Wound, Ischemia, Foot Infection (Wifi) Classification System And Its Predictive Ability Concerning Amputation-Free Survival, Mortality And Major Limb Amputation In A Portuguese Population: A Single Center Experience.

INTRODUCTION: Commonly used chronic limb-threatening ischemia (CLTI) classifications lack granularity and detail to precisely stratify patients according to risk of limb loss, expected revascularization benefit and mortality. The aim of this study is to evaluate in a Portuguese population the prognostic value of an updated CLTI classification based on Wound, Ischemia, and foot Infection (WIfI) proposed by the Society for Vascular Surgery. MATERIALS AND METHODS: Single-center retrospective evaluation of prospectively collected data of consecutive patients with CLTI submitted to lower limb revascularization from January to December of 2017. All consecutive patients with chronic peripheral artery disease with ischemic rest pain or tissue loss were included. The exclusion criteria were patients with intermittent claudication, vascular trauma, acute ischemia, non-atherosclerotic arterial disease and isolated iliac intervention. The primary end-point was major limb amputation, mortality and amputation-free survival (AFS) at 30 days, 1 year and 2 year follow-up. Secondary end-points were minor amputation, wound healing time (WHT) and rate (WHR). RESULTS: A total of 111 patients with CLTI were submitted to infra-inguinal revascularization: 91 endovascular and 20 open surgery. After categorizing them according to the WIfI: 20 had stage 1 (18.52%), 29 stage 2 (26.85%), 38 stage 3 (35.19%) and 21 stage 4 (19.44%). Overall mortality rate was 1.8%, 17% and 22.3% at 30 days, 1 year and 2 years follow-up. Major amputation rate was 0.9%, 2.7% and 2.7% at 30 days, 1 year and 2 years follow-up. AFS rate was 97.3%, 82.1%, and 76.8% at 30 days, 1 year, 2 years follow-up. In multi-variable analysis, higher WIfI score was the only predictive factor for mortality and AFS. WIfI 3 and 4 were also associated with increased risk of non-healing ulcer. CONCLUSION: This study proved the prognostic value of the WIfI classification in a Portuguese population by showing an association between higher scores and increased mortality, lower AFS and non-healing ulcer.

Risk factors for focal involvement in brucellosis.

PURPOSE: We aimed to evaluate the risk factors of focal involvement in brucellosis. METHODS: The data of brucellosis patients were analyzed retrospectively from 2010 through 2019. Patients were divided into two groups: focal involvement (-) and focal involvement (+). The clinical findings, complications and laboratory findings of patients were compared between the two groups. RESULTS: Two hundred thirty patients were included in the study. One hundred twenty-seven of the patients (55.2%) were male and mean age was 45.8 ±â€¯17.1 (16-86) years. Focal involvement was observed in 98 (42.6%) patients. The variables that differed significantly between groups were age (P < 0.001), fever (P = 0.016), back pain (P < 0.001), leukocyte (P = 0.012), neutrophil (P = 0.004), platelet (P = 0.002), mean platelet volume (MPV) (P = 0.043) and erythrocyte sedimentation rate (ESR) (P = 0.001). Older age (>45 years) and back pain were found to be independent risk factors for predicting focal involvement (P = 0.036 and P < 0.001). CONCLUSIONS: The clinical findings and markers that are significant in determining focal involvement may be useful in identifying complicated brucellosis.

[Clinical case of the month. Acute focal bacterial nephritis]. / Le cas clinique du mois. La néphrite focale bactérienne aiguë.

Focal acute bacterial nephritis (lobar nephronia) is a localized bacterial infection of the kidney that has rarely been described in childhood. It is frequently associated to urinary tract anomalies and malformations and its diagnosis is based upon renal ultrasonography and computed tomography. In this article, we report a case in an 8 year old boy admitted to hospital in a septic state.

[Dental screening of patients after organ transplantation]. / Szervtranszplantáción átesett betegek fogászati szúróvizsgálata.

INTRODUCTION: Before any organ transplantation, the patient undergoes a wide range of medical controls and is prepared for the surgical intervention, which lasts for several hours and imposes considerable stress on the organism; the patient is also prepared so as to be able to tolerate the subsequent lifelong need for immunosuppressive treatment. AIMS: A study was made of wether dental foci are eliminated appropriately in practice, and wether the necessary dental follow-up is performed. PATIENTS/METHOD: During a period of 10 months, 55 patients presented at the above Department for the control screening of dental foci an average of 27.5 months after organ transplantation. Physical and X-ray examinations were performed and the numbers of dental focal lesions were determined. RESULTS: The examinations revealed lesions that could be regarded as dental foci in 34.5% of the cases, and in many there were multiple (on average 2.7) focus-suspect lesions. In one case, the possibility arose of a health impairment connected with the inadequacy of the dental treatment. The last dental control examination had been made on average 22.4 months before the current focus screening. CONCLUSIONS: This study suggests the need for the uniformity of the principles of dental focus screening and dental care in patients awaiting organ transplantation and lifelong immunosuppressive treatment, for more systematic care in practice, and for the organization of regular dental controls in these patients.

Focal neurological disease in patients with acquired immunodeficiency syndrome.

