METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS BACTERAEMIA AT A TERTIARY TEACHING HOSPITAL

SUMMARY Between July and December 1994, 25 patients with MRSA bacteraemia were treated at the Hospital Kuala Lumpur, a tertiary hospital in Malaysia with 3000 beds. The patients included 15 males and 10 females whose mean age was 46.7 years (range 13-75). The sources of their MRSA were: Urology/Nephrology, 11; General ICU, six; Orthopaedic, four; Medicine, three; Surgery, one. Their underlying diseases were: end-stage and chronic renal failure, 11; burns, three; acute necrotising pancreatitis, two; haematological malignancies, two; and one each of fracture of the neck of the femur, pustular psoriasis, alcoholic cirrhosis, liver abscess, peptic ulcer (antrectomy), choledochol cyst, and abdominal aneurysm with gangrene of the legs. Six patients were also diabetic. A total of 19 infections were considered nosocomial. The duration of hospital stay ranged from one to 60 days, mean 16 days. On the day of blood culture, 20 patients (80%) were febrile and 15 (60%) had leucocytosis. A total of 14 patients were considered to have received prolonged broad-spectrum antibiotics before the bacteraemia; of these, 11 had had either a third-generation cephalosporin and/or a quinolone. The primary foci of infection were: vascular access dialysis catheters, six; infected AV fistulae, three; non-surgical wounds, five; orthopaedic pin, one; multiple venous lines and catheters, nine; unknown, one. The sensitivities to anti-MRSA antibiotics were: vancomycin, 100%; fusidic acid, 96%; rifampicin, 96%; ciprofloxacin and perfloxacin 28% each. In all, 13 patients (52%) eventually died; nine of these deaths were directly attributed to MRSA bacteraemia. The microbiological eradication rate was 88%. Mortality was significantly associated with duration of hospital stay and failure to remove the infected catheters/peripheral lines after the development of MRSA bacteraemia.     

Infrainguinal arterial reconstruction for limb salvage in patients with end-stage renal disease.

OBJECTIVES: to evaluate the efficacy of infrainguinal bypass for limb-threatening ischaemia in patients with end-stage renal disease (ESRD). Materials and Methods: from 1991 through 2000, 28 limbs in 22 patients with ESRD received 33 infrainguinal bypasses, while 65 limbs in 57 patients with functioning kidneys underwent 77 bypasses for limb salvage. The prevalence of diabetes is higher in the ESRD group (p = 0.03). RESULTS: perioperative mortality and patient survival rate in the follow-up period were significantly poorer in patients with ESRD (18% vs 0%; p = 0.001, and 45% vs 85%, p < 0.001, respectively). Most causes of death were related to atherosclerosis or respiratory diseases. In spite of no significant difference in 2-year primary and secondary graft patency rates and limb salvage between the ESRD and non-ESRD groups (76% vs 83%; p = 0.12, 85% vs 91%; p = 0.06, and 83% vs 93%; p = 0.06, respectively), two cases of early limb loss occurred as a result of uncontrolled infection in the ESRD group. In contrast to autogenous conduits, nonautogenous conduits revealed a poorer outcome in ESRD patients (p = 0.03). CONCLUSIONS: perioperative mortality and patient survival rate were significantly poorer in the ESRD group. Preoperative full evaluation of myocardial and brain ischaemia, revascularisation with autogenous conduits, appropriate treatment of wound infection, and strict follow-up for accompanying diseases may be needed in these patients.     

Histological grading and staging of IgA nephropathy

More than 25 years have passed since immunoglobulln A (IgA) nephropathy was introduced as a disease entity inde pendent of glomerulonephritis. it has been known that more than 30% of cases have gona into end-stage renal fallure within 20 years, indicating the presence of a chornic active group in this disease. Histologicaily this disesase is com posed of at least three types of tissue damage:(1) minimal inflammation including deposition of IgA-containing sub stances with minor matriclal increase; (II) acute lesions char acterized by matricial damsge of glomerular basement membrane (membranolysis) and/or mesangial matrix (mes anglolysis) with inflammstory cell accumulation and/or intrinsic cell proliferation; and (III) chronic lesions mainly composed of postinfiammstory sclerosis. The progression is actually accelerated by the frequency of acute lesions, resuiting in increased glomerular scierosis focl. In such a situation, the histologic grading and stagi (G-S)system is proposed, with the aim of having a more preclse understanding of the disease prosses. The histological grade (G) is estimated by the extent of acute giomerular and tubulointer stitial lesions, and the stage (S) is evaluated by the increase of extracellular matrices of the glomerull and inerstitial fibrosis. The evaluation of G and S is expressed semiquanti tativety for more helpful clinical use.     

The CT diagnosis of emphysema and correlation with pathologic findings

It is difficult to diagnose clinically silent or mild emphysema. The efficacy of CT scans for the diagnosis of emphysema has attracted attention and comparisons have been made between CT images and the pathological grade of emphysema in resected lungs. With a view to determine to what extent high resolution CT images are accurate concerning the diagnosis of mild emphysema, we conducted an extensive comparative study on CT scores of emphysema, based on high resolution CT, the pathology score derived from the cut surface of the lung identical in its plane with that of the CT and destructive index (DI) which is said to be instrumental in representing the degree of deterioration of alveolar walls in the same regions of the lungs. In this study, 42 patients who underwent thoracotomy and their lung specimens including a solitary nodule of considerable size have been employed. The CT scores and pathology scores depend on the picture grading system developed by Thurlbeck and coworkers for the basis of counting. The findings were such that with 1 mm collimation, the CT scores ranged between 12 and 57 with a mean +/- SD of 22.1 +/- 9.6 (n = 35) while with 5 mm collimation, the CT scores ranged between 7 and 46 with a mean +/- SD of 16.5 +/- 8.3 (n = 33). The pathology scores stood at 10 to 57 with a mean +/- SD of 23.2 +/- 9.8 (n = 42).(ABSTRACT TRUNCATED AT 250 WORDS)     

Aminopyrine metabolism in primary monolayer cultures of diabetic rat hepatocytes

1. A new support system has been used which provides long-term maintenance of rat liver parenchymal cells in monolayer cultures. The cells, maintained on collagen gel/polychlorinated vinylidene film, expressed aminopyrine metabolizing activity for up to 5 days. This culture system was utilized to study the metabolism of aminopyrine in the liver cells isolated from normal, alloxan- and streptozotocin-diabetic rats. 2. Aminopyrine was metabolized at a slower rate in both types of cultured diabetic rat hepatocytes than in cultured normal rat hepatocytes, as judged from higher levels of the unchanged drug in the culture medium. 3. The formation of the metabolites 4-monoaminoantipyrine, 4-acetylaminoantipyrine and 4-formylaminoantipyrine decreased in the cultured diabetic rat hepatocytes, while that of 4-aminoantipyrine was at the same levels as controls. In contrast, 3-hydroxymethyl-2-methyl-4-dimethylamino-1-phenyl-3-pyrazolin-5-on e (AM-CH2OH) formation in the cultured diabetic rat hepatocytes increased over control value. These findings agree with in vivo results which have been reported by the authors. 4. The increase in AM-CH2OH was prevented by insulin in a dose-dependent manner. However, insulin did not affect the formation of other metabolites. These findings indicate that the amount of cytochrome P-450 isozyme involved in the oxidation of 3-methyl group may be regulated by insulin. 5. The present results, indicate that this primary culture system is a useful tool for the study of drug metabolism in diabetes.