Trichosporon beigelii infection: experience in a regional burn center.

Trichosporon beigelii is a fungus once thought to cause only superficial infections, but recently has been increasingly identified as an opportunistic systemic pathogen in immunocompromised patients. There have been very limited reports of this organism in the burn patient population. We describe the first report of pharmacological management of invasive T. beigelii with a combination of amphotericin B and high dose fluconazole in a burn patient. Antifungal susceptibility testing of T. beigelii determined a change in minimum inhibitory concentrations (MICs) of amphotericin B and a consistent resistance pattern with the use of flucytosine. This paper will review our experience with T. beigelii fungus in a regional burn treatment center and review the literature on other experiences in the burn population.

Intravenous immunoglobulin as adjunctive treatment for streptococcal toxic shock syndrome associated with necrotizing fasciitis: case report and review.

Streptococcal toxic shock syndrome (STSS) is caused by infection with a toxicogenic strain of Streptococcus pyogenes. Clinical manifestations may be those of a mild illness, characterized by malaise, fever, and muscle pain, to severe sepsis and multisystem organ failure. The syndrome may be associated with several invasive infections including necrotizing fasciitis. Treatment is primarily surgical debridement of infected tissue with supportive care, antibiotics, and hemodynamic monitoring. Intravenous immunoglobulin (IVIG) is reported to have beneficial effects in the management of STSS associated with necrotizing fasciitis. The agent was successful in conjunction with surgical excision and antibiotics in a patient with necrotizing fasciitis, toxic shock, and multisystem organ failure. On the basis of this experience and a thorough literature review, we concur that IVIG may be a useful adjunct in the treatment of STSS associated with necrotizing fasciitis.

Obturator hernia: laparoscopic diagnosis and repair.

OBJECTIVE: Review of international literature reveals eight reported cases of laparoscopic obturator hernia repair. Non-specific signs and symptoms make the diagnosis of an obturator hernia difficult. Laparoscopic intervention provides a minimally invasive method to simultaneously diagnose and repair these hernias. METHODS AND PROCEDURES: A 35 year old woman presented with lower abdominal pain, vaginal bleeding, and dyspareunia. During gynecological diagnostic laparoscopy, a pelvic floor hernia was suspected, and a general surgical evaluation was sought. At a subsequent laparoscopy, the diagnosis of a left direct inguinal and a right obturator hernia was made. Both were repaired laparoscopically with polypropylene mesh. RESULTS: At follow-up at one and six weeks postoperatively, the patient's complaints of pain had completely resolved. CONCLUSION: The diagnosis of obturator hernia is problematic. The usual presenting signs and symptoms are non-specific. Without conclusive historical or physical findings, laparoscopy is an excellent method for diagnosing obturator hernia. This entity, once diagnosed laparoscopically, can be repaired simultaneously via laparoscopic mesh technique.

Glutamine protects function and improves preservation of small bowel segments.

BACKGROUND: Improved organ preservation is essential for the success of small bowel transplantation. Small bowel is usually preserved in UW (University of Wisconsin) solution which does not contain glutamine (Gln), the principal fuel for the enterocyte. We hypothesized that Gln-supplemented UW would improve mucosal function and structure of cold preserved small intestine. MATERIALS AND METHODS: Jejunum (40 cm) was harvested from Lewis rats and preserved for 18 hr at 4 degrees C in saline; UW solution only; UW with 1, 2, or 4% Gln; and UW containing 1, 2, or 4% isonitrogenous balanced nonessential amino acids (NEAA). 14C glucose transport, mucosal protein, mucosal maltase and alkaline phosphatase, jejunal villous height, and histologic damage were measured. RESULTS: UW with 2% Gln significantly increased glucose transport and mucosal protein when compared to the 2% NEAA and UW-only groups. Two percent Gln significantly decreased histologic damage of jejunum following cold preservation. Increasing Gln to 4% did not significantly increase its efficacy when compared to the UW with 2% Gln group. There were no significant differences in the activities of mucosal maltase and alkaline phosphatase among the various treatment groups. CONCLUSIONS: The addition of Gln, optimally provided at a concentration of 2%, to UW solution may protect the preserved small bowel segments from cold ischemic injury and improve mucosal function.

Underutilization of breast-conservation surgery with radiation therapy for women with stage Tis, I or II breast cancer.

Despite clinical evidence from the National Institutes of Health consensus panel in 1991 that breast-conservation surgery (BCS) with radiation therapy (RT) is appropriate treatment in early-stage breast cancer, the overall rate of acceptance and actual practice of BCS with RT has remained low. We retrospectively reviewed 228 cases of breast cancer in female patients with stage Tis, I or II breast cancer treated between 1987 and 1995. Thirty-five cases (15.4%) were stage Tis, 70 cases (30.7%) were stage I, and 123 cases (53.9%) were stage II, Overall, 57% of Tis, I or II breast cancers received conservative treatment; 57% of stage Tis, 79% of stage I, and 44% of stage II tumors. These rates of conservative therapy are higher than in other reported series in the literature. BCS with RT produces equivalent rates of morbidity and survival as MRM, and, because it preserves the breast, is preferable for the majority of women who present with stage Tis, I, or II breast cancer.

