Novel application of vacuum sealing drainage with continuous irrigation of potassium permanganate for managing infective wounds of gas gangrene.

Traumatic gas gangrene is a fatal infection mainly caused by Clostridium perfringens. It is a challenge to manage gas gangrene in open wounds and control infection after debridement or amputation. The aim of the present study was to use vacuum sealing drainage (VSD) with continuous irrigation of potassium permanganate to manage infective wounds of gas gangrene and observe its clinical efficacy. A total of 48 patients with open traumatic gas gangrene infection were included in this study. Amputations were done for 27 patients, and limb salvage procedures were performed for the others. After amputation or aggressive debridement, the VSD system, including polyvinyl alcohol (PVA) foam dressing and polyurethane (PU) film, with continuous irrigation of 1:5000 potassium permanganate solutions, was applied to the wounds. During the follow-up, all the patients healed without recurrence within 8-18 months. There were four complications. Cardiac arrest during amputation surgery occurred in one patient who suffered from severe septic shock. Emergent resuscitation was performed and the patient returned to stable condition. One patient suffered from mixed infection of Staphylococcal aureus, and a second-stage debridement was performed. One patient suffered from severe pain of the limb after the debridement. Exploratory operation was done and the possible reason was trauma of a local peripheral nerve. Three cases of crush syndrome had dialysis treatment for concomitant renal failure. In conclusion, VSD can convert open wound to closed wound, and evacuate necrotic tissues. Furthermore, potassium permanganate solutions help eliminate anaerobic microenvironment and achieve good therapeutic effect on gas gangrene and mixed infection. VSD with continuous irrigation of potassium permanganate is a novel, simple and feasible alternative for severe traumatic open wounds with gas gangrene infection.

[Generalized cutaneous candidiasis in newborn at term]. / Candidiasis cutánea generalizada en recién nacido a término.

INTRODUCTION: Cutaneous candidiasis is a disease that affects children as well as adults. The presentation may be localized or systemic, and with multiple etiological agents. The most prevalent infecting species in children differs from that of the adult. OBJECTIVE: A case is presented where a congenital cutaneous candidiasis was transmitted to the child during birth. MATERIALS AND METHODS: A full term newborn was exposed to a subclinical vaginal candidiasis infection, and 24 hr after birth, developed congenital cutaneous candidiasis. The etiological agent was Candida albicans, and was associated with sepsis and respiratory distress. Blood cultures, cutaneous biopsy of vesicular lesions, blood tests and lumbar puncture were performed. RESULTS: Biochemistry and blood count showed a CRP of 5.7 mg/dl, leukocytosis with left shift and mild anemia. After 24 hr, the blood analyses showed an increase in a CRP (7.8 mg/dl) and increased progressively for three days; consequently, a lumbar puncture was performed. Blood culture was positive for Staphylococcus aureus. Cutaneous biopsy confirmed the cutaneous candidiasis. CONCLUSIONS: The early diagnosis is essential to prevent complications derived by the Candida albicans in newborns.

Candidiasis cutánea generalizada en recién nacido a término / Generalized cutaneous candidiasis in newborn at term

Introducción. La candidiasis cutánea es una enfermedad que afecta tanto a población infantil como adulta. Las forma de presentación puede ser localizada o sistémica y el agente etiológico múltiple, siendo las especies infecciosas de Candida albicans más prevalentes en niños. Objetivo. Presentar un caso de candidiasis cutánea congénita cuya causa aparente fue la transmisión vertical durante el parto. Material y metodología. Se describe el caso de un recién nacido a término expuesto a una candidiasis vaginal subclínica, que desarrolló una candidiasis cutánea congénita por C. albicans asociada a sepsis y dificultad respiratoria en las primeras 24 horas de vida. Se practicaron hemocultivos, biopsia cutánea de las lesiones pápulopústulo-vesiculosas, análisis de sangre y punción lumbar. Resultados. En la bioquímica y el hemograma se encontró una proteína C reactiva de 5,7 mg/dl, leucocitosis con desviación a la izquierda y anemia leve. A las 24 horas, en el control se encontró una proteína C reactiva (7,82 mg/dl) que fue en aumento progresivo durante tres días, por lo que se practicó punción lumbar. El hemocultivo fue positivo para Staphylococcus aureus. La biopsia cutánea dio como resultado histológico la candidiasis cutánea. Conclusiones. El diagnóstico precoz es fundamental para prevenir complicaciones derivadas del cuadro producido por C. albicans en neonatos.

