Aseptic Rules Research Articles

S5.4c Isolation of keratinophilic fungi of the genus Microsporum from the soils of Moscow, Russia

5.4 Free oral paper session, September 22, 2022, 3:00 PM - 4:30 PMIt is reported about the discovery of zoophilic and geophilic dermatophytes in the soils of city parks and adjacent territories of Moscow, Russia. Microscopic fungi of the Microsporum genus were found in 27/50 samples (54%): Microsporum gypseum (42%) and Microsporum canis (12%), their number was higher in the soils taken from the adjacent areas where domestic animals are walked. This increases the risk of infection of animals upon contact with soil.ObjectivesThe research was conducted to determine the frequency of occurrence of potential pathogens of animal dermatophytosis in those areas of the soil cover where pets are walking. Soil samples were taken from several areas: the adjacent territories along the streets of Vishnevsky and Kostyakov, designated as areas 1 and 2, the park ‘Dubki’, Lianozovsky, Timiryazevsky, designated as 3, 4, and 5, respectively.Areas 1 and 2 are narrow patches of soil adjacent to residential buildings and sidewalks where pets are most often walked. Areas 3 and 4 are areas of soil adjacent to park paths, where animal walking is less common. Area 5 is a relatively little-visited place in the forest park, where animals are rarely walked.MethodsBefore sampling, vegetation cover and rubbish were removed from the soil area, then ∼ 100 g of soil was taken from the surface using aseptic rules in sterile plastic containers. A total of 10 soil samples were taken from each plot. The soil was dried at room temperature, sieved to remove rubbish, and plant parts, and placed in sterile Petri dishes.Isolation of fungi was carried out by the ‘bait’ method: samples of sterile pet hair about 1 cm long were placed on the surface of the soil, the soil was moistened with sterile distilled water with the addition of a selective additive for the isolation of dermatophytes (Dermasel, Oxoid). Petri dishes were periodically inspected for fungal growth on the surface of the wool and moistened if necessary.When the growth of microscopic fungi was detected on the surface of the wool, they were sterilely transferred to Petri dishes with wort agar medium (M129, HiMedia) to obtain a pure culture and identification. Only microscopic fungi of the genus Microsporum were taken into account.ResultsAs a result of the research, a total of 27 isolates of microscopic fungi, 21 of Microsporum gypseum and 6 of Microsporum canis were isolated from the soils of Moscow: 7 isolates at the area 1 (6 of M. gypseum, 1 of M. canis), 8 isolates at the area 2 (5 of M. gypseum, 3 of M. canis), 5 isolates at areas 3, and 5 (4 of M. gypseum, 1 of M. canis), 2 isolates of M. gypseum at the area 5. The results are illustrated in Figure 1.ConclusionSoils located in adjacent areas are more polluted by the hair of pets that walk there. Therefore, these soils also contain keratinophilic microscopic fungi, which includes the pathogens of animal dermatophytosis. In such places, animals are susceptible to infection with fungal infections directly from the soil.

DETECTION OF DRUG MEDICATION ERRORS OF NURSING STUDENTS IN PEDIATRIC PATIENTS THROUGH A HOSPITAL SIMULATION

Objevtive: This study aimed to detect nursing students’ drug medication errors in pediatric patients.
 Methods: The study used a comparative descriptive research design and was carried out after the necessary ethical and official permissions had been obtained. The universe of the research consisted of the students of Faculty of Nursing. The sample of the study included 94 students (third year n=47 and fourth year n=47). A laboratory of the Faculty of Nursing was simulated as a room where a nurse provides treatment. The students who participated in the study with the determined drug order were asked to prepare the drugs with the most appropriate technique, and they were observed by the researchers. Data were collected one by one by the researchers using a drug medication errors checklist prepared by the researchers. 
 Results: The third year students did not consider dry powder dosage and obtained the lowest score (X̄=0.68). The fourth year students did not attach the right label on the drug taken and received the lowest score (X̄=0.42). The third year students were more successful in attaching the right label on the remaining drug (p=0.20) and the fourth year students were more successful in observing aseptic rules (p=0.03). Students in both groups ignored dry powder dosage of the drug in total and earned the lowest score from this practice (X̄=0.64).
 Conclusion: Drug medication errors committed by the students in both groups were high, and the students did not consider dry powder dosage when reconstituting the drug.

