Resection Of Infected Tissue Research Articles

Laparoscopic drainage as a minimally invasive treatment for a psoas abscess: A single-center case series and literature review.

A psoas abscess is a rare but potentially devastating condition that is associated with risks of neurological deficits, septic shock, and even death. The current first-line treatment is percutaneous catheter drainage (PCD) under imaging guidance, combined with broad-spectrum antibiotics. Surgical drainage should be considered if PCD fails or is impossible.Although many studies on PCD and open surgical drainage have appeared, the outcomes of laparoscopic drainage have rarely been reported. Thus, we laparoscopically drained the psoas abscesses of 6 patients; drainage was complete and we encountered no recurrence or complication. All patients were evaluated by plain radiography, contrast-enhanced computed tomography, and laboratory tests; all were followed-up for 1 year. Laparoscopic drainage is a good treatment option when PCD fails, affording all the advantages of open surgery (complete drainage, resection of infected tissue, and contermporaneous treatment of concomitant lesions). Also, laparoscopic drainage is minimally invasive, requires a smaller incision, and allows rapid recovery.

First case of the succesful treatment of actinomicosis of the knee in a child

Objectives. Actinomycosis in children has not been studied enough, the number of publications is limited. Actinomycosis of the knee joint is very rare, the disease mimics tuberculosis or malignant neoplasms, which can lead to late diagnosis and inadequate treatment. Materials and methods. We report on the first case of an 8-year-girl with actinomycosis knee. Diagnosis is based on histological examination. Results. Surgical resection of infected tissue and longterm antibiotic therapy for 4.5 months was effective in the treatment of pediatric patient with knee actinomycosis. In the scientific literature no such clinical case was found.Сonclusion. Case of successful treatment of pediatric patient with knee actinomycosis is presented for the first time.

Skin flap complications after cochlear implantations.

The objective of the study was to analyse and present the surgical management strategy for major skin flap complications (MSFC) after cochlear implantations. Patients fitted with a titanium-silicone-coated implant of the same kind, operated on between 1994 and 2013 with a standardised procedure (1076 medical charts) were analysed. Analysis aimed to identify and study individuals with skin problems related to the cochlear implant treatment, i.e. requiring surgical treatment in hospital defined as MSFC and focused on incidence, risk factors and treatment of MSFC. MSFC were diagnosed in 1.76 % of patients: 2.06 % of children and 1.35 % of adults, 2.43 % after implantation with a long “C”-shaped incision and 1.28 % after short retroauricular incision. Registered risk factors included head trauma, acute otitis media, poor hygiene in children, and general comorbidities in adults. The primary intervention was dependent on skin complication severity and included revision surgery with wound closure over an implant (52.6 %) and revision surgery with explantation (47.4 %). Revision surgery without explantation was successful in 40 % and the most effective approach was debridement with a two-layer rotational flap. Explantation led to ultimate wound healing in all cases. Major skin flap complications after cochlear implantation are rare, but their treatment is complex and difficult. Revision surgery with resection of infected tissue, formation of a rotational two-layer flap preceded and supplemented by intensive targeted antibiotic therapy can be effective and should be the first treatment option. Spontaneous implant explantation, abscess formation or unsuccessful primary treatment necessitate implant removal as the ultimate solution.

Surgical outcome in patients with concomitant-infected abdominal aortic aneurysm and spondylitis

The coexistence of infected abdominal aortic aneurysms and spondylitis is rare but challenging. The etiology of the infection is frequently unknown. The aim of this study was to review the outcome of surgical repair of this complex disease. From 2004 to 2006, six patients were identified who underwent surgical repair of concomitant infected abdominal aortic aneurysm and spondylitis. Diagnosis, treatment and intermediate-term results are presented. The clinical manifestation included the signs of ongoing systemic infection, neurological deficit and abdominal or back pain. Computed tomography revealed abdominal aortic aneurysms associated with polysegmental spondylitis. Patients underwent radical debridement and aortic replacement with cryopreserved aortic allografts or silver-coated prostheses followed by antibiotic treatment. Only one patient received a simultaneous anterior vertebral stabilization. Greater omentum was placed in the abscess cavity. Intensive care unit and hospital stay averaged 3.0 and 28.0 days, respectively. Organisms were identified in all but one patient. Over a follow-up period of 4.4 years, four patients are alive and showing freedom from infection, and two patients had died unrelated at seven and eight months. In conclusion, surgical repair of infected aortic aneurysms with resection of infected tissues and implantation of a homograft or a silver-coated prosthesis achieved favorable results in this sick patient group. Simultaneous vertebral stabilization is rarely necessary.

