[Candidemia epidemiology in Córdoba Argentina. Surveillance study of five institutions]. / Epidemiologia de candidemia en Córdoba Republica Argentina. Estudio de vigilancia de cinco instituciones.

UNLABELLED: The incidence rate of invasive infections due to Candida species has increased drastically in the last 20 years, causing a 40% mortality rate in hospitalized patients. In order to comprehend the epidemiology of Candida bloodstream infection, the study was carried out. MATERIALS AND METHODS: A retrospective study was done based on microbiology laboratory reports from five terciary care hospitals from the city of Cordoba between January 2010 and August 2012. RESULTS: 158 patients had candidemia, the average age was 55,8 years, and 54% of patients were in the intensive care unit. Candida albicans (44%), Candida parapsilosis (22%) and Candida tropicalis (12%) were the main fungi isolated. Candida parapsilosis was commonly associated with catether infections. CONCLUSIONS: The data from the city of Cordoba showed that C. albicans, C. parapsilosis y C. tropicalis were the more frequent species isolated from blood cultures. This is similar to what is seen in other series published from Argentina and Latinamerica. This study may have implications when it comes to deciding which empiric antifugal agent is best for the treatment of candidemia.

La incidencia de infecciones invasivas por Candida ha aumentado en forma dramática en los últimos 20 años, siendo causa importante de mortalidad en torno al 40% en los pacientes hospitalizados. Material y métodos: Se realizó un estudio retrospectivo, basado en reportes de laboratorio de cinco hospitales de tercer nivel de la ciudad de Córdoba entre enero de 2010 y agosto de 2012, con el objetivo de conocer la epidemiología regional. Resultados: 158 pacientes con candidemia, edad promedio de 55.8 años, el 60% internados en unidades de cuidados intensivos. Candida albicans 44%, Candida parapsilosis 22% y Candida tropicalis 12% fueron las principales especies aisladas. Candida parapsilosis estuvo comúnmente asociada a infecciones relacionadas a catéteres. Conclusiones: Esta serie local de la ciudad de Córdoba muestra que C. albicans, C. parapsilosis y C. tropicalis son las especies mas frecuentes coincidente con el perfil de las series publicadas en Argentina y Latinoamérica. Esto puede tener implicancias para decidir que agente antifúngico usar empíricamente para tratar las candidemias.

Epidemiologia de candidemia en Córdoba Republica Argentina. Estudio de vigilancia de cinco instituciones / [Candidemia epidemiology in Córdoba Argentina. Surveillance study of five institutions].

UNLABELLED: The incidence rate of invasive infections due to Candida species has increased drastically in the last 20 years, causing a 40

mortality rate in hospitalized patients. In order to comprehend the epidemiology of Candida bloodstream infection, the study was carried out. MATERIALS AND METHODS: A retrospective study was done based on microbiology laboratory reports from five terciary care hospitals from the city of Cordoba between January 2010 and August 2012. RESULTS: 158 patients had candidemia, the average age was 55,8 years, and 54

of patients were in the intensive care unit. Candida albicans (44

) and Candida tropicalis (12

) were the main fungi isolated. Candida parapsilosis was commonly associated with catether infections. CONCLUSIONS: The data from the city of Cordoba showed that C. albicans, C. parapsilosis y C. tropicalis were the more frequent species isolated from blood cultures. This is similar to what is seen in other series published from Argentina and Latinamerica. This study may have implications when it comes to deciding which empiric antifugal agent is best for the treatment of candidemia.

Epidemiologia de candidemia en Córdoba Republica Argentina. Estudio de vigilancia de cinco instituciones. / [Candidemia epidemiology in Córdoba Argentina. Surveillance study of five institutions].

UNLABELLED: The incidence rate of invasive infections due to Candida species has increased drastically in the last 20 years, causing a 40

mortality rate in hospitalized patients. In order to comprehend the epidemiology of Candida bloodstream infection, the study was carried out. MATERIALS AND METHODS: A retrospective study was done based on microbiology laboratory reports from five terciary care hospitals from the city of Cordoba between January 2010 and August 2012. RESULTS: 158 patients had candidemia, the average age was 55,8 years, and 54

of patients were in the intensive care unit. Candida albicans (44

), Candida parapsilosis (22

) and Candida tropicalis (12

) were the main fungi isolated. Candida parapsilosis was commonly associated with catether infections. CONCLUSIONS: The data from the city of Cordoba showed that C. albicans, C. parapsilosis y C. tropicalis were the more frequent species isolated from blood cultures. This is similar to what is seen in other series published from Argentina and Latinamerica. This study may have implications when it comes to deciding which empiric antifugal agent is best for the treatment of candidemia.

Anatomic basis and clinical implications for nasal tip support in open versus closed rhinoplasty.

