Incidence of bacteremia following bronchoscopy with argon plasma coagulation: a prospective study.

BACKGROUND: This evaluation was undertaken to determine the incidence of bacteremia and infectious complications associated with argon plasma coagulation (APC) procedures. METHODS: Consecutive patients undergoing bronchoscopy with APC for treatment of endobronchial lesions were studied. Venesection was performed for blood cultures within 60 s of the APC procedure. APC catheter washings were cultured. Patients with positive blood cultures were reviewed immediately. All patients underwent clinical review 1 and 12 weeks after APC. RESULTS: Forty-two patients underwent 44 APC procedures. Their mean age was 66 ± 12 years. One case (2.3 %) had bacteremia with Acinetobacter lwolfii. APC catheter washing culture was positive in 14 (31.8 %) procedures. No patient had clinical features suggesting infection and there were no complications. Phone review after 1 week revealed no complications. After 3 months, 8 (18 %) had died, all related to advanced lung malignancy and not to the APC procedure. CONCLUSIONS: APC does not appear to increase the risk of bacteremia compared to airway insertion of the bronchoscope. Although contamination of the APC catheter with oropharyngeal commensal bacteria is common, clinically significant infection following the APC procedure is rare.

Long-term reflux-related symptoms after bariatric surgery: comparison of sleeve gastrectomy versus laparoscopic adjustable gastric banding.

BACKGROUND: Long-term pulmonary reflux-related symptoms following laparoscopic adjustable gastric banding (LAGB) and laparoscopic sleeve gastrectomy (LSG) have not been reported. METHODS: We designed a retrospective analysis of consecutive patients who underwent LAGB or LSG between January 2000 and December 2010. All patients provided detailed history and physical examination. We assessed both early and late reflux-related symptoms. All patients underwent spirometry and chest X-ray (CXR). RESULTS: The analysis included 307 patients who underwent either LAGB (n = 193) or LSG (n = 114). Mean age was 43 ± 12 and 46 ± 11 years, respectively; 144 (76.6 %) and 83 (73 %) were female, respectively. Similar rates of previous pulmonary disease were noted in both LAGB and LSG groups (10.9 vs. 10.5 %, respectively). However, more patients with sleep apnea were in the LSG group (13.2 vs. 6.2 %, p = 0.03). The mean interval between surgery and the onset of pulmonary symptoms was longer in patients who underwent LAGB (72 ± 22 months) than for those who had LSG (36 ± 24 months; p = 0.03). The overall complication rate was higher in the LAGB (7.3 %) than in LSG (4.4 %) group. LSG patients had significantly lower rates of morning cough (12.3 vs. 59.6 %, p = 0.001) and postprandial cough (10.5 vs. 58 %, p = 0.001) compared to the LAGB patients. Two cases of pneumonia occurred in each group. The mortality rate was zero in both groups. CONCLUSION: Both surgeries are considered safe and without major reflux-related symptoms. There is a lower incidence of cough with LSG than with LAGB.

[Omalizumab treatment in patients with asthma: summary of Meir Medical Center experience with 47 patients].

INTRODUCTION: Omalizumab is a humanized monoclonal anti-IgE for the treatment of moderate to severe allergic asthma. Although the treatment has been available for several years, there are some concerns about its safety and efficacy. AIM: To assess the efficacy and safety of Omalizumab in all asthmatic patients who were treated with Omalizumab during at least 3 months in the Pulmonary Department at the Meir Medical Center. METHODS: Retrospective analysis was conducted for all our asthmatic patients. Demographic and clinical characteristics of the patients were recorded from the computerized system of the Clalit Medical Service. Data collected included the degree of severity of the asthma, steroids usage, rate of asthma exacerbations, hospitalizations before and with Omalizumab treatment, as well as the safety profile. RESULTS: Forty seven patients were included in the study; 70% were female; mean age was 61 +/- 12 years. Duration of asthma was 25 +/- 17 years. Asthma exacerbations rate decLined from 70.2% to 38.3% (p=0.007). Pulmonary functions improved from 58 +/- 14% FEV1 to 63 +/- 17% (p=0.002). Forty five percent of the patients had no hospitalizations during the Omalizumab treatment; 25% had one hospitalization, 17% two and 13% had 3 or more hospitalizations. No anaphylaxis or malignancies were observed. No serious adverse events were noticed except for 4 patients with injection site pain. CONCLUSIONS: Data indicates that the high efficacy of add-on Omalizumab in patients with moderate to severe allergic asthma is accompanied by an acceptable safety profile.

Co-trimoxazole versus vancomycin for the treatment of methicillin-resistant Staphylococcus aureus bacteraemia: a retrospective cohort study.

OBJECTIVES: To evaluate the efficacy and safety of co-trimoxazole versus that of vancomycin in adults with methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia. PATIENTS AND METHODS: Retrospective matched cohort study. Thirty-eight patients with MRSA bacteraemia, treated with co-trimoxazole as the main therapeutic agent, were matched with 76 patients treated with vancomycin as the main agent. The groups were matched for age, sex, functional status, endovascular source of infection, appropriateness of empirical antibiotic therapy, presence of a foreign body, sepsis severity and Charlson score. The outcomes collected were 30 day mortality, persistent bacteraemia [defined as positive blood culture (BC) >14 days after the first positive BC, but within 30 days], relapse (defined as recurrence of the same phenotype >30 days after the first positive BC within 12 months) and adverse events. RESULTS: The groups were well matched. Thirty day mortality was not significantly different between the groups [co-trimoxazole 13/38 (34.2%); vancomycin 31/76 (40.8%); odds ratio 0.76, 95% confidence interval 0.34-1.7]. There was only one case of relapse in the co-trimoxazole group (2.6%) compared with nine cases in the vancomycin group (11.8%). Incidence of relapse or persistent bacteraemia was lower in the co-trimoxazole group (3/38, 7.9%) than in the vancomycin group (13/76, 17.1%), although the difference was not statistically significant (P = 0.182). Development of renal failure was similar [co-trimoxazole 11/38 (28.9%); vancomycin 21/76 (27.6%)]. CONCLUSIONS: Within the limitations of a small retrospective study, co-trimoxazole had a safety and efficacy profile similar to that of vancomycin and may offer an attractive additional therapeutic option for MRSA bacteraemia. A prospective, randomized controlled trial is warranted.