Primary pelvic hydatid cyst.
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Echinococcosis↗
Biomedical subjects
S Unal
Publications and source records attributed to S Unal.
Treatment of enteric fever with pefloxacin for 7 days versus 5 days: a randomized clinical trial.
In this prospective study of enteric fever, 22 patients received 400 mg of pefloxacin twice daily for 5 days (group A) and 24 received 400 mg of pefloxacin twice daily for 7 days (group B). Causative microorganisms were Salmonella typhi (8 in group A, 11 in group B) and Salmonella paratyphi B (14 in group A, 13 in group B). The clinical cure and bacterial eradication rates were 96% (21 of 22) in group A and 100% in group B. In conclusion, 5-day oral administration of pefloxacin was as effective as 7-day treatment of enteric fever caused by Salmonella spp.
4-Quinolones↗
Esophageal motor dysfunction in chronic renal failure.
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Adult↗
Efficacy of sulbactam-ampicillin for the treatment of severe diabetic foot infections.
Diabetic foot infections, a frequent and serious cause of morbidity in patients with diabetes mellitus, are caused by anaerobic and aerobic bacteria. Given the fact that seriously impaired host defense factors are almost always present in these patients, bactericidal agents with a broad spectrum of antimicrobial activity are required for their treatment. Seventy-four patients with diabetic foot infections were treated with parenteral sulbactam-ampicillin (1.5 g, q.i.d.). All patients were followed-up prospectively in order to determine the efficacy and safety of sulbactam-ampicillin. The mean duration (+/- SD) of treatment in patients with osteomyelitis (n = 49) and soft tissue infections (n = 25) was 41 +/- 5 and 14 +/- 3 days, respectively. Infected limbs were amputated at various levels in 14 patients (19%). Clinical cure rates were 86% and 100% in patients with osteomyelitis and with soft tissue infection, respectively. The most frequent side effect was diarrhea and observed in 10 patients (14%). The results of the present study indicate that sulbactam-ampicillin is safe and effective in the treatment of diabetic foot infections.
Adult↗
Disappearance of the pseudo-cholangiocarcinoma sign after TIPSS.
Bile duct varices, also named the "pseudo-cholangio- carcinoma sign<" are frequently encountered by ERCP in portal hypertension cases due to cavernous transformation of the portal vein. There is a documentation that, in three cases, this sign disappeared after placement of a transjugular intrahepatic portosystemic shunt.
Adult↗
Traumatic spinal cord injuries in Istanbul, Turkey. An epidemiological study.
This is a retrospective study conducted in all of the hospitals of Istanbul to survey new patients with a traumatic spinal cord injury (SCI) in 1992. In that year 152 new traumatic SCI were identified. The estimated annual incidence was 21 per million population. The male/female ratio was 3/1. The mean age was 33, being 34 for male patients and 31 for female patients. 72% of all patients were under the age of forty. The major causes of SCI were falls (43%) and car accidents (41%), followed by being struck by an object (7%), gunshot injury (5%), stab injury (2%). Fifty patients (33%) were tetraplegic and 102 (67%) paraplegic. Regarding the tetraplegic patients the commonest level was C5, in those who were paraplegic L1. There were no cases at levels C1, T1 or T2. The commonest associated injury was head trauma, followed by fractures of an extremity (or extremities). Severe head trauma, as a major cause of death, may obscure the actual incidence of SCI in this study. Accidental falls (exceeding road accidents) were mostly due to falls from buildings and accidents on work premises.
Accidental Falls↗
Aortic insufficiency and enterococcal endocarditis complicating systemic lupus erythematosus.
A case of aortic valve replacement for aortic insufficiency complicated with enterococcal endocarditis in a patient with systemic lupus erythematosus (SLE) is described. The cardiac complications of SLE may involve the endocardium, myocardium, pericardium, and coronary vessels. Steroids which are used for treatment probably increase the incidence of valve incompetence. Aortic insufficiency or infective endocarditis complicating Libman-Sacks endocarditis is rarely observed and may require valve replacement. Echocardiography is an important diagnostic tool. Renal function, pulmonary status, and cerebral complications require special attention in these patients.
Adult↗
Characterization of vancomycin resistance in Enterococcus durans.
During investigation of an outbreak of vancomycin resistant Enterococcus faecium in a paediatric hospital, an isolate of Enterococcus durans resistant to vancomycin, teicoplanin, ampicillin and highly resistant to gentamicin and streptomycin was found in the stools of a patient also colonized with a strain of E. faecium with the same resistance pattern. Minimal inhibitory concentrations of vancomycin and teicoplanin were 512 and 64 mg/mL, respectively. Resistance to vancomycin as well as high-level resistance to gentamicin was transferable to an E. faecium recipient strain. Both multiresistant E. faecium and E. durans isolates as well as the transconjugant presented only one plasmid. The vanA gene was detected and localized to the high molecular weight plasmid by DNA hybridization with a vanA gene probe. Growth in vancomycin resulted in induction of an approximately 40 kDa protein visible in membrane preparations from these cells. Genetic linkage between vancomycin and gentamicin resistance genes in the same plasmid is suggested.
