The bilateral scrotal flap: Anatomical study and it's use for the management of inflammatory granulomas following custom-made injections.

INTRODUCTION: The management of 10 cases of penile inflammatory granulomas following a subcutaneous injection of non-absorbable substance for the purpose of penile augmentation is presented. We subsequently used the bilateral scrotal flaps to cover the post-excision skin defect. A simple decision aid chart outlining the management of penile foreign body injections is proposed. METHODS: A total of 10 patients were included in this study. All required surgical management by penile degloving, followed by complete excision of the inflammatory granuloma and overlying skin. The dissection of 14 cadavers was carried out to study the blood supply to the anterior scrotal flap. Penile reconstruction was then performed using a bilateral scrotal flap in all but two cases. Post-operatively, the patients were followed up for a 1 year period. RESULTS: We obtained good results in terms of the aesthetic outcome with all of our ten patients with the area covered having similar color to penile skin. There were no major post-operative complications. There were two minor complications involving wound healing. Sensory function was maintained and no penile shortening or curvatures were noted, in addition all patients were satisfied with both the shape and function of the penis. CONCLUSION: Although much rarer, penile augmentation related complications are still seen in western countries. The treating doctor should be aware of its management. We had achieved acceptable outcomes in our experience with the bilateral scrotal flap. We believe it is a good and simple option for soft tissue coverage of the penis in cases following the complete inflammatory granuloma excision. It can achieve satisfactory aesthetic and functional results for this group of patients.

[Hetero-digital toe flap according to the « spare-part ¼ concept taken from a duplicated toe for the treatment of a cutaneous flessum of an associated clinodactyly]. / Lambeau hétéro-digital selon le principe du « doigt banque ¼ prélevé chez un orteil dupliqué pour le traitement d'un flessum cutané d'une clinodactylie associée.

INTRODUCTION: The correction of cutaneous deficiency encountered in clinodactyly is an important aspect of its treatment. The use of the skin lining of an adjacent duplicated toe as a « spare-part ¼ flap may be of interest in providing good quality tissue. CLINICAL CASE: We report the case of a child with complete duplication of the 5th toe associated with clinodactyly. The use of a heterodactyl flap taken from the amputated toe allows the release of a plantar cutaneous flange of the preserved toe. DISCUSSION: The concept of « spare-part ¼ flap is mainly used in hand surgery in traumatic lesions of the fingers. Its application in the treatment of clinodactyly on the occasion of the regularization of a polydactyly is also interesting because some fingers or toes are intended to be amputated to render a classical anatomy of five-toed foot. It is necessary for the realization of this type of flap on malformative toes to verify the existence of a distinct viable pedicle of the amputated toe, which can be done only intraoperatively. CONCLUSION: The surgery for congenital malformations of the toes requires perfect management of the skin capital. The use of a « spare-part ¼ toe flap taken from the toe to be amputated is a viable solution for the treatment of a cutaneous flessum encountered in a clinodactyly of the adjacent finger.

Abdominoplasty with simultaneous laparoscopic umbilical hernia repair: A practical approach to preserve the umbilical vascularization.

BACKGROUND: Umbilical necrosis is a well-known complication of abdominoplasty, the risk of this complication can be increased when an associated umbilical hernia requires further dissection in peri-umbilical region, potentially leading to umbilical devascularisation. Multiple minimally invasive open techniques were described to avoid this problem. The combined approach of abdominoplasty with laparoscopic umbilical hernia repair is one promising solution to avoid devascularising the umbilicus. METHODS: A retrospective evaluation of patients who underwent concomitant abdominoplasty with laparoscopic umbilical hernia repair from 2007 to 2017 was carried out. All patients were followed up and evaluated for complications, including the incidence of umbilical skin necrosis. RESULTS: A total of 47 patients were included in this study. The average operative duration was 3.3hours with an average hospital stay of 2.5 days. No cases of postoperative umbilical necrosis were encountered. A mean follow-up period was 2.4 years showed no cases of hernia or rectus abdominis diastasis recurrence. Minor complications included 4 cases of dehiscence, one hematoma. There was no major complications. CONCLUSION: The concomitant use of laparoscopic umbilical hernia repair and abdominoplasty is a feasible approach to reduce the risks of umbilical devascularization. Especially in larger hernias and in patients with higher risk of recurrence.