Theodor Bil’roth - gastric surgery founder

More than a century has passed since the death of the great German surgeon Christian Albert Theodor Billroth. Despite such an impressive time, he is still widely known in the surgical community as the founder of gastric surgery, whose results of many years of work have largely influenced the development of abdominal surgery in the XIX-XX centuries. This person combined the features of a talented surgeon, teacher and organizer in equal measure. Thanks to strict adherence to aseptic rules, Theodor Billroth was the first to begin surgical interventions in anatomical areas, previously considered«forbidden» due to the high frequency of purulent-septic complications. Over the seven years he spent as head of the Zurich surgical clinic, the Billroth contributed to its significant expansion and modernization. He first introduced into the clinical practice statistics of surgical interventions and their results, thereby taking another step from the surgical craft to art and science. Being a versatile person, one of the brightest personality traits of Theodore Billroth was artistry, which was equally manifested both at the operating table and at the piano keyboard, because he, among other things, was a gifted pianist and violinist. In his life and work, he did not oppose science and art. As a scientist-innovator, professor Billroth was the first to perform successful interventions on organs previously considered to be inaccessible to operative effects, thus opening a fundamentally new page in the history of abdominal surgery.

History of pancreatic cancer surgery

Abstract. The first mention of pancreatic cancer dates back to 1761, when the six-volume work of the famous Italian anatomist G. Morgagni On the location and causes of diseases discovered through dissection was published. However, the history of surgical treatment of malignant tumors of the pancreas dates back to the end of the 19th century. The accumulated experience of operational techniques and the introduction of aseptic rules created objective prerequisites for performing operations in complex anatomical zones during that period of time. On July 16, 1882, the famous German surgeon F. Trendelenburg, firstly, performed a successful resection of the tail of the pancreas for sarcoma, founding the development of surgery in this field. However, the success in this sphere could not be shifted to a tumor of the head of the gland due to the subsequent separation of the duct system from the duodenum. Over the following years, many outstanding surgeons tried to solve this problem, such as: A. Codivilla, W. Halsted, W. Kaush, until in the early 40s A. Whipple proposed a new method of pancreatoduodenal resection, that became the gold standard for head cancer treatment pancreas. Although it was not possible to achieve significant success in the treatment of cancer in the original method of operation, as a result at various stages of time this procedure wasnt used a lot and was almost forgotten. Today, surgery remains the leading method in the complex treatment of patients with pancreatic cancer. Minimally invasive technologies have been actively introduced into pancreatic surgery in the past two decades. The indications for surgery have been expanded, lymphadenectomy standards have been introduced, thereby increasing the chances of a successful cure.

THE FREQUENCY AND CAUSES OF COMPLICATIONS THE PERIPHERAL VEINS CATHETERIZATION

Peripheral vein catheterization is the most common invasive hospital procedure, which, however, may be accompanied by the development of various complications.The aim of the study was to assess the frequency of complications associated with peripheral vein catheterization, and to compare two types of peripheral catheters in surgical patients.Materials, methods and results. The study was conducted at the Department of Anesthesiology and Intensive Care at the National Cancer Institute. The study included 122 patients of both sexes who were scheduled for surgery. In the operating room with compliance of the aseptic rules the peripheral veins of the patients upper extremities were catheterized. Intravenous catheters of two types were used for catheterization of the peripheral vein: made of fluoroethylenepropylene (FEP) (FEP IV CannulaVogt Medical with wings and port, size 16-18 G) and of polyurethane (PU) (PU IV CannulaVogt Medical with wings, size 16-18 G) according to the diameter of the punctured vein. The frequency of complications was investigated and the causes of problems with catheterization of peripheral veins were considered. The clinical manifestations of phlebitis were evaluated on the Infusion Nurses Society Phlebitis Scale (INS) scale. The total complication rate in our study was significantly different between the two groups and amounted to 32.6% in gr. 1 and only 7% in gr. 2.Conclusion. The study shows that one of the risk factors may be the design of the instrument and the material from which the peripheral catheter is made. Despite the positive characteristics of both catheters, the impact of which we investigated in our work, the use of PU catheters contributes to reducing the number of complications and increases the duration of their use compared to FEP catheters.