Successful rhinoplasty depends on nasal tip support and its influence on nasal tip projection. The factors involved in nasal tip support are numerous; however, the role of the anterior septum versus the lower lateral cartilages has been debated in the literature. The purpose of this study was to quantitate, using fresh cadavers, the critical elements for nasal tip support with open versus closed rhinoplasty techniques. Multiple nasal manipulations, including cephalic trim, cephalic trim and interruption of the lower lateral cartilages, dorsal hump resection (1 to 4 mm), submucous resection of the septum, and complete septal removal, were performed using fresh cadaver heads and using both the open and closed rhinoplasty approach. Changes in nasal tip support were recorded. In comparing similar procedures, the mean loss of tip projection for the open approach was 3.43 mm versus 1.98 mm for the closed approach (p < 0.001). There was a significantly larger loss of tip projection in open versus closed procedures for cephalic trim, cephalic trim and interruption of the lower lateral cartilages, and cephalic trim with interruption of the lower lateral cartilages and septum removal (p < 0.001, 0.001, and 0.001, respectively). We attributed the differences between the open and closed approaches to the increases in ligamentous disruption and skin undermining that occur when using the open approach. Septum manipulation in general resulted in larger losses in tip support in both the open and closed approach. We conclude that the open approach for rhinoplasty results in a significantly increased loss of tip projection when compared with the closed technique due to the larger disruption of ligamentous support. Contrary to previous data, septal manipulation resulted in significant losses of tip projection, most likely secondary to lowering the nasal septal angle, and this effect may be more significant in closed rhinoplasty. The apparent clinical implications are that active measures, such as columellar struts and/or suture techniques for adding or maintaining nasal tip support during rhinoplasty, are indicated, especially when using the open approach and when any anterior septal alteration is performed using the open or endonasal approach.

A comparison of the histologic effects of chemabrasion, dermabrasion, and laserbrasion in the minipig.

This study was designed to evaluate the short- and long-term histologic consequences of some common skin resurfacing methods. Grids were tattooed on the sides of a Yucatan minipig, the standard model for human skin experiments. Each grid cell was treated with one of the following: Jessner's solution, lactic acid, glycolic acid, trichloroacetic acid with and without Retin-A pretreatment, phenol, dermabrasion, or carbon dioxide laser (Sharplan Silk Touch or Coherent UltraPulse. All treatments were given at the usual doses or strengths recommended for human skin. Each treatment method was represented by two grid cells on either side. Biopsy specimens were obtained from each area immediately after treatment and at 1 week, 1 month, and 3 months. The histologic sections were read by an experienced dermatopathologist. The superficial peeling agents (glycolic acid, lactic acid, and Jessner's solution) barely penetrated the epidermis. Wound depth from dermabrasion and laserbrasion could be traced to the papillary-reticular junction of the dermis in the early sections, but by 3 months the skin in these areas had resumed its normal architecture. In contrast, phenol and trichloroacetic acid produced changes to the upper reticular dermis, and these findings persisted for the duration of the observation period. The effects of treatment with the carbon dioxide lasers had dissipated by 3 months. Higher levels of laser energy are apparently needed to induce resurfacing in this model.

The lateral nasal osteotomy in rhinoplasty: an anatomic endoscopic comparison of the external versus the internal approach.

A precise and reproducible lateral osteotomy is a requirement for successful rhinoplasty. Two basic techniques have evolved: the external perforated method and the internal continuous method. The literature supporting the external perforated technique maintains that it contributes to a controlled, stable fracture and produces less nasal airway narrowing, hemorrhage, edema, and ecchymosis; however, the continuous internal method is used by many rhinoplasty surgeons. Our study was designed to compare the two techniques in the fresh cadaver nose using a blinded endoscopic evaluation of the nasal mucosa after the osteotomies were performed by one of these two techniques. Nineteen fresh cadaver heads had an external perforated lateral osteotomy performed on one side and an internal continuous lateral osteotomy performed on the alternate side by an investigator with experience in the use of both osteotomies. In a blinded fashion, four different investigators used nasal endoscopy to detect mucosal perforations and bony irregularities. Eleven percent of the perforated osteotomies resulted in mucosal tearing as opposed to 74 percent of the continuous osteotomies (p < 0.001). This anatomic study confirms our clinical experience that the external perforated osteotomy results in a more controlled fracture with less intranasal trauma and can minimize the associated morbidity (hemorrhage, edema, and ecchymosis) in the rhinoplasty patient.

Diagnostic nasal endoscopy.

Endoscopy has gained wide popularity due to its protean applications and efficacy in many surgical specialties. Diagnosis and treatment of nasal diseases have advanced in the process. However, proper training in nasal endoscopy is critical. The nose is an intricate organ fundamentally and has such proximity to other vital structures that procedural miscues can cause serious complications. This paper traces the historical development of nasal endoscopy, explains its rationale, reviews anatomic and diagnostic issues, and describes the selection of equipment and correct application of technique, emphasizing the potential for advanced diagnostic skills.

Postoperative platysmal band deformity. A pitfall of submental liposuction.

Submental liposuction is an established advance in treatment of the aging neck. However, its misapplication may result in an aesthetic deformity involving postoperative anterior platysmal banding. To identify preoperative conditions relating to this sequela, we retrospectively analyzed 301 patients treated with submental liposuction. Submental obesity and an anatomic pattern of platysmal nondecussation were found to be significant correlates in the development of postoperative anterior platysmal banding.

Continuous determination of the oxygen dissociation curve for whole blood.

We report here the development of a new method that allows continuous determination of the oxygen dissociation curve for microsamples (600 mul) of whole blood under conditions of pH, pCO2, methemoglobin concentration, and 2,3-diphosphoglycerate content closely approaching those found in the circulatory system. The method consists of gradually oxygenating a blood sample by adding H2O2 in the presence of catalase (EC 1.11.1.6), to produce the reaction H2O2 leads to H2O + 1/2 O2. Because the total oxygen content of blood can be derived from the known rate of H202 addition and the pO2 is determined in the liquid phase by an oxygen electrode, the two functions (total O2 content) and (% oxygen saturation) vs. pO2 are simple to calculate. pCO2 and pH are controlled by adding base simultaneously with the gradual oxygenation of blood. The method described thus avoids the direct measurement of oxygen saturation of whole blood.