Band 5, Heft 4

To examine the impact made on safe surgical practice by the introduction of correct site surgery documentation in a children’s hospital containing a surgical unit in South Yorkshire. A retrospective audit of randomly selected case notes of children attending the hospital for an ENT/Plastic surgery/Orthopaedic/General surgical procedure during a period in 2006 or 2008. Outcome measures included the total, correct and legible completion of correct site surgery documentation pre-operatively. Significant improvement was noted between the 2006 and 2008 audits in the amount of patients being correctly marked (33% vs. 91%), however there were no forms in either study that were fully and correctly completed. Legibility of the forms also improved markedly between the studies (33% vs. 98%). The completion of correct site surgery forms improved with greater publicisation of the forms, however the practicality of the numbers of people required to complete the forms needs to be reviewed. The international introduction of such forms will generate valuable data as to the future utility of these checklists.

Glomus caroticum tumors, usually used as an alternative term for carotid body tumor, are of neuroectodermal origin and a part of the extra adrenal neuroendocrine system pathologies. These abnormalities are the most frequently detected paraganglioma in the localization of the head and neck. In our report, we present a giant tumor mass on the left side which was operated on successfully with a review of our experience retrospectively. Between the dates of June 1995 and October 2009, 47 patients, all of which had a glomus caroticum tumor, underwent to surgery. Tumor presented a wide variety of size and clinical presentations.

The risk of carcinoma increases in patients with a 10-year or longer duration of ulcerative colitis (UC). To search for a more objective parameter to assess epithelial dysplasia. The study comprised 25 cases of longstanding UC: 7 cases with regenerative atypia, 7 with low grade dysplasia, 7 with high grade dysplasia, and 4 cases indefinite for dysplasia. The colonic biopsies obtained during endoscopy were stained with H&E to identify the aforementioned categories. Seventy-five sections from biopsy specimens were stained immunohistochemically to detect differences in the frequency and pattern of nuclei positive for the proliferation marker Ki67 and p53. In high grade dysplasia, the distribution of Ki67 positive cells was diffuse throughout the full length of the crypt, whereas low grade dysplasia and epithelium indefinite for dysplasia, as well as regenerative epithelium, showed an expanded basal zone. None of the regenerative atypia cases showed strong intensity p53 staining compared to dysplasia cases. None of the high grade dysplasia cases showed restricted p53 staining to the lower two thirds of the crypt. All the cases of HGD showed extension of Ki67 and p53 staining above the basal two thirds of the crypt. Ki67 and p53 immunostained cell assessment combined with routine histological evaluation of colorectal mucosa can improve the diagnostic accuracy, as well as the assessment of malignant transformation risk.

The aim of this study is to analyze the impact of combined treatment (thyroidectomy and radiotherapy and radioactive iodine treatment) on patients’ long-term survival with medullary thyroid carcinoma. This is a retrospective study of 59 patients treated from 1977 to 2006 for medullary carcinoma at the Institute of Oncology in Vilnius, Lithuania. Survival was estimated by the Kaplan-Meier method. Univariate and multivariate Cox proportional hazard models were used to explore the association of prognostic factors with long-term survival. The survival of MTC patients was 88.0% (95% CI 68.0–88.9), 67.9% (95% CI 52.3–79.4) and 60.5% (95% CI 43.2–74.0), respectively, 5, 10 and 15 years after diagnosis. In survival analysis, only the type of surgery and lymph node involvement were found to be significant prognostic factors. The results of this study suggest that treatment with radioiodine and external beam radiotherapy do not improve significantly the long-term survival of surgically treated MTC patients.

