Abdominal surgical site infections: a prospective study of determinant factors in Harare,Zimbabwe

Surgical site infections (SSIs) are reported in lower frequencies in the developed countries than in the developing world. A prospective evaluation of risk factors in 285 patients undergoing abdominal surgery procedures in Zimbabwe was therefore undertaken. Overall infection rate was 26%. The age group 30–39 years had the highest number of dirty wounds and the highest rate of human immunodeficiency virus (HIV) infection. Multivariate regression analysis showed a correlation between wound class and SSI (P < 0·05). This was also noted for American Society of Anesthesiologists (ASA) score (P < 0·05). HIV‐infected patients had 52% SSIs and non‐infected patients had 26% (P < 0·05). Patients receiving blood transfusion had 51% SSIs and those not transfused had 17% (P < 0·01). Patients receiving pre‐ and intra‐operative prophylactic antibiotics had 18% SSIs and those receiving postoperative administration had 37% (P < 0·01). Treatment ranged from dressings only in 11% to surgical intervention in 30% resulting in prolongation of median hospital stay from 8 to 18 days (P < 0·001). Mortality was 7%. High wound class, high ASA score, blood transfusion, HIV infection and delayed use of prophylactic antibiotics were risk factors for SSIs, resulting in surgical interventions, prolonged hospital stay and mortality.     

Hereditäre multiple Exostosen

Hereditary multiple exostosis (HME), a disorder inherited in an autosomal dominant manner, is characterized by multiple projections of bone, mainly at the extremities. The risk of malignant transformation of the exostoses is estimated to be up to 2%. The most common underlying cause of the disease involves mutations in either the EXT1 or the EXT2 gene. We report on the clinical and molecular findings in a family affected with HME.A mother and her three children from different partnerships, all clinically diagnosed with HME, were referred for genetic counseling. Subsequently, molecular analysis of the EXT1 gene was performed according to standard procedures. We identified a mutation in the EXT1 gene in all four affected family members (delA in codon 133). This mutation has not been previously described and is suggested to cause the disease in this family. Identification of disease causing mutations in patients with HME and their relatives can help to improve the clinical management of tumor prevention, early tumor detection, and orthopedic therapy.     

Cytogenetic and molecular cytogenetic analyses in diffuse astrocytomas

Diffuse astrocytomas are highly variable tumors and show complex biologic behavior that is based on multi-step oncogenesis. We report cytogenetic and molecular cytogenetic investigations in 23 cases of diffuse astrocytomas. The results of conventional karyotyping, interphase fluorescence in situ hybridization (FISH), comparative genomic hybridization, multicolor FISH, and spectral karyotyping are reported. Various numerical and structural chromosomal aberrations were identified. Clustering of structural alterations in the short arm of chromosome 2 (2p) and the long arm of chromosome 7 (7q) were detected. Using spectral karyotyping, additional chromosome rearrangements not detectable by conventional methods were found. Some of these anomalies have not been previously described in diffuse astrocytomas. An independent validation of these discrepant findings is required.     

Ultrasonography of Hands and Wrists in the Diagnosis of Complications of Chikungunya Fever

The purpose of this series was to describe the ultrasonographic and radiographic manifestations of changes to the hands and wrists in 50 patients with chronic musculoskeletal symptoms secondary to Chikungunya fever during the 2016 outbreak that occurred in Rio de Janeiro, Brazil. Most of the plain radiographs were normal (62%). The most common ultrasonographic findings were small joint synovitis (84%), wrist synovitis (74%), finger tenosynovitis (70%), and cellulitis (50%). In most cases, power Doppler did not show an increase in synovial vascular flow. The plain radiographs showed no specific findings, whereas the ultrasound images revealed synovial compromise and neural thickening.     

