Global climate change and wound care: case study of an off-season vibrio alginolyticus infection in a healthy man.

Vibrio alginolyticus is a halophilic Gram-negative bacterium normally present in seawater. Vibrios are not capable of cutaneous invasion through intact skin and their isolation from extraintestinal sites is uncommon. However, interruptions in skin integrity (cuts or abrasions) can allow these bacteria to cause complicated skin and soft tissues infections. This case study describes the clinical assessment and management of a nonhealing traumatic wound, sustained in a coastal area during the winter months, in a healthy 70-year-old man. Culture results were positive for V. alginolyticus. Appropriate antibiotic treatment and topical wound care successfully resolved the infection. V. alginolyticus infections are usually benign; respond well to treatment, even with local therapy only; and tend to result from contact with warm ocean water. The clinical characteristics of the wound prompted a suspicion of a Vibrio infection even though the wound was sustained in the winter time and the patient did not have direct contact with ocean water. Although other case studies of Vibrio infections in the absence of direct contact with ocean water have been published, increased ocean temperatures due to global climate changes may explain the out-of-season infection in this patient. Clinicians should monitor the progression of wound healing and be prepared to modify treatment based on individual circumstances, especially in the case of unusual wound presentation, nonhealing, or a progressing wound infection.

Ultrasound patterns of parathyroid glands in chronic hemodialysis patients with secondary hyperparathyroidism.

BACKGROUND: The role ofparathyroid glands (PTG) ultrasonography (US) in hemodialysis patients with secondary hyperparathyroidism (SHPT) is still controversial. The present study aimed at evaluating the relationship between US findings and SHPT degree as well as therapeutic outcome. METHODS: Twenty hemodialysis patients with moderate SHPT and 15 with severe SHPT underwent US to assess the PTG number, maximum longitudinal diameter (MLD), structural (1-hypoechoic, 2-slight heterogeneous, 3-high heterogeneous, 4-nodular) and vascular patterns (1-slight, 2-medium and 3-high). RESULTS: PTG number, MLD and US patterns were correlated with iPTH levels. MLD of patients with moderate or severe SHPT was 7.2 +/- 2.3 and 15 +/- 5.1 mm (p < 0.001). Most patients with moderate SHPT showed a single PTG with an MLD <9 mm associated with 1-2 structural and vascular pattern, whereas patients with severe SHPT exhibited more than one PTG with MLD >9 mm and 3-4 structural and vascular patterns. Thirteen patients were responders to treatment and 22 nonresponders. In nonresponders, a higher number of PTG was observed as well as higher echostructural and vascular patterns. In 14 patients who underwent parathyroidectomy, no differences were found between PTG US MLD and pathology diameter. All PTG with evidence of 3-4 structural and vascular score at ultrasound showed nodular hyperplasia at pathological examination. CONCLUSIONS: The adopted classification of US findings is correlated with SHPT degree and therapeutic outcome and might be an adjunctive predictive method useful to assess the SHPT severity and to plan the therapeutic strategy.

Botulinum toxin in gastric submucosa reduces stimulated HCl production in rats.

BACKGROUND: Botulinum toxin blocks acetylcholine release from nerve endings and acts as a long term, reversible inhibitor of muscle contraction as well as of salivary, sweat gland, adrenal and prostatic secretions. The aim of the present study is to investigate whether gastric submucosal injection of botulinum toxin type A reduces stimulated gastric production of HCl. METHODS: Sixty-four rats were randomized in two groups and laparotomized. One group was treated with botulinum toxin-A 10 U by multiple submucosal gastric injections, while the second group was injected with saline. Two weeks later, acid secretion was stimulated by pyloric ligation and acid output was measured. Body weight, food and water intake were also recorded daily. RESULTS: HCl production after pyloric ligation was found to be significantly lower in botulinum toxin-treated rats (657 +/- 90.25 micromol HCl vs. 1247 +/- 152. P = 0.0017). Botulinum toxin-treated rats also showed significantly lower food intake and weight gain. CONCLUSIONS: Botulinum toxin type A reduces stimulated gastric acidity. This is likely due either to inhibition of the cholinergic stimulation of gastric parietal cells, or to an action on the myenteric nervous plexuses. Reduction of growth and food intake may reflect both impaired digestion and decreased gastric motility.

Abdominal wall closure with ePTFE--Goretex Dual Mesh after detensive laparotomy for abdominal compartment syndrome.

INTRODUCTION: Detensive laparotomy is the first choice treatment for abdominal compartment syndrome (ACS). Tension free closure of the abdominal wall with the use of prosthesis is a broadly diffused technique; the polypropylene and the ePTFE (expanded polytetrafluoroethylene--Goretex Dual Mesh) are the most commonly used materials. MATERIALS AND METHODS: We report our experience on five patients affected by ACS submitted to detensive laparotomy and positioning of a wide Goretex Dual Mesh prosthesis. RESULTS: In our initial experience ACS has been treated with success through detensive laparotomy and there were no complications related to the use of Goretex. DISCUSSION: Even though limited, our initial clinical experience is favorable to the use of Goretex Dual Mesh as first choice material for reconstruction of the abdominal wall after detensive laparotomy for ACS.