Focal neurological disease in patients with acquired immunodeficiency syndrome may be caused by various opportunistic pathogens and malignancies, including Toxoplasma gondii, progressive multifocal leukoencephalopathy (PML), cytomegalovirus (CMV), and Epstein-Barr virus-related primary central nervous system (CNS) lymphoma. Diagnosis may be difficult, because the findings of lumbar puncture, computed tomography (CT), and magnetic resonance imaging are relatively nonspecific. Newer techniques have led to improved diagnostic accuracy of these conditions. Polymerase chain reaction (PCR) of cerebrospinal fluid specimens is useful for diagnosis of PML, CNS lymphoma, and CMV encephalitis. Recent studies have indicated the diagnostic utility of new neuroimaging techniques, such as single-photon emission CT and positron emission tomography. The combination of PCR and neuroimaging techniques may obviate the need for brain biopsy in selected cases. However, stereotactic brain biopsy, which is associated with relatively low morbidity rates, remains the reference standard for diagnosis. Highly active antiretroviral therapy has improved the prognosis of several focal CNS processes, most notably toxoplasmosis, PML, and CMV encephalitis.

Paracoccidioidomycosis associated with acquired immunodeficiency syndrome, report of seven cases

Sao apresentadas as caracteristicas clinicas e evolutivas e sete pacientes (cinco masculinos e dois do sexo feminino), a maioria dos quais usuarios de drogas ilicitas endovenosa, com paracoccidioidomicose associada a Sindrome da Imunodeficiencia Adquirida (SIDA/AIDS). Em quatro pacientes a paracoccidioidomicose comprometia os pulmoes isoladamente, nos demais a doenca era generalizada com envolvimento cutaneo. Apenas dois pacientes eram precedentes da zona rural...

Extensive skeletal involvement detected by gallium-67 citrate in a patient with multiple myeloma.

Extensive skeletal involvement of multiple myeloma was detected by Ga-67 citrate imaging while searching for infectious foci. The case was unique in that a radiographic skeletal survey showed typical lytic lesions only in the skull, and extensive myeloma involvement in the skeletal system was an incidental finding. A high tumor cell burden was presumed to be present, which led to a rapid and fulminant clinical course in this patient.

Postoperative fever after major abdominal surgery.

The investigation is a report of postoperative fever in 608 patients, who had been subjected to major abdominal surgery. There were 259 patients (259/608: 43%) who developed fever, defined as a temperature higher than or equal to 38 degrees C, on at least two consecutive measurements. A focus as an explanation of the fever could be demonstrated in 93 patients (93/259: 36%). The most frequent extraabdominal fever foci were in order of magnitude: pulmonary infection, wound infection and urinary infection. In those patients where a focus was present the maximum temperature as well as the duration of fever was longer than in patients without a focus. The time from operation to onset of fever did not differ in the two groups.

[Combination of a 3d-generation cephalosporin (cefotaxime or ceftazidime) and a new quinolone (pefloxacine) in the treatment of febrile episodes in neutropenic diseases (37 cases)]. / Association d'une céphalosporine de troisième génération (céfotaxime ou ceftazidime) et d'une nouvelle quinolone (péfloxacine) dans le traitement des épisodes fébriles des malades neutropéniques (37 cas).

The combination of beta-lactam antibiotics and new quinolones is a form of broad spectrum antibiotic therapy rapidly bactericidal in vitro which could be an alternative to the classical combination of beta-lactam antibiotics and aminoglycosides in the first line treatment of febrile episodes in patients with neutropenia. The treatment of 37 initial febrile episodes (12 cases of septicemia, 7 infectious sites and 38 cases of fever of unknown origin) in 33 neutropenic patients (PMN leucocytes less than 500/mm3) using the combination of a third generation cephalosporin (cefotaxime or ceftazidime) and a new quinolone (pefloxacin) resulted in an 86% immediate success rate (32 cases/37). Results and course during treatment were similar in both groups (cefotaxime or ceftazidime). A second febrile episode occurred in 11 cases (4 superinfections, 2 chest infections, 5 fevers of unknown origin). Clinical acceptability was satisfactory in both groups. Minimal and transient changes in liver function tests were observed in 19% of the successfully treated patients. Study of quantitative aerobic stool cultures revealed the emergence of resistant bacterial strains, essentially Pseudomonas sp. (6 cases). More extensive trials should provide a better view of the role of this new combination in the first line treatment of febrile episodes in the neutropenic patient.

[Microflora of the suppurative inflammatory foci in patients with laryngeal and pharyngeal cancer undergoing combined treatment for local postoperative complications]. / Mikroflora gnoino-vospalitel'nykh ochagov u bol'nykh rakom gortani i glotki pri kompleksnom lechenii mestnykh posleoperatsionnykh oslozhnenii.

The paper deals with the problems of treatment for local postoperative complications in patients suffering cancer of the larynx and throat. Early diagnosis of complications as well as therapy employing modern glass fibre equipment are discussed. The first attempt to study the microflora of the newly formed throat in the early postoperative period is described. A wide spectrum of dormant bacteria was identified. Healing was found to depend upon microorganism level and profile of bacterial species in the newly formed throat. Complex application of endoscopic and laser procedures proved to be an effective means of sanative care.

Etiologic diagnosis of focal pulmonary infection in immunocompromised patients by fluoroscopically guided percutaneous needle aspiration.

Fluoroscopically guided percutaneous needle aspiration of focal pulmonary lesions was performed in 108 presumed infectious episodes in 82 immunocompromised patients in whom prior diagnostic studies, including transtracheal aspiration, were negative to inconclusive. Two-thirds of the lesions were 4 cm or smaller. Single (61/79) or multiple (18/79) organisms were recovered, for a diagnostic yield of 73% (79/108). Complications were pneumothorax (26%), half of which required tube drainage, and limited hemoptysis (3%). This technique can be quickly performed and frequently repeated with existing personnel and equipment in institutions currently employing it for suspected pulmonary neoplasm, and is a productive study in the evaluation of "opportunistic pneumonia".