Procalcitonin as a diagnostic aid in diabetic foot infections

The diagnosis of diabetic foot infection (DFI) is usually a challenge to the clinician. Procalcitonin (PCT), a 116-amino acid propeptide of calcitonin, is a new marker of bacterial infections and sepsis. We evaluated the serum value of PCT as a marker of bacterial infection in diabetic patients with foot ulcers. Forty-nine diabetic patients with foot ulcers were consecutively enrolled into the study. DFI was diagnosed clinically by the presence of purulent secretions or at least two of the symptoms of inflammation including redness, warmth, swelling, and pain. According to these criteria, DFI was determined in 27 patients (DFI group) and not detected in 22 patients (NDFI group). The blood samples were taken for biochemical analysis on admission. PCT, white blood cell count (WBC) and erythrocyte sedimentation rate (ESR), but not C-reactive protein (CRP), was found significantly higher in DFI group compared with NDFI group. The best cut-off value, sensitivity and specificity were 0.08 ng/ml, 77% and 100% for PCT, 32.1 mg/dl, 29% and 100% for CRP, 8.6 10(9)/L, 70% and 72% for WBC and 40.5 mm/h, 77% and 77% for ESR, respectively. The area under the receiver operating characteristic curve for infection identification was greatest for PCT (0.859; p < 0.001), followed by WBC (0.785; p = 0.001), ESR (0.752; p = 0.003), and finally CRP (0.625; p = 0.137). These results suggest that PCT may be a useful diagnostic marker for DFI. Additional research is needed to better define the role of PCT in DFI.     

Is HBOT treatment effective in recovering zone of stasis? An experimental immunohistochemical study

Studies aimed at recovering the zone of stasis are one of the major issues of experimental burn studies. Hypoxia and oedema at that zone may cause irreversible changes. Due to anti-oedematous and antihypoxic effects of hyperbaric oxygen treatment (HBOT), it may be beneficial in recovering the zone of stasis. We performed an experimental study using 20 Sprague–Dawley rats, each weighing 350–450 g. The rats were first divided into two groups as 24 h and 5 days. Subsequently, control and treatment groups (five rats in each group) were formed. For burn wounds, we used the burn comb model, which was described by Regas and Ehrlich. In the treatment group, 2.5 ATA HBOT was applied for 90 min twice daily. A 0.8-cm punch biopsy was performed and samples for histological examination were taken from the centre of burn area. The rats were sacrificed by administering ‘3 mci technetium-99m methoxy butyl nitrite’ (⁹⁹Tc^m MIBI) through the femoral vein. Biopsy materials were evaluated by histological and immunohistochemical methods. Dorsal skin fragment, excised to 1 cm margin, was imaged by scintigraphic measurements with a gamma camera. Wet and dry weight measurements of excised skin fragments were taken. As a result, HBOT showed a positive effect at the cellular level in the first 24 h. It increased recovery potential by augmenting neovascularisation and decreasing oedema in the 5-day group.     

Analysis of antigen—antibody complexes by immunoelectrophoresis

Immune complexes composed of two insoluble and two soluble antigens and their corresponding antibodies of rabbit origin were separated by electrophoresis in agar gel performed at 56°. Antibodies could then be demonstrated in the cathodal part of the electrophoretic field; they formed precipitation lines with goat antiserum to rabbit serum. The separation of soluble antigens could be demonstrated by the precipitation reaction with their corresponding antisera.     

