Assuntos
Antibacterianos/uso terapêutico , Proteínas de Bactérias/metabolismo , Infecções por Klebsiella/tratamento farmacológico , Infecções por Klebsiella/mortalidade , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/enzimologia , beta-Lactamases/metabolismo , Feminino , Humanos , MasculinoRESUMO
SUMMARY: Emerging and re-emerging infectious disease in otorhinolaryngology (ENT) are an area of growing epidemiological and clinical interest. The aim of this section is to comprehensively report on the epidemiology of key infectious disease in otorhinolaryngology, reporting on their burden at the national and international level, expanding of the need of promoting and implementing preventive interventions, and the rationale of applying evidence-based, effective and cost- effective diagnostic, curative and preventive approaches. In particular, we focus on i) ENT viral infections (HIV, Epstein-Barr virus, Human Papilloma virus), retrieving the available evidence on their oncogenic potential; ii) typical and atypical mycobacteria infections; iii) non-specific granulomatous lymphadenopathy; iv) emerging paediatric ENT infectious diseases and the prevention of their complications; v) the growing burden of antimicrobial resistance in ENT and the strategies for its control in different clinical settings. We conclude by outlining knowledge gaps and action needed in ENT infectious diseases research and clinical practice and we make references to economic analysis in the field of ENT infectious diseases prevention and care.
Assuntos
Doenças Transmissíveis Emergentes , Otorrinolaringopatias , Algoritmos , Doenças Transmissíveis Emergentes/diagnóstico , Doenças Transmissíveis Emergentes/epidemiologia , Doenças Transmissíveis Emergentes/terapia , Farmacorresistência Bacteriana , Infecções por Vírus Epstein-Barr/diagnóstico , Infecções por Vírus Epstein-Barr/terapia , Infecções por HIV/diagnóstico , Infecções por HIV/terapia , Neoplasias de Cabeça e Pescoço/virologia , Humanos , Linfadenite/diagnóstico , Linfadenite/terapia , Infecções por Mycobacterium/diagnóstico , Infecções por Mycobacterium/terapia , Otorrinolaringopatias/diagnóstico , Otorrinolaringopatias/epidemiologia , Otorrinolaringopatias/terapia , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/terapiaRESUMO
We report two cases of central nervous system infection due to methicillin-resistant Staphylococcus epidermidis treated with linezolid. The first case was a 72-year old woman with ventriculitis in the presence of intraventricular catheter: therapeutic effectiveness was documented clinically and microbiologically; serum and cerebrospinal fluid levels were measured after the first and fourth doses: trough linezolid concentrations in cerebrospinal fluid were 1.44 and 2.9 mg/L respectively, higher than the minimum inhibitory concentration (MIC). The second case was a 27-year old man with post-traumatic cerebral abscess; during 5 days linezolid was not found in his cerebrospinal fluid despite very high serum level peak, and the drug was not detectable in cerebral tissue surgically removed after 14 days of therapy. Linezolid may not reach therapeutic concentrations in cerebrospinal fluid, and, when possible, we suggest that drug levels be monitored.