Sterility monitoring of cat stored donor blood

Abstract. Contamination of donor blood is a permanent risk factor for blood transfusion. Using of non-sterile blood products can leads to severe complications and high health risks for recipient animals. Sterility research of canned blood, its components, canned bone marrow and blood transfusion products is required to detect possible contamination of aerobic and anaerobic microorganisms. Factors of donor blood bacterial contamination may be blood collection systems, non-compliance of aseptic rules during blood collection, tightness violation of container, and others. As closed blood collection systems are not always available to veterinary practitioners, semi-closed systems or open (direct) blood collection are an alternative, which are at high risk for bacterial contamination of donor blood when used carelessly. In our research, 12 canned cat donor blood samples were analyzed in total. Samples were stored for 30 days at +2-6 °C. The donor animals were clinically healthy 12 cats. Blood was collected from the jugular vein by semi-closed systems in polymeric containers with CPDA anticoagulant. The bacterial culture method is considered as the gold standard for assessing the presence of blood contamination in most blood transfusion centers. The tested blood samples were inoculated into thioglycolate and Sabouraud medium and incubated in a thermostat at 20-25 °C. The incubation period was 14 days. According to the results of bacteriological examination of donor blood samples after their storage – non-sterile samples were not detected. Thereby, semi-closed blood collection systems are reliable and allow to obtain donor blood samples without losing its sterility in long-term storage. Keywords: animals blood transfusion, cat donor blood, microbial contamination, donor blood sterility

Sterility assurance of technetium-99m radiopharmaceuticals: no specific air conditions are required for their preparation, storage and dispensation.

The aim of this study was to ascertain whether the extemporaneous technetium-99m radiopharmaceuticals - prepared by closed procedures - maintain or not sterility throughout their lifespan regardless the quality of the environmental air where they are prepared, stored and dispensed, provided that the basic aseptic rules for closed procedures are followed. Three different types of assays were performed in this study: 1) sterility tests of each and every one of the vials with the remains of technetium-99m radiopharmaceuticals, which have been prepared in our hospital radiopharmacy during three years without any special environmental air conditions; 2) integrity tests of punctured rubber plug closures using both microbial challenge testing and dye ingress testing; and 3) simulation of the dispensing process using a liquid growth medium. Sterility tests of more than 6,000 vials with the remains of technetium-99m radiopharmaceuticals - prepared without any special ambient air conditions - were performed, all of them with a negative result (no growth of microorganisms occurs). The integrity of punctured rubber plugs closure was sufficiently proven under extreme conditions by two different methods. The maintenance of sterility during the dispensing process of technetium-99m radiopharmaceuticals was also proven by simulation of the dispensing process using a liquid growth medium. This study strongly supports that it is not necessary any special ambient air conditions to prepare, store and dispense extemporaneous technetium-99m radiopharmaceuticals in order to preserve their sterility when the basic aseptic rules for closed procedures are followed.

