Notes

Vancomycin-Resistant Staphylococcus aureus - Dom, 2015.
OBJECTIVE The aim of this study was to assess the effectiveness of gentamicin containing collagen implants in the reduction of surgical site infections (SSIs) in patients undergoing an inguinal incision for vascular surgery. METHODS Prospective blinded randomised controlled multicentre trial (RCT), performed in four hospitals in The Netherlands and Belgium. This study included 288 patients who underwent an inguinal incision for primary arterial repair (femoral endarterectomy, femorofemoral or femoropopliteal bypass, aortobifemoral bypass, thrombectomy, embolectomy, endovascular aneurysm repair) between October 2012 and December 2015. Patients were randomised to receive a gentamicin implant (study group) or no implant (control group). The calculated sample sizes of 304 patients per group were not reached. Primary outcome was SSI incidence after six weeks. Secondary outcomes were time to onset of infection, length of hospital stay, allergic reactions, treatment with antibiotics, need for re-admission, re-operatr centres with a high incidence of wound infections. However, the limitation of not reaching the calculated sample sizes should be considered. In the past, some medical device manufacturers were obtaining marketing clearance for metallic stents indicated for biliary use; however, these devices were being promoted and used in the peripheral vasculature, creating a patient safety problem. The US Food and Drug Administration (FDA) acted in 2006-2008 to help decrease off-label use of metal expandable biliary stents. This communication describes the early and continued efforts of the FDA to address safety concerns relating to off-label use of metal expandable biliary stents and the status of this issue. An analysis of Medical Device Reporting (MDR) data from January 1, 2005, through December 31, 2018, was conducted to determine the percentage of MDR reports associated with off-label use. The percentage was approximately 90% in 2001-2006 and decreased to less then 40% a decade later. In reports associated with off-label use, these devices are still associated with death and serious injury; however, the percentage of injury MDR reports associated with off-label device use has trended down since 2007. Whereas 92%-95% of reported serious injuries were with off-label placement in 2005-2007, 43%-79% of injuries were with off-label placement in 2008-2018. Collaborative efforts among the FDA, manufacturers, and physicians appear to have made progress in addressing this issue. Published by Elsevier Inc.BACKGROUND Sarcomas of the genitourinary (GU) tract are exceedingly rare, accounting for just 1% to 2% of malignancies treated by urologic surgeons. We perform a thorough investigation of incidence and mortality in the United States using the Surveillance, Epidemiology, and End Results (SEER) database. PATIENTS AND METHODS The SEER 18 database was used to identify patients diagnosed with genitourinary sarcoma over the age of 16. Data on demographics and tumor characteristics were collected. Survival analysis was performed on the most common primary tumor sites. RESULTS The search identified 3,007 patients with GU sarcomas from 1973 to 2015. In order of descending incidence, tumors presented in the bladder, kidney, paratestis, and scrotum. Amongst sarcomas arising in the bladder, leiomyosarcomas exhibited the longest median survival time (overall survival (OS) 62 months), while carcinosarcomas had the shortest (OS 9 months). Metastatic disease decreased leiomyosarcoma OS to 3 months. When comparing renal tumors, liposarcomas had the longest median survival time (OS 45 months) and carcinosarcomas had the shortest (OS 6 months). Older age (P less then 0.001 and P = 0.015) and T4 disease (P = 0.005 and P less then 0.001) predicted for worse survival amongst bladder and renal sarcomas, respectively. High tumor grade (P less then 0.001) and node positive disease (P = 0.024) also affected survival amongst renal tumors. CONCLUSIONS Tumors most commonly present in the bladder, kidney, paratestis, and scrotum, with kidney sarcomas having markedly dismal survival outcomes. Survival of identical histologic types varied by primary tumor location, suggesting that treatment strategies should be refined by type of sarcoma and primary tumor location within the GU tract. Melanosis coli (MC) is a common condition characterized by a black or brown pigment deposited in the colorectal mucosa. It is a reversible condition that is influenced by many factors, such as living habits and bowel function. However, the epidemiology and etiology of MC are still unclear. Most studies show that there is a significant correlation between the use of anthraquinone laxatives and the occurrence of MC. At present, the mechanism of the apoptosis theory is widely recognized as regards the pathogenesis of MC. selleck inhibitor There is no specific clinical manifestation of MC, and its diagnosis is mainly based on a complimentary examination, such as endoscopic and histopathological tests. General treatment, such as changing living habits, is preferred, and medical or surgical treatment should not be considered in the absence of serious malignancy. The aim of this review is to systematically present and outline the concepts of the epidemiology, etiology, histopathology, pathogenesis, clinical manifestations, diagnosis and treatment of MC, in order to improve the understanding of this condition. Whilst prophylaxis of hepatitis B is universally accepted after liver transplantation (LT), national recommendations for the prophylaxis and treatment of hepatitis B virus (HBV) infection after LT are lacking in Spain. The aim of the VII consensus meeting organised by the Spanish Society of Liver Transplantation (SETH) was to set recommendations on the prophylaxis and treatment of hepatitis B after LT. The scientific evidence and strength of recommendations was evaluated by using the "Grading of Recommendations Assessment, Development and Evaluation" (GRADE) system. This document describes the recommendations and their level of evidence for the definition and risk factors for hepatitis B recurrence after LT, monitoring and prophylaxis of hepatitis B recurrence at different periods after LT, treatment of hepatitis B before and after LT, and the prophylaxis of HBV infection by the recipients of LT with hepatitis B core antigen positive donors.
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