ЛИХОРАДКА, АССОЦИИРОВАННАЯ С МЕТАЛЛОКОНСТРУКЦИЕЙ. КЛИНИЧЕСКОЕ НАБЛЮДЕНИЕ

Metal constructions can cause fever even after a few years post implantation. This paper describes a case of 27 year old female with a fever associated with titanium construction implanted for kyphoscoliosis. 3 years post-operatively she developed afever (up to 39°С) and associated back pain. Examination revealed a hepatomegaly and lymphadenopathy (cervical and inguinal groups). Other investigations showed: neutrophilic leukocytosis (16×109\L), thrombocytosis (620×109\L), elevation of the C-reactive protein (76 ng/ml), ESR (62 mm/h) and ferritin (1615 ng/ml). There were no features of infection, connective tissue disease or hemoblastosis. A short course of therapy with methylprednisolone led to transient improvement. The metal device was surgically removed which caused an immediate elimination of fever and subsequent resolution of leukocytosis, thrombocytosis, lymphadenopathy and hepatomegaly.Металлоконструкции могут быть причиной фебрильной лихорадки даже спустя много лет после установки. В статье приведено клиническое наблюдение ассоциации лихорадки с металлоконструкцией, установленной по поводу кифосколиоза. Пациентке в возрасте 27 лет установлена торакоабдоминальная металлоконструкция. Спустя 3 года появилась фебрильная лихорадка до 39°С, возобновилась боль по ходу позвоночника, также возникли и сохранялись в течение последующих 3 месяцев нейтрофильный лейкоцитоз до 16 тыс./мкл, тромбоцитоз до 620 тыс./мкл, повышение С-реактивного белка до 76 мг/л, СОЭ до 62 мм/ч, ферритина до 1615 нг/мл, гепатомегалия, шейная и паховая лимфаденопатия. Данных в пользу инфекции, коллагеноза, гемобластоза не выявлено. Короткий курс терапии метилпреднизолоном привел к временному улучшению общего самочувствия. Металлоконструкция была удалена. Лихорадка на следующий день после операции разрешилась. Тромбоцитоз, нейтрофильный лейкоцитоз, органомегалия и лимфаденопатия регрессировали позже

Fever associated with metal device. Case report

Metal constructions can cause fever even after a few years post implantation. This paper describes a case of 27 year old female with a fever associated with titanium construction implanted for kyphoscoliosis. 3 years post-operatively she developed afever (up to 39°С) and associated back pain. Examination revealed a hepatomegaly and lymphadenopathy (cervical and inguinal groups). Other investigations showed: neutrophilic leukocytosis (16×109\L), thrombocytosis (620×109\L), elevation of the C-reactive protein (76 ng/ml), ESR (62 mm/h) and ferritin (1615 ng/ml). There were no features of infection, connective tissue disease or hemoblastosis. A short course of therapy with methylprednisolone led to transient improvement. The metal device was surgically removed which caused an immediate elimination of fever and subsequent resolution of leukocytosis, thrombocytosis, lymphadenopathy and hepatomegaly

Knowledge and preferences regarding cardiopulmonary resuscitation:A survey among older patients

Objective: Survival rates following cardiopulmonary resuscitation (CPR) are low for older people, and are associated with a high risk of neurological damage. This study investigated the relationship between the preferences, knowledge of survival chances, and characteristics among older people regarding CPR.Methods: A cross-sectional, self-administrated survey was distributed by researchers to 600 patients aged at least 50 years. The 14-question survey tool was used to collect basic demographic data, knowledge about CPR, and preference for CPR. We performed binary logistic regression analysis to predict whether patients wanted to receive CPR or not.Results: The response rate was 48%. Most respondents (84%) predicted the estimated survival rate to be higher than the actual rate. Patients were significantly less likely to want to receive CPR if they correctly estimated the survival rate, had ever contemplated CPR, were older, or female. Discussing CPR with a doctor had no influence on patient preference for CPR.Conclusion: Older patients choose to receive CPR based on incorrect knowledge.Practice implications: Doctors should be aware of the impact of knowing the true chances of survival on patient preference for CPR. Knowledge and skills need to be updated to provide this information to patients. (C) 2015 Elsevier Ireland Ltd. All rights reserved.</p

Гистиоцитоз X легких из клеток Лангерганса

Out of the 75 cases of pulmonary histiocytosis X from Langerhans’ cells under study, the diagnosis found morphological proof in 54. Alongside cytological and hystological tests, we also recurred to electronic microscopic studies, and cell immunotyping with KP-1 (CD-68), MAC-387, and S-100 protein — specific markers of histiocytosis X. This diagnosis is considered proved only when specific markers (Birbeck bodies) and/or the characteristic immunochemical markers of Langerhans’ cells — KP-1 (CD-68) and S-100 protein — are identified in the macrophages of lesion sites.Изучено 75 случаев гистиоцитоза X легких из клеток Лангерганса; в 54 случаях диагноз подтвержден морфологически. Помимо цитологического и гистологического исследований, применялись электронно-микроскопическое исследование и иммунотипирование клеток с антителами KP-1 (CD-68), MAC-387, S- 100-протеин, которые являются специфическими маркерами гистиоцитоза X. Диагноз гистиоцитоза X считается доказанным лишь при идентификации в макрофагах из очагов поражения специфических маркеров (гранул Бирбека) и/или характерных иммунохимических маркеров клеток. Лангерганса: KP-1 (CD-68), S- 100-протеин

Association of environmental surface contamination with hand hygiene and infections in nursing homes:a prospective cohort study

Background: Little is known about the presence of infections in nursing home residents, the causative micro-organisms, how hand hygiene (HH) influences the presence of infections in residents, and the extent to which environmental contamination is associated with the incidence of infection among residents. Aims: To establish if environmental contamination can be used as an indicator for HH compliance, and if environmental contamination is associated with the incidence of infection. Methods: Environmental surface samples (ESS) were collected in an exploratory study as part of a HH intervention in 60 nursing homes. ESS results from three distinct surfaces (nurses' station, communal toilet and residents' shared living area) were compared with nurses' HH compliance and the incidence of infection among residents. Real-time polymerase chain reaction assays were used to detect norovirus genogroup I and II, rhinovirus and Escherichia coli. HH compliance was measured by direct observation. The incidence of infection was registered weekly. Findings: Rhinovirus (nurses' station: 41%; toilet: 14%; living area: 29%), norovirus (nurses' station: 18%; toilet: 12%; living area: 16%) and E. coli (nurses' station: 14%; toilet: 58%; living area: 54%) were detected. No significant (P<0.05) associations were found between HH compliance and the presence of micro-organisms. An association was found between E. coli contamination and the incidence of disease in general (P=0.04). No other associations were found between micro-organisms and the incidence of disease. Conclusion: Rhinovirus, norovirus and E. coli were detected on surfaces in nursing homes. No convincing associations were found between environmental contamination and HH compliance or the incidence of disease. This study provides reference data about surface contamination