Unusual case of stroke related to Kocuria Kristinae endocarditis treated with surgical procedure.

BACKGROUND: We report the case of a 35-year-old man with stroke related to infective endocarditis (IE) caused by Kocuria kristinae. CASE DESCRIPTION: The patient with chronic hepatitis C virus infection and a former intravenous drug user developed a stroke suddenly, after three months duration of fever and malaise. Duplex ultrasonography of the carotid arteries (zero level diastolic flow, diastolic reversed flow) focused attention to cardiac valve pathology and endocarditis (definite confirmation was made by transesophageal echocardiography). Kocuria kristinae was grown from the blood culture and antibiotic therapy administered, according to the antibiogram, did not cure the infection and the patient underwent an aortic valve replacement with a mechanical prosthesis and debridement of the mitral valve. One year after the surgery, the patient had no subjective problems and neurological findings were normal.  Conclusion: To our knowledge, this is the first case of IE caused by Kocuria kristinae, which was diagnosed after the development of stroke, where IE was suspected based on Duplex ultrasonography of the carotid arteries.  This is the second case of infection by this bacterium which could not be cured by antibiotics only and had to be submitted to surgical intervention. Hippokratia 2016, 20(3): 231-234.

Clinical evaluation of a new recombinant antigen-based cytomegalovirus immunoglobulin M immunoassay in liver transplant recipients.

BACKGROUND: Human cytomegalovirus (CMV) is a significant cause of morbidity and mortality among transplant recipients. Monitoring transplant recipients by CMV IgM serology has been questioned by several studies due to the reported insensitivity of serologic tests relative to antigen detection methods. METHODS: In this retrospective study, we have evaluated the performance of the new recombinant antigen-based Abbott AxSYM CMV IgM assay and compared it with CMV culture technique in a cohort of 40 liver transplant recipients who did not receive antiviral prophylaxis. RESULTS: The sensitivity, specificity, and positive and negative predictive values for detection of CMV disease by the AxSYM CMV IgM assay were 90.0%, 60.0%, 69.2%, and 85.7%, respectively, and by culture the values were 100%, 55.0%, 69.0%, and 100%, respectively. Detection of CMV IgM occurred before or at the time of CMV disease in only R+ recipients. CONCLUSION: Although this assay is a sensitive test for CMV-specific IgM, detection of CMV IgM preceded detection of virus by culture in patients only when the liver transplant recipient was CMV immune before transplantation (R+).

An investigation into interactions between polyacrylic polymers and a non-ionic surfactant: an emulsion preformulation study.

The aim of this study was to investigate possible interactions between a polymeric emulsifier and a non-ionic surfactant, with a view of achieving better understanding of emulsion stabilisation mechanisms. The polymeric emulsifier used was acrylates/C10-30 alkyl acrylate crosspolymer (Pemulen TR-2(R)), while Polyoxyethylene 20 sorbitan mono-oleate (Polysorbate 80) has been chosen as a model surfactant. Both materials were used within the concentration range relevant for their practical application. A 0.2%w/w aqueous dispersion of polymeric emulsifier, containing various amounts of surfactant (from 0.01 to 1.0% w/w) was used throughout the study. Interfacial aspects of the proposed polymer/surfactant interactions were analysed by means of surface tension measurements. Changes in the network structure of the test dispersions were quantified by continuous shear rheometry, supported by the texture analysis. To analyse the influence of hydrophobic alkyl groups present on the Pemulen TR-2(R) chains, an unmodified, hydrophilic polyacrylic acid polymer, Carbopol 934P(R), was assessed under the same conditions. The results obtained by both surface tension and rheological studies have revealed large differences in behaviour of the two polymers in the presence of the model surfactant. Pemulen TR-2(R) was shown to desorb the surfactant from the surface, within the whole concentration range studied. Furthermore, an increase in viscosity and texture profile parameters with increasing Polysorbate 80 concentration up to 0.3% w/w was evident in the case of Pemulen TR-2(R) dispersions. This was followed by a decrease in the gel network strength at higher surfactant concentrations. On the other hand, Carbopol 934P(R) has shown no signs of surfactant desorption and only small changes in the network structure with the increasing concentration of surfactant. It is shown in this study that an interaction between a polymeric emulsifier Pemulen TR-2(R) and a non-ionic surfactant Polysorbate 80 does occur in their aqueous dispersion, and that it is: (a) hydrophobic in nature; (b) concentration-dependent; and (c) has an impact on the rheological properties of dispersion.

The Influence of Processing Variables on Performance of O/W Emulsion Gels Based on Polymeric Emulsifier (Pemulen (R)TR-2NF).