[Fasciocutaneous flap reliable by deep femoral artery perforator for the treatment of ischial pressure ulcers]. / Lambeau fasciocutané sous fessier fiabilisé par une perforante de l'artère fémorale profonde en reconstruction d'escarre ischiatique.

INTRODUCTION: The surgical management of pressure ulcers in the paraplegic or quadriplegic population is marked by the high risk of recurrence in the long-term. In the current era of perforator flaps, newer reconstructive options are available for the management of pressure ulcers, decreasing the need to use the classically described muscular or musculocutaneous locoregional flaps. The coverage of ischial sores described in this article by a pedicled flap based on a deep femoral artery perforator, appears to be an effective first-line reconstructive option for the management of limited size pressure ulcers. PATIENTS AND METHOD: A number of fifteen paraplegic or quadriplegic patients having at least one ischial bed sore with underlying osteomyelitis were included in this series. The approximate location of the deep femoral artery perforator was initially identified using the "The Atlas of the perforator arteries of the skin, the trunk and limbs", which was confirmed, with the use of a Doppler device. A fasciocutaneous transposition flap was elevated, with the pivot point based on the cutaneous bridge centered on the perforator, and then transposed to cover the area of tissue loss. The donor site was closed primarily. RESULTS: A total of fifteen patients were operated from November 2015 to November 2016. The series comprised of 16 first presentations of a stage 4 pressure ulcers associated with underlying osteomyelitis that were subsequently reconstructed by the pedicled deep femoral artery perforator flap. The healing rate and functional results were both satisfactory. CONCLUSION: Fasciocutaneous flap reliable by deep femoral artery perforator appears to have a promising role in the treatment of ischial pressure sores. It is an attractive option to spare the use of musculocutaneous flaps in the area. Thus this flap could be used as a first-line option to cover ischial pressure ulcers of limited size.

Triple flap technique for vulvar reconstruction.

OBJECTIVE: Perineal defects are encountered ever more frequently, in the treatment of vulvar cancers or abdominoperineal resection. The surgical treatment of vulvar cancer leads to significant skin defect. The aim of the reconstruction is not to provide volume but rather to resurface perineum. We propose a new solution to cover the extensive skin defect remaining after excision. METHODS: We report 3 patients who underwent large excision for vulvar cancer, with lymph node dissection. For reconstruction, we performed 3 advancement flaps. Two V-Y flaps cantered on the infra-gluteal folds and based on pudendal perforator arteries were used to cover the postero-lateral parts of the defect. The third advancement flap from the superior aspect of the defect was a Y-V Mons pubis flap. RESULTS: The defects were successfully covered by the 3 flap technique. The first patient suffered a non-union that slowly healed by secondary intention. For the other cases, we used the same technique, but applied negative pressure wound therapy on the sutures, with excellent results. CONCLUSION: The 3 flap technique is a simple and reliable method and the donor site morbidity is minimal. It can be realised without changing the position of the patient after tumour excision, and does not require delicate perforator dissection. This surgical option can be easily applied, allowing better management of these cases.

Anatomy and Aesthetics of the Labia Minora: The Ideal Vulva?

Female genital cosmetic surgery is becoming more and more widespread both in the field of plastic and gynaecological surgery. The increased demand for vulvar surgery is spurred by the belief that the vulva is abnormal in appearance. What is normal in terms of labial anatomy? Labia minora enlargement or hypertrophy remains a clinical diagnosis which is poorly defined as it could be considered a variation of the normal anatomy. Enlarged labia minora can cause functional, aesthetic and psychosocial problems. In reality, given the wide variety of vulvar morphology among people, it is a very subjective issue to define the "normal" vulva. The spread of nudity in the general media plays a major role in creating an artificial image and standards with regard to the ideal form. Physicians should be aware that the patient's self-perception of the normal or ideal vulva is highly influenced by the arguably distorted image related to our socio-psychological environment, as presented to us by the general media and internet. As physicians, we have to educate our patients on the variation of vulvar anatomy and the potential risks of these surgeries. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Antimicrobial resistance pattern and genetic correlation in Enterococcus faecium isolated from healthy volunteers.

