1/40. Removal of infected pacemaker leads with deep hypothermic circulatory arrest and open surgical exploration of the superior vena cava and innominate veins.Despite the use of transvenous methods for extraction of infected leads, failed attempts may result in retained lead fragments. Retained lead fragments may be a focus of continued infection leading to sepsis. We present two patients in which conversion from cardiopulmonary bypass to hypothermic circulatory arrest allowed direct visualization, using venotomies in the superior vena cava and innominate vein to achieve complete removal of retained pacemaker lead fragments. Use of venotomies in the extracardiac venous system is a technical addition to prior descriptions of lead extraction using deep hypothermia and circulatory arrest.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
2/40. Odontogenic sinusitis causing orbital cellulitis.BACKGROUND: Odontogenic sinusitis is a well-recognized condition that usually is responsive to standard medical and surgical treatment. Current antibiotic therapy recommendations are directed against the usual odontogenic and sinus flora. CASE DESCRIPTION: The authors present a case of a patient with acute sinusitis initiated by a complicated tooth extraction that did not yield readily to standard treatment. The case was complicated by orbital extension of the sinusitis. The authors isolated methicillin-resistant staphylococcus aureus, or MRSA, species from the affected sinus that usually is not encountered in uncomplicated acute nonnosocomial or odontogenic sinusitis. CLINICAL IMPLICATIONS: Though such forms of resistant microbial flora as MRSA are rare, they may be seen in patients who have a history of intravenous, or i.v., drug use and in immunocompromised patients. Management of patients with orbital extension of sinusitis requires hospitalization and i.v. antibiotic treatment.- - - - - - - - - - ranking = 0.5keywords = extraction (Clic here for more details about this article) |
3/40. brain abscesses from neglected open head injuries: experience with 17 cases over 20 years.We are reviewing our experience with 17 civilian cases with post-traumatic brain abscesses treated in the era of CT scanning over a period of 20 years. The principal cause for this intracranial complication was the neglected compound depressed fracture. One was a newborn infant with left parietal abscess caused by a vacuum extraction. We have used the following methods of treating the abscesses: single burr hole aspiration in the newborn with an excellent result; repeated aspiration, with debridement of the depressed fracture, in 5 cases (1 death); aspiration with early subsequent excision, via craniotomy, in 7 cases (no death), and primary excision, via craniotomy, in 4 cases (1 death). The early subsequent excision of the abscess, 2 or 3 days after the initial aspiration, has proved in our experience very satisfactory. In cases with bone fragment into the abscess cavity the excision of the abscess is indicated. The cultured pus from the abscess cavity showed mixed flora (streptococci and staphylococci) in 7 cases; staphylococcus aureus in 4; staphylococcus epidermidis in 2, and no growth in 4 cases. Antibiotics play an important role in the treatment of post-traumatic brain abscesses.- - - - - - - - - - ranking = 0.5keywords = extraction (Clic here for more details about this article) |
4/40. Infectious keratitis after photorefractive keratectomy in a comanaged setting.A 48-year-old man had simultaneous bilateral photorefractive keratectomy (PRK). The surgeon who performed the PRK did not see the patient in follow-up, and there was confusion regarding the comanaging doctor. Therefore, the patient was not examined immediately postoperatively. Several days later, he was hospitalized for an unrelated, painful orthopedic problem and heavily sedated. Seven days after the PRK, an ophthalmologist was consulted for ocular irritation and discharge. Examination showed bilateral, purulent conjunctivitis and severe infectious keratitis in the left eye. The patient was treated with periocular and topical antibiotics. Corneal cultures yielded Staphylococcus aureus. The keratitis resolved slowly, leaving the patient with hand motion visual acuity. A corneal transplant and cataract extraction was performed 15 months later, resulting in a best corrected visual acuity of 20/400 because of glaucomatous optic nerve damage. Severe infectious keratitis may occur after PRK. Poor communication between the surgeon, comanaging doctor, and patient may result in treatment delay.- - - - - - - - - - ranking = 0.5keywords = extraction (Clic here for more details about this article) |
