Reconstruction of Coracoclavicular Ligaments with Semitendinosus Autograft and Temporary Kirschner Wires is a good option for Chronic Acromioclavicular Joint Instability.

Introduction: This study reports the results of surgical anatomic reconstruction of torn coracoclavicular ligaments with an autogenous semitendinosus graft and temporary Kirschner wires (K-wires) in chronic acromioclavicular (AC) joint dislocations. Materials and methods: Nineteen shoulders underwent surgical anatomic reconstruction of torn coracoclavicular (CC) ligaments with an autogenous semitendinosus tendon graft and temporary K-wires for Rockwood grade III, IV and V chronic AC joint dislocations. Pre-operative data included patients' demographic characteristics, injury characteristics and surgical histories. The primary outcome measures were the University of California Los Angeles (UCLA) shoulder rating scale and visual analogue pain scoring (VAS), and the complications were noted for each patient. Results: Surgical anatomic reconstruction of torn CC ligaments was performed in 19 patients with a mean age of 41.6±16 years (range 21-72 years). All of the patients were satisfied and felt better after CC ligament reconstruction. The average UCLA shoulder rating scale score was good/excellent: 29.4 (range 23-34) out of 35 points. The average pre-operative VAS score was 7.7 points out of 10 and improved to 1.1 points post-operatively (p<0.05). None of the patients experienced failure during the follow-up. One patient had a mild subluxation, but the patient was satisfied with the result. Conclusions: This technique is simple, reliable, and biologic without major complications. It is also a cost-effective procedure since it can be performed with Kirschner wires and autogenous grafts. It has a major advantage of leaving no implants inside the joint, which can lead to hardware complications, and it can be performed in basic operating room settings.

In vitro activity of fluoroquinolones against common respiratory pathogens.

The treatment of respiratory infections is often empiric, necessitating the use of agents with a broad range of antimicrobial activity. The fluoroquinolones, having activity against common respiratory pathogens, fit this description. New fluoroquinolones have been developed in an attempt to improve the in vitro activity against a wide variety of respiratory tract pathogens. The objective of the study is to compare in vitro activity of newest fluoroquinolones, gatifloxacin and moxifloxacin, with levofloxacin and ciprofloxacin using three major respiratory pathogens, Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis. Minimum inhibitory concentrations (MICs) of four fluoroquinolones were tested against 93 S pneumoniae, 62 H influenzae and 60 M catarrhalis, ie 215 isolates by the E-test method. National Committee for Clinical Laboratory Standards (NCCLS)-approved interpretive criteria were used throughout. All isolates were susceptible to the tested fluoro-quinolones. Ninety per cent of S pneumoniae strains were inhibited by ciprofloxacin at concentrations of 2 mg/L. The gatifloxacin and moxifloxacin MICs were lower than the ciprofloxacin and levofloxacin MICs against S pneumoniae. In contrast to S pneumoniae, in vitro activities of gatifloxacin and moxifloxacin offered no apparent advantages over ciprofloxacin and levofloxacin for H influenzae and M catarrhalis.

In vitro activity of daptomycin alone and in combination with various antimicrobials against Gram-positive cocci.

The increasing prevalence of resistant Gram-positive cocci requires the need to search for more effective agents and synergistic combinations. Forty-two vancomycin-resistant Enterococcus faecium (VREF), 30 methicillin-resistant Staphylococcus aureus (MRSA) and 36 Staphylococcus epidermidis (MRSE) strains were studied. Minimum inhibitory concentrations (MICs) were determined and synergy testing was performed by using E test for daptomycin, ampicillin-sulbactam, piperacillin-tazobactam and ticarcillin-clavulanate against staphylococci; for daptomycin, ampicillin, rifampin, and gentamicin against enterococci. Daptomycin in combination with ampicillin, rifampin, and gentamicin was tested against enterococci; daptomycin in combination with ampicillin-sulbactam, piperacillin-tazobactam, and ticarcillin-clavulanate was tested against staphylococci. Interaction categories were defined by the fractional inhibitory concentration (FIC) index. All strains of staphylococci and enterococci were susceptible to daptomycin. All three combinations showed synergy against more than 70% of the MRSA strains. Daptomycin in combination with ampicillin, rifampin, and gentamicin against enterococci showed synergies of 64.2%, 57.1% and 21.4%, respectively. This study indicates that daptomycin alone and combined with beta-lactams seems to be effective against MRSA, but further in vitro and in vivo studies on the subject are required before clinical use can be recommended.

In vitro activity of fluoroquinolones against common respiratory pathogens / La actividad in vitro de las fluorquinolonas contra los patógenos respiratorios

The treatment of respiratory infections is often empiric, necessitating the use of agents with a broad range of antimicrobial activity. The fluoroquinolones, having activity against common respiratory pathogens, fit this description. New fluoroquinolones have been developed in an attempt to improve the in vitro activity against a wide variety of respiratory tract pathogens. The objective of the study is to compare in vitro activity of newest fluoroquinolones, gatifloxacin and moxifloxacin, with levofloxacin and ciprofloxacin using three major respiratory pathogens, Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis. Minimum inhibitory concentrations (MICs) of four fluoroquinolones were tested against 93 S pneumoniae, 62 H influenzae and 60 M catarrhalis, ie 215 isolates by the E-test method. National Committee for Clinical Laboratory Standards (NCCLS)-approved interpretive criteria were used throughout. All isolates were susceptible to the tested fluoro-quinolones. Ninety per cent of S pneumoniae strains were inhibited by ciprofloxacin at concentrations of 2 mg/L. The gatifloxacin and moxifloxacin MICs were lower than the ciprofloxacin and levofloxacin MICs against S pneumoniae. In contrast to S pneumoniae, in vitro activities of gatifloxacin and moxifloxacin offered no apparent advantages over ciprofloxacin and levofloxacin for H influenzae and M catarrhalis.

La terapia de las infecciones respiratorias es a menudo empírica, y exige por ende el uso de agentes con un amplio espectro de actividad antimicrobiana. Por su actividad contra los patógenos respiratorios comunes, las fluorquinolonas se ajustan a esta descripción. Nuevas fluorquinolonas han sido desarrolladas, en un intento por mejorar la actividad in vitro contra una variedad de patógenos de las vías respiratorias. El objetivo de este estudio es comparar la actividad in vitro de las fluorquinolonas más recientes – la gatifloxacina y la moxifloxacina – con la levofloxacina y la ciprofloxacina, usando tres de los más importantes patógenos respiratorios: Streptococcus pneumoniae, Haemophilus influenzae y Moraxella catarrhalis. Las concentraciones inhibitorias mínimas (CIMs) de las cuatro fluorquinolonas fueron sometidas a prueba contra 93 S pneumoniae, 62 H influenzae y 60 M catarrhalis, para un total de 215 aislados mediante el método de E-test. En todos los casos se aplicaron criterios interpretativos aprobados por el Comité Nacional para Normas del Laboratorio Clínico (NCCLS). Todos los aislados resultaron sensibles a las fluorquinolonas ensayadas. El noventa por ciento de las cepas de S pneumoniae fueron inhibidas por la ciprofloxacina a concentrationes of 2 mg/L. Las CIMs de la gatifloxacina y la moxifloxacina fueron más bajas que las CIMs de la ciprofloxacina y la levofloxacina contra S pneumoniae. En contraste con S pneumoniae, la actividad in vitro de la gatifloxacina y la moxifloxacina no ofrecieron ventajas aparentes por encima de la ciprofloxacina y la levofloxacina frente a H influenzae y M catarrhalis.