The proper concentrations of dextrose and lidocaine in regenerative injection therapy: in vitro study.

BACKGROUND: Prolotherapy is a proliferation therapy as an alternative medicine. A combination of dextrose solution and lidocaine is usually used in prolotherapy. The concentrations of dextrose and lidocaine used in the clinical field are very high (dextrose 10%-25%, lidocaine 0.075%-1%). Several studies show about 1% dextrose and more than 0.2% lidocaine induced cell death in various cell types. We investigated the effects of low concentrations of dextrose and lidocaine in fibroblasts and suggest the optimal range of concentrations of dextrose and lidocaine in prolotherapy. METHODS: Various concentrations of dextrose and lidocaine were treated in NIH-3T3. Viability was examined with trypan blue exclusion assay and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay. Migration assay was performed for measuring the motile activity. Extracellular signal-regulated kinase (Erk) activation and protein expression of collagen I and α-smooth muscle actin (α-SMA) were determined with western blot analysis. RESULTS: The cell viability was decreased in concentrations of more than 5% dextrose and 0.1% lidocaine. However, in the concentrations 1% dextrose (D1) and 0.01% lidocaine (L0.01), fibroblasts proliferated mildly. The ability of migration in fibroblast was increased in the D1, L0.01, and D1 + L0.01 groups sequentially. D1 and L0.01 increased Erk activation and the expression of collagen I and α-SMA and D1 + L0.01 further increased. The inhibition of Erk activation suppressed fibroblast proliferation and the synthesis of collagen I. CONCLUSIONS: D1, L0.01, and the combination of D1 and L0.01 induced fibroblast proliferation and increased collagen I synthesis via Erk activation.

Hybrid Robotic Single-Site Myomectomy Using the GelPoint Platform.

Background: To overcome the limitations of single-port laparoscopic myomectomy (SP-LM) and robotic single-site myomectomy (RSSM), we designed a new surgical technique, the so-called hybrid RSSM (H-RSSM), by integrating the advantages of both procedures. This study describes the surgical technique of H-RSSM and reports our initial experiences. Materials and Methods: Between February 2018 and September 2018, H-RSSM was performed in 25 women with symptomatic fibroids. During the H-RSSM, the enucleation of the fibroid was carried out using single-port laparoscopy and the uterine defect was repaired using robotic single-site surgery. To assess the feasibility and efficacy of H-RSSM, the results of this study were compared with those of our previous study on SP-LM and its modified surgical technique, so-called single-port laparoscopically assisted transumbilical ultraminilaparotomic myomectomy (SPLA-TUM). Results: The mean operation time, hemoglobin change, return of bowel activity, and length of hospital stay were 69.4 ± 18.2 minutes, 1.2 ± 0.9 g/dL, 37.1 ± 15.5 hours, and 4.0 ± 0.8 days, respectively. There was no conversion to laparotomy or multiport laparoscopy. There were no surgical or wound complications. Comparing with SP-LM and SPLA-TUM, H-RSSM had significantly shorter operation time and return of bowel activity. Conclusion: H-RSSM can reduce operating time and the conversion rate to multiport laparoscopy and can be considered a feasible alternative for selected patients with symptomatic fibroids. However, further studies are needed to clearly demonstrate these benefits.

Persistent Organic Pollutant-Mediated Insulin Resistance.

Persistent organic pollutants (POPs) such as organochlorine (OC) pesticides, polychlorinated biphenyls (PCBs), polychlorinated dibenzo-p-dioxins (PCDDs), and polychlorinated dibenzofurans (PCDFs) have become wide-spread environmental contaminants as a consequence of their extensive use, long-range transport, and persistence. Because POPs are highly resistant to metabolic degradation, humans bioaccumulate these lipophilic and hydrophobic pollutants in fatty tissues for many years. Previous studies have demonstrated that POPs including PCBs are involved in the development of diabetes mellitus (DM) type 2 and insulin resistance. Numerous epidemiological studies suggest an association between POP burden and DM type 2/metabolic syndrome. In addition, several experimental studies have provided additional evidence supporting the association between POP exposure and DM type 2 or insulin resistance. Epidemiological and experimental studies have provided compelling evidence indicating that exposure to POPs increases the risk of developing insulin resistance and metabolic disorders. However, the detailed molecular mechanism underlying POP-induced insulin resistance is yet to be elucidated. In this article, we review literature that has reported on the association between POP burden and insulin resistance and the mechanism underlying POP-induced insulin resistance, and discuss implications for public health.

