Effect of clarithromycin in patients with suspected Gram-negative sepsis: results of a randomized controlled trial.

BACKGROUND: A previous randomized study showed that clarithromycin decreases the risk of death due to ventilator-associated pneumonia and shortens the time until infection resolution. The efficacy of clarithromycin was tested in a larger population with sepsis. METHODS: Six hundred patients with systemic inflammatory response syndrome due to acute pyelonephritis, acute intra-abdominal infections or primary Gram-negative bacteraemia were enrolled in a double-blind, randomized, multicentre trial. Clarithromycin (1 g) was administered intravenously once daily for 4 days consecutively in 302 patients; another 298 patients were treated with placebo. Mortality was the primary outcome; resolution of infection and hospitalization costs were the secondary outcomes. RESULTS: The groups were well matched for demographics, disease severity, microbiology and appropriateness of the administered antimicrobials. Overall 28 day mortality was 17.1% (51 deaths) in the placebo arm and 18.5% (56 deaths) in the clarithromycin arm (P = 0.671). Nineteen out of 26 placebo-treated patients with septic shock and multiple organ dysfunctions died (73.1%) compared with 15 out of 28 clarithromycin-treated patients (53.6%, P = 0.020). The median time until resolution of infection was 5 days in both arms. In the subgroup with severe sepsis/shock, this was 10 days in the placebo arm and 6 days in the clarithromycin arm (P = 0.037). The cost of hospitalization was lower after treatment with clarithromycin (P = 0.044). Serious adverse events were observed in 1.3% and 0.7% of placebo- and clarithromycin-treated patients, respectively (P = 0.502). CONCLUSIONS: Intravenous clarithromycin did not affect overall mortality; however, administration shortened the time to resolution of infection and decreased the hospitalization costs.

High origin of a testicular artery: a case report and review of the literature.

INTRODUCTION: Although variations in the origin of the testicular artery are not uncommon, few reports about a high origin from the abdominal aorta exist in the literature. We discuss the case of a high origin of the testicular artery, its embryology, classification systems, and its clinical significance. CASE PRESENTATION: We report a very rare case of high origin of the left testicular artery in a 68-year-old Caucasian male cadaver. The artery originated from the anterolateral aspect of the abdominal aorta, 2 cm cranially to the ipsilateral renal artery. Approximately 1 cm after its origin, it branched off into the inferior suprarenal artery. During its course, the artery crossed anterior to the left renal artery. CONCLUSIONS: A knowledge of the variant origin of the testicular artery is important during renal and testicular surgery. The origin and course must be carefully identified in order to preserve normal blood circulation and prevent testicular atrophy. A reduction in gonadal blood flow may lead to varicocele under circumstances. A knowledge of this variant anatomy may be of interest to radiologists and helpful in avoiding diagnostic errors.

Duplicated gallbladder: surgical application and review of the literature.

Duplicated gallbladder is a rare congenital anomaly, usually asymptomatic and occurring as incidental radiographic or surgical finding during upper abdomen, liver and extrahepatic biliary tract surgery. We report on a case of two separate gallbladders, one main and one accessory, each one with its own cystic duct. The main cystic duct drained into the common bile duct while the accessory bile duct extruded into the left side of common bile duct just inferior to the main cystic duct termination. Imaging advances such as computerized tomography, intraoperative endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography may aid in the establishment of accurate diagnosis. The anomaly is of great importance because the surgeon may miss the main or the accessory gallbladder and the patient may need to be re-operated in case of cholelithiasis.

The supratrochlear foramen of the humerus and its relation to the medullary canal: a potential surgical application.

BACKGROUND: The supratrochlear foramen of the humerus is located at the septum separating the coronoid from the olecranon fossa. Beyond its anthropologic interest, that trait seems to have clinical significance as well. MATERIAL/METHODS: The supratrochlear foramen was studied in 240 macerated adult humeri. The foramen was recorded in each sex and each side. We attempted to enlighten the likely relation of the foramen with the inferior edge of the medullary canal, as well as that of the dimensions of that canal of humerus and compare it to contralateral humeri without foramen. RESULTS: The medullary canal width at the entry point of a retrograde intramedullary nail was statistically smaller in humeri with foramen than in humeri without it. Furthermore, the medullary canal of the humeri with foramen ends more proximally than the canal of nonforamen humeri. CONCLUSIONS: In cases of humeral fractures of the supratrochlear foramen, the surgeon must keep in mind that it is better to perform an antegrade medullary nailing than a retrograde one; as there is higher chance of a secondary fracture, due to the extreme narrowness of the canal at the distal portion of humeri with the supratrochlear foramen.

Osseous variations of the hypoglossal canal area.

BACKGROUND: The hypoglossal canal is a paired bone passage running from the posterior cranial fossa to the nasopharyngeal carotid space. Hyperostotic variations of this structure have been described. MATERIAL/METHODS: One hundred sixteen adult cadaveric dried skull specimens were analyzed. Several canal features, dimensions, and distances relative to constant and reliable landmarks were recorded. RESULTS: One osseous spur in the inner or outer orifice of the canal was present in 18.10% of specimens (42/232). Two or more osseous spurs were evident in 0.86% of specimens (2/232). However, complete osseous bridging, in the outer or inner part of the canal, was evident in 19.83% of specimens (46/232). Osseous bridging extending through the entire course of the canal was visible in 1.72% of the specimens (4/232). The mean lateral length of the canal was 10.22 mm, the mean medial length was 8.93 mm, the mean transverse and vertical diameters of the internal orifice were 7.44 mm and 4.42 mm, respectively, and the mean transverse and vertical diameters of the external orifice were 6.15 mm and 3.91 mm, respectively. The mean inclination of single hypoglossal canals was 42.3 degrees and 32.4 degrees on the right and left side, respectively. CONCLUSIONS: A detailed and accurate evaluation of the hypoglossal canal topographic anatomy with regard to specific, standard osseous landmarks was performed. Additional data with respect to several morphologic features of the hypoglossal canal area also was obtained. Results of this study provide important information that will enable effective and reliable surgical intervention in the area of the hypoglossal canal.

Osteopoikilosis: a case report of a symptomatic patient.

Osteopoikilosis (OP) is a very rare benign sclerosing bony dysplasia with an autosomal dominant inheritance. We describe the morphology of an osteopoikilosis male patient, associated with severe pain on wrist and hand joints, report on the relative literature and focus on clinical significance, due to mimicking capability of other more severe conditions such as bone metastases.