Antibiotic prophylaxis in elective thoracic surgery: cefuroxime versus cefepime

BACKGROUND: Infection is one of the major morbidity factors after thoracic surgery. Although different prophylactic regimens have been used to prevent this complication, the ideal prophylactic agent, dose and duration of administration remain unknown. METHODS: All patients included underwent elective lung resection. 102 selected patients consecutively scheduled for major thoracic surgery were enrolled in this study and randomized into either the cefuroxime group (n = 50) or the cefepime group (n = 52). RESULTS: Twelve pathologic bacterium strains were isolated in the cefepime group, whereas only 5 pathogenic strains were isolated in the cefuroxime group; the difference was statistically significant (p = 0.04). Two empyemas (3.8 %) in the cefepime group were noted, while the cefuroxime group showed no cases of empyema (p = 0.16). Overall infection rate (pneumonia + bronchopneumonia + empyema) were 14.0 % and 26.7 % in the cefuroxime and the cefepime groups, respectively (p = 0.12). Using chest radiography, pulmonary infiltration was found to be more frequent in the cefuroxime group (p=0.002). CONCLUSION: Cefuroxime as a prophylactic agent in major thoracic surgical operations was marginally more effective than cefepime, and presented an additional cost advantage.     

Long-term effects of beta blocker therapy on P-wave duration and dispersion in congestive heart failure patients: a new effect?

Atrial fibrillation (AF) is associated with heart failure in approximately 20%-50% of patients with increased morbidity and mortality. P-wave maximum duration (PWM) and P-wave dispersion (PWD) are recent ECG markers and reflect increased risk of AF. The aim of our study was to investigate the long-term effects of metoprolol on atrial conduction abnormalities as estimated by PWM and PWD, which were calculated on 12-derivation surface ECG in heart failure patients. Forty-two NYHA class 3 to 4 patients (23 males, 19 females and aged 52.9 +/- 11.2) were enrolled in the study. At the end of the 6 months, PWM and PWD values were significantly decreased (for PWM: from 115.2 +/- 12.6 to 105.4 +/- 13.5; for PWD: from 39.3 +/- 9.1 to 28.6 +/- 10.5; P <.001 for both). Metoprolol treatment is associated with a decreased duration of PWM and PWD and this may reflect a reduction in the probability of atrial fibrillation in heart failure patients.     

Pedunculated uterine leiomyoma associated with pseudo-Meigs' syndrome and elevated CA-125 level: CT features

A 38-year-old woman presented with a 1-week history of low back pain, distension, weakness, and loss of appetite. Laboratory studies showed a serum CA-125 level of 281 U/ml (normal value 1.2-32 U/ml). Abdominopelvic sonography revealed massive ascites, left pleural effusion, and a heterogeneous, hypoechogenic, and smoothly outlined solid mass. The mass had a close proximity and to the anterior side of the right ovary. Doppler sonography showed that the mass was hypervascularized. Computed tomography demonstrated numerous, tortuous vascular structures around the mass and along the omentum indicating its auxiliary vascularization from the omentum. Exploratory laparotomy and histopathological examination revealed pedunculated leiomyoma with parasitized blood supply from the omentum. Ascites and pleural effusion disappeared 6 months after surgery. We present the clinical and CT features of a parasitic leiomyoma adhering to the omentum.     

Intraocular pressure changes in the vitreon study

BACKGROUND AND OBJECTIVE: To detect the effect of Perfluoroperhydrophenanthrene (vitreon) on intraocular pressure (IOP) changes. PATIENTS AND METHODS: One hundred-five eyes with proliferative vitreoretinopathy undergoing vitrectomy using vitreon as an intraoperative surgical adjunct were randomized to 2 groups. Vitreon was completely removed in 43 eyes (Group A) at the end of operation while it was left intravitreally in 62 eyes (Group B) for 4 weeks. Patients were followed for at least 18 months. RESULTS: During the first postoperative week, 6 eyes (14%) in Group A and 14 eyes (22%) in Group B had IOP of 23 mm Hg or more (P = .393) while no eyes in either group had hypotony. At the last follow-up 2 eyes (5%) in Group A and 6 eyes (10%) in Group B showed chronic hypotony (P = .561). CONCLUSION: Although postoperative chronic hypotony risk increased twofold by vitreon when it was left intravitreally for 4 weeks, this difference was statistically insignificant. Vitreon can be used as a vitreous substitute for 4 weeks in this regard.     

Investigation of serum vitamin A levels of children who had a history of recurrent diarrhoea and acute respiratory infections in Ankara

Vitamin A deficiency is considered a widespread public health problem among preschool children in the developing countries. A limited number of studies reveal an association between xerophthalmia and significant systemic diseases including protein-energy malnutrition, diarrhoea, and acute respiratory infections. The present study was carried out to assess the vitamin A status of preschool children who have a history of recurrent acute respiratory infections and diarrhoea. We have already shown that serum vitamin A levels of all the study groups were lower than the control group (P less than 0.001) and the detailed statistical analyses made clear that malnutrition is the major contributing factor (P less than 0.001) although infections also have a negative effect on serum vitamin A levels (P less than 0.01). We have also shown that subclinical vitamin A deficiency is a problem of public health importance in this region, since about 64 per cent of the children examined were found to have low levels of serum vitamin A (less than 20 micrograms/dl).     