Chronic Granulomatous Disease: Lessons from a Rare Disorder

Chronic granulomatous disease (CGD) is a rare primary immunodeficiency with X-linked or autosomal recessive inheritance involving defects in genes encoding phox proteins, which are the subunits of the phagocyte NADPH oxidase. This results in failure to produce superoxide anion and downstream antimicrobial oxidant metabolites and to activate antimicrobial proteases. Affected patients are susceptible to severe, life-threatening bacterial and fungal infections and excessive inflammation characterized by granulomatous enteritis resembling Crohn's disease and genitourinary obstruction. Early diagnosis of CGD and rapid treatment of infections are critical. Prophylaxis with antibacterial and mold-active antifungal agents and the administration of interferon-γ has significantly improved the natural history of CGD. Currently, the only cure is allogeneic hematopoietic cell transplant (HCT), although there remains controversy as to which patients with CGD should get a transplant. Allele-based HLA typing of alternative donors, improved supportive care measures, and use of reduced toxicity conditioning have resulted in event-free survival (EFS) of at least 80% even with an unrelated donor and even better when the patient has no active infections/inflammation. Gene correction of CGD would eliminate the risks of graft-versus-host disease (GVHD) and the immunoablative chemotherapy required for allogeneic HCT. Based on gene therapy trials in patients with SCID-X1, ADA-SCID, and the early experience with CGD, it is clear that at least some degree of myeloablation will be necessary for CGD as there is no inherent selective growth advantage for gene-corrected cells. Current efforts for gene therapy focus on use of lentivector constructs, which are thought to be safer from the standpoint of insertional mutagenesis and more efficient in transducing hematopoietic stem cells (HSCs).

Visceral Debranching and Aortic Endoprosthesis for a Suspected Mycotic Pseudoaneurysm of the Abdominal Aorta Involving Visceral Arteries

Celiac aortic localization of mycotic pseudoaneurysm is serious. The conventional treatment, resection of infected tissues with in situ revascularization, is associated with a high surgical morbid-mortality rate. We report a case of mycotic pseudoaneurysm of the abdominal aorta involving visceral arteries excluded by an aortic endoprosthesis after visceral debranching. A 69-year-old man developed a celiac mycotic pseudoaneurysm after an acute prostatitis with septicemia (Escherichia coli). He underwent celiac aortic exclusion by an aortic endoprosthesis associated with a retrogade visceral bypass at the same time, under adequate antibiotherapy. Postoperative course was uneventful. After 18-months of follow-up, he was asymptomatic without signs of infection. Hybrid procedure for mycotic celiac aortic pseudoaneurysm seems to be a complementary technique to conventional open repair, especially in emergency. Endovascular approach does not preclude conversion toward conventional surgery, if necessary. This case report raises the matter of aortic endoprosthesis in infected area, the duration of suppressive antibiotherapy, and the conversion in open repair.

Aspergillus infection limited to the anastomosed artery following renal transplantation: a report of 4 cases

We present 4 cases of Aspergillus fumigatus infection limited to the anastomosed artery following renal transplantation. All grafts were nephrectomized. Two patients received 2 weeks of itraconazole therapy; both showing recurrence of pseudoaneurysms following discontinuation of therapy. Another 2 patients received 3 months of itraconazole therapy without recurrence of pseudoaneurysms. Surgical interventions were life saving. Resection of infected tissues and 3 months of antifungal therapy seemed to give better results than shorter antifungal strategies.

Latest developments in fungal lung infection in solid organ transplantation (SOT)

The incidence of invasive mycoses following solid organ transplant (SOT) ranges from 5 to 42% depending on the organ transplanted. Despite the increasing impact of viral infections in SOT, fungal infections still have a main role in transplant recipients. In fact, they remain a common cause of morbidity and mortality in the early and late post-transplant periods. Aspergillus spp. and Candida spp. account for most IFI, but recent epidemiological and clinical studies suggest the emergence of mycelia fungi other than Aspergillus as well as resistant strains of Candida in these patients. Due to the difficulty in making a definitive diagnosis, the treatment is sometimes delayed or is not prescribed (post-mortem diagnosis). Serological and molecular detection of Aspergillus antigens or fungal DNA, in blood and/or BAL samples, may improve the diagnosis of pulmonary aspergillosis, but in SOT the sensitivity is variable and more studies are needed. Another pendent issue is antifungal prophylaxis in SOT recipients; it is unknown which is the best agent or the time duration, and in which receptors must be applied. Treatment combining AmB preparations, newer antifungal drugs, early surgical resection of infected tissue and discontinuation or modulation of immunosuppressive treatment can to be necessary in selected patients and in certain occasions, and all of them may improve prognosis of IFI. However, there are two main handicaps in the management of FI in transplant recipients: firstly, to establish an early diagnosis, secondly, delays in applying early treatment with antifungal drugs. Development of new early diagnostic tools more precise and well-designed multicenter evaluations of diagnostic methods and therapeutic regimens available at present are the important work in the next 3-5 years. This review highlights changing spectrum of invasive fungal infections, risk factors, antifungal prophylaxis, and treatment following SOT.

