Cases reported "Staphylococcal Infections"

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1/324. Late bleb-related endophthalmitis after trabeculectomy with mitomycin C.

    To present two cases of delayed-onset postoperative endophthalmitis following trabeculectomy combined with mitomycin C for secondary glaucoma after penetrating keratoplasty. We retrospectively evaluated two patients with late endophthalmitis after trabeculectomy combined with intraoperative mitomycin C application. Both patients underwent trabeculectomy for uncontrolled glaucoma following penetrating keratoplasty and they developed thin-walled cystic blebs. intraocular pressure was normal, and grafts remained clear postoperatively. Severe endophthalmitis with hypopyon developed at 3 and 7 months postoperatively. Both patients had concomitant bleb infection. They underwent vitreous sampling and intravitreal injection of vancomycin and amikacin and were given topical fortified and systemic antibiotic therapy. Intravitreal injection was repeated once in both patients. Cultures grew streptococcus pneumonias in one and Staphylococcus aureus in the other. Although the treatment of endophthalmitis was successful in both patients, only one of them achieved useful vision (20/40). For the other patient who had been infected with S. pneumoniae, vision was light perception. Delayed-onset endophthalmitis following trabeculectomy with mitomycin C application is a severe and vision threatening complication. It seems that the development of thin cystic filtering blebs secondary to intraoperative mitomycin C application may be a predisposing factor for bleb-related late endophthalmitis.
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2/324. Late complications of Silastic duraplasty: low-virulence infections. Case report.

    The authors describe three patients with expanding hemorrhagic mass lesions who presented 13 to 18 years after undergoing Silastic duraplasty. In all patients, results of bacteriological cultures of the masses obtained intraoperatively were positive, revealing low-virulence bacteria. Two of the patients were treated with antibiotic drugs and made a good recovery. The third did not receive antibiotic medications initially and later developed an epidural empyema that necessitated reoperation, but subsequently made a complete recovery. Vascularized neomembranes are generally agreed to be causes of the expanding masses, but the possibility that patients could be harboring chronic infections must be considered. Thus, on removal of duraplasty materials a complete bacteriological culture should be obtained, and if it is positive the proper antibiotic therapy should be administered. Furthermore, the creation of a registry of patients who have received implants is advocated to facilitate tracking of implanted material in case of complications.
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3/324. Revision hip arthroplasty in patients with a history of previous malignancy.

    BACKGROUND AND OBJECTIVES: The potential association between implants and malignancy has been discussed in the literature, but never as a cause of loosening of joint arthroplasty. methods: The records of all patients who underwent revision arthroplasty at our institution between 1992 and 1995 were reviewed. RESULTS: Among 93 patients who underwent revision hip arthroplasties, 11 (11.8%) had a history of previous malignancy. At surgery, in 2 of these patients, metastasis was found to be the cause of loosening in the affected hip. CONCLUSIONS: When revision hip arthroplasty is considered, patients with a history of malignancy require attenuated pre-, intra-, and postoperative workup. Management algorithm in such cases is proposed.
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4/324. Conservative management of a methicillin-resistant staphylococcus aureus (MRSA)-infected aortobifemoral graft: report of a case.

    A 63-year-old man was referred to our department for treatment of intermittent claudication in the right lower limb. The preoperative angiogram showed severe stenosis extending from the terminal aorta to the bilateral common femoral arteries, with occlusion of the right superficial femoral artery and the left popliteal artery. He underwent aortobifemoral bypass with thromboendarterectomy of the left common femoral artery, and right graft-popliteal artery bypass. The patient had an uneventful postoperative course; however, 14 days after the operation, a pulsatile mass suddenly appeared in the left groin. Emergency surgery revealed disruption of the left distal anastomosis of the aortobifemoral bypass and therefore, revision, in the form of graft-profunda femoris artery interposition with graft-superficial femoral artery bypass, was performed. Microscopic examination showed colonies of bacteria in the host artery adventitia adjacent to the anastomosis. culture of the discharge from the right groin operative scar revealed methicillin-resistant staphylococcus aureus (MRSA). The discharge resolved following the intravenous administration of vancomycin and the local application of vancomycin ointment. There were no operative complications other than the MRSA infection, and the patient was discharged 20 days after revision surgery. In the 14 months since the revision, all grafts have remained patent and there have been no further symptoms of graft infection.
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5/324. Multiple intestinal ulcerations and perforations secondary to methicillin-resistant staphylococcus aureus enteritis in infants.

