Dimensions and anatomic variations of left main coronary artery in normal population: multidetector computed tomography assessment

OBJECTIVES: The aim of our study was to determine the dimensions, morphology and anatomic variations of the left main coronary artery (LMCA) in normal participants, on multidetector computed tomography. BACKGROUND: Accurate imaging of LMCA dimensions and configuration is crucial to avoid misdiagnosis of LMCA disease. MATERIALS AND METHODS: Seventy morphologically normal LMCAs of 70 participants were carefully selected from among 600 consecutive coronary computed tomography angiography studies performed in our institute. LMCA cross-sectional diameters and areas were obtained at three points of each vessel: ostium, midvessel and distal. The length, cross-sectional shape, three-dimensional (3D) morphology and position of origin were studied. Influences of age, body weight, height and body surface area (BSA) on LMCA dimensions were evaluated. RESULTS: Different dimensions in each measured point of the LMCA were detected. Cross-sectional elliptic shape at ostium, mid-LMCA and distal LMCA was found in 66/70 (94%), 51/70 (73%) and 54/70 (77%) of the participants, respectively. On the basis of the 3D presentation, four types of LMCA were identified: biconcave-shape appearance (type 1), tapering morphology (type 2), combined morphology (type 3) and funnel-shape appearance (type 4). Fifty-two of the 70 participants had an LMCA orifice originating in the middle third of the aortic sinus, 15/70 in the posterior third and 3/70 in the anterior third. In men, significant correlation was found between LMCA cross-sectional area and body weight, height and BSA. In women, no correlation was found regarding body weight, height and BSA. CONCLUSION: LMCA is not a simple straight tube but usually has various anatomical configurations, variable dimensions and cross-sectional shapes. Ostial angulation is a normal variant usually associated with the posterior position of the LMCA orifice of origin in the aortic sinus.     

Infective endocarditis caused by daptomycin-resistant Enterococcus faecalis: a case report

Daptomycin is a first-in-class antibiotic with efficacy against Gram-positive bacteria. We document the second report of daptomycin resistance in a clinical isolate of Enterococcus faecalis.     

Expression of antimicrobial peptides in the normal and involved skin of patients with infective cellulitis

BACKGROUND: Endogenous antimicrobial peptides participate in the innate defense of skin against a variety of pathogens. The systemic expression of these peptides in normal-appearing skin of patients with infective cellulitis is unknown. METHODS: Study patients were adults with infective cellulitis and signs of systemic inflammation. Skin biopsy and serum specimens were obtained from patients and from control subjects with no active infection. Cathelicidin and human beta-defensin 2 mRNA expression were determined by real-time polymerase chain reaction. RESULTS: Skin biopsy specimens from 11 patients and 4 uninfected control subjects were analyzed. The relative expression level for cathelicidin mRNA was elevated in both the involved and the distal normal-appearing skin of patients with cellulitis, compared with expression in the skin of control subjects (mean ratios, 39.46 vs. 1.32, P=.0059; and 21.41 vs. 1.32, P=.0059). Similarly, the relative expression level of human beta -defensin 2 mRNA was elevated in both the involved skin (mean ratios, 20,844 vs. 11.65; P=.0015) and in distal normal-appearing skin of patients with cellulitis (mean ratios, 201.1 vs. 11.65; P=.0103). DISCUSSION: In response to cutaneous infection there is a local and distal increase in endogenous antimicrobial peptide mRNA in both involved and normal-appearing skin. These observations show, for the first time to our knowledge, that after infection the human body responds by increasing systemic innate immunity.     

Telavancin for the treatment of serious gram-positive infections, including hospital acquired pneumonia

INTRODUCTION: Hospital-acquired pneumonia is a common infection, associated with substantial mortality. Despite the increasing prevalence of nosocomial pneumonia caused by methicillin-resistant Staphylococcus aureus (MRSA), approved treatment options for this pathogen are limited. AREAS COVERED: This article reviews the pharmacokinetics, dosing, preclinical studies and clinical efficacy, and safety of telavancin, with a particular focus on results from trials in nosocomial pneumonia. PubMed and Congress websites were searched for relevant articles published between 2003 and 2010. EXPERT OPINION: Telavancin is a lipoglycopeptide antibiotic with rapid, bactericidal activity against MRSA, and may provide another option for the treatment of nosocomial pneumonia, owing to Gram-positive pathogens.     

Surgical volume and the risk of surgical site infection in community hospitals: size matters

OBJECTIVE: To determine if surgical volume affects the risk of surgical site infections (SSI) in community hospitals. BACKGROUND: The utility of public reporting and the optimal methods to employ when reporting SSI rates remain controversial and contentious issues. Studies examining the association between surgical volume and SSI risk have included few community hospitals and have reported conflicting results. METHODS: A prospective study of surgical procedures performed at 18 community hospitals from January 1, 2004 to December 31, 2005, was performed. Hospitals were separated based on average surgical volume per year: small (<1500 procedures), medium (1500 < or = procedures < 4000), and large (> or =4000 procedures). The risk of SSI for each category was determined using multivariable Poisson regression. RESULTS: Prospective surveillance identified 1434 SSIs after 132,111 surgical procedures (prevalence rate = 1.09/100 procedures). In unadjusted analysis, the risk of SSI was almost twice as high at small hospitals [prevalence rate ratio (PRR) = 1.9 (95% CI 1.78-2.05)] and large hospitals [PRR = 1.79 (95% CI 1.70-1.90)] compared with medium hospitals. After adjusting for differences between hospital category and important confounders, the risk of SSI at small hospitals was still 1.5 times higher than medium hospitals [adjusted PRR = 1.49 (95% CI 1.39-1.60)], whereas the risk at large hospitals was substantially decreased compared with medium hospitals [adjusted PRR = 1.29 (95% CI 1.22-1.36)]. OUTCOMES: The relationship between hospital surgical volume and rates of SSI in community hospitals is important and complex. As public reporting of SSI rates expands, improved methods for risk-adjusting infection rates are needed.