Cases reported "Proteus Infections"

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1/15. Diagnostic and therapeutic vitrectomy for endophthalmitis.

    The introduction of a compact portable vitreous suction cutter enables the aspiration and resection of infected ocular tissues for diagnostic and therapeutic purposes. Four cases of postoperative bacterial endophthalmitis are presented in which mechanical anterior vitrectomy was performed in addition to conventional antimicrobial therapy. Three of these eyes were saved and 2 retained the possibility of useful vision. A rationale for the aggressive managements of endophthalmitis is presented.
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ranking = 1
keywords = operative
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2/15. Total excision of the sternum and thoracic pedicle transposition of the greater omentum; useful strategems in managing severe mediastinal infection following open heart surgery.

    Mediastinal sepsis following open heart surgery is a significant cause of death. Open drainage of the mediastinumalone was employed originally in management of this problem. More recently, debridement, drainage, and reclosure have been used. Various irrigation solutions, such as antibiotics and Betadine, have been advocated to control severe mediastinal sepsis. Three principles of management in patients unresponsiveness to the above techniques have proved successful in two patients with life-threatening mediastinal sepsis: (1) radical, complete excision of the sternum and adjacent costal cartilages; (2) transposition of the greater omentum on a vascular pedicle to the mediastinum; and (3) primary closure with full-thickness rotational skin flaps. The radical excision of the sternum removes residual foci of sepsis in cartilage and sternal bone marrow. The transposition of the omentum provides a highly vascular, rapidly granulating covering for the contaminated great vessels and hase been successfully to prevent recurrence of suture line bleeding of an exposed ascending aortic anastomosis site. Primary closure of the wound with full-thickness skin flaps provides a suprisingly satisfactory covering for the heart. Preoperative and postoperative measurements of ventilatory mechanics have shown relatively small ventilatory impairment after the alteration of the thoracic cage imposed by excision of the sternum. Two patients have returned to active lives. A treatment failure probably due to incomplete adherence to these guidelines also is presented.
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ranking = 2
keywords = operative
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3/15. Staghorn calculus endotoxin expression in sepsis.

    Staghorn calculi are infrequent and generally are infected stones. Struvite or apatite calculi are embedded with gram-negative bacteria, which can produce endotoxin. sepsis syndrome may occur after surgical therapy or endoscopic manipulation of infected or staghorn calculi. sepsis, which can occur despite perioperative antibiotic use, may be due to bacteremia or endotoxemia. We present a child with an infected staghorn calculus who developed overwhelming sepsis and died after percutaneous stone manipulation. Endotoxin assay of stone fragments demonstrated an extremely high level of endotoxin despite low colony bacterial culture growth. This is the first reported case in which endotoxin was demonstrated in stone fragments from a child who died of severe sepsis syndrome after percutaneous staghorn stone manipulation.
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ranking = 1
keywords = operative
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4/15. Mycotic aneurysm of the internal carotid artery--a case report.

    Extracranial internal carotid artery (ICA) mycotic aneurysms are rare entities that may result in significant neurologic morbidity and mortality. Several operative techniques have been described in the literature for the management of this difficult condition. This case report describes a contained ruptured mycotic aneurysm of the extracranial ICA associated with proteus mirabilis infection successfully treated by an end-to-end spatulated interposition saphenous vein graft.
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ranking = 1
keywords = operative
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5/15. Intracranial complications following mastoidectomy.

    Mastoidectomy is a common surgical procedure in otology. However, postoperative complications of various degrees of severity may occur. We present 4 children who underwent mastoidectomy for middle ear and mastoid disease and developed postoperative intracranial complications. One child was operated on for brain abscess 1 week after the initial mastoidectomy. Another child appeared with seizures 5 days after the initial mastoidectomy and a subdural empyema was drained during revision surgery. Large bone defects with exposed middle cranial fossa dura were found at revision surgery in both cases and proteus vulgaris and methicillin-resistant staphylococcus aureus were isolated from the mastoid and abscess cavities in these children. A small epidural collection was diagnosed in the third patient 2 days after initial mastoid surgery and was managed with intravenous antibiotics only. The other child was found to have sigmoid sinus thrombosis the day after mastoidectomy that was performed for nonresponsive acute mastoiditis. This child received both intravenous antibiotics and anticoagulants. Timely revision surgery, combinations of third- or fourth-generation cephalosporins with vancomycin or metronidazole and the addition of anticoagulants in cases of sinus thrombosis can lead to full recovery.
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ranking = 2
keywords = operative
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6/15. Operative intervention in active endocarditis in children: report of a series of cases and review.

