Diabetic foot ulcers—where do we stand microbiologically?

Foot ulcers in diabetics are prone to polymicrobial infection by bacteria as well as fungi. Infection retards healing of ulcers leading to gangrene and ultimately, amputation of the extremity. The choice of empiric antibiotic therapy is extrapolated from results of studies from other regions, western literature or infection at other sites which may be inappropriate. Thus, a study was conducted to determine microbial aetiology of diabetic foot ulcers and their susceptibility patterns. Pus aspirates or wound swabs were collected from foot ulcers of 70 diabetics at the time of admission and processed for isolation of bacteria (aerobic and anaerobic) and fungi according to standard protocols. Organisms were identified upto species level. Antimicrobial susceptibility testing was performed by Kirby Bauer disk diffusion method as per CLSI standards. One hundred forty-seven organisms were isolated from 70 specimens. Seventy-three percent showed polymicrobial growth. The proportion of Gram negative bacilli, Gram positive cocci, anaerobes and fungi were 57 %, 27 %, 4 % and 12 % respectively. Enterobacteriaceae were the predominant Gram negative bacilli and S.aureus, the predominant Gram positive cocci. Clostridium and Candida species were the commonest among anaerobes and fungi respectively. Twenty-three percent of S.aureus were MRSA and 23 % of Enterobacteriaceae were ESBL producers. Ps.aeruginosa strains demonstrated good susceptibility to antipseudomonal antimicrobials and 16.5 % strains were meropenem resistant. Due to the associated risk of increased morbidity and mortality in infected diabetic ulcers, the wide spectrum of organisms associated with it and their differing susceptibility profile, treatment should be individualised based on microbial culture and antimicrobial susceptibility results.     

Neonatal Gastric Perforations: Are They Really Spontaneous?

Case Report

We report a case of 4-day-old male infant who developed rapid abdominal distension with progression to shock. Abdominal radiography showed free gas under diaphragm for which emergency laparotomy was done revealing a perforation in the greater curvature of the stomach that was sutured after excising surrounding ischemic stomach wall.     

Intrathoracic anastomosis after oesophageal resection for cancer

Cervical anastomosis has been advocated to avoid the pulmonary complications and life-threatening anastomotic disruptions following intrathoracic oesophagogastric anastomosis. This is a retrospective review of 111 oesophageal resections followed by an intrathoracic anastomosis. These resections were performed between September 1993 and August 1994 within a residency training program. The left thoracoabdominal approach was used for distal tumours and the Ivor Lewis technique for more proximal tumours. Squamous cell carcinoma accounted for 72% patients (n = 80), adenocarcinoma for 25% (n = 28), and others for 2.7% patients (n = 3). Of the patients, 69% had pathologic Stage III tumours. Operative mortality rate was 1.8% (two patients). Perioperative complications occurred in 39 patients, including anastomotic leak in 10 patients and myocardial infarction in 2 patients. In the absence of a leak, there were no major pulmonary complications requiring intensive care or ventilatory support. Of those patients with anastomotic disruption, 89% were salvaged by early clinical diagnosis and appropriate treatment. We conclude that transthoracic oesophagectomy with an intrathoracic anastomosis is a safe procedure that can be performed with low mortality and acceptable morbidity. © 1996 Wiley-Liss, Inc.     

Soleus motor neuron excitability before and after standing

H-reflexes have been used to assess the effect of various postures on the excitability of the soleus motor neuronal pool. The purpose of this study was to determine if the excitability of the motor neuron pool, measured via H-reflexes in a seated position, change after a standing protocol in able-bodied individuals. We hypothesized that the excitability of the motor neuronal pool is minimally affected by the standing protocol leading to a reproducible H-reflex. Ten healthy individuals (height = 69.05+/-2.27 inches, weight = 161.7+/-22.44 lbs, age = 27.7+/-7.0 years) participated in the study. Soleus H-reflex recruitment curves were established before and after a standing protocol in a seated position. The standing protocol involved 12 minutes of active upright standing interspersed with 10 minutes of relaxed passive standing in a standing frame, similar to a protocol currently used for spinal cord injured subjects. The maximum M-waves and H-reflex amplitudes were not systematically changed before and after standing. There was also a strong agreement between the H-reflexes and M-waves measured before and after standing (ICC = 0. 99 and .96, respectively). We conclude that the H-reflexes measured in this study were reproducible, indicating that standing had no long lasting effect on the motor neuronal pool excitability. The findings support that the method discussed in this report is appropriate to assess the effects of electrically induced standing on motor neuron pool excitability in individuals with spasticity from spinal cord injury.     

改良小梁切除术治疗伴有高眼压及大瞳孔的急性房角关闭

目的 评价改良小梁切除术治疗伴有高眼压及大瞳孔的急性房角关闭的临床疗效。方法收集2005年1月至2009年3月中山大学中山眼科中心青光眼专业实施改良小梁切除术治疗伴有高眼压及大瞳孔的急性房角关闭21例（21眼）的临床资料,对术后并发症及手术前后的眼压、视力、瞳孔等进行统计分析。 结果 术前眼压(48.25±3.14) mmHg,平均用降眼压药种类3.35种,明显高于出院时眼压(10.47±1.15)mmHg(t=11.4573,P＜0.01)及术后3个月眼压(13.86±0.93) mmHg(t=11.2641,P＜0.01)。出院视力(0.09±0.05)与术前视力(0.11±0.06)差异无统计学意义(沁0.8702,P= 0.3913),术后3个月视力(0.21±0.04)则稍好于术前（t=-2.7907,P=0.0112）。术前瞳孔垂直径(5.81±0.23) mm与出院时瞳孔垂直径(5.92±0.21 )mm差异无统计学意义（t=-1.5013,P=0.1672）。无严重并发症发生。 结论 改良小梁切除术是治疗伴有高眼压及大瞳孔的急性房角关闭的有效方法,术中分次放房水、巩膜瓣调节缝线、术毕形成前房等措施可有效减少严重并发症的发生。