Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC): Occupational Health and Safety Aspects

Background

Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a novel approach for treating peritoneal carcinomatosis. First encouraging results have been obtained in human patients. However, delivering chemotherapy as an aerosol might result in an increased risk of exposure to health care workers, as compared with other administration routes.

Methods

PIPAC was applied in two human patients using chemotherapeutic drugs (doxorubicin and cisplatin), and air contamination levels were measured under real clinical conditions. Air was collected on a cellulose nitrate filter with a flow of 22.5 m³/h. To exclude any risk for health care workers, both procedures were remote controlled. Toxicological research of cisplatin was performed according to NIOSH 7300 protocol. Sampling and analysis were performed by an independent certification organization.

Results

The following safety measures were implemented: closed abdomen, laminar airflow, controlled aerosol waste, and protection curtain. No cisplatin was detected in the air (detection limit < 0.000009 mg/m³) at the working positions of the surgeon and the anesthesiologist under real PIPAC conditions.

Conclusions

For the drugs tested, PIPAC is in compliance with European Community working safety law and regulations. Workplace contamination remains below the tolerance margin. The safety measures and conditions as defined above are sufficient. Further protecting devices, such as particulate (air purifying) masks, are not necessary. PIPAC can be used safely in the clinical setting if the conditions specified above are met. However, a toxicological workplace analysis must be performed to confirm that the procedure as implemented complies with local regulations.     

In Vivo Analysis of the Morphologic Characteristics of Synthetic Mesh to Resist MRSA Adherence

Background

Synthetic mesh has significantly reduced recurrence rates for ventral hernia repair; however, prosthetic mesh infections remain a significant complication. We hypothesized that unique mesh constructs might alter the ability of various synthetic meshes to clear bacterial contamination. To evaluate this, we studied commercially available synthetic meshes ability to clear a bacterial contamination with methicillin resistant Staphylococcus aureus infection.

Methods

Two hundred and eighty-three rats underwent hernia repair with one of nine synthetic materials. Control animals were closed, and the remainder was inoculated with either 10⁴ or 10⁶ methicillin-resistant S. aureus (MRSA). Animals were survived for 30?days without systemic antibiotics. At necropsy, the mesh was harvested and quantitative cultures and bacterial clearance assessed.

Results

All clean repairs remained sterile. Rates of bacterial clearance for 10⁴ repairs revealed that unprotected monofilament materials cleared significantly more bacteria than composite meshes and multifilament meshes (p?=?<0.01 and p?=?0.01, respectively). At higher levels of bacterial contamination (10⁶), all materials had a reduction in bacterial clearance, although monofilament materials had higher bacterial clearance compared to composite meshes (p?=?0.03).

Conclusions

Monofilament unprotected polypropylene and polyester mesh can clear a large percentage of MRSA contaminants. Multifilament, composite anti-adhesive barrier meshes, and laminar antimicrobial impregnated mesh are not able to clear bacterial contamination with MRSA. Unique properties of synthetic material should be considered when evaluating a prosthetic for high-risk incisional hernia repair.     

The in vitro research of bacterial invasion of prosthetic vascular grafts: comparison of elastomer-sealed and gelatin-coated Dacron vascular grafts

Purpose

To investigate the process of bacterial invasion from the surface to inside prosthetic vascular grafts.

Methods

Elastomer-sealed Dacron vascular grafts (ESDVGs) and gelatin-coated Dacron vascular grafts (GCDVGs) were cut into 6-cm segments and placed in a U-shaped configuration on culture plates. Physiological saline was poured inside the grafts and a suspension of Pseudomonas aeruginosa was added to the outside. Samples taken from inside the grafts at nine time points for up to 60 h were spread on agar. Bacterial colonies were then analyzed. The grafts were also examined using scanning electron microscopy (SEM).

Results

Contaminated vascular graft models were produced in 18 ESDVGs (group T) and 12 GCDVGs (group G). The bacterial counts inside the vascular grafts in both groups increased over time. Bacterial colonies were confirmed in all samples from group G by 30 h, whereas bacteria appeared inside the grafts from group T at various times between 0 and 60 h. Bacteria were undetectable in one model from group T throughout the study. SEM revealed that the elastomeric membrane in the ESDVG was uneven.

