Outbreak of skin and soft tissue infections in a hospital newborn nursery in Italy due to community-acquired meticillin-resistant Staphylococcus aureus USA300 clone.

BACKGROUND: Community-acquired meticillin-resistant Staphylococcus aureus (CA-MRSA) is responsible for severe infections in previously healthy people acquired in the community in different areas of the world. AIM: To report an outbreak of CA-MRSA in a hospital newborn nursery in northern Italy in September-October 2010, its investigation and control measures. METHODS: The epidemiology of the outbreak is reported. The investigation included screening neonates, parents and staff for MRSA carriage. Molecular strain typing was performed on MRSA isolates. FINDINGS: The outbreak affected nine neonates with three severe infections. In addition, four mothers had postpartum mastitis, and three mothers and one father had skin infection. The outbreak strain belonged to the USA300 CA-MRSA clone. Asymptomatic carriage of the outbreak strain was found among neonates, parents and hospital staff. The implementation of appropriate infection control measures in the hospital terminated the outbreak. CONCLUSIONS: To our knowledge, this is the first report of a hospital outbreak caused by the USA300 CA-MRSA clone in Europe. It is important to reinforce infection control measures, particularly in high-risk groups, such as neonates, to prevent USA300 from becoming endemic in European hospitals.

[Effectiveness of inpatient pulmonary rehabilitation (AHB). Results of a multicenter prospective observation study]. / Effektivität der pneumologischen Anschluss-Rehabilitation (AHB). Ergebnisse einer multizentrischen prospektiven Beobachtungsstudie.

BACKGROUND AND OBJECTIVE: The value of pulmonary rehabilitation in the treatment of chronic obstructive pulmonary disease (COPD) is well accepted. However, there are no data on the efficacy of in-patient rehabilitation instituted within 14 days after an acute disease episode, as practised in Germany. It was the purpose of this multi-centre prospective study to assess changes in lung function, exercise capacity, symptoms and disease-related quality of life (QoL) in patients discharged from hospital for an episode of worsening COPD or asthma, pulmonary embolism, pneumonia or treatment of lung cancer. PATIENTS AND METHODS: 207 patients (mean age 60 13 years) with COPD (n=86), pneumonia (n=42), lung cancer (n=24), asthma (n=14), pulmonary embolism (n=7) or other pulmonary disease (n=34) were included. Measurements of lung function, exercise capacity and disease-related QoL were carried out at the beginning and end of rehabilitation. Socio-economic data and disease-related QoL measurements were recorded again after 2 months. RESULTS: Rehabilitation led to a significant improvement of lung function, exercise capacity and QoL. Patients felt rehabilitation was efficacious (95%), to be recommended (99%) and important (100%). Improvement of QoL was maintained at two 2 months and only 16% of previously working patients had applied for retirement. CONCLUSIONS: The data demonstrate the clinically relevant benefit of in-patient pulmonary rehabilitation immediately after a period of acute illness. In view of these result and the known morbidity and mortality of patients with COPD after hospitalization for a period of acute illness, this form of pulmonary rehabilitation should be considered as standard treatment for these patients.

[Analysis of respiratory mechanics in fiberoptic bronchoscopy in healthy probands and patients]. / Analyse der Atemmechanik während Fiberbronchoskopie bei Gesunden und Patienten.

The airway resistance was measured via oscillation in 30 patients during routine bronchoscopy. In 10 healthy subjects body plethysmographic measurements were done during fiberoptic bronchoscopy. It was found that fiberoptic bronchoscopy results in an only slight, but significant increase in airway resistance. The Raw rose from an average of 1.94 to 3.04 mbar/l/s.

[Bronchial carcinoma and pulmonary hypertension. Significance for lung resection]. / Bronchialkarzinom und pulmonale Hypertonie. Bedeutung für die Lungenresektion.

