Bacteriology of the anal wound after open hemorrhoidectomy

The purpose of this study is to analyze the size of the bacterial colonies in anal wounds after open hemorrhoidectomy. Twenty patients were studied during predetermined postoperative time periods. Material was collected from the surface and from within the tissue of each patient's three open wounds, intraoperatively, on the 6th, 13th and 20th postoperative days for bacteriologic examination in aerobic, microaerophilic, and anaerobic media. The bacterium most commonly identified was Escherichia coli,followed by Staphylococcus aureus and Staphylococcus epidermidis. Pseudomonas aeruginosa, Enterococcus faecalis, Klebsiella pneumoniae, Proteus vulgaris,and Proteus mirabilis were also identified. Critical indexes of colonization were present since the intraoperative stage (>10 ⁵ bacteria/g of tissue and >10 ⁶ bacteria/ml); obligate anaerobic bacteria were not identified; neither the species nor the number of bacteria, even when critical indexes were present, prevented proper healing. The same bacteria were not necessarily present on the surface and in the tissue; the bacterial load observed among the three wounds (left lateral, right posterior, and right anterior), was the same.Presented at the Postgraduate Course, Surgical Technique and Experimental Surgery, offered by the Escola Paulista de Medicina (Paulista Medical School) and the Department of Biomedical Sciences of the University of Taubaté, São Paulo, Brazil.     

Transfer of EMG Training: Another Look at the General Relaxation Issue

A study was made of the extent to which electromyographic (EMG) response-decrease training with biofeedback on each of two successive sites would affect the other site in terms of generalization and transfer of training. Thirty-two subjects were assigned to four groups of equal size. Groups Frontal-Arm and Arm-Frontal were first provided with auditory feedback for EMG responses on either the forehead (frontal) or forearm extensor areas in an initial set of training sessions and on the alternate area in a second set of training sessions. Control groups Relax-Arm and Relax-Frontal were provided with instructions designed to induce “motivated relaxation” on one of the two sites in initial training followed by biofeedback training on the alternate site in subsequent training. The EMG training, but not the instructions, resulted in reduced EMG potentials in both the forearm and frontal areas. However, training on one site did not appear to facilitate more rapid acquisition of reduced potentials (transfer of training) during subsequent biofeedback on the alternate site. There was also no evidence for generalized training effects in the form of reduced potentials on other sites, skin temperatures, or self-reports at the time of training on one site.     

Case for diagnosis

Idiopathic Atrophoderma of Pasini and Pierini (IAPP) is a rare, exclusivelycutaneous disease. It is more frequent in females, with incidence peak in thesecond and third decades of life. The etiopathogenesis remains unknown. IAPPmost commonly affects the back, abdomen and proximal regions of the limbs.Lesions may be rounded, oval or circular; single or multiple. The evolution isvariable and the course is initially progressive. Collagen changes such asatrophy, thinning, condensation and sclerosis may be observed in the papillarydermis. This paper describes a case of Idiopathic Atrophoderma of Pasini andPierini with histopathologic findings.     

A Performance Assessment Method for Hospitals: The Case of Municipal Hospitals in Angola

Over 60% of the recurrent budget of the Ministry of Health (MoH) in Angola is spent on the operations of the fixed health care facilities (health centres plus hospitals). However, to date, no study has been attempted to investigate how efficiently those resources are used to produce health services. Therefore the objectives of this study were to assess the technical efficiency of public municipal hospitals in Angola; assess changes in productivity over time with a view to analyzing changes in efficiency and technology; and demonstrate how the results can be used in the pursuit of the public health objective of promoting efficiency in the use of health resources. The analysis was based on a 3-year panel data from all the 28 public municipal hospitals in Angola. Data Envelopment Analysis (DEA), a non-parametric linear programming approach, was employed to assess the technical and scale efficiency and productivity change over time using Malmquist index.The results show that on average, productivity of municipal hospitals in Angola increased by 4.5% over the period 2000–2002; that growth was due to improvements in efficiency rather than innovation.     

Analysis of the Risk of Wear on Cemented and Uncemented Polyethylene Liners According to Different Variables in Hip Arthroplasty

Wear debris in total hip arthroplasty is one of the main causes of loosening and failure, and the optimal acetabular fixation for primary total hip arthroplasty is still controversial because there is no significant difference between cemented and uncemented types for long-term clinical and functional outcome. To assess and predict, from a theoretical viewpoint, the risk of wear with two types of polyethylene liners, cemented and uncemented, a simulation using the finite element (FE) method was carried out. The risk of wear was analyzed according to different variables: the polyethylene acetabular component’s position with respect to the center of rotation of the hip; the thickness of the polyethylene insert; the material of the femoral head; and the relationship of the cervical–diaphyseal morphology of the proximal end of the femur to the restoration of the femoral offset. In all 72 simulations studied, a difference was observed in favour of a cemented solution with respect to the risk of wear. With regard to the other variables, the acetabular fixation, the thickness of the polyethylene, and the acetabular component positioning were statistically significant. The highest values for the risk of wear corresponded to a smaller thickness (5.3 mm), and super-lateral positioning at 25 mm reached the highest value of the von Mises stress. According to our results, for the reconstruction of the acetabular side, a cemented insert with a thickness of at least 5 mm should be used at the center of rotation.     

