Removal of silicone oil: prognostic factors and incidence of retinal redetachment.

PURPOSE: To evaluate the incidence of retinal redetachment after the removal of silicone oil endotamponade for complicated retinal detachment and identify possible factors affecting outcome. METHODS: This is a retrospective review of 173 patients who underwent pars plana vitrectomy with silicone oil tamponade for complex retinal detachment and subsequent removal of silicone oil (ROSO). The outcome factors studied included anatomical success, best-corrected visual acuity and intraocular pressure pre- and post-ROSO. RESULTS: Anatomical success was achieved in 167 of the 173 eyes (96.5%) after ROSO. The mean duration of silicone oil tamponade was 70 ± 48 weeks (median, 56 weeks; mode, 48 weeks). The cause for primary retinal detachment was proliferative diabetic retinopathy in 36 (20.8%) and proliferative vitreoretinopathy in 137 of 173 cases (79.2%). Best-corrected visual acuity of greater than 20/100 was achieved in 83 cases (49.4%) at 3 months after ROSO. Levene's test for equality of variances was used to determine the association between previous unsuccessful retinal surgeries and redetachment (P = 0.523) and between duration of endotamponade and anatomical success (P = 0.451). CONCLUSION: The incidence of retinal redetachment after ROSO in our study was 3.46%. Aggressive removal of the vitreous base, performing retinotomies, ensuring complete silicone oil filling for adequate tamponade, and argon retinopexy can lead to low complication rates and improved outcomes.

Tubulinosema sp. microsporidian myositis in immunosuppressed patient.

The Phylum Microsporidia comprises >1,200 species, only 15 of which are known to infect humans, including the genera Trachipleistophora, Pleistophora, and Brachiola. We report an infection by Tubulinosema sp. in an immunosuppressed patient.

A retained sponge is a complication of vacuum-assisted closure therapy.

Vacuum-assisted closure (VAC) system has become a widely used, efficacious, and overall safe method for managing many types of open wounds. The authors present a case of a rare but avoidable complication caused by a retained piece of sponge after VAC therapy (KCI Inc, San Antonio, TX). They emphasize the need for awareness and careful evaluation of the patient who receives VAC therapy to avoid diagnostic confusion and morbidity to the patient.

Group G Streptococcus spinal epidural abscess: case report and review of the literature.

Group G streptococci have been identified as a recently emerging pathogen. Spinal epidural abscess is an infrequent but well described infection of the central nervous system that may present with non-specific clinical symptoms and physical examination findings. Group G streptococci are a rare cause of spinal epidural abscess that should be considered in the clinical picture so that appropriate therapy can be initiated in a timely fashion.

Halo pin insertion-associated brain abscess: case report and review of literature.

STUDY DESIGN: A case report of a patient with a halo pin-associated brain abscess and a review of literature. OBJECTIVES: To report a rare complication of halo pin insertion-associated brain abscess, and to discuss the diagnostic and treatment approach to its management. SUMMARY OF BACKGROUND DATA: Halo orthosis is a commonly used, well-tolerated spinal stabilizing device. However, on rare occasions, it can penetrate the inner table of the cranium, resulting in abscess formation that needs to be investigated urgently and treated promptly. METHODS: A 23-year-old male sustained a C2 vertebral fracture from a motor vehicular accident and was placed in halo traction. Two and a half months later, he noted loosening of the right occipital halo pin, which was tightened in the clinic. Fourteen days after pin tightening, he developed right-sided headaches, and it was decided to remove the halo traction. After the halo removal, the patient noted purulent discharge from the right occipital pin site, worsening headache, and associated nausea and vomiting. Magnetic resonance imaging of the brain demonstrated a right parietal lobe abscess and a sinus tract extending through the overlying calvarium. The patient underwent an evacuation of the abscess, and the culture was positive for methicillin-resistant Staphylococcus aureus. The patient was treated with intravenous vancomycin for 6 weeks. RESULT: The patient reported mediated improvement after surgery and on a follow-up visit was doing well without any neurologic sequelae. CONCLUSION: Halo pin-associated brain abscess is a rare but extremely important complication requiring prompt diagnosis and immediate intervention. Halo pin loosening with signs of local infection, fever, headaches, or seizures needs to be investigated urgently with neuroimaging. We conclude that with early diagnosis and appropriate treatment, serious morbidity and mortality can be avoided.

Ineffectiveness of the measurement of 'routine' vital signs for adult inpatients with community-acquired pneumonia.

More frequent vital sign evaluation does not result in a statistically significant difference in survival or the number of transfers to the intensive care unit (for progression of disease) after adjusting for age, gender, duration of intravenous antibiotics and comorbid conditions.

Anaerobic spondylodiscitis: case series and systematic review.

BACKGROUND: Bacterial spondylodiscitis is rarely caused by anaerobic organisms. We describe two patients with lumbar vertebral osteomyelitis and discitis caused by anaerobic bacteria, including an unusual occurrence after an endodontic procedure, and review the salient clinical features and outcomes of 31 previously reported cases. METHODS: Case reports and review of the literature. RESULTS: Median age at presentation was 65 years, with a male-to-female ratio of 2:1. The most common presenting symptoms were back pain, fever, and neurologic deficits. The lumbar spine was most frequently involved (43%); an equal number of cases involved contiguous extension or hematogenous spread. Causative anaerobes were recovered from disk space or vertebrae (13), blood (4), and/or soft tissue abscess and included Bacteroides species (12), Propionibacterium acnes (7), Peptococcus species (4), Peptostreptococcus species and Clostridium species (3 each), Corynebacterium diphtheroides and Fusobacterium species (2 each), and unspecified anaerobes (3). CONCLUSIONS: Apart from specific antibiotic selection, medical treatment and outcomes for anaerobic spondylodiscitis are similar to those for aerobic vertebral disk infection.