Long-term follow-up and residual sequelae after treatment for intracerebral germ-cell tumour in children and adolescents

Background: Information on long-term follow-up of children and adolescents treated for intracerebral germ-cell tumour is scant. We report on the results of a small series of patients treated at a single institution. Patients and methods: Hospital records from 15 patients treated between 1980 and 1998 were reviewed. An attempt was made to correlate sequelae to tumour location and treatment modalities. Results: This cohort constitutes 5.5% of all brain tumours diagnosed at our institution. Histology: 10 germinomas, 2 benign teratomas, 2 malignant teratomas, and one mixed germ-cell tumour. Overall survival was 87%, with a mean follow-up time of 7 years and 8 months. The majority of patients have long-term sequelae involving one or several organ systems. In 66% endocrine, in 47% ophthalmologic, in 60% neuropsycho-logical defects were observed. Endocrine and ophthalmologic sequelae show a correlation to tumour location. Neuropsycho-logical long-term abnormalities are frequent and are associated with cranial irradiation in particular at young age, but less with tumour location, irradiation dose or surgery. Conclusions: Our preliminary data suggest that today intracerebral germinomas and mature teratomas have a good prognosis even when a relapse occurs. The outcome for mixed germ-cell tumours and malignant teratomas is less favourable. Although long-term sequelae are present in the majority of patients, there is some evidence that patients treated after 1990 suffer fewer severe long-term defects, thereby indicating that recent treatment protocols may result in a reduction of sequela

Comparison of hospital-wide and unit-specific cumulative antibiograms in hospital- and community-acquired infection

Background: Empirical antibacterial therapy in hospitals is usually guided by local epidemiologic features reflected by institutional cumulative antibiograms. We investigated additional information inferred by aggregating cumulative antibiograms by type of unit or according to the place of acquisition (i.e. community vs. hospital) of the bacteria. Materials and methods: Antimicrobial susceptibility rates of selected pathogens were collected over a 4-year period in an university-affiliated hospital. Hospital-wide antibiograms were compared with those selected by type of unit and sampling time (48h after hospital admission). Results: Strains isolated >48h after admission were less susceptible than those presumably arising from the community (48h after admission. When compared to hospital-wide antibiograms, susceptibility rates were lower in the ICU and surgical units for Escherichia coli to amoxicillin-clavulanate, enterococci to penicillin, and Pseudomonas aeruginosa to anti-pseudomonal beta-lactams, and in medical units for Staphylococcus aureus to oxacillin. In contrast, few differences were observed among strains isolated within 48h of admission. Conclusions: Hospital-wide antibiograms reflect the susceptibility pattern for a specific unit with respect to community-acquired, but not to hospital-acquired strains. Antibiograms adjusted to these parameters may be useful in guiding the choice of empirical antibacterial therap

Intra-hospital differences in antibiotic use correlate with antimicrobial resistance rate in <i>Escherichia coli</i> and <i>Klebsiella pneumoniae</i>: a retrospective observational study.

