Clinical and microbiologic studies of 50 cases of viridans streptococcal bacteremia in cancer patients were performed. The bacteria were identified to species level by sequencing analysis of the 16S rRNA gene. At least nine Streptococcus spp. were found, including S. mitis (25 strains, 50.0% of 50); currently unnamed Streptococcus spp. (11 strains); S. parasanguis (five strains); S. anginosus (three strains); S. salivarius (two strains); and one strain each of S. gordonii, S. sanguis, S. sobrinus, and S. vestibularis. There were no S. oralis strains. Among 11 antibiotics of nine classes tested, no resistance to vancomycin, linezolid, or quinupristin-dalfopristin was seen. Resistance to penicillin (MIC, 4 to 12 g/ml) was noted only among S. mitis strains (28.0%, 7/25) and not non-S. mitis strains (0/25) (P ‫؍‬ 0.004). Significantly more S. mitis strains than non-S. mitis strains were resistant to fluoroquinolones and to >3 classes of antibiotics. Isolation of quinolone-resistant organisms was associated with the prior usage of quinolones (P ‫؍‬ 0.002). Quantitative blood cultures showed that the strains resistant to levofloxacin or gatifloxacin were associated with higher colony counts than were their corresponding nonresistant strains. The young and elderly patients also had higher levels of bacteremia caused predominantly by S. mitis. Septic shock was present in 17 (34.0% of 50) patients, and 13 of those cases were caused by S. mitis (P ‫؍‬ 0.007). These results suggest that S. mitis is the most common cause of viridans streptococcal bacteremia in cancer patients and is more resistant to antibiotics than other species.Viridans streptococci represent a group of 24 currently described Streptococcus species that are nutritionally fastidious and mainly alpha-hemolytic on sheep blood agar (30). These gram-positive cocci are commensals of the oral cavity, upper airway, and gastrointestinal and genitourinary tracts. Despite the overall low virulence, they may cause infective endocarditis, contribute to polymicrobic abscess, and invade the bloodstream during the state of neutropenia.The bloodstream infection usually occurs in cancer patients with mucositis and neutropenia due to antineoplastic chemotherapy-related toxicity. In these patients, studies have found that viridans streptococci are among the most common organisms isolated from the cultures of bacteremia samples (17). As cancer care has improved and intensified over recent decades and the patients survive longer, these and other infectious complications become more pronounced. A study from our institution showed that the rate of viridans streptococcal bacteremia increased from 1 per 10,000 admissions to 47 per 10,000 during the 13-year period from 1977 to 1989 (11). These bacteremias cause substantial morbidity, and mortality in these patients is at 6 to 12% (17, 29).The most common viridans streptococci that cause neutropenic bacteremia have been S. oralis, S. mitis, and S. salivarius (4,11,15,17). Identification of these species, however, was reached through...

Finger length ratio has been proposed as a putative marker for prenatal hormone exposure, as well as the action of HOX, AR, and a variant of the LIN28b genes. These genes have been recently connected to carcinogenesis and digit ratio could help to identify patients with this predisposition. Objectives: The purpose of this study was to investigate the possible correlations between digit ratio, oral squamous cell carcinoma (OSCC)—the most common oral cancer—and oral premalignant lesions (OPLs) in tobacco‐consuming males, the main risk group for this disease. Methods: Digital images of the right hands of patients diagnosed with OSCC (n = 25), OPLs (n = 25), and age‐matched controls (n = 25) were obtained. Fingers were measured using Adobe Photoshop® and the mean ratios between the 2nd and 4th digits were compared. Data were analyzed by ANOVA (α = 0.05). Results: Risk factors (alcohol and tobacco consumption, familial history) were similar between the three study groups. Males in the OSCC group presented significantly higher digit ratio (P = 0.03) in comparison with males with OPLs and individuals without oral lesions. Conclusions: According to the results, males with the higher digit ratio seem to be more prone to undergo malignization of lesions in the oral cavity. Similar deleterious habits for the three groups allows us to infer that digit ratio could add to the research of etiological factors and be a putative marker for the screening of patients' susceptibility to develop oral squamous cell carcinoma. Am. J. Hum. Biol. 2011. © 2011 Wiley‐Liss, Inc.

Release of unusually large von Willibrand factor (UL vWF) multimers and a deficiency of vWF metalloprotease may result in thrombotic thrombocytopenic purpura (TTP), a life threatening disease. Surgery has been associated with TTP, probably by releasing massive amounts of UL vWF. An association between TTP and orthopedic surgery has never been reported in the literature. We report a case of TTP following a total knee replacement surgery in which prior use of ticlopidine might have played a role.

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