Transient isolation of Burkholderia multivorans and Burkholderia cenocepacia from a Brazilian cystic fibrosis patient chronically colonized with Burkholderia vietnamiensis

Fifteen serial Burkholderia cepacia complex isolates recovered over a period of 4 years from a single cystic fibrosis patient were analysed for genomovar status by means of recA sequence determination, and genetic relatedness by RAPD-PCR. Twelve isolates were assigned as Burkholderia vietnamiensis, two as Burkholderia cenocepacia and one as Burkholderia multivorans. B. vietnamiensis persisted in the airways during 4 years, except in three occasions when B. cenocepacia or B. multivorans were isolated. The patient was chronically colonized by B. vietnamiensis with the RAPD-profile 12 and transiently by the RAPD-profile 15.     

Laparoscopic revision of gastric band surgery

Aim: To identify the outcome of laparoscopic revision of gastric band surgery with respect to percentage of excess weight lost (%EWL). Methods: Analysis of a prospective database was then performed and %EWL was plotted with respect to time from initial procedure and also time from revision procedure. Results: All revision operations were performed laparoscopically. There were no patient deaths, but two serious complications. Percentage excess weight loss after replacement of the band because of prosthetic failure or dysphagia was 57% at an average follow‐up of 19 months. For repositioning of the band due to slippage, the %EWL was 72% at an average of 15 months follow‐up for those who had the existing band repositioned, and 42% at an average of 23 months follow‐up for those who had a new band repositioned. Conclusion: Revision laparoscopic gastric band surgery is a safe option for patients, and results in good %EWL at an average follow‐up period of 19 months.     

PILONIDAL DISEASE

All patients with pilonidal disease (abscess or sinus) managed surgically (‘laying open’) between 1975 and 1990 in the Colorectal Service, University Department of Surgery, Wellington School of Medicine were reviewed. A total of 323 operations (177 males, 146 females) were performed in 311 patients. Seven males and 5 females required two operations before satisfactory healing was achieved (recurrence rate 3.8%). Males were older than females (mean, 26.4 vs. 21.5 years). One patient's wound bled following surgery and required immediate repacking. There were no other wound problems. One hundred and seventy-seven patients presented acutely with pilonidal abscess and 146 patients presented with pilonidal sinus. Patients with pilonidal abscess were younger than those with pilonidal sinus (male, 25.8 vs 26.9 years and female, 20.8 vs 23.5 years). There were proportionately more Maori patients who presented acutely. ‘Laying open’ under general anaesthesia seems to be a safe and successful method for managing pilonidal disease in all but the few patients in whom multiple operations have been performed previously or in those in whom healing has failed to occur. Based on our initial experience of ‘day case’ surgery the procedure could safely be done on an outpatient basis.     

Intra-operative Doppler Flow Measurement do not Predict ‘At-risk’ Status of Infrainguinal Bypass Grafts

AIMS: Patients undergoing infrainguinal arterial reconstruction using vein conduits, frequently undergo intra-operative Doppler flow measurements to determine technical adequacy. The aim of this study was to determine the proportion of vein grafts with normal intra-operative haemodynamic parameters that were subsequently discovered to be 'at risk' on post-operative duplex surveillance scanning. METHODS: We prospectively collected data on 82, primary infrainguinal vein bypass grafts. Post papaverine graft flow and peripheral resistance were measured using the Scimed Opdop intra-operative Doppler machine. All grafts were determined to be technically adequate on the basis of measured peripheral resistance units (mPRU) being < or =1. At 1 week, a post-operative duplex surveillance scan was performed. At risk status was determined and compared to the intra-operative Doppler flow measurement. Statistical analysis was performed using the Mann-Whitney U-test. RESULTS: The post-operative duplex scan demonstrated that 53 (65%) of the 82 vein bypass grafts were diagnosed as being 'not at risk'; and 29 (35%) were regarded as at risk. When the groups were compared, there was no significant difference in intra-operative haemodynamic parameters between those not at risk and those at risk (P=0.19, Mann-Whitney U-test). The 1 month primary patency rate was 79% with a secondary patency rate of 100%. CONCLUSION: Despite normal intra-operative Doppler flow measurements, 35% of vein grafts were regarded as being at risk at the 1 week post-operative duplex surveillance scan. No single value may be universally applicable for identifying at risk grafts intraoperatively. Indeed, graft failure appears to be a multifactorial process.     

The effects of relationship stress and unmitigated communion on physical and mental health outcomes

This study investigated the interactive effects of relationship stress and ‘unmitigated communion’ (UC) when predicting health outcomes among college students (n = 97). It was hypothesized that those participants who scored high on a scale of ‘UC’ (the tendency to focus on relationships rather than on one's own needs or desires) would be more negatively affected by interpersonal stress than those participants who scored lower on this scale. Paper‐and‐pencil measures of ‘UC’, perceived interpersonal stress, vitality, mental health, anxiety, depression, and positive and negative affect were completed. The results of the study strongly supported the hypothesis on both the physical and psychological levels. Gender was investigated as a potential moderating factor. While there was no evidence that this was the case, the results do provide limited evidence that men may be more prone to the negative effects of relationship stress than women (when controlling for ‘UC’). Implications for counselling are such that a participant's standing on ‘UC’ should be addressed during therapy. Failure to do so may result in inappropriate, or even harmful, treatment. Copyright © 2007 John Wiley & Sons, Ltd.     

