Cases reported "Streptococcal Infections"

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1/116. 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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2/116. Spinal anaesthesia and meningitis in former preterm infants: cause-effect?

    meningitis associated with spinal anaesthesia is a rare but well-known complication. We report on a case of fatal bacterial meningitis following spinal anaesthesia in a former preterm infant. The aetiology of this meningitis could not be established. Former preterm infants represent a high-risk population because of their susceptibility to group B streptococcal meningitis at this age as documented in a second case. Therefore we discuss whether meningitis was consequential or coincidental with spinal anaesthesia and could have been prevented by more comprehensive preoperative laboratory screening or prophylactic antibiotics.
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3/116. Acute appendicitis complicated with necrotizing soft tissue infections in the elderly: report of a case.

    A case of acute appendicitis complicated with necrotizing soft tissue infections (NSTIs) in an extremely elderly woman (98 years-old) is reported. She was admitted to our hospital with a history of increasing pain localized in the right lower abdomen. Abdominal ultrasonography revealed appendicolithiasis and periappendiceal fluid. An appendectomy and closure of the perforated cecum was performed. On the 5th post-operative day, the patient developed skin erythemas and crepitation in the right lower quadrant. An exploration and drainage of the recent operative incision was performed under the diagnosis of NSTIs. Despite the declining overall incidence of appendicitis, it has been increasing among the elderly. The elderly patients are associated with underlying defects in immune function. NSTIs, which are characterized by rapidly progressing inflammation and necrosis of soft tissue, comprise a spectrum of disease ranging from necrosis of the skin to life-threatening infections. The most common etiology of NSTIs was post-operative infections of the abdominal wall, which primarily occurred after operations with extensive fecal contamination. NSTIs are no longer a rare post-operative complication in the elderly and initial treatment should be selected according to the condition of the patient.
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4/116. endophthalmitis after phakic intraocular lens implantation to correct high myopia.

    A 36-year-old woman had uneventful implantation of an angle-supported anterior chamber phakic intraocular lens (IOL) to correct high myopia. On the first postoperative day, she developed infectious endophthalmitis likely associated with intraoperative contamination. Group B beta-hemolytic streptococcus endophthalmitis was confirmed by microbiologic studies. To our knowledge, this is the first documented case of infectious endophthalmitis after anterior chamber phakic IOL implantation to correct high myopia.
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keywords = operative
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5/116. Stentless tricuspid valve replacement.

    Stentless tricuspid valve replacement was performed in a 21-year-old patient with severe destructive tricuspid valve endocarditis resistant to medical therapy. Postoperative recovery was uneventful. Stentless atrioventricular valves are considered an additional treatment option besides stented valves or homograft implantations for severe right-sided endocarditis. Transvalvular hemodynamics are excellent, and right ventricular function can be preserved by suspending the valve at the papillary muscles.
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ranking = 0.2
keywords = operative
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6/116. Video-assisted endoscopic removal of infected endocardial pacemaker lead with large floating vegetation.

    The best management of pacemaker lead related endocarditis is complete surgical or percutaneous removal of the pacemaker system. Although the traditional surgical approach is via median sternotomy, we present two cases in which the lead and vegetations were removed using a video-assisted endoscopic technique through a limited right submammary incision. In each case the patient was supported by partial extracorporeal perfusion. Additional tricuspid valve repair and atrial septal defect closure was performed in one case. The postoperative courses were uneventful, illustrating that, when compared to the conventional open heart surgical approach, the less invasive approach can be a safe and effective way to remove an infected foreign body from the right heart with increased comfort, fast recovery, and a better cosmetic result.
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ranking = 0.2
keywords = operative
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7/116. Purulent pericarditis due to group B streptococcus and mycotic aneurysm of the ascending aorta: case report.