In 227 patients with bronchial carcinoma whose forced expiratory volume was less than 2.5 l, measurements revealed a mild but significant rise in mean pulmonary arterial pressure at rest and on mild exercise (60 W). There was no clinically useful correlation between the degree of pulmonary hypertension and other measurable values, such as stage of the tumor or spirometric, whole-body plethysmographic, scintigraphic, electrocardiographic and blood-gas measurements. The degree of pre-operative pulmonary hypertension in 142 operated patients correlated with neither postoperative complications nor with post-operative mortality. Six months after lung resection there was a mild rise in pulmonary artery mean pressure among 30 patients, statistically significant only in those after pneumonectomy at rest. These results do not justify routine pre-operative right-heart catheterization. This should be reserved for patients with marginal ventilatory findings and cardiac risk factor.

Bullectomy.

The aims of this study were to investigate whether a relevant functional improvement before and after bullectomy was achieved in cases of a localized bulla and generalized bullous changes early and late postoperatively and to establish clear criteria for bullectomy. For this purpose, 21 patients with a localized bulla compressing the rest of the lung, and 19 with generalized bullae with emphysematous changes of the remaining lung were examined before and after (1 1/2 months and 1 1/2 years) surgery. Comparison of the preoperative and postoperative data and the follow-up included X-ray studies with planimetric assessment of the size of the bullae, lung function tests, perfusion scintigrams and clinical findings. The preoperative and postoperative statistical values of lung volume and respiratory mechanics showed the most significant differences. Bullectomy for a localized bulla with compression of the rest of the lung led to an improvement in gas exchange and respiratory mechanics. This operation, however, produced no functional improvement in cases of generalized bullous changes. Functional and clinical success is greater, the larger and more delimited the bulla is to be seen on X-ray, the more the healthy lung tissue is compressed, and, finally, the less associated diseases such as chronic bronchitis are present. Indication for bullectomy should be limited to these cases. The size of the bulla should amount to at least 2/3 of the hemithorax, preoperative function should be clearly reduced and the patient should be suffering from dyspnea.

Functional diagnosis in surgery of the large airways.

The main indications for surgery of the airways are (1) non-tumorous airway stenosis and (2) tumors of the large airways with and without relevant stenoses. The aim of the following study was to find out which degree of stenosis is an absolute indication for resection and to what extent the functional disturbances are reversible following surgery. We investigated various groups of patients (stenosis of the trachea, lobectomy with sleeve resection, extended pneumectomy with resection of the distal trachea, pneumectomy with resection of the bifurcation, resection of the main bronchus and lobectomy, rupture of the main bronchus) from 1978 to 1982, before and up to 3 years after surgery. Body-plethysmography (one second forced expiratory volume = FEV1; one second forced inspiratory volume = FIV1; Residual volume = RV; total lung capacity = TLC; airway resistance = Raw; specific airway conductance = sGaw), flow volume relation measurements (maximal inspiratory flow = Vmax insp; maximal expiratory flow = Vmax exp; and flow at various lung volumes), blood gas analysis and an endoscopic estimation of the tracheal diameter were performed. Tracheal resection with end-to-end anastomosis in patients with non-tumerous tracheal stenosis improved the tracheal diameter from 6.0 to 11.7 mm, the sGaw from 0.04 to 0.08 (cmH2O s)-1 and the severity of dyspnea significantly. There was no measurable change in airway caliber following administration of beta 2-adrenergics. The most sensitive parameters for describing the tracheal stenosis are the resistance and flow volume values. A tracheal diameter smaller than 6.5 mm corresponding to a sGaw smaller than 0.03 (cmH2O s)-1 procedured severe dyspnea, which is incompatibly with normal life.(ABSTRACT TRUNCATED AT 250 WORDS)

Regional and global lung function in unilateral fibrothorax after conservative therapy and decortication.

