Antimicrobial resistance of gram-negative isolates from intensive care units in Turkey: comparison to previous three years

Resistance rates to selected antibiotics of gram-negative bacteria isolated from intensive care units (ICU) of 16 Turkish hospitals during 1998 were evaluated and compared to data from the previous 3 years. Antibiotic susceptibilities to imipenem, ceftazidime, ceftazidime-clavulanate, cefoperazone-sulbactam, ceftriaxone, cefepime, cefodizime, cefuroxime, piperacillin-tazobactam, ticarcillin-clavulanate, gentamicin, amikacin and ciprofloxacin were determined by Etest. A total of 1,404 isolates from 1,060 patients were collected, mainly from urinary and respiratory tracts. As in the previous 3 years, Pseudomonas spp. was the most frequently isolated gram-negative species (29.7%), followed by Escherichia coli, Acinetobacter and Klebsiella spp. Imipenem was the most active in vitro agent (73.4% susceptible), followed by ciprofloxacin (60.6%), cefoperazone-sulbactam (58.7%), cefepime (56.7%), piperacillin-tazobactam (55.0%) and amikacin (54.7%). In 1996, a decline in susceptibility rates of all antibiotics was evident. With the exception of imipenem, resistance to which remained stable, rates somewhat increased in 1997. In 1998, susceptibility to imipenem and cefepime remained stable, amikacin resistance tended to increase and susceptibility rates to other antibacterials showed a favorable increase. These results may in part be due to the implementation of a surveillance program and increased understanding of the magnitude of the resistance problem.     

Life-years gained from modern cardiological treatments and population risk factor changes in England and Wales, 1981-2000

OBJECTIVES: We estimated life-years gained from cardiological treatments and cardiovascular risk factor changes in England and Wales between 1981 and 2000. METHODS: We used the IMPACT model to integrate data on the number of coronary heart disease patients, treatment uptake and effectiveness, risk factor trends, and median survival in coronary heart disease patients. RESULTS: Compared with 1981, there were 68230 fewer coronary deaths in 2000. Approximately 925415 life-years were gained among people aged 25-84 years (range: 745 195-1 138 655). Cardiological treatments for patients accounted for approximately 194145 life-years gained (range: 142505-259225), and population risk factor changes accounted for approximately 731270 life-years gained (range; 602695-879430). CONCLUSIONS: Modest reductions in major risk factors led to gains in life-years 4 times higher than did cardiological treatments. Effective policies to promote healthy diets and physical activity might achieve even greater gains.     

Giant Renal Hydatid Cyst Resembling a Simple Cyst: An Intraoperative Diagnosis

An interesting case of a giant renal hydatid cyst is presented. The big cystic mass detected at ultrasonography (US) and computerized tomography (CT) in a ten-year-old girl looked like a simple cyst. No germinative membrane or any other radiological sign of a hydatid cyst was present. The operation was planned for a simple cyst; but was altered, after an intraoperative diagnostic needle sampling brought out the characteristic fluid of hydatid cyst. We came to the conclusion that hydatid cystic masses may not always present with their characteristic radiological findings; and that extreme caution should be practiced by the radiologist and the surgeon in order to prevent iatrogenic echinococcal dissemination.     

Detection of acute renal ischemia in swine using blood oxygen level-dependent magnetic resonance imaging

PURPOSE: To determine the feasibility and sensitivity of blood oxygen level-dependent (BOLD) magnetic resonance imaging (MRI) to detect acute renal ischemia, using a swine model, and to present the causes of variability and assess techniques that minimize variability introduced during data analysis. MATERIALS AND METHODS: BOLD MRI was performed in axial and coronal planes of the kidneys of five swine. Color R2* maps were calculated and mean R2* values and 95% confidence intervals (CIs) for the cortex and medulla were determined for baseline, renal artery occlusion and reperfusion conditions. Paired Student's t-tests were used to determine significance. RESULTS: Mean R2* measurements increased from baseline during renal artery occlusion in the cortex (axial, 13.8-24.6 second(-1); coronal, 14.4-24.7 second(-1)) and medulla (axial, 19.3-32.2 second(-1); coronal, 20.1-30.7 second(-1)). These differences were significant for both the cortex (axial, P < 0.04; coronal, P < 0.005) and medulla (axial, P < 0.02; coronal, P < 0.0005). No significant change was observed in the contralateral kidney. CONCLUSION: R2* values were significantly higher than baseline for medulla and cortex during renal artery occlusion. More variability exists in R2* measurements in the medulla than the cortex and in the axial than the coronal plane.     

