A Case Report: Organs From a Donor With Highly Virulent Zoonotic Outbreak Strain of Streptococcus agalactiae Serotype III, Multilocus Sequence Type 283 Infective Endocarditis Did Not Result in Transmission With Adequate Prophylactic Antibiotic Cover.

In 2015, an outbreak involving a highly virulent zoonotic outbreak strain of Streptococcus agalactiae serotype III, multilocus sequence type 283 occurred in Singapore with increased neurologic complications, septic arthritis, and spinal infections in healthier patients. We report a case of a successful dual kidney transplant from a deceased donor with infective endocarditis and disseminated infection with the same strain of S agalactiae and we review the current literature.

Is Radical Bowel Cancer Resection Under Local Anaesthesia and Sedation Feasible?

Some patients with bowel cancer have significant comorbidities, making them unfit for major surgery under general anaesthesia. However, treatment without surgery offers no possibility of cure, and furthermore, symptom control may be poor. We investigated the possibility of performing these resections under local anaesthesia in patients with a slim body habitus in a cohort of patients rejected for general anaesthesia. Eight patients (4 M, 4 F) aged 77-89 were included in this study. All had significant comorbidities and were deemed unfit for general anaesthesia by the consultant anaesthetist in charge of pre assessing high-risk patients. All patients had undergone a thorough assessment, which included P-POSSUM scoring. The recruited patients underwent a careful and fully informed consenting process, leading to standard cancer resections. These resections occurred between 2005 and 2012, under combined local anaesthesia and sedation. The operations undertaken were four right hemicolectomies (for caecal cancer), two Hartmann's procedures (for sigmoid cancer), one Hartmann's procedure with en bloc small bowel resection (for sigmoid cancer invading small bowel) and one transverse colectomy (for mid transverse colon cancer). Seven patients survived radical surgery without complications, although one died from an unrelated cause 8 months after surgery. One of these surviving patients subsequently underwent CABG and further bowel surgery under GA 2 years later for a metachronous sigmoid cancer. There was one postoperative death due to cardiogenic shock on the third postoperative day. Radical cancer resections under local anaesthesia are feasible in suitably selected high-risk patients with acceptable mortality and comparable medium- to long-term results.

The use of the early cannulation prosthetic graft (Acuseal™) for angioaccess for haemodialysis.

OBJECTIVES: Autogenous arteriovenous (AV) accesses are the preferred choice for the delivery of haemodialysis (HD). With an increase in the prevalence of end-stage renal disease and in the life expectancy of these patients, the quality and availability of superficial vessels can be limited and reduced with time. The use of prosthetic AV accesses may therefore become necessary for the delivery of HD. A new early cannulation vascular prosthesis (GORE® ACUSEAL Vascular Graft) has been introduced, developed to hinder suture line and cannulation needle bleeding. The authors report their experience with this new conduit at a London teaching hospital. METHODS: Between May 2011 and June 2013, 52 patients underwent 55 procedures where the ACUSEAL® prosthetic AV access was utilized to facilitate HD. The majority of procedures involved the placement of prosthetic brachio-axillary accesses or prosthetic axillo-axillary chest accesses. RESULTS: The 1-year primary and secondary patency was found to be 46% and 61%, respectively. Successful cannulation of the newly placed AV access was performed with 24 hours of surgery in 40 patients (73%). Tunnelled vascular catheters were required in only 10 (18%) patients. Six (11%) of the patients in the study suffered early complications, and 9 (16%) patients developed AV access infection. CONCLUSIONS: These results show that, while providing patency results that compare favourably to those published for other types of regular prosthetic accesses, the conduits are amenable to very early cannulation with few cannulation-related complications. This leads to a dramatic reduction in the need for temporary or tunnelled catheters.

Acute kidney injury as a presentation of primary renal diffuse large B-cell lymphoma in HIV.

We report a case of acute kidney injury due to primary renal diffuse large B-cell lymphoma, which developed after initiation of tenofovir-containing antiretroviral therapy in a 28-year-old HIV-positive man.

Tension faecopneumothorax: a rare presentation of colonic diverticular perforation.

Tension faeco-pneumothorax is rare, typically occurring following strangulation of a diaphragmatic hernia. We report the case of a 69-year-old gentleman with a previous history of thoraco-abdominal oesophagectomy, who presented with an acute abdomen and respiratory distress. Initial investigations revealed pneumoperitoneum and left-sided pneumothorax. The patient rapidly deteriorated with development of tension pneumothorax. Following tube thoracostomy, feculent fluid was drained. At laparotomy, gross faecal peritonitis secondary to colonic diverticular perforation was encountered, with no evidence of intestinal diaphragmatic herniation. This case report highlights the rarity of this clinical entity as well as the possible complications of hiatal surgery.

Enhanced immunity to Hyalomma anatolicum anatolicum ticks in cross-bred (Bos indicus x Bos taurus) calves using ascaris extract immunomodulator with the tick salivary gland extract antigens.

Development of acquired immunity in cross-bred (Bos indicus x Bos taurus) calves against Hyalomma anatolicum anatolicum, a tick vector of bovine tropical theileriosis was studied using ascaris extract (AE), an immunomodulator of IgE responses, along with the tick salivary gland extract (SGE) antigens in Freund's incomplete adjuvant (FIA) emulsion. Calves immunised with SGE + FIA showed significant rejection (47.4 +/- 2.8%) of larvae, whereas only marginal rejection (12.47 +/- 1.5%) of nymphs was observed. In contrast, calves immunised with the immunomodulator AE in addition to SGE + FIA showed significant enhanced rejection of nymphs (50.25 +/- 5.2%), while the rejection of larvae was only slightly higher (55.8 +/- 11.4%), and not statistically different. In addition, incorporation of the immunomodulator AE also resulted in significant enhancement in the percentage recovery of abnormally fed larvae and nymphs. This abnormal feeding was characterised by their white to pale-yellow colour instead of the dark-grey colour of normally fed ticks. It may possibly be attributed to their inability to gain access to the blood vessels owing to the host immunological reaction at the bite sites. Consequently, the ticks fed on extravascular fluid devoid of red blood cells resulting in their white to pale-yellow colour. Difference in the disease transmission potential of normally and abnormally fed ticks is of future interest. Sera from all the immunised calves after 2 weeks of immunisation were positive for anti-tick SGE antibodies in the dot enzyme immunoassay (DOT-EIA). The immunised calves were positive for immediate type hypersensitivity (ITH) skin reaction on intradermal inoculation of the tick SGE antigens. There was no apparent difference in the DOT-EIA antibody titres between the two immunised groups. However, ITH skin swelling was significantly higher in AE + SGE + FIA immunised calves. The study indicates that use of the AE as an immunomodulator along with the tick SGE antigens enhanced anti-tick immunity.