Conclusion

Bacterial invasion of vascular grafts does not always occur immediately after contamination. ESDVGs may be more resistant to bacterial invasion as they have a thicker and evenly enriched elastomeric membrane.     

Bacterial cultures in burn patients’ mattresses

Background

The hospital bed and, especially, mattresses and pillows, which are in direct contact with patients, pose a potential risk of infection for the patient if not adequately decontaminated. The aim of this study was to examine the bacterial cultures of the mattresses in burn center and the correlation between the bacterial cultures of the burn patients and their mattresses.

Methods

Three bacterial samples from the mattresses of 11 burn patients were taken during the treatment in the burn center, resulting in 28 samples.

Results

The most common bacteria in mattress swabs were coagulase-negative staphylococci, typical skin normal bacterial flora. Pathogens problematic to burns patients (pseudomonas and acinetobacteria) transferred from the patients to mattresses. Some bacteria were found only in the mattresses.

Conclusions

Our data show that bacterial transfer from the patient to mattress is possible. We recommend that, as a part of the infection control program, burn centers should monitor the decontamination of mattresses by sampling them after disinfections. Level of Evidence: Level IV, diagnostic study.     

A comparison between the Boussignac™ continuous positive airway pressure mask and the venturi mask in terms of improvement in the PaO2/F i O2 ratio in morbidly obese patients undergoing bariatric surgery: a randomized controlled trial

Purpose

This study compared the Boussignac^? continuous positive airway pressure (CPAP) mask with the venturi face mask in terms of the postoperative PaO₂/F _i O₂ (PF) ratio in morbidly obese patients after bariatric surgery.

Methods

Following hospital Research Ethics Board approval and written informed consent, morbidly obese (body mass index > 35 kg·m^?2) patients undergoing bariatric surgery were recruited. The patients were anesthetized and laparoscopic Roux-en-Y gastric bypass was performed. Patients were assigned randomly to receive either the Boussignac (Boussignac Group) or the venturi face mask (Venturi Group) immediately after tracheal extubation. Patients were transported to the postanesthesia care unit, and the respective devices were applied for one hour. The PF ratio was recorded after tracheal intubation and at one hour and two hours post extubation. The percent forced expiratory volume (%FEV₁) and the percent forced vital capacity (%FVC) were recorded preoperatively and at one hour and two hours post extubation. Independent Student’s t tests were used for continuous variables, and the Chi square test was used for categorical variables. P < 0.05 was considered statistically significant.

Results

Eighty-one patients (Group Boussignac, n = 43; Group Venturi, n = 38) completed the study. Mean ages and body mass indices were similar in the two groups. At one hour post extubation, the PF ratio in the Boussignac Group was 361 (170) compared with 279 (91) in the Venturi Group (P = 0.007), and at two hours post extubation, the PF ratio in the Boussignac Group was 371 (162) compared with 323 (127) in the Venturi Group (P = 0.1). The postoperative %FEV₁ and %FVC were comparable in both groups at all time points.

Conclusion

Compared with the venturi mask, the Boussignac CPAP mask improves the postoperative PF ratio in morbidly obese patients after bariatric surgery. The postoperative %FEV₁ and %FVC are comparable for both groups.     

Does a mobile laminar airflow screen reduce bacterial contamination in the operating room? A numerical study using computational fluid dynamics technique

Background

Air-borne bacteria in the operating room (OR) may contaminate the surgical wound, either by direct sedimentation from the air or indirectly, by contaminated sterile instruments. Reduced air contamination can be achieved with an efficient ventilation system. The current study assesses the additive effect of a mobile laminar airflow (MLAF) unit on the microbiological air quality in an OR supplied with turbulent-mixing air ventilation.

