1/12. mycobacterium chelonae conjunctivitis and scleritis following vitrectomy.The atypical, or nontuberculous, mycobacteria are opportunistic pathogens that usually cause infection following accidental trauma or surgery. These organisms are ubiquitous in nature but have been found with increasing frequency in other environments that include medical offices and surgical suites. Management of atypical mycobacterial ocular infections can be difficult because in vitro antibiotic activity does not always correlate with in vivo efficacy and because normal immune defenses against mycobacteria may work too slowly to prevent irreversible damage to infected ocular tissues. This report describes a patient who developed a severe ocular infection due to mycobacterium chelonae after vitrectomy. Despite eradication of the infection, the eye became blind and painful. Arch Ophthalmol. 2000;118:1125-1128- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/12. Infection is an unusual but serious complication of a femoral artery catheterization site closure device.Percutaneous devices have been developed to close the femoral artery puncture site after catheterization. Because direct compression is not needed, the devices save time for the treating health-care provider, reduce patient discomfort, and obviate the need for post-catheterization bed rest. Reported complications with use of these devices are similar in nature and frequency to those accompanying direct compression. Complications of infection requiring surgical treatment are exceedingly rare with use of these devices. We describe a series of five catheterization site infections occurring among 1807 patients (0.3%) whose femoral artery puncture was closed with a percutaneous suture closure device. All patients required operative intervention and there was one late death. physicians should be aware of this uncommon but serious complication to expedite evaluation and treatment of patients with suspected infections from these devices.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/12. An algorithm for management of residual posttraumatic calvarial defects in adults.For the discussion of options in late reconstruction of residual posttraumatic calvarial defects in adults, the calvaria is divided into three reconstructive zones. Zone 1 comprises the frontal sinus region and the contour of the supraorbital brow; Zone 2 comprises the smooth, cosmetically visible prehairline forehead; Zone 3 comprises the posthairline area and the calvaria. The particular reconstructive requirements (autogenous bone versus alloplastic material) of each zone are described and illustrated with clinical cases. The merits of bone from various donor sites and those of alloplastic material are discussed. The authors present an algorithm of reconstructive choices for residual posttraumatic calvarial defects in adults based on the nature of the defect and the aesthetic reconstructive zone.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/12. Wound erysipelas following appendectomy caused by group B beta-hemolytic Streptococcus (streptococcus agalactiae).BACKGROUND: Case description of a patient who developed erysipelas of the surgical wound following appendectomy for acute appendicitis, and literature review of invasive group B streptococcal infections. methods: A 65-year-old man with perforated appendicitis underwent urgent appendectomy and drainage. antibiotic prophylaxis with tobramycin (100 mg) and metronidazole (500 mg) was administered. At surgery, a phlegmon was identified with free perforation of the appendix and purulent peritoneal fluid. appendectomy, irrigation with 0.9% NaCl solution, and drainage with a Silastic closed-suction drain was performed. A literature search in all languages was performed using medline, using the search terms surgical site infection, wound infection, group B streptococcus, streptococcus agalactiae, necrotizing fasciitis, and postoperative infection. RESULTS: erysipelas of the surgical wound developed on the fourth postoperative day. Intravenous penicillin and amoxicillin/clavulanic acid were administered empirically. culture of the wound drainage identified streptococcus agalactiae and a few colonies of escherichia coli. The broad-spectrum antibiotic was discontinued, and a 10-day course of penicillin was completed. CONCLUSIONS: erysipelas of the surgical wound is unusual, and infection with group B streptococci is rare compared with infection by group A streptococci. streptococcus agalactiae is recognized to be increasingly virulent, with an increasing predilection for bacteremic infections in healthy hosts. Although streptococcus agalactiae remains highly susceptible to antimicrobial agents effective against gram-positive cocci, the changing epidemiology and potentially invasive nature of these infections should have clinicians alert to the possibility of infection caused by group B streptococci.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/12. Septic arthritis caused by erysipelothrix rhusiopathiae infection after arthroscopically assisted anterior cruciate ligament reconstruction.A case of septic arthritis caused by erysipelothrix rhusiopathiae, after an arthroscopically assisted anterior cruciate ligament (ACL) substitution in a non-immunosuppressed patient is described. An 18-year-old man underwent an ACL reconstruction with a quadruple hamstring graft. Eight days postoperatively, the patient developed fever, knee pain, and effusion without erythema or suppuration. He was readmitted to the hospital with the diagnosis of septic arthritis. The patient's erythrocyte sedimentation rate, c-reactive protein level, and white blood cell count were high. The joint was aspirated and the fluid was sent for cultures that revealed the presence of E rhusiopathiae. E rhusiopathiae is widespread in nature, it is transmitted by direct cutaneous laceration, and it causes septic arthritis, meningitis, endocarditis, and renal failure in immunosuppressed people with poor prognosis. In our case, the infection was treated with arthroscopic lavage and debridement, retention of the graft and hardware, and intravenous antibiotic administration for 6 weeks, followed by oral administration for 16 weeks.