Effect of quinolone antibiotics on hepatic growth and protein synthesis following partial hepatectomy in rats

Quinolone antibiotics inhibit eukaryotic as well as prokaryotic cell growth and protein synthesis. To determine whether these properties adversely affect hepatic growth and recovery following surgical resection, five groups of healthy, adult male rats (n = 7–8/group) were treated for 10 days with equal volumes of either ofloxacin (50 mg/kg), fleroxacin (25mg/kg), ciprofloxacin (25 mg/kg), norfloxacin (15mg/kg) or sterile saline (controls) prior to 70% partial hepatectomy (PH) and daily thereafter until death. Restituted liver mass, DNA and protein synthesis rates were determined at 24, 48 and 72 h PH. The results of the study revealed that all parameters of hepatic regeneration were similar in the five study groups at each time interval. To ensure that an effect on hepatic regeneration was not dose-dependent, additional experiments were performed where 1, 10 and 100 mg/kg ciprofloxacin was administered and DNA synthesis was measured 24 h post-PH. Once again, the results were similar to sterile saline-treated controls. These findings suggest that the quinolone antibiotics are unlikely to have an adverse effect on hepatic recovery following surgical resection of the liver and are safe to use in that setting.     

Case Report: Severe cholestatic jaundice induced by Epstein-Barr virus infection in the elderly

Infectious mononucleosis due to Epstein-Barr virus (EBV) is almost always a self-limited disease, most commonly seen in young adults. Hepatitis is a well-recognized complication of EBV infection that usually resolves spontaneously. Jaundice occasionally results from the unusual complication of autoimmune haemolytic anaemia rather than hepatitis. We report a 60-year-old man with severe cholestatic jaundice whose history, liver histology and laboratory findings suggested EBV infection. He also developed significant jaundice related to his hepatitis, but not to autoimmune haemolysis, a situation that led to diagnostic delay. Costly diagnostic laboratory tests and invasive procedures were performed to rule out a malignant extrahepatic biliary obstruction. Physicians need to be aware of this complication and EBV infection should be included in the differential diagnosis of cholestatic jaundice in the elderly.     

Infectious discitis in adults: 9 years experience from Al‐Yarmouk Teaching Hospital in Baghdad,Iraq

Aim: The objective of this study was to analyse the presentation, aetiology, diagnosis, management, and outcome of infectious discitis. Methods: A screening prospective case‐finding study was carried out at Al‐Yarmouk teaching hospital in Baghdad, Iraq from 1997 to 2006. Fifty adult patients (12 men and 38 women) were diagnosed with infectious discitis from different referral sources. The diagnosis was based on laboratory biochemical tests, isolation of micro‐organisms from blood and needle aspiration tissue, and radiological investigations including magnetic resonance images (MRI). Results: Of the 50 cases, 32 (64%) patients presenting within 4 weeks, 94% had pelvic and abdominal surgical interventions, 70% presented with severe neck pain and 36% had neurological deficits. Marked elevation of erythrocyte sedimentation rate and high serum C‐reactive protein levels were observed in all patients. Positive blood, percutaneous disc aspiration and surgical exploration samples for Staphylococcus aureus, Streptococcus viridans, E. coli, Pseudomonas aureginosa and Candida albicans were found. Radiological images showed that disc involvement did not exceed more than one intervertebrate disc with two adjacent vertebrae. The clinical outcome was full recovery (86%), residual neurological deficits (10%) and death (4%). Conclusions: Infectious discitis in adults should be suspected in every case presenting with severe neck or back pain, followed by pelvic or abdominal surgical interventions. Therefore, MRI techniques should be performed on every case and an early empirical antibiotic therapy is advised.