Tuberculosis of the breast: experience of a UK breast clinic serving an ethnically diverse population

Tuberculosis (TB) of the breast is an uncommon disease in the West but its incidence is likely to increase. Five cases of breast tuberculosis are presented. The diagnosis and management of this condition are discussed.

Vertebral osteomyelitis due to Staphylococcus epidermidis

Vertebral osteomyelitis due to Staphylococcus epidermidis is extremely rare and usually occurs in the context of immunosuppression in association with an adequate portal of entry for infection. This paper reports a case of vertebral osteomyelitis due to S. epidermidis in a man with no evidence of immunosuppression or obvious portal of entry. The patient presented with severe back pain but there were no clinical signs of infection. Radiographs and computerized tomographs showed destruction of thoracic vertebral bodies and an adjacent soft tissue mass. S. epidermidis was grown from multiple blood cultures. All isolates had identical antibiograms and biochemical profiles. There was evidence of healing of the vertebral bodies and resolution of the soft tissue mass after appropriate antistaphylococcal treatment.

Typing of Aeromonas spp. by numerical analysis of immunoblotted SDS-PAGE gels

One hundred and three isolates of Aeromonas spp., collected from both environmental sources and patients, were examined by SDS-PAGE of whole cells followed by immunoblotting with polyclonal rabbit antiserum raised against whole cells of A. sobria. All isolates were typable, yielding 15-20 well separated bands. Reproducibility of the technique was good and discrimination excellent, yielding 30 types amongst 103 isolates. Immunoblot type was not related to biochemical phenotype. Attempts to correlate immunoblot type with serotype were unsuccessful because only 42% of the strains tested could be serotyped.

Peripheral Perfusion Index: A Predictor of Post-Spinal Hypotension in Caesarean Section

Background

Early prediction of hypotension helps to decide appropriate prophylactic measures and, hence, safe anaesthesia for mothers and improved neonatal outcomes. Perfusion index (PI) measured from a standard pulse oximeter has shown positive results in the prediction of hypotension. This study aims to determine if PI can equally predict hypotension in parturients after administration of spinal anaesthesia at different time points.

Methods

Parturients posted for elective caesarean section belonging to the American Society of Anesthesiology II (ASA II) were divided into two groups based on baseline PI as group A <3.5 and group B ≥3.5. Fifty-six parturients were enrolled in the study. PI and blood pressure were monitored at baseline, every two minutes for 12 minutes and every five minutes until the end of the surgery, after administration of spinal anaesthesia with hyperbaric bupivacaine 10 mg. Incidence of hypotension was compared between groups at all time points of observation. Spearman’s rank correlation coefficient was determined to check the correlation between baseline PI and the number of episodes of hypotension. Receiver operating characteristic (ROC) curve was plotted to determine the ideal cut-off at different time points.

Results

Baseline PI significantly correlated with the number of episodes of hypotension (r-0.525). The overall incidence of hypotension was significantly higher in parturients with baseline PI ≥3.5 (79.16%) as compared to those with PI <3.5 (33.33%). The incidence of hypotension at sixth, 10th and 37th minutes post-spinal anaesthesia administration was significantly higher in the group with PI ≥3.5. The sensitivity and specificity for the 3.5 cut-off of PI were 85.7% and 60%, respectively, at the 6th and 10th minute after spinal administration. A higher cut-off of 3.9 increases the specificity to 69% without much change in the sensitivity.

Conclusion 

Parturients with PI >3.9 at baseline have a higher risk of hypotension in the initial 10-12 minutes following spinal anaesthesia during caesarean delivery.

Comparison of analgesic efficacy of continuous transversus abdominis plane (TAP) block with continuous epidural analgesia in renal transplant recipients

Background

Transversus abdominis plane (TAP) block has been shown to be an effective analgesic modality for various abdominal surgeries. In this study, a direct comparison between continuous TAP block with continuous epidural block was made in kidney transplant recipients.

Methods

A total of 62 participants were randomly allotted to receive either continuous epidural or continuous TAP block.

In the epidural group

infusion of 0.25% ropivacaine at a rate of 4-10 mL per hour depending on patient characteristics and block level as assessed clinically.

In the TAP block group

after an ultrasound-guided posterior approach TAP block, a bolus of 0.25% ropivacaine (20 mL) was deposited in the plane, followed by a continuous infusion of 0.25 ropivacaine. In both groups, the infusion was continued for 24 h postoperatively. Rescue analgesia was provided in the form of patient-controlled fentanyl intravenously. Numerical pain rating score (0-100) was recorded at each of the study points (0, 1, 2, 6, 12, and 24 postoperatively).

Results

Demographic data and baseline investigations were not significantly different between the groups. No significant difference was found between the median numerical pain rating scale (NRS) scores at rest and on coughing at all study points (P > 0.05). The mean consumption of fentanyl in 24 h postoperatively was similar in group E (685.48 ± 76.86) and group T (695.16 ± 78.37). Similarly, no significant difference was noted in the hemodynamic parameters and patient satisfaction (P > 0.05).

Conclusions

Continuous TAP block is non-inferior to epidural technique for postoperative analgesia in patients undergoing renal transplant recipients.