Introduction. Cutaneous candidiasis is a disease that affects children as well as adults. The presentation may be localized or systemic, and with multiple etiological agents. The most prevalent infecting species in children differs from that of the adult. Objective. A case is presented where a congenital cutaneous candidiasis was transmitted to the child during birth. Materials and methods. A full term newborn was exposed to a subclinical vaginal candidiasis infection, and 24 hr after birth, developed congenital cutaneous candidiasis. The etiological agent was Candida albicans, and was associated with sepsis and respiratory distress. Blood cultures, cutaneous biopsy of vesicular lesions, blood tests and lumbar puncture were performed. Results. Biochemistry and blood count showed a CRP of 5.7 mg/dl, leukocytosis with left shift and mild anemia. After 24 hr, the blood analyses showed an increase in a CRP (7.8 mg/dl) and increased progressively for three days; consequently, a lumbar puncture was performed. Blood culture was positive for Staphylococcus aureus. Cutaneous biopsy confirmed the cutaneous candidiasis. Conclusions. The early diagnosis is essential to prevent complications derived by the Candida albicans in newborns.

Avaliação in vitro da sensibilidade da Corynebacterium pseudotuberculosis frente a diferentes tipos de antissépticos e desinfetantes e determinação de sua curva de crescimento / In vitro evaluation of the susceptibility of Corynebacterium pseudotuberculosis to different kinds of antiseptics and disinfectants, and the determination of its growth curve

O objetivo deste estudo foi avaliar o efeito in vitro de antissépticos e desinfetantes contra a Corynebacterium pseudotuberculosis e descrever a curva de crescimento deste micro-organismo em caldo de infusão de cérebro e coração adicionado de 0,1% de Tween 80 (BHI + T), ao longo de 48 horas. Foram avaliados tintura de iodo a 10%, hipoclorito de sódio a 2,5%, permanganato de potássio a 5%, sabonete líquido antisséptico Aseptol® e álcool etílico absoluto (99,8%), por meio da metodologia da disco-difusão. Um swab estéril foi imerso na suspensão bacteriana produzida e semeado em placa de ágar Mueller-Hinton. Discos estéreis foram embebidos em cada solução a ser testada e distribuídos na superfície do ágar. Os resultados foram obtidos de acordo com o diâmetro do halo produzido ao redor dos discos. Para obtenção da curva de crescimento, colônias isoladas do micro-organismo foram inoculadas em frasco contendo BHI + T. A cada quatro horas, 2 mL eram retirados para medição da massa celular em espectrofotômetro e 1 mL para realização das diluições seriadas, plaqueamento em ágar sangue e contagem de células viáveis. Observou-se que, para a obtenção de uma concentração máxima de C. pseudotuberculosis, próxima a 1.200 x 105 células viáveis/mL, deve-se manter o inóculo sob incubação adequada por um período de 28 a 40 horas. Quanto à prova de sensibilidade, verificou-se que a tintura de iodo a 10%, seguida pelo hipoclorito de sódio a 2,5% e permanganato de potássio a 5%, foram os antissépticos e desinfetantes com maior poder bactericida in vitro contra a C. pseudotuberculosis.