    PURPOSE: The aim of this study was to define a distinctive clinical entity of multiple intestinal ulcerations and perforations in infants. methods: Two infants underwent abdominal exploration for surgical abdomen and were noted to have multiple intestinal ulcerations and perforations. A peculiar and unique surgical finding, numerous transverse linear ulcerations scattered along the entire small intestine, prompted us to search for similar instances. Five similar cases were additionally identified by members of the Korean association of Pediatric Surgeons. The clinical courses, the surgical findings, and the results of bacterial cultures were reviewed. As well, the tissues of resected intestines were examined histopathologically. RESULTS: The characteristics of this entity are as follows. (1) It usually occurs in infants who have been treated with broad-spectrum antibiotics. (2) Despite broad-spectrum antibiotic treatment, diarrhea and abdominal distension developed progressively and deteriorated. (3) Histological evaluation showed mucosal ulcers with neutrophil infiltration, submucosal microabscesses, and colonies of gram-positive cocci. (4) methicillin-resistant staphylococcus aureus (MRSA) was the predominant organism cultured from the body fluid. (5) Only two cases, the completely resected one and the one immediately treated postoperatively with vancomycin, survived. CONCLUSIONS: This entity is caused by multiple intestinal ulcerations and perforations secondary to MRSA enteritis in infants. It has a high mortality rate because of its difficult diagnosis. However, early recognition of this entity can lead to successful treatment.
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6/324. Recurrent endocarditis in silver-coated heart valve prosthesis.

    BACKGROUND AND AIM OF THE STUDY: In order to prevent prosthetic valve endocarditis (PVE), the implantation of a new silver-coated sewing ring has been introduced to provide peri- and postoperative protection against microbial infection. methods: A 56-year-old woman with aortic stenosis had elective replacement with a St. Jude Medical mechanical valve fitted with a silver-coated sewing ring (Silzone). The patient developed early PVE, which necessitated reoperation after one month. Despite a second Silzone prosthesis being implanted, the endocarditis recurred. During a third operation an aortic homograft was implanted, and after six months a fourth operation was performed for a pseudoaneurysm at the base of the homograft, in proximity to the anterior mitral valve leaflet. RESULTS: The diagnosis of PVE was confirmed by the presence of continuous fever, transesophageal echocardiography and growth of penicillin-resistant staphylococcus epidermidis from the valve prosthesis. CONCLUSION: The implantation of all prosthetic valves is encumbered with a risk of endocarditis. Although silver has bacteriostatic actions, the advantages of silver-coated prostheses in the treatment of this condition have yet to be assessed in clinical trials.
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ranking = 0.2
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7/324. Hyperbaric oxygen therapy in deep sternal wound infection after heart transplantation.

    The results of orthotopic heart transplantation (OHTx) are still burdened with considerable early mortality due to graft rejection or infection. sternum osteomyelitis is an infrequent postoperative complication. We report a case of deep sternal wound infection (2 months after OHTx) that was treated with hyperbaric oxygen therapy in addition to local surgical treatment.
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ranking = 0.2
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8/324. Reconstructive treatment of sclerosing osteomyelitis of the entire femur of 30 years' duration with avoidance of segmental resection.

    We describe the successful operative treatment of a patient with chronic sclerosing osteomyelitis of the femur in which en bloc resection was avoided. Therapy consisted of combined endoscopic, computed tomography and bone scan-guided fenestration and intramedullary reaming, with removal of all sclerotic zones and normalization of the cortical thickness. An adequate supply of oxygen to the area was ensured by improved vascularisation and the application of hydrogen peroxide. At the medium term follow-up no recurrence was seen, and hip and knee function was normal.
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ranking = 0.2
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9/324. Postoperative toxic shock syndrome caused by a highly virulent methicillin-resistant staphylococcus aureus strain.

    We report on a rare fatal case of postoperative toxic shock syndrome caused by infection with a highly virulent methicillin-resistant staphylococcus aureus strain, designated Sak-1, which was found to be characteristic in its increased production of toxic shock syndrome toxin 1 in human whole blood (about 30-fold more than produced in Tod Hewitt broth). The strain also produced a high level of toxic shock syndrome toxin 1 in the circulating blood of mice experimentally infected with the strain.
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10/324. Endovascular occlusion of a carotid pseudoaneurysm complicating deep neck space infection in a child. Case report.

    Pseudoaneurysm formation of the cervical internal carotid artery (ICA) is a rare, potentially lethal complication of deep neck space infection. This entity typically occurs following otolaryngological or upper respiratory tract infection. The pseudoaneurysm is heralded by a pulsatile neck mass, Homer's syndrome, lower cranial neuropathies, and/or hemorrhage that may be massive. The recommended treatment includes prompt arterial ligation. The authors present a case of pseudoaneurysm of the cervical ICA complicating a deep neck space infection. A parapharyngeal Staphylococcus aureus abscess developed in a previously healthy 6-year-old girl after she experienced pharyngitis. The abscess was drained via an intraoral approach. On postoperative Day 3, the patient developed a pulsatile neck mass, lethargy, ipsilateral Horner's syndrome, and hemoptysis, which resulted in hemorrhagic shock. Treatment included emergency endovascular occlusion of the cervical ICA and postembolization antibiotic treatment for 6 weeks. The patient has made an uneventful recovery as of her 18-month follow-up evaluation. Conclusions drawn.from this experience and a review of the literature include the following: 1) mycotic pseudoaneurysms of the carotid arteries have a typical clinical presentation that should enable timely recognition; 2) these lesions occur more commonly in children than in adults; 3) angiography with a view to performing endovascular occlusion should be undertaken promptly; and 4) endovascular occlusion of the pseudoaneurysm is a viable treatment option.
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ranking = 0.2
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