[Conservative surgery of ovarian torsion in pediatrics]. / Cirugía conservadora de la torsión de ovario en pediatría.

The authors describe the case of two girls diagnosed of ovarian torsion secondary to a cyst. They were operated on by conservative ovarian therapy regardless the time of evolution and ovary macroscopical aspect. These 2 patients were 9 and 13 years old, with abdominal colic pain of 48 and 36 hours of evolution. The diagnosis by doppler sonography was ovarian torsion, with a 4 cms cyst in the right ovary in the first case and a 5 cms cyst in the left ovary in the second patient. Both patients were operated on. After untwisting the ovary, we instille warm saline solution to this ovary and, after waiting for 10 minutes, we resect the ovarian cyst and it recuperates partial and heterogeneous its pink colour. We advise to the family about the possibility of surgical reintervention if the ovary is not viable. After 10 and 12 days of surgical intervention, the Doppler sonography has confirmed the existence of ovary flow and the symmetry of affected ovary in comparation to the opposite on. At the present, both patients are asymptomatic, with exhaustive ultrasound controls. Ovarian torsion is the most frequent complication of ovarian tumours of pediatrics (3-16%) and this is a real emergency in gynecology. Traditionally, it has been recommended the exeresis of ovarian torsion. Regardless the blue aspect of isquemic ovary affected by torsion and the time of evolution, in our experience when there is a minimal possibility of ovarian viability, it is possible to follow a conservative therapy because the macroscopical aspect of the ovary is not necessarily related with the following evolution of the case.

Evaluation of chlorhexidine and silver-sulfadiazine impregnated central venous catheters for the prevention of bloodstream infection in leukaemic patients: a randomized controlled trial.

It has been suggested that central venous catheters impregnated with antiseptics such as chlohexidine and silver-sulfadiazine reduce the risk of catheter-related bacteraemia in intensive care patients. Patients suffering from haematologic malignancy treated by chemotherapy through a central venous catheter are at even greater risk of catheter-related bacteraemia. A prospective double-blind randomized controlled trial was performed in order to investigate the effectiveness of chlorhexidine and silver-sulfadiazine impregnated catheters (CH-SS) in these patients. A total of 680 catheters (13,826 catheter days) were inserted, of which 338 were antiseptic impregnated. Bloodstream infection was observed in 105 cases with an overall risk of 7.6 per 1000 catheter days. Thirty-two infections (30.5%) were catheter-related, corresponding to a risk of 2.3 per 1000 catheter days. There was no statistically significant different between the overall rates of bloodstream infection for impregnated and non-impregnated catheters (14.5 vs. 16.3%). The incidence of catheter-related infection was also similar in both groups (5 vs. 4.4%) and there was no difference in the time of the onset of bacteraemia in the two groups. It is concluded that the use of CH-SS catheters in patients with haematologic malignancy reduces neither the overall risk of bloodstream infection, nor the catheter-related infection rate, nor the delay for the occurrence of infection.

Evaluation of pulsed-field gel electrophoresis and rep-PCR for the epidemiological analysis of Ochrobactrum anthropi strains.

Pulsed-field gel electrophoresis and polymerase chain reaction genome fingerprinting based on repetitive chromosomal sequences (rep-PCR) were used for typing 14 strains of Ochrobactrum anthropi. Six strains isolated during an outbreak of bacteraemia in patients who had received a contaminated rabbit anti-thymocyte globulin gave identical patterns by both techniques. Different patterns were found in sporadic and reference strains, except for one clinical isolate received from another hospital that showed the same pattern as the epidemic clone. This patient had also received rabbit anti-thymocyte globulin from the same source at the time of the outbreak. This study illustrates the advantages of genetic typing methods in terms of high typeability and discriminating power, even for rare pathogens. Furthermore, it highlights the need for interhospital communication for effective identification of common sources of outbreaks related to intrinsic drug contamination.

Specific detection of methicillin-resistant Staphylococcus species by multiplex PCR.

In Staphylococcus aureus, mecA and femA are the genetic determinants of methicillin resistance. By using a multiplex PCR strategy, 310- and 686-bp regions of the mecA and femA genes, respectively, were coamplified to identify susceptible (lacking mecA) and resistant (mecA+) staphylococci and to differentiate S. aureus (femA+) from coagulase-negative staphylococci (lacking femA). A third staphylococcal genomic sequence, corresponding to IS431 and spanning 444 bp, was used as a PCR control. One hundred sixty-five staphylococcal strains were tested. All 72 methicillin-resistant strains were found to be mecA+, and 92 of the 93 susceptible isolates lacked mecA. Only one coagulase-negative Staphylococcus isolate carrying the mecA gene was highly susceptible to oxacillin. The femA determinant was a unique feature of S. aureus; it was found in 100% of the S. aureus strains tested but was undetectable in all of the coagulase-negative staphylococci tested. The possibility of directly detecting the mecA and femA genes in blood samples was also investigated. After two amplification steps, a sensitivity of 50 microorganisms per ml of freshly collected spiked blood was achieved. In conclusion, coamplification of mecA and femA determinants proved to be very reliable both for rapid detection of methicillin resistance and differential diagnosis between S. aureus and other staphylococci. This technique, which can be successfully performed with blood samples, could be a useful tool in the diagnosis and treatment monitoring of staphylococcal infections.

