Guess what! Pseudomonas aeruginosa sepsis

A 62-year-old woman affected by end-stage renal disease secondary to Waldenstrom's disease was admitted to place a central venous catheter for hemodialysis purposes. During the admission, she gradually developed a number of necrotic ulcerative and fluctuant nodular skin lesions on the submammary flexures, groins and limbs accompanied by high fever and chills. Yellow-green purulent material could be drained from the site of introduction of the jugular catheter. Skin biopsies were taken from the edge of an inguinal necrotic-ulcerative lesion and from a fluctuant nodular lesion of the thigh, where pus was drained and cultured.     

Chronic actinic dermatitis treated with cyclosporine-A

Chronic actinic dermatitis (CAD) groups together all chronic photodermatosis with light photosensitivity. We report the case of a 69-year-old man who, for over one year, had presented a reddish-brown erythema and shedding, with thickened and hypo-elastic skin on the face, scalp, neck and on the back of the hands and forearms. Patch tests were positive to isoeugenolo 1% and photo-patch tests showed a positivity to phenotiazine 2%. After a short and ineffective treatment with beta-carotene and photo-protectors, the clinical picture was resolved with the administration of oral steroids but with a relapse of the dermatitis once the dosage was lowered. We therefore started treatment with cyclosporine-A (4.5 mg/kg/die), which resulted in a rapid improvement of the clinical picture, but with a reappearance of the manifestations when the dosage was lowered. The treatment was resumed and we observed that the dose of 1.5/mg/kg/die resulted morbus-static. The patient is still being treated with this drug at this dosage. The result is that the disease is under control and no side effects are present. As we consider CAD an invalidating disease it seems to us that Cy-A could be taken into consideration as an alternative to traditional treatments.     

Psychiatric pharmacogenetics: personalizing psychostimulant therapy in attention-deficit/hyperactivity disorder

There is a substantial amount of variation in response and adverse drug reactions to psychostimulant therapy in attention-deficit/hyperactivity disorder (ADHD). Psychiatric pharmacogenetics is a rapidly developing field, which can be applied to identify genetic predictors of this variability in outcome to psychostimulant medications. This article will briefly review ADHD and its pharmacotherapy. This will be followed by an overview of the pharmacokinetics and pharmacodynamics of methylphenidate, the most commonly used psychostimulant in the US. Then the field of psychiatric pharmacogenetics will be introduced and its methodology will be described. This will be followed by a discussion about how pharmacogenetics can be applied to children afflicted with ADHD. The future of psychiatric pharmacogenetics will then be presented with an emphasis being placed on developing prospects that will ensure the continued advancement of this field.     

Vasovagal syncope in emergency room patients: analysis of a metropolitan area registry

The aim of this study was to assess the epidemiology of syncope in unselected patients referred to an emergency room and eventually admitted to the clinical wards to perform a complete work-up, and to analyze the costs of hospitalization. The clinical charts of all patients referred for all causes to the emergency rooms of three hospitals in the Florence area during the year 2000 and of all patients admitted from the emergency rooms to the clinical wards with a diagnosis of lone-related (vasovagal) or disease-related syncope were revised. A total of 1,290 (3.36%) cases of syncope out of 38,330 presentations were registered; among these, 702 cases (1.83% of all presentations, 54% of all syncopes) were directly discharged, and 443 cases (1.14% of all presentations, 34% of all syncopes) were hospitalized. The remaining 149 cases (12% of all syncopes) refused admission. Following admission, 500 patients were discharged with the diagnosis of syncope: 115 lone-related (23%) and 385 disease-related syncopes (77%). A cost-benefit analysis of the hospitalized patients showed that admitting patients with lone syncope leads to an economical loss to the hospital.     

Billroth I versus Billroth II versus Roux-en-Y after subtotal gastrectomy. Prospective [correction of prespective] randomized study

BACKGROUND/AIMS: The aim of this study was to evaluate functional results after Billroth I, Billroth II and Roux-en-Y reconstruction in subtotal gastrectomy. METHODOLOGY: Forty-five patients were randomized between 1990 and 1995 and stratified in 3 different groups: 15 BI, 15 BII and 15 Roux. They were investigated by esophagogastroduodenoscopy with multiple biopsies and upper gastrointestinal scintiscanning, to evaluate gastroesophageal reflux and dynamics of gastric emptying. They also answered a questionnaire: Gastrointestinal Quality of Life. Index. RESULTS: A reflux esophagitis was found in 5 BI, in 7 BII and in 2 Roux (p < 0.001). No gastric lesions were found in 6 BI, in 5 BII and in 12 Roux, (BI vs. Y, p < 0.05; BII vs. Y, p < 0.001). Chronic superficial gastritis was present in 9 BI, in 4 BII and in 3 Roux (BI vs. Y, p < 0.05). Dynamic scintiscan demonstrated the presence of gastroesophageal reflux in 5 BI and gastric emptying was fast (37' < T 1/2 < 86'), but incomplete (60' residual activity: 49-62%). Gastroesophageal reflux was evident in 7 BII with slow (28' < T 1/2 < 143') and incomplete (60' residual activity: 48-72%) gastric emptying. Gastroesophageal reflux was detected in 2 Roux and radioactive bolus progression in the Roux limb was fast (24' < T 1/2 < 53') and complete (60' residual activity: 42-52%) (BI vs. Y; BII vs. Y, p < 0.001). There was no statistical significance between Gastrointestinal Quality of Life Index score in the 3 groups. CONCLUSIONS: The Authors affirm that Roux-en-Y is the technique of choice in subtotal gastrectomy, if compared with BI and BII.     

In vitro removal of therapeutic drugs with a novel adsorbent system

BACKGROUND/AIMS: Substances in the middle molecular weight range have been shown to play a significant pathogenetic role in as diverse disorders as end-stage renal disease and multiple organ failure. To overcome the limitations in the amount removed by hemofilters, new sorbents with a high biocompatibility are actively being developed. Furthermore, biocompatible sorbents by their nonspecific adsorptive behavior could have great impact on detoxification treatment in exogenous intoxications. We performed an in vitro evaluation of a newly developed highly biocompatible sorbent cartridge (Betasorb((R))), examining its adsorptive capacity concerning therapeutic drugs. METHODS: Uremic blood spiked with a range of therapeutic drugs was recirculated for 2 h in an in vitro hemoperfusion circuit containing a Betasorb device for hemoperfusion. The drug concentrations before and after the passage of the cartridge were measured, and the total amount removed was calculated. RESULTS: The sorbent showed effective removal of glycopeptide antibiotics, digoxin, theophylline, phenobarbital, phenytoin, carbamazepine, and valproic acid. Moderate removal could be demonstrated for tacrolimus and cyclosporine A; aminoglycosides were removed to a small extent only. CONCLUSION: Betasorb hemoperfusion shows a potent adsorptive capacity concerning therapeutic drugs (except aminoglycosides) and could be of major value in the treatment of intoxications. On the other hand, drug monitoring and possible adjustments are necessary during Betasorb hemoperfusion to maintain the therapeutic ranges of the drugs in blood.