Combination of ofloxacin and amikacin in the treatment of sternotomy wound infection.

Mycobacterium fortuitum infection of soft tissue and wound (postoperative or otherwise) has been well reported in medical literature. In 1987, ten patients in our hospital with various cardiac diagnoses requiring open-heart surgery developed M fortuitum infection at the sternotomy site. As successful chemotherapy, in addition to surgical debridement, relies on in vitro susceptibility testing, ofloxacin and amikacin were thus assessed and found to have very satisfactory MIC. For the former: 1.25 mg/L for eight isolates, 2.5 mg/L for one isolate, and greater than 20 mg/L for one isolate were found. For the latter: 1 mg/L for six isolates, 2 mg/L for two isolates, and 4 mg/L and 8 mg/L for the remaining two isolates were found, respectively. These patients were given ofloxacin (300 mg once daily to 1,200 mg daily in divided doses) for three to six months and 500 mg amikacin daily (in two divided doses intravenously or intramuscularly) for three to eight weeks. The clinical outcome was favorable except for one patient who died of bacteremia due to M fortuitum coupled with many medical complications. Encouraged by these preliminary results, a future prospective study with ofloxacin as single agent for soft tissue, particularly postoperative sepsis due to M fortuitum, will be planned.

An unusual lethal complication of preservation of chordae tendineae in mitral valve replacement.

In two patients, several chordae tendineae of the mural leaflet were preserved during mitral valve replacement. Hemorrhagic necrosis and spontaneous rupture of the preserved posterior papillary muscle led to disc entrapment and the death of both patients.

Aortic atresia with complete transposition.

Aortic atresia with ventriculoarterial discordance in a three day old neonate was studied by cross sectional echocardiography and the anatomy was confirmed at necropsy.

Effects of Russell's viper venom on blood coagulation, platelets and the fibrinolytic enzyme system.

The effects of Russell's viper venom (RVV) on blood coagulation, platelts and fibrinolysis were studied in vivo and in vitro in rabbits and dogs as experimental subjects. RVV was shown to be a strong coagulant, and at the time of manifestation of bleeding due to consumption coagulopathy, the most striking hemostatic abnormalities were fall of fibrinogen level, reduction in platelet count, delayed ADP aggregation of platelets, increased fibrinolytic activity and presence of fibrin degradation products. These findings showed that RVV interfered with blood coagulation, caused abnormalities of platelet function and also activated the fibrinolytic enzyme system.

Changes in the tissues of the immune system in dengue haemorrhagic fever.

A total of 100 post-mortems were done on patients clinically diagnosed as dengue haemorrhagic fever from Rangoon Children's Hospital. Histopathological changes in bone marrow, thymus, spleen, lymph nodes and other associated tissues of the immune system were analysed and correlated with the clinical picture and serology results. The major changes in cases with a positive serology result for secondary dengue infection consist of hypoplasia of the bone marrow, acute atrophy and wasting of the thymus, atrophy and depletion of cells in the periarterial lymphatic sheaths of the spleen and the paracortical areas of the lymph nodes. The tissues affected are the thymus-dependent areas of the spleen and lymph nodes, and the thymus itself. Thymus-independent areas of the secondary lymphatic tissues are also affected but to a lesser extent. The pathological observations suggest that immunodepression may be an integral part of the pathophysiology of dengue haemorrhagic fever.