Monitoring antimicrobial use and resistance in hospitals are important tools of antimicrobial stewardship programs. We aimed to determine the association between the use of frequently prescribed antibiotics and the corresponding resistance rates in &lt;i&gt;Escherichia coli&lt;/i&gt; and &lt;i&gt;Klebsiella pneumoniae&lt;/i&gt; among the clinical departments of a tertiary care hospital. We performed a retrospective observational study to analyse the use of nine frequently prescribed antibiotics and the corresponding antimicrobial resistance rates in hospital acquired &lt;i&gt;E. coli&lt;/i&gt; and &lt;i&gt;K. pneumoniae&lt;/i&gt; isolates from 18 departments of our institution over 9 years (2008-2016). The main cross-sectional analysis assessed the hypothetical influence of antibiotic consumption on resistance by mixed logistic regression models. We found an association between antibiotic use and resistance rates in &lt;i&gt;E. coli&lt;/i&gt; for amoxicillin-clavulanic acid (OR per each step of 5 defined daily dose/100 bed-days 1.07, 95% CI 1.02-1.12; &lt;i&gt;p&lt;/i&gt;  = 0.004), piperacillin-tazobactam (OR 2.11, 95% CI 1.45-3.07; &lt;i&gt;p&lt;/i&gt;  &lt; 0.001), quinolones (OR 1.52, 95% CI 1.25-1.86; &lt;i&gt;p&lt;/i&gt;  &lt; 0.001) and trimethoprim-sulfamethoxazole (OR 1.59, 95% CI 1.19-2.13; &lt;i&gt;p&lt;/i&gt;  = 0.002). Additionally, we found a significant association when all nine antibiotics were combined in one analysis. The association between consumption and resistance rates was stronger for nosocomial than for community strains. In &lt;i&gt;K. pneumoniae,&lt;/i&gt; we found an association for amoxicillin-clavulanic acid (OR 1.07, 95% CI 1.01-1.14; &lt;i&gt;p&lt;/i&gt;  = 0.025) and for trimethoprim-sulfamethoxazole (OR 2.02, 95% CI 1.44-2.84; &lt;i&gt;p&lt;/i&gt;  &lt; 0.001). The combined analysis did not show an association between consumption and resistance (OR 1.06, 95% CI 0.99-1.14; &lt;i&gt;p&lt;/i&gt;  = 0.07). We documented an association between antibiotic use and resistance rate for amoxicillin-clavulanic acid, piperacillin-tazobactam, quinolones and trimethoprim-sulfamethoxazole in &lt;i&gt;E. coli&lt;/i&gt; and for amoxicillin-clavulanic acid and trimethoprim-sulfamethoxazole in &lt;i&gt;K. pneumoniae&lt;/i&gt; across different hospital departments. Our data will support stewardship interventions to optimize antibiotic prescribing at a department level

[Risk factors for infectious foot disorders on two Swiss cattle mountain pastures].

In the present study, risk groups for infectious foot disorders were identified on two large Swiss cattle mountain pastures by analyzing animal and treatment data of a total of 3256 animals of the bovine species. Both mountain pastures were part of the Federal Office for Agriculture (FOAG) consultancy project «Healthy animals, attractive herdsmen positions and less medication on large cattle mountain pastures». The project was launched in 2020 following the increased incidence of lameness on these mountain pastures. Bacteriological and histological analyses were to provide information as to whether the most common foot disorder was interdigital phlegmon (IP) or whether digital dermatitis also occurred. Further, the temporal distribution of cases over the mountain pasture season and the influence of mountain pasture and year were investigated and interpreted for the project years 2020 to 2022, and treatment incidences were compared between years. Multiple treatment cycles in the same individual were classified into persistent infections and new infections. Nineteen of 394 first-treated cattle were clinically examined, 12 of them were additionally sampled for bacteriological and histological analyses. All cases examined showed, both clinically and following laboratory analyses, typical characteristics for IP. In contrast, there was no specific evidence for the presence of digital dermatitis. No persistent infections occurred during treatment with benzylpenicillin. Multivariate logistic regression analyses identified > 365-730-day-old cattle (odds ratio OR 8,29), as well as inseminated (OR 5,30) and non-inseminated (OR 7,85) heifers as risk groups for the disease studied (p < 0,05). Association with the oestrus activity of non-inseminated heifers and a generally higher locomotor activity in heifers compared to cows - with a correspondingly increased risk of injury - is conceivable. Meat breeds had a reduced risk compared to dairy breeds (OR 0,29). Breed differences in behavior and/or the effectiveness of the local immune response might have an impact. Knowing about these risk groups can be put to use in the future when selecting animals to be taken to the mountain pastures and/or when planning pasture management in order to reduce the prevalence of infectious foot disorders and thereby the use of antibiotics

Exploring Quaker organising to consider the possibilities for relational leadership

