EARSS: European Antimicrobial Resistance Surveillance System; gegevens uit Nederland (1999). Prevalentie en incidentie van resistentie voor Streptococcus pneumoniae en Staphylococcus aureus

In a porspective prevalence and incidence survey in The Netherlands in 1999 antimicrobial susceptibility data on invasive Streptococcus pneumoniae and Staphylococcus aureus infections were collected sithin the framework of European Antomicrobial Resistance Surveillance System (EARSS). The EARSS project covered approximately 40% of the Dutch population (extramural) and 40% of the total number of patient-days (intramural). Penicillin resistance in S. pneumoniae was minimal; only 9 of 767 (1,2%) isolates were non-susceptible. Resistance to oxacillin in S. aureus was low, only (0,3%) isolates were MRSA (mecA positive). The incidence of invasive S. pneumoniae was 117 cases/1.000.000 person-years; the incidence of invasive penicillin non-susceptible S. pneumoniae was 1 case/1.000.000 person-years. The incidence of invasive S. aureus infections was 0.25 cases/1000 patient-days; the incidence of invasive MRSA infections was 0.0006 cases/1000 patient-days. It may be concluded that resistance to antibiotics in these two pathogens, when compared to other European countries, is still very low.Gevoeligheid voor antimicrobiele middelen in Streptococcus pneumoniae en Staphylococcus aureus werd bepaald in 1999 in Nederland binnen het raamwerk van het European antomicrobial Resistance Surveillance System (EARSS). Het EARSS project had in Nederland een dekkingsgraad van 40% van de Nederlandse populatie (extramuraal) en 40% van het totale aantal patientdagen (intramuraal). Resistentiie tegen penicilline in S. pneumoniae was minimaal; slechts 9 van 767 (1,2%) isolatn waren niet gevoelig. Resistentie tegen oxacilline in S. aureus was ook laag; slechts 4 ((0,3%) isolaten waren MRSA. de incidentie van invasieve S. pneumoniae was 117 gevallen/1.000.000 persoonsjaren, de incidentie van invasieve penicilline niet gevoelige S. pneumoniae was 1 geval/1.000.000 persoonsjaren. De incidentie van invasieve S. aureus infecties was 0,25 gevallen/1000 patientdagen; de incidentie van invasieve MRSA infecties was 0,0006 gevallen/1000 patientdagen. hetis duidelijkj dat resistentie tegen antibiotica bij deze twee pathogenen in vergelijkijng tot andere Europese landen nog steeds erg laag is

Segmental resection of the duodenum for gastrointestinal stromal tumor (GIST)

<p>Abstract</p> <p>Background</p> <p>Gastrointestinal stromal tumors (GIST) are the most frequent mesenchymal tumors of the gastrointestinal tract. The biological appearance of these tumors reaches from small lesions with benign appearance to aggressive sarcomas. Only 3–5% of GISTs are localized in the duodenum. There is a controversy, if duodenal GISTs should be treated by a duodenopancreatectomy or by a limited resection of the duodenum.</p> <p>Case presentation</p> <p>A 29-year-old man presented with an acute upper gastrointestinal bleeding from a submucosal tumor located in the proximal part III of the duodenum, 3 cm distal of the papilla of Vater. After an emergency laparotomy with ligation of tumor-feeding vessels in a primary hospital, definitive surgical therapy was performed by partial resection of the duodenum with a duodenojejunostomy. Histology revealed a GIST with a diameter of 2.5 cm and <5 mitoses/50 high power fields, indicating a low risk of malignancy. Therefore no adjuvant therapy with Imatinib was initiated.</p> <p>Conclusion</p> <p>GISTs of the duodenum are a rare cause of upper gastrointestinal bleeding. Partial resection of the duodenum is a warranted alternative to a duodenopancreatectomy, as this procedure has a lower operative morbidity, while providing comparable oncological results.</p

Severe paraneoplastic hypoglycemia in a patient with a gastrointestinal stromal tumor with an exon 9 mutation: a case report