Enterococci are known as a cause of nosocomial infections and this aptitude is intensified by the growth of antibiotic resistance. In the present study, Enterococcus faecium isolates from healthy volunteers were considered to determine the antibiotic resistance profiles and genetic correlation. A total 91 normal flora isolates of enterococci were included in this study. Identification of Enterococcus genus and species were done by biochemical and PCR methods, respectively. Sensitivity for 10 antibiotics was determined and genetic relatedness of all isolates was assessed using Repetitive Element Palindromic PCR (REP-PCR) followed by Pulse Field Gel Electrophoresis (PFGE) on the representative patterns. None of the isolates were resistant to teicoplanin, vancomycin, quinupristin-dalfopristin, linezolid, chloramphenicol, ampicillin and high-level gentamicin. On the other hand, the resistance rate was detected in 30.7%, 23%, and 3.29% of isolates for erythromycin, tetracycline and ciprofloxacin, respectively. The results of PFGE showed 19 (61.5% of our isolates) common types (CT) and 35 (38.5%) single types (ST) amongst the isolates. This is the first study to describe antibiotic resistance pattern and genetic relationship among normal flora enterococci in Iran. This study showed no prevalence of Vancomycin Resistant Enterococci (VRE) and high degrees of diversity among normal flora isolates by genotyping using PFGE.

Prevalence of high-level gentamicin-resistant Enterococcus faecalis and Enterococcus faecium in an Iranian hospital.

This study was designed to determine the molecular characteristics and antimicrobial resistance of enterococcal strains isolated from patients admitted to an Iranian Hospital. Enterococcal strains were isolated from the burn patients. All strains were screened for genes encoding resistance to aminoglycoside [aac(6')-Ie-aph(2'')-Ia, aph (3'), ant (4')], resistance to vancomycin (vanA, vanB), resistance to tetracycline (tetK, tetL, tetM, tetO), and resistance to erythromycin (ermA, ermB, ermC) by PCR and multiplex PCR-based methods. Genetic diversity was evaluated via Random Amplified Polymorphic DNA (RAPD)-PCR. All enterococcal isolates showed complete sensitivity to vancomycin with MIC ≤ 0.5µg/ml. Resistance to gentamicin, tetracycline, erythromycin, ciprofloxacin or quinopristin-dalfopristin was detected, whilst more than 96.2% of isolates were high-level gentamicinresistant (HLGR) and multiple drug resistant. The most prevalent aminoglycoside resistance gene was aac(6')-Ie-aph(2'')-Ia, that was found in 96.2% (26/27) of the isolates. The most prevalent tetracycline resistance genes were tetM, found in 85.1% (23/27) followed by tetL and tetO found in 7.4% (2/27) of the isolates. The ermA and ermB genes were detected in 33.3% (9/27) and 44.4% (12/27) of the isolates respectively. RAPD-PCR analysis yielded 17 distinct profiles among 27 investigated isolates. One cluster of isolates shared the same RAPD pattern, while 16 isolates had unique RAPD pattern. Our study showed that during the examination time period one RAPD genotype was the common type and was disseminated among patients in the burn unit. Interestingly, most of these strains had an identical or very similar antibiotic and gene resistance pattern.

Antimicrobial susceptibility patterns of the gram-negative bacteria isolated from septicemia in Children's Medical Center, Tehran, Iran.