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/12. Infected vertebroplasty. Report of two cases and review of the literature.Transpedicular vertebroplasty has been established as a safe and effective treatment for thoracic and lumbar compression fractures. Complications are rare and infectious complications requiring surgical management have only been reported once in the literature. In this paper the authors present two patients in whom osteomyelitis developed after vertebroplasty in which corpectomy was required. The serious nature of these infections, their surgical management, and complication avoidance are discussed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/12. Hospital-acquired wound mucormycosis.Cutaneous infections due to fungi of the order mucorales are uncommon and usually present as a fulminant necrotizing cellulitis. We describe a case of a progressive wound infection at a surgical drain site caused by rhizopus rhizopodoformis. The indolent nature of the infection and lack of systemic toxicity were atypical features. mucormycosis should be suspected in cases of slowly progressive cellulitis in the appropriate clinical setting.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/12. Late bacterial granuloma at an intrathecal drug delivery catheter.In the case reported, neurological complaints were pain and dysaesthesiae in the lower back and thigh, as well as paresis of the ileopsoas muscle. MRI of the lumbar spine showed an intradural-extramedullary mass at the level of L1 homogeneously enhancing with gadolinium. This mass was situated at the tip of an intrathecal catheter implanted 11 years before for a morphine trial infusion as therapy for phantom pain after amputation of the right arm. Now, removal of the catheter was performed. Cultures of lumbar CSF and the catheter tip demonstrated coagulase negative staphylococcus. Antibiotic medication with cephalosporines was given for 6 weeks. After removal of the catheter, the patient was free of pain and he progressively regained full neurological function. Although most catheter-associated granulomas reported so far were sterile in nature, bacterial infection should still be considered even years after catheter placement.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/12. Undetected diabetes and the plastic surgeon.Plastic surgery candidates are generally healthy. Therefore, major postoperative complications are rare. Should they happen, the surgeon should search for possible causes, one of which is undetected diabetes mellitus. Six patients are presented who, based on the individual or family history or the unusual nature of their complications, were suspected of having diabetic tendencies. This experience necessitated our in-depth search into the role of silent or undetected diabetes. This report emphasizes the importance of positive family history of diabetes and the role of glucose tolerance tests on suspected cases. Even with normal glucose tolerance tests, however, some of these patients with a positive family history of diabetes and history of previous infections suffer from deficiencies in the chemotactic immune system. We recommend full discussion of the increased risk of infection and delayed healing with these patients, conservatism during surgical procedures, and prophylactic use of antibiotics perioperatively.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/12. paper clip stab wounds: four case reports.Four prisoners recently evaluated at a county hospital sustained self-inflicted paper clip stab wounds of the abdomen on 22 occasions. Guidelines for management based on physical examination, abdominal films and wound exploration with paper clip extraction and short-term admission for observation have been successful in avoiding laparotomy in most instances. Evaluation and surgical treatment of penetrating abdominal injuries are controversial. Some authors propose mandatory laparotomy for all stab wounds violating the peritoneum, while others recommend selective management based on physical findings, local exploration of the wound and subsequent peritoneal lavage. Recently, four prisoners have inserted sharpened paper clips into and through the abdominal wall on 22 occasions, raising questions about the appropriate treatment of these injuries. These wounds differ from other stab wounds in several respects: 1) underlying psychiatric disturbances and the self-inflicted nature of the wound increase the difficulty of patient management; 2) attempts are often multiple, precluding repeated peritoneal lavage for evaluation; 3) the foreign body may be completely intraperitoneal; and 4) peritoneal penetration is similar to that incurred during a peritoneal tap with an 18-gauge needle. The differing presentations of these patients are reported, and a plan for management of these injuries is proposed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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