Comparative structural analysis of polyurethane and silicone catheters of totally implantable venous access devices by micro-computed tomography

Objectives: To investigate microstructural alterations of explanted long-term central venous catheters of totally implantable venous access devices, using micro-computed tomography. Methods: A total of 16 catheters (9 made of silicone and 7 made of polyurethane), all non-fractured, have been analyzed in this study. Eight catheters were implanted for an average duration of 994 days (min-max: 98-2731 days), while the remaining eight catheters (four for each material, forming the SIref and PUref control groups) were analyzed before implant and used as a reference. X-ray micro-computed tomography was used to reconstruct the three-dimensional geometry of selected segments of each catheter (ca. 10 cm per sample). Results: Morphometric analysis of the catheters revealed increases wall thickness and section area in the polyurethane group as compared with the reference central venous catheters of the same materials (wall thickness: 403 ± 12 μm in the polyurethane (PU) group vs 382 ± 4 μm in PUref, p = 0.014; wall cross-section area: 2.04 ± 0.09 mm2 in PU vs 1.91 ± 0.03 mm2 in PUref, p = 0.04), whereas implanted silicone catheters showed a larger luminal cross section as compared with their controls (lumen cross-section area = 0.851 ± 0.020 mm2 in silicone (SI) group vs 0.811 ± 0.007 mm2 in SIref, p = 0.007). All analyzed samples in this study presented some type of alteration in the catheter walls, namely, hyperdense spots (below 0.1 mm size), air gaps/bubbles and displacements of inner and outer axes causing heterogeneous wall thickness. The incidence of air gaps showed no difference with respect to both material type and duration of implant, whereas the SI group revealed more hyperdense spots as compared to all other groups. Conclusion: Morphological change and local structural alteration can occur in both silicone and polyurethane catheters. This evidence suggests the need for further studies connecting those morphological changes with modification of mechanical robustness, which ultimately can play a role for patient safety

Efficacy of high frequency spinal cord stimulation for the treatment of Buerger’s disease: a case report - Efficacia della stimolazione midollare ad alta frequenza per il trattamento del morbo di Buerger: caso clinico

SCS are used extensively in refractory peripheral artherosclerotic disease. The patient was a 50 year-old woman smoker affected by advanced Buerger’s disease with pain localized mostly in the distal extremities of lower limbs. Following the failure of different treatments we suggested performing SCS to obtain better pain control and better microcirculation. In 2009 the patient underwent SCS implantation and in May 2012, was found to have a decubitus ulcer in the area of the subcutaneous pocket. In October 2012 we implanted a high frequency SCS. We used a 10 cm VAS and ESAS Edmonton Symptoms Assessment Scale) to evaluate difference in quality of life, sleep, disability, pain relief and Patient Global Impression Scale (PGIS) to compare the patient’s satisfaction between treatments. The patient reported a significant improvement in pain reduction with both types of stimulators (tonic and high frequency). The quality of life improved more with the high frequency stimulation and the patient considers high frequency stimulation more effective than tonic stimulation. Our case report suggests that high frequency SCS can be a useful therapy for ischemic pain control

Comparison of methods for the microbiological diagnosis of totally implantable venous access port-related infections