Novel approach to aortic cannulation suturing: tangential suture technique

BACKGROUND: Pursestring suture for ascending aortic cannulation in open heart surgery that requires cardiopulmonary bypass may cause serious events, especially in patients who have a thin or calcific aorta. We introduce a novel suturing method, called the 'tangential suture technique', and submit our clinical experience. METHODS: Adult patients undergoing cardiopulmonary bypass were included in this study. Patients in whom the tangential suture technique was applied (Group A; n = 146) were compared with patients in whom the classic pursestring technique was applied (Group B; n = 152). RESULTS: The age (38 +/- 11 years vs 36 +/- 10 years), sex (males 65.1% vs 62.5%) and operation types were similar in both groups. Although the difference was not significant (P > 0.05), subadventitial haematoma occurred more frequently in Group B (13 patients; 8.6%) than in Group A (3 patients; 2.1%). However, none in Group A required opening the adventitia. No aortic dissection was observed in peri- or postoperative periods in either group. In Group B, seven (4.6%) patients required repair by suture after tying of pursestring sutures following decannulation because of bleeding, while none was required in Group A (P = 0.0156). CONCLUSIONS: Tangential suture technique allows the needle to take a longer segment from the media layer while decreasing the likelihood of entering the lumen. Because the tract of the suture almost perfectly fits to the needle curve, tissue injury is less, even on fragile aortas, and this ensures more stable closure of the hole when the suture is tied following decannulation. By considering both its theoretical advantages and our clinical experience, we believe tangential suture technique should be preferred to the classic method.     

Intraspinal metalloma resulting in late paraparesis

The metal-related complications caused by orthopedic implants have long been a concern, but these problems have been considered mostly in the field of arthroplasty or internal fixation of fractures. The recent prevalence of spinal instrumentation has evoked a similar concern among spine surgeons. Here, we present a case of intraspinal metallosis adjacent to the pedicular hook occurring after treatment of vertebral fracture by posterior spinal instrumentation and fusion, and causing paraparesis at the 3rd postoperative year. Metallic granulomas can appear around the pedicular hooks as in the reported case. Crevice and fretting corrosion are results at the junctions of rod-screw, rod-hook, transverse connector rod and other connector rods in modular spinal implants. Adequate usage of transpedicular screws may inhibit the occurrence of such a complication. For this reason, further studies are necessary to increase metallic corrosive resistance to inhibit crevice and fretting corrosion.     

TNF Alpha−308 Genotype and Renin–Angiotensin System in Hemodialysis Patients: An Effect on Inflammatory Cytokine Levels?

BACKGROUND: Renin-angiotensin system (RAS) was suggested to modulate inflammatory cytokine production. Angiotensin II was consistently shown to increase production of tumor necrosis factor alpha (TNF-alpha). However, inflammatory cytokines and RAS were modulated by genetic polymorphisms such as TNF-alpha-308 G > A and angiotensin-converting enzyme (ACE) I/D gene polymorphisms. The aim of this study was to investigate the effects of ACE and TNF-alpha genotypes on inflammatory cytokines in hemodialysis (HD) patients. METHODS: ACE I/D and TNF-alpha-308 G > A genotypes, pre- and postdialysis plasma renin activity (PRA), serum ACE, interleukin-1 beta (IL-1beta), and TNF-alpha levels were determined in 22 HD patients. RESULTS: Predialysis serum ACE activity is correlated with TNF-alpha (r = 0.63; P = 0.01), and PRA was correlated with IL-1beta levels (r = 0.49; P = 0.02). Pre/postdialysis IL-1beta and TNF-alpha were similar in DD and II/ID ACE genotypes. Predialysis TNF-alpha and IL-1beta (32.4 +/- 5; 35.1 +/- 4.2 vs. 28.1 +/- 3.7; 26.5 +/- 6.2 pg/mL; P < 0.05) and postdialysis TNF-alpha levels (30.4 +/- 1.4 vs. 28.4 +/- 0.82 pg/mL; P < 0.05) were significantly higher in TNF1/2 than TNF1/1 patients. CONCLUSION: ACE and TNF-alpha-308 G > A (1/2) gene polymorphisms may contribute to modulation of proinflammatory cytokine production and hence chronic inflammation in HD patients.