The use of qualitative cultures for detecting infection in open tibial fractures

PURPOSE

To determine the role of qualitative cultures for detecting infection in open tibial fractures.

METHODS

From January 2003 to December 2004, 95 men and 13 women (mean age, 34 years) with open tibial fractures in one or both limbs and without any other sites of infection were prospectively studied. Patients who had been treated with intravenous or oral antibiotics before presentation and/or had undergone debridement or other surgery were excluded.

RESULTS

Infection was not correlated with age, sex, interval from injury to debridement, and cause of fracture. The association of infection with predebridement cultures was stronger (odds ratio=12.5) than that with postdebridement cultures (odds ratio=4.7).

CONCLUSION

Pre- and post-debridement cultures have a role in detecting infection in open tibial fractures. For detecting infection, predebridement cultures have better sensitivity, while postdebridement cultures have better specificity.

Targeting FGF19 inhibits tumor growth in colon cancer xenograft and FGF19 transgenic hepatocellular carcinoma models

Although fibroblast growth factor 19 (FGF19) can promote liver carcinogenesis in mice its involvement in human cancer is not well characterized. Here we report that FGF19 and its cognate receptor FGF receptor 4 (FGFR4) are coexpressed in primary human liver, lung and colon tumors and in a subset of human colon cancer cell lines. To test the importance of FGF19 for tumor growth, we developed an anti-FGF19 monoclonal antibody that selectively blocks the interaction of FGF19 with FGFR4. This antibody abolished FGF19-mediated activity in vitro and inhibited growth of colon tumor xenografts in vivo and effectively prevented hepatocellular carcinomas in FGF19 transgenic mice. The efficacy of the antibody in these models was linked to inhibition of FGF19-dependent activation of FGFR4, FRS2, ERK and beta-catenin. These findings suggest that the inactivation of FGF19 could be beneficial for the treatment of colon cancer, liver cancer and other malignancies involving interaction of FGF19 and FGFR4.

Chromosome 22 microdeletion by F.I.S.H. in isolated congenital heart disease

OBJECTIVE

To analyze the frequency of del22q11.2 in non-syndromic CHDs using classical cytogenetics and Fluorescence In Situ Hybridization (FISH) technique in Indian population.

METHODS

105 prospective cases which included 6 families with isolated, non-syndromic cardiac defects were analyzed clinically by a cardiologist and a geneticist. The cases were then subjected to karyotypic (classical cytogenetics) as well as FISH analysis. The efficacy of FISH technique was compared with inference drawn from classical cytogenetics.

RESULTS

Karyotypic analysis of all the 105 patients revealed a normal chromosomal complement. Microdeletion 22q11.2 was observed in six patients (5.71%) by FISH studies. FISH studies were also performed on the parents of these six patients who revealed a normal chromosome 22. No correlation was found between clinical features (mild or unspecific) with 22q11.2 microdeletion.

CONCLUSION

The testing for microdeletion 22q11.2 in isolated non-syndromic patients using FISH technique is mandatory even when mild/unspecific extracardiac abnormalities are seen in the patients.

Passive donor-to-recipient transfer of antiphospholipid syndrome following allogeneic stem-cell transplantation

Autoantibody production following allogeneic stem-cell transplantation is common and is often ascribed to the immune dysregulation associated with graft-versus-host disease. Recent data suggests that donor-memory B cells can be reactivated on exposure to antigen and result in antibody production in the recipient identical to that seen in the donor. Here we describe the production of autoantibodies in a recipient of bone marrow from a donor with systemic lupus erythematosus and antiphospholipid syndrome. Autoantibody appearance was precipitated by the onset of graft-versus-host disease, was identical to that of the donor, and ultimately lead to cerebrovascular thrombosis, which was successfully treated with antiplatelet and anticoagulant therapy.

Intracochlea acoustic neuroma: a case report and discussion

A case of an intracochlea acoustic neuroma that was diagnosed radiologically is presented and discussed.

Recent advances in surgery for snoring-somnoplasty (radiofrequency palatoplasty) a pilot study: effectiveness and acceptability

A prospective study was designed to investigate the effects of Somnoplasty (Radiofrequency palatoplasty) in patients with snoring. A group of 22 patients fulfilling the inclusion and exclusion criteria outlined underwent somnoplasty performed by a single surgeon. Every patient completed a standard questionnaire containing visual analogue scales at six weeks post operatively. The parameters assessed were post-operative pain, change in snoring score, effects on sleep of the patient and bed partner, speech and swallowing, alteration in weight, acceptance of the procedure and recommendation to friends and family. Results of improvement in snoring score were correlated to body mass index (BMI) kg/m2. We conclude that somnoplasty is an effective procedure in elimination of snoring and the success is closely linked to BMI. Best response is obtained in those with BMI < 25 and moderate response is obtained in those with BMI between 25-30. Obese (BMI > 30) patients are more likely to have a poor response. Morbidity associated with the procedure is minimal and patient acceptance is 100%. The long-term success of this procedure needs to be confirmed with further follow up.