BACKGROUND: Non-islet cell tumor induced hypoglycemia (NICTH) is a very rare phenomenon, but even more so in gastrointestinal stromal tumors. It tends to present in large or metastatic tumors, and can appear at any time in the progression of the disease. We present herein a case of NICTH in a GIST tumor and report an exon 9 mutation associated to it. CASE PRESENTATION: A thirty nine year-old man with a recurrent, metastatic gastrointestinal stromal tumor presented to the hospital with nausea, dizziness, loss of consciousness, and profound hypoglycemia (20 mg/dL). There was no evidence of factitious hypoglycemia. He was stabilized with a continuous glucose infusion and following selective vascular embolization, the patient underwent debulking of a multicentric 40 cm × 25 cm × 10 cm gastrointestinal stromal tumor. After resection, the patient became euglycemic and returned to his normal activities. Tumor analysis confirmed excessive production of insulin-like growth factor II m-RNA and the precursor protein, "big" insulin-like growth factor II. Mutational analysis also identified a rare, 6 bp tandem repeat insert (gcctat) at position 1530 in exon 9 of KIT. CONCLUSION: Optimal management of gastrointestinal stromal tumor-induced hypoglycemia requires a multidisciplinary approach, and surgical debulking is the treatment of choice to obtain immediate symptom relief. Imatinib or combinations of glucocorticoids and growth hormone are alternative palliative strategies for symptomatic hypoglycemia. In addition, mutations in exon 9 of the tyrosine kinase receptor KIT occur in 11–20% of GIST and are often associated with poor patient outcomes. The association of this KIT mutation with non-islet cell tumor induced hypoglycemia has yet to be established

Osteoporosis-related fracture case definitions for population-based administrative data

<p>Abstract</p> <p>Background</p> <p>Population-based administrative data have been used to study osteoporosis-related fracture risk factors and outcomes, but there has been limited research about the validity of these data for ascertaining fracture cases. The objectives of this study were to: (a) compare fracture incidence estimates from administrative data with estimates from population-based clinically-validated data, and (b) test for differences in incidence estimates from multiple administrative data case definitions.</p> <p>Methods</p> <p>Thirty-five case definitions for incident fractures of the hip, wrist, humerus, and clinical vertebrae were constructed using diagnosis codes in hospital data and diagnosis and service codes in physician billing data from Manitoba, Canada. Clinically-validated fractures were identified from the Canadian Multicentre Osteoporosis Study (CaMos). Generalized linear models were used to test for differences in incidence estimates.</p> <p>Results</p> <p>For hip fracture, sex-specific differences were observed in the magnitude of under- and over-ascertainment of administrative data case definitions when compared with CaMos data. The length of the fracture-free period to ascertain incident cases had a variable effect on over-ascertainment across fracture sites, as did the use of imaging, fixation, or repair service codes. Case definitions based on hospital data resulted in under-ascertainment of incident clinical vertebral fractures. There were no significant differences in trend estimates for wrist, humerus, and clinical vertebral case definitions.</p> <p>Conclusions</p> <p>The validity of administrative data for estimating fracture incidence depends on the site and features of the case definition.</p

Gastrointestinal stromal tumor

<p>Abstract</p> <p>Background</p> <p>GISTs are a subset of mesenchymal tumors and represent the most common mesenchymal neoplasms of GI tract. However, GIST is a recently recognized tumor entity and the literature on these stromal tumors has rapidly expanded.</p> <p>Methods</p> <p>An extensive review of the literature was carried out in both online medical journals and through Athens University Medical library. An extensive literature search for papers published up to 2009 was performed, using as key words, GIST, Cajal's cells, treatment, Imatinib, KIT, review of each study were conducted, and data were abstracted.</p> <p>Results</p> <p>GIST has recently been suggested that is originated from the multipotential mesenchymal stem cells. It is estimated that the incidence of GIST is approximately 10-20 per million people, per year.</p> <p>Conclusion</p> <p>The clinical presentation of GIST is variable but the most usual symptoms include the presence of a mass or bleeding. Surgical resection of the local disease is the mainstay therapy. However, therapeutic agents, such as Imatinib have now been approved for the treatment of advanced GISTs and others, such as everolimus, rapamycin, heat shock protein 90 and IGF are in trial stage demonstrate promising results for the management of GISTs.</p