5/40. Intravitreal antibiotic injection and vitrectomy in acute bacterial endophthalmitis.Two days after an unplanned extra-capsular cataract extraction with sector iridectomy, a patient showed typical signs of bacterial endophthalmitis. Vitreous and aqueous were aspirated for culture, and gentamicin and dexamethasone were injected. Twenty-four hours later, after isolation of staphylococcus epidermidis, a vitrectomy to remove the central vitreous was done. Postoperatively, vision progressively improved; at the last review nine months after vitrectomy, visual acuity was 20/50.- - - - - - - - - - ranking = 0.5keywords = extraction (Clic here for more details about this article) |
6/40. Pacemaker endocarditis: approach for lead extraction in endocarditis with large vegetations.We present the case of a patient with vegetations on a pacing lead from a pacemaker implanted 13 years previously. A new surgical technique for removal of infected leads was developed to avoid the increased risk of septic pulmonary embolism. The electrode with vegetations was removed without cardiopulmonary bypass using the direct surgical approach described.- - - - - - - - - - ranking = 2keywords = extraction (Clic here for more details about this article) |
7/40. Case Report. Multiple etiology post-surgery endophthalmitis.The case describes a septic endophthalmitis arisen in a convalescence period following surgery of cataract extraction. The infection was due to Staphylococcus aureus and three fungal components, candida albicans, candida glabrata and acremonium kiliense, which were subsequently isolated. A careful and prompt laboratory investigation allowed the clinicians to adjust the antimycotic therapy and attain an excellent clinical result.- - - - - - - - - - ranking = 0.5keywords = extraction (Clic here for more details about this article) |
8/40. vitreous hemorrhage as the initial presentation of postoperative endophthalmitis.PURPOSE: To describe a patient with postoperative endophthalmitis whose only abnormal finding at presentation was a vitreous hemorrhage. DESIGN: Interventional case report. methods: A 68-year-old diabetic woman underwent cataract extraction with intraocular lens implantation in the left eye. Three days after surgery, she had painless loss of vision, minimal anterior chamber inflammation, and dense vitreous hemorrhage in the left eye. RESULTS: On the fourth postoperative day, significant anterior chamber inflammation developed with fibrin and a hypopyon. During vitrectomy with intravitreal antibiotic injection, an area of retinitis surrounding an eroded retinal blood vessel was found. Cultures of undiluted vitreous fluid grew coagulase-negative Staphylococcus organisms. The endophthalmitis resolved and 20 months later, her best-corrected visual acuity had improved to 20/40. CONCLUSION: Postoperative endophthalmitis may present as a vitreous hemorrhage, secondary to retinitis and erosion of a retinal blood vessel.- - - - - - - - - - ranking = 0.5keywords = extraction (Clic here for more details about this article) |
9/40. Coronary abscess: a complication of stenting.We report the case of a 72-year-old male who underwent primary angioplasty for an acute myocardial infarction and developed a coronary stent infection with Staphylococcus aureus. The patient was treated with a prolonged course of IV antibiotics and underwent debridement and partial stent extraction successfully.- - - - - - - - - - ranking = 0.5keywords = extraction (Clic here for more details about this article) |
10/40. Unusual presentation of papillary fibroelastoma: utility of serial transesophageal echocardiograms.Papillary fibroelastomas are uncommon benign tumors usually involving heart valves that may be potential sources of emboli. Transesophageal echocardiography has greatly enhanced the ability to make the diagnosis of these surgically treatable tumors in a timely fashion. We describe an unusual presentation of a 62-year-old man with suspected bacterial endocarditis, in whom initial transesophageal echocardiogram suggested the presence of pacemaker lead infection but a repeat study after extraction of the pacemaker lead revealed a large pedunculated mass arising from the superior vena cava. The mass was surgically removed and histopathology revealed papillary fibroelastoma. This case is unusual with respect to the size and site of origin of the papillary fibroelastoma as well as its echocardiographic presentation mimicking vegetations on a pacemaker wire.- - - - - - - - - - ranking = 0.5keywords = extraction (Clic here for more details about this article) |
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