué? El objetivo de este artículo es justamente revelar las razones de este proceder. En efecto, Plutarco elogia el amor matrimonial en el Erótico y éste no es el camino que sigue Mann, pero, al mismo tiempo, el escritor alemán halla en el diálogo plutarqueo todo lo necesario para construir su historia de amor masculino y decide no prescindir de él.

Thomas Mann's Death in Venice or Plutarch's way towards Eros

In Death in Venice Thomas Mann refers explicitly to Plato's Symposium and Phaedrus in order to explain the relationship between Gustav von Aschenbach and Tadzio but he hides that his novel also depends on Plutarch's Eroticus. Why? The aim of this article is precisely to reveal the different reasons for such an attitude. Indeed, Plutarch speaks highly of conjugal love in his Eroticus and this way is not followed by Mann in Death in Venice but, at the same, the German writer finds in this Plutarch's philosophical dialogue all the necessary elements to build his story of masculine love and decides not to manage without it.

Philo of Alexandria's De opificio mundi (LIII-LXI): discovering the essential features of Greek and Western Misogyny in a Platonising Jewish Text

The aim of this article is to show the Western centuries-old misogynist tradition from its origins in Greece by analysing a text by the allegorical interpreter of the Bible Philo of Alexandria, his De opifico mundi, which on many occasions is read by him from a Platonic point of view. The accurate analysis of the chapters devoted to the creation of the woman by God proves to what extent it is not possible to understand this text if one does not take into account a Greek philosophical tradition which was already centuries-old.

Antihelenismo y anticlasicismo en la obra de Oscar Wilde. El polo opuesto de una mente paradójica.

Gracias a una poderosa arma intelectual, la paradoja, Oscar Wilde descubre también los déficits del Clasicismo y del Helenismo. Un análisis riguroso del conjunto de su obra desde la perspectiva de la Tradición Clásica, nos revela también un Oscar Wilde diferente del usual Wilde filohelénico y, sobre todo, platónico. El objetivo de este artículo es abordar un tema muy poco estudiado por los filólogos clásicos cual es el anticlasicismo y el antihelenismo como necesidades intelectuales.

Antihel·lenisme i anticlassicisme en l'obra d'Oscar Wilde. L'altre pol d'una ment paradoxal.

Gràcies a una poderosa arma intel·lectual, la paradoxa, Oscar Wilde descobreix tambè els dèficits del Classicisme i l'Hel·lenisme. Una anàlisi acurada del conjunt de les seves obres des de la perspectiva de la Tradició Clàssica, ens revela també un Oscar Wilde diferent de l'usual Wilde filohel·lènic i, sobretot, platònic. L'objectiu d'aquest article és abordar un tema molt poc estudiat pels filòlegs clàssics, l'anticlassicisme i l'antihel·lenisme com a necessitats intel·lectuals

Anti-Hellenism and Anti-Classicism in Oscar Wilde's Works. The Second Pole of a Paradoxical Mind.

Thanks to a powerful intellectual weapon, paradox, Oscar Wilde also discovers the dark side of both Classicism and Hellenism. An accurate analysis of his works from the point of view of the Classical Tradition shows an Oscar Wilde who is quite different from the usual Philhellenic one and, above all, from the Platonic one. The aim of this article is to approach a theme which has been hardly studied by classical philologists, that is, anti-classicism and anti-hellenism as an intellectual urge.

Abandonando la caverna en busca de la vida (Lectura platónica de La caverna de Rodolf Sirera)

El objetivo de este artículo es mostrar cómo un dramaturgo contemporáneo piensa de nuevo en la imagen platónica de la caverna para hablar del necesario viaje existencial y de la formación del hombre, lejos de la protección que las cavernas de cualquier tipo, como el hogar, el jardín familiar o la misma familia, pueden representar. Aunque desde una perspectiva en absoluto idealista o metafísica, Platón se convierte una vez más gracias a R. Sirera y a la aplicabilidad de las mismas imágenes platónicas en una referencia clásica tan útil como ineludible, si se tiene en cuenta el origen platónico de todas las cavernas literarias.

Mitología y Literatura en "Suddenly Last Summer" de Tennessee Williams: luchando contra Venus y Edipo

The aim of this article is to analyze accurately the role played by two classical references, Venus and Oedipus, in Tennessee Williams's Suddenly Last Summer, in accordance with the usual nature of studies on Classical Tradition -Greek and Roman- and focusing in this case on the relationship between literature and mythology. It is thanks to Venus and Oedipus that the playwright succeeds in showing the magnitude of men¿s and women¿s tragedy, which from his point of view is simply that they have failed to see either kindness in the face of God or to feel his loving and fatherly providence.

Tennessee Williams's Cat on a hot tin roof or the dramatic aptitudes of the goddess Diana

The aim of this article is to show which are the dramatic "yields" of the inclusion of the reference to the goddess Diana in Tennessee Williams's Cat on a Hot tin Roof. In the author's opinion, it does not deal simply with a meaningful reference; on the contrary, the accurate analysis of Williams's text proves that it is a true nuclear and cohesive element of the whole drama.