Introduction. Totally implanted venous access ports (TIVAPs) are widely used in patients receiving long-term chemotherapy but may lead to serious complications such as catheter-related bloodstream infections (CRBSIs). Diagnosis of CRBSI requires catheter culture, but there is no consensus on microbiological culture methods to be adopted.Aim. To compare three different procedures to recover bacterial cells from colonized catheters and to determine which section of the TIVAP (i.e. tip, septum, reservoir) is the probable source of infection. To investigate the correlation between blood culture results and TIVAP culture in order to get further evidence about the utility of differential time to positivity (DTP) as a diagnostic tool before TIVAP removal.Hypothesis/Gap statement. Comparisons of different diagnostic procedures for catheter culture have been rarely reported for TIVAPs. We hypothesized that the optimization of methods to recover micro-organisms from different parts of TIVAPs may help to decrease the number of false-negative results in the diagnosis of TIVAP-related bloodstream infections.Methodology. A total of 53 TIVAPs removed because of suspected infection (n=36) or end of use (n=17) were evaluated. The reservoir, the septum and the catheter tip were separated and subjected to different treatments for the recovery of adherent micro-organisms: (a) flushing of the catheter lumen, (b) sonication and flushing, (c) treatment with dithiothreitol and flushing. The three methods were also evaluated in an in vitro catheter infection model with Staphylococcus epidermidis. Culture results were compared to those obtained from paired blood cultures drawn from TIVAP and peripheral vein and to the relative DTP.Results. The results obtained demonstrated that vigorous flushing/vortexing of the catheter lumen/septum, allows the recovery of a number of micro-organisms comparable to that of more complex procedures such as sonication or chemical treatment. Among 24 positive TIVAP-cultures, nine were tip-culture negative, whereas the corresponding reservoirs and septa were culture positive. A good correlation was observed between DTP and TIVAP cultures (P<0.001).Conclusions. The results support the evidence that sending the port reservoir in addition to the catheter tip to the microbiology laboratory may increase the sensitivity and the accuracy of CRBSI diagnosis. Moreover, when a TIVAP-related infection is suspected, DTP is a useful diagnostic tool to decide between device removal or a more conservative approach

Corynebacterium pseudotuberculosis biovar ovis: evaluación de la sensibilidad antibiótica in vitro

Los objetivos de este trabajo fueron estudiar la sensibilidad antibiótica de aislamientos de Corynebacterium pseudotuberculosis procedentes de pequeños rumiantes e investigar la presencia de integrones que contienen genes de resistencia. Se estudiaron 15 aislamientos de diferentes fuentes por los métodos de difusión y dilución. Por el método de difusión, amoxicilina-clavulánico, ampicilina, cefotaxima, cefoxitina, ciprofloxacina, cloranfenicol, eritromicina, estreptomicina, gentamicina, imipenem, kanamicina, norfloxacina, penicilina, rifampicina, tetraciclina, trimetroprima-sulfametoxazol y vancomicina fueron activos frente al 100% de los aislamientos, mientras que amicacina presentó resultados variables. En los aislamientos que desarrollaron frente a amicacina se investigó la presencia de integrones de clase 1. El resultado fue negativo, sugiriendo la ausencia del integrón. Utilizando el método de dilución, los antibióticos más activos correspondieron a los grupos de cefalosporinas, glucopéptidos, macrólidos, quinolonas y tetraciclinas. Se demostró menor actividad de B-lactámicos y aminoglucósidos. No se registró variabilidad en los perfiles antibióticos en los aislamientos procedentes de diferentes fuentes.The aims of this work were to study the antibiotic susceptibility in Corynebacterium pseudotuberculosis isolated from small ruminants and to determine the presence of integrons that contain resistance genes. Fifteen isolates of different sources were analysed using the diffusion and the dilution methods. When the diffusion method was performed, amoxicillin-clavulanic, ampicillin, cefotaxime, cefoxitin, ciprofloxacin, chloramphenicol, erythromycin, streptomycin, gentamicin, imipenem, kanamycin, norfloxacin, penicillin, rifampicin, tetracycline, trimethoprim-sulfamethoxazole and vancomycin were effective against the 100% of isolates, while amikacin showed variable results. The isolates that were able to grow with amikacin, were studied in relation to the presence of integron class 1. The result was negative, suggesting the absence of integron. Using dilution method, the antibiotics belonging to the cephalosporin, glycopeptide, macrolide, quinolone, and tetracycline groups were the most active ones for the C. pseudotuberculosis biovar ovis isolates. Less activity of β-lactam and aminoglycosides were observed. There was no observation of variability in the antibiotic patterns in the strains coming from different sources.Estación Experimental Agropecuaria BarilocheFil: Gallardo, Adriana Alicia. Universidad Nacional de la Patagonia San Juan Bosco. Facultad de Ciencias Naturales y Ciencias de la Salud. Centro Regional de Investigación y Desarrollo Científico-Tecnológico; ArgentinaFil: Toledo, Rocío Andrea. Universidad Nacional de la Patagonia San Juan Bosco. Facultad de Ciencias Naturales y Ciencias de la Salud. Centro Regional de Investigación y Desarrollo Científico-Tecnológico; ArgentinaFil: Gonzalez Pasayo, Ramón Alejandro. Instituto Nacional de Tecnología Agropecuaria (INTA). Unidad Integrada Balcarce. Laboratorio de Bacteriología. Universidad Nacional de Mar del Plata; ArgentinaFil: de Carvalho Azevedo, Vasco Ariston. Universidade Federal de Minas Gerais. Instituto de Ciencias Biológicas. Departamento de Biología General; BrasilFil: Robles, Carlos Alejandro. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Bariloche. Area de Produccion Animal. Grupo de Sanidad Animal; ArgentinaFil: Paolicchi, Fernando.Instituto Nacional de Tecnología Agropecuaria (INTA). Unidad Integrada Balcarce. Laboratorio de Bacteriología. Universidad Nacional de Mar del Plata; ArgentinaFil: Estevao Belchior, Silvia Graciela. Universidad Nacional de la Patagonia San Juan Bosco. Facultad de Ciencias Naturales y Ciencias de la Salud. Centro Regional de Investigación y Desarrollo Científico-Tecnológico; Argentin

