Sucralfate is widely used as a cytoprotective agent in patients with peptic ulcer and other intestinal mucosal damage. In this study, the effects of sucralfate and/or selective intestinal decontamination with gentamycin on bacterial translocation (BT) in rats with experimentally-induced mechanical jaundice were investigated. Seventy-five adult male Wistar albino rats were divided into five groups of 15 each. In all except a sham group, we performed ligation of the common bile duct (CBD) via a vertical laparatomy. After surgery, the rats in group 1 were treated with oral sucralfate (5 mg/kg per day); those in group 2 underwent oral gentamycin therapy (5 mg/kg per day) for 5 days. Group 3 rats were treated with sucralfate and gentamycin for 5 days subsequent to the operation. The rats in group 4 served as controls, and received only 0.9% saline solution. Group 5 was a sham group. After 5 days of surgery, all rats were killed; the mesenteric lymph nodes (MLN), liver, and a segment of terminal ileum were harvested aseptically. The collected tissues were cultured in McCaunkey medium and chocolate agar. For each specimen, the colony-forming units (CFU) were calculated and the percentage of viable translocated micro-organisms was counted. In all rats who had ligation of the CBD, high numbers of bacteria were demonstrated in the liver, MLN, and ileum. In the liver of rats with sucralfate and/or gentamycin treatment, there was a marked reduction in CFU compared to the control group. Similarly, in the MLN measurements of CFU were higher in the control rats than the study groups. In both McCaunkey and chocolate media, the numbers of bacteria in control rats were significantly higher than in the study groups (P < 0.001). However, among the study groups themselves there was no significant difference in CFU in any of the specimens or culture media (P > 0.05). Experimentally-induced mechanical jaundice from ligation of the CBD causes significant BT in rats. Sucralfate and/or gentamycin may reduce the degree of BT from the bowel mucosa. We did not find any difference in protection from BT between sucralfate and gentamycin or both in rats with experimentally-induced mechanical jaundice.
Herein we present an acute lymphoblastic leukemia (ALL) case that developed Aeromonas sobria bacteriemia while undergoing consolidation treatment. In malignant hematologic diseases Aeromonastype microorganisms are rarely encountered agents of opportunistic bacterial infection during the neutropenic period following chemotherapy [1]. A 17-yearold male patient that presented to our outpatient clinic with malaise and abdominal pain was diagnosed as ALL and the BFM95 chemotherapy protocol was commenced. A chemotherapy combination given for consolidation resulted in severe back and abdominal pain on the 21 st d. The pain subsided without acute surgical intervention and mixed-type neuropathy -particularly drug-related -was considered and therefore vincristine (Vincristine Amphar Flacon 1 mg; Atabay) treatment was not continued. The patient had fever on the 30th d of the consolidation protocol, and iv imipenem (Tienam-IV Flacon 500 mg; MSD) 4×500 mg d -1 was added to the treatment after the required cultures were obtained. The following day his fever persisted and hypoxemia developed along with deterioration of his general health status; therefore, iv vancomycin (Edicin Flacon 0.5 g; Sandoz) 2×1 g d -1 and iv ciprofloxacin (ciprofloxacin infusion, 400 mg, Biofarma) 2×400 mg d -1 iv were started. Nonetheless, the patient's renal function deteriorated along with an associated decrease in blood pressure, and, therefore, vancomycin (Edicin Flacon 0.5 g, Sandoz) was withdrawn and iv linezolid (Zyvoxid İnfusion Solution mg mL -1 , Pfizer) 2×600 mg d -1 was started. As the patient's general health status showed no improvement, he was referred to the intensive care unit. The patient's fever remained unresponsive and the patient died on the 32 nd day of the consolidation treatment due to sepsis. The results of blood cultures obtained during febrile neutropenia showed that Aeromonas sobria was sensitive to the antibiotics that the patient was already taking. Written informed consent was obtained from the patient's family.Although in neutropenic and immunocompromised patients Aeromonas-type bacteria generally lead to uncomplicated bacteriemia with an unknown
Neutropenia is a rare and commonly reversible side effect of antidepressant treatment [1]. Mirtazapine is a noradrenergic and specific serotonergic antidepressant that is approved for use in the treatment of major depression in many countries [2]. A major hematological side effect of mirtazapine is agranulocytosis. Herein we report a patient with depression that developed severe neutropenia-associated thrombocytopenia during treatment with mirtazapine; the patient was safely treated by switching to another drug.A 72-year-old Caucasian male presented to the emergency room with fever and epistaxis. On presentation his white blood cell, neutrophil, and platelet counts were 3.27 x 10 9 L -1 , 0.17 x 10 9 L -1 , and 28.10 x 10 9 L -1 , respectively. The patient was hospitalized with neutropenic fever and thrombocytopenia. Complete blood cell count from 20 d earlier was essentially normal.The patient had a medical history of diabetes mellitus type 2 (regulated by diet), hypertension, and cervical spondylosis. His medication use included isosorbide-5-monohydrate and metoprolol succinate for 5 years. He had no obvious past history of hematological disorders. He did have a 1-month history of depressive symptoms, including low mood and alysosis. Because of his symptom profile 10 d earlier he was started on mirtazapine 15 mg at night by the neurology department.On physical examination he did not have organomegaly or lymphadenopathy; nor did he have ecchymoses or petechia/purpura. Laboratory findings, including immunoglobulin, vitamin B12, folate, and immunofixation levels were within normal limits. Other tests performed to determine a possible infectious etiology were negative. Peripheral blood smear showed thrombocytopenia and leucopenia/neutropenia. Bone marrow aspiration biopsy was performed with the permission of the patient. Bone marrow examination showed hypocellularity with differentiation of the myeloid lineage and mildly decreased megakaryocytes. There was no evidence of malign infiltration.
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