Perforation of jejunal diverticulum: case report and review of literature

We report the case of a 90-year-old woman, previously diagnosed with jejunal and colonic diverticula, who presented with left lower quadrant abdominal pain suggesting either colonic diverticulitis or ischemic colitis. A computed tomography scan revealed a perforated jejunal diverticulum with abscess formation. The patient promptly was treated surgically without complications. A review of the literature indicates the rarity of perforation of jejunal diverticula and the difficulty of early diagnosis. We discuss the etiology, pathogenesis, diagnosis, and management of this rare entity. It is important for primary care physicians to be familiar with this disease. Delay in work-up often results in catastrophic consequences.

Role of atrial ischaemia in development of atrial fibrillation following coronary artery bypass surgery

OBJECTIVE

Atrial fibrillation (AF) is a common complication after coronary artery bypass grafting (CABG) operations, occurring in 5 to 40% of cases. A number of studies have implicated atrial ischaemia in the genesis of this arrhythmia. The aim of this study was to examine the relationship between atrial coronary anatomy and the incidence of post operative atrial fibrillation.

METHOD

To investigate a possible anatomical explanation to the onset of AF after CABG, 25 patients with documented AF after CABG were matched and compared to 25 patients which remained in sinus rhythm (SR). All coronary angiograms were reported blindly by a cardiac radiologist with reference to the blood supply of the sino-atrial (SA) node and atrio-ventricular (AV) node before and after surgery.

RESULTS

Univariate analysis of risk factors did not identify any significant difference (Fisher exact test, P > 0.05) between the two groups in age, gender, left ventricular function, ischaemic time, number of vessels diseased or grafted, renal dysfunction and withdrawal of beta-blockade. However, significant disease in the SA nodal artery was present in 2 patients of the SR group when compared to 9 in the AF group. Significant disease of AV nodal artery was present in only 4 patients of the SR group when compared to 18 in the AF group. Comparison between the two groups showed a significantly increased incidence of SA or AV nodal artery disease in the AF group, (SA: P = 0.018, AV: P = 0.0001). Mean hospital stay was 8.1 days for the SR group and 9.1 days in the AF group (P = 0.175).

CONCLUSION

Obstructive disease in the SA nodal and AV nodal arteries is more common in patients developing atrial fibrillation following coronary artery bypass surgery than those who remain in sinus rhythm. If the incidence of AF could be predicted by the anatomical distribution of arterial disease then targeting prophylaxis to this group may be possible.

Ciba Corning ACS:180 testosterone assay evaluated

A fully automated direct assay of testosterone has been developed for the Ciba Corning ACS:180 immunoassay system. We have evaluated this method and compared specimen results with those from the Diagnostic Products Corp. (DPC) and Medgenix direct assays and an in-house extraction assay. Accuracy of the method was assessed by measuring GC-MS-targeted serum pools. Within-assay im- precision was <6% and between-assay imprecision <9% over the concentration range examined. High concentrations of lipid caused an increase in the measured testosterone but other potential interferents were without effect. Recovery was quantitative but was affected by sex-hormone-binding globulin. The method was positively biased with respect to the DPC and Medgenix assays but negatively biased with the extraction assay. Measurement of the GC-MS-targeted serum pools showed the assay to overestimate recovery by approximately 13%. The ACS:180 assay is particularly attractive as a routine assay because it is fully automated, obtains the first result in only 15 min, and shows good assay performance.

Effects of progesterone antagonist, lilopristone (ZK 98.734), on induction of menstruation, inhibition of nidation, and termination of pregnancy in bonnet monkeys

The effects of a progesterone antagonist, lilopristone (ZK 98.734), on induction of menstruation, inhibition of implantation or pregnancy, and termination of early and mid-pregnancy were studied in bonnet monkeys. In the regularly menstruating animals, administration of lilopristone (25 mg/day, s.c.) during the mid-luteal phase (Days 20-22 of the menstrual cycle) induced menstruation within 2-4 days after the initiation of treatment. A premature drop in circulating progesterone levels was also observed. The luteolytic effect of lilopristone was prevented by exogenous treatment with hCG; however, the animals showed premature menstruation, in spite of high progesterone levels (above 4 ng/ml). Treatment around the time of implantation (between Days 8 and 12 after the mid-cycle peak in estradiol levels) in mated animals provided 100% pregnancy protection. Treatment of pregnant animals on Days 30-32 of the menstrual cycle, i.e. about Day 20 after the estradiol peak, induced abortion in 8 of 10 animals. A significant (p less than 0.05) decrease in serum progesterone levels was observed on Day 3 after the initiation of treatment. However, the decrease was slower (slope: -0.36, r: 0.96) compared to that observed in nonpregnant animals (slope: -0.72, r: 0.95). In the other two animals, pregnancy was not affected. However, when the treatment was delayed until about Day 50 after the estradiol peak, all four animals aborted. This study suggests that lilopristone is a progesterone antagonist with a potential to induce menstruation, inhibit nidation, and terminate pregnancy. The antifertility effects are mediated through blocking progesterone action at the endometrium as well as decreasing progesterone bioavailability, which appears to be due to its effects on gonadotropin release.

