A six-week antibiotic treatment of endocarditis with spondylodiscitis is not associated with increased risk of relapse: A retrospective cohort study.

BACKGROUND: We compared the relapse rate at 1 year in patients with vertebral osteomyelitis with or without associated endocarditis. PATIENTS AND METHODS: We conducted a retrospective cohort study. Inclusion criteria were patients hospitalized in the infectious disease, rheumatology, cardiology, cardiovascular surgery and two internal medicine units for vertebral osteomyelitis (blood culture and/or disco-vertebral biopsy) and compatible imaging, between 2014 and 2017. We compared patients with associated endocarditis (VO-EI group) and without endocarditis (VO group) using logistic regression to determine the factors associated with relapse and EI. The main outcome was the relapse rate at 1 year. RESULTS: Out of the 207 eligible patients, 62 were included (35 in the VO group and 27 in the VO-EI group). Four patients presented with a new VO during follow-up, one (2.86%) patient in VO group and three (11.11%) in VO-EI group (P=0.68). There were more men in the VO-EI group than in the VO group (74.07% vs. 48.57%, P=0.04), valvulopathies (13/27 vs. 8/35, P=0.06), vertebral localization (1.22±0.50 vs. 1.03±0.17, P=0.04) and septic kidney embolism (5/27 vs. 0/35, P=0.01). Control blood cultures were more often positive in the VO-EI group (12/27 vs. 8/35, P=0.04). In 45% of patients, the germ was a staphylococcus, 29% streptococci, 10% enterococci, 10% gram-negative bacillus (GNB). There were more streptococci and enterococci in the VO-EI group than in the VO group (44.44% vs. 17.14% and 18.52% vs. 8.57%, respectively). Antibiotic safety was good and comparable between groups. CONCLUSION: In a relatively small population, we did not find significantly more relapse in the endocarditis group.

Importance of metabolic changes induced by chemotherapy on prognosis of early-stage breast cancer patients: a review of potential mechanisms.

Weight variation has been reported as a side effect of chemotherapy treatment in early breast cancer patients and has been identified as a factor of poor prognosis. Causes of weight variation during chemotherapy and mechanisms involved in the poor prognosis have been little studied. Here is reviewed the current knowledge about the main causes and mechanisms involved in body weight change. Special emphasis is placed on factors associated with weight variation which could potentially be involved in the risk of relapse in breast cancer survivors. In recent decades, some studies have investigated the causes of weight variation by studying energy balance of breast cancer patients during chemotherapy. Weight gain or loss may be the consequence of energy imbalance through different factors linked with chemotherapy, such as poor treatment tolerance, decreased muscle mass and function, or hormonal alterations. This results in body composition modifications in favour of fat gain and/or lean body mass loss. Increased adipose tissue, especially in the abdominal region, could induce metabolic disturbances such as insulin resistance, through various pathways involving adipokines. These molecules have growth properties and could therefore play a role in cancer relapse. Understanding such mechanisms is key to developing preventive strategies for improving the prognosis of early-stage breast cancer patients.

[Our attitude in esophageal and gastric post-caustic lesions]. / Atitudinea noastra în leziunile esofagiene si/sau gastrice post caustice.

The authors present the experience of the surgery section in patients treatment with oesophagian or gastric lesions after caustic substances ingestion. From a group of 70 patients who were treated in a conservative way (with medicines and dilatations) 60 of them returned to the surgery for nourishment gastrostomy. In two cases, the oesophagian and gastric lesions was established preoperations trough radiologic examination and in thirteen cases the lesions were found intraoperation. The adopted attitude is exemplified presenting a case. Under a general anaesthesia is done a limited resection (about 3 cm) with termino-terminal anastomosis of the stenosed antral area keeping the vascular arches of the little and big gastric curvature. A minimal a la Gavriliu gastrostomy is mounted on the vertical area of the little curvature. Through the gastrostomy (Petzzer) probe is put a tube of perfusor to the first jejununal ansa. In the first 48 hours the Petzeer is used for the gastric drainage in the perfusor probe for feeding. After 48 hours the jejununal probe is taken away and the gastrostomic feeding begins. After six mouths from the caustic ingestion 25 patients come back again for oesophagian reconstruction. For 24 patients the Gavriliu I, II proceeding is applied and for a case it is used the small intestine ansa. They lost 3 patients (2 with gastric tube and 1 with intestinal ansa). The evolution in 24 years time was very good.

Fatal chemical pneumonitis due to cadmium fumes.

Acute exposure to high concentrations of cadmium fumes may cause acute chemical pneumonitis with a possibly fatal outcome. The etiologic diagnosis of acute cadmium intoxication from inhaled fumes may be difficult and can be confused with other forms of acute respiratory failure. We report on a case of a fit 53 year-old man who was exposed to cadmium fumes after flame-cutting an alloy containing around 10% of cadmium for a period of 60-75 minutes. He developed severe chemical pneumonitis and died 19 days after exposure.