Nonsurgical management of mild primary hyperparathyroidism – a reasonable option

Primary hyperparathyroidism (PHPT) is a relatively common disorder which is often diagnosed incidentally and characterized in the majority of those affected by mild stable biochemical abnormalities and lack of symptoms. Nephrolithiasis and bone loss leading to an increased risk of fracture are generally accepted complications of PHPT. Some epidemiological studies report associations between PHPT and a wide range of common diseases, but these relationships may be confounded by the increased body weight observed in PHPT. Because there is a dearth of controlled clinical trial evidence in PHPT, optimal management is controversial. For individuals with mild stable PHPT, low fracture risk and no renal stones, observation without intervention is reasonable. Surgical treatment is clearly indicated for patients at risk of severe hypercalcaemia or with nephrolithiasis. For individuals with increased risk of fracture, antiresorptive therapies improve bone mineral density to a similar degree to surgical treatment. Calcimimetic agents may have a role in managing patients with symptomatic PHPT who cannot undergo, or fail, surgical treatment. There is a need for additional randomized clinical trials to inform management of PHPT.     

Home intravenous antimicrobial infusion therapy: a viable option in older adults

OBJECTIVES: To determine whether older adults and younger adults are equally able to administer home intravenous antimicrobial infusion therapy (home IV antimicrobials) without intensive support from home care agencies. DESIGN: Retrospective cohort study. SETTING: Veterans Affairs Ann Arbor Healthcare System, a 100-bed tertiary care medical center. PARTICIPANTS: All patients who received home IV antimicrobials from July 1, 2000, through December 31, 2003. MEASUREMENTS: Demographic data, underlying medical conditions, indications for therapy, antimicrobial agents administered, concomitant medications, frequency of patient visits and phone calls, adverse events, and outcomes of infections. RESULTS: A total of 205 patients received 231 courses of home IV antimicrobials, with 107 courses in patients aged 60 and older and 124 courses in patients younger than 60. For both groups, the most common indication for therapy was osteoarticular infections, and the predominant pathogens were Staphylococcus aureus and coagulase-negative Staphylococcus. Older patients were significantly more likely than younger patients to require the assistance of family members to help with the infusion and were more likely to be seen in urgent care or to call the infectious diseases pharmacist or physicians with questions. Overall, clinical outcomes and numbers of adverse events were similar in both groups, with the exception of nephrotoxicity, which was greater in the older group (P=.02). CONCLUSION: With appropriate support from a hospital-based home IV antimicrobials therapy team, home IV antimicrobial appears to be a viable option for older adults.     

Frequency of MRSA in diabetic foot infections

Staphylococcus aureus is one of the most common bacterial pathogens isolated from diabetic foot infections (DFIs). The increasing prevalence of meticillin-resistant S. aureus (MRSA) in patients with diabetes is associated with complications. The aim of this study was to determine the prevalence of S. aureus in DFIs and antibiotic susceptibility patterns of MRSA and non-MRSA isolates. Identification of S. aureus and MRSA was performed by the phenotypic and molecular methods. The Kirby-Bauer and agar dilution methods were performed for determination of antibiotic susceptibility patterns. Thirty-four isolates of S. aureus were isolated from March 2014 to February 2015. The rate of MRSA was 38.23 % according to the disk cefoxitin and oxacillin agar dilution methods, and as by PCR method 12) 35.29 %), isolates were found to have the mecA gene. All MRSA and non-MRSA isolates were susceptible to linezolid and vancomycin. The resistance rate to ceftriaxone was high followed by amoxicillin-clavulanic acid, tetracycline, gentamicin, and erythromycin. The most common bacterial pathogen isolated from DFIs was S. aureus. To ensure effective treatment, accurate detection of MRSA is critical. Our findings showed that MRSA isolates had high-level resistance to antimicrobial agents and that appropriate antibiotic therapy, based on the antibiotic susceptibility pattern, is essential to ensure a good result.     

Community acquired MRSA infections in a paediatric population in Greece

We investigated the characteristics of 20 community acquired methicillin resistant Staphylococcus aureus (MRSA) strains isolated in a paediatric hospital in Athens. Eighteen of these, all isolated from skin and soft tissue infections, carried the Panton-Valentine leukocidin (PVL) determinants. They all were found resistant to fusidic acid, tetracycline and kanamycin, and displayed a PFGE pattern identical to that of the well-described ST80 CA-MRSA clone circulating in various European countries.     

Throwing patterns of older adults: a follow-up investigation.

Previous investigations of the movement patterns of older adults have focused on functional movements. Performance declines have been reported with increasing age. Many investigations, however, do not require older adults to perform maximal, force producing actions. Smaller declines might be observed if older adults made a maximal effort. This investigation examined changes in a maximal skill--the overarm throw for force. Active, older adults were videotaped as they threw tennis balls. Thirteen people were filmed for two consecutive years. Gender and age differences were examined for movement patterns, ball velocity, and selected kinematic measures. Participants threw using patterns and velocities generally observed in children in middle elementary-school years. This result suggested there was a decline in this force production skill. Some older adults regressed in the movement patterns they used over the two years of testing. Older males threw faster, using more advanced movement patterns than older females.     