INTRODUCTION: The choice of antimicrobial treatment for septicemia is often empirical and based on the knowledge of local anti-microbial activity patterns of the most common bacteria causing such bloodstream infections. The current study aimed to study the prevalence of bacterial pathogens causing septicemia and their antimicrobial resistant profiles in hospital admitted patients. METHODS: This cross sectional study done at Children's Medical Center, Tehran, Iran. We examined 168 bacterial strains isolated from 186 clinically diagnosed septicemia cases refereed at Children's Medical Center, Tehran, Iran. Over a period of twelve months from July 2010 to 2011 July. 11446 blood samples from patients of clinically suggestive septicemia were evaluated. RESULTS: Bacterial strains were isolated from 910 (7.95%) of blood cultures. Gram-negative bacteria identified were Pseudomonas species (20.5%), Pseudomonas aeruginosa (1.86%), Salmonella spp (1.09%), Acinetobacter naumannii (8.13%), Escherichia coli (4.06%), Klebsiella spp (5.16%). Gram-negative pathogens were more than gram positive in bloodstream infections. Antimicrobial susceptibility testing was done according to Clinical and Laboratory Standards Institute (CLSI, USA) guidelines against: amikacin ampicillin, amoxicillin, amoxiclav, cefuroxime, cefotaxime, ceftazidime, cefoperazone tetracycline, chloramphenicol, ciprofloxacin, gentamicin. Resistanc to different antibiotics in the most important isolated bacteria were: 32.1%, 10.8%, 87.8%, 96%, 39.1%, 35.2, 49.4%, 69%, 80.02%, 22%, 59%, 30.1% respectively, for Pseudomonas spp, 32%, 3.7%, 84.2%, 83.2%, 80.1%, 75.4%, 44.8%, 45.2%, 33.3%, 19%, 34.1, 11.5% respectively for Acinetobacter species. DISCUSSION: Resistant to majority of the antimicrobial agents for several pathogens implicated in bloodstream infections, particularly in Gram-negative bacteria, can make complication in treatment of infection cause by them.

A molecular survey on virulence associated genotypes of non-O1 non-O139 Vibrio cholerae in aquatic environment of Tehran, Iran.

Thirty-seven Vibrio cholerae strains were isolated from surface water sources at 5 different locations in Tehran, Iran during 2006 and were identified as non-O1 and non-O139 isolates. PCR for SXT element and class 1 integron was positive for 19% and 5.4% of isolates, respectively. PCR for virulence associated-genes within the vibrio pathogenicity island (VPI) gene cluster showed the presence of LJ, int and RJ in 8, 59 and 30% of the isolates, respectively. None of the V. cholerae isolates contained the toxin encoding genes (ace, zot, ctx) in the CTX genetic element. Biochemical fingerprinting using PhPlate system (PhP-RV) was able to type all strains and resulted in 8 common types (containing 78% of the isolates) and 8 single types (22%). Out of 37 isolates, only 26 isolates were typeable with pulsed-field gel electrophoresis (PFGE) producing banding patterns. The results presented in this study showed no genotyping correlation between the V. cholerae isolated from surface water and the clinical setting which had been reported previously by this laboratory. Furthermore, combination of PFGE and PhP-RV methods was proved beneficial for non-typeable V. cholerae isolates.

Characterization of aminoglycoside resistance mechanisms in Acinetobacter Baumannii isolates from burn wound colonization.

Clinical isolates of Acinetobacter baumannii have a tendency to develop antimicrobial resistance against commonly prescribed antimicrobial agents, including aminoglycoside agents, particularly in hospitalized patients worldwide. Resistance mechanisms of the bacterium to aminoglycosides are diverse and commonly involve production of aminoglycoside-modifying enzymes and efflux systems. The aim of this study was to investigate the frequency of gene encoding aminoglycoside-modifying enzymes and expression level of adeB efflux gene in A. baumannii isolates recovered from burn wound colonization. A total of 47 clinical isolates of A. baumannii were obtained from burned patients admitted to the Burns Teaching Hospital, Tehran, in 2018. Standard antimicrobial susceptibility screening was performed to determine resistance pattern. A polymerase chain reaction (PCR) assay was performed to determine aminoglycoside-modifying genes ACC(6'), aph(3')-Via, aph(3')-IIb, aadA1, aphA1 and aph6. Semi-quantitative RT-PCR was also carried out to quantify the expression level of the adeB gene. According to the results of the present study, the acc(6') was the predominant aminoglycoside-modifying enzyme gene (80.9%), followed by aph(3')-via, aph6, aph(3')-IIb and aphA1, which was detected in 59.6%, 42.6%, 14.9% and 14.9% of isolates, respectively. None of the A. baumannii isolates harboured the aadA1 gene. The up regulation of adeB gene expression was observed in 63.8% of strains. Moreover, we indicated that there is a relationship between adeB expression and high resistance to gentamicin. Our results revealed that aminoglycoside resistance could be explained by the production of one or a combination of known aminoglycoside-modifying enzymes rather than overexpression of adeB.