Polychlorinated biphenyl 138 exposure-mediated lipid droplet enlargement endows adipocytes with resistance to TNF-α-induced cell death.

Although epidemiological reports have shown the association between polychlorinated biphenyls (PCBs) and obesity, the molecular mechanism of PCB-induced obesity is mostly unknown. The aim of the present study was to further dissect the significance of lipid droplet (LD) enlargement in PCB-induced obesity. For this aim, we hypothesized that PCB-induced LD enlargement endows adipocytes with resistance to cell death, inhibiting the natural loss of adipocytes. Four types of PCBs were screened, and the detailed molecular mechanism was investigated by using PCB-138. We observed that PCB-138-conferred cell death resistance to hypertrophic adipocytes with enlarged LDs. We further observed that PCB-138 prevents Tumour necrosis factor-α (TNF-α)-induced apoptosis and necroptosis in 3T3-L1 adipocytes and increases the expression of anti-apoptotic proteins, including survivin, in vitro and in vivo. In addition, we demonstrated that fat-specific protein 27 (Fsp27), perilipin, and survivin endow adipocytes with resistance to TNF-α-induced cell death through sustaining enlarged LDs. Thus, the present study suggests that PCB-138-induced LD enlargement endows adipocytes with resistance to TNF-α-induced cell death and that Fsp27, perilipin, and survivin, at least in part, help adipocytes to sustain enlarged LDs, contributing to the induction of obesity.

Chronic Calf Pain Caused by Fibroma-Induced Chronic Inflammation Around the Tibial and Peroneal Nerves that Was Misdiagnosed as Centralized Neuropathic Pain: A Case Report.

INTRODUCTION: The etiology of calf pain varies widely; therefore, it is difficult to diagnose and requires careful history taking and physical examination by primary care unit physicians. Because ultrasonography is easy to perform, cheap, and readily available to physicians during a routine consultation, it is the first choice of modality for the evaluation of calf pain. However, simple inflammation around the nerve should also be considered as a possible etiology. Here we describe a 35-year-old man with chronic pain in the right calf that was actually caused by fibroma-induced chronic inflammation around the tibial and peroneal nerves but misdiagnosed as centralized neuropathic pain. CASE REPORT: The patient presented with chronic pain and a tingling sensation in the right calf. He had a slowly growing tibial nerve neurilemmoma that was excised at 28 years of age; however, the pain and tingling sensation persisted. He visited several hospitals for 7 years and was misdiagnosed with peripheral nerve injury-induced neuropathic pain. At 35 years of age, he visited our hospital for further evaluation. Ultrasonography revealed a mass in the popliteal region, which was excised and confirmed to be a fibroma via histopathological analysis. Severe inflammation was observed in the operative field. His symptoms finally ameliorated after this surgery. CONCLUSION: The findings from this case suggest that ultrasonography should be used as the primary modality for the evaluation of calf pain. Although the features of unresolved calf pain are similar to those of neuropathic pain, more curable etiologies should be considered.

Anti-apoptotic and myocardial protective effects of ethyl pyruvate after regional ischaemia/reperfusion myocardial damage in an in vivo rat model.