Analysis of the monitoring study of the antibiotic-resistance of the agents of purulent-inflammatory processes of soft tissue

The main factor in the treatment of suppurative and inflammatory processes is the timely optimization of treatment measures taking into account the nature of the microflora and its susceptibility to antimicrobial drugs. The purpose of the study is to monitor the spectrum of microorganisms – pathogens of purulent-inflammatory processes of soft tissues in surgical patients; study of the sensitivity of isolated strains to antibiotics. The material was collected in accordance with aseptic rules. The identification of a pure culture of bacteria was carried out according to morphological, culture, biochemical properties, and the presence of virulence enzymes. Sensitivity of bacteria to antibiotics was determined by the standard disks method (by Kirby-Bauer’s). 255 patients with purulent-inflammatory processes of soft tissues were examined for the period from 2014 to 2017. 229 strains of isolated bacteria were included to Escherichia coli, Citrobacer freundii, Enterobacter cloacae, E.aerogenes, Proteus vulgaris, Staphylococcus aureus, S.epidermidis, Streptococcus pyogenes, S.viridians, S.agalactiae, Pseudomonas aeruginosa. The main cause of purulent-inflammatory processes of soft tissues is Staphylococci (67,2%). Compared to previous studies, the number of P.aeruginosa isolated cultures increased (7.9%). In monoculture and in association with other microorganisms, E. coli (9.6% of cases), E.cloacae et aerogenes (3.9% of cases), P.vulgaris (3.9% of cases), C.freundi (2.5% of cases), S.agalactiae, S.pyogenes, S.viridans (3.5%). The number of associated sows reaches 12%. Clinical strains of microorganisms remain most sensitive to fluoroquinolones, cephalosporins, and also retains high sensitivity to gentamicin, lincomycin, rifampicin, which is important for empirical antibiotic therapy. To increase the effectiveness of antibacterial therapy, strict adherence to the mode of appointment of antibiotics, justification of indications, a combination of antibiotics of different spectrum of action, mandatory correction after determining the sensitivity of the pathogen.

Interventions to prevent urinary catheter–associated infections in children and neonates: a systematic review

Few data are available to inform strategies for the prevention of catheter-associated urinary tract infection (CAUTI) in children and neonates. Many recommendations are derived from studies in adults and cannot be applied to the paediatric population. This study was aimed to identify all studies that measured the efficacy of an intervention for the prevention of CAUTI in children and neonates. A systematic review using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) was conducted. Eligible studies published between January 1st, 1995 and December 31st, 2017, were identified in PubMed, the Cochrane Database of Systematic Reviews, LILACS, SciELO and DOAJif applying an intervention with the aim of CAUTI prevention in inpatient children, infants or neonates. The following study designs were included: controlled and non-controlled before-and-after studies, (controlled) interrupted time series analyses and randomized controlled trials. Quantitative or qualitative studies on interventions in both adults and children were eligible if data on children could be extracted. Reviews, case series, letters, notes, conference abstractsand opinion articles were excluded. Of 99 articles identified, six were included in the final analysis, after consensus from three independent investigators. Four studies used a multimodal strategy (using at least four or more different components at the same time) as follows: aseptic rules during catheter insertion and removal; cleaning the urethral meatus with sterile water; use of a new silicone catheter per insertion with a closed sterile drainage system by a sterile technique; daily evaluation of catheter requirement; placement of indwelling urinary catheters only for approved indications; reducing of urinary catheter days and positioning of the patient and collection device to assist in urine drainage. One study tested periurethral cleaning intervention to reduce CAUTI. One study described the association of the presence of a physician safety champion with urinary catheter device utilization ratios. Catheter-associated UTI reduction rates were reported in four studies; three achieved statistically significant decreases in CAUTI rates. Positive results were achieved only when a multimodal strategy was used with at least four or more components. This strategy could be adopted for paediatric healthcare institutions to reduce CAUTI rates in children and neonates. Evidence exists to support the use of a multimodal strategy for CAUTI reduction in hospitalized children and neonates.

