[Does nasal decontamination reduce the incidence of infections after cardiac surgery?]

Mupirocin applied to the anterior nares four times daily usually eliminates Staphylococcus aureus, including methicillin resistant, within 48 hours. Prophylactic intranasal mupirocin is safe, inexpensive and effective in reducing the overall sternal wound infection after open-heart surgery. This study was designed to determine whether decreasing nasal bacterial colonization by applying mupirocin intra nasally decreases mediastinal, sternal, pulmonary and cutaneous infections after open-heart surgery. After institutional approval and informed consent, 392 patients were included in a randomized, prospective study. Nasal cultures were taken for all patients before surgery. Patients were divided in two groups: Group I [n=190] receiving mupirocin in the anterior nares 4 times daily for 48 hours before surgery; Group II [n=202] was the control group. Patients were followed for a month after surgery. All mediastinal, sternal, pulmonary and cutaneous infections were documented and treated with appropriate antibiotics. A Student test for quantitative data and a X [2] test for qualitative data were used for statistical analysis. p

[Genotoxic effect of hydrogen peroxide on bone marrow erythrocytes of female Balb/C mouse]

Hydrogen peroxide is a strong oxidant which is being widely used in hairdresser places. Genotoxic effect of such substances, referred to as "interaction between gene and environment, is one of the most worrying problems of international health society. On the basis of the wide use of hydrogen peroxide, its capability on induction of chromosomal damages on polychromatic erythrocytes of bone marrow of exposed female Balb/C mice was investigated. The female Balb/C mice were used as experimental model. The mice were divided to three different groups including: control, Sham-exposed and experimental groups. The experimental group was exposed to inhalation of 9% oxidant vapor, containing hydrogen peroxide, for 2 and 3.5 hours per day for 7 days. Bone marrow cells of exposed as well as control and sham-exposed mice were collected using FCS, and micronucleus assay was performed. The chromosomal aberration was investigated by scoring the micronucleus containing polychromatic erythrocytes. The data was statistically analyzed by t-test. The results showed that mean No. of polychromatic erythrocytes in sham-exposed 1 and treated 1 [2 hours exposure to H2O2] were 8.87 +/- 1.01 and 5.75 +/- 3.05 respectively [P<0.05], and sham-exposed 2 and treated 2 [3.5 hours exposed to H2O2] were 8 +/- 2.36 and 42.37 +/- 4.8 respectively [P<0.01]. Also increasing the exposure treatment time with H2O2 could increase the chromosomal abnormality [P<0.05]. Results of this study revealed the genotoxic effects of inhalation of 9% H2O2 on bone marrow cells of female Balb/C mouse

Vertebral scalloping in neurofibromatosis-1

A 39-year-old male patient known to have neurofibromatosis-1, presented with sciatica and low back pain. At the age of 27, an MRI of the spine revealed widening of the lumbar canal due to posterior scalloping of the last 4 lumbar vertebrae. Repeat MRI and simple lateral lumbosacral plain film at the age of 39, revealed significant progression of the lumbosacral lesion. In view of the progression of the disease during the last 15 years, we opted for insertion of a lumbo-peritoneal [LP] shunt to decrease the CSF pressure, which is the most probable cause of scalloping. We shied away from lumbar fixation as we thought that this would not stop the vertebral erosion. The LP shunt affected good symptomatic and radiologic outcome over a 2-year follow up

rare, late complication in a hemispherectomised patient: a brucella abscess in the contralateral hemicranium

Pathology in the contralateral hemicranium following hemispherectomy has been reported only once; a meningioma was found at autopsy, compressing the remaining hemisphere of a patient who had been submitted to a hemispherectomy for a malignant glioma [14] Intracranial brucella abscess have been reported only 10 times in the literature. We are reporting a case of cerebral brucella abscess in the remaining hemisphere following a hemispherectomy for infantile uncontrollable seizures and behaviour problems. The literature is reviewed and a new approach to the medial aspect of the remaining hemisphere is described

Analysis of protection effect of vitamins A, E against Gamma induced chromosomal abnormalities post and past-irradiation on mouse bone marrow cells usingmicronucleus assay

The radioprotectory effects of vitamins A and E post and past Gamma-irraiation on mouse bone marrow cells using micronucleus assay was analyzed. Micronucleus assay is a very fast and effective method in evaluating, structural as well as numerical chromosomal abnormalities. Search for find/ng an effective way of protection against harmful effects of induced or spontaneous irradiation is actively progressing. Effects of antioxidants such as vitamin A and E in in vivo have studied extensively. In this study effect of different doses of vitamin A and E post and past Gamma-irradiation of 2 Gy wererepresenting chromosomal damages. Of all doses used [0.6mg/kg, 1.2mg/kg and 2.4mg/kg for vitamin A and 50mg/kg, l00mg/kg and 200mg/kg for vitamin E/ l.Amg/kg, body weight of vitamin A and 200mg/kg body weight of vitamin E had the best effect on reducing induced-damages. Combination of two vitamins in these doses post and past irradiation revealed that vitamin E was the most effective post irradiation whereas vitamin A was the most effective past irradiation in reducing the frequency of micronucleus.According to our knowledge this is the first time that the anticlastogenic effect of vitamin A and E post and past irradiation in in vivo has been studied at the same time using micronucleus assay