INTRODUCTION: The integration of reactive oxygen species is strongly associated with important pathophysiological mechanisms that mediate myocardial ischaemia/reperfusion (I/R) damage. Pyruvate is an efficacious scavenger of reactive oxygen species and a previous study has shown that ethyl pyruvate (EP) has a myocardial protective effect against regional I/R damage in an in vivo rat model. The purpose of this study was to determine whether the myocardial protective effect of EP is associated with anti-apoptosis. METHODS: Rats were allocated to receive EP dissolved in lactated Ringer's solution or lactated Ringer's solution alone, via intraperitoneal infusion one hour before ischaemia. They were exposed to 30 minutes of ischaemia followed by reperfusion of the left coronary artery territory over two hours. Anti-apoptotic effects were checked using several biochemical parameters after two hours of reperfusion. Apoptosis was analysed using measured caspase-3 activity, Western blotting of B-cell lymphoma 2 (Bcl-2) family protein cleaved by caspase-3, and assessment of DNA laddering patterns and the terminal deoxynucleotidyl transferase dUTP nick end labelling (TUNEL) staining test. RESULTS: In ischaemic myocardium, EP increased Bcl-2 expression, but reduced Bcl-2-associated X protein and cleaved caspase-3 expressions. EP reduced the expression of DNA laddering and the number of myocardial I/R-damaged TUNEL-positive cells. CONCLUSION: This study demonstrated that EP has an anti-apoptotic effect after regional I/R damage in an in vivo rat heart model. The myocardial protective effect of EP may be related to its anti-apoptotic effect.

Polychlorinated biphenyls exposure-induced insulin resistance is mediated by lipid droplet enlargement through Fsp27.

Although epidemiological and experimental studies demonstrated that polychlorinated biphenyls (PCBs) lead to insulin resistance, the mechanism underlying PCBs-induced insulin resistance has remained unsolved. In this study, we examined in vitro and in vivo effects of PCB-118 (dioxin-like PCB) and PCB-138 (non-dioxin-like PCB) on adipocyte differentiation, lipid droplet growth, and insulin action. 3T3-L1 adipocytes were incubated with PCB-118 or PCB-138 during adipocyte differentiation. For in vivo studies, C57BL/6 mice were administered PCB-118 or PCB-138 (37.5 mg/kg) by intraperitoneal injection and we examined adiposity and whole-body insulin action. PCB-118 and PCB-138 significantly promoted adipocyte differentiation and increased the lipid droplet (LD) size in 3T3-L1 adipocytes. In mice, both PCBs increased adipose mass and adipocyte size. Furthermore, both PCBs induced insulin resistance in vitro and in vivo. Expression of fat-specific protein 27 (Fsp27), which is localized to LD contact sites, was increased in PCB-treated 3T3-L1 adipocytes and mice. Depletion of Fsp27 by siRNA resulted in the inhibition of LD enlargement and attenuation of insulin resistance in PCB-treated 3T3-L1 adipocytes. An anti-diabetic drug, metformin, attenuated insulin resistance in PCB-treated 3T3-L1 adipocytes through the reduced expression of Fsp27 protein and LD size. This study suggests that PCB exposure-induced insulin resistance is mediated by LD enlargement through Fsp27.

Effects of Acidification and Alkalinization on the Lipid Emulsion-Mediated Reversal of Toxic Dose Levobupivacaine-Induced Vasodilation in the Isolated Rat Aorta.