Сучасний спосіб судинного доступу при критичних станах у дітей

To provide a vascular access is the main task during the first minutes of resuscitation, but it should not interrupt the chest compression or ventilation. Vascular access includes the catheterization of peripheral vein or intraosseous space. The European Resuscitation Council in 2005 has recommended to establish the practice of intraosseous access (IOA) during resuscitation. The following updates of the European Resuscitation Council Recommendations (2010, 2015) has also considered that it necessary to use intraosseous access during cardiopulmonary resuscitation. The emergency physician should use intraosseous access as useful alternative to peripheral venous access. Intraosseous access has all advantages of central venous access, but it is much easier and faster. Consequently, in case of cardiac arrest and apnoea as well as decompensated shock, when the introduction of adrenaline and/or infusion solutions is the first-line treatment, the most appropriate vascular access is intraosseous one. Provided that the procedure is performed in compliance with aseptic rules, the risk of infectious complications is very low. However, intraosseous access should be transitional vascular access and should be removed as soon as possible. Its use must never exceed 24 hours.

Der artifizielle Sphinkter für die Inkontinenztherapie

The artificial urinary sphincter (AUS) has been successfully implanted in the last 40 years. Continuous improvement of the AUS and increasing experience with the device has led to its widespread acceptance. The major indication is still post-prostatectomy incontinence. In this collective patient satisfaction was reported in over 90%. In a number of patients with neurogenic bladder dysfunction and congenital or acquired anatomical disorders of the urethra, an AUS can be an alternative to urinary diversion. Nonetheless, complications such as infections and erosions are still a problem, leading to revisions and secondary procedures in up to 20% of the cases. Therefore, operative expertise and precise execution of aseptic rules are basic prerequisites.

Infection grave compliquant une angioplastie avec utilisation d’Angio-Seal ®

Diagnostic or interventional femoral artery catheterizations are more and more commonly practiced, so are haemostatic puncture closure devices, used to prevent bleeding complications and decrease hospital length of stay. Complications, such as infections, have been reported after using haemostatic puncture closure devices. We report the case of a female patient presenting with severe infection after Angio-Seal ® use: femoral artery infection with sepsis and multiple organ failure, septic embolism with embolic skin abscesses, bacterial arthritis and inferior limb necrosis. Studies comparing the infectious risk of manual compression versus haemostatic puncture closure devices are contradictory. Nevertheless, aseptic rules must be strictly observed. Indications for these devices concern only patients with high risk of hemorrhage and should be discussed for immunodepressed, diabetic, or obese patients.

Analysis of Risk Factors for Catheter-Related Bacteremia in 2000 Permanent Dual Catheters for Hemodialysis

Background: Infection constitutes a leading cause of morbidity and mortality in hemodialysis (HD) patients. The type of vascular access is an important determinant of the risk of infection. Therefore, identification of risk factors leading to catheter-related bacteremia (CRB) is strongly required. The aim of this prospective large cohort study of HD patients using only catheters as vascular access was to isolate risk factors for CRB. Methods: 2,230 permanent silicone dual catheters implanted in 1,749 patients between November 1982 and November 2005 were studied. The following data were collected at the time of catheter implantation: presence of hypertension, diabetes mellitus, obesity, atherosclerosis, immunodepression, Wright-Khan index, site and side of catheter insertion, and history of bacteremia. Results: The site of catheter insertion was internal jugular (n = 2,133), subclavian (n = 79) and femoral (n = 17). Duration of catheter use was as follows: 30–90 days (n = 1,607) and >90 days (n = 1,054); 226 episodes of bacteremia occurred in 197 catheters. Microorganisms responsible were mainly Staphylococcus aureus, coagulase-negative staphylococci, Enterobacter spp. and Pseudomonas aeruginosa. The overall incidence of bacteremic episodes was 0.514/1,000 catheter days. Hypertension, atherosclerosis, diabetes mellitus, site of catheter implantation, duration of catheter use, Wright-Khan comorbidity index and previous history of CRB were significant risk factors associated with bacteremia in univariate analysis. Multivariate analysis revealed that a previous history of a bacteremic episode (odds ratio, OR = 2.70, 95% confidence interval, CI = 1.56–4.68), diabetes mellitus (OR = 2.37, 95% CI = 1.65–3.39), duration of catheter use >90 days (OR = 1.85, 95% CI = 1.35–2.55) and hypertension (OR = 1.49, 95% CI = 1.08–2.04) were still significant factors associated with bacteremia. Conclusion: Reducing CRB is still a challenge for nephrologists to reduce patient morbidity and mortality. Our study could demonstrate that diabetes, previous history of CRB, site of catheter implantation and duration of catheter use were the most important risk factors for bacteremia. Therefore, to prevent CRB, particular attention should be paid to patients with diabetes and a previous history of bacteremia following strict hygienic and aseptic rules for catheter handling associated with the regular use of antiseptic lock solutions.

