Surgical site infections following short-term radiotherapy and total mesorectal excision: results of a randomized study examining the role of gentamicin collagen implant in rectal cancer surgery

Background

Despite the findings of several randomized clinical studies, the role of gentamicin collagen implant (GCI) in rectal cancer surgery is unclear. Local pelvic application of GCI following preoperative radiotherapy and total mesorectal excision (TME) was evaluated to determine the risk of surgical site infections (SSI).

Methods

In this single-center trial, 176 patients with rectal cancer after preoperative, short-term radiotherapy (5 × 5 Gy) were randomized either to the study group in which GCI was used or in the control group without GCI. Prior to surgery and intraoperatively five patients were excluded from the study. The remaining 171 patients were analyzed; 86 were in the study group and 85 in the control group.

Results

There were no statistically significant differences in the overall rate of early postoperative complications between the study and control group: 25.6 and 34.1 % respectively; p = 0.245, relative risk (RR) 0.750 [95 % confidence interval (CI) 0.471–1.195]. The reoperation rate was similar in both groups: 12.8 versus 9.4 %; p = 0.628; RR 1.359; (95 % CI 0.575–3.212). The total rate of SSI and organ space SSI were 22.2 and 15.8 % without differences between the study and control group. In patients without anastomotic leakage, the risk of organ space SSI was significantly reduced in patients who received GCI: 2.6 versus 13.0 %; p = 0.018.

Conclusions

Application of GCI in the pelvic cavity after short-term preoperative radiotherapy and TME may reduce the risk of organ space SSI but only in the absence of anastomotic leakage.     

Pregnancy outcome following gestational exposure to echinacea: a prospective controlled study

BACKGROUND: Echinacea products are among the most popular phytomedicines on the North American market. Since at least half of all pregnancies are unplanned, many women inadvertently use echinacea in their first trimester. Presently, there is a paucity of information regarding the gestational safety of this herb. The primary objective of this study was to evaluate the safety of echinacea in pregnancy when used for upper respiratory tract ailments. PATIENTS AND METHODS: The study group consisted of women who were prospectively followed up after contacting the Motherisk Program regarding the gestational use of echinacea. This cohort was disease-matched to women exposed to nonteratogenic agents by maternal age, alcohol, and cigarette use. Rates of major and minor malformations between the groups were compared. RESULTS: A total of 206 women were enrolled in the study group after using echinacea products during pregnancy; 112 women used the herb in the first trimester. There were a total of 195 live births, including 3 sets of twins, 13 spontaneous abortions, and 1 therapeutic abortion. Six major malformations were reported, including 1 chromosomal abnormality, and 4 of these malformations occurred with echinacea exposure in the first trimester. In the control group, there were 206 women with 198 live births, 7 spontaneous abortions, and 1 therapeutic abortion. Seven major malformations were reported. There were no statistical differences between the study and control groups for any of the end points analyzed. CONCLUSIONS: This first prospective study suggests that gestational use of echinacea during organogenesis is not associated with an increased risk for major malformations.     

Peritonitis in continuous ambulatory peritoneal dialysis: twenty years of center's experience

Twenty years of our experiences in diagnosis and treatment of peritonitis in patients treated with continuous ambulatory peritoneal dialysis are presented. Special attention was put on reduction of frequency and efficacy of treatment improvement of this complication. Influence of peritonitis on peritoneal transport and dialysis adequacy was also analyzed. There were neither persistent changes of peritoneal membrane permeability nor worsening of dialysis adequacy following peritonitis.     

Structure of a Fe4O6-Heteraadamantane-Type Hexacation Stabilized by Chelating Organophosphine Oxide Ligands

Metal-containing heteraadamantanes are compounds of interest due to their spectroscopic and magnetic properties, which make them promising materials for non-linear optics and semiconductors. Herein we report the comprehensive structural characterization of a new coordination compound of the formula [(µ-OH′)₂(µ-OH″)₄(O = P(Ph₂)CH₂CH₂(Ph₂)P = O)₄{Fe(t-BuOH)}₄](PF₆)₄(Cl)₂ with the chelating ligand Ph₂P(O)-CH₂CH₂-P(O)Ph₂. The compound crystallizes as a polynuclear metal complex with the adamantane-like core [Fe₄O₆] in the space group I-43d of a cubic system. The single-crystal XRD analysis showed that the crystal contains one symmetrically independent octahedrally coordinated Fe atom in the oxidation state +3. The adamantine-like scaffold of the Fe complex is formed by hydroxy bridging oxygen atoms only. Hirshfeld surface analysis of the bridging oxygen atoms revealed two types of µ-OH groups, which differ in the degree of exposure and participation in long-range interactions. Additionally, the Hirshfeld surface analysis supported by the enrichment ratio calculations demonstrated the high propensity of the title complex to form C-H^…Cl, C-H^…F and C-H^…O interactions.     

