Systemic antibiotic therapy does not significantly improve outcome in a rat model of implant-associated osteomyelitis induced by Methicillin susceptible Staphylococcus aureus.

Introduction: Treatment of implant-associated osteomyelitis regularly involves the use of systemic antibiotics in addition to surgical intervention. However, it remains unclear if perioperative systemic application of bactericide substances can improve overall outcome in models of severe intramedullary infection. The present study investigated the use of systemic gentamicin in addition to a controlled local release from a highly lipophilic gentamicinpalmitate compound while the previous study showed efficacy of sole antibiotic implant-coating.

Coating with a novel gentamicinpalmitate formulation prevents implant-associated osteomyelitis induced by methicillin-susceptible Staphylococcus aureus in a rat model.

Purpose: Implant-associated osteomyelitis still represents a demanding challenge due to unfavourable biological conditions, bacterial properties and incremental resistance to antibiotic treatment. Therefore different bactericide or bacteriostatic implant coatings have been developed recently to control local intramedullary infections. Controlled local release of gentamicin base from a highly lipophilic gentamicin palmitate compound achieves extended intramedullary retention times and thus may improve its bactericide effect.

[Opiate dependent pregnant patients and mothers. What must be regarded in drug substitution and detoxification].

Substitution treatment with methadone, is a major addition to the therapeutic options available to opiate-dependent patients. In the case of opiate-dependent pregnant women and mothers with children, however, it brings other problems with it. Thus, for example, cases of methadone poisoning of children have become known.

Spontaneous obliteration of a pseudo-aneurysm complicating an aortic homograft.

Pseudoaneurysm formation after aortic homograft replacement in patients with active endocarditis is a common observation and usually occurs at the site of a former abscess or paravalvular leak in case of prosthetic valve endocarditis. A 53-year-old man with prosthetic endocarditis underwent aortic valve homograft replacement and developed a pseudoaneurysm at the right and noncoronary aortic sinus which was documented by Doppler echocardiography. Follow-up examination ten months after operation unexpectedly revealed a complete obliteration of the previously echo free space between the homograft and the native aortic root and, thus, spontaneous obliteration of the pseudoaneurysm.

Differentiation between systolic and diastolic dysfunction.

Left ventricular (LV) failure can be divided into systolic and diastolic dysfunction. The former is characterized by a reduced ejection fraction and an enlarged LV chamber, the latter by an increased resistance to filling with increased filling pressures. Systolic dysfunction is clinically associated with left ventricular failure in the presence of marked cardiomegaly, while diastolic dysfunction is accompanied by pulmonary congestion together with a normal or only slightly enlarged ventricle.

[Neuroendocrine tumors of the stomach (stomach carcinoid)].

We report about two patients with gastric neuroendocrine tumours (carcinoids) and chronic atrophic gastritis. A 68-year-old woman presented with nonspecific dyspeptic complaints. Gastroscopy revealed a single neuroendocrine tumour of the corpus.

[Left ventricular insufficiency: systolic versus diastolic dysfunction].

Left ventricular failure has been subdivided into different forms. Systolic pump failure (= systolic dysfunction) and diastolic filling failure (= diastolic dysfunction) are important entities in the overall framework of heart failure. The clinical patterns of both are presented in light of 2 case reports: systolic dysfunction involves the combination of left ventricular failure, cardiomegaly and depressed systolic ejection fraction.

[Lupus erythematosus in old age].

Over a period of 2 months an 88-year-old man developed progressively more severe breathing-related pain under the right shoulder blade, loss of appetite, general weakness, depressive mood, sub-febrile temperature and nocturnal sweating. Various inflammation parameters were raised (sedimentation rate 43 mm in the first hour; C-reactive protein 26 mg/dl; white cell count 12,500/microliters). There also were pleural effusion and signs of mild nonspecific hepatitis.

Hypersensitivity to molybdenum as a possible trigger of ANA-negative systemic lupus erythematosus.

After implantation of two metal plates a 24 year old woman developed fever of unknown origin and successively more symptoms of an ANA-negative systemic lupus erythematosus (SLE). These symptoms resolved after removal of the plates and recurred during patch testing of the metal components, which showed a reaction to molybdenum. A lymphocyte transformation test indicated a delayed-type hypersensitivity to molybdenum.

[Postoperative tetanus].

12 days after an operation for pericaecal abscess due to perforation of the appendix, a 57-year-old man developed severe tetanus requiring mechanical ventilation for 37 days. Additional complications--pneumonia with septicaemia, disseminated intravascular coagulopathy, prolonged renal failure--were controlled by intensive medical measures. The tetanus was most likely of endogenous origin: Clostridium tetani occurs as a saprophyte in the gastrointestinal tract.