Molecular epidemiology and the clinical significance of <Emphasis Type="Italic">Acinetobacter baumannii</Emphasis> complex isolated from cerebrospinal fluid in neurosurgical intensive care unit patients

Objective  

This study was intended to investigate the clinical significance and molecular epidemiology of Acinetobacter baumannii complex (ABC) isolated from cerebrospinal fluid (CSF) in neurosurgical intensive care unit (NSICU) patients, particularly comparing isolates from healthcare workers’ (HCW) hands.     

Transcatheter Aortic Valve Implantation through a Left Aortoiliac Graft

The indications for transcatheter aortic valve implantation have been increasing with the development of new-generation valves and delivery systems. Our patient, an 81-year-old man with aortic stenosis, had an existing coronary artery bypass graft and bilateral aortoiliac bypass grafts. We used the transfemoral approach through the left femoral artery and the left aortoiliac graft to successfully deploy a new-generation Edwards SAPIEN valve.Key words: Aortic stenosis, arterial disease, peripheral, heart valve prosthesis implantation/methods, transcatheter aortic valve implantationTranscatheter aortic valve implantation (TAVI) has emerged as a promising alternative to conventional aortic valve replacement for patients whose severe, symptomatic aortic stenosis is otherwise left untreated due to comorbidities and to the high operative mortality rates associated with open-heart surgery under those circumstances.¹ The first application of this method in human beings was performed in 2002 by Cribier and colleagues.² Today, there are 2 widely used valve types. These are the balloon-expandable Edwards SAPIEN transcatheter valves (Edwards Lifesciences LLC; Irvine, Calif) and the self-expanding CoreValve® valves (Medtronic CV Luxembourg S.a.r.l.; Luxembourg). The first-generation Edwards SAPIEN valve is approved for use in the United States, but the latest generations of both valves are awaiting approval.     

Epicardial mass causing cardiac compression: an unusual involvement in lymphomatoid granulomatosis

Lymphomatoid granulomatosis is a rare, diffuse, large B-cell lymphoma that is positive for Epstein-Barr virus. A multiorgan process, it manifests itself chiefly in the lungs but can also affect the skin, nervous system, and kidneys. Cardiac involvement and pericardial effusion are very unusual. We report the case of a 62-year-old man with lymphomatoid granulomatosis involving the heart and lungs. Diagnosis was confirmed with wedge biopsy at pericardiotomy, and the patient was treated with cyclophosphamide, prednisolone, and vincristine. Although the patient was still symptomatic at 6-month follow-up, he was in partial remission with improved functional capacity.     

Carbohydrate antigen-125 and N-terminal pro-brain natriuretic peptide levels: compared in heart-failure prognostication

Carbohydrate antigen-125 (CA-125) is emerging as a prognostic biomarker of risk in heart failure. In a prospective study, we compared the prognostic values of CA-125 and amino-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with stable heart failure.We enrolled 102 consecutive chronic, stable, systolic-heart-failure patients (68 men and 34 women; median age, 71 yr) from November 2008 through February 2010. We measured baseline NT-proBNP and CA-125 levels and compared their prognostic values. The primary endpoint was all-cause death and other major adverse events, defined as hospitalization for decompensated heart failure or acute coronary syndrome.During a mean follow-up period of 14 ± 2 months, 12 patients died and 35 others sustained major adverse events. We found that CA-125 level significantly correlated with New York Heart Association functional class, pulmonary artery pressure, microalbuminuria, creatine kinase-MB fraction, and hemoglobin, albumin, and NT-proBNP levels. Upon receiver operating characteristic curve analysis, CA-125 and NT-proBNP had similar accuracy in predicting major adverse events and death: for major adverse events, area under the curve (AUC) was 0.699 for CA-125 (P=0.002) and 0.696 for NT-proBNP (P=0.002); for death, AUC was 0.784 for CA-125 (P=0.003) and 0.824 for NT-proBNP (P=0.001). Multivariate Cox regression analysis showed that CA-125 levels greater than 32 U/mL and NT-proBNP levels greater than 5,300 pg/mL had independent prognostic value for major adverse events and death.We conclude that baseline CA-125 and NT-proBNP levels are comparably reliable as heart-failure markers, and that CA-125 can be used for prognosis prediction in heart failure.     

Surgical treatment of lower limb ischemia in diabetic patients – long-term results

Introduction

Lower limb ischemia may cause nonhealing ulcers, infection, amputation and even mortality in diabetic patients. In this study, we review our data of ischemic lower limb revascularization procedures in diabetic patients and present the early, mid- and long-term results.

Material and methods

From March 2004 to September 2008, 83 patients with lower limb ischemia in Fontaine class III and IV underwent distal arterial bypass procedures. Saphenous vein grafts were used for below-knee arterial bypasses in all patients. In 16 (19%) patients femoropopliteal bypasses were performed with PTFE grafts. Short-term and long-term surgical results were evaluated.

Results

Ulcer recovery was determined in 36% of patients. Graft patency was 95% and 1 death (1%) occurred in short-term follow-up. In long-term follow-up the total effectiveness rate was 74%. Graft patency was 79% and 6 deaths (7%) occurred during the follow-up.

Conclusions

Lower limb ischemia is a serious event in patients with diabetes mellitus. The consequences may include increased mortality and morbidity in this particular patient population. However, distal arterial revascularizations are considerably effective procedures to avoid amputation, to eliminate symptoms, to promote ulcer recovery and to help the patient participate in social life with acceptable short, mid- and long-term follow-up results.     