Methods

A recently designed OR in NKS (Nya Karolinska Sjukhuset, Stockholm, Sweden) was the physical model for this study. Simulation was made with MLAF units adjacent to the operating table and the instrument tables, in addition to conventional turbulent-mixing ventilation. The evaluation used numerical calculation by computational fluid dynamics (CFD). Sedimentation rates (CFU/m²/h) were calculated above the operating table and two instrument tables, and in the periphery of the OR. Bacterial air contamination (CFU/m³) was simulated above the surgical and instrument tables with and without the MLAF unit.

Results

The counts of airborne and sedimenting, bacteria-carrying particles downstream of the surgical team were reduced to an acceptable level for orthopedic/implant surgery when the MLAF units were added to conventional OR ventilation. No significant differences in mean sedimentation rates were found in the periphery of the OR.

Conclusions

The MLAF screen unit can be a suitable option when the main OR ventilation system is unable to reduce the level of microbial contamination to an acceptable level for orthopedic implant surgery. However, MLAF effect is limited to an area within 1 m from the screen. Increasing air velocity from the MLAF above 0.4 m/s does not increase the impact area.

     

Microbial contamination assessment of cryostored autogenous cranial bone flaps: should bone biopsies or swabs be performed?

Background

Autogenous cranioplasty infection requiring bone flap removal is under-recognised as a major complication causing significant morbidity. Microbial contamination of stored bone flaps may be a significant contributing factor. Current infection control practices and storage procedures vary. It is not known whether ‘superficial’ swabs or bone cultures provide a more accurate assessment.

Method

Twenty-five skull flaps that were cryo-stored for more than 6 months were studied. Two swab samples (superficial and deep) and a bone biopsy sample were taken from each skull flap sample and cultured. Half blood agar and half chocolate agar plates were inoculated with the swabs for anaerobic and aerobic cultures respectively. The bone biopsy samples were cultured in brain-heart broth and subcultured similar to the swabs for 5 days.

Results

Incidence of microbial contamination was 20 % in the bone flaps studied. One swab culture and five bone biopsy cultures were positive for bacterial growth, all of which contained Propionibacterium acnes (p?=?0.014). Positive cultures were from bone flaps stored less than 18 months, whereas no growth was obtained from bone flaps that were stored longer (p?=?0.014).

Conclusions

Bone biopsy culture is a more sensitive technique of assessing microbial contamination of cryo-stored autogenous bone flaps than swab cultures. The clinical implications of in vitro demonstration of microbial contamination require further study.     

Accelerated Gastric Emptying but No Carbohydrate Malabsorption 1 Year After Gastric Bypass Surgery (GBP)

Background

Following gastric bypass surgery (GBP), there is a post-prandial rise of incretin and satiety gut peptides. The mechanisms of enhanced incretin release in response to nutrients after GBP is not elucidated and may be in relation to altered nutrient transit time and/or malabsorption.

Methods

Seven morbidly obese subjects (BMI?=?44.5?±?2.8?kg/m²) were studied before and 1?year after GBP with a d-xylose test. After ingestion of 25?g of d-xylose in 200?mL of non-carbonated water, blood samples were collected at frequent time intervals to determine gastric emptying (time to appearance of d-xylose) and carbohydrate absorption using standard criteria.

Results

One year after GBP, subjects lost 45.0?±?9.7?kg and had a BMI of 27.1?±?4.7?kg/m². Gastric emptying was more rapid after GBP. The mean time to appearance of d-xylose in serum decreased from 18.6?±?6.9?min prior to GBP to 7.9?±?2.7?min after GBP (p?=?0.006). There was no significant difference in absorption before (serum d-xylose concentrations?=?35.6?±?12.6?mg/dL at 60?min and 33.9?±?9.1?mg/dL at 180?min) or 1?year after GBP (serum d-xylose?=?31.5?±?18.1?mg/dL at 60?min and 27.2?±?11.9?mg/dL at 180?min).

Conclusions

These data confirm the acceleration of gastric emptying for liquid and the absence of carbohydrate malabsorption 1?year after GBP. Rapid gastric emptying may play a role in incretin response after GBP and the resulting improved glucose homeostasis.     

