Ayse Yildirim

Central venous catheter related infections: Risk factors and the effect of glycopeptide antibiotics

BackroundWe undertook a prospective study of all new central venous catheters inserted into patients in the intensive care units, in order to identify the risk factors and to determine the effect of glycopeptide antibiotics on catheter – related infections.MethodsDuring the study period 300 patients with central venous catheters were prospectively studied. The catheters used were nontunneled, noncuffed, triple lumen and made of polyurethane material. Catheters were cultured by semiquantitative method and blood cultures done when indicated. Data were obtained on patient age, gender, unit, primary diagnosis on admission, catheter insertion site, duration of catheterization, whether it was the first or a subsequent catheter and glycopeptide antibiotic usage.ResultsNinety-one (30.3%) of the catheters were colonized and infection was found with 50 (16.7%) catheters. Infection was diagnosed with higher rate in catheters inserted via jugular vein in comparison with subclavian vein (95% CI: 1.32–4.81, p = 0.005). The incidence of infection was higher in catheters which were kept in place for more than seven days (95% CI 1.05–3.87, p = 0.03). The incidence of infection was lower in patients who were using glycopeptide antibiotic during catheterization (95% CI: 1.49–5.51, p = 0.005). The rate of infection with Gram positive cocci was significantly lower in glycopeptide antibiotic using patients (p = 0.01). The most commonly isolated organism was Staphylococcus aureus (n = 52, 37.1%).ConclusionDuration of catheterization and catheter insertion site were independent risk factors for catheter related infection. Use of glycopeptide antibiotic during catheterization seems to have protective effect against catheter related infection.

Toxicity and Survival Results of a Phase II Study Investigating the Role of Postoperative Chemo-radioimmunotherapy for Gastric Adenocarcinoma

Background and Purpose:To investigate the role of postoperative concomitant chemoradioimmunotherapy in gastric adenocarcinoma patients.Patients and Methods:59 patients, who underwent total or subtotal gastrectomy, with lymph node involvement, positive microscopic surgical margins or serosal involvement were included in the study. Radiotherapy started concomitantly with chemotherapy and levamisole. Extended-field radiotherapy was given to gastric bed and regional lymphatics via two anterior-posterior/posterior-anterior fields. A total dose of 45 Gy in 25 fractions with a fraction size of 1.8 Gy was planned. In 28 patients (48%) with positive surgical margins a 10-Gy boost dose was given to the anastomosis site. An adjuvant i.v. bolus of 450 mg/m2/day 5-fluorouracil (5-FU) was administered concomitantly during the first 3 days and at the 20th day of irradiation. After completion of radiotherapy, i.v. boluses of 450 mg/m2/day 5-FU and 25 mg/m2/day rescuvorin were continued for 6 months once a week. Levamisole 40 mg/day orally was started at the 1st day of radiotherapy and also continued for 6 months. Median follow-up was 37 months (7–112 months).Results:Median survival was 23 months. Overall 3- and 5-year survival rates amounted to 35% and 14%, respectively. Median survival of the patients with positive surgical margins was 22 months. The 3- and 5-year locoregional control rates were 59% and 55%, respectively. The most common toxicity was upper gastrointestinal system toxicity, which was observed in 42 patients (71%). Four patients (7%) died on account of early toxic effects, and six (10%) could not complete treatment.Conclusion:Although 48% of the study population involved patients with microscopic residual disease, the survival results as a whole were satisfactory. However, due to high toxicity, radiotherapy must be delivered with the most proper techniques along with adequate nutrition and supportive care.Hintergrund und Ziel:Untersuchung der Rolle der postoperativen Radiochemotherapie bei Patienten mit Adenokarzinom des Magens.Patienten und Methodik:59 total oder subtotal operierte Patienten mit Adenokarzinom des Magens, die eine Invasion der Serosaoberfläche, einen Befall der regionären Lymphknoten oder positive Resektionsränder aufwiesen, wurden in die Studie eingeschlossen. Postoperativ wurde eine simultane Radiochemotherapie begonnen. Die Bestrahlung wurde in „Extended-field“-Technik über zwei Felder (anterior-posterior und posterior-anterior) mit einer Gesamtdosis von 45 Gy in 25 Fraktionen zu 1,8 Gy appliziert. 28 Patienten (48%) mit positiven Resektionsrändern erhielten zusätzlich einen 10-Gy-Boost auf den Anastomosenbereich. Die adjuvante Chemotherapie mit einem 450-mg/m2-Bolus 5-Fluorouracil (5-FU) wurde an den ersten 3 Tagen verabreicht und am 20. Tag wiederholt. Nach der Strahlentherapie erhielten die Patienten 450 mg/m2 5-FU i.v. und 25 mg/m2 Leukovorin i.v. wöchentlich für weitere 6 Monate. Die Immunmodulation mit 40 mg Levamisol p.o. wurde am 1. Bestrahlungstag begonnen und für 6 Monate weitergeführt. Der mediane Nachuntersuchungszeitraum lag bei 37 Monaten (7–112 Monate).Ergebnisse:Die mediane Überlebenszeit betrug 23 Monate. Die 3- und 5-Jahres-Gesamtüberlebensraten lagen bei 35% und 14%. Patienten mit positiven Resektionsrändern wiesen eine mediane Überlebenszeit von 22 Monaten auf. Die lokoregionale Kontrollrate betrug 59% nach 3 Jahren und 55% nach 5 Jahren. Die häufigsten Nebenwirkungen der Behandlung waren gastrointestinale Beschwerden bei 42 Patienten (71%). Vier Patienten (7%) starben infolge der Nebenwirkungen. Sechs Patienten konnten die Behandlung aufgrund von Nebenwirkungen nicht beenden.Schlussfolgerung:Obwohl 48% der Patienten in dieser Studie einen mikroskopisch nachweisbaren Resttumor aufwiesen, war die beobachtete Überlebenszeit verhältnismäßig gut. Aufgrund der hohen Toxizität sollte die Behandlung jedoch sehr sorgfältig unter Einsatz angemessener supportiver Maßnahmen durchgeführt werden.

