Peritonitis is a common and potentially serious infection in patients undergoing continuous ambulatory peritoneal dialysis (CAPD). The most common organisms usually associated with CAPD peritonitis are Staphylococcus aureus and Staphylococcus epidermidis. Rarely, aerobic gram negative bacilli have been the causative agents of CAPD peritonitis. The treatment of CAPD peritonitis requires removal of the peritoneal catheter and treatment with parenteral antibiotics active against the causative pathogen. While hospitalized for CAPD peritonitis, a 55-year-old man on CAPD had nosocomial peritonitis secondary to infection by ESBL-producing E.coli, that was sensitive to imipenem and meropenem. He was treated successfully with a 4-week course of intraperitoneal meropenem therapy without subsequent relapse, loss of peritoneal catheter, ultrafiltration failure, or dialysis inadequacy.
Anti-Bacterial Agents ; Catheters ; Dialysis ; Escherichia coli ; Humans ; Imipenem ; Peritoneal Dialysis ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis ; Recurrence ; Staphylococcus aureus ; Staphylococcus epidermidis ; Thienamycins ; Ultrafiltration

PURPOSE: The aim of this study was to examine the effects of systematic information on maternal attachment, parenting stress and maternal confidence of mothers of premature infants. METHODS: Using a non-equivalent control group pre-post quasi-experimental design, 42 participants were assigned to one of two groups, an experimental group (n=20), which received systematic information; and a control (n=22), which received the usual discharge education. Prior to the intervention, baseline data were collected (pretest) and then the systematic information was provided four times for the experimental group. Maternal attachment, parenting stress and maternal confidence were measured. Data were collected three times: Seven to 10 days prior to discharge, day of discharge, and two weeks after discharge. RESULTS: Mothers in the experimental group had significantly higher scores in maternal attachment (F=6.16, p=.005), lower parenting stress scores (F=5.56, p=.004), and higher scores for maternal confidence (F=16.50, p<.001) than mothers in the control group. These tendencies were progressively enhanced even two weeks after discharge from the hospital. CONCLUSION: The results indicate that provision of systematic information to mothers with premature infants is an effective intervention to enhance mothers' maternal attachment, decrease parenting stress, and enhance maternal confidence.
Humans ; Infant, Newborn ; Infant, Premature ; Mothers ; Parenting ; Parents

No Abstract Available.
Humans

The deletion 9p syndrome is a well characterized syndrome with about one hundred cases having been reported. Most patients have dysmorphic facial features, cardiac anomalies, and mental retardation. We report on a female infant with micrognathia, corneal opacity, cleft palace, cardiac anomaly, left polycystic kidney, and deletion 9p. Chromosome analysis and fluorescence in situ hybridization (FISH) showed her to have a derived chromosome 9 inherited from a maternal t(9;16) (p22;p13.2) by adjacent I segregation There are few reports of this particular chromosome rearrangement. We review deletion Sp syndrome.
Chromosomes, Human, Pair 9 ; Corneal Opacity ; Female ; Fluorescence ; Humans ; In Situ Hybridization ; Infant ; Intellectual Disability ; Polycystic Kidney Diseases

Intravascular catheter embolism is common and the most important complication of subclavian catheterization. The catheter fragment can lead to pulmonary embolism, vascular perforation, sepsis, arrhythmia, and even death. The intravascular foreign body can be removed using surgical or non-surgical methods. With technological advances, the percutaneous retrieval of intravascular foreign bodies has become a relatively common procedure. A commonly used method for retrieving intravascular foreign bodies is the loop snare. Sometimes biopsy forceps can be used. We experienced a case of non-surgical retrieval of an intravascular foreign body. We used the standard loop snare technique to remove a 5-cm catheter fragment from the left pulmonary artery.
Arrhythmias, Cardiac ; Biopsy ; Catheterization ; Catheters ; Embolism ; Foreign Bodies ; Pulmonary Artery ; Pulmonary Embolism ; Sepsis ; SNARE Proteins ; Surgical Instruments