Glomerular filtration rate in prospective living kidney donors

Purpose

Measurements of glomerular filtration rate (GFR) are frequently interpreted assuming a linear variation with age. Nonlinear relationships may give a better representation of the changes associated with normal ageing.

Methods

This was a retrospective study of 904 subjects (468 women, 436 men; age range 18–84 years) undergoing assessment as prospective living kidney donors. GFR was evaluated from ⁵¹Cr-EDTA plasma clearance using blood samples taken at 2, 3 and 4 h. The slope–intercept GFR was corrected for body surface area (BSA) using the Haycock formula and for the fast exponential using the Brochner-Mortensen equation. The relationship between age, gender and GFR was examined using best-fit curve analysis. Nonlinear relationships with age were explored using fractional polynomials.

Results

There was no gender difference in BSA-corrected GFR over five decades of age (P = 0.40). However, female donors with a body mass index >30 kg/m² had a statistically significantly lower GFR than nonobese women (P < 0.01). The best-fit relationship between age and GFR was nonlinear and described using a fractional polynomial model of degree 1 (GFR = 103.9–0.0061 × Age² mL/min/1.73 m²) with a root mean standard error of 12.9 mL/min/1.73 m². The residual variance for this model was significantly smaller than for the best-fit linear model (P = 0.006).

Conclusions

GFR measurements in prospective living kidney donors are best corrected for age using a nonlinear relationship.     

Simultaneous Indocyanine Green and 99mTc-Antimony Sulfur Colloid-Guided Laparoscopic Sentinel Basin Dissection for Gastric Cancer

Background

There are few reports on a dual dye and isotope approach using laparoscopy in gastric cancer sentinel node mapping. The aim of this study is to evaluate the feasibility of laparoscopic sentinel basin dissection for gastric cancer using simultaneous indocyanine green (ICG) and ^99mTc-antimony sulfur colloid (ASC) injections.

Methods

Sixty-eight patients were enrolled who had been diagnosed with cT1–T2 and cN0 stage gastric cancers. They underwent laparoscopic sentinel basin dissection between June 2005 and May 2008. ICG and ^99mTc-tin colloid (separate injections in the first phase, n = 16) or ICG and ^99mTc-ASC (simultaneous injections in the second phase, n = 52) were injected into the submucosa endoscopically. After performing the sentinel basin dissection, laparoscopy-assisted gastrectomy with curative lymphadenectomy was done. Green-stained or radioactive sentinel nodes (SNs) were analyzed by hematoxylin and eosin staining and by immunohistochemistry for cytokeratin.

Results

SNs were identified in 62 of the 68 patients (91.2%; mean 3.3 per patient). Eighteen patients had lymph node metastases. The sensitivity and specificity were, respectively, 72.2 and 100% using the dye method and 83.3 and 100% by the isotope method. However, the dual dye/isotope procedure improved both sensitivity and specificity to 100%. Patients receiving this protocol had significantly more SNs than those receiving separate ICG and ^99mTc-tin colloid injections (3.3 vs. 1.9, P = 0.008).

Conclusion

Simultaneous ICG and ^99mTc-ASC-guided laparoscopic sentinel basin dissection is an effective tool for gastric cancer SN mapping, giving a high detection rate and excellent sensitivity.     

Does Presoaking Synthetic Mesh in Antibiotic Solution Reduce Mesh Infections? An Experimental Study

Background

Prosthetic mesh infection is one of the most challenging complications after hernia repair. We evaluate the efficacy of soaking mesh in antibiotics to prevent prosthetic infection in an animal model of clean–contaminated ventral hernia repair (VHR).

Material and Methods

Rats underwent an acute VHR with one of four synthetic meshes (composite multifilament polyester (Parietex PCO), multifilament polyester (Parietex TET), composite monofilament polypropylene (Ventralight), or monofilament polypropylene (SoftMesh)). Prior to implantation, mesh was soaked in saline or 10 mg/ml of vancomycin for 15 min. Following implantation, meshes were contaminated with 10⁴ CFU of methicillin-resistant Staphylococcus aureus (MRSA) bacteria. Thirty days after implantation, mesh samples were cultured and evaluated under scanning electron microscope for biofilm formation.