Postoperative Prevention of Nosocomial Pneumonias, by Using Airway Filters under Artificial Ventilation

Objective: to determine the duration of exposition of filters and their most optimum position in different types of respiratory circuits. Subjects and methods. Group 1 comprised patients receiving not more than 12-hour artificial ventilation (AV) through a coaxial respiratory-circuit, without a humidifier, moisture accumulators, and a nebulizer. The filters were set between the intubation tube and the circuit. Group 2 included patients having more than 12-hour AV through the disposal respiratory circuits including a nebulizer, a humidifier, and inspiratory and expiratory moisture accumulators. The filters were set in front of the inspiratory circuit and behind the expiratory one on an AV apparatuses. Before regularly replacing a filter and/or a circuit, samples were taken for bacteriological tests from different portions of the circuit at various intervals: 4, 12, 24, 48, 96, 120, and 144 hours after initiation of AV, as well as before tracheal extubation in a patient. Results. The data obtained during the study have indicated that the breathing circuit filters afford a reliable protection from the entry of environmental microorganisms into the patient’s respiratory tract. In Group 1, AV did not result in the occurrence of pneumonia or tracheobronchitis. The moisture accumulators and the Y-shaped connector are the most infection-susceptible parts of a respiratory circuit. Mechanical circuit contamination and a larger number of pathogenic microbial strains were observed after 4—5-day AV. Conclusion. All procedures associated with circuit seal failure should be performed, by observing the aseptic rules. The recommended time of using a respiratory circuit during prolonged AV is 96—120 hours. Key words: intensive care unit, artificial ventilation, nosocomial pneumonia, antibacterial respiratory circuit filter.

Dialysis catheter insertion with and without peel-away sheaths

Tunnelled central venous line (TCVC) as a long-term vascular access in haemodialysis patients started to be used in our unit in 1993. Although it is certainly not the optimal access type, its use is increasing because of increasing patient age associated with various comorbidities such as compromised cardiovascular system condition, peripheral vascular disease (diabetes mellitus, ischemic heart disease), etc. rendering creation of an AV-access practically impossible. Since 1993 until the end of 2006 we have inserted 444 lines. Conventional insertion procedure includes local anaesthesia, adherence to aseptic rules and use of modified Seldinger’s technique, best under ultrasound guidance. The right jugular internal vein is preferred because this vessel has the lowest complication rate. First, the jugular vein is punctured with a needle. Then, a wire of about 20cm insertion length is introduced, after which the puncture needle is removed. A three to five centimetre long incision is made at the puncture site fastening up to the created subcutaneous tunnel. The tunnel leads from the fossa supraventricularis minor laterally towards the thorax and the TCVC is drawn through it. The next step is the introduction of the peel-away sheath with a dilator over the guide wire into the vein. The dilator with the wire is then removed and the catheter is inserted through the sheath. During the insertion the sheath is concurrently being taken out and peeled away. Because of possible complications with the long peel-away sheath, Bhat described a technique using a shortened sheath [1]. This work has been subsequently commented on by Shetty [2] who questioned the safety of the shortening the peel-away sheath and suggested the modified approach of sliding the sheath to just about half of the dilator length. We have also experienced various complications with the insertion of permanent catheters by the conventional technique, such as rupture of the superior vena cava, haemothorax, etc., that prompted us to introduce a less invasive technique not using the peel-away sheath at all. For dilation of the subcutaneous tunnel we use dilators of the size (12–15F) matching that of the catheter used. The catheter is inserted via the guide wire only, similarly to the insertion of acute catheters. This procedure is used also during reinsertion when a permanent catheter is replaced by a new one or an acute catheter is exchanged for a permanent one. In those cases, access into the central vein is already performed by the previous line. Blood flow obtainable from the catheter (regardless of insertion technique) is checked during the first haemodialysis using the Doppler-based HD01 instrument (Transonic Systems Inc., Ithaca, USA). Comparison of success rate (as defined by the K/DOQI guidelines [3]) has not shown any difference between catheters inserted by the conventional procedure (306 procedures) and those inserted without using the peelaway sheath (138 procedures). No difference was seen in the maximum obtainable flow (measured at a prepump pressure of 200mmHg) either. Insertion of the permanent cuffed catheters using only dilators without any peel-away sheath appears to be a less invasive procedure which is associated with fewer complications. Advantages of this approach include minimal blood losses, less discomfort for the patient but mainly lower risk of damage to the vascular venous system. Safe clinical applicability is supported by the 138 insertions performed by this technique in our unit so far.