Acinetobacter baumannii (AB) est de plus en plus fréquemment isolé de prélèvements cliniques de par le monde. Il est très susceptible de développer des résistances aux antibiotiques, parmi lesquels les aminosides, en particulier dans les hôpitaux. Les mécanismes sont variables, le plus souvent enzymatiques ou par efflux. Le but de cette étude était d'évaluer les fréquences des gènes codant pour des enzymes modifiant les aminosides et le niveau d'expression du gène de pompe d'efflux adeB chez 47 AB isolés de zones brûlées dans le CTB du CHU de Téhéran. Les gènes codant pour AAC(6'), aph(3')-Via, aph(3') IIb, aadA1, aphA1 et aph6 ont été recherchés par PCR. Le niveau d'expression du gène adeB a été étudié par PCR semi-quantitative : aac(6') était le gène le plus fréquemment retrouvé (80,9%), suivi par aph(3')-Via (59,6%), aph6 (42,6%), aph(3') IIb (14,9%) et aphA1 (14,9%). Nous n'avons pas mis en évidence aadA1. Une surexpression de adeB a été observée chez 63,8 % des souches, reliée à une résistance élevée à la gentamicine. Ces résultats montrent que la résistance de AB aux aminosides est plus d'origine enzymatique que liée à un efflux.

Echocardiographic Pulmonary Hypertension Predicts Post-transplantation Renal Allograft Failure.

BACKGROUND: Pulmonary hypertension in the setting of renal transplantation has been associated with early allograft dysfunction and increased mortality, but this relationship has not been extensively studied. METHODS: We performed a retrospective cohort study of adult patients who underwent their first renal transplantation in the years 2003-2009 and had pre-transplantation echocardiograms. Pulmonary hypertension was defined as right ventricular systolic pressure ≥40 mm Hg in the absence of left-sided valvular disease and/or left ventricular ejection fraction ≤50%. Eighty-two of 205 patients (40%) met the inclusion criteria. The relationship between pulmonary hypertension and death-censored allograft failure (hemodialysis dependence or retransplantation) and serum creatinine was assessed with the use of Cox hazard regression and generalized mixed models. RESULTS: The presence of pulmonary hypertension was associated with a 3-fold increase in the risk of death-censored allograft failure (95% confidence interval, 1.20-7.32; P = .02). Failure rates were 19% at 24 months and 51% at 96 months for those with pulmonary hypertension versus 7% at 24 months and 20% at 86 months for those without pulmonary hypertension (P = .01). Among those without graft failure, there was an increase in creatinine levels after transplantation (P = .01). Effect estimates were unchanged by adjustment for multiple covariates and when pulmonary hypertension was defined as right ventricular systolic pressure ≥36 mm Hg. CONCLUSIONS: Pulmonary hypertension before renal transplantation carries a 3-fold increased risk of death-censored allograft failure. The relationship between the pulmonary circulation and renal allograft failure warrants further study.

PFGE genotyping and molecular characterization of Campylobacter spp. isolated from chicken meat.

A total of 70 samples were collected from chicken meat obtained from 10 markets in Tehran, Iran from which 39 Campylobacter coli were isolated. Among 10 antibiotics used, maximum resistance was seen to trimethoprim-sulphamethoxazole (SXT) (97.36%), nalidixic acid (94.8%), ciprofloxacin (87.7%), streptomycin (89.72%), and tetracycline (97.4%). No resistance was to gentamycin was observed. None of the Campylobacter strains under study harbored integron, suggesting the involvement of other resistance mechanisms in emergence of multi drug resistance (MDR) phenotype among the isolates. Two major types (A and B) and 15 subtypes (A1-A8 and B1-B7) were identified. Pulsed-field gel electrophoresis (PFGE) analysis demonstrated a high degree of homogeneity while the majority of the isolates shared identical or very similar PFGE genotypes. Isolates with identical genotypes differed in their resistance profile, although all of them assigned to MDR phenotype. To our knowledge, this is the first molecular survey from Iran characterizing Campylobacter isolates from poultry, which adds to our knowledge the epidemiological linkage of Campylobacter isolates with MDR properties from different sources and emphasizes the need for cautious use of antimicrobials in different fields of food production chain.

Suicidal behavior by burns among women in two bordering provinces in Iran.

