Postoperative contamination after using vancomycin and gentamicin during phacoemulsification.

OBJECTIVE: To investigate if the addition of vancomycin and gentamicin to the irrigating solutions during phacoemulsification with lens implantation reduces the incidence of positive postoperative intraocular cultures. DESIGN: Two-part double-masked, placebo-controlled, randomized clinical trial. PATIENTS: In the preliminary study, intracameral antibiotic concentrations were measured immediately after surgery (in 10 eyes) and 2 hours after surgery (in 10 eyes) in patients treated with antibiotics. In the primary study, 120 eyes underwent uncomplicated surgery. The treatment group and the placebo group were composed of 60 eyes each. INTERVENTION: The treatment group received vancomycin, 20 micrograms/mL, and gentamicin, 8 micrograms/mL, in the irrigating fluid. The placebo group received only irrigating fluid. All patients in the primary study underwent anterior chamber aspiration following surgery, and culturing was performed 2 hours later. MAIN OUTCOME MEASURE: Identification and quantification of positive cultures in thioglycolate broth and chocolate agar. RESULTS: In the preliminary study, the half-life of both intraocular antibiotics was less than 2 hours. In the primary study, intraocular aspirates yielded positive cultures in 3 specimens (5.0%) in the antibiotic-treated group and in 7 specimens (12.0%) in the placebo group. CONCLUSIONS: Although we found a higher rate of positive postoperative cultures in the placebo group (odds ratio = 2.51), 2 hours of contact between the antibiotic solution and bacteria did not produce results that reached statistical significance (P =.18) to support adding vancomycin and gentamicin to the irrigating solutions during phacoemulsification. Further studies are needed to evaluate the clinical implications of using antibiotics in irrigating solutions.

Value of limited necropsy in HIV-positive patients.

We performed limited autopsy with histological examination of tissue cores obtained percutaneously using the Tru-Cut needle and the Jamshidi trocar in 150 adult HIV-positive patients. Data were compared retrospectively with the antemortem clinical diagnosis. Eighty-one percent of the patients were male, and 78% were intravenous drug users. Specimens were obtained from the brain, liver, lung, bone marrow, and kidney of most patients. The main findings included liver cirrhosis in 22 cases (associated with HCV infection in 81%), Pneumocystis carinii pneumonia in 21, Cytomegalovirus (CMV) infection in 19, Mycobacterium avium-intracellulaire (MAI) infection in 17, bacterial pneumonia in 14, tuberculosis in 12, and lymphoma in 13 cases. Forty-six (30.6%) patients had at least one clinical diagnosis that was confirmed by autopsy, i.e., there was 40.6% agreement between pre- and postmortem findings. Forty-six (30.6%) patients had at least one clinical diagnosis that was not confirmed at autopsy, whereas 41 (27.3%) had at least one AIDS-related or unrelated disease that was not suspected clinically. The results obtained by limited autopsy are principally comparable to those achieved by full necropsy, with the advantages of decreasing the contagious risk, saving cost and time, including a rapid final diagnosis, and easily obtaining the consent for postmortem examination so that necropsy studies may be performed on a larger number of patients, thus contributing to a better understanding of the spectrum of HIV infection in our environment.

Reduction of Kt/V by food intake during haemodialysis.

BACKGROUND: Urea kinetic modelling is a method for verifying that the amount of dialysis prescribed equals the amount of dialysis delivered. DOQI guidelines help to assess the causes of a low Kt/V: fistula integrity, treatment duration, methods of obtaining BUN samples, dialysis machine and patient specific variables. OBJECTIVE: To demonstrate the relation between food intake during HD and measurement of Kt/V. METHODS: Prospective study on 14 patients. We measured the amount of dialysis during the second week, with and without food intake during HD. HD prescription (blood flow, dialysate flow, dialyser, dry weight, heparin) was not changed. Statistical analysis was performed using Paired T test. CONCLUSIONS: 1. There was no significant change in protein catabolic rate, average urea concentration and intradialysis gain with food intake. 2. There was a significant change in levels of Kt/V using Gotch formula and Dugirdas formula with food intake.

[The microbiologist and the catheter related infection]. / El microbiólogo y la infección asociada a catéters.

Different multicentre epidemiological studies such as ENVIN-HELICS or EPINE, have remarked that catheter related bloodstream infection (CRBI) is an increasingly condition in hospital environment. The microbiologist plays a major role in the diagnosis, either by recommending what type of catheter must be considered for confirmatory diagnosis, when these samples must be sent for culture, when is indicated to perform surveillance studies of the catheter and what results are clinically significant to be informed. In this paper, different aspects of the CRBI, such as the pathogenesis, etiology, epidemiology and diagnosis are reviewed. The different microbiological diagnostic methods, both conservatives and those involving the removal of the catheter are up-to-dated.

