rifampin and Hyperplasia

Synthetic vascular conduits used in traumatic or infected fields have a high failure rate leading to catastrophic consequences including amputation and death. Although efforts to coat vascular grafts with antibiotics have had varying results, we developed a novel coating technique for expanded-polytetrafluoroethylene (ePTFE), which has proven to be effective in vitro. Thus, we hypothesized that the coated grafts would resist infection and have decreased neointimal hyperplasia when used in vivo in a large animal model.. Minocycline and rifampin suspended in a mixture of methacrylates were coated onto a 3cm segment of 6mm ePTFE (Bard, Tempe, AZ). An antibiotic-coated (ABX), adhesive-coated (AC), or control (C) ePTFE graft was then placed as an end-to-side graft into the left iliac artery of a male mongrel pig. Sterile saline or innoculum containing 3x10(8)Staphylococcus aureus (SA) or Staphylococcus epidermidis (SE) was then placed directly on the graft and the reflected peritoneum re-approximated to confine the bacteria. After 6 wk, the graft was harvested, cultured, and morphometric analyses of neointimal hyperplasia were performed.. Twenty-seven pigs had grafts placed (9 ABX, 9 AC, 9 C) and harvested. Of the nine grafts exposed to SA, the uncoated and adhesive-coated grafts averaged greater than 50,000 colonies of SA while the antibiotic-coated grafts averaged less than 50 colonies. Although not statistically significant, neointimal hyperplasia was decreased by 15% to 20% when using an ABX graft in an infected field.. The coated grafts appeared to decrease NIH formation although not significantly in this small pilot study. The methacrylate antibiotic-coated ePTFE graft did provide resistance to infection when used in infected fields.

Topics: Adhesives; Animals; Anti-Bacterial Agents; Blood Vessel Prosthesis; Coated Materials, Biocompatible; Disease Models, Animal; Hyperplasia; Male; Methacrylates; Microscopy, Electron, Scanning; Minocycline; Pilot Projects; Polytetrafluoroethylene; Prosthesis-Related Infections; Rifampin; Staphylococcal Infections; Staphylococcus aureus; Staphylococcus epidermidis; Swine

Bacillary angiomatosis is an opportunistic bacterial infection caused by either Bartonella henselae or B. quintana. The classic histologic presentation of bacillary angiomatosis involves three components: a lobular proliferation of capillaries with enlarged endothelial cells, neutrophilic debris, and clumps of finely granular material identified as bacteria with staining techniques. Pseudoepitheliomatous hyperplasia is a histologic reaction pattern characterized by epithelial proliferation in response to a variety of stimuli, including mycobacterial, fungal, and bacterial infections. We describe a case of bacillary angiomatosis associated with pseudoepitheliomatous hyperplasia in an immunocompromised patient with Acquired Immunodeficiency Syndrome. Histologic examination of a finger lesion demonstrated a capillary proliferation with neutrophilic debris and characteristic amorphous granular deposits. Warthin-Starry and Giemsa staining revealed clumps of coccobacilli. Cervical lymph node tissue also revealed organisms identified as Bartonella with PCR techniques. Stains and cultures for acid fast bacilli, fungus, and bacteria were negative. To our knowledge, there has been only one other report of bacillary angiomatosis presenting with pseudoepitheliomatous hyperplasia. We conclude that the differential diagnosis of entities associated with pseudoepitheliomatous hyperplasia should be expanded to include bacillary angiomatosis.

Topics: Acquired Immunodeficiency Syndrome; AIDS-Related Opportunistic Infections; Angiomatosis, Bacillary; Anti-Bacterial Agents; Bartonella; DNA, Bacterial; Doxycycline; Drug Therapy, Combination; Epidermis; Fingers; Humans; Hyperplasia; Immunocompromised Host; Lymph Nodes; Male; Middle Aged; Ofloxacin; Rifampin; Treatment Outcome

Three adult patients with tuberculous cervical (submandibular) lymphadenitis were treated in the past year in the Department of Oral and Maxillofacial Surgery, Evangelismos Hospital, University of Athens. None had a history of exposure to tuberculosis. In all, the chest X-rays were clear but the PPD tests were positive. All patients underwent excisional biopsy of grossly involved lymph nodes and histological examination and special stains confirmed the diagnosis. The patients were subsequently treated with triple drug administration. Antituberculosis chemotherapy consisted of isoniazid, rifampin and ethambutol and all are well after a follow-up of 9, 10 and 11 months respectively. Medical approaches often failed to diagnose tuberculous cervical lymphadenitis conclusively, and this disease remains a diagnostic and therapeutic challenge, because it mimics other pathological processes. The treatment of choice seems to be surgical excision and long term antituberculosis chemotherapy. Surgery provides a rapid tissue diagnosis, because the histological examination of the excisional biopsy is the most reliable diagnostic test.

Topics: Aged; Diagnosis, Differential; Ethambutol; Female; Follow-Up Studies; Humans; Hyperplasia; Isoniazid; Lymph Nodes; Middle Aged; Neck; Rifampin; Tuberculosis, Lymph Node

Topics: Adolescent; Adult; Child; Child, Preschool; Female; Humans; Hyperplasia; Isoniazid; Lymph Nodes; Male; Mediastinum; Rifampin