Anti-Bacterial Agents↗
Tc-99m MIBI accumulation in remnant thymus. A cause of false-positive interpretation in parathyroid imaging.
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Adenoma↗
Tc-99m nanocolloid and Tc-99m MDP three-phase bone imaging in osteomyelitis and septic arthritis. A comparative study.
The aim of this study was to compare Tc-99m nanocolloid scintigraphy with Tc-99m MDP bone imaging in the diagnosis of osteomyelitis and septic arthritis. Overall, 31 Tc-99m MDP bone scans and 39 Tc-99m nanocolloid studies were performed in 34 patients (15 female, 19 male; mean age, 14.88 years +/- 19.00 years) who were suspected of osteomyelitis and/or septic arthritis. The final diagnoses were established by needle aspiration, cultures, radiography, clinical course, and, in some patients, with CT, ultrasonography, and biopsy. The sensitivity, specificity, and accuracy were 100%, 75%, and 92%, respectively for both Tc-99m MDP and Tc-99m nanocolloid scans in detecting osteomyelitis. For septic arthritis, Tc-99m MDP bone imaging showed 100%, 85%, and 94%, and Tc-99m nanocolloid scans showed 90%, 59%, and 76%, sensitivity, specificity, and accuracy, respectively. These results show that, although both scans are in good agreement for osteomyelitis, for septic arthritis nanocolloid is not specific enough to recommend it to be a complementary method to MDP bone scans.
Adolescent↗
Comparison of renal perfusion indices in captopril scintigraphy.
Perfusion indices used in renal scintigraphy were adapted to captopril-enhanced renal scintigraphy in order to determine if these parameters have any value in differentiating patients with renovascular hypertension (RVH) from normal subjects. Regions of interest (ROIs) were chosen over the aorta and kidneys, and time-activity curves generated. The ratio of integrated aortic counts to renal counts, from the time of injection to arterial peak, was calculated. The difference in the value of this index between captopril and basal scintigraphies was -17 +/- 12 and -16 +/- 13 for the right and left kidneys, respectively, in the group of patients with essential hypertension, whereas in the patients with renovascular hypertension, these values were 24 in the stenotic and 14 in the non-stenotic kidney. This parameter is useful for separating patients with RVH from normal subjects.
Adult↗
False-positive uptake of Tc-99m penta-DMSA in fibrous dysplasia of breast in a patient with medullary carcinoma of thyroid.
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Adrenal Gland Neoplasms↗
Comparison of tests for detection of methicillin-resistant Staphylococcus aureus in a clinical microbiology laboratory.
By microdilution testing, 186 of 1,450 clinical isolates of Staphylococcus aureus were preliminarily classified as oxacillin resistant (MIC > or = 4 micrograms/ml); 15 of these isolates gave conflicting results by alternative methods and were studied further. Only 2 of these (MIC > 4 micrograms/ml) were mecA positive; 13 were inhibited by oxacillin at 4 micrograms/ml. Significant numbers of S. aureus strains classified as resistant with an oxacillin MIC of 4 micrograms/ml may prove susceptible by other methods.
Base Sequence↗
Site-directed mutagenesis of the mecA gene from a methicillin-resistant strain of Staphylococcus aureus.
The mecA-27r gene from Staphylococcus aureus 27r encodes penicillin-binding protein 2a (PBP2a-27r), which causes this strain to be methicillin resistant. Removal or replacement of the N-terminal transmembrane domain had no effect on binding of penicillin, but removal of portions of the putative transglycosylase domain (144, 245, or 341 amino acids after the transmembrane region) destroyed penicillin-binding activity. The SXXK, SXN, and KSG motifs, present in all penicillin-interacting enzymes, were found in the expected linear spatial arrangement within the putative transpeptidase region of PBP2a-27r. Alterations of amino acids in all three of these motifs resulted in elimination of penicillin-binding activity, confirming their roles in the interaction with penicillin.
Amino Acid Sequence↗
The value of captopril renal scintigraphy in assessing the results of percutaneous transluminal renal angioplasty and in following up renovascular hypertension--a case report.