Results

Presoaking meshes significantly improves bacterial clearance in composite meshes and multifilament polyester mesh. MRSA clearance was as follows for all meshes (saline-soaked vs. vanco-soaked): Parietex PCO (0 vs. 56 %, p?=?0.006), Parietex TET (0 vs. 50 %, p?=?0.01), Ventralight (20 vs. 78 %, p?=?0.012), and SoftMesh (70 vs. 80 %, p?=?0.6). MRSA biofilm formation was consistent with bacterial growth.

Conclusion

Presoaking multifilament and composite mesh in vancomycin solution reduces MRSA bacterial growth. Its implementation may reduce the risk of mesh infection in clean–contaminated cases, although further investigation with human trials should be performed.     

A Silver Ion-doped Calcium Phosphate-based Ceramic Nanopowder-coated Prosthesis Increased Infection Resistance

Background

Despite progress in surgical techniques, 1% to 2% of joint arthroplasties become complicated by infection. Coating implant surfaces with antimicrobial agents have been attempted to prevent initial bacterial adhesion to implants with varying success rates. We developed a silver ion-containing calcium phosphate-based ceramic nanopowder coating to provide antibacterial activity for orthopaedic implants.

Questions/purposes

We asked whether titanium prostheses coated with this nanopowder would show resistance to bacterial colonization as compared with uncoated prostheses.

Methods

We inserted titanium implants (uncoated [n = 9], hydroxyapatite-coated [n = 9], silver-coated [n = 9]) simulating knee prostheses into 27 rabbits’ knees. Before implantation, 5 × 10² colony-forming units of Staphylococcus aureus were inoculated into the femoral canal. Radiology, microbiology, and histology findings were quantified at Week 6 to define the infection, microbiologically by increased rate of implant colonization/positive cultures, histologically by leukocyte infiltration, necrosis, foreign-body granuloma, and devitalized bone, and radiographically by periosteal reaction, osteolysis, or sequestrum formation.

Results

Swab samples taken from medullary canals and implants revealed a lower proportion of positive culture in silver-coated implants (one of nine) than in uncoated (eight of nine) or hydroxyapatite-coated (five of nine) implants. Silver-coated implants also had a lower rate of colonization. No cellular inflammation or foreign-body granuloma was observed around the silver-coated prostheses.

Conclusions

Silver ion-doped ceramic nanopowder coating of titanium implants led to an increase in resistance to bacterial colonization compared to uncoated implants.

Clinical Relevance

Silver-coated orthopaedic implants may be useful for resistance to local infection but will require in vivo confirmation.     

Implant Design Influences Tibial Post Wear Damage in Posterior-stabilized Knees

Background

The tibial post in posterior-stabilized total knees is a potential source of polyethylene wear debris, but the relationship between the shape and location of the tibial post in relation to the tibiofemoral bearing surfaces and the subsequent wear damage patterns remains unknown.

Questions/purposes

We used observations made on retrieved implant components from three contemporary posterior-stabilized knee designs to examine how differences in tibial post design affected wear damage on the post.

Methods

We examined 113 retrieved Zimmer NexGen^®, 103 Exactech Optetrak^®, and 58 Smith and Nephew Genesis^® II posterior-stabilized inserts using a subjective scale to grade post damage.

Results

All 274 inserts demonstrated wear damage. Total wear scores and scores for wear damage on the anterior post differed among designs: Optetrak^® 20 ± 4 and 5 ± 1, NexGen^® 13 ± 4 and 3 ± 1, and Genesis^® II 8 ± 3 and 1 ± 1, respectively. The Optetrak^® had predominantly anterior wear damage, the NexGen^® had more global wear damage, and the Genesis^® II had predominantly posterior wear damage. Tibial post wear damage and anterior post wear damage were primarily determined by implant design and to a lesser extent by length of implantation and revision diagnosis.

