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Amaç: Kemoterapiye bağlı febril nötropeni (FEN) gelişen hastalarda ölümlerin en önemli nedeni infeksiyonlardır. Bu nedenle nötropenik hastalarda ateş, aksi ispat edilinceye kadar infeksiyon olarak kabul edilip empirik geniş spektrumlu antibiyotik tedavisine hemen başlanılması gerekmektedir. Çalışmamızda kemoterapiye bağlı gelişen 236 FEN atağı; infeksiyon kategorileri, izole edilen patojen mikroorganizmalar, mortalite oranları ve uygulanan antibiyotik tedavileri açısından retrospektif olarak değerlendirildi. Merkezimizdeki infeksiyon etkenlerinin ve tedavi protokollerinin belirlenmesi amaçlanmıştır. Gereç ve Yöntem: Çalışmaya, İnönü Üniversitesi Tıp Fakültesi Turgut Özal Tıp Merkezi, Erişkin Hematoloji Kliniği’nde 2002 ile 2010 tarihleri arasında takip ve tedavisi yapılan 87 akut myeloid lösemi (AML) hastası alındı. 236 FEN atağı retrospektif olarak değerlendirildi. FEN kriterlerini karşılayan hastaların ataklarında infeksiyonlar mikrobiyolojik olarak tanımlanmış infeksiyon (MTİ), klinik olarak tanımlanmış infeksiyon (KTİ) ve nedeni bilinmeyen ateş (FUO) olarak kategorize edildi. Hastaların fizik muayene ve kültür sonuçları dosya kayıt sistemi ve mikrobiyoloji kayıtlarından elde edildi. Bulgular: Hastaların 53’ü erkek, 34’ü kadındı. Yaş ortalaması 52.44 yıl olarak bulundu. 236 FEN atağının %30.9’u MTİ, %40.3’ü KTİ ve %28.8’i FUO olarak kategorize edildi. Ataklarının %19.9’unda kan kültüründe etken patojen mikroorganizma izole edilirken, %80,1’inde izole edilmediği saptandı. Kan kültürlerinden izole edilen mikrorganizmaların %51.1’ini gram-pozitif bakteriler, %40.4’ünü gram-negatif bakteriler ve %8.5’ini ise fungal etkenlerin oluşturduğu saptandı. Klinik olarak dökümante edilen 95 ataktan %47.4’ünde pnömoni saptandı. Tüm ataklarlarda ortalama nötropeni süresi 13.33, MDİ’de 16.69, KTİ’de 13.09 ve FUO’da ise 10.04 gün olarak bulundu. Mortalite atak başına %8.5 olarak tespit edildi. Sonuç: Merkezimizde bakteriyemi etkeni olarak gram-pozitif mikroorganizmalar daha sık saptanmıştır. Her merkezin kendi infeksiyon etkenlerini yakından izleyip empirik antibiyotik tedavi politikalarını belirlemesi, FEN sürecinin daha iyi yönetilmesinde olumlu katkı sağlayabilir., Aim: The most important cause of mortality in febrile neutropenic episodes (FNEs) which mature after chemotherapy s infections. Fever in neutropenic patients must be accepted as an infection and broad-spectrum empric antibiotherapy must be started immediately as a standard approach. The infection categories, isolated pathogen microorganisms, mortality ratios and antibiotherapy regimens in 236 FNEs which matured after chemotherapy have been examined retrospectively. Our goal was identification of infectious agents and to determine our treatment protocol. Materials and Methods: Our study includes 87 patients who were treated because of acute myeloid leukemia (AML) at Inonu University Turgut Özal Medicine Center Adult Hematology Clinic between 2002 and 2010. 236 FNEs were examined retrospectively. Infections of patients who met FNE criterias were categorized as microbiologic defined nfection (MDI), clinical defined infection (CDI) and fever of unknown origin (FUO). Physical examination and microbiological culture results were obtained from the records. Results: Fifty-three patients were male and 34 female. The mean age was 52.44 years. Fever was evaluated in 30.9% MDI, 40.3% CDI and 28.8% FUO categories. In FNEs, 19.9% efficient pathogen microorganisms were isolated from blood cultures. 51.1% of pathogens which were isolated from blood cultures were gram-positive, 40.4% were gram-negative bacteries and 8.5% were fungus. Pneumonia was detected 47.4% in 95 CDI episodes. The mean neutropenia duration was 13.33 days in all episodes, 16.69 in MDI, 13.09 in CDI and 10.04 days in FUO. Conclusion: If medical centers follow their infection agents closely and modify their empiric antibiotic treatment policies they can supply a useful additive for a better FEN management process.