Preliminary Italian Experience of Lumbar Spine Percutaneous Laser Disc Decompression According to Choy's Method

Objective: The purpose of this paper is to describe the preliminary first Italian experience on lumbar spine percutaneous laser disc decompression (PLDD) using a Nd:YAG laser according to Choy's technique. Background Data: PLDD is a minimally invasive technique for the treatment of a widely selected group of patients affected by herniated disc problems. Several studies, using a variety of different lasers used, have demonstrated its safety and worth. The current study is the first large PLDD series reported in Italy. Materials and Methods: Lumbar PLDD procedures, according to Choy's method, were performed in 92 patients. There were 53 male and 39 female patients, and their ages ranged from 21 to 79 years. All the patients were treated in the operative room according to aseptic rules. Results: The overall results, evaluated with the MacNab criteria with a short follow-up (medium 5 months, maximum 12 months) were as follows: 76 patients (82.8%) showed excellent or good improvement, and 16 patients (17.2%) showed no or poor improvement. No complications were observed. Conclusion: These results, even though a longer follow-up is needed in future studies, have confirmed that PLDD (according to Choy's method) is a first-choice treatment for a large group of patients affected by herniated disc that is not responding to conservative treatment.

Deux observations d'infections iatrogènes à streptocoques oraux: méningite et spondylodiscite

The multiplication of invasive spine investigations for either diagnostic or therapeutical purposes increases the risk for iatrogenic infections. We report two cases of iatrogenic infections, one case of meningitidis and one case of spondylodiscitis due to Streptococcus viridans. The two cases included a 42-year-old male patient presenting with spondylodiscitis due to Streptococcus oralis following nucleolysis for discal node and a 51-year-old female patient with purulent meningitidis due to Streptococcus salivarius following hysteroscopy with spinal anesthesia. According to the disease chronology and bacterial results, iatrogenesis was evidenced. The streptococci originate from the patient's skin or from the operators' endobuccal flora. Simple aseptic rules, including wearing a surgical mask during any spinal tap, would definitely avoid iatrogenic infections.

Cylinder pencil case for sterilization and storage of spokes

We propose a cylinder-pen for sterilization and storage of spokes used for osteosynthesis. The device corresponds to the sizes of spokes produced by the medical industry and consists of two hollow cylinders: an external one (with a sealing lid) and an internal one. The latter holds 40 spokes and has 5 mm diameter holes in its walls which allow the free flow of boiling water. Once the sterilization of both cylinders is completed, the inner one (containing the spokes) is sealed observing all aseptic rules.