New aspects in the pathogenesis and prevention of polymer-associated foreign-body infections caused by coagulase-negative staphylococci

The significance of polymer-associated infections caused by coagulase-negative staphylococci is discussed. The aspects of bacterial adhesion to polymeric materials as the first important pathogenetic step in the development of such infections are treated. The role of extracellular slime substance (ESS) produced by the bacteria in the pathogenesis is elucidated and newer results concerning the interference of ESS with host defense mechanisms and antibiotic therapy are presented. As an approach to the prevention of polymer-associated foreign-body infections, the modification of the polymeric materials is introduced. Results of recent studies to achieve antiadhesive materials by radiation modification of polymers as well as the development of antimicrobial surfaces by incorporating or bonding antibiotics to polymers are presented.     

The desmoid syndrome. New aspects in the cause, pathogenesis and treatment of the desmoid tumor

Based on a detailed clinical and laboratory investigation of 89 patients with histologically verified desmoid tumor and the pertinent medical literature, we have reviewed the etiologic factors, clinical characteristics, and results of treatment of this rare disorder. The incidence of the tumor in the Finnish population is low, 2.4 to 4.3 new cases per 10(6) inhabitants per year. The age distribution profile demonstrated four distinct peak periods: the juvenile period, the fertile period, the middle-age period and the old-age period. The juvenile desmoid tumor is an extraabdominal tumor found in young girls, the fertile variety is an abdominal tumor found in women, the middle age variety is also overwhelmingly abdominal but the sex ratio approaches equality, whereas in the old age group, both abdominal and extraabdominal tumors are equally frequent and the sex ratio is equal. In all male patients, the growth rate was low. A low growth rate was also recorded in young girls. A growth rate of twice that speed was seen in fertile women and four times that speed in the middle age group. In the old age group, a low growth rate, equal to that of male patients, was a rule. The fertile female patients with desmoid tumor had a significant predisposition to estrogen dominance and deviation from progesterone dominance. The direct relationship of the growth rate to the level of endogenous estrogen in the female patients and the demonstration of significant amounts of estradiol but not progesterone receptors in the tumor cytosol further suggest that the growth rate of desmoid tumor is regulated by steroid sex hormones. A significant number of patients with an abdominal desmoid tumor had a history of surgical trauma in the region of subsequent tumor growth. A very high number of the patients demonstrated multiple minor malformations of the bony skeleton. An increased frequency of these malformations was also recorded in the families of the patients and the distribution of the malformations among the family members was compatible with an autosomally dominant pattern of inheritance. After operation, the frequency of recurrence was not statistically different, regardless of whether the tumor was completely removed or not. A combination of operation and radiotherapy did not reduce the frequency of recurrences; in fact, it doubled it.(ABSTRACT TRUNCATED AT 400 WORDS)     

Severe hyponatremic encephalopathy after pediatric surgery: report of seven cases and recommendations for management and prevention

BACKGROUND: The infusion of hypotonic solutions in the perioperative period can lead to the development of hyponatraemic encephalopathy which is a severe, life threatening but preventable complication. CLINICAL PRESENTATION: Seven children aged 3-6 yr, ASA 1 or 2, operated on for a scheduled surgical procedure, presented at the 11th postoperative hour with seizures or status epilepticus, associated with vomiting (5/7), and a constant loss of consciousness (median Glasgow Coma Scale at 7), while one child presented with a respiratory arrest. At arrival in ICU, serum sodium was 120 mmol.L-1. All children had received in the perioperative period an hypotonic solution infusion (mainly dextrose 5%), at a high rate for most of them. Management included mechanical ventilation (3/7), antiepileptic drugs (7/7), fluid restriction (7/7), sodium chloride infusion (5/7), and diuretics (6/7). Serum sodium increased to a mean of 135 mmol.L-1 in 12 hours. Six children had a good neurologic outcome while one child died from brain death. CONCLUSION: The use of hypotonic solute in the perioperative period can lead to hyponatremic encephalopathy, a severe neurologic complication of acute hyponatremia. It must be prevented by the use of appropriate solutions i-e isotonic fluids in regards of the low free water elimination capacities of the surgical patient.     

Laryngotracheal stenosis in children. Current aspects of the surgical treatment and prevention

In the past 6 years, 40 children underwent surgery for laryngotracheal stenosis; 32 by the external approach, 8 by endoscopic CO2 laser. Twenty-seven children (67%) were less than 5 years old at the moment of treatment and 80% of the stenoses (n = 32) corresponded to an etiology that is secondary to endotracheal intubation and/or tracheotomy. By grading the stenoses according to the amount of narrowing of the lumen, the authors emphasize the interest of conservative treatment (endoscopic) for grade I (less than 70%, n = 8), and treatment by external surgical methods for grade II (70%-90%, n = 13), grade III (90%-99%, n = 14), and grade IV (total obstruction, n = 5). At this time, the most commonly used technique is laryngotracheoplasty with costal cartilage interposition. In this series, 88% of the patients were successfully decannulated. As for the treatment of stenosis in infants, the authors describe their recent experience of laryngotracheofissure in 7 patients as an alternative to either tracheotomy in cases of difficult extubation or laryngotracheoplasty when the child is underweight.     

