Molecular characterisation of quinolone resistance in Escherichia coli from animals in Turkey.

The aim of this study were to detect the gyrA, parC and marR mutations and qnr genes (qnrA, qnrB and qnrS) in 120 strains of Escherichia coli isolated from animals. European Committee on Antimicrobial Susceptibility Testing and Clinical Laboratory Standards Institute disc diffusion and minimum inhibitory concentration (MIC) tests, respectively, were used to determine fluoroquinolone (FQ) resistance, and molecular methods were used to detect the mutations and the genes. E coli isolates with an MIC of ≥8 mg/l had mutation at Ser-80 in parC in addition to mutations at Ser-83, Asp-87 or both in gyrA. The nucleotide change was detected in marR (Ser-3 → Asn, Ala-53 → Glu, Gly-103 → Ser, Tyr-137 → His). Only four E coli isolates (3.3 per cent) contained qnrA and qnrS, and qnrB was not detected. Two E coli isolates from healthy calves also contained qnrA and qnrS. The MICs of enrofloxacin and danofloxacin for qnr-containing E coli isolates ranged from 32 mg/l to 256 mg/l. The results of this study indicated that the FQ-resistant E coli isolates presented an alteration in gyrA (Ser-83 → Leu, Asp-87 → Asn) and parC (Ser-80 → Ile) with high MICs (8-256 mg/l), and there was a low prevalence of qnr genes among E coli isolated from animals.

Necrotizing fasciitis secondary to peritonsillar abscess: a new case and review of eight earlier cases.

Necrotizing fasciitis is a potentially fatal soft-tissue infection that occurs only rarely in the head and neck region. Broad-spectrum parenteral antibiotics and surgical debridement are the mainstays of treatment. Until now, only eight cases of necrotizing fasciitis secondary to peritonsillar abscess have been described in the English-language literature. In this article, we report a new case that occurred in an otherwise healthy 43-year-old woman. In addition to standard treatment, the patient underwent a hot tonsillectomy. After 23 months of follow-up, she is in good health.

A comparative study of azithromycin and pseudoephedrine hydrochloride for otitis media with effusion in children.

We compared the outcomes of two different regimens--azithromycin and pseudoephedrine hydrochloride (PHCl)--for the treatment of otitis media with effusion (OME) in children. In a double-blind randomized clinical study, a total of 90 children aged between 2 and 13 years with persistent OME were randomly assigned to one of 3 treatment groups. The first group received azithromycin at a dose of 10 mg/kg once daily for 3 days and this regimen was repeated weekly for up to 12 weeks according to the results of tympanometry and pneumatic otoscopy. The second group received azithromycin at a dose of 10 mg/kg once daily for 3 days for the first week, and this regimen was repeated for 1 day a week for the following 11 weeks. The third group received PHCl, 4 mg/kg, 3 times daily for up to 12 weeks. Each patient underwent pneumatic otoscopic and tympanometric investigations at baseline and at Weeks 4, 8 and 12. The outcomes in the azithromycin-treated groups were superior to that in the decongestant group. However, the difference between the outcomes in the azithromycin groups according to the treatment protocol was not statistically significant. Azithromycin therapy, particularly a once-weekly regimen, helps patients to comply with treatment and also helps us to achieve good results with minimal therapy.

Computerized tomographic alignment of silastic implant in type 1 thyroplasty.

PURPOSE: We designed a computerized tomography (CT)-based silastic implant preparation method that enabled custom fit to the individual size of the patient's larynx for medialization laryngoplasty. MATERIALS AND METHODS: Three women with unilateral vocal cord paralysis underwent type I thyroplasty operation. The individual size of the patient's larynx was determined by preoperative measurements on CT scan and the implant was prepared accordingly. The implant was then inserted through a rectangular window at the level of vocal cords which had been outlined according to CT findings. RESULTS: Three patients, who were age 41, 25, and 37 years, underwent medialization laryngoplasty by this technique. They were followed up for 37, 16, and 4 months, respectively. There was not any rejection reaction, and satisfactory functional results with 10, 7, and 9 seconds of phonation duration have been achieved, respectively. CONCLUSION: In this technique, the desired medialization of the paralyzed vocal cord was accomplished by the first insertion of the implant. Thus, the duration of the operation and the vocal cord edema aroused by manipulation of the inner perichondrium and internal laryngeal structures were reduced.

Prognostic importance of lymphatic reaction pattern in laryngeal carcinoma.

PURPOSE: Cervical lymph node status is a widely accepted important prognostic parameter in laryngeal carcinoma. PATIENTS AND METHODS: In this study, we retrospectively reviewed neck specimens of 46 laryngeal carcinoma patients operated in our clinic. Presence of neck metastasis and pattern of reactivity in nonmetastatic nodes was correlated with recurrence and survival during a follow-up period of at least 2 years. RESULTS: Fourteen of the patients had at least one metastatic node and survival was 64%; 32 of the patients had reactional nodes only and the survival was 81%. Pattern of lymph node reactivity was evaluated as stimulated in type I (lymphocyte predominance) and type II (germinal center predominance); as unstimulated in type III (histiocytosis and/or normal) and type IV (lymphocyte depletion). Thirty two neck [-] patients had reactional nodes--16 of them were classified as stimulated and 16 of them as unstimulated; the 2-year survivals were 94% and 68%, respectively. In the 14 patients with cervical metastasis (classified according to nonmetastatic reactional nodes) 9 were stimulated and 5 were unstimulated with 2-year survivals of 100% and 0%, respectively. CONCLUSION: Stimulated lymphatic pattern reflects a better prognosis, especially in N+ neck laryngeal cancer patients.