    A 61-year-old female, with a history of uterine and cervical cancer treated with radical hysterectomy and 2 years of postoperative chemotherapy, presented to the emergency department with dyspnea on exertion. Computed tomography of the chest revealed a large pericardial effusion and a sacciform aneurysm of the ascending aorta. The patient subsequently underwent emergency pericardiocentesis with drainage of approximately 330 ml of a bloody and turbid effusion. Cultures from the effusion yielded group B streptococcus. multiple organ failure and disseminated intravascular coagulation syndrome occurred in the acute phase, but gradually improved with continuous antibiotic therapy. On the 194th hospital day, in situ reconstruction of the ascending aorta was successfully performed using a synthetic graft. Although rarely reported, both purulent bacterial pericarditis and mycotic aneurysm can be life-threatening.
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8/116. brain abscess as a complication of orthognathic surgery: diagnosis, management, and pathophysiology.

    We present what we believe is the first case of a brain abscess resulting from orthognathic surgery reported in the literature. Although recent advances have significantly improved the treatment of brain abscesses, delays in diagnosis lead to persistent high rates of mortality. Often, the initial symptoms are vague and nonspecific. Commonly, the neurologic status of the patient deteriorates significantly before suspicion is raised and a CT scan is obtained. This case report is intended to benefit all practitioners who participate in the perioperative care of orthognathic surgery patients. Although the occurrence of a brain abscess is rare, it is hoped that this case will heighten the awareness of clinicians to this potential complication.
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ranking = 0.2
keywords = operative
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9/116. Surgical management of primary lung cancer in an elderly patient with preoperative empyema.

    A 74-year-old man with primary lung cancer developed preoperative empyema but was successfully managed surgically. The patient was given a diagnosis of c-T2N1M0, stage IIB, moderately differentiated squamous cell carcinoma, but before surgery pneumothorax and empyema developed, resulting from rupture of the carcinoma. Thoracic drainage, lavage and systemic administration of antibiotics improved his empyema. As there were no malignant cells in the drainage fluid, right middle-lower bilobectomy, empyemal cavity resection and lymph node dissection were performed. The bronchial stump was covered with an intercostal muscle flap. Thoracic drainage, lavage and systemic administration of antibiotics were performed for 6 days following the operation. The patient was discharged on the 27th postoperative day without any complications having developed. The pathological diagnosis of the tumor was p-T4N2(#7)M0, stage IIIB, br(-), ly( ), v( ), p3(pleura), pm1 and d0. He died of recurrence at home 18 months after the operation. We believe the following to be the minimum requirements for surgical management of such patients: (1) immediate thoracic cavity drainage and lavage with systemic antibiotic therapy, aiming at infection control before surgery; (2) prophylactic lavage of the thoracic cavity during and after surgery and (3) coverage of the bronchial stump with an adequate flap. Six reported cases of primary lung cancer with preoperative empyema are also discussed.
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ranking = 1.4
keywords = operative
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10/116. Diffuse chronic sclerosing osteomyelitis and the synovitis, acne, pustolosis, hyperostosis, osteitis (SAPHO) syndrome in two sisters.

    Two sisters with diffuse chronic sclerosing osteomyelitis of the mandible and the humerus and the synovitis, acne, pustolosis, hyperostosis and osteitis syndrome (SAPHO syndrome) are presented. The diagnoses of diffuse chronic sclerosing osteomyelitis at the age of 12 years and 27 years, respectively, were based on typical medical history, clinical symptoms and radiographic, histologic and scintigraphic findings. Because skin lesions and scintigraphic enhancement of the sternoclavicular joints with hyperostosis were present, a SAPHO syndrome was diagnosed in both sisters. Microbiological cultures of biopsy specimens revealed coagulase-negative staphylococcus aureus at the humerus and haemophilus parainfluenzae, streptococcus, actinomyces and Veilonella species at the mandible. Repeated operative procedures, including decortications, resection and reconstruction, and multiple histologic and microbiologic studies were performed over a period of up to 20 years. Since HLA typing yielded identical gene loci, we suggest that hereditary and autoimmune factors may play a role in the pathogenesis of these cases.
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ranking = 0.2
keywords = operative
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