Pemulens(R) (BF Goodrich) are hydrophobically-modified copolymers of acrylic acid (Acrylates/C10-C30 alkyl acrylates) that could act both as primary emulsifiers for o/w emulsions and viscosity enhancing agents. The aim of this study was to assess the influence of different processing conditions (mixing equipment, speed and time of agitation) on the aesthetic characteristics, viscosity and physical stability of o/w emulsion gels based on the polymeric emulsifier (Pemulen TR-2 NF). This objective was achieved by applying a two-factor three-level experimental design at two sets: using a laboratory mixer and a disperser. Independent variables were mixing speed and time and dependant variables i.e. responses, were millimetres of oil phase separated after centrifugation at 3500 rpm in a laboratory centrifuge, and viscosity at shear rate 180 l/s. The responses were fitted into a second order model by means of a multiple regression analysis. For the samples prepared on the laboratory mixer it was shown that mixing time and speed produce a statistically important influence on viscosity, but not on physical stability: with increasing mixing speed and time the viscosity linearly increases. If we assume that greater energy input obtained by increasing the mixing speed and time produces a decrease in drop size and polydispersity and better developed gel network, then the optimal processing conditions will be at the point where maximal viscosity is attained. This result was in accordance with the centrifugation test - the best stability appeared when maximal mixing speed and time were applied, although this effect appeared not to be statistically significant. For samples prepared using dispersers no statistically important influence of processing variables on viscosity and physical stability was found. Additionally, emulsion samples prepared using the laboratory mixer appeared homogenous, while in samples prepared using the disperser, undispersed polymer lumps appeared. Based on physical characteristics of the emulsions, it could be concluded that the disperser is an inappropriate tool for processing the emulsions based on Pemulen polymers.

Effectiveness of ultrasonography in diagnosis of maxillary sinus disease: a prospective comparison with radiographic and sinusoscopic examinations.

AIM: To assess the diagnostic accuracy of ultrasonography in comparison to radiographic and sinusoscopic techniques of maxillary sinuses examinations in acute and chronic sinus inflammations. METHODS: Ninety diseased sinuses in 50 patients (32 male and 18 female) were examined radiographically, ultrasonographically, and sinusoscopically. Ultrasonography was performed with Sinuscan 102 Sinusprint with 3.0 MHz transducer frequency, with A-mode curve display and Bulk-display. Radiography was performed in occipitonasofrontal and occipitonasomental projection, and sinusoscopy by local anesthesia using an optic instrument under 0 degrees, 30 degrees, and 70 degrees. Statistical assessment of ultrasonography sensitivity and specificity in relation to radiographic and sinusoscopic techniques was carried out. The data were compared using McNemar's test for paired data. RESULTS: Negative ultrasonographic agreed with negative radiographic findings in 18 of 20 sinuses. When ultrasonographic findings revealed mucosal thickening, complete filling, polyp or cyst, the agreements with radiographic findings were 24/30, 21/25, and 11/15, respectively. Negative ultrasonography agreed with negative sinusoscopic findings in 17/20 sinuses. When ultrasonographic findings revealed mucosal thickening, complete filling, polyp or cyst of the maxillary sinuses, the agreements with sinusoscopic findings were 26/30, 23/25, and 13/15, respectively. In comparison to radiological findings, the sensitivity of ultrasonography was 0.93 and specificity 0.60, and in comparison to sinusoscopic examination, sensitivity of ultrasonography was 0.93 and specificity 0.74. CONCLUSIONS: Ultrasonography can be used as a diagnostic method in the early diagnosis of sinus diseases. Compared to radiographic and sinusoscopic findings, it shows a high agreement in negative and positive findings, i.e., a high sensitivity and specificity.

[Reconstruction of the cervical esophagus with free autotransplantation of the jejunum--direct monitoring of viability]. / Rekonstrukcija vratnog jednjaka slobodnim autotransplantatom jejunuma--izravno pracenje vitalnosti.

Although free jejunum transfer has become an accepted form of hypopharyngeal reconstruction, an ideal method of monitoring the viability of the graft has not been devised yet. The method of direct visualisation through the incision in the skin above the transferred jejunum has proven very reliable and easy to perform, especially for the nursing staff. This reliable method of monitoring free vascularised jejunum to the neck region has been used in two patients. After two days of direct monitoring, the incision in the skin healed without additional sutures. No failures of the graft occurred, and 12 days later the patients were able to swallow fluids without difficulty. The effectiveness of this technique has surpassed that of all previously published methods.

Fibrous dysplasia in paranasal cavities.

Presentation is made of 2 boys and a girl with fibrous dysplasia involving the frontal and ethmoidal sinuses and the maxilla. This tumor-like growth of the bone was not restricted to the sinus alone but expanded to the orbit, adjacent sinus, skull base and infratemporal or pterygoid fossa. In such cases, surgical therapy is the treatment of choice, with maximal preservation of healthy tissue and avoidance of major devastations that may result in undesired cosmetic defects. The etiology of the disease is still unknown. However, it should be emphasized that all 3 patients had suffered an injury to the adjacent bony structures at various time points preceding the disease manifestation. That is why we are inclined to believe that trauma might be a factor responsible for the onset of fibrous dysplasia.

Arachidonic acid metabolites and sinonasal polyposis. I. Possible prognostic value.