Inguinal anastomotic aneurysm due to salmonellosis treated with orthotopic reconstruction

Femoral anastomosis following either an aortofemoral or femoropopliteal bypass, is a common site for anastomotic aneurysms occurring with an incidence of 2% to 5%. Among the factors contributing to the pathogenesis of such aneurysms, graft infection should be considered as a major one. We report the case of a 74 years old woman with history of an aorto-femoral right and -iliac left bypass with a Dacron Y-prosthetic graft due to abdominal aneurysm. The patient presented with a painful, inflammatory, and pulsating mass in her right inguinal region. She was treated surgically with wide radical resection of infected tissues including the anastomotic aneurysm, and in situ bypass reconstruction using a Silver-Dacron graft. Cultures of inflamed wound tissue, graft, and stools were positive for Salmonella typhimurium. In the postoperative period the patient was submitted to subtotal colectomy due to colon cancer and later to an iliofemoral crossover-bypass from right to left due to acute ischaemia of the left limb. Her postoperative follow up has been insignificant. Infected femoral anastomotic aneurysms due to salmonellosis are a rarity. Although their treatment of choice consist in an extra-anatomic bypass, under specific conditions in situ reconstruction may be adopted as a feasible and effective surgical technique to treat these infected aneurysms.

Normalization of cancer antigen 125 after mitral valve replacement in a patient with congestive heart failure due to mitral valve endocarditis

A 63-year-old woman with a history of uterine cancer was admitted to our hospital with dyspnea and stroke. Echocardiography showed a huge vegetation attached to the posterior mitral leaflet with severe mitral regurgitation. Blood culture identified Streptococcus galactiae. The serum level of cancer antigen 125 (CA125) was elevated at 199.4 U/ml. Resection of infected tissue including mobile vegetation and replacement of mitral valve were performed. The postoperative course was uneventful and the patient was discharged after 4 weeks of antibiotic therapy. The values of CA125 returned to normal (less than 15 U/ml) on the 90th postoperative day. These findings have suggested that a high serum value of CA125 is a possible indicator of infection-related congestive heart failure.

Infections of the subcutis and skin of dogs caused by rapidly growing mycobacteria

Nine dogs with panniculitis due to rapidly growing mycobacteria (RGM) were examined over 17 years. Dogs were two to 15 years; five were male, four were female. All were obese or in good condition. Antecedent injury, typically a dog bite or vehicular trauma, could be identified in some patients, while one bitch had hyperadrenocorticism. Infections involved different locations, although the cervicothoracic region, dorsum or flank were most often affected. Patients were systemically well, apart from one dog with pyrexia and two with pain or lameness. Cytology demonstrated pyogranulomatous inflammation, but in only one case was it possible to see acid-fast bacilli (AFB) in smears. Histology demonstrated chronic active pyogranulomatous panniculitis and dermatitis; AFB could be detected in only four specimens. Culture of aspirates or resected tissues demonstrated RGM in all cases, comprising six Mycobacterium smegmatis group and three Mycobacterium fortuitum group isolates. Resection of infected tissues, perioperative injectable antimicrobials and long courses of oral antimicrobials chosen according to susceptibility data generally effected a cure, although some cases recurred.

Infections Due to Cunninghamella bertholletiae in Patients with Cancer: Report of Three Cases and Review

Limited information is available regarding the pathogenesis and clinical manifestations of infection with Cunninghamella bertholletiae. In this report, we describe the clinical courses of three patients with leukemia and fatal C. bertholletiae infection and review the literature. In all patients, the infection developed in the setting of severe neutropenia following high doses of cytotoxic chemotherapy. Clinical presentation always consisted of fever and pneumonia and could be associated with dissemination to numerous organs. The course of infection was very rapid, and the diagnosis was made around or after the time of death. The most important risk factors for C. bertholletiae infection described in the literature include corticosteroid administration and prolonged severe granulocytopenia. Four infectious syndromes due to Zygomycetes have been described: rhinocerebral, pulmonary, cutaneous and soft tissue, and disseminated. The outcome of disseminated infection with C. bertholletiae has been almost uniformly fatal. Most previously described patients, however, did not receive aggressive treatment consisting of amphotericin B administration, resection of infected tissues, and, most importantly, control of the underlying disease.

Surgical management of mycotic aneurysms and the complications of infection in vascular reconstructive surgery

A series of seventeen mycotic aneurysms treated over the past fifteen years at this institution has been reported. Thirteen of these involved the abdominal aorta and four involved peripheral vessels. Rupture of the aneurysm occurred in ten. There were no survivors in the seven patients with ruptured aneurysms that involved the aorta, four of whom underwent emergency surgery. There were two survivors among the three patients with peripheral ruptured mycotic aneurysms. There were five survivors of the seven with nonruptured aneurysms treated surgically. Four of the six patients with mycotic nonruptured aneurysms of the aorta treated surgically survived and are well at periods of nineteen months to nine years. Three additional successfully managed cases of infection complicating vascular reconstructive procedures have been presented, emphasizing the technics of management. The following factors appear to be of importance to the successful management of mycotic aneurysms or infection complicating vascular reconstructive surgery: (1) early diagnosis and prompt surgery; (2) appropriate pre- and intraoperative antibiotic therapy and postoperative intravenous antibiotic therapy for a period of at least six weeks; (3) resection of infected tissue, foreign material, and adequate drainage; (4) placement of the new graft reconstruction through clean tissue planes; (5) use of wide drainage and local antibiotic irrigation in addition to systemic antibiotics in rare situations in which resection and reconstruction does not seem possible; (6) careful long-term follow-up study.