The objective of the study was to describe epidemiologic features of suicidal behavior by burns among women in two bordering provinces in Iran. A prospective hospital-based study of all suicidal behaviors by burns among women was carried out in the Iranian provinces of Khorasan (which borders Afghanistan) and Ilam (which borders Iraq) in 2006. These two provinces suffered from war and economic instability with high rates of poverty and unemployment. Data were obtained from patients, family members, and/or significant others through interviews during the course of hospitalization. Of 181 hospitalized patients, 130 (71.8%) were female, representing a hospital separation rate of 5.4 per 100,000 person-year (P-Y). The rate of suicidal behavior involving burns among the rural population was higher than that in the urban population (6.3 vs. 4.7 per 100,000 P-Y, P = 0.09). The median age of the patients was 23 years old, with a mean (±SD) of 27.9 (±14.3) years old. Approximately 68.5% of women were married. Quarrels with "a family member, spouse, a relative, or a friend" (marital plus other conflicts) was identified as the most common precipitating factor (88.5%) in attempting suicide. More than one third of women were abused (physically and/or verbally) by family members (i.e. spouse, father-in-law). Case fatality rate in this study was 52.3% (68/130). Suicide by burns is still a socio-epidemiological problem in Iran, particularly among young, married women in rural areas. Social and economic conditions, as well as violence against women, play a major role in the high rate of suicide by burns. The findings of this study highlight the need for the implementation of a well-organized approach to reduce the rate of suicide by burns among the most vulnerable populations in Iran.

L'objectif de l'étude était de décrire les caractéristiques épidémiologiques de comportements suicidaires par brûlures chez les femmes dans deux provinces frontalières de l'Iran. Une étude prospective en milieu hospitalier de tous les phénomènes suicidaires par brûlures chez les femmes a été réalisée dans les provinces iraniennes du Khorasan (qui borde l'Afghanistan) et Ilam (frontalière de l'Irak) en 2006. Ces deux provinces ont souffert de la guerre et de l'instabilité économique avec des taux élevés de pauvreté et de chômage. Les données ont été obtenues à partir de patients, membres de la famille et / ou d' autres au cours de l'hospitalisation. Sur les 181 patients hospitalisés, 130 (71,8%) étaient des femmes et environ 68,5% d'entre elles étaient mariées. Le taux de comportement suicidaire par brûlures chez la population rurale était supérieur à celui de la population urbaine. L'âge médian des patients était de 23 ans, avec une moyenne (± SD) de 27,9 (± 14,3) ans. Les querelles avec «un membre de la famille ou un ami¼ ont été identifiées comme le facteur le plus déterminant (88,5%) dans une tentative de suicide. Plus d'un tiers des femmes ont été victimes de violence (physique et / ou verbale) par les membres de la famille. Le taux de létalité dans cette étude était de 52,3% (68/130).Le suicide par brûlure est toujours un problème socio-épidémiologique en Iran, en particulier chez les jeunes femmes mariées dans les zones rurales. Les conditions sociales et économiques, ainsi que la violence contre les femmes, jouent un rôle majeur dans le taux élevé de suicide par brûlures. Les résultats de cette étude soulignent la nécessité de la mise en oeuvre d'une approche bien organisée pour réduire le taux de suicide par brûlures chez les populations les plus vulnérables en Iran.

Intranasal immunization with HIV reverse transcriptase: effect of dose in the induction of helper T cell type 1 and 2 immunity.

HIV reverse transcriptase (RT) is immunologically recognized by the host after natural infection with HIV. To study the immune response to this nonenvelope protein and the effect of the antigen dose and the immunization route on the differential induction of cellular or humoral responses, CB6F1 mice were immunized intranasally with various doses of recombinant RT (0.025-25 microg/dose) in the presence of the mucosal adjuvant cholera toxin (CT). An antigen-specific, dose-dependent, in vitro proliferative response was observed in splenic cells from all mouse groups immunized with RT and CT. Proliferative responses in salivary gland-associated lymph node (SGALN) cells from the same mice were detected only with higher antigen dose immunizations (2.5, 25 microg/dose). IFN-gamma, a Th1-type cytokine, was detected in RT-stimulated culture supernatants from splenic and SGALN cells from all groups of mice immunized with RT and CT in a dose-dependent fashion. IL-4, a Th2-type cytokine, was detected in RT-stimulated culture supernatants from splenic and SGALN cells from mice immunized with higher doses of RT and CT. RT-specific IgG2a, a Th1-type-related antibody, was detected consistently in sera from all animals immunized with RT and CT and was predominant in mice immunized with lower antigen doses (0.025, 0.25 microg/dose). RT-specific IgG1, a Th2-type-related antibody, was detected consistently in mice immunized with higher antigen doses and was predominant in these groups. These studies demonstrate the immunogenicity of recombinant RT and the effect of the antigen dose in the induction of Th1-type and Th2-type immune responses after mucosal immunization.

