Evaluation of different phenotypic methods for detection of methicillin [oxacillin] resistance in coagulase-negative staphylococci

Coagulase-negative staphylococci [CNS] are one of the major causes of nosocomial infections. Methicillin [oxacillin] resistant strains are particularly important because they narrow therapeutic options. Detecting methicillin resistance among CNS has been a challenge for years. The objective of this study was to evaluate the ability and accuracy of four phenotypic methods, disk diffusion [DD]; agar screening plate with 6 micro g of oxacillin per ml [OXA]; E-test and the MRSA-Screen latex agglutination test [Denka-Seiken, Tokyo, Japan], to determine the susceptibility of CNS to oxacillin. The methods were evaluated by using the presence of the mecA gene, as detected by PCR, as the "gold standard". One hundred and ninety seven strains of CNS of 7 species were analysed. 49.2% were mecA positive. For the different methods evaluated, the sensitivities and specificities were as follows: for disk diffusion, 93.8 and 93%, respectively; for the agar screen test 95.9 and 98%, respectively; for E-test, 100 and 95%, respectively; and for the slide latex agglutination test, 96.9 and 100%, respectively. The latex agglutination test sensitivity was increased to 100% when retested after induction. In conclusion, all of the phenotypic methods evaluated in the present study appeared to perform very well for the detection of oxacillin resistance in CNS. The MRSA-Screen latex agglutination test was not only the most sensitive, specific and accurate method but also rapid and technically simple method to be applied in routine laboratories for the detection of oxacillin resistance which is mediated by the mecA gene

Autologous rectus sheath graft for stress urinary incontinence repair

To evaluate the results of autologous rectus sheath graft sling procedure for treatment of genuine stress urinary incontinence [GSUI]. Twenty-four female patients having GSUI were scheduled for surgical repair using rectus sheath graft. Via a suprapubic mid-line incision a graft of rectus sheath was fashioned and passed behind the bladder neck retropubically to be anchored to the anterior rectus sheath. Patients were followed-up for 12-18 months, with clinical assessment, urinalysis, urodynamic study and ascending and voiding cystourethrography in certain cases. Eighteen patients became dry and continent with a cure rate of 75%. Improvement was achieved in 4 patients [16.6%], with variable degrees based on pad test and voiding diary with an overall success rate of 91.6%. The remaining 2-patients [8.3%] were considered as failure. Sling procedure using rectus sheath is effective in over 90% of cases of GSUI. It could be considered as a primary surgical treatment for cases with stress urinary incontinence as it has low complications rate, low cost with satisfactory outcome

Surgical management of venogenic impotency; new technique

This study included 300 patients presented with secondary impotence for not less than 6 months duration. 140 patients with negative stamp and papaverine tests underwent duplex sonography, dynamic cavernosography and bulbocavernosus reflex latency test. It was found that venous leakage existed only in 85 patients [60.5%], while venous leakage mixed with other lesion was present in 40 cases [29%]. Pure arteriogenic lesion was present in 9 cases [6.4%] and neurogenic affection in 4 cases [2.8%]. Deep dorsal vein ablation combined with crural ligation was done for 85 patients. Results are 80% success with follow up 12 months. This is probably due to occlusion of both intermediate and deep venous systems of the penis