Ectopic Primary B Cell Lymphoma of the Thyroid Presenting as an Anterior Mediastinal Mass. A Case Report

Ectopic thyroid tumours arising in the mediastinum without connection to the cervical thyroid gland are very rare. Follicular adenoma, papillary carcinoma and follicular carcinoma in the mediastinum has been reported, but primary ectopic thyroid B cell lymphoma has not been reported previously. We report mediastinal primary ectopic thyroid large B cell lymphoma in an 80-year-old man. Differential diagnosis from primary mediastinal large B cell lymphoma and clinicopathologic features are discussed.     

Mesangial proliferative glomerulonephritis in familial Mediterranean fever patient with E148Q mutation: the first case report

Familial Mediterranean fever (FMF) is an autosomal recessive hereditary disease characterized by recurrent attacks of fever, usually accompanied by sterile polyserositis. Although amyloidosis is the most common renal involvement, non-amyloid renal lesions, such as glomerulonephritis, have been described in patients with FMF. In this report, we present the first case of an FMF patient with heterozygous mutation of E148Q, mesangial proliferative glomerulonephritis, and no amyloidosis. While the association of mutation E148Q with renal involvement is still obscure, colchicine treatment is useful in mesangial proliferative glomerulonephritis with FMF.     

Effects of impaired fasting glucose on aortic elasticity

The pathophysiology of atherosclerosis development in patients with diabetes mellitus (DM) is similar to that in nondiabetics. However, atherosclerosis develops earlier and runs a rapid course in patients with diabetes. Aortic stiffness, strain and distensibility are the parameters used to assess an increase in arterial stiffness and can be measured by invasive and non-invasive methods.Aortic elastic properties were compared among patients with normal oral glucose tolerance test but impaired fasting glucose and healthy individuals. The study group consisted of 50 subjects with impaired fasting glucose who had no known risk factors for atherosclerosis. The control group was composed of the same number of volunteers.It was found that aortic strain and distensibility were reduced (8.78±4.3 vs. 10.65±2.6 p<0.01 and 4.1±2.1 vs. 5.1±1.7 p<0.01 respectively) and aortic stiffness index was significantly increased (6.9±3.2 vs. 5.01±1.6, p<0.0001) in patients with impaired fasting glucose compared to those in the control group.It was demonstrated that aortic elasticity was impaired in those with impaired fasting glucose, which indicates that these patients should be kept under close follow-up for cardiovascular events.     

Evaluation of hearing loss in patients with Graves' disease

Hearing loss has commonly been reported in association with thyroid disorders and during treatment with propylthiouracil. The relationship between hyperthyroidism and the auditory system has not been previously investigated. The aim of this cross-sectional, case-control study was to investigate hearing loss in patients with Graves' disease (GD). The study population consisted of patients with newly diagnosed GD and healthy controls. Pure tone audiometry at frequencies of 250, 500, 1000, 2000, 4000 and 8000 Hz, along with immittance measures including tympanometry and acoustic reflex tests, were performed in all participants. Twenty-two GD patients and 22 healthy controls consented to inclusion in the study. The differences between groups with regards to age and gender distribution were statistically insignificant (P = 0.567 and P = 0.757, respectively). The hearing thresholds of right and left ears were also similar in both groups (P > 0.05). When single-ear evaluations were taken into account (total of 44 ears for both groups), hearing thresholds in the GD group were significantly higher than healthy controls at all frequencies (P < 0.05). Following testing at the designated frequencies, the only significant effect of thyrotoxicosis was observed with frequencies of 4000 and 8000 Hz. The odds ratio for having hearing loss at a frequency of 8000 HZ associated with GD was 14.97 (95% confidence interval 4.03-55.64). In patients with GD, right and left pure tone audiometric findings at a frequency of 8000 Hz correlated positively with FT3, FT4 and negatively with TSH. Our results are highly suggestive of a decrease in hearing ability in patients with GD, particularly at high frequencies. Further studies are needed to help elucidate the mechanisms behind hearing loss which develops in association with GD.     

Cord blood nesfatin-1 and apelin-36 levels in gestational diabetes mellitus

To assess maternal serum and cord blood apelin-36 and nesfatin-1 concentrations in pregnant women with and without gestational diabetes mellitus (GDM). Thirty pregnant women with GDM and 30 gestational age matched healthy pregnant subjects participated to the study. Maternal serum and cord blood nesfatin-1 and apelin-36 levels were measured with ELISA, at the time of birth. The relationships between maternal serum and cord blood nesfatin-1 and apelin-36 levels, anthropometric and metabolic parameters were also assessed. Maternal serum apelin-36 levels were found higher (13.5?±?8.3 vs. 9.6?±?5.9?ng/ml, P?=?0.001) and nesfatin-1 levels were found lower (5.5?±?8.1 vs. 8.1?±?23.9?ng/ml, P?=?0.001) in patients with GDM compared with control pregnant women. However, the cord blood apelin-36 levels (8.8?±?4.3 and 8.2?±?1.9?ng/ml, P?=?0.618) and nesfatin-1 levels (5.4?±?4.0 and 6.2?±?10.3?ng/ml, P?=?0.688) were similar in the GDM and control groups, respectively. Maternal serum apelin-36 and nesfatin-1 levels correlated positively with their respective cord blood levels. Maternal serum and cord blood apelin-36 levels correlated negatively with the gestational age and birth weight. Similarly maternal serum and cord blood nesfatin-1 levels correlated negatively with the gestational age, but there was no correlation with the birth weight. We did not find a correlation between maternal serum apelin-36 and nesfatin-1 levels, maternal age, BMI, fasting glucose, fasting insulin, and HOMA-IR. Also cord blood apelin-36 and nesfatin-1 levels did not correlate with the maternal age, BMI, HOMA-IR, cord blood glucose, and cord blood insulin levels. Our results indicate that apelin-36 concentrations increase and nesfatin-1 concentrations decrease in maternal serum of women with GDM.