Pigmented squamous cell carcinoma is a very rare malignant, pigmented, epidermal tumor. The rarity of pigmented squamous cell carcinomas may reflect in part their misdiagnosis as other pigmented neoplasms, particularly malignant melanoma. To our knowledge, only five cases have been reported in literature. We recently experienced a case of pigmented squamous cell carcinoma arising from pigmented actinic keratosis in a 77 years old female. Physical examination showed a 0.8 0.6 cm, smooth, dark brown pigmented patch with irregular but sharply defined borders located on the upper left chest. The biopsy specimen showed histologic findings of pigmented actinic keratosis with abundant melanin pigments, which became pigmented squamous cell carcinoma. Most of pigments in the squamous cell carcinoma were contained within the melanocytes along with the neoplastic squamous cells.
Actins* ; Aged ; Biopsy ; Carcinoma, Squamous Cell* ; Diagnostic Errors ; Female ; Humans ; Keratosis, Actinic* ; Melanins ; Melanocytes ; Melanoma ; Physical Examination ; Skin ; Thorax

INTRODUCTIONWe aimed to determine the impact of diabetes mellitus (DM) on long-term survival after coronary artery bypass grafting (CABG) in patients with multivessel coronary artery disease.

MATERIALS AND METHODSA retrospective review was conducted for 5720 consecutive patients who underwent isolated first CABG between 1982 and 1999. Outcomes were reviewed to include in-hospital mortality and long-term survival. Mean follow-up was 13.0 ± 5.8 years. To obtain comparable subgroups, 561 diabetic patients were matched with 561 non-diabetic controls based on estimated propensity scores.

RESULTSMean age was 59.3 ± 9.1 years with 4373 (76.5%) males. Amongst 5720 patients, 1977 (34.6%) had DM. Hypertension and dyslipidaemia were the most common cardiovascular comorbidities, present in 2920 (51.0%) and 2664 patients (46.6%) respectively. Emergency surgery was performed in 563 patients (9.8%). In-patient mortality occurred in 115 patients (2.0%), 48 (2.4%) in the DM group and 67 (1.8%) in the non-DM group, (P = 0.102). In the unmatched cohort, overall 20-year survival rates were 30.9 ± 1.6% in diabetics and 49.2 ± 1.0% in non-diabetics (P <0.001). Freedom from cardiac mortality at 20 years was 56.0 ± 2.0% in diabetics and 68.4 ± 1.0% in non-diabetics (P <0.001). In the propensity-matched group, overall 20-year survival rates were 35.4 ± 2.5% in diabetics and 48.9 ± 2.9% in non-diabetics (P <0.001). Freedom from cardiac mortality at 20 years was 57.8 ± 3.0% in diabetics and 70.2 ± 2.9% in non-diabetics (P = 0.001). Multivariable Cox regression analysis identified age (hazard ratio (HR): 1.03/year), female gender (HR: 1.43), DM (HR: 1.51), previous myocardial infarction (HR: 1.54) and left ventricular ejection fraction (LVEF) <35% (HR: 2.60) as independent factors influencing long-term cardiac mortality.

CONCLUSIONDespite low operative mortality, long-term survival and freedom from cardiac death are significantly lower in patients with DM compared to non-diabetics. Aggressive treatment of DM, cardiovascular comorbidities and smoking cessation are essential to improve long-term survival in diabetic patients.