The goal of this in vitro study was to examine the effects of pre-acidification and pre-akalinization on the lipid emulsion-mediated reversal of toxic dose levobupivacaine-induced vasodilation in isolated rat aorta. Isolated aortic rings with and without the nitric oxide synthase inhibitor N(ω)-nitro-L-arginine methyl ester (L-NAME) were exposed to four types of Krebs solution (pH 7.0, 7.2, 7.4, and 7.6), followed by the addition of 60 mM potassium chloride. When the toxic dose of levobupivacaine (3 × 10(-4) M) produced a stable and sustained vasodilation in the isolated aortic rings that were precontracted with 60 mM potassium chloride, increasing lipid emulsion concentrations (SMOFlipid(®): 0.24, 0.48, 0.95 and 1.39%) were added to generate concentration-response curves. The effects of mild pre-acidification alone and mild pre-acidification in combination with a lipid emulsion on endothelial nitric oxide synthase (eNOS) phosphorylation in human umbilical vein endothelial cells were investigated by Western blotting. Mild pre-acidification caused by the pH 7.2 Krebs solution enhanced the lipid emulsion-mediated reversal of levobupivacaine-induced vasodilation in isolated endothelium-intact aortic rings, whereas mild pre-acidification caused by the pH 7.2 Krebs solution did not significantly alter the lipid emulsion-mediated reversal of the levobupivacaine-induced vasodilation in isolated endothelium-denuded aortic rings or endothelium-intact aortic rings with L-NAME. A lipid emulsion attenuated the increased eNOS phosphorylation induced by the pH 7.2 Krebs solution. Taken together, these results suggest that mild pre-acidification enhances the lipid emulsion-mediated reversal of toxic dose levobupivacaine-induced vasodilation in the endothelium-intact aorta via the inhibition of nitric oxide.

Lipofundin® MCT/LCT 20% increase left ventricular systolic pressure in an ex vivo rat heart model via increase of intracellular calcium level.

BACKGROUND: Lipid emulsions have been used to treat various drug toxicities and for total parenteral nutrition therapy. Their usefulness has also been confirmed in patients with local anesthetic-induced cardiac toxicity. The purpose of this study was to measure the hemodynamic and composition effects of lipid emulsions and to elucidate the mechanism associated with changes in intracellular calcium levels in myocardiocytes. METHODS: We measured hemodynamic effects using a digital analysis system after Intralipid® and Lipofundin® MCT/LCT were infused into hearts hanging in a Langendorff perfusion system. We measured the effects of the lipid emulsions on intracellular calcium levels in H9c2 cells by confocal microscopy. RESULTS: Infusion of Lipofundin® MCT/LCT 20% (1 ml/kg) resulted in a significant increase in left ventricular systolic pressure compared to that after infusing modified Krebs-Henseleit solution (1 ml/kg) (P = 0.003, 95% confidence interval [CI], 2.4-12.5). Lipofundin® MCT/LCT 20% had a more positive inotropic effect than that of Intralipid® 20% (P = 0.009, 95% CI, 1.4-11.6). Both lipid emulsion treatments increased intracellular calcium levels. Lipofundin® MCT/LCT (0.01%) increased intracellular calcium level more than that of 0.01% Intralipid® (P < 0.05, 95% CI, 0.0-1.9). CONCLUSIONS: These two lipid emulsions had different inotropic effects depending on their triglyceride component. The inotropic effect of lipid emulsions could be related with intracellular calcium level.

Comparison of meperidine and nefopam for prevention of shivering during spinal anesthesia.

BACKGROUND: Shivering is a frequent event during spinal anesthesia and meperidine is a well-known effective drug for prevention and treatment of shivering. Nefopam is a non-opiate analgesic and also known to have an anti-shivering effect. We compared nefopam with meperidine for efficacy of prevention of shivering during spinal anesthesia. METHODS: Sixty five patients, American Society of Anesthesiologists physical status I or II, aged 20-65 years, scheduled for elective orthopedic surgery under spinal anesthesia were investigated. Patients were randomly divided into two groups, meperidine (Group M, n = 33) and nefopam (Group N, n = 32) groups. Group M and N received meperidine 0.4 mg/kg or nefopam 0.15 mg/kg, respectively, in 100 ml of isotonic saline intravenously. All drugs were infused for 15 minutes by a blinded investigator before spinal anesthesia. Blood pressures, heart rates, body temperatures and side effects were checked before and at 15, 30, and 60 minutes after spinal anesthesia. RESULTS: The incidences and scores of shivering were similar between the two groups. The mean arterial pressures in Group N were maintained higher than in Group M at 15, 30, and 60 minutes after spinal anesthesia. The injection pain was checked in Group N only and its incidence was 15.6%. CONCLUSIONS: We conclude that nefopam can be a good substitute for meperidine for prevention of shivering during spinal anesthesia with more stable hemodynamics, if injection pain is effectively controlled.