Twenty-six patients suffering from unilateral fibrothorax were investigated before surgery or conservative therapy (decortication, n = 15; conservative treatment, n = 11) and followed up after 24.5 and 18.6 months respectively. Global lung function analysis was done by body plethysmography, ventilation and gas exchange analysis and blood-gas analysis under resting and exercise conditions. Regional lung function analysis included the semiquantitative description of fibrothorax by X-ray photos, and ventilation-perfusion scintigraphy. The functional result of unilateral fibrotic pleurisy is restriction which is also persistent after therapy, but to a lesser degree. This restriction is shown in an increased dead space ventilation as well as in ventilatory inhomogeneities, which causes a distortion of respiratory gas exchange. A decrease of compliance of the lung and chest wall is not measurable after therapy. Conservative treatment leads to a functional improvement to the same degree as decortication in cases of severe preoperative functional disturbances of the operated patients. After a course of 1.5 and 2 years respectively, the reference value has not been reached in either group. The regional pattern after therapy is characterized by a restriction and under-perfusion of the formerly affected site. The regional improvement of lung function is independent of the type of therapy, however, it shows a close correlation to the amount of pleurisy prior to therapy. Conservative treatment is the therapy of choice as long as no complications of insufficient recovery impede the course of the illness.

Effects of surgery on airway mechanics in tracheal stenosis.

12 patients suffering from severe extrathoracic tracheal stenosis mainly caused by long-term artificial ventilation were investigated by comparing their airway mechanics before and after tracheal sleeve resection and during long-term follow up. The investigations included body plethysmography, flow-volume relation, effect of bronchodilator, bronchial challenge and endoscopic estimation of the tracheal diameter. Tracheal sleeve resection in stenosis doubles the tracheal diameter from 5.9 to 11.0 mm. Resistance parameters and forced expiratory flow values reflected the significant improvement best. Airway structure remains stable during long-term follow-up, and effort-dependent parameters improve further. Compared to normal volunteers with artificially induced stenosis patients show a higher tolerability for airway narrowing. A tracheal diameter of 5 mm produces severe complaints and distinct functional distortions which are shown in specific airway resistance of 7.5 cm H2O X s, specific airway conductance of 0.02 cm H2O-1 X s-1 and FEV1 of 1 l X s-1. These values are absolute indications for resection. Tracheal stenosis after long-term artificial respiration can be influenced slightly by bronchodilator therapy. Nonspecific bronchial hyperreactivity is present, suggesting increased reagibility of the bronchial smooth muscles.

[Smoking in the childhood--results of the school study Berlin-Karow 1976 (author's transl)]. / Rauchen im Kindesalter--Ergebnisse einer Schuluntersuchung in Berlin-Karow 1976.

The smoking habits and the lung function of 369 boys and 340 girls aged 6-16 were examined in a school. The boys are beginning to smoke at the age of 9, the girls at the age of 13. 62 per cent of the children aged 16 are smoking (20 per cent of the girls and 30 per cent of the boys are smoking regularely more than 1 cigarette/day). 58 per cent of the children have a smoker in their family. Only 10 per cent of the parents have knowledge about the smoking of their child aged 12, and 59 per cent of the parents of their child aged 16. The lung function tests (ventilation, distribution, bodyplethysmography, single-breath-test, blood gases) of the healthy teen-agers dont show differences between smokers and non-smokers.

[Screening tests for the determination of risk groups in respiratory insufficiency under conditions of epidemiological serial studies]. / Screeningtests zur Erfassung von Risikogruppen der respiratorischen Insuffizienz unter den Bedingungen epidemiologischer Reihenuntersuchungen

A report is given on a system of effective respiratory functional tests which proved its value when used in epidemiological mass examinations in connection with the mass miniature radiography in Berlin, Brandenburg and Halle as well as in mass examinations in Berlin enterprises. Thereby a new development - Pneumotest - is presented, an electronic spirometer for the recognition of ventilatory and distribution analytic preliminary parameters with digital indication of 5 sizes of the breath test manoeuvre which is to be applied as successor of the well-known spirotest device. In this paper the functional capacity of the further developed fluorographic densimetry as preliminary emphysematic test is proved. The application of the rapid helium or O2/N2 breathing back technique for the determination of residual volume and closing volume has in connection with the automatic establishment of the measuring values proved as basic diagnostics for emphysema with a large efficiency and at the same time with high reliability. The digestion of the epidemiological functional data with the help of electronic data processing is carried out in the own microcalculator system following immediately the application during examination.