Acetic acid as a decontamination method for ICU sink drains colonized by carbapenemase-producing Enterobacteriaceae and its effect on CPE infections.

BACKGROUND: Carbapenemase-producing Enterobacteriaceae (CPE) are emerging pathogens representing a major concern for public health. In Belgium, the OXA-48 carbapenemase resistance gene is identified most frequently. Sink drains in intensive care units (ICUs) are known to be colonized by Gram-negative bacilli. A correlation between environmental contamination and CPE infections in ICUs has been established. A long-term CPE epidemic in a local ICU proved difficult to control. METHODS AND RESULTS: A variety of CPE strains, all carrying the OXA-48 resistance gene, were isolated from almost all sinks in patient rooms in the ICU. Decontamination of the sinks with 250 mL 25% acetic acid three times weekly was implemented. Sink drain colonization was followed up for six months thereafter. Both the number of CPE-colonized sinks and the number of patients colonized or infected with CPE decreased drastically, to the extent that the epidemic was considered to be eradicated. In-vitro growth of all isolates was inhibited by a concentration of acetic acid equal to or smaller than that used for decontamination. Epidemiological analysis demonstrated a positive and significant relationship between contaminated sinks and CPE acquisition of patients admitted to ICU rooms, indicating the importance of contaminated sinks as the environmental reservoir of the epidemic. CONCLUSION: Decontamination of sink drains with acetic acid is a valuable alternative to other methods, such as heated sinks and water-free care, especially when other options are not feasible in the short term. Acetic acid is cheap, widely available, effective and manageable from a safety and technical point of view.

Value of MRI in the diagnosis of non-clival, non-sacral chordoma.

OBJECTIVE: To determine the MR features of non-sacral, non-clival chordoma and to describe a MR prototype of the lesion. DESIGN AND PATIENTS: We reviewed the MR findings of 10 patients with a histologically proven chordoma (6 cervical spine, 1 thoracic spine, 3 lumbar spine). There were three female and seven male patients. Age ranged from 12 to 66 years with a mean age of 44.6 years. The MR images were reviewed for signal intensity (SI) and morphology. RESULTS: All lesions showed a soft tissue extension spanning several vertebral segments. Most of the lesions exhibited a so-called collar button appearance (sagittal images). Two cases of cervical chordoma displayed a "dumbbell morphology" (axial images) or "mushroom" appearance without bone involvement and with enlargement of the neuroforamen mimicking a neurogenic tumor. Although the region of the nucleus pulposus is the last part of the fetal notochord in the adult to involute, disks were surprisingly spared in all patients. Eight of 10 patients showed heterogeneous SI on all sequences. The overall SI of all lesions was isointense or slightly higher than that of muscle on T1-weighted images. All lesions exhibited high SI on T2-weighted images. After gadolinium contrast administration there was a moderate enhancement in most cases. CONCLUSIONS: Although the SI on MR imaging is not specific, chordoma should be considered when a destructive lesion of a vertebral body is associated with a soft tissue mass with a collar button or mushroom appearance and dumbbell morphology, spanning several vertebral segments and sparing the disk(s).

Ectopic pregnancy within a rudimentary horn in a case of unicornuate uterus.

We report the MRI features of two cases of unicornuate uterus and occluded rudimentary horn. In one patient pregnancy had occurred in the occluded horn, prompting to urgent resection. The second patient illustrates more conventional findings in occluded rudimentary horn. In both cases MRI was able to correctly characterise the nature of the developmental anomaly. Furthermore, on the basis of signal intensities, differentiation between distended lumen due to blood accumulation and amniotic sac in the case of pregnancy could be made. Because of its high accuracy in determining the type of anomaly present, the lack of ionizing radiation, and the ability to evaluate, with the exception of the fallopian tubes, the entire genitourinary tract, MR imaging is essential and plays a key role in the evaluation of women who are consulting for infertility.

Pre- and intraoperative methods of controlling cerebral circulation in giant aneurysm surgery.

The surgical treatment of giant aneurysms usually requires temporary clipping of the aneurysmatic vessel. In planning the surgical approach and in applying temporary clips, the surgeon must consider collateral circulations. The functional integrity of the collateral vessels frequently decides the patient's outcome. In 8 patients with internal carotid artery giant aneurysm, measurements of blood flow velocities in the ipsilateral middle cerebral artery were performed preoperatively with transcranial Doppler ultrasound (TCD) during manual occlusion of the carotid artery at the neck. Three different perfusion patterns were established, and each collateral capacity was rated as insufficient, temporarily sufficient, or long-term unproblematic. Surgical strategies were conceived. In one patient with giant aneurysm of the middle cerebral artery the temporary occlusion test was not carried out preoperatively. Intraoperatively, collateral circulation was controlled using microvascular Doppler sonography (MVD). In 8 cases cortical blood flow (CoBF) was monitored by thermal diffusion flow probe and/or laser Doppler. In some cases, the complex pathological anatomy required a change in surgical strategy and a new MVD determination of collateral capacity. Despite these precautions 2 patients suffered ischemia of the basal ganglia and the white matter.