‘Workaholism’ and potential outcomes in well‐being and health in a cross‐occupational sample

This study examined ‘workaholism’ components (work involvement, drive, enjoyment of work) and potential outcomes in terms of psychological well‐being and health. A sample of 661 Norwegian cross‐occupational employees from six different organizations completed an online questionnaire measuring ‘workaholism’, job satisfaction, life satisfaction, insomnia and subjective health complaints. A short version of the Norwegian‐translated Workaholism Battery showed significant relationships with reports of psychological well‐being and subjective health. Enjoyment of work was positively associated with job and life satisfaction and negatively associated with symptoms of poor health. Work involvement and drive were the strongest predictors of job dissatisfaction. Both were positively related to symptoms of poor health. Drive was, in addition, negatively associated with life satisfaction. The results showed that it is important to discriminate between different ‘workaholic’ features when investigating associations between ‘workaholism’ and potential outcomes, which were related in predictable ways to outcomes in terms of psychological well‐being and health. Copyright © 2010 John Wiley & Sons, Ltd.     

Genetic forms of nephrotic syndrome

Mutations of NPHS1, NPHS2 , or WT1 may be responsible for severe forms of nephrotic syndrome in children, progressing to end-stage renal failure. Recent studies have shown that congenital nephrotic syndrome may be secondary to mutations of one of these three genes and that some patients have a digenic inheritance of NPHS1 and NPHS2 mutations. The clinical spectrum of NPHS2 mutations has broadened, with the demonstration that mutations in the respective gene podocin may be responsible for nephrotic syndrome occurring at birth, in childhood, or in adulthood. It is now well recognized that podocin mutations are found in 10%–30% of sporadic cases of steroid-resistant nephrotic syndrome with focal segmental glomerulosclerosis. Data from large cohorts indicate that the risk of recurrence of nephrotic syndrome after renal transplantation in patients with podocin mutations is very low.     

THE MANAGEMENT OF PATIENTS WITH PILONIDAL DISEASE A COMPARATIVE STUDY

Patients with pilonidal disease presenting at wellington hospital between 1979 and 1982 have been studied retrospectively. Of 218 admissions, 113 were for pilonidal sinus and 105 for pilonidal abscess. Fifty-five sinuses and 82 abscesses were ‘laid open’. Hospital stay, recurrence rates and costs were considerably lower in those patients who were laid open. It is suggested that laying open is the procedure of choice for patients with both pilonidal abscess and sinus.     

The surgical treatment of the Zollinger-Ellison syndrome in sporadic and MEN-I patients

The current emphasis in the management of patients with theZollinger-Ellison syndrome is to identify those without liver metastases and attempt resection for cure. The presence of lymph node metastases does not imply inoperability for cure. Primary duodenal gastrinomas are frequent (20 to 40%) in sporadic as well as MEN-I (60 to 90%) patients. Duodenal exploration is necessary in sporadic patients whenever a pancreatic primary is absent and in all MEN-I patients, regardless of pancreatic findings. Many MEN-I patients with gastrinomas will benefit from resection of the distal pancreas, duodenotomy and lymph node dissection. An outline of our current therapy in sporadic and MEN-I patients and results is presented.      

Successful management of Brucella mellitensis endocarditis with combined medical and surgical approach

Objectives: Brucella endocarditis is an underdiagnosed complication of human brucellosis, associated with high morbidity and mortality. We report the successful management of a number of cases of Brucella mellitensis endocarditis. Patients and methods: Seven consecutive cases of Brucella mellitensis endocarditis were treated over the last 20 years, based on high suspicion of the disease at first place. The early suspicion of Brucella endocarditis relied on medical history and a standard tube agglutination titer ≥1:320. Blood and/or cardiac tissue cultures were positive in all patients, but available late following surgery. All patients were successfully treated with a combination of aggressive medical and early surgical therapy. All affected valves were replaced within 1 week from admission (five aortic and three mitrals). Medical treatment included co-trimoxazole, tetracyclines and streptomycin, before surgery, followed by co-trimoxazole and tetracyclines for a median of 12 months (range: 3–15 months) after surgery until the titers returned to a level ≤1:160. Results: There were neither operative deaths nor recurrence of infection. One patient died two years after the operation due to massive cerebrovascular accident. Ten-year survival was 85.7±13.2%. Conclusion: Although Brucella mellitensis endocarditis is a rare entity, its optimum management should be a combination of aggressive medical treatment and early surgical intervention, based on high degree of suspicion in areas with high incidence of the disease.     

Successful medical treatment of multiple brain abscesses due to Nocardia farcinica in a paediatric renal transplant recipient

Brain abscesses caused by Nocardia are rare, but it is very important to detect and treat them early because the associated mortality is 3 times higher than that associated with other bacterial brain abscesses. This infection is prevalent among adults on long-term immunosuppressive therapy; we report the case of a male kidney transplant recipient aged 12.7 years who developed early multiple Nocardia-induced brain abscesses that were successfully treated with linezolid, a novel antibiotic therapy.     