An outbreak of Ochrobactrum anthropi bacteraemia in five organ transplant patients.

Nosocomial bacteraemia caused by Ochrobactrum anthropi occurred over a 1-month period in five organ transplant recipients, four of whom were in the same renal and pancreatic transplant unit. Bacteraemia occurred with cyclosporin A, azathioprine and steroids, and with a rabbit anti-thymocyte globulin (RATG) during the induction phase. RATG appeared to be the only common factor among the five cases. Over the period described, 71.4% of all patients receiving RATG developed O. anthropi bacteraemia. Three patients presented with fever and chills during or shortly after RATG infusion. Analysis of residues of the infusion, and the used vials of RATG, showed the presence of O. anthropi in concentrations of between 20 and 1000 cfu ml-1 in 5.3% of samples. Unused vials were found to be heavily contaminated with either O. anthropi or Microbacterium spp. in 23.5% of samples. All positive vials were of one particular lot number suggesting a malfunction in the manufacturing process. Many parenteral drugs such as the RATG used here do not contain preservatives and, although aseptically prepared, will not withstand thermal sterilization. Bacterial contamination of these small volume medications is not always easily detectable by conventional methods. This outbreak highlights the need for accurate quality control testing to detect small inocula that may occur during or after the manufacturing process.

Bacteriologic quality of intraoperative autotransfusion.

Controversies remain about the bacteriologic aspects of intraoperative blood salvage despite the widespread use of this technique. In this prospective study, intraoperative salvaged blood was cultured in 401 patients, according to a direct plating technique. Bacterial growth was detected in 12.7% of cases. These results were compared with those obtained in control studies with sterile water and blood bank units under the same culture conditions. Most microorganisms were coagulase-negative staphylococci, followed by other skin and environmental contaminants. Quantitative estimates of contaminations showed low counts of colony-forming units (CFU/ml): 82% of positive cultures yielded 1 or 2 CFU/ml and 6% had 5 to 20 CFU/ml. Patients were followed up for a minimum of 3 months to detect septic complications. No statistically significant correlation could be found between bacteriologic results of autotransfused blood and infectious complications. This study suggests that bacteriologic monitoring of patients who have undergone autotransfusion may help in detecting surgical field contamination. It also confirms that intraoperative autotransfusion adds little septic risk to cardiac surgery.

[Is it necessary to remove polycystic kidneys?]. / Es necesario extirpar los riñones multiquísticos?

The Multicystic Dysplastic Kidney is the most frequent renal congenital anomaly and the second most common cause of an abdominal mass in the newborn. Traditionally, since this pathological entity was described as such by Spene in 1955, early resection has been deemed its best treatment. In the last decade, a conservative approach has been advocated by some authors, except for the patients presenting with concomitant abdominal pain or infection. In our hospital, relying on the support afforded by the echographic assessment of these patients, we have proposed an expectant behaviour in the management of this entity. So far, we have had the opportunity to follow the course of the disease in 15 patients with the diagnosis of Multicystic Dysplastic Kidney, with the result that in no one of them the size of the cystic mass increased, but instead the mass disappeared completely in one case, diminished greatly in three cases, had a moderate decrease in size in eight cases and in just three patients it has not varied in size. No patient has complained of abdominal pain or has become infected. In the face of such findings, we believe that early resection of the multicystic kidney is not warranted if no complications develop.

[Our experience in the treatment of cervico-facial adenitis caused by non-tuberculous mycobacteria (atypical mycobacteria)]. / Nuestra experiencia en el tratamiento de las adenitis cervicofaciales por micobacterias no tuberculosas (micobacterias atípicas).

The authors believe that the greater part of chronic cervicofacial adenitis actually observed in our hospitals, are not caused by M. tuberculosis or M. bovis but by scrofulaceum mycobacterium, M. avium, M. fortuitum and M. Kansasii, and above all, by the first two of these. They present their experience with 16 cases of cervico-facial adenitis due to atypical mycobacterium (CAAM) treated in our centre during the last years, in which period no case of cervical tuberculosis (CT) was observed. It is important to establish an early differential diagnosis between both etiologies, seeing as treatment is different. Whilst tuberculostatics can solve the phymic infection, surgical extirpation is the only solution for CAAM. The diagnosis of these types of infection is achieved by means of a very characteristic clinical procedure and by cutaneous tests specific for each bacteria. Faced with the clinical suspicion, the total extirpation should be effected of the adenopathic block affected. The exact diagnosis can only be made by the culture of the operatory mass.