To investigate CD4+CRTH2+ cells in peripheral blood in advanced stage non small cell lung cancer (NSCLC) patients. Forty-six patients with advanced stage NSCLC, who are chemotherapy or radiotherapy naïve, and 17 healthy volunteers, were enrolled in this study. The study was performed using flow cytometry and a complete blood cell counter analyser. CD4+ T cell percentage, CD4/CD8 ratio, CRTH2+CD4+ cell percentages, counts, and mean fluorescein intensity (MFI) and hematological parameters were evaluated in both groups. A survival analysis was performed to compare the patients with high CD4+CRTH2+ cell percentage and those with low CD4+CRTH2+ percentage. CD4+ T cell percentage in total lymphocytes and the CD4/CD8 ratio were lower in the patient group than in the control group. The absolute CD8 T cell count was higher in the patient group than in the control group, whereas the total T cells was not different. The CRTH2+ cell percentage in CD4+ T cells (7.96% ± 6.21% vs 3.37% ± 3.55%; respectively; p: 0,001) and the absolute count of CRTH2+CD4+ cells ( 97 mm-3 ± 109 mm-3 vs 37 mm-3 ± 38 mm-3, respectively; p: 0,033) in the patient group were higher than in the control group, but CRTH2-PE MFI values were not different between groups. Cox regression analysis did not show that CRTH2+CD4+ cell count or percentage is an independent prognostic factor. The study found that CRTH2 expression of CD4+ T cells and CRTH2+CD4+ cell number are higher in the peripheral blood of NSCLC patients than in that of healthy subjects. Further studies that explore the biological significance of high CD4+CRTH2+ cells in lung cancer patients, should be pursued.

Cardiac myxomas are the most common primary benign tumors of the heart and appears particularly in the left atrium. Myxomas exhibit a wide spectrum of symptoms from asymptomatic to very serious according to the localisation of the tumours. Only 5% of these tumours occur in the right and left ventricles. We report an unusual case of a 21-year-old woman with a leukemia in remission, in whom routine transthorasic echocardiographic examination demonstrated an incidental left ventricular mass. The patient underwent successful resection of the left ventricular mass under cardiopulmonary bypass through the left atrial approach. Histopathologic examination was diagnostic for myxoma. In this case, the presentation of the mass was atypical for two reasons: the tumour was a cardiac myxoma in the left ventricular localisation and in a patient with leukemia in remission.

We report the first case of early postoperative infection after a medial hemiarthroplasty of the knee with a customized ConforMIS iForma™ interpositional device. The infection was treated successfully by revision surgery with implant removal and antibiotic therapy. Despite the additional diagnosis of rheumatoid arthritis that did not affect the treated knee, the preservation of bony and ligamentous structures enabled a successful re-implantation of another iForma™ implant 9 months later with good clinical results at follow-up examination 1 year postoperatively. This is very much in contrast to the extensive and complex revision surgery, with significant bone loss, in patients with infected unicompartmental or total knee arthroplasties. The iForma™ device may be an alternative treatment option in early and moderate unicompartmental arthritis of the knee, with easy revision with the same type of implant in the rare case of infection.

Sclerosing hemangioma of the lung is an uncommon benign tumour that usually presents as an asymptomatic solitary nodule and affects middle age women. Because there are few findings on radiologic studies that are characteristic of sclerosing hemangioma, it is difficult to diagnose on the basis of imaging and biopsy remains the definitive diagnostic test. We report a case of pulmonary sclerosing hemangioma with extremely unexpected imaging findings and review the literature.

Early detection and treatment of preneoplastic lesions represents an obvious option to reduce morbidity and mortality from lung malignancies. Until now, radiological detection, sputum cytology, and autofluorescence have shown limited effectiveness as screening methods. Novel technologies such as Narrow Band Imaging (NBI) are showing promising results, but new studies are still needed to evaluate their use as screening methods. Together with early detection, adequate methods of lesion treatment, such as argon plasma coagulation, are needed. This case report concerns a 45-year-old man who was referred for bronchoscopy after his annual checkup. Using NBI technology, a preneoplastic lesion was identified, and treated using argon plasma coagulation. Our experience has shown us that both NBI screening and argon plasma coagulation are very promising, easily implemented, methods.

