Efficacy and nephrotoxicity of polymyxin B in elderly patients with carbapenem resistant bacterial infection.

BACKGROUND: To study the efficacy and nephrotoxicity of polymyxin B in the treatment of elderly patients with carbapenem-resistant organism (CRO) infection. METHODS: The clinical and microbiological data of patients with CRO-infected sepsis treated with polymyxin B were retrospectively analyzed. The effective rate, bacterial clearance, incidence and recovery rate of acute renal injury (AKI) and prognosis-related indicators in AKI at different stages were compared. RESULTS: The effective rate of 215 elderly patients with CRO infection treated with polymyxin was 50.7%. The total bacterial clearance rate was 44.2%, the total incidence of AKI was 37.2%, the recovery rate of AKI was 35%, and the incidence range of polymyxin B-related AKI was 10.2-37.2%. Logistic multivariate regression analysis showed that the predictors of AKI in elderly patients were high APACHE II score, long duration of polymyxin, chronic renal insufficiency and ineffective outcome; the ROC curve showed that the cutoff value for predicting AKI was a serum creatinine concentration of 73 mmol/L before polymyxin B use, and the AUC was 0.931. CONCLUSIONS: Rational use of polymyxin B is safe and effective in elderly patients with CRO infection, and its effective outcome can improve the recovery rate of AKI.

[Reconstruction of anal stenosis induced by scar contracture after repair of defect in perineal region with paraumbilical flap using random pattern flap].

Objective: To investigate the method and timing of reconstruction of anal stenosis induced by scar contracture after repair of defect in perineal region with paraumbilical flap using random pattern flap. Methods: Ten patients who suffered anal stenosis induced by scar contracture after the first phase repair of defect of perineal region with paraumbilical flap were hospitalized from July 2009 to September 2015. Eight patients were with central type scar contracture of perineal region after healing of burn wound, and two patients were with lesion of perineal region which had been excised. In 6 to 8 weeks after the first phase surgery, two or three random pattern flaps were designed around the narrow anus in the survived paraumbilical flap. After thorough release of the narrow anus, the random pattern flaps were transferred to enlarge the anus. The tip of the lifted triangular flap was transferred to insert into the anal canal. The skin of anal canal or rectal mucosa was pulled out to be crossly-stitched with the flap. Results: All the patients' narrow anuses were released and enlarged with one operation, and the diameters of the narrow anuses were enlarged to 2.0 to 3.0 cm. During follow-up of 6 to 36 months, the anal stenosis was totally released, and the symptom of difficult defecation was significantly improved; 7 patients were excellent and 3 patients were good with evaluation of clinical criteria of anus function; no symptom of anal stenosis or rectal mucosal prolapse was observed any more. Conclusions: In 6 to 8 weeks post repair of defect in perineal region with paraumbilical flap, designing of random pattern flap in the survived paraumbilical flap to enlarge and reconstruct the narrow anus has good therapeutic effects on anatomical narrow and difficult defecation.

[The application of expanded polytetrafluoroethylene in the treatment of facial depression with facial nerve palsy].

OBJECTIVE: In order to investigate the effect of expanded polytetrafluoroethylene (e-PT-FE) in repair of facial depression. METHODS: From February 1997 to July 1998. The e-PTFE was used as a filling and suspending material for facial depression and facial nerve palsy in 6 cases. They were followed up for 2-16 months. RESULTS: After filling of the facial depression, the deformed side of the face became symmetrical to that of contralateral side, and those following the suspending technique using this material the affected eyelids could close completely and the oral corners were symmetrical in its static status. CONCLUSION: The expanded PTFE was a safe, biocompatible and easily applied material, especially served as a filling or suspending material in the repair of facial depression with facial nerve palsy.