WOS: 000445782800327

No data on whether brucellar meningitis or meningoencephalitis can be treated with oral antibiotics or whether an intravenous extended-spectrum cephalosporin, namely, ceftriaxone, which does not accumulate in phagocytes, should be added to the regimen exist in the literature. The aim of a study conducted in Istanbul, Turkey, was to compare the efficacy and tolerability of ceftriaxone-based antibiotic treatment regimens with those of an oral treatment protocol in patients with these conditions. This retrospective study enrolled 215 adult patients in 28 health care institutions from four different countries. The first protocol (P1) comprised ceftriaxone, rifampin, and doxycycline. The second protocol (P2) consisted of trimethoprim-sulfamethoxazole, rifampin, and doxycycline. In the third protocol (P3), the patients started with P1 and transferred to P2 when ceftriaxone was stopped. The treatment period was shorter with the regimens which included ceftriaxone (4.40 +/- 2.47 months in P1, 6.52 +/- 4.15 months in P2, and 5.18 +/- 2.27 months in P3) (P = 0.002). In seven patients, therapy was modified due to antibiotic side effects. When these cases were excluded, therapeutic failure did not differ significantly between ceftriaxone-based regimens (n = 5/166, 3.0%) and the oral therapy (n = 4/42, 9.5%) (P = 0.084). The efficacy of the ceftriaxone-based regimens was found to be better (n = 6/166 [3.6%] versus n = 6/42 [14.3%]; P = 0.017) when a composite negative outcome (CNO; relapse plus therapeutic failure) was considered. Accordingly, CNO was greatest in P2 (14.3%, n = 6/42) compared to P1 (2.6%, n = 3/ 117) and P3 (6.1%, n = 3/ 49) (P = 0.020). Seemingly, ceftriaxone-based regimens are more successful and require shorter therapy than the oral treatment protocol.

PURPOSE: To evaluate the spatial specificity of functional MR imaging by comparing it with intraoperative electrocortical mapping. METHODS: Functional MR imaging was performed in 28 patients before awake craniotomy and intraoperative electrocortical mapping. Activation was mapped for finger movement, lip movement, tongue movement, word generation, and counting paradigms. During surgery, finger movement, lip movement, tongue movement, counting, and/or speaking were mapped. The functional images and the photographic recordings of the brain functions mapped during surgery were converted to bit maps and coregistered by a computer program. The distance between the intraoperatively mapped function site and the MR activation site for a comparable function was measured. RESULTS: Forty-six functions were recorded on MR images and intraoperative maps. In 100% of correlations, the intraoperative site and the MR activation site were within 20 mm; in 87% of correlations they were within 10 mm. For each paradigm, 67% or more of the intraoperative stimulation maps correlated within 10 mm of the MR activation site. CONCLUSIONS: For the tasks used in this study, the activation site on functional MR images correlated well with the site at which intraoperative stimulation identified function.

PURPOSE: To compare activation of the ipsilateral cerebral hemisphere during tactile sensory and motor tasks involving the right and left hands. METHODS: Eight volunteers had functional MR imaging to measure the extent of cerebral hemisphere activation during a motor task and sensory task involving each hand. Hemispheric indexes (left hemisphere activation minus right hemisphere activation)/(left hemisphere activation plus right hemisphere activation) were computed for each hand and each task. The indexes for two tasks and the two hands were compared. RESULTS: The left-hand motor tasks activated the ipsilateral hemisphere in right handers significantly more than did the right-hand tasks. Motor tasks produced a greater activation of the ipsilateral hemisphere than did the sensory tasks. No significant differences were found between the hemispheric indexes for the right-hand and left-hand sensory tasks. CONCLUSION: This study confirms findings of a previous study, showing that the left hemisphere is active in left-hand motor tasks. Activation of the ipsilateral hemisphere is significantly less pronounced during sensory tasks than during motor tasks.