Post-dural puncture headache: pathogenesis, prevention and treatment

Spinal anaesthesia developed in the late 1800s with the work of Wynter, Quincke and Corning. However, it was the German surgeon, Karl August Bier in 1898, who probably gave the first spinal anaesthetic. Bier also gained first-hand experience of the disabling headache related to dural puncture. He correctly surmised that the headache was related to excessive loss of cerebrospinal fluid (CSF). In the last 50 yr, the development of fine-gauge spinal needles and needle tip modification, has enabled a significant reduction in the incidence of post-dural puncture headache. Though it is clear that reducing the size of the dural perforation reduces the loss of CSF, there are many areas regarding the pathogenesis, treatment and prevention of post-dural puncture headache that remain contentious. How does the microscopic pattern of collagen alignment in the spinal dura affect the dimensions of the dural perforation? How do needle design, size and orientation influence leakage of CSF through the dural perforation? Can pharmacological methods reduce the symptoms of post-dural puncture headache? By which mechanism does the epidural blood patch cure headache? Is there a role for the prophylactic epidural blood patch? Do epidural saline, dextran, opioids and tissue glues reduce the rate of CSF loss? This review considers these contentious aspects of post-dural puncture headache.     

手掌部创伤性假性动脉瘤的诊断与防治及形成机制

目的 研究手掌部创伤性假性动脉瘤的诊断、治疗、预防方法及其形成机理。方法 报告３例因锐器戳伤手掌部掌浅动脉弓及指掌侧总动脉而形成创伤性假性动脉瘤的临床表现、诊断和治疗。并通过动物实验研究小动脉创伤性假性动脉瘤的形成机理,从而提出预防方法。结果 ３例明确诊断后均行手术治疗,术后１年随访,假性动脉瘤未复发,手部血循环正常。实验证实,小动脉外伤致破裂后５～１１ｄ或形成创伤性假性动脉瘤。结论 手掌部创伤性假性动脉瘤的诊断依据是：（１）手掌部有锐器戳伤史;（２）伤后１周左右,局部隆起博动性小包块;（３）超声多普勒检查该包块具有收缩期血管杂音,彩色多普勒超声显像仪显示该包块呈囊状结构形态,囊腔内有血液涡流信号。治疗方法是切除瘤本并结扎其近、远两端载瘤动脉。伤后及时结扎手掌部破损动脉能预防创伤性假性动脉瘤的形成。     

Studies in the pathogenesis, diagnosis, and treatment of Candida sepsis in children

The pathogenesis of Candida sepsis was investigated by animal studies in the laboratory and by correlation of experimental data obtained with a 10-yr clinical experience in the management of 29 children with yeast septicemia.The intestinal tract of the primate was found to be much more susceptible to fungal invasion than was a bacteria-free granulating wound in the dog. Prophylaxis against Candida sepsis by oral nystatin in 100 randomized burned children gave results that agreed with these findings.Difficulties in confirming the clinical diagnosis of Candida septicemia are probably due to tissue filtration of yeast from the circulation, thereby making venous blood samples of little value until late in the patient's course. Arterial or right atrial blood has now been demonstrated to provide a more reliable specimen.For treatment to be successful, the source of Candida invasion must be eliminated as soon as possible. Mere parenteral antifungal drugs alone are of little benefit, while continuation of systemic antibiotics almost assures a fatal outcome.     

Infection in burn patients: the problems of pathogenesis, prevention and treatment]

Urgent issues of pathogenesis, prophylaxis and treatment of infection in patients with thermal injuries are considered. Analysis of the results of multifactorial dynamic examinations of immunological reactivity and nonspecific resistance of 198 burnet patients is presented. For the first time a substantial decrease of B-lymphocytes count in normal or elevated level of immunoglobulins of the main classes is shown as well as a decrease in plasma fibronectin content. Lowering of T-lymphocytes content and polymorphonuclear leucocytes function disturbances, dominant role of St. aureus and P. aeruginosa in etiology of infections in burnt patients and high antibiotic resistance of these microorganisms are demonstrated. Pathogenetic substantiation of combined therapeutic usage of thymus and interferon preparations and when indicated--immunoglobulines is recorded. Positive experience in application of recombinant interleukine-2 (Ronkoleukine) is outlined. The data are provided on advisability of application of new cephalosporines and fluorine-quinolones for antibiotic therapy and prophylaxis in the burnet. In complicated forms of gram-negative infections the combination of aminoglycosides with ureidopenicillines or cyprofloxacine is recommended, in infections provoked by polyresistant strains of S. aureus vancomycin is indicated. With prophylactic aim in case of early surgical treatment it is recommended to apply modern antibacterial preparations with broad spectrum of action. Prophylaxis of hospital infections inpatients of specialised clinics for the burnt is discussed.     

Various aspects of prognosis, treatment and prevention of pulmonary thromboembolism

In a work, the analysis of sectional investigations in 47 patients, who died from pulmonary thromboembolism (PTE), is presented. The causes and results of treatment of PTE after operation in 34 patients are studied. The non-specific and specific measures for PTE prophylaxis are suggested.