ABSTRACT
PURPOSE: Pseudomonas aeruginosa has emerged as one of the most problematic bacteria in modern hospital settings, and this organism is increasingly isolated as a nosocomial pathogen. Burn patients are particularly susceptible to Pseudomonas infection. Therefore, the accurate and sensitive microbiologic tests are needed for strict management of this prevalent microorganism. METHODS: A nested polymerase chain reaction test based on consecutive amplification of the lipoprotein genes, oprL and oprI, was designed and evaluated, in comparison with the conventional blood culture, for its ability to detect Pseudomonas aeruginosa in clinical materials of burn patients. RESULTS: Positive results of PCR based on oprL gene were observed only for Pseudomonas aeruginosa. All other bacteria (n=4) tested by this amplification method were negative. Also the lowest detection level was 1X101 bacteria per ml of blood samples. In addition, PCR afforded a significantly higher detection rate for Pseudomonas aeruginosa than the conventional blood culture technique in clinical materials of burn patients (25.9% vs. 8.6%). CONCLUSION: This study suggests that the nested PCR technique is highly specific and sensitive test for detectionof Pseudomonas aeruginosa, and therefore it may be a useful adjunct tool, in combination with other conventional techniques, for detection of Pseudomonas aeruginosa infection.
Subject(s)
Humans , Bacteria , Burns , Culture Techniques , Lipoproteins , Polymerase Chain Reaction , Pseudomonas aeruginosa , Pseudomonas Infections , PseudomonasABSTRACT
Liability to vascular trauma in orthopedic procedures results from the close relation between bones and vessels and complicated use of sharp instruments and retractors. Prompt diagnosis and management are mandatory to avoid high mortality and morbidity. We report 6 vascular injuries secondary to orthopedic procedures performed between 1994 and 1998. Two injuries occurred as a consequence of intramedullary nailing and Ilizarov external fixation of a femur fracture, one injury from lumbar laminectomy, one injury as a result of total hip replacement, one from hip flexion contracture release and the other one secondary to knee flexion contracture release. Injury occurred to three femoral arteries, one femoral artery and vein, one popliteal artery, and one iliac artery and IVC. Four vascular injuries required bypass grafts, division was done in AV fistula following disc operation. Conservative treatment was given to one vascular injury. There was no significant complication and death in our series except one case of graft infection that was revised with extra-anatomic bypass. The goal of management of vascular trauma that occurs during the orthopedic procedure is to save the limb and even the life. Urgent management based on knowledge of vascular structure and skillful surgical technique are needed.
Subject(s)
Arthroplasty, Replacement, Hip , Contracture , Diagnosis , Extremities , Femoral Artery , Femur , Fistula , Fracture Fixation, Intramedullary , Hip , Iliac Artery , Knee , Laminectomy , Mortality , Orthopedic Procedures , Orthopedics , Popliteal Artery , Transplants , Vascular System Injuries , VeinsABSTRACT
A case of symptomatic bilateral popliteal artery entrapment syndrome is reported. A twenty-one-year old male, a candidate of athlete, complained of coldness, weakness, pallor and cyanosis of right lower leg and intermittent claudication to both calves during walking or exercise for ten months. Studies revealed that the right popliteal artery was completely occluded, but the left popliteal artery was non-occlusive. An endarterectomy and onlay vein patch graft to the thrombosed and fibrotic right popliteal artery, and myotomies of bilateral medial heads of gastrocnemius muscle were done (May 20, 1998). Follow-up examinations for the last ten months showed a complete relief of symptoms with normal distal arterial flow. It is thought that even though the majority of patients present with unilateral calf claudication, the possiblity of bilateral problems need to be also considered.
