Bacterial spectrum of perm-cath related infection among hemodialysis patients

Dual-lumen cuffed central venous catheter [perm-cath] is an alternative vascular access in maintenance hemodialysis Infection however is a major problem associated with long-term central venous catheters. This study assesses the spectrum of catheter related bacterial infectkin among hemodialysis patients. Charts of 174 patients were reviewed during The period between January 2005 and December 2006. Quantitative blood culture was obtained simultaneously from the catheter and from a peripheral vein when catheter related infection is suspected. Episodes of catheter related infection were registered including the causative bacteria. 76perm-cath double-lumen catheters rooted in 76 [43.7%] hemodialysis patients. Seventy nine episodes of catheter related bacteria in 45 [59%] patients were analyzed Six [13.33%] patients had more than one episode of catheter related infection. The rate of infection is equal to 3.3 per hundred patient-month treatment The causative bacteria included Gram-positive organisms in 51 [64.6%]. Staphylococcus aureus in 33 [41.8%] episodes. Methicillin resistant staphylococcus aureus [MRSA] was detected in 25 [31.6%] episodes. Coagulase negative staphylococcus species in 9[11.4%] episodes, and enterococci in 6[7.5%] episodes. Gram-negative bacteria were the cause of infection in 28 [35.4%] episodes. Pseudomonas was isolated in 6[7.5%] episodes, acinetobacter in 5[6.3%] episodes, and E-coli in 5[6.3%] episodes. Other bacteria were the cause of infection in 15[18.9%] episodes. Bacteremia was reported in 47[59.5%] episodes. Isolated exit site infection was reported in 26[32.9%] episodes. Concomitant exit site infection and septicemia was reported in 6 [7.5%] episodes. Seventy five [95%] episodes were cured with proper antibiotics without catheter removal and 4 episodes [5%] required catheter removal. This study dearly demonstrated that MRSA is most common cause of perm-cath infection in hemodialysis patient. Early treatment and or catheter removal reduces patients' morbidity. Exit site infection should be treated punctually

Weekly irinotecan in patients with progressive or rapidly recurrent colorectal cancer pretreated with fluorouracil-based chemotherapy

To prospectively evaluate efficacy and tolerability of weekly irinotecan [CPT-11] in patients with advanced colorectal carcinoma [CRC] that had recurred or progressed following fluorouracil [5-FU]-based therapy. Forty eight patients were enrolled in this study. They were treated with irrinotecan 125 mg/m[2] intravenously [IV] every week for 4 weeks, followed by a 2- week rest. All patients were accessible for toxicity and only 44 patients completed one full course of therapy and were accessable for response. Nine patients [20.5%] attained partial response [95% CI, 10% to 27%] and no cases achieved complete response. The median duration of response was 7 months [range4to 11.5 months]. The median survival time was 10 months [95% CI 8.2 to 13.1 months] and the 1-year survival rate was 43.8% [95% CI, 33% to 53%]. Median time to progression was 4.0 months [95% CI, 2.6 to 5.1 months]. Grade 3-4 diarrhea was observed in 17 patients [35.4%], grade 3-4 nausea and vomiting in 3 patients [6.3%] and 4 patients [8.3%] respectively. Grade 3-4 neutropenia was reported in 5 patients [31.3%]. Grade 3-4 febrile neutropenia or infection affected only 2 patients [4.2%]. Weekly schedule of irinotecan has demon strated significant activity against colorectal cancer that has progressed during or shortly after treatment with 5-FU-based chemotherapy. Diarrhea is the most frequent dose limiting toxicity but can be substantially reduced through appropriate interventional management

Orchidectomy versus Orchidectomy plus cyproterone acetate in the treatment of metastatic prostatic carcinoma

This study included 42 patients all underwent orchidectomy and only 22 received cyproterone acetate in a dose of 150-200 mg PO daily. Clinical, laboratory and radiological evaluations were done during the period of the study [from January 1992 to June 1997 inclusive]. There was no high difference in the causes of death. The mean overall survival was longer in the combined treatment group [44.9 m vs. 36.9 m]. Time to disease progression was significantly longer in the combined modality group [30.7 m vs. 22.7 m]. Hot flushes were less in the combined group [31.0% vs. 60.6%] but the difference was insignificant