[Early administration of antibiotic susceptible strain of Escherichia coli in the intestine of the premature infant]. / Administration précoce d'une souche de Escherichia coli antibiosensible dans l'intestin du nouveau-né prématuré.

An antibiotic-susceptible, innocuous Escherichia coli strain of human origin was administered to premature infants in order to protect them from nosocomial colonization by antibiotic-resistant enteric organisms. The strain was given to 16 untreated patients in the first six hours of life, and to 11 patients treated with antibiotics in the first six hours after cessation of treatment. The strain was able to colonize the intestinal tracts of all treated infants and 14/16 untreated infants. Colonization of these patients by antibiotic-resistant enteric organisms was compared with results obtained in a control group of 15 unadministered and untreated infants. A significant difference was recorded in the first ten days after administration. Our results show that previous antibiotic treatments did not impair intestinal colonization by an antibiotic-susceptible strain, and demonstrate the in vivo antagonistic abilities of the administered strain. Such antagonistic strains might thus be used for control of nosocomial infections of intestinal origin due to antibiotic-resistant enteric organisms.

Expansion technique for skin grafts (Meek technique) in the treatment of severely burned patients.

The important limiting factor in the treatment of the severely burned patient is the lack of autograft donor skin. The method of obtaining uniform widely expanded postage stamp autografts described by Meek in 1963 has been evaluated in this study amongst seven severely burned patients. The expansion ratio of 1:4, 1:6, 1:9 was mostly used. After the removal of polyamide gauze on seventh post-operative day the autografts island were covered with overlay allograft, if the expansion ratio of 1:6 and above was used. The mean epithelialization rate was 90% within 4-5 weeks. The preliminary experience suggests, and proves that, it is a method of choice in severely burned patients.

Nosocomial infections in an Iranian burn care center.

Burn patients are obviously at high risk for nosocomial infections due to the immunocompromizing effects of burn injury. Pseudomonas aeruginosa is an important life-threatening nosocomial pathogen in burn units. The aim of this study was to determine nosocomial infections in the Tohid Burn Center in Tehran, Iran. Materials of this study were samples of burn wounds and blood from 582 patients who required hospitalization during March 1996 and September 1998. Burn wound samples were taken on admission day, 3 and 7 days after admission. Frequency of culture positive on admission day, 3 and 7 days after admission were 15, 66, and 88%, respectively. Frequency of P. aeruginosa and Staphylococcus aureus on admission day were 35 and 34%, on the third day after admission 73 and 15%, and at the end of the first week of admission 87 and 9%, respectively. Frequency of blood culture positive was 36% (19/53) of which 89% were P. aeruginosa. Overall mortality rate was 18.5% (108/582). Of these patients, frequency of positive wound culture was 92% (99/108). In conclusion, our results show that P. aeruginosa is the leading cause of nosocomial infections in our burn center. It is also necessary to introduce urgent measures for restriction of the spread of P. aeruginosa infections in our burn center.

Pediatric burn injuries in Tehran, Iran.

The objective of this study was to identify the epidemiologic features of pediatric burn injuries in western Tehran. Study subjects included all children up to the age of 15 years who were treated as inpatients at the Tohid Burn Center in Tehran between April 1995 and March 1998. Among the 3341 burns admitted to the Center over the 3-year study period, 1454 (43.5%) occurred in children less than 16 years of age. The overall case fatality rate for children was 16%, while the annual burn incidence rates ranged from 22.7 to 17.8 burns per 100000 child-years. The overall gender ratio (boys/girls) was 2.6. Children less than 2 years of age had the highest burn incidence and burn mortality rates. These findings will be used as a basis for developing targeted preventive programs to protect Iranian children from burns.