Conclusions

Although tibial post wear damage is multifactorial, the primary determinant of wear damage, and specifically anterior wear damage, is implant design.

Clinical Relevance

The constraint provided by the posterior-stabilized post-cam contact in modern knee arthroplasties is reflected in the wear damage patterns that occur during in vivo use. Unintended constraint such as anterior impingement should be addressed through design modifications for future posterior-stabilized knee arthroplasties.     

Predictive performance of eGFR equations in South Africans of African and Indian ancestry compared with 99mTc-DTPA imaging

Background

South African guidelines for early detection and management of chronic kidney disease (CKD) recommend using the Cockcroft?CGault (CG) or Modification of Diet in Renal Disease (MDRD) equations for calculating estimated glomerular filtration rate (eGFR) with the correction factor, 1.212, included for MDRD-eGFR in black patients. We compared eGFR against technetium-99m-diethylenetriaminepentaacetic acid (^99mTc-DTPA) imaging.

Methods

Using clinical records, we retrospectively recorded demographic, clinical, and laboratory data as well as ^99mTc-DTPA-measured GFR (mGFR) results obtained from routine visits. Data from 148 patients of African (n?=?91) and Indian (n?=?57) ancestry were analyzed.

Results

Median (IQR) mGFR was 38.5 (44) ml/min/1.73?m², with no statistical difference between African and Indian patients (P?=?0. 573). In African patients with stage 3 CKD, MDRD-eGFR (unadjusted for black ethnicity) overestimated mGFR by 5.3% [2.0 (16.0) ml/min/1.73?m²] compared to CG-eGFR and MDRD-eGFR (corrected for black ethnicity) that overestimated mGFR by 17.7% [6.0 (15.0) ml/min/1.73?m²] and 17.1% [6.0 (17.5) ml/min/1.73?m²], respectively. In stage 1?C2, CKD eGFR overestimated mGFR by 52.5, 38.0, and 19.3% for CG, MDRD (ethnicity-corrected), and MDRD (without correction), respectively. In Indian stage 3 CKD patients, MDRD-eGFR underestimated mGFR by 35.6% [?21.0 (6.5) ml/min/1.73?m²] and CG-eGFR by 4.4% [?2.0 (27.0) ml/min/1.73?m²], while in stage 1?C2 CKD, CG-eGFR and MDRD-eGFR overestimated mGFR by 13.8 and 6.3%, respectively.

Conclusion

MDRD-eGFR calculated without the African-American correction factor improved GFR prediction in African CKD patients and using the MDRD correction factor of 1.0 in Indian patients as in Caucasians may be inappropriate.     

Effect of Laparoscopic Roux-en-Y Gastroenterostomy with BMI?<?35?kg/m2 in Type 2 Diabetes Mellitus

Background

Roux-en-Y gastric bypass (RGB) has been endorsed by the ??First World Congress on International Therapies for Type 2 diabetes?? as a possible therapeutic option in patients with type 2 diabetes with a body mass index (BMI) of less than 35?kg/m². In the present study, we assessed the improvement in clinical indicators associated with laparoscopic Roux-en-Y gastric bypass (LRYGB) in patients with non-obese type 2 diabetes mellitus (T2DM).

Methods

LRYGB was performed in 30 T2DM patients with a BMI <35?kg/m². The patients were followed up for 1?year. Pre- and postoperative changes in BMI, waist circumference, and biochemical indicators including fasting plasma glucose and glycosylated hemoglobin were recorded.

Results

Significant reduction in glycosylated hemoglobin from 8.02?±?1.77 to 5.59?±?1.02?% (p?Conclusions LRYGB is beneficial for non-obese T2DM patients in China.     

Urinary bacteria in adult women with urgency urinary incontinence

Introduction and hypothesis

This study’s aims were to detect and quantify bacterial DNA in the urine of randomized trial participants about to undergo treatment for urinary urgency incontinence (UUI) without clinical evidence of urinary tract infection (UTI) and to determine if the presence of bacterial DNA in baseline urine relates to either baseline urinary symptoms or UTI risk after urinary tract instrumentation.