Chemical restraint and sanitary assessment of wild vizcachas (Lagostomus maximus) in the arid argentin chaco

Fil: Ferreyra, Hebe. Wildlife Conservation Society; Argentina.Fil: Uhart, Marcela M. Wildlife Conservation Society. Field Veterinary Program; Argentina.Fil: Romano, Marcelo C. Centro de Investigaciones en Biodiversidad y Ambiente Ecosur; Argentina.Fil: Beldoménico, Pablo M. Universidad Nacional del Litoral. Facultad de Ciencias Veterinarias; Argentina.Fil: Samartino, Luis. Instituto Nacional de Tecnología Agropecuaria. Instituto Patobiología del CICV y A,; Argentina.Fil: Paolicchi, Fernando. Instituto Nacional de Tecnología Agropecuaria. Laboratorio Bacteriología; Argentina.Fil: Lauricella, Marta. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Parasitología Dr. Mario Fatala Chaben; Argentina.Fil: Jorge, Maria Cristina. Universidad Nacional del Centro de la Provincia de Buenos Aires. Departamento de Sanidad Animal y Medicina Preventiva; Argentina.Fil: Schettino, Adriana. Universidad Nacional del Centro de la Provincia de Buenos Aires. Departamento de Sanidad Animal y Medicina Preventiva; Argentina.Fil: Guida, Nora. Universidad de Buenos Aires. Departamento de Enfermedades Infecciosas; Argentina.Fil: Martín, Ana M. Veterinaria San Carlos; Argentina.Con el objetivo de evaluar la salud de vizcachas salvajes (Lagostomus maximus), se capturaron en el Chaco Árido argentino 10 ejemplares y se efectuaron 11 inmovilizaciones con anestesias fijas o inhalatoria. Para las anestesias, se administraron una combinación de tiletamina- zolazepam (n = 7) o una combinación de medetomidina y ketamina (n = 2) o gas isofluorano con un vaporizador portátil creando un circuito semicerrado (n = 2). Los estudios de salud comprendieron hematología, bioquímica sanguínea, análisis parasitológicos y de exposición a agentes infecciosos mediante cultivo y serología. El uso de tiletamina-zolazepam resultó en una pobre calidad anestésica y recuperaciones prolongadas. Por el contrario, el uso de medetomidina-ketamina o de isofluorano, proporcionaron inmovilizaciones más seguras. Se concluye que el protocolo testado de tiletamina-zolazepam no sería recomendable para esta especie, sobre todo en vida libre. La búsqueda de anticuerpos para los agentes infecciosos evaluados resultó negativa, por otra parte, se aisló Listeria innocua serovar 6a en hisopados rectales, se constató infestación con pulgas (Pulex irritans), ooquistes de Eimeria lagostomi, huevos de la Familia Trichostrongylidae y huevos similares a Heteroxynema viscaciae. (EN) In order to evaluate the sanitary condition of wild vizcachas (Lagostomus maximus), 10 animals were captured in the Arid Chaco of Argentina and 11 immobilizations were performed through injectable or volatile anesthesia. Three different protocols were used: tiletamine-zolazepam (n = 7), medetomidine-ketamine (n = 2), or isofluorane with a portable vaporizer in a semi-closed circuit (n = 2). The sanitary assessment consisted of hematology, blood chemistry, parasitological analysis, and the assessment of the exposure to infectious agents by culture and serology. The use of tiletamine-zolazepam caused poor anesthetic quality and prolonged recoveries, while the medetomidine-ketamin combination, however, caused safer immobilizations. Thus, the use of the tested protocol of tiletamine-zolazepam is not advisable for this species, mainly for free-ranging animals. The search of antibodies for the evaluated infectious agents was negative, but there was isolated Listeria innocua serovar 6a from rectal swabs , fleas were found (Pulex irritans), oocytes of Eimeria lagostomi, Trichostrongylidae eggs as well as similar Heteroxynema viscaciae eggs