American Society of Transplant Surgeons’ White Paper: Impact of Closed ICUs on Transplant Patients’ Care

The following paper was produced by the collaborative effort of the Critical Care Task‐Force of the American Society of Transplant Surgeons (ASTS) and was formally adopted by the ASTS Executive Council as the society's stand on the subject of ‘closed’ intensive care units.     

The effect of stressful behavioural exposure on endocrine and immune parameters in the rat

Stress and depression are associated with a variety of alterations in the endocrine and immune systems. Leucocyte adhesiveness/aggregation (LAA) has recently been proposed as a simple indicator of stress in humans. The objective of the present study was to examine the serum concentration of corticosterone, neutrophil phagocytosis, lymphocyte proliferation, LAA and differential white blood cell (WBC) count in rats at different time intervals following an exposure to the behavioural despair and ‘open field’ tests. Thirty min following exposure to the behavioural despair test, the concentration of corticosterone was significantly elevated. An increase in the percentage of neutrophils and LAA, and a decrease in the percentage of lymphocytes and monocytes in the WBC count, were also found 30 min and 60 min after exposure to both the behavioural despair and ‘open field’ tests. A reduction in neutrophil phagocytosis was also observed 60 min after the exposure to these situations. The results show that there are endocrine and immune changes following exposure to these experimental situations. LAA appears to be a particularly useful indicator of acute stress in rats.     

Hemolytic uremic syndrome associated with Clostridium difficile colitis

Pediatric Nephrology -     

针刀治疗腕管综合征的病例对照研究

目的:研究针刀治疗腕管综合征的疗效。方法:2014年7月至2016年12月,60例门诊收治的腕管综合征患者分为两组,针刀治疗组(治疗组)和支具药物组(对照组),每组30例。治疗组男8例,女22例;平均年龄(49.38±7.43)岁。对照组男7例,女23例;平均年龄(50.23±8.71)岁。治疗前两组患者的年龄、性别、病程、感觉神经传导速度(SCV)、感觉神经动作电位波幅(SNAP)、运动传导末端潜伏期(DML)差异无统计学意义。治疗组患者采用针刀治疗1~2次;对照组患者口服塞来昔布、维生素B1、维生素B12,并采用支具固定;疗程结束后观察两组患者SCV、SNAP、DML变化。结果:两组患者治疗后,SCV分别为(48.63±7.33)、(41.24±6.15)m/s,SNAP分别为(9.89±3.71)、(8.22±2.19)m/s,DML分别为(5.11±2.28)、(6.13±2.23)m/s,均较治疗前改善,且治疗组优于对照组。结论:针刀疗法可以减轻患者症状,具有可行性,适合在临床中推广使用。     

Toxic shock syndrome originating from the foot

The most familiar etiology of toxic shock syndrome (TSS) is that of menstruation and tampon use. Nonmenstrual TSS has been described in all types of wounds including postsurgical, respiratory infection, mucous membrane disruption, burns, and vesicular lesions caused by varicella and shingles. A case of TSS occurring in a diabetic male patient with foot blisters is presented. Early recognition by an infectious disease specialist and appropriate medical management led to complete recovery. There have been no reported cases of Staphylococcus aureus TSS originating in the foot to date.     

Successful surgical treatment of a mycotic right coronary artery aneurysm complicated by a fistula to the right atrium

We reported successful surgical treatment of a mycotic right coronary artery aneurysm complicated by a fistula to the right atrium in a 60-year-old man admitted to hospital because of acute worsening of renal function and erythroderma. After admission, he suffered from methicillin-resistantStaphylococcus aureus septicemia. Despite administration of vancomycin hydrochloride, a low-grade fever persisted. Subacute cardiac tamponade occurred three months after admission, and acute inferior wall myocardial infarction occurred two weeks after pericardial drainage. An emergent coronary angiography demonstrated a large saccular aneurysm of the right coronary artery forming a fistula to the right atrium and obstruction of the distal right coronary artery. We emergently resected the aneurysm including the right atrial wall and repaired the defect in the right atrium. Pathological examination of the aneurysmal wall revealed its mycotic nature; the postoperative course was uneventful. (Jpn J Thorac Cardiovasc Surg 2005; 53: 661–664)     

Successful treatment of visceral leishmaniasis in Finnish-type congenital nephrotic syndrome

Visceral leishmaniasis is a parasitic disease endemic in the Mediterranean Basin, including Malta. Finnish-type congenital nephrotic syndrome is an autosomal recessive condition that presents in the first 3 months of life with heavy proteinuria, hypoalbuminemia with secondary edema, and hyperlipidemia. We present an infant with congenital nephrotic syndrome who had had unilateral nephrectomy and who also developed visceral leishmaniasis. He was successfully cleared of the infection by the administration of sodium stibogluconate, with no deterioration of renal function or other complications. Received: 17 May 1999 / Revised: 16 September 1999 / Accepted: 21 September 1999