Epidural Blood Patch for the Treatment of Abducens Nerve Palsy due to Spontaneous Intracranial Hypotension -A Case Report-.

Intracranial hypotension is characterized by a postural headache which is relieved in a supine position and worsened in a sitting or standing position. Although less commonly reported than postural headache, sixth nerve palsy has also been observed in intracranial hypotension. The epidural blood patch (EBP) has been performed for postdural puncture headache, but little is known about the proper timing of EBP in the treatment of sixth nerve palsy due to intracranial hypotension. This article reports a case of sixth nerve palsy due to spontaneous intracranial hypotension which was treated by EBP 10 days after the onset of palsy.

Risk factors for surgical site infection after gastric surgery: a multicentre case-control study.

BACKGROUND: Surgical site infection (SSI) is a potentially morbid and costly complication of surgery. We conducted a multicentre case-control study to determine the risk factors for SSI in patients undergoing gastric surgery and to establish strategies to reduce the risk of SSI. METHODS: Between January 2007 and December 2008, 121 patients who developed an SSI after gastric surgery were matched with controls who had undergone surgery on the dates closest to those of the cases, at 13 centres in Korea. RESULTS: The results of multivariate analyses showed that the independent risk factors for SSI after gastric surgery were older age (p = 0.016), higher body mass index (BMI) (p = 0.033), male gender (p = 0.047), and longer duration of prophylactic antibiotic use (p < 0.001). CONCLUSION: Older age, higher BMI, male gender, and longer duration of prophylactic antibiotic use were independently associated with significant increases in the risk of SSI. Additional prospective randomized studies are required to confirm these results.

Social support, stress, and practice of prenatal care in married immigrant women in Korea.

PURPOSE: This study aimed to identify the correlations among social support, stress, and practice of prenatal care and elucidate the predictors affecting the practice of prenatal care in married immigrant women in Korea. METHOD: This study employed a descriptive correlational DESIGN: Social support and prenatal-care practice were positively correlated, and stress was negatively correlated with both prenatal-care practice and social support. The practice of prenatal care in married immigrant women was most influenced by social support. CONCLUSION: As such, there is a need for nursing intervention that fosters social support for pregnant immigrant women. Concerted efforts are also required to reduce their stressors. This study could form the basis for developing childbirth management programs for pregnant women who have immigrated to Korea in order to marry.

Accuracy of the epidural catheter position during the lumbar approach in infants and children: a comparison among L2-3, L3-4, and L4-5 approaches.

BACKGROUND: The aim of this study was to compare the accuracy of the position of the epidural catheter inserted from three different lumbar intervertebral spaces, L2-3, L3-4, and L4-5, in infants and children. METHODS: Seventy-five children were randomly allocated to 3 groups according to the epidural catheter insertion site (L2-3, L3-4, and L4-5). The epidural catheter tip was identified using 50% diluted Iohexol and fluoroscopy. The incidence of correct position was compared among the groups and between infants and children. RESULTS: The incidence of correct position was significantly higher in the L2-3 group as compared to the L3-4 and L4-5 groups (P = 0.023 and P = 0.046 respectively). The incidence of correct position was higher in infants compared to children (P = 0.017). CONCLUSIONS: The L2-3 intervertebral space is preferable during epidural catheter insertion in children older than 1 year, but a low lumbar level should be considered in infants because they have a higher risk of neural damage.

Characterization of a Paenibacillus woosongensis beta-Xylosidase/alpha-Arabinofuranosidase produced by recombinant Escherichia coli.