Disulfiram, an old drug with new potential therapeutic uses for human hematological malignancies

Disulfiram (DSF) is an aldehyde dehydrogenase inhibitor currently used for the treatment of alcoholism. Here, we show that multiple myeloma (MM) cell lines and primary cells from newly diagnosed and relapsed/resistant patients affected by MM, acute myeloid and lymphoblastic leukemia are significantly sensitive to DSF alone and in combination with copper. These effects are present at doses lower than those achievable in vivo after DSF standard administration. The cytotoxic effect achieved by this treatment is comparable to that obtained by conventional chemotherapy and is absent in normal hematopoietic cells. In addition, we found that DSF plus copper induces loss of mitochondrial membrane potential, triggers reactive oxygen species (ROS) production and activates executioner caspases. DSF-copper-induced apoptosis and caspases activation are strongly reversed by antioxidant N-acetylcysteine, thus indicating a critical role of ROS. These results might suggest the use of the old drug DSF, alone or in combination with copper, in the treatment of hematological malignancies.     

Nasal colonization among premature infants treated with nasal continuous positive airway pressure

We examined the relationship between the use of nasal continuous positive airway pressure (CPAP) and nasal colonization among low-birth-weight (LBW) infants. We prospectively cultured the nares of LBW infants on admission and weekly until hospital discharge. The modality of respiratory support during each culture was recorded. Bivariate and multivariate analyses were conducted to test the relationship between CPAP and nasal colonization. Analyses were repeated after stratifying infants into three birth-weight categories: 1500 to 2499 g, 1000 to 1499 g, and < 1000 g. In total, 766 nasal cultures were obtained from 167 infants. Nasal colonization with gram-negative bacilli was increased with the use of CPAP in all birth-weight categories ( P < 0.05) and with vaginal delivery in infants weighing < 1000 g and 1500 to 2499 g ( P = 0.04 and P = 0.02, respectively). Nasal colonization with any potential pathogen increased with the use of CPAP in all birth-weight categories ( P < 0.001), with the presence of chorioamnionitis in infants < 1000 g ( P = 0.055) and at younger gestational age in infants 1000 to 1499 g ( P = 0.0026). Caucasian infants 1500 to 2499 g had less colonization than infants of other races ( P = 0.01). Nasal CPAP is associated with increased colonization with gram-negative bacilli.     

Vertebroplasty in multiple myeloma with osteolysis or fracture of the posterior vertebral wall. Usefulness of a delayed cement injection

Aim  

The goal of this study was to specifically address the incidence of dorsal leakage when performing vertebroplasty in patients with posterior wall osteolysis or fracture, by using a delayed injection of cement with the aim of increasing its viscosity.     

Aural Barotrauma in Submarine Escape: Is Mastoid Pneumatization of Significance?

OBJECTIVE: Submarine escape training is carried out by preselected, healthy young men under strictly controlled conditions regarding exposure to pressure and the rate of pressure change. This provides a unique opportunity to investigate the relations between middle ear characteristics and susceptibility to barotrauma while avoiding possible confounding parameters. We examined a possible association between mastoid pneumatization and middle ear barotrauma (MEB) in submarine escape trainees. STUDY DESIGN: Cross-sectional, parallel-group design. METHODS: Sixty-six subjects aged 19 to 28 participated in the study. The escape simulation included pressurization to 30 or 60 feet followed by a buoyant ascent to the surface. Subjects were evaluated for MEB after each ascent. A Schuller's mastoid radiograph was taken for the evaluation of mastoid pneumatization. RESULTS: Fifteen (23%) of the subjects suffered from MEB, and 6 (40%) of them had bilateral involvement. Repeated impedance audiometry after the completion of a successful ascent revealed a significant increase in middle ear compliance. Schuller's radiographs were obtained from 49 (74%) of the subjects. Of these radiographs, 16 (16%) were of ears that had suffered MEB. Mastoid pneumatization for all ears approached a normal Gaussian distribution, with a mean area of 9.58 cm. The mastoid areas and the proportion of ears with mastoid pneumatization at the extremes of the study population did not differ between barotrauma and no-barotrauma ears. CONCLUSION: In a population with no history of recurrent or chronic otitis media and normal tympanic membrane morphology and compliance, the amount of mastoid pneumatization probably represents merely the normal distribution of variation in organ size and is not related to the ability to equalize pressure in the middle ear.