Cryoglobulinemia in hepatitis C virus infection

Various extrahepatic manifestations are described during infection by hepatitis C virus [HCV]. They are essentially represented by cryoglobulinemia. We report a case of cryoglobulinemia associated with chronic hepatitis C. A 62 years old woman was hospitalised due to members purpura, associated with peripheral neuropathy localised in lower members. A biologic check-up showed a moderate hepatic cytolysis. A mixed cryoglobulin of type II has been found. Test for antibodies to HCV in serum was positive. HCV RNA was detectable in serum with a low content. The genotype was 2a/2c. Liver biopsy showed active hepatitis. The check-up before the treatment was normal, as well as the renal function. The treatment consisted of the combination of interferon plus ribavirin for 6 months

Overview of brain hydatid and its surgical management: personal experience with cyst delivery

even though surgery of cerebral hydatid disease has gone through many phases; the ultimate remains unchanged: the removal of the cyst intact so as to prevent recurrence. The purpose of this paper is to provide a surgical methodology to that end. a short review of the life cycle of echinococcus granulosus tapeworm is presented along with the pathology of hydatid cysts and their clinical presentation. We provide a step by step approach to the successful delivery of intracerebral hydatid cysts, stressing the caveat and pitfalls of such surgery. the patient's head on the operative table should remain free. The craniotomy should be a large one. All possible factors, which may lead to the rupture of the cyst, should be attended to [rough surfaces, sharp instruments, heat, etc.]. Rupture of the pericyst, episiotomies, Crede's manoeuvre and gravity are the four essential steps in the delivery of these cysts. Floatation of the cyst with saline can also be used. until a radical medicinal treatment for hydatid cysts of the brain is found, surgery should aim at delivering the cyst intact

Origins and development of surgical treatment of epilepsy

Purpose: to provide a concise history of the surgical treatment of epilepsy. we reviewed clinically the medical literature, periodicals and books, related to the subject. it is reported that during the Neolithic period holes were placed in the skull of seizure sufferers to let out evil spirit. Dudley, in 1828, performed the first document craniotomy for the relief of epilepsy. Jackson, in 1873, was the first to recognise that epilepsy was due to an abnormal discharge of the gray matter, thus paving the way to its modern surgical treatment. Forester and Penfield laid down the scientific foundation for the surgical management of seizures in 1930. The latter consolidated the surgical technique, which was made possible thanks to the development of electroencephalography introduced by Berger in 1929. Temporal lobectomy became standardised and other cortical excisions perfected. Excision of smaller foci became possible with the advent of computed tomography and magnetic resonance imaging. Video electroencephalography, positron emission tomography, single photon emission computed tomography and other technical advances improved the methods of localisation and the results of surgery. Other advances in the surgical management of epilepsy include corpus callosotomy in 1940, hemispherectomy in 1950, hemispherectomy in 1950, multiple subpial transactions and cerebellar stimulation in 1973. it is thanks to the global and concerted effort of groups of specialists, including pathologist, physiologists, physicist, neurologists, and neurosurgeons that the predicament of patients with uncontrolled seizures can be, at present, improved through surgery

Pattern of bacteria and fungi growth in the non-insulin dependent diabetes mellitus'toe webs

To assess the growth of bacteria and fungi in the Non Insulin Dependent Diabetes Mellitus [NIDDM] toe webs and to correlate with the glycaemic control and to frequent feet washing. Sixty one NIDDM patients [28 males, 33 females] with a mean age of 51.7 years, and mean diabetes duration of 7 years [0.5-30 years]. Compared with 29 non-diabetic healthy subjects as a control group with mean age 45.5 years, were randomly selected, evaluated and examined in the Endocrine Clinic - KHMC for skin peripheral pulse status. Skin scrapings were taken from both 4th toe webs regardless of the presence or absence of any lesion. These were cultured on Saboroud's dextrose and blood agar media. Gram stain and lactophenol cotton blue stain were also obtained. Venous blood for blood sugar and HbA 1c was also extracted. HbA 1c was considered as a measure of control. Levels < 7% were considered good control, 7.1-9.5% fair control, > 9.5% poor control. In the NIDDM group, there were 21 [34.4%] patients with superficial skin lesions over the fourth toe web, 28 [45.9%] were having absent tibialis posterior and dorsalis pedis pulses bilaterally and 5 unilaterally. 55.7% were having associated diseases and 80.33% were using frequent foot washings for religious purposes. Seventeen patients were having good control of their diabetes, 29 fair control and 15 with poor control. The mean HbA1c was 8.68 +/- 1.16 [ +/- SD]. In the control group 2 were having skin lesions and 75.86% were using frequent foot washings. 7.4% of the diabetic sample were having positive cultures, gram positive cocci, candida albicans, mixed growth of gram positive and negative, gram negative cocci and dermatophytes in decrescendo manner were obtained [19.7%, 14.7%, 13.2%, 4.9%, 4.9% versus 6.9% in the control group [Candida Albicans 100%] P <0.05. All patients with poor glycaemic control were having positive cultures, versus 41.7% with fair control and 47% with good glycaemic control P<0.001. None of the patients with dermatophytes were having intact skin, while 55% of patients with candida were having superficial lesions. Positive cultures with normal skin occurred in 27.9% in NIDDM group versus 6.9% in control group, and with toe lesions in 29.5% in NIDDM group, versus none in control group P <0.05. 61.2% of feet washers in NIDDM group have positive cultures versus 4.5% in control group. Diabetic patients have a higher carriage rate of both bacteria and fungi which increases with skin breakdown. Susceptibility of infection in increased by poor glycaemic control. Diabetes does not predispose to the carriage of dermatophytes in the toe webs of normal appearance. Frequent feet washing predisposes more to infection in diabetics and needs special attention