The Protective Effect of Topical Rifamycin Treatment against Sternal Wound Infection in Diabetic Patients Undergoing on-Pump Coronary Artery Bypass Graft Surgery : Cardiovascular Topic

Objectives: The aim of this study was to investigate the protective effect of topical rifamycin SV treatment against sternal wound infection (SWI) in diabetic patients undergoing on-pump coronary artery bypass graft (CABG) surgery. Methods: One hundred and fifty-nine diabetic patients who were scheduled to undergo isolated on-pump CABG surgery were included. Eight were excluded for various reasons. Of the 151 patients; 51 were on insulin therapy and 100 were on oral anti-diabetics. The risk of mediastinitis was assessed using the American College of Cardiology/American Heart Association 2004 guideline update for CABG surgery. According to the risk scores; patients were divided into two comparable groups: the rifamycin group (n = 78) received topical rifamycin treatment after on-pump CABG surgery; and the control group (n = 73) received no topical treatment. Results: Deep sternal wound infection (mediastinitis) was not observed in either group (0/78 vs 0/73; p = 1.0). No superficial sternal wound infection was observed in the rifamycin group; however; it did occur in one patient in the control group (0/78 vs 1/73; p = 0.303). Wound culture was performed and coagulase-negative staphylococci were observed. The infection regressed on initiation of antibiotic therapy against isolated bacteria and the patient was discharged after a full recovery. Conclusion: Although the difference in rate of superficial sternal wound infection (SSWI) in the rifamycin and control groups was not statistically significant; locally applied rifamycin SV during closure of the sternum in the CABG operation may have had a protective affect against SWI

Carbon monoxide induced cortical visual loss: treatment with hyperbaric oxygen four years later

We present a patient who developed visual loss after carbon monoxide [CO] poisoning and was treated with hyperbaric oxygen. Clinical Presentation and Intervention: A 21-year-old woman poisoned with CO [with coma lasting 4 h and carboxyhemoglobin level 46%] developed seizures and cortical blindness 3 days after poisoning. Four years later, her visual acuity was 0.2 in both eyes. An 18F-fluorodeoxyglucose positron emission tomography [PET] scan showed reduced metabolism in the bilateral posterior temporal and occipital lobes. The patient received a total of 50 hyperbaric oxygen sessions over 3 months for visual loss and the visual acuity improved to 0.5 in both eyes. In addition, increased metabolism was detected in the brain in post-treatment PET scans. PET documented brain hypoperfusion 4 years after CO poisoning and hyperbaric oxygen therapy improved visual acuity. However, we cannot endorse routine use of hyperbaric oxygen for such patients, until results of further clinical trials demonstrate efficacy of hyperbaric oxygen in CO-induced chronic brain injury

Pulmonary alveolar microlithiasis with pectus excavatum. Case report.

Pulmonary alveolar microlithiasis is a rare disease of unknown etiology. There is a formation of calcific bodies within the alveoli. The X-Ray shows extensive infiltration of both lungs. So far less than 100 cases were reported. However, we are unware of a case with pectus excavatum. In this report we discuss a case of pulmonary alveolar microlithiasis with pectus excavatum, and its treatment and medical intervention.