Prosthetic hip infection due to Brucella melitensis: case report and literature review

Prosthetic joint infection (PJI) due to Brucella spp. is extremely rare. We report the case of a prosthetic hip infection due to Brucella melitensis in a 51-year-old male patient. The initial presentation was a gluteal abscess. There was radiographic evidence of implant loosening. The patient was cured after prolonged treatment with streptomycin, rifampicin, and doxycycline, followed by 2-stage exchange of the prosthesis. Brucella spp. should be considered in the differential diagnosis of PJI in countries where brucellosis is endemic. The review of all cases previously reported shows that a conservative approach using antibiotics alone can be followed in patients without signs of implant loosening. In contrast, prolonged antibiotic treatment and prosthetic joint revision should be considered in patients with evidence of implant loosening.     

Structural features of linear,homo‐Aib‐based peptides in solution: a spectroscopic and molecular mechanics investigation

Abstract: In continuation of our studies on the determination of the structural features of functionalized peptides in solution by combining time‐resolved fluorescence data and molecular mechanics results, the conformational properties of a series of linear, homo‐Aib peptides in methanol (a structure‐supporting solvent) were investigated. These compounds have the general formula P(Aib)_nN, where Aib is α‐aminoisobutyric acid, N is naphthalene and P is the monomethylated protoporphyrin IX, the two latter chromophores being covalently attached to the peptide C‐ and N‐termini, respectively, while n = 3, 6 and 9. According to ¹H NMR and IR spectra, the peptides investigated largely populate a 3₁₀‐helical structure in CDCl₃, which is also a structure‐supporting solvent. Both steady‐state and time‐resolved fluorescence measurements show a strong quenching of the N emission that parallels an increase of the P fluorescence intensity, suggesting the occurrence of long‐range energy transfer from ¹N* to ground‐state P. Comparison of quenching efficiencies and lifetime pre‐exponents with those obtained theoretically from the deepest energy minimum conformers is very satisfactory. The computed structures, built up by partially taking into account the solvent medium, exhibit a rigid, highly compact arrangement, owing to both the 3₁₀‐helix conformation of the backbone chain and the very few peptide‐to‐chromophore covalent linkages. As a result, only one or two stable conformations for each peptide were theoretically found, in full agreement with the time‐resolved fluorescence data. Orientational effects between the probes must be taken into account for a correct interpretation of the fluorescence decay results, which implies that interconversion among conformational substates of the N linkages is slower than 10 ns, corresponding to the upper limit of the energy transfer
characteristic time.     

Derivative spectrophotometry in the analysis of mixtures of cefotaxime sodium and cefadroxil monohydrate

Derivative spectrophotometry (ratio-spectra 1st- and 2nd-derivative and zero-crossing 2nd-derivative techniques) was applied for the determination of some cephalosporins in two component mixtures. Cefotaxime sodium salt (C(16)H(16)O(7)N(5)S(2)Na) and cefadroxil monohydrate (C(16)H(17)N(3)O(5)S.H(2)O) were examined. In all procedures, the calibration plots are linear up to 43 microg/ml of each antibiotic, with r ranging from 0.9997 to 0.9999. In the ratio-spectra method, the measurements were taken at 239.5 and 291.5 nm (cefotaxime, 1st-derivative), 238 and 283 nm (cefadroxil, 1st-derivative), 284 and 303 nm (cefotaxime, 2nd-derivative), and 229.5 and 245.5 nm (cefadroxil, 2nd-derivative). Detection limits at P=0.05 level of significance, calculated by a statistical treatment of calibration data, ranged from 0.15 to 0.58 microg/ml. LOD and LOQ ranged, respectively, from 0.19 to 0.51 and from 0.63 to 1.70 microg/ml. By the zero-crossing 2nd-derivative method, lines of regression are linear at 257 and 279 nm (cefotaxime) and 242 and 296 nm (cefadroxil). Detection limits from 0.28 to 0.51 microg/ml. LOD and LOQ from 0.27 to 0.41 and from 0.90 to 1.37 microg/ml, respectively. All the samples were tested for stability in solution and in the course of actual analysis, up to 80 h from their preparation. The developed derivative spectrophotometric methods were applied to synthetic mixtures and the RSD values ranged between 0.05 and 1.35% (ratio-spectra technique) and 0.01 and 1.07% (zero-crossing technique). The methods were also applied to vials and tablets for these drugs. The recoveries obtained were between 100.9 and 102.4% (ratio-spectra) and between 99.8 and 102.0% (zero-crossing). The procedures are simple, rapid, and did not require any preliminary separation or treatment of the samples. Instrumentation commonly available was utilised. The cephalosporins analysed are frequently used antibiotics of relevant clinical and pharmacological importance; hence this work would be of interest for the readers of journals devoted to pharmaceutical and biomedical analysis.