Chemical restraint and sanitary assessment of wild vizcachas (Lagostomus maximus) in the arid argentin chaco

Fil: Ferreyra, Hebe. Wildlife Conservation Society; Argentina.Fil: Uhart, Marcela M. Wildlife Conservation Society. Field Veterinary Program; Argentina.Fil: Romano, Marcelo C. Centro de Investigaciones en Biodiversidad y Ambiente Ecosur; Argentina.Fil: Beldoménico, Pablo M. Universidad Nacional del Litoral. Facultad de Ciencias Veterinarias; Argentina.Fil: Samartino, Luis. Instituto Nacional de Tecnología Agropecuaria. Instituto Patobiología del CICV y A,; Argentina.Fil: Paolicchi, Fernando. Instituto Nacional de Tecnología Agropecuaria. Laboratorio Bacteriología; Argentina.Fil: Lauricella, Marta. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Parasitología Dr. Mario Fatala Chaben; Argentina.Fil: Jorge, Maria Cristina. Universidad Nacional del Centro de la Provincia de Buenos Aires. Departamento de Sanidad Animal y Medicina Preventiva; Argentina.Fil: Schettino, Adriana. Universidad Nacional del Centro de la Provincia de Buenos Aires. Departamento de Sanidad Animal y Medicina Preventiva; Argentina.Fil: Guida, Nora. Universidad de Buenos Aires. Departamento de Enfermedades Infecciosas; Argentina.Fil: Martín, Ana M. Veterinaria San Carlos; Argentina.Con el objetivo de evaluar la salud de vizcachas salvajes (Lagostomus maximus), se capturaron en el Chaco Árido argentino 10 ejemplares y se efectuaron 11 inmovilizaciones con anestesias fijas o inhalatoria. Para las anestesias, se administraron una combinación de tiletamina- zolazepam (n = 7) o una combinación de medetomidina y ketamina (n = 2) o gas isofluorano con un vaporizador portátil creando un circuito semicerrado (n = 2). Los estudios de salud comprendieron hematología, bioquímica sanguínea, análisis parasitológicos y de exposición a agentes infecciosos mediante cultivo y serología. El uso de tiletamina-zolazepam resultó en una pobre calidad anestésica y recuperaciones prolongadas. Por el contrario, el uso de medetomidina-ketamina o de isofluorano, proporcionaron inmovilizaciones más seguras. Se concluye que el protocolo testado de tiletamina-zolazepam no sería recomendable para esta especie, sobre todo en vida libre. La búsqueda de anticuerpos para los agentes infecciosos evaluados resultó negativa, por otra parte, se aisló Listeria innocua serovar 6a en hisopados rectales, se constató infestación con pulgas (Pulex irritans), ooquistes de Eimeria lagostomi, huevos de la Familia Trichostrongylidae y huevos similares a Heteroxynema viscaciae. (EN) In order to evaluate the sanitary condition of wild vizcachas (Lagostomus maximus), 10 animals were captured in the Arid Chaco of Argentina and 11 immobilizations were performed through injectable or volatile anesthesia. Three different protocols were used: tiletamine-zolazepam (n = 7), medetomidine-ketamine (n = 2), or isofluorane with a portable vaporizer in a semi-closed circuit (n = 2). The sanitary assessment consisted of hematology, blood chemistry, parasitological analysis, and the assessment of the exposure to infectious agents by culture and serology. The use of tiletamine-zolazepam caused poor anesthetic quality and prolonged recoveries, while the medetomidine-ketamin combination, however, caused safer immobilizations. Thus, the use of the tested protocol of tiletamine-zolazepam is not advisable for this species, mainly for free-ranging animals. The search of antibodies for the evaluated infectious agents was negative, but there was isolated Listeria innocua serovar 6a from rectal swabs , fleas were found (Pulex irritans), oocytes of Eimeria lagostomi, Trichostrongylidae eggs as well as similar Heteroxynema viscaciae eggs