Knockdown of protein tyrosine phosphatase SHP-1 inhibits G1/S progression in prostate cancer cells through the regulation of components of the cell-cycle machinery.

SHP-1, a haematopoietic cell-specific tyrosine phosphatase, is also expressed in human prostate. In this study, we report that SHP-1 depletion in PC-3 cells induced by small interfering RNAs causes G1 phase cell-cycle arrest accompanied by changes in some components of the cell-cycle machinery. SHP-1 knockdown increases p27(Kip1) (p27) protein stability, its nuclear localization and p27 gene transcription. These effects could be mediated by PI3K-AKT pathway as SHP-1 interacts with PI3K regulating its activity and p110 catalytic subunit phosphorylation. The increase in p27 protein stability could also because of reduced cyclin-dependent kinase (CDK2) activity. SHP-1 knockdown decreases the CDK6 levels, inducing retinoblastoma protein hypophosphorylation, downregulation of cyclin E and thereby a decrease in the CDK2 activity. However, the codepletion of SHP-1 and p27 does not produce re-entry into the cycle, implying that p27 is not required to maintain cell-cycle arrest induced by SHP-1 depletion. The maintenance of the PC-3 cell anti-proliferative response after p27 loss could be because of mislocalization of CDK2 induced by SHP-1 knockdown. This study shows that SHP-1 depletion promotes cell-cycle arrest by modulating the activity of cell-cycle regulators and suggests that SHP-1 may be required for the proper functioning of events governing cell-cycle progression.

["Tailored" polysomnography: an alternative method in the assessment of obstructive sleep apnea syndrome]. / Polisomnogramas "a medida". Un método alternativo en la evaluación del síndrome de apnea obstructiva del sueño.

The conventional study of obstructive sleep apnea syndrome (OSAS) requires two polysomnographic recordings on two different nights, one for diagnosis and the other for determining an effective level of continuous positive airway pressure (CPAP). In this study we examined an alternative method requiring a single night of polysomnographic recording encompassing both diagnostic and treatment functions. In order to obtain recordings of all phases of sleep, as well as recordings taken in supine decubitus position, the duration of polysomnographic readings was individualized ("made to order" polysomnograms). A single-night session was sufficient for diagnosis and for adjusting treatment in most cases. In some cases the night was extended well into the morning hours in an effort to obtain all the necessary data. "Made-to-order" polysomnograms were compared to traditional ones by contrasting breathing parameters (the U of Mann Whitney) and sleep architecture findings for two groups of men diagnosed consecutively of OSAS. Thirty-four patients were studied over two nights (mean age: 50 years; BMI 37 Kg/m2). Forty-six patients (mean age: 49 years; BMI: 38 Kg/m2) were studied in single-night sessions. The differences between the two groups were not significant. For most patients studied in "made to order" sessions, all sleep stages were recorded and readings were taken in supine position. REM sleep was not recorded, however, for 26% of the patients in this group. No significant differences between the double- and single-session groups were found for apnea (51 versus 62), maximum oxygen desaturation (72% versus 75%) and effective CPAP level (9 versus 10 cm H2O). These data suggest that both study methods are equally useful for evaluating OSAS severity and for prescribing effective CPAP treatment. We discuss, however, the need to arrange for two-night studies in the minority of patients for whom no REM sleep recordings become available during a single session.

Clonal differences among erythromycin-resistant Streptococcus pyogenes in Spain.

The aim of this study was to determine whether the high levels of erythromycin resistance in Streptococcus pyogenes found in Spain are due to the introduction and spread of one or more clones. Phenotypic and genotypic techniques were used to characterize all erythromycin-resistant S. pyogenes (ErR) isolated in Gipuzkoa, Spain, in the last 10 years and 128 ErR isolated in Vitoria and Madrid during 1996. Of 437 ErR, 97% had the M phenotype; all 283 of the strains studied had the mefA determinant of resistance. After biotyping, T serotyping, emm typing, and genotyping, four major clones were detected. Clones B (biotype I, type T4, emm4, pulsed-field gel electrophoresis [PFGE] II) and D (biotype V, type T8.25, emm75, PFGE IV) comprised 78.8% of all ErR. The resistance of S. pyogenes to erythromycin was mainly due to an efflux mechanism of resistance (M phenotype); few clones were responsible for it.

Remitting seronegative symmetrical synovitis with pitting edema associated with subcutaneous Streptobacillus moniliformis abscess.

We describe an 84-year-old woman who developed remitting seronegative symmetrical synovitis with pitting edema (RS3PE) associated with a subcutaneous abscess of the hand due to Streptobacillus moniliformis. Polyarthritis and edema were relieved after therapy with corticosteroids. We review the association of RS3PE to different rheumatologic, neoplastic, or infectious diseases.