Switching to Sulphonylureas in Children With iDEND Syndrome Caused by KCNJ11 Mutations Results in Improved Cerebellar Perfusion

OBJECTIVE

Activating mutations in the KCNJ11 gene, encoding the Kir6.2 subunit of the K_ATP channel, result in permanent neonatal diabetes mellitus. They also may cause neurologic symptoms such as mental retardation and motor problems (iDEND syndrome) and epilepsy (DEND syndrome). Sulphonylurea (SU) treatment is reported to alleviate both the neurologic symptoms and diabetes in such cases. The study aimed to establish the magnitude and functional basis of the effect of SUs on the neurologic phenotype in children with iDEND using neuroimaging before and after insulin replacement with glibenclamide.

RESEARCH DESIGN AND METHODS

To localize and quantify the effect of glibenclamide administration, we performed single-photon emission computed tomography in seven patients with different mutations in KCNJ11. In five patients, measurements before and after initiation of SU treatment were performed.

RESULTS

Significant changes in single-photon emission computed tomography signal intensity after transfer to SU therapy were restricted to the cerebellum, consistent with previous data showing high Kir6.2 expression in this brain region. Cerebellar perfusion improved for both left (P = 0.006) and right (P = 0.01) hemispheres, with the mean improvement being 26.7 ± 7.1% (n = 5). No patients showed deterioration of cerebellar perfusion on SU therapy. Electrophysiological studies revealed a good correlation between the magnitude of K_ATP channel dysfunction and the clinical phenotype; mutant channels with the greatest reduction in adenosine 5′-triphosphate inhibition were associated with the most severe neurologic symptoms.

CONCLUSIONS

We conclude it is likely that at least some of the beneficial effects of SU treatment on neurodevelopment in iDEND patients result from improved cerebellar perfusion.Approximately 50% of cases of permanent neonatal diabetes mellitus are caused by mutations in the genes encoding either the pore-forming (Kir6.2, KCNJ11) or regulatory (SUR1, ABCC8) subunits of the ATP-sensitive K⁺ (K_ATP) channel (1). In some patients with these mutations, neurologic symptoms such as mental retardation, impaired motor development, and hypotonia coexist with neonatal diabetes (iDEND syndrome); if epilepsy is also present, then the condition is called DEND syndrome (2). Previous studies have shown that it is possible to alleviate diabetes and some of the neurologic symptoms by substituting insulin therapy with orally ingested sulphonylurea (SU) drugs (3). In one patient, the improvement in neurologic function was associated with enhanced perfusion of the brain, particularly of the cerebellum, as measured by single-photon emission computed tomography (SPECT). To determine if this effect is common to patients treated with SU, we performed SPECT in patients with different mutations in KCNJ11 and varying clinical phenotypes.     

Complications of primary hyperthyroidism as a consequence of subsitutional therapy interruption

The case of a 32-year old female patient with primary hypothyroidism suffering from severe myxoedema as a consequence of denying thyroxin taking is presented. Severe expression of pathological changes in circular-respiratory system and uncommon skin changes are discussed.     

Abdominal hernia as risk for continuation of continuous ambulatory peritoneal dialysis: case report

On the case of 37 old patient with diabetic nephropathy, treated with peritoneal dialysis since 12 months, actual problems of clinical and imaging diagnostics of abdominal hernias in continuous ambulatory peritoneal dialysis patients are presented. We paid special attention to the postoperative management and prophylaxis of abdominal hernia recurrences.     

Serum IL-18 concentration does not depend on the presence of HCV-RNA in serum or in PBMC

BACKGROUND/AIMS: To establish if serum IL-18 concentration depends on presence of HCV-RNA in serum or in peripheral blood mononuclear cells. To relate serum levels of IL-18 to histological parameters of chronic hepatitis C. METHODOLOGY: IL-18 serum concentration was measured by ELISA in 92 patients with chronic hepatitis C (43 serum HCV-RNA positive and 49 serum HCV-RNA negative after treatment). In 13 patients from the latter group HCV-RNA persisted in peripheral blood mononuclear cells, while in 34 it was negative. Thirty-five healthy individuals were the control. RESULTS: IL-18 level was higher in 92 patients than in the control (77+/-31pg/mL us. 58+/-34pg/mL; p=0.002). Significant difference was found between the control and HCV-RNA positive (80+/-29pg/mL, p=0.002), HCV-RNA negative (75+/-32pg/mL, p=0.019), patients who eliminated HCV-RNA from serum and from PBMC (85+/-36pg/mL, p=0.002). IL-18 concentration was higher in serum HCV-RNA positive than in serum HCV-RNA negative patients (p=0.019) and it was related to histological inflammatory activity (p=0.008). CONCLUSIONS: Serum IL-18 concentration is related to presence of HCV-RNA in serum, in PBMC and liver inflammation. Increased level of this cytokine in patients with undetectable HCV-RNA may result from occluded persistence of the virus in the liver.     

Lipoidproteinosis. A report of four cases

Four cases of lipoid proteinosis (Urbach-Wiethe disease) are presented. The incidence, clinical features, relevant special investigations and possible treatment of the disease are reviewed. These patients present with hoarseness and lesions of the skin and mucosa. The condition is often misdiagnosed by general practitioners and otolaryngologists.