Methods

Women without clinical evidence of baseline UTI were randomized to cystoscopic onabotulinum toxin A injection and oral placebo medication versus cystoscopic placebo injection and active oral medication. Bacterial DNA in participants’ catheterized urine was measured by quantitative polymerase chain reaction (qPCR).

Results

Bacterial DNA was detected in the urine of 38.7 % of participants (60 out of 155). In these 60 qPCR-positive participants, baseline daily UUI episodes were greater than in the 95 qPCR-negative participants (5.71 [±2.60] vs 4.72 [±2.86], p?=?0.004). Neither symptom severity by questionnaire nor treatment outcome was associated with qPCR status or with qPCR level in qPCR-positive subjects. In contrast, the presence of urinary bacterial DNA was associated with UTI risk: only 10 % of the qPCR-positive women developed a UTI post-treatment, while 24 % of the qPCR-negative women did so. The median qPCR level for qPCR-positive samples did not differ significantly by UTI status (UTI 2.58?×?10⁵ vs no UTI 1.35?×?10⁵ copies/mL, p?=?0.6).

Conclusions

These results may indicate a urinary bacterial contribution to both baseline UUI and the risk of post-treatment UTI.     

Arm circumference: its importance for dialysis patients in the obesity era

Purpose

The purposes of this study were to investigate the association between arm circumference and body mass index (BMI) and to discuss problems, mainly arm circumference and cuff size mismatch, that could affect the reliability of home blood pressure monitoring (HBPM) among peritoneal dialysis (PD) and hemodialysis (HD) patients.

Methods

525 PD and 502 HD patients from 16 centers were included in the study. A two-part questionnaire was used to gather information from the participants. Arm circumferences were categorized into four groups according to the British Hypertension Society cuff size recommendations.

Results

Mean BMI and arm circumference of all participants were 25.0 kg/m² and 27.6 cm, respectively. There was a significant correlation between BMI and arm circumference. The mean BMI and arm circumference values were higher in PD patients than in HD patients. Requirement of a large-sized adult cuff was more common among PD patients compared to HD patients (14 % vs 8 %, p = 0.002).

Conclusions

Since HBPM is a useful tool for clinicians to improve BP control, nephrologists should be aware of the problems related to HBPM in dialysis patients and take an active role to increase the reliability of HBPM.     

Bacterial prostatitis

Objectives

The prostatitis syndrome is classified into bacterial prostatitis (acute and chronic), chronic pelvic pain syndrome and asymptomatic prostatitis. The aim of this report is to review current management standards for bacterial prostatitis.

Methods

A research was performed on literature dealing with acute and chronic bacterial prostatitis.

Results

There is a consensus on diagnostic management of bacterial prostatitis comprising microbiological sampling of midstream urine in acute bacterial prostatitis and performance of a bacterial localisation test in chronic bacterial prostatitis. Approximately 10 % of acute bacterial prostatitis cases eventually develop into chronic bacterial prostatitis and further 10 % into chronic pelvic pain syndrome. Bacterial isolates causing acute bacterial prostatitis are highly virulent strains comprising an array of different virulence factors. Presumably, the additional ability of isolates to form biofilms might be one factor amongst others to facilitate development of chronic bacterial prostatitis. Therapy for infectious prostatitis is standardised with antibiotics as the primary agents, empirically administered in acute prostatitis and after susceptibility testing in chronic bacterial prostatitis. Fluoroquinolones exhibit more favourable pharmacological properties; therefore, fluoroquinolones have been recommended as first-line agents in the treatment for chronic bacterial prostatitis. Antibiotic resistance to fluoroquinolones, however, is increasing and is posing significant clinical problems. Further studies on alternative antibiotics active within the prostate are therefore needed both for prophylaxis in transrectal prostate biopsy, for example, and for therapy of chronic bacterial prostatitis.