Prophylaktische mammachirurgische Versorgung von BRCA-Mutationsträgerinnen

For women with positive BRCA 1 or BRCA 2 results during screening, a prophylactic mastectomy can be advisable. The essential aim of this intervention is an individual risk reduction of disease probability from 55-80 % to 1-2 %. The intervention is usually carried out by subcutaneous mastectomy with preservation of the overlying skin and nipple with simultaneous reconstruction. The authors recommend an ultimate reconstruction without using foreign material and with safe operative results in correspondingly specialized centers. Perioperative and postoperative complications occur at a very low level in the mostly young and otherwise healthy women. If tumor manifestation has already been confirmed as invasive or preinvasive carcinoma, a sequential approach is selected with skin preservation by subcutaneous mastectomy and simultaneous implant reconstruction (spacer) in order to be able to consider the final histopathological assessment and if necessary a R1 situation in the definitive reconstructive concept. Because the durability of implant reconstructions in tumor patients, without the development of high-grade capsular fibrosis necessitating surgery, is on average only a few years, the authors recommend autologous tissue reconstruction with a deep inferior epigastric artery perforator (DIEP) or fasciocutaneous infragluteal (FCI) flap. If high-grade capsular fibrosis occurs necessitating an intervention or at the request of the patient after termination of adjuvant chemotherapy and/or radiotherapy, the reconstruction can be concluded in a secondary intervention using free autologous tissue transplantation in order to achieve a permanent positive reconstruction result. The consultative, operative and postoperative approaches are described in detail in this article.     

Effects of Ionizing Radiation on Respiratory Function Tests and Blood Parameters in Radiology Staff

Aim:

To evaluate pulmonary function tests and blood parameters and their relationship with sociodemographic data for radiology staff continuously exposed to ionizing radiation.

Subjects and Method:

Thirty-eight personnel from Suleyman Demirel University Training and Research Hospital, Radiology Unit, were included in this study. Sociodemographic data were evaluated by a questionnare that was developed by the researchers. Height and weight measurements were performed with a standard scale and meter. Routine blood parameters and spirometric lung function measurements of the cases were recorded. Statistical significances were determined by independent t-test, analysis of variance (ANOVA), bivariate correlation and Kruskal-Wallis tests using SPSS 18.0.

Results:

The mean age was 32.42 ± 5.5 years; 19 patients (50%) were male and 19 patients (50%) were female. Body mass index (BMI) was calculated as 25.68 ± 0.47 for men and 24.58 ± 1.13 for women. Forced vital capacity (FVC), forced expiratory volume in the 1^st second (FEV₁), peak expiratory flow (PEF) and maximum mid-expiratory flow (FEF_25-75) showed statistically significant differences between gender (p < 0.01). In addition, FEV1 and FEF_25-75 also demonstrated statistically negatively significant difference with the type of task (p < 0.05). A statistically significant negative difference was found between FEF_25-75 value and time to start smoking (p < 0.05). Among FVC, FEV₁, PEF and FEF_25-75 values and alcohol usage, statistically significant positive difference was detected (p < 0.05). Statistically significant positive difference was found among FVC, PEF and FEF_25-75 values and sports activity (p < 0.05). According to BMI groups, statistically significant positive difference with FVC, FEV₁ and PEF values were found (p < 0.05). Statistically significant correlations were found among FVC value and haemoglobin level (Hgb), haematocrit level (Hct) and mean corpuscular volume (MCV), among FEV1 value and Hgb, MCV, among PEF value and red blood cell count (RBC), Hgb, Hct, MCV, red cell distribution width (RDW), and between FEF_25-75 value and MCV.

Conclusion:

Although respiratory functions of radiology staff are affected by many factors, continuous exposure to ionizing radiation is one of the important parameters. Radiology staff should be informed about factors that negatively affect the respiratory functions.     

Molekulargenetischer Mutationsnachweis im PTPN11-Gen beim Multiple-Lentigines- (LEOPARD-)Syndrom

Hintergrund und Fragestellung  

Das LEOPARD-Syndrom (MIM #151100) ist eine seltene autosomal dominant erbliche Erkrankung mit charakteristischen Hautanomalien, fazialen Auffälligkeiten, Hypertelorismus, kardialen Anomalien und gelegentlich Schallleitungsschwerhörigkeit. Kausale Gendefekte wurden im PTPN11-Gen beschrieben. Mutationen im PTPN11-Gen sind u. a. auch charakteristisch für das klinische Bild des Noonan-Syndroms (MIM #163950). Unter differenzialdiagnostischen Gesichtspunkten kann eine molekulargenetische Untersuchung des PTPN11-Gens auch bei klinischem Verdacht auf ein Multiple-Lentigines-Syndrom hilfreich sein.