Methicillin-resistant Staphylococcus aureus carrying SCCmec type II was more frequent than the Brazilian endemic clone as a cause of nosocomial bacteremia

Fifty consecutive MRSA blood isolates were evaluated: 30(60%) carried SCCmec type II (single PFGE clone; sequence type 5 or ST105); 12 (26%), IV; 5 (10%), III; 3 (6%), I. Brazilian endemic clone, carrying SCCmec type III, has been the main nosocomial clone in Brazil; however, this study showed that a clone carrying type II predominated.     

Vagus nerve stimulation: effectiveness and tolerability in patients with epileptic encephalopathies

Purpose  

We discuss the effectiveness, tolerability, and safety of vagus nerve stimulation (VNS) as adjunctive therapy in 26 patients with refractory epileptic encephalopathies (EEs).     

Mycobacterium bovis abdominal aortic and femoral artery aneurysms following intravesical bacillus Calmette–Guérin therapy for bladder cancer

BackgroundInfectious complications of intravesical bacillus Calmette–Guérin (BCG) therapy are rare, but these have included a handful of cases of mycotic aneurysm.Methods and ResultsWe present the case of a patient with a ruptured abdominal aortic aneurysm and a femoral artery aneurysm who had previously received intravesical BCG therapy for bladder carcinoma. Histopathologic examination of resected tissue revealed numerous acid-fast bacilli, and subsequent mycobacterial culture of blood and resected tissue revealed BCG strain Mycobacterium bovis.ConclusionsClinicians should be aware of the possible extravesical complications, albeit rare, of BCG therapy. Therapy should consist of combined medical and surgical management.     

Understanding the patterns of adjustment to infertility of IVF users using narrative and autobiographical timeline

ObjectiveTo examine how Hong Kong Chinese women and men coped with and adjusted to the infertility problem over time.MethodsUsing purposive sampling and theoretical sampling, nine heterosexual couples and ten women who had completed IVF were recruited. Data were collected using a narrative interviewing technique and autobiographical timeline, based on a grounded theory approach.ResultsRegardless of the outcome of IVF, coping with infertility and treatment was emotionally taxing. Four themes relating to the coping experiences were identified and captured innovatively in pictorial and narrative forms. They were: ‘one of the many’, resilience, recovery and prolonged grief. The findings concurred with the existing literature – coping with infertility is emotionally taxing, and variability exists in the degree of adjustment to infertility, which in turn influences well-being. The study also demonstrated the advantages of creative use of clinical-interview methods in research on couples subjective and lived experience of infertility.ConclusionThe findings suggest that the participants varied in their coping and adjustment to the experience of infertility, with most of them demonstrated positive meanings and resiliency over time. The combined use of both clinical-interview methods helped to facilitate exploration and articulation of the lived experiences of infertility among participants, allowing both in-depth understanding of the phenomenon and adherence to methodological rigor. The clinical-interview research methods can also promote evidence-based reflective practice for researchers and an empowering experience for participants.     

Susac's syndrome: Intratympanic therapy for hearing loss and a review of the literature

Two cases of Susac's Syndrome are presented with a discussion of treatment modalities for the associated severe sensorineural deafness. Patients were managed with high dose oral steroids, anticoagulants and immunosuppressive drugs. The addition of intratympanic methylprednisolone injections were added to one patient's regimen with initial improvement but subsequent relapse and progression to profound deafness. The management of Susac's syndrome is difficult and still in need of innovative methods as the standard treatment continues to be ineffective in the long term. Laryngoscope, 119:141–144, 2009     

Viral Infections of the Central Nervous System: A Case-Based Review

Three patients with viral infections of the central nervous system (CNS) were evaluated on an inpatient infectious diseases consultation service within a two-week period. These cases, caused by herpes simplex virus, varicella zoster virus and enterovirus, highlight the importance of viral pathogens in causing debilitating infections of the CNS and provide examples of the utility of molecular diagnostics in evaluating patients with encephalitis and meningitis. The importance of antiviral therapy is particularly underscored by these cases, as is the variability in response of patients to such agents.     

Accidental displacement and migration of endosseous implants into adjacent craniofacial structures: A review and update

Objectives: Accidental displacement of endosseous implants into the maxillary sinus is an unusual but potential complication in implantology procedures due to the special features of the posterior aspect of the maxillary bone; there is also a possibility of migration throughout the upper paranasal sinuses and adjacent structures. The aim of this paper is to review the published literature about accidental displacement and migration of dental implants into the maxillary sinus and other adjacent structures. Study Design: A review has been done based on a search in the main on-line medical databases looking for papers about migration of dental implants published in major oral surgery, periodontal, dental implant and ear-nose-throat journals, using the keywords “implant,” “migration,” “complication,” “foreign body” and “sinus.” Results: 24 articles showing displacement or migration to maxillary, ethmoid and sphenoid sinuses, orbit and cranial fossae, with different degrees of associated symptoms, were identified. Techniques found to solve these clinical issues include Cadwell-Luc approach, transoral endoscopy approach via canine fossae and transnasal functional endoscopy surgery. Conclusion: Before removing the foreign body, a correct diagnosis should be done in order to evaluate the functional status of the ostiomeatal complex and the degree of affectation of paranasal sinuses and other involved structures, determining the size and the exact location of the foreign body. After a complete diagnosis, an indicated procedure for every case would be decided. Key words:Implant, oral surgery, foreign body, paranasal sinuses, displacement, migration.