Effects of Ischemia/Reperfusion on ß Cells of Pancreas and Protective Effects of Melatonin Treatment

Los radicales libres del oxigeno son considerados como uno de los componentes mas importantes que participan en las alteraciones fisiopatologicas del tejido durante la isquemia-reperfusion (I/R). En este estudio, se investigo el supuesto efecto protector del tratamiento de melatonina sobre la lesion pancreatica I/R. Ratas Sprague Dawley machos fueron sometidas a 30 minutos de oclusion del pediculo pancreatico seguido de 90 minutos de reperfusion. La melatonina (10 mg/kg) fue administrada 30 minutos antes de la isquemia o de la aplicacion I/R. Al finalizar los periodos de reperfusion, las ratas fueron decapitadas. Fueron tomadas muestras pancreaticas para el analisis en microscopia electronica de transmision. Los resultados indicaron que la isquemia ocasiono dano en las celulas s demostrado por la dilatacion entre el nucleo interior y la membrana exterior y la degeneracion de los islotes de celulas pancreaticas, los que fueron revertidos por el tratamiento de melatonina. Como la administracion de melatonina revirtio estos danos microscopicos, parece probable que ella proteja al tejido pancreatico contra el dano oxidativo.

Case report of severe metabolic alkalosis: life-compatible new level.

Metabolic alkalosis is the most common acid-base disturbance observed in hospitalized patients, accounting for 50% of all acid-base disorders.1 Severe metabolic alkalosis (blood pH 7.55) is a serious medical problem. Mortality rates have been reported as 45% in patients with an arterial blood pH of 7.55 and 80% when the pH was greater than 7.65.1 And, it has been noted in textbooks and practically accepted by the clinicians that the pH value greater than 7.80 is more than the range of clinically viable pH values.2–5 The most common causes of metabolic alkalosis are the use of diuretics and the external loss of gastrointestinal system secretions. The physical signs of metabolic alkalosis are not specific and depend on severity of the decrement in pH. Because metabolic alkalosis decreases ionized calcium concentration, signs of hypocalcemia (e.g., tetany, Chvostek sign, and Trousseau sign), change in mental status, or seizures may be present. Physical examination is helpful to establish the cause of metabolic alkalosis. Important aspects of the physical examination include the evaluation of volume status. Because hypokalemia is usually present, the patient may experience weakness, myalgia, and polyuria. Hypoventilation develops because of inhibition of the respiratory center in the medulla. We presented probably the first report illustrating a surviving case who had severe metabolic alkalosis with a pH of 7.87 induced by gastrointestinal system losses.

Targeting novel antigens in the arterial wall in thromboangiitis obliterans

Thromboangiitis obliterans is an inflammatory disease possibly resulting from cigarette smoking as a primary etiologic factor, perhaps as a delayed type of hypersensitivity or toxic angiitis. As little is known about the pathogenesis of the disease, we aimed to determine novel antigens that might be responsible from the local inflammatory reactions and structural changes observed in this disease. An indirect immunoperoxidase technique is used to examine the tissue samples obtained from the dorsalis pedis artery of affected individuals with twenty monoclonal antibodies. Among these several antigens which are not previously reported in TAO like CD34, CD44 and CD90 were determined in the tissue samples examined. On the other hand, many other antigens like cytokine/chemokine receptors, several enzymes and leukocyte/lymphocyte antigens were lacking giving some clues about the local pathological reactions. We briefly discussed our findings for several critical antigens those first described in the present work, possibly having roles in the development of the disease. Expression of the CD90/CD11c receptor/ligand pair seems to play an important role in mononuclear cell recruitment to the damage site. Vascular invasion of not only tunica intima but also the tunica media in affected vessels is clearly demonstrated using endothelial cell specific antigens.