Not always a commensal: A case of mastitis by Corynebacterium amycolatum.

Gram positive rods seen on Gram's stain are often dismissed as skin commensal organisms. Diphtheroids (Non-diphtherial Corynebacterium species), as they are collectively called, are taken as harmless bystanders in a skin and soft tissue infection (SSTI). However, emerging evidence has established virulence factors in some of these species leading to various infections. Here, we describe a case of mastitis in a 43 year old female caused by Corynebacterium amycolatum. The organism was seen as thick Gram positive rods on Gram stain and was isolated as a pure growth on Blood agar. Identification was done on Vitek-2 and confirmed by matrix assisted laser desorption-ionization - Time-offlight (MALDI-TOF). Patient was managed successfully with surgical excision and antibiotics.

Induction therapy in pediatric kidney transplant recipients discharged with a triple drug immunosuppressive regimen.

We evaluated the effectiveness of induction therapy on transplant outcomes during 2004-2007 in the United States. We retrospectively reviewed OPTN/UNOS registry and selected kidney pediatric (<21-yr) recipients that received no induction (NoIND), IL-2RA, or rabbit anti-THY and were discharged with a triple drug immunosuppressive maintenance regimen, including steroids. Of 2932 recipients, 20%, 36%, and 43% were in NoIND, THY, and IL-2RA groups, respectively. The majority received tacrolimus (88%) and MMF (89%) at discharge. There was no association of induction with the risk of acute rejection even after adjusting for known cofounders. Compared to NoIND, IL2-RA, but not THY, had a modest decrease (3%) in absolute rate of graft loss and was associated with a risk reduction ratio of 0.51 (95% CI, 0.31-0.84) in one-yr graft loss. At three yr, no induction agent was associated with decreased graft loss. In conclusion, induction agents were used in 80% of pediatric kidney recipients discharged with a triple drug immunosuppressive maintenance regimen between 2004-2007 in the United States. Neither THY nor IL-2RA was associated with reduced rejection episodes. The use of induction therapy was not associated with improvement in three-yr graft survival.

Effect of 4-aminopyridine on the postsynaptic action of polymyxin B.

Polymyxin B produces neuromuscular blockade by acting at pre- and postsynaptic sites. Its postsynaptic effect has been attributed either to blockade of open ionic channels or to the conversion of the end-plate receptor from a low to a high affinity state, i.e. to a state similar to the desensitized one caused by agonists. Since 4-aminopyridine inhibits agonist-induced end-plate receptor desensitization, we decided to investigate its effect on the postsynaptic action of polymyxin B. The experiments were carried out on the isolated rat diaphragm; miniature end-plate potentials (m.e.p.p.s) and carbachol-induced depolarization at the end-plate region were recorded with microelectrode techniques. Polymyxin B, 40 micrograms/ml reduced the amplitude of the m.e.p.p.s and suppressed them in about 30 min. 4-Aminopyridine completely antagonized this effect. Neostigmine did not restore the m.e.p.p.s suppressed by polymyxin B nor did 4-aminopyridine antagonize the effect of d-tubocurarine on these potentials. The carbachol-induced depolarization was blocked only partially by polymyxin B. 4-Aminopyridine B nearly completely antagonized this effect. The antagonistic effect of 4-aminopyridine on the postsynaptic action of polymyxin B favors the receptor desensitization' hypothesis.

Anestesia para laparoscopia pelvica. / Anesthesia for pelvic laparoscopy

Foram estudadas 15 pacientes do sexo feminino, com estado fisico I (ASA) submetidas a laparoscopia pelvica, subdivididas em 3 grupos de acordo com a tecnica anestesica empregada. O grupo A recebeu anestesia geral venosa mais inalatoria com ventilacao controlada mecanica, o grupo B recebeu anestesia geral venosa mais inalatoria com ventilacao espontanea e o grupo C recebeu anestesia peridural. Esta investigacao foi proposta para se verificar qual das tres tecnicas era a mais segura do ponto de vista hemodinamico e ventilatorio, com base nos parametros estudados: pPH, PaCO2,DB pressao arterial e frequencia cardiaca.Constatou-se que a anestesia geral venosa mais inalatoria com ventilacao controlada mecanica foi a tecnica mais adequada e em segundo lugar a anestesia peridural. A anestesia geral inalatoria ventilacao espontanea apresentou alteracoes significativas dos valores de pH e PaCO2

Succinilcolina, apneia prolongada e pseudocolonesterase atipica: relato de um caso. / Prolonged apnea by succinylcholine and atypical pseudocholinesterase. Report of a case

Os autores relatam um caso de apneia prolongada em mulher caucasoide de 70 anos, decorrente do emprego de succinilcolina. A presenca de pseudocolinesterase atipica, detectada laboratorialmente, foi responsavel pela apneia prolongada. Discutem-se, ainda, os aspectos etiologicos da deficiencia de pseudocolinesterase, genetica e adquirida, e suas relacoes com o uso da succinilcolina

Effect of 4-aminopyridine on end-plate receptor desensitization caused by carbachol.

The effect of 4-aminopyridine on receptor desensitization was investigated in the isolated rat diaphragm by measuring transmembrane potential in the end-plate region. When 4-aminopyridine was added to the bath before carbachol, the depolarization produced by the agonist was permanent, that is 4-aminopyridine completely inhibited the receptor desensitization produced by prolonged exposure of the receptors to carbachol. When it was added after carbachol in the phase in which the membrane had already repolarized, the end-plate region depolarized. Therefore, 4-aminopyridine was also able to reverse the receptors from the desensitized state to the resting non-desensitized one. The effect of 4-aminopyridine was concentration-dependent. Calcium antagonized the effect of 4-aminopyridine. 4-Aminopyridine also reversed the receptors from their desensitized state to the resting one in the isolated and chronically denervated rat hemidiaphragm. The known action of the aminopyridines cannot explain the effect of 4-aminopyridine described here. It is suggested that it is caused by an action on either the receptor-ionic channel complex or the lipids of the postjunctional membrane surrounding it.