    We describe in detail 14 children (age, less than or equal to 19 years) who underwent operative intervention during active infection of the heart and/or great vessels. The series included five children less than 6 years old, who constitute 10% of all such cases reported in this age group to date. We also review the 132 published reports in which children underwent operative intervention during active endocarditis. We found the following: (1) The survival rate for all cases was 77%. (2) Persistent infection, embolic phenomena, and increasing congestive heart failure were the most frequent indications for operative intervention. (3) Survival rates were independent of the duration of preoperative antibiotic treatment. (4) Survival rates were independent of positive results of cultures of blood or tissue obtained at operation. (5) The perioperative mortality in our series was 14%. (6) Only 67% of patients had conditions thought to predispose to endocarditis. (7) Except for removal of catheter-associated cardiac masses from neonates, operative intervention in active endocarditis was uncommon among children less than 4 years old. (8) Staphylococcus aureus and viridans streptococci were the etiologic agents in the majority of cases of endocarditis requiring operation during active infection in children.
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ranking = 6
keywords = operative
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7/15. Late bacterial endophthalmitis following retinal detachment surgery.

    We report two cases of late postoperative bacterial endophthalmitis that occurred following retinal detachment repair. Both patients presented months after their scleral buckling procedures with a subacute uveitis. Over a period of one to two weeks, the inflammation gradually increased, until the classic clinical appearance of fulminant bacterial endophthalmitis was present. In an effort to treat the infection, a pars plana vitrectomy was performed in both cases. At the time of vitreous surgery, intrusion of the scleral buckling elements into the globe was observed, suggesting a possible means of entry for the infectious agent. Removal of the buckling elements, repair of the scleral defects, and injection of intravitreal antibiotics were performed as therapeutic interventions. Vitreous cultures were positive in both cases for proteus mirabilis. Postoperatively the retina remained attached in both instances, and, in one case, the visual acuity returned to 20/20.
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ranking = 2
keywords = operative
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8/15. Gram-negative endocarditis following cystoscopy.

    patients with bacteriuria are at risk for local and distant infectious complications at the time of urologic procedures. The american heart association recommends that penicillin and streptomycin be given prophylactically to patients with rheumatic or congenital heart disease without reference to the presence or absence of bacteriuria. A patient with unrecognized calcification of the mitral annulus who underwent cystoscopy for evaluation of urinary retention is reported. Although bacteriuria was present preoperatively antibiotics were not given. Subsequently, serratia marcescens and possibly Proteus morgani mitral valve infection developed and the patient died. Calcification of the mitral valve annulus and an extensive urinary tract infection were identified at autopsy. This case suggests that calcification of the mitral annulus may be an endocarditis risk factor. The spectrum of prophylactic antibiotic coverage given at the time of urologic procedures to patients with congenital or aquired heart disease, including calcification of the mitral annulus, should include whatever organisms are present in the urine.
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ranking = 1
keywords = operative
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9/15. Management of infection stones: the Stanford experience.

    In summary, 46 renal lithotomies were performed in 40 patients for struvite infection stones. All patients had documented urinary tract infections at the time of surgery; all stones were cultured, demonstrated to contain bacteria and proved crystallographically to be composed primarily of struvite with smaller amounts of apatite. The recurrence rate in a mean followup period of 7 years was 2.5% (one patient). The negligible recurrence rate emphasizes that struvite stones are caused by urea-splitting bacteria, rather than metabolic disorders, and that a comprehensive approach that emphasizes biochemical, bacteriologic, and roentgenographic techniques is more important than the type of surgical procedure used to remove the stones. We believe that our routine of leaving a small polyethylene nephrostomy tube in every patient, combined with postoperative plain-film tomograms regardless of the results of intraoperative radiography, and the liberal use of hemiacidrin irrigation to dissolve any residual struvite particles with their entrapped bacteria, accounts for the virtual absence of stone recurrences in our series.
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ranking = 2
keywords = operative
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10/15. The use of the Papineau bone-grafting technique in salvage of the infected total joint implant.

    The development of osteomyelitis after first metatarsophalangeal total implant-arthroplasty can be a complication encountered by any foot surgeon. The postoperative course is often long with a guarded to poor prognosis. The authors present a salvage procedure for this surgical complication utilizing aggressive surgical debridement followed by an autogenous bone graft. The technique, as described by Papineau, was developed to shorten hospitalization time and reduce deformity. A case presentation is given to illustrate the successful use of this procedure in the treatment of postoperative osteomyelitis of the foot without systemic antibiotics.
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ranking = 2
keywords = operative
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