Effect of mitomycin-C on vocal fold healing in a canine model.

For evaluation of the effect of topical mitomycin-C on vocal fold healing and return of function after surgical excision of mucosa, 6 dogs underwent suspension microlaryngoscopy with bilateral microflap excision of vocal fold mucosa. Topical mitomycin-C, a chemotherapeutic agent and a fibroblast inhibitor, was applied randomly to one side, with the contralateral side serving as the control. Laryngeal videostroboscopy (LVS) was performed on each animal before the operation, at 2 weeks, and before sacrifice at 4 weeks. Both functional analysis with LVS and histologic analysis were performed in a blinded fashion to determine the effect of mitomycin-C on healing. Histologic analysis was augmented with computer morphometrics. The LVS revealed diminished mucosal wave vibration in the vocal folds treated with mitomycin-C, as well as a more atrophic appearance to the vibratory surface. The vocal folds treated with mitomycin-C showed fewer fibroblasts and less collagen within the superficial layer of the lamina propria than the control vocal folds (p < .05, Student's t-test, paired analysis). Inflammatory infiltrate was not significantly different between the two sides. Consistent with the known suppression of fibroblast proliferation by mitomycin-C, the treated vocal folds showed less connective tissue response to the surgical injury. In contrast to the reported positive effects of mitomycin-C on tracheal and glottic stenosis, the observed decrease in the healing response in the present study had negative consequences on the vocal fold vibratory pattern.

Outbreak of multiply resistant Staphylococcus aureus in a pediatric intensive care unit after consolidation with a surgical intensive care unit.

Patients in a pediatric intensive care unit were placed with patients in an adult surgical intensive care unit (SICU) in a large, 12-bed room previously occupied exclusively by the adult patients. The occurrence of multiply resistant Staphylococcus aureus (MRSA) in pediatric patients increased from zero cases during the preceding 12 months to seven cases (p less than 0.001) for the 95 days that the units were combined. The rate of acquisition of MRSA by the patients in the SICU remained unchanged. Pediatric patients who acquired MRSA had longer lengths of stay (p less than 0.001) and underwent more surgical (p less than 0.01) and invasive procedures than did pediatric patients who did not acquire MRSA. Removal of the pediatric patients to their own unit returned their rate of MRSA acquisition to the previous low level.