Comparison of resistance against erythromycin and moxifloxacin, presence of binary toxin gene and PCR ribotypes in Clostridium difficile isolates from 1990 and 2008.

Worldwide increasing rates of Clostridium difficile infections (CDI) with severe courses and outbreaks have been reported. This change in CDI epidemiology has on one hand been related to the spread of specific PCR ribotypes (e.g. 027) and on the other hand to increased prevalence of resistant C. difficile strains. This single-centre retrospective analysis characterized resistance against erythromycin and moxifloxacin, presence of binary toxin gene and ribotypes in 73 C. difficile isolates from 2008 in comparison with 23 isolates from 1990. In 1990, five different PCR ribotypes including 027 were identified. Resistance against erythromycin was detected in 3 of 23 (13%), while 20 of 23 (87%) from all isolates were susceptible to both erythromycin and moxifloxacin. In contrast, in 2008 a significantly increased prevalence of resistant C. difficile strains was observed, with 40 of 73 (54.8%) isolates being resistant against both antibiotics. Resistant C. difficile strains were mainly assigned to PCR ribotype 001. No isolates belonging to PCR ribotype 027 were identified. Our data provide evidence that the increase of resistant C. difficile strains belonging to PCR ribotype 001 rather than the spread of C. difficile PCR ribotype 027 contribute to the changing epidemiology of CDI.

[Fatal sinus vein thrombosis in a patient with mixed connective tissue disease and secondary antiphospholipid antibody syndrome]. / Letale Sinusvenenthrombose bei einer Patientin mit Mischkollagenose und sekundärem Antiphospholipid-Antikörper-Syndrom.

BACKGROUND: The antiphospholipid (Huges) syndrome is a complication of connective tissue diseases characterized by thromboembolic occlusions of arterial and venous blood vessels. CASE REPORT: At the age of 13, the patient developed connective tissue disease with arthritis and myositis. The course of her disease was characterized by frequent relapses despite immunosuppressive treatment. She developed deep venous thrombosis of her right leg as a manifestation of secondary antiphospholipid antibody syndrome at the age of 15 and was subsequently started on oral anticoagulation therapy. Approximately 10 months later, however, she decided to try alternative medicine and stopped both anticoagulation and immunosuppressive therapy. Only after 4 weeks she developed seizures followed by respiratory arrest with the need for cardiopulmonary resuscitation. Despite intensive care she died 2 days later with the signs of severe cerebral edema causing herniation of the brainstem. Autopsy confirmed the diagnosis of severe edema of the brain as a result of extensive thrombosis of all sinus veins. CONCLUSION: A complete sinus vein thrombosis is a rare manifestation of antiphospholipid antibody syndrome. The lethal thrombosis in this case occurred during a period of reactive hypercoagulability after termination of immunosuppressive and/or anticoagulation therapy. This case report underlines the need for long-term anticoagulation in patients with the antiphospholipid syndrome.

Rapid detection of chlorinated bisbibenzyls in Bazzania trilobata using MALDI-TOF mass spectrometry.

Chlorinated bisbibenzyls of the bazzanin type are detected in crude bryophyte plant extracts of Bazzania trilobata from different locations using MALDI-TOF mass spectrometry. These results show that these chlorinated compounds are not artefacts of an incidental occurrence or of the sample preparation but are genuine and produced by the liverwort or an endosymbiotic metabolism. Further experiments were performed concerning the in vitro chlorination of the halogen free basic unit isoplagiochin C.

Rapid detection of multiple chlorinated bis(bibenzyls) in bryophyte crude extracts using laser desorption/ionization time-of-flight mass spectrometry.

Chlorinated bis(bibenzyls) of the bazzanine type were detected in crude bryophyte plant extracts of Bazzania trilobata from different locations using laser desorption/ionization time-of-flight (LDI-TOF) mass spectrometry without addition of an additional chemical matrix. The degree of chlorination could be identified by the characteristic isotope patterns. These results suggest that these chlorinated compounds are not artefacts of an incidental occurrence, or of the sample preparation, but are genuine natural products produced by the liverwort or by an endosymbiotic metabolism.

[Postoperative pulmonary function after lung surgery. Total intravenous anesthesia with propofol in comparison to balanced anesthesia with isoflurane]. / Untersuchungen zur postoperativen Lungenfunktion nach lungenchirurgischen Eingriffen. Total intravenöse Anästhesie mit Propofol im Vergleich zur balanzierten Anästhesie mit Isofluran.

After lung resection, early extubation and the rapid return of the patients ability to cooperate is the predominant goal. Propofol anaesthesia is characterised by rapid awakening and recovery of cognitive and psychomotor functions and is consequently desirable for such operations. Experience so far in lung surgery, however, is limited. Besides the level of consciousness we investigated various spirometric parameters after lung resection. Total intravenous anaesthesia was performed with propofol, while balanced anaesthesia was performed with isoflurane. METHODS. A total of 93 patients evaluated electively for wedge excision or lobectomy were enrolled in an open, prospective, randomised, interindividual comparative study. Sixty-three patients could be evaluated with complete data sets. In the evening and the morning before the operation the patients were premedicated orally with clorazepate 0.5-0.7 mg/kg. Anaesthesia was induced in group 1 with propofol (1.0-2.5 mg/kg) and maintained with propofol (4-12 mg/kg) in 50% O2/air. The patients in group 2 received methohexital (1-2 mg/kg) for induction and isoflurane (0.4-2.0 vol%) in 50% O2/air for the maintenance of general anaesthesia. In both groups analgesia was achieved by using fentanyl (up to 10 micrograms/kg) and muscle relaxation by using atracurium. Psychomotor tests (minimal mental state, reaction time) were performed the day before the operation (t1), immediately prior to induction of anaesthesia (t2) and 5 min, 30 min, 60 min, 90 min, 24 h, and 7 days after extubation (t3-t8). Spirometry (forced expiratory volume in 1 s, FEV1; forced vital capacity, FVC; peak expiratory flow, PEF) was carried out at times t1, t2 and t5-t8. RESULTS. The two groups were comparable regarding preoperative status (age, sex, preoperative risk score, psychomotor tests, and spirometric values) and the operation performed (wedge excision/lobectomy, duration of anaesthesia). The extubation time was slightly shorter in the propofol group (18 +/- 8 min) than in the isoflurane group (20 +/- 6 min). Also, the results of the psychomotor tests were somewhat better in the propofol group than those in the isoflurane group. The clearest differences were found in the early postoperative period, but not all differences were significant. Statistically highly significant differences between the two groups were found for the three spirometric parameters. Based on the FEV1 value of the 7th postoperative day, FEV1 taken 60 min after extubation declined by 27.9% in the propofol group vs. 51.7% in the isoflurane group (P = 0.01). At 90 min after extubation the corresponding decline in the propofol group was 26.6%, in the isoflurane group 51.1% (P = 0.003). In addition, the decline of FVC and PEF measured 60 min and 90 min after extubation was significantly smaller in the propofol group than in the isoflurane group. CONCLUSION. The postoperative impairment of lung function after lung resection under propofol anaesthesia is statistically significantly smaller than under isoflurane anaesthesia. Total intravenous anaesthesia with propofol is particularly suitable for this kind of operation.