A gene encoding the beta-xylosidase/alpha-arabinofuranosidase (XylC) of Paenibacillus woosongensis was cloned into Escherichia coli. This xylC gene consisted of 1,425 nucleotides, encoding a polypeptide of 474 amino acid residues. The deduced amino acid sequence exhibited an 80% similarity with those of both Clostridium stercorarium beta-xylosidase/alpha-N-arabinosidase and Bacillus cellulosilyticus alpha-arabinofuranosidase, belonging to the glycosyl hydrolase family 43. The structural gene was subcloned with a Cterminal His-tag into a pET23a(+) expression vector. The His-tagged XylC, purified from a cell-free extract of a recombinant E. coli BL21(DE3) Codon Plus carrying a xylC gene by affinity chromatography, was active on paranitrophenyl- alpha-arabinofuranoside (pNPA) as well as paranitrophenyl- beta-xylopyranoside (pNPX). However, the enzymatic activities for the substrates were somewhat incongruously influenced by reaction pHs and temperatures. The enzyme was also affected by various chemicals at different levels. SDS (5 mM) inhibited the enzymatic activity for pNPX, while enhancing the enzymatic activity for pNPA. Enzyme activity was also found to be inhibited by addition of pentose or hexose. The Michaelis constant and maximum velocity of the purified enzyme were determined for hydrolysis of pNPX and pNPA, respectively.

Effect of various anesthetic induction agents on blood magnesium and calcium concentration.

BACKGROUND: Decrease in blood magnesium and calcium concentration is associated with an increase in the incidence of arrhythmia, especially during the induction period. Therefore, it is important to evaluate the effects of propofol, pentothal sodium, and sevoflurane on calcium and magnesium concentration. METHODS: Thirty-six premedicated, ASA grade I patients were selected and randomly allocated into 3 groups. Six percent sevoflurane inhalation (sevo group), propofol 1.5 mg/kg (propofol group), and 5 mg/kg of pentothal sodium (pento group) were administered for anesthetic induction and anesthetic maintenance was done with end-tidal sevoflurane concentration at 3.5%. Blood sampling was performed during the pre-induction period (pre-induction), just before tracheal intubation (pre-intubation), and 2 min after intubation (post-intubation). pH corrected ionized magnesium and calcium were calculated and analyzed simultaneously. RESULTS: Both total calcium and magnesium concentrations decreased significantly in all groups during the pre-intubation and post-intubation periods compared with the pre-induction period. Ionized calcium only decreased significantly during pre-intubation and post-intubation in the pento group, and did not change throughout the study period in the sevo and propofol groups. Ionized magnesium did not change throughout the study period in any of the groups. pH corrected ionized calcium decreased significantly only at post-intubation in the pento group. CONCLUSIONS: All anesthetic induction agents administered in this study can be used safely in terms of magnesium-associated arrhythmia. However, ionized calcium concentration decreased in the pento group, but all values were within normal limits. This finding indicated that it is safe to use propofol, pentothal sodium, and sevoflurane for anesthetic induction.

Risk factors and outcomes of bloodstream infections with metallo-beta-lactamase-producing Acinetobacter.

The spread of Gram-negative bacilli with acquired metallo-beta-lactamase (MBL) threatens the successful treatment of major nosocomial infections. The objective of this study was to evaluate the differences in the clinical characteristics of bacteremia caused by MBL-producing Acinetobacter species and MBL non-producing isolates. Two retrospective case-control studies were conducted using data on patients with Acinetobacter bacteremia, who were admitted between January 2001 and December 2005 at a 1500-bed, tertiary-care teaching hospital. Case group 1 (n=27) included patients from whom imipenem-resistant Acinetobacter was isolated in blood culture, and case group 2 (n=7) consisted of those patients from group 1 who yielded MBL-producing isolates. The control group (n=41) included patients from whom carbapenem-susceptible Acinetobacter isolates were isolated in blood culture. Multivariate analysis revealed that the independent risk factors for imipenem-resistant Acinetobacter bacteremia were neutropenia and prolonged use of carbapenem. The independent risk factors for MBL-producing Acinetobacter bacteremia were neutropenia and prolonged use of cephalosporins. The results of this study suggest that a prolonged use of cephalosporins may be associated with MBL-producing Acinetobacter bacteremia.