Age Factors ; Aged ; Awards and Prizes ; Case-Control Studies ; Comorbidity ; Coronary Artery Bypass ; Coronary Artery Disease ; epidemiology ; surgery ; Diabetes Mellitus ; epidemiology ; Dyslipidemias ; epidemiology ; Female ; Follow-Up Studies ; Hospital Mortality ; Humans ; Hypertension ; epidemiology ; Male ; Middle Aged ; Multivariate Analysis ; Myocardial Infarction ; epidemiology ; Prognosis ; Propensity Score ; Proportional Hazards Models ; Retrospective Studies ; Sex Factors ; Singapore ; epidemiology ; Stroke Volume

Steroid cell tumor, not otherwise specified (NOS), are rare ovarian tumor, in addition, it is more rare in children. The majority of these tumors produce several steroid hormones, particularly testosterone. Estrogen also secreted by steroid cell tumor, NOS, but it is uncommon. Furthermore, hypertension is an infrequent sign in steroid cell tumor, NOS. An 8.5-yr-old girl with hypertension and frequent vaginal spotting visited at our clinic. On laboratory evaluation, secondary hypertension due to an elevated plasma renin level and isosexual pseudoprecocious puberty was diagnosed. Right solid ovarian mass was detected in radiologic tests. She underwent a right ooporectomy and it revealed renin and progesterone receptor positive steroid cell tumor, NOS. After operation, her blood pressure returned to normal level and vaginal bleeding disappeared. Even though this case is very rare, when hypertension coincides with virilization or feminization, a renin-secreting ovarian steroid cell tumor, NOS, should be considered.
Child ; Female ; Humans ; Hypertension/*etiology ; Ovarian Neoplasms/complications/*diagnosis/pathology ; Puberty, Precocious/enzymology/*etiology ; Receptors, Cell Surface/metabolism ; Receptors, Progesterone/metabolism ; Renin/blood ; Sex Cord-Gonadal Stromal Tumors/complications/*diagnosis/pathology ; Steroids/biosynthesis ; Tomography, X-Ray Computed ; Vacuolar Proton-Translocating ATPases/metabolism

BACKGROUND: The primary outcome of sugammadex reversal for rocuronium-induced neuromuscular block (NMB) is a train-of-four ratio (TOFR) of 0.9, not first twitch (T1) height. We investigated whether the recovery of TOFR or T1 differs based on the reversal of NMB with neostigmine or sugammadex. METHODS: The acceleromyographic responses from 0.6 mg/kg of rocuronium were monitored supramaximally in 80 patients after induction of anesthesia. The TOFR and T1 height were recorded, and saved in a personal computer using TOF-Watch SX Monitor software in all patients. Patients were randomly assigned to 2 groups to receive either neostigmine 50 µg/kg with glycopyrrolate 10 µg/kg (neostigmine group, n = 40) or sugammadex 2.0 mg/kg (sugammadex group, n = 40). The primary objective was to determine the difference of recovery time between TOFR to 0.9 and T1 to 0.9 after sugammadex or neostigmine administration during moderate rocuronium-induced NMB. RESULTS: The recovery pattern of the TOFR 2 min after sugammadex administration was 1.0 or more, but that of T1 was less than 90% (T1 / control value) up to 6 min after drug was injected. The recovery pattern of TOFR and T1 was similar during the 20 min after reversal with neostigmine. CONCLUSIONS: If you have not performed the T1 monitoring, both TOFR and T1 should be considered to confirm suitable recovery during the 6 min after reversal with sugammadex during rocuronium-induced moderate NMB.
Anesthesia ; Depression* ; Glycopyrrolate ; Humans ; Microcomputers ; Neostigmine ; Neuromuscular Blockade* ; Neuromuscular Monitoring

Although anaphylactic shock during the perioperative period is rare, it can be lethal due to severe cardiovascular and respiratory collapse. Midazolam is generally used as premedication for relieving anxiety about the operation, and the danger of anaphylactic shock after intramuscular injection is not widely recognized. We report the first case of anaphylactic shock occurring during the perioperative period after intramuscular injection of midazolam. Since anaphylactic shock after intramuscular injection can be of slow onset, the operation should be delayed if an anaphylactic reaction is suspected, even if the symptoms are limited. In addition, anesthesiologists should be prepared for the occurrence of anaphylaxis at any time in the perioperative period.
Anaphylaxis* ; Anxiety ; Injections, Intramuscular* ; Midazolam* ; Perioperative Period* ; Premedication