PURPOSE: To determine the test-retest precision of functional MR maps of regions in the brain "activated" by sensory, motor, and cognitive tasks. METHODS: Echo-planar images were acquired at 1.5 T in four subjects during voluntary motor activity involving the thumb and fingers and during tactile stimulation of the palm. Each subject performed the two tasks twice. Functional images of each task were generated at three thresholds. Test-retest precision was calculated in terms of two ratios: 1) the pixels activated in both iterations of the tasks in proportion to the pixels activated by either iteration of the task, and 2) the ratio modified to include first-order neighboring pixels. The first is referred to as pixel precision, and the latter as first-order-neighbor pixel precision. RESULTS: In each subject, activation from the first and second iteration of each task was located in the same region of the same gyrus. Pixel precision was .57 for the two tasks (at a threshold of 0.50). First-order-neighbor precision was greater than .80 for the two tasks at the same threshold. CONCLUSION: High test-retest precision can be obtained in functional MR.

PURPOSE: To compare contrast enhancement per unit of dose of contrast medium in MR imaging at 0.5 and 1.5 T. METHODS: Contrast enhancement in images made at 0.5 and 1.5 T after 0.1 mmol/kg of gadopentetate dimeglumine and 0.3 mmol/kg of gadodiamide was measured and the degree of contrast enhancement in the cavernous sinus and pituitary gland compared. RESULTS: At both field strengths and both contrast medium doses, contrast enhancement was noted in the cavernous sinus, pituitary gland, infundibulum, maxillary sinus mucosa, falx cerebri, and choroid plexus on inspection of images. Enhancement was significantly and conspicuously less in the cavernous sinus and pituitary gland at 0.5 T (96% and 33%, respectively) than at 1.5 T (160% and 102%, respectively). No tissues were identified that enhanced only with the larger dose or higher field strength. CONCLUSION: In tissues that normally enhance after intravenous administration of gadolinium chelates, enhancement is greater at 1.5 T than at 0.5 T.

PURPOSE: To use functional MR imaging to compare brain activation during processing of languages in which multilingual volunteers are fluent with brain activation during processing of languages in which they are not fluent. METHODS: Echoplanar images were obtained for five right-handed male multilingual subjects who performed a language task in three languages, one of which was a language in which the subject was not fluent. The functional MR technique included echoplanar images obtained at 1 per second during cycles of rest and performance of the task, from which functional images were processed by means of cross-correlation analysis. The numbers of active pixels in each volunteer and for each language were compared. RESULTS: Activation was noted in the left frontal lobe in all subjects performing language tasks. In each subject, the number of activated pixels was greatest for the language in which the subject was least fluent. CONCLUSION: Functional MR imaging shows differences in the processing of different languages in multilingual volunteer subjects, depending on the level of fluency in the language, and it is an effective functional imaging method for studying the processing of different languages.

PubMed ID: 22155822, No data on whether brucellar meningitis or meningoencephalitis can be treated with oral antibiotics or whether an intravenous extended-spectrum cephalosporin, namely, ceftriaxone, which does not accumulate in phagocytes, should be added to the regimen exist in the literature. The aim of a study conducted in Istanbul, Turkey, was to compare the efficacy and tolerability of ceftriaxone-based antibiotic treatment regimens with those of an oral treatment protocol in patients with these conditions. This retrospective study enrolled 215 adult patients in 28 health care institutions from four different countries. The first protocol (P1) comprised ceftriaxone, rifampin, and doxycycline. The second protocol (P2) consisted of trimethoprim-sulfamethoxazole, rifampin, and doxycycline. In the third protocol (P3), the patients started with P1 and transferred to P2 when ceftriaxone was stopped. The treatment period was shorter with the regimens which included ceftriaxone (4.40 ± 2.47 months in P1, 6.52 ± 4.15 months in P2, and 5.18 ± 2.27 months in P3) (P = 0.002). In seven patients, therapy was modified due to antibiotic side effects. When these cases were excluded, therapeutic failure did not differ significantly between ceftriaxone-based regimens (n = 5/166, 3.0%) and the oral therapy (n = 4/42, 9.5%) (P = 0.084). The efficacy of the ceftriaxone-based regimens was found to be better (n = 6/166 [3.6%] versus n = 6/42 [14.3%]; P = 0.017) when a composite negative outcome (CNO; relapse plus therapeutic failure) was considered. Accordingly, CNO was greatest in P2 (14.3%, n = 6/42) compared to P1 (2.6%, n = 3/117) and P3 (6.1%, n = 3/49) (P = 0.020). Seemingly, ceftriaxone-based regimens are more successful and require shorter therapy than the oral treatment protocol. Copyright © 2012, American Society for Microbiology. All Rights Reserved.