[Multicenter study of isolated micro-organisms resistant to antimicrobials in 10 Portuguese hospitals in 1994]

In 1994, Microbiology Laboratories of ten Portuguese hospitals analysed isolated microorganisms found in blood and urine samples and studied antimicrobial susceptibilities of the most frequent bacterial pathogens. From 63780 blood samples, the most frequent were Staphylococcus spp. and from 69189 urine samples significant numbers of Escherichia coli, Enterococcus spp., Pseudomonas aeruginosa and Candida spp. were isolated. Escherichia coli strains (c.7000) revealed a low percentage of resistance to antibiotics with the exceptions of ampicillin (48%) and co-trimoxazol (25%). Klebsiella pneumoniae isolates (c.2000) revealed important resistance to ampicillin (98%), cephalotin (31%), co-trimoxazol (38%) and gentamicin (28%), while values for 3rd generation cephalosporins varied among hospitals, with several strains showing phenotype of extended-spectrum beta-lactamase. A great variation in resistance values of P. aeruginosa (c.4000) was found in relation to the antibiotics as well as to the hospitals. Resistance to methicillin in S. aureus (c.6000) was high, reaching an average of 47%, and it was even higher with S. epidermidis (c.3000) and S. haemolyticus (c.650). Only vancomycin was always active against these strains. In E. faecalis (c.2500) resistance was of 2% to ampicillin, 35% to gentamicin, 45% to streptomycin and 1% to vancomycin. E. faecium isolates (c.300) showed the most worrying results with 70% resistance to ampicillin, 42% to gentamicin, 59% to streptomycin and 9% (30 strains isolated in 5 hospitals) to vancomycin. Vancomycin resistant strains were also resistant to all other antibiotics.

The nonrefluxing ileal conduit: a new form of urinary diversion

PURPOSE

We describe a variation of the ileal conduit that includes a nonrefluxing nipple valve designed to protect the upper urinary tracts.

MATERIALS AND METHODS

A total of 13 patients underwent urinary diversion with the nonrefluxing ileal conduit. The nonrefluxing nipple valve is created by intussuscepting the ileum into the conduit.

RESULTS

Followup ranged from 3 to 35 months. No patient demonstrated radiographic deterioration of the upper tracts or a clinically significant increase in serum creatinine level during followup.

CONCLUSIONS

The nonrefluxing ileal conduit appears to be a viable treatment option in select patients with neurogenic bladder dysfunction.

[Kinship lexical organization and psychosis]

The main goal of this study was to investigate the use, by schizophrenic and manic-depressive patients and by those suffering from mild reactive psychoses, of parental lexical terms. Based on five questions that evaluate the classical dimensions of parental relationships, we tried to ascertain the different types of errors that occur, and their relationships with the psychoses under study. The results revealed a greater incidence of errors in the questions linked with the generational dimension. This work corraborates the difficulty of psychotic patients to establish the differentiation among generations.

[Silent coronary artery-left ventricular fistula and acute myocardial ischemia]

A 65-year-old woman developed severe coronary insufficiency associated with papillary muscle dysfunction. She was submitted to cineangiocoronarography which ruled out obstructive coronary disease. Coronarography revealed a communication between the coronary arteries and the left ventricle, but a coronary arterial fistula was not seen. The possibility of this uncommon form of coronary drainage to the left ventricle, named silent fistula, being the cause of myocardial ischemia related to the coronary steal phenomenon is discussed.

Energy metabolism and substrate oxidation as possible factors for net protein accretion in growing rats

This study describes an experimental model with growing rats in which we have measured energy expenditure and substrate oxidation as possible factors for regulation of net protein synthesis in intravenously fed growing rats. Orally fed rats were used as a reference group. Rats were given intravenous nutrition for 10 days at a high (350 kcal/kg/day) and a low (270 kcal/kg/day) energy level with four different fat-to-carbohydrate compositions at each energy level: N (no fat), L (low fat, 6% nonprotein calories), M (medium fat, 30% nonprotein calories) and H (high fat, 60% nonprotein calories). Continuous O2-consumption and CO2 production of the animals were measured. Whole body substrate oxidation was calculated from respiratory gas exchange and nitrogen excretion. Body composition was assessed in all animals at the end of infusions. Energy balance with zero growth was reached at 240 kcal/kg/day. Growth rate was normal in animals receiving 350 kcal/kg/day compared with freely eating reference animals irrespective of the glucose-to-fat ratio of the intravenous solutions. Animals on 270 kcal/kg/day showed retarded growth rate, but the differences in growth rate among the groups were mainly explained by carcass fat. Net protein accretion did not differ among most of the groups irrespective of intravenous or oral intake at different levels. The whole body oxidation rate of glucose was directly proportional to the infusion rate of glucose, while the net fat oxidation was inversely correlated to the infusion rate of glucose. The oxidation rate of amino acids and proteins was not directly correlated to the oxidation of glucose or fat.(ABSTRACT TRUNCATED AT 250 WORDS)