This study describes the in vivo activity of Lactobacillus acidophilus in Giardia lamblia infected BALB/c mice. Experimentally, it was observed that daily administration of lactobacilli 7 days before or in simultaneous inoculation with Giardia trophozoites efficiently reduced G. lamblia infection in mice. More specifically, excretion of Giardia cysts were reduced significantly in probiotic-treated groups, and resolution of infection was observed by day 21 post-inoculation. It was also observed that the lactobacillus count increased tremendously and continuously in faeces of all probiotic-fed mice, and was significantly higher as compared with that in control mice. Histological analysis of microvilli membrane integrity revealed that probiotic administration also protected mice against parasite-induced mucosal damage, whereas Giardia-infected mice had severe villous atrophy, oedema, vacuolation and ileitis. Immunologically, the anti-Giardia serum IgG level was not stimulated significantly by probiotic treatment administered both prior to and simultaneous with Giardia infection, but remained high after the infection peak. Taken together, the data demonstrates the anti-giardial effect of the probiotic in vivo by modulation of the intestinal epithelial cells, inhibiting the colonization of Giardia trophozoites and thereby reducing the severity of Giardia infection.

The aim of this study is to determine the difference in efficiency of direct immunoenzyme-linked assay (EIA) and conventional microscopy (CM) plus conventional concentration technique (CCT) using comparative analysis in the diagnosis of symptomatic and asymptomatic lambliosis when only one stool sample is to be tested. The study enrolled 577 examinees: 208 patients and 369 asymptomatic examinees. Lambliosis was diagnosed using CM plus CCT (three stool samples) and direct EIA (the first sample). All statistical parameters of the EIA method were 100% in the patients with symptoms of infection. In addition to that, in the group of asymptomatic carriers of Giardia lamblia (G. lamblia) some very high values of these parameters were recorded too, with sensitivity and negative predictive value being both at 100%. In contrast to the EIA method, CM plus CCT of the first stool sample demonstrated significantly lower sensitivity (66.67%) compared to the reference standard. The study did not demonstrate any statistically significant differences in diagnostic efficiancy between the EIA testing of one stool sample and CM plus CCT (p<0.05). However, the observed difference in diagnostic efficiency between the methods was very close to the cut-off value for statistical significance (p=0.06).

Arcobacter spp. are emerging food borne pathogens associated with prolonged diarrhea and occasional systemic infections such as bactereamia and peritonitis in humans. Information on faecal shedding patterns to assess the potential role they play within the intestine however, is lacking. This study was designed to investigate faecal shedding of local isolates of Arcobacter spp. Using real time PCR for confirmation, A. cryaerophilus and A. butzleri were isolated from the stool of healthy chickens. Pathogenicity of the organisms was tested by administering a single oral challenge of 102–109 cfu/ml to 45 healthy adult male albino rats divided equally among 5 groups. Uninfected rats were used as the control group. A. cryaerophilus and A. butzleri produced infection in 100% of the animals. Experimental infection was dose dependent and caused diarrheal illness and faecal shedding was noted up to 5 weeks post infection. The present study demonstrates that rats can act as a reservoir and potential source of Arcobacter infection in humans and animals exposed to this pathogen.

Tuberculous spondylitis is more common in patients with chronic renal failure who receive hemodialysis because of their abnormal T-cell-mediated immunity. It frequently poses both diagnostic and therapeutic challenges. We describe two cases of tuberculous spondylitis in patients undergoing chronic hemodialysis therapy. They are IFN-γ assay diagnosed (QuantiFERON-TB Gold) and conservatively treated. Our cases suggest that IFN-γ assays equip clinicians with more accurate tools for tuberculosis control. A combination of T-SPOT.TB testing and MRI assessment may be the accurate method to diagnose tuberculous spondylitis in patients with end-stage renal disease.