Conclusions

Bacterial prostatitis has developed into well-managed entities with increasing antimicrobial resistance being the most severe drawback of yielding therapeutic success.     

Comparative Evaluation of [99mTc]Tilmanocept for Sentinel Lymph Node Mapping in Breast Cancer Patients: Results of Two Phase 3 Trials

Background

Sentinel lymph node (SLN) surgery is used worldwide for staging breast cancer patients and helps limit axillary lymph node dissection. [^99mTc]Tilmanocept is a novel receptor-targeted radiopharmaceutical evaluated in 2 open-label, nonrandomized, within-patient, phase 3 trials designed to assess the lymphatic mapping performance.

Methods

A total of 13 centers contributed 148 patients with breast cancer. Each patient received [^99mTc]tilmanocept and vital blue dye (VBD). Lymph nodes identified intraoperatively as radioactive and/or blue stained were excised and histologically examined. The primary endpoint, concordance (lower boundary set point at 90 %), was the proportion of nodes detected by VBD and [^99mTc]tilmanocept.

Results

A total of 13 centers contributed 148 patients who were injected with both agents. Intraoperatively, 207 of 209 nodes detected by VBD were also detected by [^99mTc]tilmanocept for a concordance rate of 99.04 % (p < 0.0001). [^99mTc]tilmanocept detected a total of 320 nodes, of which 207 (64.7 %) were detected by VBD. [^99mTc]Tilmanocept detected at least 1 SLN in more patients (146) than did VBD (131, p < 0.0001). In 129 of 131 patients with ≥1 blue node, all blue nodes were radioactive. Of 33 pathology-positive nodes (18.2 % patient pathology rate), [^99mTc]tilmanocept detected 31 of 33, whereas VBD detected only 25 of 33 (p = 0.0312). No pathology-positive SLNs were detected exclusively by VBD. No serious adverse events were attributed to [^99mTc]tilmanocept.

Conclusion

[^99mTc]Tilmanocept demonstrated success in detecting a SLN while meeting the primary endpoint. Interestingly, [^99mTc]tilmanocept was additionally noted to identify more SLNs in more patients. This localization represented a higher number of metastatic breast cancer lymph nodes than that of VBD.     

Short- and long-term efficacy of levamisole in children with steroid-sensitive nephrotic syndrome

Purpose

In this study, we aimed to evaluate short- and long-term effects of levamisole therapy in steroid-sensitive nephrotic syndrome (SSNS) in children.

Methods

The study consisted of 29 SSNS patients who had been treated with levamisole for 12 months. Laboratory values and clinical data were analyzed for three separate periods for each patient: 1 year prior to the initiation of levamisole therapy (Pre-Lev), during 1 year of levamisole therapy (During-Lev), and the year following cessation of levamisole therapy (End-Lev).

Results

The level of proteinuria fell from median 135.0 (24.0–633.0) mg/h/m² Pre-Lev to median 4.4 (2.4–654.0) mg/h/m² During-Lev and median 4.8 (2.2–105.0) mg/h/m² End-Lev (p = 0.0001, for each). Median relapse frequency fell from 4.0 (3.0–8.0) relapses/patient per year Pre-Lev to 0.0 (0.0–2.0) During-Lev (p = 0.0001) with 23/29 patients having no relapse and 0.0 (0.0–1.0) End-Lev (p = 0.0001) with 18/29 patients without relapse. During-Lev, all children had marked diminution in annual steroid burden from a median of 5582.0 (2137.0–17340.0) mg/m² per year Pre-Lev to 2166.0 (840.0–9325.0) mg/m² per year (p = 0.0001). End-Lev, the annual steroid burden also continued to fall, to 0.0 (0.0–5386.0) mg/m² per year (p = 0.0001). The age and duration of NS were significantly higher in the children with relapses than in the children with sustained remission (p = 0.009 and p = 0.014, respectively). The side effects that are expected during levamisole therapy did not occur in our patients.

Conclusion

Thus, our study showed that levamisole is a safe and effective steroid-sparing agent, with long-lasting effect even 12 months after withdrawal.