This paper develops the perspective of ‘relational leadership’ by exploring dynamics of influence within Quaker organising. The theory of relational leadership is drawn upon as it is connected with more sustainable and equitable ways of organising. A Quaker context is studied as it is conducive for understanding possibilities for relational leadership because there is no formal hierarchy. By applying three aspects of a relational leadership perspective (mutual influence process [1], momentary [2] and socially co-constructed [3]) to a thematic analysis of interview data, understanding is developed about the potential dynamics of influence and leadership in non-hierarchical organising. Two contributions to relational leadership theory are offered. Firstly, the paper shows a need for greater critical attention to appreciate the potential subtleties and tensions involved in influencing dynamics in non-hierarchical organising; and, secondly, assumptions about the continuous potential for fluidity of influencing are challenged

A comparative evaluation of the efficacy of manual, magnetostrictive and piezoelectric ultrasonic instruments: an in vitro profilometric and SEM study

OBJECTIVES: The debridement of diseased root surface is usually performed by mechanical scaling and root planing using manual and power driven instruments. Many new designs in ultrasonic powered scaling tips have been developed. However, their effectiveness as compared to manual curettes has always been debatable. Thus, the objective of this in vitro study was to comparatively evaluate the efficacy of manual, magnetostrictive and piezoelectric ultrasonic instrumentation on periodontally involved extracted teeth using profilometer and scanning electron microscope (SEM). MATERIAL AND METHODS: 30 periodontally involved extracted human teeth were divided into 3 groups. The teeth were instrumented with hand and ultrasonic instruments resembling clinical application. In Group A all teeth were scaled with a new universal hand curette (Hu Friedy Gracey After Five Vision curette; Hu Friedy, Chicago, USA). In Group B Cavitron(TM) FSI - SLI(TM) ultrasonic device with focused spray slimline inserts (Dentsply International Inc., York, PA, USA) were used. In Group C teeth were scaled with an EMS piezoelectric ultrasonic device with prototype modified PS inserts. The surfaces were analyzed by a Precision profilometer to measure the surface roughness (Ra value in µm) consecutively before and after the instrumentation. The samples were examined under SEM at magnifications ranging from 17x to 300x and 600x. RESULTS: The mean Ra values (µm) before and after instrumentation in all the three groups A, B and C were tabulated. After statistically analyzing the data, no significant difference was observed in the three experimental groups. Though there was a decrease in the percentage reduction of Ra values consecutively from group A to C. CONCLUSION: Within the limits of the present study, given that the manual, magnetostrictive and piezoelectric ultrasonic instruments produce the same surface roughness, it can be concluded that their efficacy for creating a biologically compatible surface of periodontally diseased teeth is similar

Ultrastructural Observations on Bacterial Invasion in Cementum and Radicular Dentin of Periodontally Diseased Human Teeth

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141124/1/jper0493.pd

Long-term follow-up and residual sequelae after treatment for intracerebral germ-cell tumour in children and adolescents

Background: Information on long-term follow-up of children and adolescents treated for intracerebral germ-cell tumour is scant. We report on the results of a small series of patients treated at a single institution. Patients and methods: Hospital records from 15 patients treated between 1980 and 1998 were reviewed. An attempt was made to correlate sequelae to tumour location and treatment modalities. Results: This cohort constitutes 5.5% of all brain tumours diagnosed at our institution. Histology: 10 germinomas, 2 benign teratomas, 2 malignant teratomas, and one mixed germ-cell tumour. Overall survival was 87%, with a mean follow-up time of 7 years and 8 months. The majority of patients have long-term sequelae involving one or several organ systems. In 66% endocrine, in 47% ophthalmologic, in 60% neuropsycho-logical defects were observed. Endocrine and ophthalmologic sequelae show a correlation to tumour location. Neuropsycho-logical long-term abnormalities are frequent and are associated with cranial irradiation in particular at young age, but less with tumour location, irradiation dose or surgery. Conclusions: Our preliminary data suggest that today intracerebral germinomas and mature teratomas have a good prognosis even when a relapse occurs. The outcome for mixed germ-cell tumours and malignant teratomas is less favourable. Although long-term sequelae are present in the majority of patients, there is some evidence that patients treated after 1990 suffer fewer severe long-term defects, thereby indicating that recent treatment protocols may result in a reduction of sequela