PURPOSE: The etiology of sinonasal polyps is sometimes obscure. This study was undertaken to evaluate the potential role of arachidonic acid metabolites (AAm) on recurrent polyposis. MATERIALS AND METHODS: Tissue production of prostaglandin E2 (PGE2), 6-keto-prostaglandin F1-alpha (PGI2), thromboxane A2 (TxA2), and leukotriene C4 (LTC4) by nasal mucosa was determined by radioimmunoassay in 27 patients with sinonasal polyposis (SNp) and in 10 volunteers. RESULTS: The group of patients with SNp with the evidence of recurrences in postoperative period (Group 1) showed significantly lower PGE2 concentrations than group of patients with SNp recurrences (Group 2). The differences in concentrations of PGI2 in mentioned groups were insignificant. In comparison with other groups, a group of patients who underwent surgery several times for SNp (Group 4) had a higher mean TxA2 concentration. The LTC4 concentrations were the highest in groups of patients where SNp recurrences were observed. When the incidence of polyposis recurrences (within 18 months after surgery) was correlated with the level of LTC4 production at the time of surgery, the rate of recurrence was significantly higher in patients with increased LTC4 level than in those with normal LTC4 levels. CONCLUSIONS: LTC4 might have a prognostic value. The possible role of AAm in occurrence of SNp is apparent and suggests possible role for medical intervention.

Reconstruction of laryngotracheal war injuries with the median layer of the deep cervical fascia.

Surgical exploration and immediate reconstruction with the median layer of the deep cervical fascia (MLDCF) was performed in 8 of 22 patients with exogenous war injuries of larynx and cervical trachea. A surgical technique of reconstruction with the median layer of the deep cervical fascia is described. The 7 surviving patients had good respiration without signs of stenosis of the larynx and/or the trachea. Four had good and 3 satisfactory, phonation, and none had swallowing difficulties. Owing to the simplicity of the surgical approach, its size and biological properties, the median layer of deep cervical fascia proved itself to be a suitable material in the immediate reconstruction of exogenerous war injuries of the larynx and cervical trachea.

Lipid-bound sialic acid, prostaglandin E and histamine in head and neck cancer.

Blood concentration of lipid-bound sialic acid (LBSA), prostaglandin E (PGE) and histamine were determined in 37 patients with carcinoma of hypopharynx and larynx (supraglottic and glottic), in 12 non-cancer patients and in 10 healthy subjects. The concentration of LBSA was significantly increased in 94.4% cancer patients preoperatively and fell to somewhat lower levels within 1 month after tumour resection. In patients with complete tumour resection and no tumour recurrences within 2 years, it steadily decreased thereafter, reaching normal levels within 6-24 months after surgery, whereas in patients with tumour recurrences or incomplete tumour resection it rose again within 6 months after tumour resection. Similarly, the concentration of PGE was significantly increased in about two thirds of cancer patients (67.6%) preoperatively, dropped significantly within 1 month after tumour resection and rose again in patients with tumour recurrences. Preoperative histamine concentration was decreased in 24.3% of cancer patients and postoperatively it rose both in patients with or without tumour recurrences.

[Radiotherapy in carcinoma of the epipharynx]. / Radioterapija karcinoma epifarinksa.

In five year period (1977-1982) 38 patients were treated for the epipharyngeal cancer in Department for oncology and radiotherapy and Department of otolaryngology of Medical Faculty in Zagreb. Most of the patients were male (76%), between 40 and 70 years of age. In 23 (60%) the cancer was poorly differentiated, in 15 (40%) well differentiated. Most of the patients were in advanced stage (III and IV - 37 patients, only one in I stage). All patients were primary treated by radiotherapy (telecobalt). The applied dose was 60 Gy in 50% of the patients. The other received lower doses (ten of them less than 55 Gy), only one received 70 Gy by classic fractions. Surgery was performed for residual neck nodes (radical neck dissection). Adjuvant chemotherapy was administrated as a rule in cases of poorly differentiated squamous carcinoma, as well as in all cases with local recurrence and/or distant metastases. Two years survival was 45%, three years 42% and five years 21%. The other radiotherapy techniques are discussed concerning the treatment improvement and diminishment of irradiation sequalae.

[Branchial cyst and fistula of the first branchial cleft. Apropos of a case]. / Kyste branchial et fistule du premier sillon branchial. Présentation d'un cas.

We describe a case of a fistula from the first branchial cleft. At the otorhinolaryngology clinic of the Faculty of Medicine at the University of Zagreb we have operated on more than 100 cases of congenital abnormalities of the branchial arches. However, it is only recently that we had the first case of fistula from the first branchial cleft. We report the clinical aspects and operative course in detail.

[Functional results following stapedectomy. A 5-year study]. / Funktionelle Ergebnisse nach der Stapedektomie. Eine fünfjährige Studie.

Results of partial stapedectomy with the formation of small fenestra and the use of teflon piston prostheses in the period of 1980-1984 are shown. Particular attention was paid to the group of patients under 18 years of age representing 3.3% of all operated cases, as well as to patients with combined hearing loss. In both groups, functional results of surgery were very good. Of the total of 284 operated ears, there were 20 reoperations.