Colonic short chain fatty acids mediate jejunal growth by increasing gastrin.

Colonic infusion of short chain fatty acids (SCFAs) is trophic to rat jejunum and is associated with raised jejunal gastrin concentration. This study examined the hypothesis that the jejunal trophic effects of colonic SCFAs are mediated in part by gastrin. Forty six adult rats underwent caecectomy to reduce endogenous production of SCFA, ileocolonic anastomosis, and placement of a colonic infusion catheter. SCFA (70 mM acetate, 35 mM propionate, 20 mM butyrate) or saline were continuously infused into the colon for seven days. Rats received either a gastrin receptor blocker (L-365,260) or a control solution and animals were killed on day 8. SCFA infused into the colon acted systemically to significantly improve jejunal structure and increase jejunal gastrin concentrations. Gastrin receptor blockade abolished effects of SCFA on jejunal DNA, protein, crypt cell proliferation, and gastrin. Gastrin blockade did not reduce SCFA induced augmentation of villous height or crypt depth. It is concluded that the jejunal trophic effects of colonically infused SCFA are mediated in part by gastrin.

Effect of prolonged normobaric hyperoxia on regional cerebral metabolic rate for glucose in conscious rats.

The CNS tolerance to prolonged normobaric hyperoxia (NH) was investigated using alterations in regional cerebral metabolic rate for glucose (rCMRgl) as a sensitive measure of brain oxygen poisoning. Conscious rats were continuously exposed either to air or to oxygen for 24 h at atmospheric pressure inside a closed and ventilated environmental chamber. The rCMRgl was measured during ongoing air or oxygen exposures by [14C]2-deoxyglucose (2-DG) autoradiographic technique. No significant difference in the rCMRgl of 29 neuroanatomical structures investigated was found between two groups of air- and oxygen-exposed rats. At the same time however, a significant reduction in the respiratory frequency (f) was observed only in the oxygen-exposed rats. It is suggested that brain energy metabolism is not affected at least up to 24 h NH in conscious rats. The NH-induced reduction in f on the other hand, may be due to alterations in afferent inputs from peripheral and central chemoreceptors or lung stretch receptors. Furthermore, since slight changes in rCMRgl of small neuroanatomical structures are not detectable by limited resolution power of [14C]2-DG autoradiographic technique, a subtle NH-induced damage to central respiratory control mechanisms cannot yet be ruled out.

Study of an attenuated strain of feline infectious enteritis (panleucopaenia) virus. I. Spread of vaccine virus from cats affected with feline respiratory disease.

In the course of developing a living attenuated feline infectious enteritis (panleucopaenia) vaccine, it was found that respiratory disease-infected cats newly inoculated with this vaccine spread vaccine virus to respiratory disease-infected in-contact controls. These in-contact controls were able to infect other cats with which they were placed in contact so that after five natural transmissions in this way and two oral administrations and subsequent re-isolations, reversion to virulence became evident. It is clear that before general release of a new living feline infectious enteritis vaccine, there must be satisfactory evidence that concurrent infection will not affect the safety of the modified antigen.In cats infected with feline infectious enteritis there appears to be a short period, coinciding with the onset of leucopaenia, during which they are highly infectious. It seems possible that some infected animals may become immune carriers because virus has been recovered from the small intestine of two of four cats with significant antibody titres 22-24 days after exposure to infection.

Study of an attenuated strain of feline infectious enteritis (panleucopaenia) virus. II. Removal of the spread factor by further passaging in tissue culture.

The propensity of an attenuated strain of feline infectious enteritis (panleucopaenia) virus to spread from vaccinated cats affected with intercurrent feline respiratory disease to unvaccinated in-contact cats was eradicated by further passaging of the vaccine virus in tissue culture. No virus was recovered from, and no antibody was found in the sentinel cats in contact with seven vaccinated animals. Thus, a further 27 passages of the vaccine virus in tissue culture has eliminated the spread factor.

Deterination of an optimal dilution of virlent feline infectious enteritis (panleucopaenia) virus for challenge purposes.

When ten cats were infected orally with undiluted or a 10(-1) dilution of virulent feline infectious enteritis (panleucopaenia) virus, all developed severe leucopaenia followed by the development of demonstrable antibody, but none died. Eighteen of 29 cats given a 10(-2) dilution of virus died of the disease. Three of the survivors had white blood cell counts of less than 4000 and three had counts between 4000 and 6000 cells. Although the remaining five animals never had individual counts of less than 6000 cells, the geometric means of these counts showed that a marked depression in the leucocyte counts had occurred. All surviving cats developed antibody.Among the ten cats dosed with either 10(-3) or 10(-4) dilution of virus, four died of feline infectious enteritis and three developed antibody after falls in the leucocyte counts. It is suspected that low dilutions of feline infectious enteritis virulent virus in cats produce a phenomenon similar to that reported by von Magnus (1954) with influenza virus in eggs.Leucopaenia is commonly defined as less than 4000 white blood cells/mm.(3) of blood. Counts lower than this are usual in cats which either die of the disease or have received large doses of virus; they are less common in cats surviving after administration of diluted virus. Challenge of cats with pre-existing antibody did not provoke a depression in the leucocyte counts.