Surgical wound infection, tuboovarian abscess, and sepsis caused by Edwardsiella tarda: case reports and literature review.

Edwardsiella tarda is a freshwater pathogen that may cause mild to invasive infections with high mortality in humans. We describe two patients with serious E. tarda infections. The first patient was a woman with a tuboovarian abscess (TOA) and bilateral salpingitis requiring surgical resection and drainage. Her hospital course was complicated by a postoperative wound infection. TOA fluid as well as surgical wound culture revealed pure growth of E. tarda resistant to several antibiotics. The second patient was a man with a bloodstream E. tarda infection and cholangitis who recently traveled to Ecuador. He presented with hypoxia and further workup revealed choledocholithiasis and common bile duct benign polyps. Both patients made a full recovery.

Neurosurgically related nosocomial Acinetobacter baumannii meningitis: report of two cases and literature review.

Nosocomial meningitis is an uncommon complication of neurosurgical procedures, although nosocomial Gram-negative bacillary meningitis does occur occasionally in neurosurgical intensive care units (NSICUs). Acinetobacter baumannii is a rare cause of nosocomial meningitis, and is an even rarer cause of meningitis outbreaks in NSICUs. We report two cases of A. baumannii meningitis in an NSICU due to suboptimal aseptic technique in obtaining cerebrospinal fluid (CSF) specimens. After institution of infection control measures, i.e. aseptically collecting CSF specimens from distal external ventricular drain ports, there were no further cases. This report also reviews nosocomial Acinetobacter meningitis in adult neurosurgical patients.

Safety of meropenem in patients reporting penicillin allergy: lack of allergic cross reactions.

Over the years, meropenem has become the mainstay of empiric therapy for serious systemic infections in critically ill patients. Although we have had extensive clinical experience since 1996 using meropenem safely in treating hundreds of patients with reported allergic reactions to penicillin without any adverse events, we have not published our experience. This study was conducted to document our clinical practice experience. Accordingly, over a 12-month period we prospectively monitored 110 patients treated with meropenem reporting penicillin allergic reactions for that 12-month period. Since early empiric therapy in such patients is essential, there is often no time for penicillin skin testing. Penicillin skin testing was not done in this "real world" clinical study. Patients were divided into two groups, depending on the nature of their penicillin allergic reactions. During a 12-month period, 110 patients with non-anaphylactic (59) and anaphylactic (51) penicillin allergic reactions tolerated prolonged meropenem therapy (1-4 weeks) safely without any allergic reactions. Based on these data and our previous clinical experience, there appears to be little/no potential cross reactivity between meropenem and penicillins even in patients with a definite history of anaphylactic reactions to penicillins. To the best of our knowledge, this is the first prospective clinical study demonstrating that meropenem may be safely given to patients with known/unknown allergic reactions to penicillin, including those with anaphylactic reactions, without penicillin skin testing. We conclude that meropenem may be given safely to patients reporting a history of non-anaphylactic or anaphylactic allergic reactions to penicillins without penicillin skin testing.

Appropriateness of empiric gentamicin and vancomycin therapy for bacteremias in chronic dialysis outpatient units in the era of antibiotic resistance.

Bacteremias in inpatient chronic HD units have been described, but there is little information on bacteremias in ambulatory HD units. To determine the frequency of bacteremia and pathogen distribution in ambulatory chronic HD units, we retrospectively reviewed our experience with 107 bacteremias in 5 chronic ambulatory HD units over a 3 year period. The object of the study was twofold. The first objective was to determine if bacteremias in ambulatory HD setting were substantially different in frequency or type than in the inpatient HD setting. Secondly, febrile patients suspected of having bacteremia in chronic HD patients are often empirically treated with vancomycin and gentamicin. Chronic HD patients require repeated and frequent venous access for HD. Bacteremias are common in chronic HD patients and may be primary or secondary and are often related to venous access site infections. The distributions of bacteremia pathogens in chronic HD patients are predominantly reflective of skin flora, i.e., staphylococci and to lesser extent aerobic Gram-negative bacilli. After S. aureus (MSRA/MSSA) and coagulase-negative staphylococcus (CoNS), enterococci are the next most important Gram-positive pathogens in bacteremic HD patients. Most strains of E. faecalis are sensitive to vancomycin and for practical purposes should be considered as vancomycin sensitive enterococci (VSE). In contrast, most strains of E. faecium are resistant to vancomycin and should be considered as vancomycin resistant enterococci (VRE). We retrospectively reviewed 107 patients on chronic ambulatory HD to determine the adequacy of empiric vancomycin and gentamicin prophylaxis. We found amikacin is preferred to gentamicin and that meropenem is an effective alternate substitution for gentamicin and vancomycin combination therapy.