Activity-based costing analysis of the analgesic treatments used in postoperative pain management in Italy

BACKGROUND: The aim of this analysis is to evaluate the costs of 72-hour postoperative pain treatment in patients undergoing major abdominal, orthopedic and thoracic procedures in nine different Italian hospitals, defined as the cumulative cost of drugs, consumable materials and time required for anesthesiologists, surgeons and nurses to administer each analgesic technique. METHODS: Nine Italian hospitals have been involved in this study through the administration of a questionnaire aimed to acquire information about the Italian clinical practice in terms of analgesia. This study uses activity-based costing (ABC) analysis to identify, measure and give value to the resources required to provide the therapeutic treatment used in Italy to manage the postoperative pain patients face after surgery. A deterministic sensitivity analysis (DSA) has been performed to identify the cost determinants mainly affecting the final cost of each treatment analyzed. Costs have been reclassified according to three surgical macro-areas (abdominal, orthopedic and thoracic) with the aim to recognize the cost associated not only to the analgesic technique adopted but also to the type of surgery the patient faced before undergoing the analgesic pathway. RESULTS: Fifteen different analgesic techniques have been identified for the treatment of moderate to severe pain in patients who underwent a major abdominal, orthopedic or thoracic surgery. The cheapest treatment actually employed is the oral administration "around the clock" (€ 8.23), whilst the most expensive is continuous peripheral nerve block (€ 223.46). The intravenous patient-controlled analgesia costs € 277.63. In terms of resources absorbed, the non-continuous administration via bolus is the gold standard in terms of cost-related to the drugs used (€ 1.28), and when administered pro re nata it also absorbs the lowest amount of consumables (€0.58€) compared to all other therapies requiring a delivery device. The oral analgesic administration pro re nata is associated to the lowest cost in terms of health professionals involved (€ 6.25), whilst intravenous PCA is the most expensive one (€ 245.66), requiring a massive monitoring on the part of physicians and nurses. CONCLUSIONS: The analysis successfully collected information about costs of 72-hour postoperative pain treatment in patients undergoing major abdominal, orthopedic and thoracic procedures in all the nine different Italian hospitals. The interview showed high heterogeneity in the treatment of moderate to severe pain after major abdominal, orthopedic and thoracic surgeries among responding anesthesiologists, with 15 different analgesic modalities reported. The majority of the analgesic techniques considered in the analysis is not recommended by any guideline and their application in real life can be one of the reasons for the high incidence of uncontrolled pain, which is still reported in the postoperative period. Health care costs have become more and more important, although the choice of the best analgesic treatment should be a compromise between efficacy and economic considerations