Quantitative ultrasound (QUS) is of increasing interest for evaluation of osteoporosis because, compared with dual-energy X-ray absorptiometry (DXA), it is portable, less expensive, and radiation-free. The aim of our study was to determine the sensitivity, specificity, and cut-off values of quantitative ultrasound parameters in identifying patients with osteoporosis compared to the World Health Organization (WHO) standard definition. We performed a cross-sectional investigational study of 73 subjects, and determined total hip and lumbar spine T-scores by dual-energy X-ray absorptiometry (DXA) (Prodigy Advance Lunar-GE). The QUS parameters (broadband ultrasound attenuation [BUA], speed of sound, bone mineral density, the stiffness index, and QUS T-score) were determined with Sahara Hologic equipment. The AUC was 0.81 (95% CI 0.67–0.95, p<0.05) for speed of sound (SOS) and 0.76 (95% CI 0.62–0.90, p<0.05) for BUA for the patients with DXA T-scores ≥ −1 DS; the cut-off values were 1542.2 meters per second for SOS and 63.3 dB/MHz for BUA. In patients with DXA T-scores ≤ − 2.5 DS, AUC was 0.80 (95% CI 0.70–0.90, p<0.05) for SOS, and 0.76 (95% CI 0.65–0.87, p<0.05) for BUA. The cut-off values were 1504.95 meters per second for SOS and 49.5 dB/MHz for BUA. Pearson correlation coefficients were positive and statistically significant (> 50%) for all QUS parameters in both groups, (2-tailed, p<0.05). QUS parameters correctly identified normal patients (false negative 34.21% and false positive 2.53%) and those with osteoporosis (false negative 8.55% and false positive 7.82%). The patients with QUS parameters between the cut-off values corresponding to DXA T-scores of −1 SD and − 2.5 SD should be further evaluated by DXA.

The study is a retrospective analysis of data obtained from a cardiovascular disease prevention program financed by the National Health Fund (Poland). The aim of the study was to evaluate the population to demonstrate the prevalence of favourable and unfavourable lipid parameters and blood pressure values depending on age and BMI. A total of 2,616 subjects were included in the study (811 men and 1805 women aged between 35 and 55 years of age) who perceived themselves as completely healthy individuals and in whom no cardiovascular disease or diabetes mellitus had been diagnosed. We evaluated blood pressure values, body weight, height, BMI, fasting glucose, total cholesterol, triglycerides, HDL and LDL in the serum of venous blood. The above-mentioned parameters were compared in women and men depending on BMI and age. It was demonstrated that the epidemiological situation of women in the analysed age group, regardless of the studied parameter and method of its evaluation, is much more favourable than that of men. We have demonstrated that evaluation of the analysed lipid parameters and blood pressure should be performed with consideration to gender and age. Otherwise conclusions may be obtained which are not satisfied by 75-95% of the population in a given age group. Obesity was highlighted as a factor triggering further lipid disturbances and blood pressure increase.

Gaucher’s disease is an inherited storage disease caused by a deficiency of the enzyme glucocerebrosidase. Although the hepatic manifestations are seen frequently, pulmonary and cardiovascular involvements are known to be very rare in Gaucher’s disease. This report presents these rare findings made by conventional radiography, computerized tomography (CT), and High-resolution CT (HRCT) of a 16-year-old female patient with fatal Gaucher’s disease.

We aimed to evaluate the risk factors for VRE colonization in neonatal intensive care units. In December 2007, we identified a neonate with VRE infection (urinary tract infection and we performed blood and stool cultures for VRE until the last colonized patient was discharged from our clinic. All the neonates hospitalized in NICU during December 2007 to January 2008. Active surveillance cultures for VRE fecal carriage was carried out in neonatal intensive care unit. Resistance to vancomycin was detected by the E-test method. Epidemiological data was recorded for all patients included in the study and was used for the risk factors. Totally 54 infants in NICU were screened for VRE colonization. Totally 11 infants (20%) were colonized with vancomycin-resistant enterococci. The average duration of all antimicrobial therapy was significantly longer in colonized patients. The infants who were hospitalized for more than 10 days were found to be significantly more colonized with VRE when compared to the infants with shorter hospital stay (p<0.05). There were no statistically significant differences between VRE colonized and non-colonized infants in respect to sex, to third generation cephalosporin usage, glycopeptide usage, presence of prematurity, presence of mechanical ventilation(p> 0.05). The premature infants and the mature infants were under risk of VRE colonization. Longer duration of hospitalization and antimicrobial usage were the prominent risk factors. Since infants in neonatal intensive care units were under risk of infections, periodic active surveillance cultures should be combined with logical antimicrobial therapy.

