Ventilator-associated pneumonia in surgical emergency intensive care unit

To investigate the incidence, risk factors and the etiology of ventilator-associated pneumonia [VAP] in surgical emergency intensive care unit [ICU] patients. We conducted this prospective cohort study in the surgical emergency ICU of Istanbul Medical Faculty between December 1999 and May 2001. We included 100 mechanically ventilated patients in this study. We diagnosed VAP according to the current diagnostic criteria. We identified the etiology of VAP cases by both quantitative cultures of endotracheal aspiration and blood cultures. To analyze the predisposing factors for the development of VAP, we recorded the following variables: age, gender, acute physiology and chronic health evaluation [APACHE] II score, Glasgow coma scale [GCS], sequential organ failure assessment [SOFA] score, serum albumin level, duration of mechanical ventilation [MV] prior to the development of VAP, and underlying diseases. We determined the VAP incidence rate as 28%. We found the APACHE II score and the duration of MV to be statistically significant variables for the development of VAP. There were no significant differences regarding age, gender, GCS, SOFA score, albumin level, or underlying diseases for the development of VAP. The isolated bacteria among VAP cases were as follows: Staphylococcus aureus [n=12, 43%], Acinetobacter spp. [n=6, 21%], coagulase-negative Staphylococci [n=4, 15%], Pseudomonas aeruginosa [n=3, 10.7%] and Klebsiella pneumoniae [n=3, 10.7%]. Ventilator-associated pneumonia is a common infection, and certain interventions might affect the incidence of VAP. The ICU clinicians should be aware of the risk factors for VAP, which could prove useful in identifying patients at high risk for VAP, and modifying patient care to minimize the risk of VAP

Immunohistochemical analysis of CD31, CD36, and CD44 antigens in human omentum

Milky spots in the human omental tissue are known to be consisting of lymphocytes, macrophages and mast cells. Our goal was to evaluate the relationship of lymphoid cells and macrophages with vasculature and stromal components. In this study we examined the biopsy specimens obtained from the adult patients whom were operated for different purposes in the General Surgery Department of Dicle University Hospital, Ankara, Turkey. We used CD31 as an endothelial cell marker, CD36 which is known to react with microvascular endothelium and adipocytes, and CD44 which is a hyaluronic acid receptor using an indirect immunoperoxidase technique. We observed that CD31 was mainly reactive with vascular endothelial cells and platelets, CD36 was reactive with microvascular endothelium and adipocytes and CD44 was mainly expressed by the endothelial cells of high endothelial venules, fibroblasts in stromal compartments and by large mononuclear cells. We determined the structural and immunophenotypic features of omental lymphoid tissue components stressing vascular and stromal elements, and we briefly discussed the significance of the expression of these molecules in the determined locations