Assuntos
Acetamidas/líquido cefalorraquidiano , Abscesso Encefálico/tratamento farmacológico , Ventrículos Cerebrais , Encefalite/tratamento farmacológico , Resistência a Meticilina , Oxazolidinonas/líquido cefalorraquidiano , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus epidermidis , Adulto , Idoso , Abscesso Encefálico/líquido cefalorraquidiano , Monitoramento de Medicamentos , Encefalite/líquido cefalorraquidiano , Feminino , Humanos , Linezolida , Masculino , Infecções Estafilocócicas/líquido cefalorraquidianoRESUMO
BACKGROUND/AIM: Restoration of the bowel continuity after Hartmann's procedure has been reported to carry a high rate of both general and anastomosis-related complications. Aim of the study was to test the hypothesis of the Hartmann's procedure reversal as high-risk surgery. STUDY DESIGN, SETTING: Retrospective analysis of a cases series, University hospital, Italy. MATERIAL: Forty patients (male n = 25; female n = 15) with a mean age of 64.8 yrs. (range 35 to 82 yrs.) who underwent manual (n = 4; 10%) or stapled (n = 36; 90%) colorectal anastomosis. The mean interval between the Hartmann's procedure and the colostomy closure was 259 days. MAIN OUTCOME MEASURES: Mortality, morbidity, anastomotic complications. RESULTS: No death was recorded. The overall complication rate was 37.5 per cent (n = 15 patients), being wound infection the most common (n = 9). Complications of the colorectal anastomosis were observed in n = 5 patients (12.5%). In details, four patients (10%) developed stenosis of the anastomosis and one (2.5%) bled from the suture line. No instance of leak was observed. Surgery was required to correct a recurrent stenosis of the colorectal anastomosis. CONCLUSION: Restoration of the bowel continuity after Hartmann's procedure is safe and has an acceptable rate of general and anastomosis-related morbidity. Most of the anastomotic complications will resolve without further surgery.
Assuntos
Colectomia , Colo/cirurgia , Colostomia , Procedimentos de Cirurgia Plástica/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/métodos , Anastomose Cirúrgica/estatística & dados numéricos , Colectomia/estatística & dados numéricos , Colostomia/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Procedimentos de Cirurgia Plástica/estatística & dados numéricos , Reoperação/métodos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Resultado do TratamentoAssuntos
Acidentes de Trabalho , Lesões Encefálicas/terapia , Lobo Temporal/lesões , Adulto , Lesões Encefálicas/diagnóstico , Corpos Estranhos/cirurgia , Humanos , Masculino , Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologiaRESUMO
BACKGROUND: Laparoscopic colectomy has developed rapidly with the explosion of technology. In most cases, laparoscopic resection is performed for colorectal cancer. Intraoperative staging during laparoscopic procedure is limited. Laparoscopic ultrasonography (LUS) represents the only real alternative to manual palpation during laparoscopic surgery. METHODS: We evaluated the diagnostic accuracy of LUS in comparison with preoperative staging and laparoscopy in 33 patients with colorectal cancer. Preoperative staging included abdominal US, CT, and endoscopic US (for rectal cancer). Laparoscopy and LUS were performed in all cases. Pre- and intraoperative staging were related to definitive histology. Staging was done according to the TNM classification. RESULTS: LUS obtained good results in the evaluation of hepatic metastases, with a sensitivity of 100% versus 62.5% and 75% by preoperative diagnostic means and laparoscopy, respectively. Nodal metastases were diagnosed with a sensitivity of 94% versus 18% with preoperative staging and 6% with laparoscopy, but the method had a low specificity (53%). The therapeutic program was changed thanks to laparoscopy and LUS in 11 cases (33%). In four cases (12%), the planned therapeutic approach was changed after LUS alone. CONCLUSIONS: The results obtained in this study demonstrate that LUS is an accurate and highly sensitive procedure in staging colorectal cancer, providing a useful and reliable diagnostic tool complementary to laparoscopy.
Assuntos
Neoplasias Colorretais/patologia , Endossonografia/métodos , Laparoscopia/métodos , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/secundário , Biópsia , Neoplasias Colorretais/diagnóstico por imagem , Neoplasias Colorretais/cirurgia , Reações Falso-Negativas , Reações Falso-Positivas , Feminino , Humanos , Masculino , Monitorização Intraoperatória/métodos , Estadiamento de Neoplasias , Cuidados Pré-Operatórios , Sensibilidade e EspecificidadeRESUMO
Superficial cervical plexus block in association with laryngeal mask for the airways control has improved the postoperative outcome, in comparison with a previous group in general anaesthesia, performed by the same equipment. The local anaesthetic infiltration as a preemptive analgesia give us good evidences in pain control. The laryngeal mask contributes to a good surgical field and avoid the neck hypertension.