The reasonable drainage option after laparoscopic common bile duct exploration for the treatment of choledocholithiasis

Objective

To obtain a reasonable drainage after laparoscopic common bile duct exploration (LCBDE) for the treatment of choledocholithiasis.

Treatment of older women with alcohol problems: meeting the challenge for a special population

As a larger proportion of the U.S. population reaches late life, there are new challenges to providing quality health care services for this group. Record numbers of adults over 60 are seeking health care for acute and chronic conditions. Older women represent the largest single group of health care users in this country. Twelve percent of older women regularly drink in excess of recommended guidelines (no more than one drink per day or seven drinks per week) and can be considered at-risk drinkers. Problems related to alcohol use and misuse can seriously affect many of the health concerns common among older women, including chronic illnesses and depression. Older women have specific risks and vulnerabilities to alcohol use, which include a swifter progression to alcohol-related illness. However, women in later life who have alcohol problems are underscreened and underdiagnosed, have significant barriers in accessing health care, and respond differentially to standard specialized treatment protocols. To date, research on these topics has been limited. Furthermore, there is a paucity of research focused on treatment outcomes for elderly adults with alcohol problems, with almost no emphasis on women. This paper presents the state of knowledge about alcohol health services for older women and provides recommendations for necessary future health services research on this vulnerable population.     

Treatment of a patient with chronic renal failure with rituximab for a follicular lymphoma: safe and successful option of rituximab therapy

A 47-yr-old woman presented a chronic renal failure for 5 yr, with a creatinine clearance of 12 mL/min. In June 2002, she had a right axillary lymph node (of 4 cm diameter). A biopsy revealed a follicular lymphoma (histology: follicular small cleaved-cell). She had Ann Arbor stage III disease, with a high tumor burden according to the GELF criteria. She received rituximab as single first-line treatment (375 mg/m2 by intravenous infusion for a total of four dosages: days 1, 8, 15 and 22). Rituximab therapy was extremely well tolerated, and we obtained a partial response, 4 wk after completing the treatment. In January 2003, she received one maintenance course of rituximab. Six weeks after maintenance therapy, a complete response was achieved.     

Pancreas transplantation: a treatment option for people with diabetes

Since the first pancreas transplants in the early 1960s, whole‐organ pancreas transplantation, either alone or combined with kidney transplantation, has become commonplace in many countries around the world. Whole‐organ pancreas transplantation is available in the UK, with ~200 transplants currently carried out per year. Patient survival and pancreas graft outcome rates are now similar to other solid organ transplant programmes, with high rates of long‐term insulin independence. In the present review, we will discuss whole‐pancreas transplantation as a treatment for diabetes, focusing on indications for transplantation, the nature of the procedure performed, graft survival rates and the consequences of pancreas transplantation on metabolic variables and the progression of diabetes‐related complications.     

Epidemiological investigation of MRSA with antagonistic effects of beta-lactam antibiotic and vancomycin

The combination of vancomycin and beta-lactam antibiotic synergistically is known to act on vancomycin-susceptible Staphylococcus aureus (VSSA). But some MRSA with the antagonism in the combination of vancomycin and beta-lactam antibiotic was identified in Japan. We called the MRSA "beta-lactam antibiotic-induced vancomycin-resistant MRSA (BIVR)", to distinguish it from hetero-VISA. The percentage of hetero-VISA isolated in Japan that Hiramatsu et al. reported in The Lancet in 1997 was that of "candidate-hetero-VISA" because it did not satisfy the criteria for detection of hetero-VISA that they proposed. Therefore, except for Mu3, a strictly defined hetero-VISA strain has never been detected in Japan. However, BIVR is certainly detectable in Japan. We performed a retrospective study of BIVR in 189 MRSA strains isolated from blood between 1978 and 1999 at the same institution. To performed a retrospective study, 189 MRSA strains were divided such as 1978-1984 (45strains), 1985-1989 (45strains), 1990-1994 (49strains), 1995-1999 (50strains). MIC90 of anti-MRSA drugs according to above chronological transition were 2, 2, 2, 1 as vancomycin, 2, 1, 1, 1 as teicoplanin, and 8, 8, 1, 1 microgram/mL as arbekacin, respectively, and then the detection rate of BIVR was 2.2, 2.2, 6.1, 10.4%, respectively. The BIVR detection rate in MRSA isolated from blood at 14 institutions was 14.8% (12/81) in 1999-2002, and that of non-blood was 4.6% (42/905) (p < 0.001; chi 2-t examination). Of particular importance is that the percentage of BIVR isolated from blood is higher than that from non-blood, and the detection rate of BIVR from blood increases annually.