[The specific features of the work of the visual mechanisms in the right and left hemispheres of the human brain]. / Spetsifika raboty zritel'nykh mekhanizmov zritel'nykh mekhanizmov pravogo i levogo mozga cheloveka.

Disturbances in the visual perception were analysed in groups of patients after commissurotomy, unilateral electroshock therapy, local brain lesions in the structure of the visual system. Three groups of symptoms were distinguished, i. e., deficit in attention switching, defects of image fragment recognition, and disturbances in assessment of special relations between the fragments and their groups. It was shown that these groups of symptoms were variously expressed in disorders of visual perception during pathologically autonomous activity of the left or right hemisphere. A model concept of hemispheric specificity in the visual perception is developed.

[Use of various non-pharmacological methods in the treatment of patients in the early stages of arterial hypertension]. / Primenenie nekotorykh nemedikamentoznykh metodov dlia lecheniia bol'nykh s rannimi stadiiami gipertonicheskoi bolezni.

Patients with labile hypertension received various kinds of nonmedicinal therapy: psychological intervention (40 patients), acupuncture (25 patients), physical training (11 patients). Chemotherapy was provided to 38 patients. A significant antihypertensive effect was achieved with the use of the nonmedicinal therapeutic methods. Their efficacy was comparable with that of chemotherapy.

[Functional reserves of myocardial perfusion in patients with chronic ischemic heart disease with varying degrees of damage of the coronary arteries]. / Funktsional'nye rezervy perfuzii miokarda u bol'nykh khronicheskoi ishemicheskoi bolezn'iu serdtsa s razlichnoi stepen'iu porazheniia koronarnykh arterii.

A comparative study of data provided by coronaro-angiography and myocardial perfusion scintigraphy (resting and exercise tests), and clinical/electrocardiographic results of the exercise test in 102 chronic coronary patients demonstrated that non-invasive myocardial perfusion 201Tl scintigraphy combined with threshold bicycle-ergometric exercise adds considerably to the clinico-electrocardiographic assessment of the exercise test and thus helps to detect myocardial blood supply (perfusion) disorders in some of coronary patients with doubtful or negative test results. Reduced functional reserves of myocardial blood supply, as reflected in deficient perfusion at the peak of threshold exercise, are seen in all coronary patients with angiographically intact coronary arteries and in most patients with both the so-called "functionally-insignificant" and marked coronary arterial stenosis (94.7 and 88.3%, respectively).

Peripheral polyneuropathy and monoclonal gammopathy of undetermined significance.

The prevalence of peripheral polyneuropathy in patients with monoclonal gammopathy is known to be higher than in the general population. A prevalence as high as that in the series of Osby et al, who found clinical and/or electrophysiological evidence compatible with peripheral polyneuropathy in 15 of 21 patients has not been reported before. These results could not be confirmed in a study in which 19 patients with benign monoclonal gammopathy were investigated. In contrast there were only two patients with questionable evidence of peripheral neuropathy: one had lower limb symptoms and signs only, the other had evidence of a subclinical polyneuropathy with some abnormalities of nerve conduction.

[Use of exercise tests and echocardiography during long-term observation of patients with mitral stenosis and cardiac insufficiency]. / Primenenie nagruzochnykh testov i ékhokardiografii pri dlitel'nom nabliudenii bol'nykh s mitral'nym stenozom i serdechnoi nedostatochnost'iu.

Findings of echocardiography and bicycle exercise testing were considered objective hemodynamic criteria during long-term follow-up studies of patients with mitral stenosis and early stages of cardiac insufficiency. In patients with the first degree cardiac insufficiency the most sensitive parameters were: exercise tolerance, physical adaptation index and left atrial size. In patients with the second A degree cardiac insufficiency additional information has also been obtained upon studying the ejection fraction and the rate of left ventricular circular shortening.