Percutaneous transluminal renal angioplasty (PTRA) was performed in a patient with bilateral renal artery stenoses diagnosed noninvasively by captopril renal scintigraphy and confirmed by renal arteriography. The captopril renal scintigraphy parameters returned to normal in correlation with improved blood pressure response fifteen days after PTRA. Five months later hypertension reappeared and the repeated captopril renal scintigraphy suggested left renal artery stenosis. PTRA was repeated and a stent was implanted with reversal of blood pressure, and captopril renal scintigraphy findings returned to normal levels. Six months after second PTRA, the blood pressure increased to hypertensive levels, and captopril renal scintigraphy indicated left renal artery stenosis. The renal arteriography, however, revealed a new stenosis at the left renal artery ostium. The PTRA with a second stent implantation was performed successfully. The captopril renal scintigraphic parameters and the blood pressure were again normalized after the last intervention and remained normal for thirteen months of follow-up.
Angioplasty, Balloon↗
In-vitro synergy and mechanism of interaction between vancomycin and ciprofloxacin against enterococcal isolates.
In-vitro synergy between vancomycin and ciprofloxacin against 44 enterococcal isolates was studied. Synergy occurred in chequerboard MIC determinations with six Enterococcus faecium strains resistant to both vancomycin and ciprofloxacin. The combination was additive for strains susceptible to one or both antibiotics. Time-kill studies involving selected strains with different susceptibility patterns confirmed the chequerboard results. The effect of ciprofloxacin on the induction of vancomycin resistance was compared in two vancomycin-resistant strains of E. faecium. Sub-inhibitory concentrations of ciprofloxacin prevented induction of vancomycin resistance in a ciprofloxacin-resistant strain, but not in a ciprofloxacin-susceptible strain. Membranes isolated from vancomycin-resistant ciprofloxacin-resistant cultures grown with vancomycin and ciprofloxacin at < or = 8 mg/L (0.125 x MIC) expressed a 39.5-kDa membrane protein involved in the expression of vancomycin resistance, but the protein was not detected in membranes from cultures grown in ciprofloxacin 16 mg/L. These findings indicated that a vancomycin-ciprofloxacin combination can be synergic against enterococci resistant to both vancomycin and ciprofloxacin, but would be unlikely to offer any advantage in the treatment of enterococcal infections because of the high concentrations required.
Bacterial Outer Membrane Proteins↗
A gene conferring resistance to vancomycin but not teicoplanin in isolates of Enterococcus faecalis and Enterococcus faecium demonstrates homology with vanB, vanA, and vanC genes of enterococci.
We report the sequence of a 630-bp fragment of a gene associated with resistance to high levels of vancomycin in a clinical isolate of Enterococcus faecalis which retained susceptibility to teicoplanin. This gene was similar to the recently sequenced vanB and partially homologous with vanA, but it showed less-marked similarity to vanC. A DNA probe, derived from this polymerase chain reaction-amplified gene fragment, hybridized specifically with genomic DNA from Enterococcus faecium and E. faecalis isolates which were vancomycin resistant (MICs ranged from 8 to 512 micrograms/ml) but susceptible to teicoplanin. Curing of vancomycin resistance was associated with loss of DNA hybridization with the gene probe. Transfer of DNA which hybridized with the probe accompanied transfer of vancomycin resistance to a susceptible recipient strain. Neither curing nor transfer of vancomycin resistance was consistently related to loss or acquisition, respectively, of plasmid DNA.
Amino Acid Sequence↗
Quinolones in treatment of human brucellosis: comparative trial of ofloxacin-rifampin versus doxycycline-rifampin.
Quinolones have been reported to be active against Brucella species in vitro. In this prospective randomized study, the efficacy and safety of the combination of ofloxacin plus rifampin were compared with the efficacy and safety of doxycycline plus rifampin, both combinations administered for a 6-week period in treatment of brucellosis. Sixty-one patients were enrolled in the study, and 49 had blood or bone marrow cultures positive for Brucella melitensis. Thirty patients received 200 mg of doxycycline plus 600 mg of rifampin once daily, and 31 patients were treated with 400 mg of ofloxacin plus 600 mg of rifampin once daily for 6 weeks. Nine patients in each group had complications of the disease. There was one therapeutic failure in the ofloxacin-rifampin treatment group, and one patient from each group relapsed (3.3% of those in the doxycycline-rifampin treatment group versus 3.2% of those in the ofloxacin-rifampin treatment group). Gastric discomfort was the major side effect observed in 13 patients (43.3%) who received doxycycline plus rifampin, whereas only 2 patients (6.5%) treated with ofloxacin plus rifampin complained of gastric irritation. These results suggest that the combination of ofloxacin plus rifampin administered for 6 weeks is as effective as doxycycline plus rifampin given for the same period, regardless of the presence of complications of the disease.
Adolescent↗