Emergence of carbapenemases in Gram-negative bacteria in Hamburg, Germany

We analyzed a collection of carbapenem-resistant Gram-negative bacterial isolates and detected VIM-1, VIM-2, and KPC-2 in diverse enterobacterial species and Pseudomonas aeruginosa isolates. Our findings suggest a more widespread dissemination of carbapenemases in Germany than currently appreciated.     

Mitochondrial DNA content in paired normal and cancerous breast tissue samples from patients with breast cancer

Introduction  We develop a multiplex quantitative real-time PCR for synchronized analysis of mitochondrial DNA (mtDNA) and nuclear DNA (nDNA) to investigate relative mtDNA abundance in paired normal and cancerous breast tissues. Materials and methods  The amounts of nDNA and mtDNA in 102 tissue samples were quantified for both glyceraldehype-3-phosphodehydrogenase (GAPDH) gene and mtDNA encoded ATPase (MTATP) 8 gene. The average threshold cycle (Ct) number values of the nDNA and mtDNA were used to calculate relative mtDNA content in breast tissues. Results  The median delta Ct (ΔCt) and the median mtDNA content for normal and cancerous breast tissues were 6.73 and 2.54, as well as 106.50 and 5.80 (P = 0.000, respectively). The mtDNA content was decreased in 82% of cancerous breast tissues compared with the normal ones. The changes were associated with hormone receptor status. Conclusion  Our finding suggests that decreased mtDNA content in breast cancer may have diagnostic and prognostic value for the disease.     

Impairment of activities of daily living requiring memory or complex reasoning as part of the MCI syndrome

BACKGROUND: Mild Cognitive Impairment (MCI) is a borderline state between age-associated cognitive decline and mild dementia. MCI is separated from mild dementia by an absence of global intellectual deterioration and the preservation of activities of daily living (ADL). However, even mild degrees of cognitive deterioration are known to have negative effects on complex ADL. OBJECTIVES: To examine whether patients with MCI have impaired ADL as compared to healthy controls, which areas of ADL are particularly involved, and whether limitations on ADL are associated with demographical or clinical data. METHODS: Forty-eight patients with MCI diagnosed according to research criteria and 42 cognitively unimpaired controls were enrolled. Cognitive function was inter alia assessed by the MMSE, complex ADL by the ADCS-MCI-ADL scale. Frequency distributions were compared between patients and controls using chi-square tests. Mean values were examined for statistically significant differences using Kruskal-Wallis tests. A Bonferroni correction for multiple comparisons was applied to the comparison of the 18 areas of the ADCS-MCI-ADL scale. Associations between ADL and biographical or clinical data were analysed using non-parametric correlations. RESULTS: The overall score on the ADCS-MCI-ADL scale was significantly lower in the MCI group. Patients performed significantly worse on 14 out of 18 activities. Activities involving memory or complex reasoning were particularly impaired, whereas more basic activities were unimpaired. There were no statistically significant associations of the ADCS-MCI-ADL overall score with age, years of formal education, gender, or number of cognitive domains affected in the group of MCI patients. However, there was a statistically significant association between the ADCS-MCI-ADL and the MMSE score. CONCLUSION: MCI patients may be impaired in complex ADL. Copyright (c) 2006 John Wiley & Sons, Ltd.     

The effect of apolipoprotein polymorphism on brain in mild cognitive impairment: a voxel-based morphometric study

We investigated the effect of apolipoprotein E (ApoE) on the whole brain in 51 individuals with mild cognitive impairment using voxel-based morphometry. Between cases heterozygous for the ApoE epsilon4 (n = 15) and those who were ApoE epsilon4 noncarriers (n = 28), only the right parahippocampal gyrus, with the entorhinal cortex included, reached the level of statistical significance. In cases homozygous for the epsilon4 allele (n = 8) versus noncarriers, the greatest atrophy was located in the right amygdala followed by the right parahippocampal gyrus, the left amygdala and the left medial dorsal thalamic nucleus.     

Management of a patient with tracheomalacia and supraglottic obstruction after thyroid surgery

Purpose

We describe an unusual combination of dynamic supraglottic, glottic, subglottic, and intrathoracic airway obstructions following a total thyroidectomy. These problems were anticipated, documented videographically, and managed preemptively.

Clinical features

Following a total thyroidectomy, we replaced the endotracheal tube with a laryngeal mask airway, namely, the LMA-Classic?, in a patient with symptomatic tracheal compression and probable obstructive sleep apnea. Spontaneous ventilation was observed bronchoscopically through the LMA-Classic. Supraglottic swelling, extraglottic collapse on inspiration, and intrathoracic collapse on expiration were documented prior to recovery. These observations were of sufficient concern to warrant reinsertion of the endotracheal tube and subsequent tracheal extubation over a tube exchanger. Thereafter, we provided face-mask continuous positive airway pressure using a Boussignac mask with an endotracheal ventilation catheter in situ.

Conclusions

Acute airway collapse following thyroid surgery is a rare and potentially serious complication. Diagnosis by conventional methods may be insensitive. Difficulties may not be apparent until the patient becomes distressed after tracheal extubation, and this circumstance will worsen airway compromise. In such a state, re-establishing the airway can become life-threatening. We describe the preemptive identification, physiologic manifestations, and management of the supraglottic and subglottic obstruction exemplified by this case.     

Technical tailoring of pancreaticoduodenectomy in patients with hepatic artery anatomic variants

BACKGROUND:Pancreaticoduodenectomy is the treatment of choice for periampullary and pancreatic head tumors.In case of hepatic artery abnormalities,early pancreatic transection during pancreaticoduodenectomy may prove inappropriate Early retroportal lamina dissection improves exposure of the superior mesenteric vessels and anatomic variants of the hepatic artery,where safeguarding is mandatory.METHOD:We describe our early retroportal lamina approach in patients with anatomic variants of the hepatic artery be...