Binding characteristics of progesterone and antiprogestin ZK 98.299 in human endometrial and myometrial cytosol

The binding of ZK 98.299, a synthetic progesterone antagonist, with human endometrium and myometrium cytosol was studied and compared with that of progesterone. Progesterone showed specific saturable binding to its receptors in both endometrium and myometrium. ZK 98.299 and progesterone were mutually competitive for binding to progesterone receptors; however, the relative binding affinity of ZK 98.299 was 16% that of progesterone. ZK 98.299 exchanged the progesterone-labelled receptor sites. [3H]ZK 98.299 showed specific binding which was linearly related to the cytosol protein concentration. The binding was not saturable at 15 nM of ligand. The binding capacity and binding affinity of ZK 98.299 receptor was less than that of progesterone. Progesterone also partially displaced the binding of [3H]ZK 98.299. This study suggest that ZK 98.299 and progesterone both bind to the same protein. However, whether ZK 98.299 binds to progesterone receptors alone or even to other functionally related sites is not known. It appears that ZK 98.299 when present in higher concentration than progesterone would be an effective receptor ligand.

Congestive heart failure and left ventricular dysfunction complicating doxorubicin therapy. Seven-year experience using serial radionuclide angiocardiography

To impact on the development of clinical congestive heart failure as a complication of doxorubicin therapy, left ventricular ejection fraction was monitored with serial resting radionuclide angiocardiography in 1,487 patients with cancer over a seven-year period in both university and community hospital environments. A high-risk subset of 282 patients was selected for retrospective analysis of their clinical outcome. High-risk patients were identified by one or two of the following three criteria: decline of 10 percent or more in absolute left ventricular ejection fraction from a normal baseline to 50 percent or less; high cumulative dose of doxorubicin (more than 450 mg/m2); abnormal baseline left ventricular ejection fraction (less than 50 percent). Clinical congestive heart failure occurred in 46 (16 percent) during the treatment period, and in an additional three patients (1.3 percent) at last follow-up examination 11.8 +/- 14.2 months following discontinuation of doxorubicin. Total cumulative dosages of doxorubicin that precipitated congestive heart failure (75 to 1,095 mg/m2) and those that did not (30 to 880 mg/m2) varied widely. Decline of 10 percent or more in absolute left ventricular ejection fraction to a value of 50 percent or less preceded administration of the final dose of doxorubicin that precipitated clinical congestive heart failure in the majority of patients in whom congestive heart failure developed. Clinical congestive heart failure improved in 87 percent given routine therapy with digitalis, diuretics, and/or vasodilators. Criteria for monitoring left ventricular ejection fraction and discontinuing doxorubicin were formulated. The occurrence of clinical congestive heart failure was compared in those patients whose management was concordant with proposed criteria (Group A) and in those whose management was not (Group B). Group A had a lower incidence of congestive heart failure compared with Group B (2.9 percent versus 20.8 percent, p less than 0.001) and had only mild congestive heart failure that resolved with treatment (n = 2) and no deaths due to congestive heart failure. Multivariate analysis with proportional-hazards regression (Cox's model) demonstrated a fourfold reduction in the incidence of congestive heart failure independent of other clinical predictor variables in those patients whose management was concordant with proposed guideline criteria. The incidence, persistence, late development, predictability, and reversibility of clinical congestive heart failure were comparable in university and community hospital settings.(ABSTRACT TRUNCATED AT 400 WORDS)

Endocrine effects of low dose aminoglutethimide as an aromatase inhibitor in the treatment of breast cancer

The endocrine effects of low dose (62.5 mg, twice a day) aminoglutethimide (AG), without hydrocortisone (HC), escalating at monthly intervals to a conventional dose of AG (500 mg twice a day) combined with HC, were studied in 33 postmenopausal breast cancer patients. Pretreatment serum concentrations of oestrone (E1) and oestradiol (E2) were significantly suppressed by 62.5 mg of AG twice a day. Although further suppression of E1 appeared to occur with 125 mg of AG twice a day, this was not statistically significant. For E1 and E2, higher doses of AG or combined AG and HC failed to cause further significant suppression compared with that obtained at 125 mg of AG twice a day. Significant rises in serum androstenedione were found with all doses of AG alone, although pretreatment concentrations of androstenedione were not significantly altered by combined AG and HC treatment. Mean pretreatment concentrations of dehydroepiandrosterone sulphate (DHA-S) were significantly suppressed by 62.5 mg of AG twice a day and further marked suppression occurred on combined AG and HC therapy. Serum cortisol, aldosterone and plasma ACTH concentrations showed no significant alterations throughout treatment. Aminoglutethimide is as effective at 125 mg twice a day without HC in its suppression of oestrogen levels as at 500 mg twice a day with HC, and its use in this form warrants clinical evaluation.