A 7-year national survey on bacterial resistance in bronchoalveolar lavage from patients hospitalized in Argentina

The purpose of this study is to undertake a nationwide survey on bacterial resistance in bronchoalveolar lavage (BAL) from patients hospitalized in Argentina. A 2-month point prevalence study was conducted twice yearly (April-May and October-November) from 1997 to 2003 by 36 Argentinean centers. Antimicrobial susceptibility data of the potential pathogens recovered from the BAL (samples containing <1% of squamous epithelial cells and bacterial counts >or=10(4) CFU/mL) of inpatients (i.e., >or=48-h hospital length of stay) with suspected hospital-acquired pneumonia (HAP) were collected on a computerized system (SIR) described previously. The survey was split into 2 periods for comparison purposes, 1997 to 2000 and 2001 to 2003. A total of 752 organisms were included. Staphylococcus aureus was the most frequent species, followed by Acinetobacter spp. and Pseudomonas aeruginosa. In both periods, more than a half of the Klebsiella pneumoniae strains displayed a phenotype of extended-spectrum beta-lactamase producer. A doubling of imipenem-resistant Acinetobacter frequency was shown from the 1st period to the 2nd one (25-48%). More than two-thirds of the S. aureus strains proved to be methicillin resistant in both periods, and a pronounced decrease of resistance rates to trimethoprim/sulfamethoxazole and rifampin was shown in the 2nd period. The present study shows the worrisome increasing bacterial resistance in BAL samples to most available antimicrobial options for treating patients with suspected HAP. Variations over time support the need for systematic tailored surveillance and compel us to establish a rational usage of antimicrobial agents in our country.     

Autologous Cultured Melanocytes in Vitiligo Treatment

BACKGROUND: Surgical treatment of vitiligo is indicated when lesions are localized in poorly responding areas. OBJECTIVES: The objectives were: (1) to establish the melanocyte culture obtained from the epidermis of vitiligo patients for future treatment; (2) to estimate the influence of selected factors on the formation of suction blisters and the results of culture; and (3) to compare the results of treatment of vitiliginous macules localized in the dorsum of the hands and lower limbs by transplantation of cultured autologous melanocytes plus psoralen and ultraviolet A (PUVA) therapy (CMP), suction blister transplantation plus PUVA therapy (SBP), cryotherapy plus PUVA-therapy (CP), and only PUVA therapy (OP). METHODS: Forty patients were qualified for the study. The roofs of the suction blisters were used as a melanocyte source for culture establishment or were directly transplanted. RESULTS: The CMP procedure was successfully performed on only 10 of 20 patients because of the difficulties in cell culture establishment. The SBP method was carried out on all 20 patients. A total lack of effectiveness was found in CP and OP methods. CONCLUSIONS: The effectiveness of culture depends on time of suction blister forming, phototype, and previous PUVA therapy. This study demonstrated the advantage of the SBP over the CMP method.     

不同外科术式治疗多节段脊髓型颈椎病的疗效评价

目的评价不同外科术式在治疗多节段脊髓型颈椎病中的应用和临床疗效。方法对临床收住的经影像学诊断的186例多节段颈椎病患者资料作回顾性分析，主要依靠术式和术前脊髓功能评分，结合术时年龄、性别和病程，将符合标准的87例患者归类为均衡相似的3组，A组35例为颈后路椎管成形术患者；B组31例为颈前路椎体次全切除术患者；C组21例为颈前路多平面环锯减压椎间盘切除术患者。术后疗效利用日本矫形外科学会（JOA）评分标准评定脊髓功能恢复情况，随访各组并发症，并统计分析。结果随访3个月～3年2个月，平均约8个月，各组术后脊髓功能均有不同程度改善，3组优良率分别为65．7％、80．6％和71．4％，术后3组优良率经Chi—square检验无显著差别（χ^2=1．844，P=0．397〉0．05），但B组优良率最高，其并发症例次率也较高（22．3％），主要发生于B组多椎体次全切除术式患者，而该组单椎体次全切除附加椎间盘切除术13例患者并发症较低，仅1例，组内两术式并发症发生率比较有显著差别（P〈0．05）。结论不同术式治疗多节段脊髓型颈椎病均可获得较好临床疗效，单椎体次全切除结合椎间盘切除融合的分节段混合减压术可能是较理想术式，其减压彻底有效且并发症少。