Melioidosis and the vascular surgeon: Hospital Kuala Lumpur experience.

Bacterial arteritis is relatively uncommon and management of this condition, which carries high morbidity and mortality, is difficult and time-consuming. Common organisms implicated include Salmonella and Staphylococcus. Arteritis as a result of infection by Burkholderia pseudomallei (formerly Pseudomonas pseudomallei) has been rarely reported in the English literature. This organism, which is endemic in our part of the world, is well known to cause a wide spectrum of septic conditions. A review of cases managed at Hospital Kuala Lumpur revealed that bacterial arteritis due to melioidosis is not such a rare entity. We share our experience in the management of this condition using three cases as examples.

[Current indications for superior dorsal sympathectomy. Apropos of 84 cases]. / Indications actuelles de la sympathectomie dorsale supérieure. A propos de 84 cas.

Results of dorsal sympathectomy in patients (67 operations) for vasomotor disorders of the upper limbs were assessed after follow-up for between 6 months and 15 years, in order to determine the best indications for surgery. Based on clinical results, sympathectomy should be performed not only when medical treatment fails, but also in the presence of a severe clinical picture of trophic disturbances or pain of the ischemic type. Two types of investigation are essential before deciding on operative therapy:--plethysmography with a hyperemia test,--arteriography of the hand. Assessment of results as a function of etiology demonstrated that they were excellent in cases of hyperhidrosis, very satisfactory in atheromatous digital arteritis or a thoracic inlet syndrome (associated with rib resection in the latter case), but only moderately good in scleroderma or post-traumatic lesions. Finally, Raynaud's disease or thromboangiitis do not appear to be indications for this operative procedure.

Progressive and static nonarteritic ischemic optic neuropathy treated by optic nerve sheath decompression.

PURPOSE: Optic nerve sheath fenestration has been advocated as an effective treatment for progressive nonarteritic ischemic optic neuropathy (NAION) and anecdotally effective for selected patients with NAION who have not had progressive visual loss. To determine whether optic nerve sheath decompression is of any benefit in patients with NAION, the authors reviewed their experience, surgically treating 23 patients with progressive NAION and 15 patients with static or nonprogressive NAION. RESULTS: Patients with progressive NAION had a significant improvement in visual function as measured by Snellen visual acuity after optic nerve sheath decompression (P = 0.0005). There was no statistically significant improvement in visual field mean deviation (P = 0.11). The 15 patients undergoing optic nerve sheath decompression for static NAION failed to demonstrate significant improvement in either visual acuity (P = 0.90) or visual field mean deviation (P = 0.87). Preoperative standardized echography was used to measure the optic nerve sheath diameter and ascertain its compressibility (30 degrees test). There was a significant difference in compressibility between eyes with static NAION and eyes with progressive NAION (P = 0.001). Accumulation of optic nerve sheath fluid was documented in three eyes initially presenting with NAION and then with development of progressive visual dysfunction. CONCLUSION: Optic nerve sheath decompression improves visual acuity but has little effect on overall visual function in patients with progressive NAION. Optic nerve sheath decompression does not improve visual field or acuity in patients with static NAION. Detection of significant intrasheath fluid by standardized echography helps to objectively differentiate patients with NAION who may benefit from optic nerve sheath decompression.