Evidence of less severe aortic valve destruction after treatment of experimental staphylococcal endocarditis with vancomycin and dexamethasone

The beneficial effects of therapy combining an antibiotic and dexamethasone have been reported in human studies of meningitis and in experimental studies on septic arthritis, nephritis, and endopthalmitis. Since most patients with staphylococcal endocarditis need a combination of medical and surgical treatment, the purpose of this study was to determine whether the addition of dexamethasone to vancomycin has any beneficial effect regarding the degree of valve tissue damage or the course of experimental aortic valve endocarditis caused by a methicillin-resistant strain of Staphylococcus aureus. Rabbits with catheter-induced aortic valve vegetations were randomly assigned to a control group and to groups receiving dexamethasone (0.5 mg/kg of body weight, intravenously [i.v], twice a day [b.i.d]), vancomycin (30 mg/kg, i.v., b.i.d), or dexamethasone plus vancomycin, for a total of 10 doses (two doses per day for 5 days). The severity of valve tissue damage was significantly less in group receiving vancomycin plus dexamethasone compared with that of the group receiving vancomycin alone (P < 0.001). The severity of tissue damage was inversely correlated with the mean polymorphonuclear leukocyte number in valve tissue. No statistically significant differences were observed between the vancomycin-treated group and the vancomycin- plus-dexamethasone-treated group in survival, blood culture sterilization rate, or reduction of the microbial burden (in CFU per gram) in valvular tissue. In conclusion, treatment with a combination of vancomycin and dexamethasone for 5 days reduces the severity of valve tissue damage in experimental staphylococcal aortic valve endocarditis. These findings could have significant implications in the treatment of staphylococcal endocarditis and deserve further confirmation in clinical trials.Η συγχορήγηση δεξαμεθαζόνης και αντιβιοτικών έχει αποδειχθεί ευεργετική σε κλινικές μελέτες ασθενών με μηνιγγίτιδα και σε πειραματικές μελέτες που αφορούν λοιμώξεις όπως η σηπτική αρθρίτιδα, νεφρίτιδα και ενδοφθαλμίτιδα. Με δεδομένο ότι η θεραπεία της σταφυλοκοκκικής ενδοκαρδίτιδας λόγω της μεγάλης ιστικής καταστροφής, απαιτεί στις περισσότερες περιπτώσεις συνδυασμένη χειρουργική και φαρμακευτική αντιμετώπιση, σκοπός της παρούσης μελέτης ήταν να ελεγχθεί εάν η σύγχρονη χορήγηση δεξαμεθαζόνης και βανκομυκίνης μειώνει την ιστική βλάβη. Για τον σκοπό αυτό χρησιμοποιήθηκε μοντέλο πειραματικής ενδοκαρδίτιδας της αορτικής βαλβίδας σε κονίκλους. Για την πρόκληση της χρησιμοποιήθηκε ανθεκτικό στη μεθικιλλίνη στέλεχος Staphylococcus aureus (MRSA). Τα πειραματόζωα χωρίσθηκαν σε 4 ομάδες: ομάδα μαρτύρων, ομάδα δεξαμεθαζόνης (0.5 mg/kg σωματικού βάρους κάθε 12 ώρες ενδοφλεβίως), ομάδα βανκομυκίνης (30 mg/kg σωματικού βάρους κάθε 12 ώρες ενδοφλεβίως), ομάδα βανκομυκίνης (30 mg/kg σωματικού βάρους κάθε 12 ώρες ενδοφλεβίως) και δεξαμεθαζόνης (0.5 mg/kg σωματικού βάρους κάθε 12 ώρες ενδοφλεβίως). Τα πειραματόζωα των ομάδων θεραπείας έλαβαν 10 δόσεις των φαρμάκων. Η βαρύτητα της καταστροφής του βαλβιδικού ιστού ήταν σημαντικά μεγαλύτερη στην ομάδα που έλαβε μόνο βανκομυκίνη, σε σχέση με την ομάδα που έλαβε βανκομυκίνη και δεξαμεθαζόνη. Η βαρύτητα των βλαβών ήταν αντίστροφος ανάλογη του μέσου αριθμού των πολυμορφοπύρηνων στον ιστό. Όσον αφορά την επιβίωση, την αποστείρωση των αιμοκαλλιεργειών και το ποσό των μικροοργανισμών στον βαλβιδικό ιστό, δεν παρατηρήθηκαν στατιστικά σημαντικές διαφορές μεταξύ της ομάδος που έλαβε βανκομυκίνη και της ομάδος που έλαβε βανκομυκίνη και δεξαμεθαζόνη. Συμπερασματικά, ο συνδυασμός βανκομυκίνης και δεξαμεθαζόνης για 5 ημέρες, μειώνει σημαντικά την ιστική βλάβη της αορτικής βαλβίδας σε πειραματικό μοντέλο MRSA ενδοκαρδίτιδας. Η κλινική σημασία αυτού του ευρήματος πρέπει να επιβεβαιωθεί με κλινικές μελέτες

Intra-Abdominal Hemorrhage following Cardiopulmonary Resuscitation: A Report of Two Cases

Cardiopulmonary resuscitation (CPR) represents an emergency procedure, consisting of chest compressions and artificial ventilation. Two rare cases of intra-abdominal bleeding following cardiac compressions are reported. The first case was a 29-year-old female with massive pulmonary embolism (PE). Following CPR due to cardiac arrest, she showed signs of intra-abdominal bleeding. A liver laceration was found and sutured. The patient passed away, due to massive PE. The second patient was a 62-year-old female, suffering from cardiac arrest due to drowning at sea. CPR was performed in situ. At presentation to the emergency department she showed signs of intra-abdominal bleeding. The origin of the hemorrhage was found to be vessels of the lesser curvature of the stomach, which were ligated. Regarding the first patient PE has already been described as a cause for liver lacerations in CPR due to stasis and liver enlargement. The second case is the first report of gastric vessel injury without gastric rupture/laceration and pneumoperitoneum. Complications of CPR should not represent a drawback to performing cardiac compressions. Parenchymatic injuries have been related to inappropriate technique of chest compressions during basic life support. Therefore, it is of utmost importance for the providers to refresh their knowledge of performing CPR

Leiomyoma of the Round Ligament of the Uterus Mimicking Inguinal Hernia

Masses of the round ligament of the uterus are uncommon. Leiomyomas are the most common of them, followed by mesothelial cysts and in some cases endometriosis. The exact incidence is not known, but most cases are frequently encountered during the fertility age. Leiomyomas are benign tumors, which can present as hernias, lymph nodes, or other inguinal masses. Surgical excision is the appropriate treatment. We are presenting a case of a 47-year-old female patient who was admitted to the hospital with a left inguinal mass. Our patient underwent surgery, and a leiomyoma of the round ligament was found

Leiomyoma of the Round Ligament of the Uterus Mimicking Inguinal Hernia

Masses of the round ligament of the uterus are uncommon. Leiomyomas are the most common of them, followed by mesothelial cysts and in some cases endometriosis. The exact incidence is not known, but most cases are frequently encountered during the fertility age. Leiomyomas are benign tumors, which can present as hernias, lymph nodes, or other inguinal masses. Surgical excision is the appropriate treatment. We are presenting a case of a 47-year-old female patient who was admitted to the hospital with a left inguinal mass. Our patient underwent surgery, and a leiomyoma of the round ligament was found