Subject(s)
Humans , Male , Athletes , Cyanosis , Endarterectomy , Follow-Up Studies , Head , Inlays , Intermittent Claudication , Leg , Muscle, Skeletal , Pallor , Popliteal Artery , Transplants , Veins , WalkingABSTRACT
The well-known prognostic factors for breast cancer, such as axillary lymph node status, do not always account for the exact outcome. The development of other accurate prognostic factors would help in assessing high risk for the disease recurrence and death. Recently, there are reports that peritumoral lymphatic vessel invasion is a good prognostic factors to solid tumors in animal studies and clinical trials. This study was performed to estimate the significance of peritumoral lymphatic vessel invasion (PLVI) as a prognostic factor in breast cancer. Also, PLVI was compared withb establishwd established clinicopathological prognostic factors and hormone receptors. MATERIALS AND METHODS: A group of patient was selected from the Department of Surgery, College of Medicine, Hallym University, which consists of 43 out of 96 patients who received curative operation from 1985 to 1993. Peritumoral lymphatic vessel invasion by tumor cells on H&E stain was considered PLVI positive. We classified 43 breast-cancer patients into 32 with negative PLVI and 11 with positive PLVI. We estimated the correlation between the PLVI and other established prognostic factors. We also calculated survivals based on PLVI. RESULT: The 4-year disease-free survival rate was 61.8+/-.7%, and the 4-year overall survival rate was 73.0+/-.0%. The receptor status of estrogen and of progesterone had significant impacts on survival (ER: p=0.0001, PR: p=0.0001). Also, metastasis status of lymph node had significant impacts on overall survival (p=0.0148). We found a significant correlation between PLVI and tumor size (p=0.004), estrogen receptor (p=0.002), progesterone receptor(p=0.006), but could not find any significant correlation between PLVI and menopausal status, histologic grade, unclear grade, lymph node metastasis. PLVI status was correlated with disease free survival rate (p=0.01) and overall survival rate(p=0.01). CONCLUSIONS: The determination of PLVI in breast cancer tissue may be useful as a prognostic factor, but it is necessary to investigate the PLVI in a large number of patients before this conclusion can be stated with certainty.
Subject(s)
Animals , Humans , Breast Neoplasms , Breast , Disease-Free Survival , Estrogens , Lymph Nodes , Lymphatic Vessels , Neoplasm Metastasis , Progesterone , Recurrence , Survival RateABSTRACT
PURPOSE: The well-known prognostic factors for breast cancer, such as axillary lymph node status, do not always account for the exact outcome. The developinent of other accurate prognostic factors would help in assessing high risk for the disease recurrence and death. Recently, there are reports that peritumoral lymphatic vessel invasion is a good prognostic factor to solid tumors in animal studies and clinical trials. This study was performed to estimate the significance of peritumoral lymphatic vessel invasion (PLVI) as a prognostic factor in breast cancer. Also, PLVI was compared with established clinicopathological prognostic factors and hormone receptors. MATERIALS AND METHODS: A group of patient was selected from the Department of Surgery, College of Medicine, Hallym University, which consists of 43 out of 96 patients who received curative operation from 1985 to 1993. Peritumoral lymphatic vessel invasion by tumor cells on H&E stain was considered PLVI positive. We classified 43 breast-cancer patients into 32 with negative PLVI and ll with positive PLVL. We estimated the correlation between the PLVI and other established prognostic factors. We also calculated survivals based on PLVI. RESULTS: The 4-year disease-free survival rate was 61.8+/-8.7%, and the 4-year overall survival rate was 73.0+/-8.0%. The receptor status of estrogen and of progesterone had significant impacts on survival (ER: p=0.0001, PR: p=0.0001). Also, metastasis status of lymph node had significant impacts on overall survival (p=0.0148). We found a significant correlation between PLVI and tumor size (p=0.004), estrogen receptor (p=0.002), progesterone receptor (p=0.006), but could not find any significant corelation between PLVI and menopausal status, histologic grade, nuclear grade, lymph node metastasis. PLVI status was corelated with disease free survival rate (p=0.01) and overall survival rate (p=0.01). CONCLUSION: The determination of PLVI in breast cancer tissue may be useful as a prognostic factor, but it is necessary to investigate the PLVI in a large number of patients before this conclusion can be stated with certainty.