Clinical significance of acute traumatic intracranial pneumocephalus

Among 1142 patients with head injuries hospitalized in the Neurosurgery Department of Gazi University Medical School during the period between 1979 and 1992, 583 had initial CT scans. A retrospective analysis of these initial CT images revealed intracranial air on admission in only 21 cases. These were classified as acute traumatic intracranial pneumocephalus: a potentially serious complication of head injury.CT scans were re-evaluated so as to reveal whether air was situated in the epidural, subdural, or subarachnoid spaces or intracerebrally; whether associated space-occupying lesions were present; and whether the air bubbles were single or multiple. Clinical data such as the presence of persistant rhinorrhea and/or otorrhea, tension pneumocephalus, severity and type of trauma, and outcome were also assessed to determine the significance of this rare finding.     

Misoprostol moistened with acetic acid or saline for second trimester pregnancy termination: a randomized prospective double-blind trial

BACKGROUND: This study was conducted to evaluate the efficacy and side effects of a new regimen of 800 microg misoprostol administered intravaginally every 6 h up to a maximum of three doses in 24 h for second trimester pregnancy termination. METHODS: A total of 66 women seeking termination of second trimester pregnancy (30 fetal structural anomaly, six chromosomal abnormality and 30 fetal death) were randomly assigned to one of two treatment groups: (i) intravaginal misoprostol moistened with 3 ml of 5% acetic acid in group A (n = 33); or (ii) intravaginal misoprostol moistened with 3 ml of saline in group B (n = 33). RESULTS: The overall median (range) induction-abortion interval was 10 h (2-46) [10 h (4-35) in 36 live fetuses and 9 h (2-46) in 30 dead fetuses, P = 0.515]. All of the patients in both groups aborted within 48 h (100% success rate). The median (range) induction-abortion interval revealed a significantly faster delivery time (P < 0.001) in group A [8 h (2-24)] than in group B [14 h (3-46)]. CONCLUSIONS: This new regimen of 800 microg of vaginal misoprostol every 6 h for a maximum of three doses in 24 h was an effective alternative method for second trimester abortion. In addition, misoprostol moistened with acetic acid was significantly more effective than misoprostol moistened with saline.     

A recurrent homozygous LMNA missense variant p.Thr528Met causes atypical progeroid syndrome characterized by mandibuloacral dysostosis,severe muscular dystrophy,and skeletal deformities

Atypical progeroid syndromes (APS) are premature aging syndromes caused by pathogenic LMNA missense variants, associated with unaltered expression levels of lamins A and C, without accumulation of wild-type or deleted prelamin A isoforms, as observed in Hutchinson-Gilford progeria syndrome (HGPS) or HGPS-like syndromes. A specific LMNA missense variant, (p.Thr528Met), was previously identified in a compound heterozygous state in patients affected by APS and severe familial partial lipodystrophy, whereas heterozygosity was recently identified in patients affected by Type 2 familial partial lipodystrophy. Here, we report four unrelated boys harboring homozygosity for the p.Thr528Met, variant who presented with strikingly homogeneous APS clinical features, including osteolysis of mandibles, distal clavicles and phalanges, congenital muscular dystrophy with elevated creatine kinase levels, and major skeletal deformities. Immunofluorescence analyses of patient-derived primary fibroblasts showed a high percentage of dysmorphic nuclei with nuclear blebs and typical honeycomb patterns devoid of lamin B1. Interestingly, in some protrusions emerin or LAP2α formed aberrant aggregates, suggesting pathophysiology-associated clues. These four cases further confirm that a specific LMNA variant can lead to the development of strikingly homogeneous clinical phenotypes, in these particular cases a premature aging phenotype with major musculoskeletal involvement linked to the homozygous p.Thr528Met variant.     

Effect of exercise on blood pressure in rats with chronic NOS inhibition

Regular training lowers blood pressure in hypertensive humans and other animals. We investigated the response to 4 weeks of treadmill exercise training in hypertensive male Wistar rats receiving the nitric oxide synthase inhibitor N ^ω-nitro-L-arginine methyl ester (L-NAME). The rats were on either a short- (4 weeks) or long-term (10 weeks) L-NAME treatment protocol and were subjected to running exercise that started concomitantly in the short-term group and in the 6th week in the long-term group. Four weeks of exercise training induced a fall in mean arterial pressure in both the short- [mean (SEM) 137.6 (4.0) mmHg] and long-term hypertensive groups [161.4 (2.3) mmHg] compared to their sedentary hypertensive controls [160.4 (3.3) mmHg and 176.8 (8.9) mmHg, respectively]. Exercise also increased muscle nitric oxide synthase activity in both of the trained hypertensive groups. Muscle nitrite levels were higher in the exercising short-term hypertensive group compared to both the sedentary control and the sedentary hypertensive groups, and were not different between the sedentary and exercising long-term hypertensive groups. Increased wall thickness of the aortic and mesenteric vessels was observed in the hypertensive groups, but was prevented in the exercising long-term hypertensive group. In rat, exercise reduces the elevated blood pressure in L-NAME-induced hypertension via increasing nitric oxide synthase activity. Changes in vessel structure with exercise training may also be involved in the blood-pressure-lowering effects. Electronic Publication