Effectiveness and safety of enteral vancomycin to control endemicity of methicillin-resistant Staphylococcus aureus in a medical/surgical intensive care unit.

A prospective trial was undertaken to assess the effectiveness and safety of enteral vancomycin in controlling methicillin-resistant Staphylococcus aureus (MRSA) in an endemic setting. Over the 49 month period patients aged >14 years were enrolled, following admission to a medical/surgical intensive care unit (ICU) and expected to require ventilation for three days or more. A total of 799 patients were included in the trial. Period one, 1 July 1996-30 April 1997, (N=140), was observational. During period two, 1 May 1997-30 September 1998, (N=258), surveillance samples were obtained. MRSA carriers were isolated and received enteral vancomycin. During period three, 1 October 1998-31 July 2000, (N=400), all ventilated patients were given selective digestive decontamination (SDD) with polymyxin E, tobramycin, amphotericin B and vancomycin and four days of intravenous cefotaxime. The primary endpoints were: (1) incidence of patients with diagnostic samples positive for MRSA acquired on the ICU; (2) incidence of patients with vancomycin-resistant enterococci (VRE) in surveillance or diagnostic samples; (3) incidence of patients with samples positive for S. aureus with intermediate sensitivity to glycopeptides (GISA). The incidence of patients with MRSA in diagnostic samples were 31%, 14%, and 2% in periods one, two and three, respectively (P<0.001). There was a VRE outbreak involving 13 patients during period three. VRE disappeared with no change in policy. GISA was not detected. These findings support the effectiveness and safety of enteral vancomycin in the control of MRSA.

Unilateral femoral deformity due to a focal fibrous tether.

The purpose of this paper is to assess the radiological features of the unilateral angular deformity of the distal end of the femur secondary to a focal fibrous tether. Only five cases of this entity have been reported in the literature. We report another two patients. Magnetic resonance study was performed on one of them, which has not been used in previous cases. Both cases are described with illustrations of the typical radiographic appearances supplemented by CT and MR imaging.

Changes in family structure after a renal transplant.

It is suggested that the study and diagnosis of family structure before a renal transplant, increases the possibility of selecting the most suitable donor candidate from a biological as well as from a psychological point of view. It will allow a greater possibility of success, not only in the medical aspects, but also in regard to better structural functioning of the family after the transplant. Furthermore, the diagnosis of the family structure before the transplant may help to predict what changes will appear within the family after the renal transplant. This would raise the level of consciousness for detecting family dysfunction as soon as possible and thus make it possible to respond more quickly with psychotherapeutic assistance to bring the family back to a functional level.

[Evaluation of psychological and social rehabilitation of the child with chronic renal failure]. / Valoración de la rehabilitación psicológica y social en el niño con insuficiencia renal crónica.

Fifteen children with chronic renal failure were studied from the psychological and social viewpoints. Seven of them had been treated under a program of chronic hemodialysis; seven had been transplanted a kidney from a living donor and one from a dead donor. The degree of psychological and social rehabilitations was compared between the transplanted patients and those under chronic hemodialysis. It was observed that the latter did not achieve an acceptable degree of rehabilitation. The importance of the donor's position within the family structure, prior to the transplant, is also emphasized as the key relevant factor contributing to the family balance after the transplant.