Phosphate number and acyl chain length determine the subcellular location and lateral mobility of phosphoinositides.

Phosphoinositides are critical regulators of ion channel and transporter activity. There are multiple isomers of biologically active phosphoinositides in the plasma membrane and the different lipid species are non-randomly distributed. However, the mechanism by which cells impose selectivity and directionality on lipid movements and so generate a non-random lipid distribution remains unclear. In the present study we investigated which structural elements of phosphoinositides are responsible for their subcellular location and movement. We incubated phosphatidylinositol (PI), phosphatidylinositol 4-monophosphate (PI(4)P) and phosphatidylinositol 4,5-bisphosphate (PI(4,5)P2) with short or long acyl chains in CHO and HEK cells. We show that phosphate number and acyl chain length determine cellular location and translocation movement. In CHO cells, PI(4,5)P2 with a long acyl chain was released into the cytosol easily because of a low partition coefficient whereas long chain PI was released more slowly because of a high partition coefficient. In HEK cells, the cellular location and translocation movement of PI were similar to those of PI in CHO cells, whereas those of PI(4,5)P2 were different; some mechanism restricted the translocation movement of PI(4,5)P2, and this is in good agreement with the extremely low lateral diffusion of PI(4,5)P2. In contrast to the dependence on the number of phosphates of the phospholipid head group of long acyl chain analogs, short acyl chain phospholipids easily undergo translocation movement regardless of cell type and number of phosphates in the lipid headgroup.

Comparison of efficacy of cefoperazone/sulbactam and imipenem/cilastatin for treatment of Acinetobacter bacteremia.

Multiple antibiotic resistance threatens successful treatment of Acinetobacter baumannii infections worldwide. Increasing interest in the well-known activity of sulbactam against the genus Acinetobacter has been aroused. The purpose of this study was to compare the outcomes for patients with Acinetobacter bacteremia treated with cefoperazone/sulbactam versus imipenem/cilastatin. Forty-seven patients with Acinetobacter baumannii bacteremia were analyzed through a retrospective review of their medical records for antibiotic therapy and clinical outcome. Thirty-five patients were treated with cefoperazone/sulbactam, and twelve patients with imipenem/cilastatin. The percentage of favorable response after 72 hours was not statistically different between cefoperazone/sulbactam group and imipenem/cilastatin group. The mortality rate was not statistically different, too. Cefoperazone/sulbactam was found to be as useful as imipenem/cilastatin for treating patients with Acinetobacter bacteremia.

Intermediate dose 5-fluorouracil-induced encephalopathy.

As an acute neurotoxicity, high dose 5-fluorouracil (5-FU)-induced encephalopathy is well-known, but encephalopathy associated with lower dose is rarely reported. Here, we report a case of a male with anal cancer who was treated with 5-FU 1000 mg/m(2), continuous infusion for 5 days q4 weeks. At the second and the fourth cycles of chemotherapy, sudden confusion, cognitive dysfunction and disorientation occurred during 5-FU infusion. They were accompanied by hyperammonemia in the absence of focal neurological deficits or structural abnormalities. These symptoms completely disappeared and the serum ammonia level returned to normal after discontinuation of 5-FU and conservative care. In order to investigate a possible deficit of dihydropyrimidine dehydrogenase (DPD), we checked its mRNA level before and after treatment using real-time PCR. The patient's pre-treatment level was 80% compared with reference group, and it was elevated up to 187% of initial after 5-FU treatment, implying that that his encephalopathy may be 5-FU catabolite type rather than DPD deficiency. In conclusion, we report that encephalopathy can develop even with the dose of 5-FU lower than ever reported, and it should be considered as a differential diagnosis for proper management.