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In many cases of suspected sepsis, causative microorganisms cannot be isolated. Multiplex real-time PCR generates results more rapidly than conventional blood culture systems.In this study, we evaluated the diagnostic performance of multiplex real-time PCR (LightCycler® SeptiFast, Roche, Mannheim, Germany), and compared with blood cultures and cultures from focus of infection in nosocomial sepsis.Seventy-eight nosocomial sepsis episodes in 67 adult patients were included in this study. The rates of microorganism detection by blood culture and PCR were 34.2% and 47.9%, respectively. Sixty-five microorganisms were detected by both methods from 78 sepsis episodes. Nineteen of these microorganisms were detected by both blood culture and PCR analysis from the same sepsis episode. There was statistically moderate concordance between the two methods (κ=0.445, P0.001). There was no significant agreement between the blood culture and PCR analysis in terms of microorganism detected (κ=0.160, P=0.07). Comparison of the results of PCR and cultures from focus of infection revealed no significant agreement (κ=0.110, P=0.176). However, comparison of the results of PCR and blood cultures plus cultures from focus of infection (positive blood culture and/or positive culture from focus of infection) showed poor agreement (κ=0.17, P=0.026). When the blood culture was used as the gold standard, the sensitivity, specificity, positive and negative predictive value of PCR in patients with bacteremia was 80%, 69%, 57% and 87%, respectively.SeptiFast may be useful when added to blood culture in the diagnosis and management of sepsis.

To determine the effect of marginal donor livers on mortality and graft survival in liver transplantation (LT) recipients. Materials and methods: Donors with any 1 of following were considered marginal donors: age =>65 years, sodium level =>165 mmol/L and cold ischemia time =>12 h. Donors were classified according to the donor risk index (DRI) 1.7. The transplant recipients' model for end-stage liver disease (MELD) scores were considered low if 20. Early graft dysfunction (EGD) and mortality rate were evaluated. Results: During the study period 47 patients underwent cadaveric LT. The mean age of the donors and recipients was 45 years (range: 5¬-72 years) and 46 years (range: 4-66 years), respectively. In all, there were 15 marginal donors and 18 donors with a DRI >1.7. In total, 4 LT patients that received livers from marginal donors and 5 that received livers from donors with a DRI =>1.7 had EGD. Among the recipients of marginal livers, 5 died, versus 4 of the recipients of standard livers. There was no significant difference in EGD or mortality rate between the patients that received livers from marginal donors or those with a DRI =>1.7 and patients that received standard donor livers. Conclusion: Marginal and DRI =>1.7 donors negatively affected LT outcomes, but not significantly.

Background and objective: This randomized, double-blind, placebo-controlled study was carried out to determine the effect of esmolol on the incidence and severity of pain during propofol injection using a venous retention technique, and to compare it with lidocaine and placebo. Methods: After institutional ethical approval, 150 ASA I-II patients (ages 21–70) undergoing general anaesthesia for elective surgery were randomized to receive esmolol (0.5 mg/kg) (n = 50), lidocaine (0.5 mg/kg) (n = 50) or saline (placebo group, n = 50) diluted into a 5 ml solution after tourniquet application (70 mmHg) on the forearm. The occlusion was released after 30 seconds and 25% of the calculated induction dose of propofol was administrated at the rate of 0.5 ml/s. The patients were observed and asked immediately if they had pain in the arm, and the response was recorded. Results: Twenty-seven patients in the esmolol group, 28 in the lidocaine group, and 8 in the placebo group reported no pain (both groups vs. pl...

The aim of this study was to compare the effects of 3 different sedative-analgesic regimens in patients with intracranial mass lesions undergoing stereotactic brain biopsy. A 135 outpatients with American Society of Anesthesiologists I to II were divided into 3 groups: group A (n = 45) received a loading dose of IV alfentanil 7.5 microg/kg followed by infusion rate of 0.25 microg/kg/min; group F (n = 45) received a bolus dose of 1 microg/kg IV fentanyl and repeated as needed; and group R (n = 45) received infusion of 0.05 microg/kg/min remifentanil. Target level of sedation was 3 to 4 of the Ramsay Sedation Scale. Systolic and diastolic blood pressure, heart rate, respiratory rate, peripheric oxygen saturation (SpO2), and end-tidal carbon dioxide were recorded at different stages of the procedures. The patients in group F had significantly lower mean heart rate than those in groups A and R, but this was not in the limits of the bradycardia. The patients in group A had significantly lower mean SpO2 than those in the other groups, but mean SpO2 values did not drop below 94%. There were no significant differences in end-tidal carbon dioxide and respiratory rate values among the groups. Our results suggest that all 3 regimens have relatively similar hemodynamic and respiratory responses. The use of bolus fentanyl technique caused less hemodynamic stability. The continuous infusion technique of remifentanil or alfentanil provided better control on hemodynamic parameters.