Pancreatic Pseudocyst as a Cause of Gastrointestinal Bleeding and Hemobilia

A case of hemobilia from a pancreatic pseudocyst which developed after cholecystostomy and aspiration of the pseudocyst, intended to relieve biliary obstruction, is discussed. These previously reported cases are briefly reviewed.     

Device-associated infections: a macroproblem that starts with microadherence.

Medical devices are responsible for a large portion of nosocomial infections, particularly in critically ill patients. Device-associated infections can cause major medical and economic sequelae. Bacterial colonization of the indwelling device can be a prelude to both infection and malfunction of the device. The pathogenesis of device-associated infection centers around the multifaceted interaction among the bacteria, the device, and the host. Bacterial factors are probably the most important in pathogenesis of infection, whereas device factors are the most amenable to modification with the objective of preventing infection. Some, but not all, of the studied bacterial receptors satisfy the proposed "adherence/infection" version of Koch's postulates. Traditional surface-modifying preventive approaches have largely focused on antimicrobial coating of devices and resulted in variable clinical success in preventing device-associated infections. The potential protective role of newer innovative approaches, such as biofilm modification and bacterial interference, ought to be further investigated.     

Of mice,men, and King Tut: autosomal recessive Klippel–Feil syndrome is caused by mutations in MEOX1

Mutations in MEOX1, encoding mesenchyme homeobox 1, cause Klippel‐Feil anomaly. Jawahir et al. (2013) The American Journal of Human Genetics 92: 157–161     

In Vitro Activity and Durability of a Combination of an Antibiofilm and an Antibiotic against Vascular Catheter Colonization

Catheter-associated infections can cause severe complications and even death. Effective antimicrobial modification of catheters that can prevent device colonization has the potential of preventing clinical infection. We studied in vitro the antimicrobial activities of central venous catheters impregnated with N-acetylcysteine (NAC), an antibiofilm agent, and a broad-spectrum antibiotic against a range of important clinical pathogens. NAC-levofloxacin-impregnated (NACLEV) catheters were also evaluated for their antiadherence activity. NACLEV catheters produced the most active and durable antimicrobial effect against both Gram-positive and Gram-negative isolates and significantly reduced colonization (P < 0.0001) by all tested pathogens compared to control catheters. These in vitro results suggest that this antimicrobial combination can potentially be used to combat catheter colonization and catheter-associated infection.     

Staphylococcus aureus Bacteriuria: Source, Clinical Relevance, and Management

Staphylococcus aureus bacteriuria is a common condition with still largely undetermined clinical relevance. Although S. aureus bacteriuria can be secondary to bacteremia and systemic infection in some patients, it may predispose to bacteremia and invasive disease in others. Whereas most patients with S. aureus bacteriuria do not have symptomatic urinary tract infection, it is reportedly associated with endocarditis and other types of invasive diseases, thereby resulting in major morbidity and occasional mortality. This review summarizes and analyzes the results of previous reports of S. aureus bacteriuria and assesses the clinical relevance and management of this increasingly recognized entity.     

Association of hypercoagulable states and increased platelet adhesion and aggregation with bacterial colonization of intravenous catheters

Bacterial adherence to intravenous catheters may be mediated, in part, by adherence to coagulation proteins and platelets. The possibility that catheter infection is associated with gene polymorphisms that cause hypercoagulability or increased platelet stickiness was examined. Among patients with infected catheters, there was no increase in the frequency of polymorphisms that increase coagulability, including factor V Leiden R506G, factor II (prothrombin) G20210A, and methylenetetrahydrofolate reductase C677T, compared with control subjects. The incidence of polymorphisms of the platelet beta(3) integrin among patients with infected catheters was also similar to that among control subjects. The C/D heterozygote of the variable number tandem repeat polymorphism and the C/T heterozygote of the KO polymorphism of glycoprotein Ibalpha were more frequent among patients with infected catheters than they were among control subjects. In a small proportion of patients, a genetic predisposition to platelet stickiness may be associated with infection of intravenous catheters, but in the majority, a recognized genetic tendency to hypercoagulability or platelet stickiness does not underlie infection.     

Image Processing for the Evaluation of Gastric Ulcer Scars Using a Personal Computer

Abstract: Image processing of gastric ulcer scars was conducted using a computer-equipped electronic endoscope in order to quantitatively classify the quality of gastric ulcer scars. Frontal images of 66 gastric ulcer scars (red scar stage), in 60 patients, obtained by electronic endoscopy were fed into a desktop computer system. Ulcer scars were classified according to the standard deviation of green signal intensity and unevenness of the scar surface, following repeated application of smoothing, into three groups. Group I: ulcer scars with a standard deviation of green signal intensity less than or equal to 15 and a flat surface after smoothing had been carried out 10 times. Group II: ulcers other than Group I or III. Group III: ulcers with a standard deviation greater than or equal to 25 and markedly uneven features after smoothing had been carried out 20 times. Follow-up gastroscopy examinations were performed at 2-week intervals and the cumulative recurrence rate, as well as the transition from red scar stage to white scar phase, were determined 7 months after initial healing. There were 15 Group I, 28 Group II and 23 Group III ulcer scars. The proportion of ulcer relapse was 6.7% in Group I, 35.7% in Group II and 47.5% in Group III. Regarding the relationship between the transition rate from red scar to white scar and the scar classification, 66.7% of Group I, 28.6% of Group II and 17.4% of Group III ulcer scars progressed to the white scar stage. This classification of gastric ulcer scars provides a representative index of the quality of ulcer healing, which is potentially useful for planning maintenance treatment.     

Predictors of Positive Head-Up Tilt Test in Patients with Suspected Neurocardiogenic Syncope or Presyncope

OH, J.H., et al .: Predictors of Positive Head-Up Tilt Test in Patients with Suspected Neurocardiogenic Syncope or Presyncope. Neurocardiogenic syncope is the most common cause of syncope in patients who present in outpatient clinics. Head-up tilt test (HUT) has been widely used to diagnose neurocardiogenic syncope. However, the HUT does not always produce a positive response in patients with suspected neurocardiogenic syncope. The aim of the present study was to assess the clinical history and characteristics of patients with suspected neurocardiogenic syncope or presyncope who undertook HUT, and to identify prognostic factors of a positive HUT response. During the first phase of HUT, patients were tilted to a 70-degree angle for 30 minutes. If the first phase produced a negative response, the second phase was subsequently performed involving intravenous isoproterenol administration. Of 711 patients, 423 (59.5%) patients showed a positive HUT response. In contrast to previous studies, this study showed that the vasodepressive type (76.6%) was the most common pattern of positive response, and that the rate of positive response during the first phase was low (7.1%). By multivariate analysis, the occurrence of junctional rhythm was found to be a predictor of an impending positive response in HUT   (P < 0.001)   . The shorter time interval between the last episode and HUT was also a predictor of positive response   (P = 0.0015)   . Younger age   (P = 0.0003)   and a history of physical injury during a syncopal episode   (P = 0.019)   were found to be associated with a positive response in the first phase of HUT. (PACE 2003; 26[Pt. I]:593–598)