Brain abscesses represent organized foci of suppuration within the parenchyma. In this paper, we describe the case of a 3-month old girl with a large, complicated cerebral abscess. In addition, the course of treatment is presented. The patient’s recovery was excellent. The follow-up MRI showed only subtle porencephalic changes as the only parenchymal sequels, which may have been due to central nervous system (CNS) plasticity in infants.

To examine the clinical spectrum of complications in pulmonary system and changes of some parameters of humoral and cell mediated immunity related to heroin overdose. The study includes 16 patients who are long-term heroin abusers with acute heroin and mixed with other psychoactive drugs intoxications with an average age of 21,5 ± 5.04 years (12 men and 4 woman). All patients were hospitalized in the Clinic of Toxicology, MHATEM “N.I.Pirogov”, Sofia. We have used clinical, clinico-laboratory, immunological, chimicotoxicological, instrumental methods. In severe intoxications with heroin and other psychoactive drugs, we observed pulmonary system complications, i.e. pneumonia, aspiration of gastric contents, noncardiogenic pulmonary edema (NCPE) and acute respiratory distress syndrome (ARDS.). Of the 16 patients in our study, 3 patients died due to complications. Some changes in the immune reactivity observed in the study were (1) statistically significant lower mean levels of IgG and (2) tendency to lower mean levels of IgA, IgM and complement components — C3 in the studied patients in comparison with the values in healthy people. The changes were more demonstrative in the group with pulmonary complications compared to the group without pulmonary complications. We observed that the CD4 lymphocytes were significantly less in the studied patients; in addition, a lower level of CD56-bearing lymphocytes (natural killer /NK/ cells) was observed in comparison to healthy controls. The results show that the mixture of acute heroin with other psychoactive drugs leads to complications in the pulmonary system and changes of some parameters of cell-mediated and humoral immunity.

Patients who have survived myocardial infarction (MI), compared to the general population, have an increased risk of reinfarction, myocardial revascularization, and death. In this study we investigated the prognostic significance of the predictors of the risk for adverse coronary events in 118 patients, both male and female, with a confirmed diagnosis of MI in the last 3 years. The predictors of reinfarction, revascularization and death in patients who survived MI were: poor adherence to hypolipemics (hazard ratio [HR] 3.06, p=0.006), physical inactivity (HR 2.22, p=0.056), the number of variable risk factors (HR 1.29, p=0.025), and age (HR 1.06, p=0.007). After the inclusion of the invariable risk factors in the model of multivariant analysis, the following factors were singled out as significant predictors of the risk: gender (HR 3.86, p=0.0015), physical inactivity (HR 2.38, p=0.007), change in the level of triglycerides (HR 1.49, p=0.040), change in the number of variable risk factors (HR 1.41, p=0.0007), and age (HR 1.05, p=0.009). A 3-year follow-up of the patients who survived the first MI and who were enrolled in this study of secondary prevention demonstrated that physical inactivity, the number of variable risk factors and age significantly contributed to an increased risk of reinfarction, revascularization, and death.

The value of plasma fibrinogen and antithrombin as predictors of severe sepsis was investigated in 69 adult hematological patients, who had altogether 93 periods of neutropenic fever. Patients had either acute myeloid leukemia or had received a high dose of chemotherapy supported by autologous stem cell transplantation. In febrile periods with severe sepsis, the median fibrinogen concentration at the start of the fever was significantly higher (5.0 g/L) than that without severe sepsis (4.5 g/L) (p=0.009). Normal plasma fibrinogen could rule out a group of patients with severe sepsis at the beginning of the fever. The antithrombin activity decreased, both in fever periods with severe sepsis and in those without. The decrease in antithrombin activity was found to be greater in fever periods characterized by severe sepsis. In conclusion, elevated plasma fibrinogen and constantly decreasing antithrombin were shown to be linked to the development of severe sepsis.