The aim of this study was to evaluate the in vitro effect of antiseptics and disinfectants against Corynebacterium pseudotuberculosis, and to define the growth curve of this microrganism inoculated in brain heart infusion broth plus 0.1% of Tween 80 (BHI + T), for 48 hours incubation. For the susceptibility test, evaluations were made using 10% iodine, 2.5% sodium hypochlorite, 5% potassium permanganate, Aseptol® liquid soap, and absolute ethyl alcohol (99.8%), by way of the disc-diffusion method. A sterile swab was immersed in a bacterial suspension and plated in Mueller-Hinton agar. Sterile discs were immersed in each solution to be tested and distributed on the agar surface. The results were obtained according to the inhibition circle diameter formed around the disc. For the growth curve determination, colonies were inoculated in a bottle containing BHI + T. Every 4 hours, 2 mL was withdrawn to evaluate the cell mass in a spectrophotometer, and 1 mL was taken to perform serial dilutions, blood agar base plating and counting of viable cells. It was observed that in order to reach the maximum concentration of C. pseudotuberculosis, close to 1,200 x 105 viable cells/mL, the inoculum must be maintained at appropriate incubation for a period of 28-40 hours. The sensibility test indicated.

A simplified acute physiology score in the prediction of acute aluminum phosphide poisoning outcome.

BACKGROUND: Aluminum phosphide (AlP) is used as a fumigant. It produces phosphine gas, which is a mitochondrial poison. Unfortunately, there is no known antidote for AlP intoxication, and also, there are few data about its prognostic factors. AIMS: The aim of this study was to determine the impact of the Simplified Acute Physiology Score II (SAPS II ) in the prediction of outcome in patients with acute AlP poisoning requiring admission to the Intensive Care Unit (ICU). MATERIALS AND METHODS: This was a prospective study in patients with acute AlP poisoning, admitted to the ICU over a period of 12 months. The demographic data were collected and SAPSII was recorded. The patients were divided into survival and non-survival groups due to outcome. STATISTICAL ANALYSIS: The data were expressed as mean ± SD for continuous or discrete variables and as frequency and percentage for categorical variables. The results were compared between the two groups using SPSS software. Results : During the study period, 39 subjects were admitted to the ICU with acute AlP poisoning. All 39 patients required endotracheal intubation and mechanical ventilation in addition to gastric decontamination with sodium bicarbonate, permanganate potassium, and activated charcoal, therapy with MgSO 4 and calcium gluconate and adequate hydration. Among these patients, 26 (66.7%) died. SAPSII was significantly higher in the non-survival group than in the survival group (11.88 ± 4.22 vs. 4.31 ± 2.06, respectively) (P < 0.001). CONCLUSION: SAPSII calculated within the first 24 hours was recognized as a good prognostic indicator among patients with acute AlP poisoning requiring ICU admission.

Wound myiasis in a patient with squamous cell carcinoma.

A 60-year-old, otherwise healthy, male farmer presented to our Dermatology Department with a large ulcer on his lower right leg. The lesion had started as a small papule 6 months before, which became eroded and transformed into a rather rapidly progressive ulcer. On careful inspection, numerous larvae were found moving within the wound. The larvae were analyzed and found to be Lucilia sericata (the green bottle blowfly). The lesion was diagnosed histopathologically as squamous cell carcinoma. The myiasis was treated by submerging the wound in a dilute permanganate potassium solution.

Eficiencia del Permanganato de Potasio aplicado en las heridas sépticas en el servicio de cirugía cervico-facial / Efficiency of the Permanganato of Potassium applied in the septics wounded in the service of surgery cervix facial

se realizó un estudio a 20 pacientes con tumoraciones avanzadas y heridas sépticas con fetidez, ingresados en el servicio de cirugía cérvicofacial del Hospital Docente Oncológico "Conrado Benítez" de Santiago de Cuba, durante los meses de enero a julio de 1994.En los cuales se aplicó fomentos de Permanganato de potasio al 1x16000, 3 o 4 veces al día, en curaciones y pinceladas locales al 1 por ciento, con la misma frecuencia.El dato primario se obtuvo de las historias clínicas, donde se analizaron variables como: localización anatómica del tumor, tiempo en que desaparece la sepsis, fetidez y gérmenes aislados.Se obtuvieron resultados alentadores como desaparición de la fetidez y por consiguiente ausencia de sepsis, la no utilización de antibióticos terapia ni sistemático, ni local; debemos además señalar que en los pacientes estudiados no se detectó reacción abversa al uso del Permanganato de Potasio

Bilateral pyoderma gangrenosum of the hand: treatment with dapsone.

The first reported case of bilateral pyoderma gangrenosum of the hands is presented. One lesion was treated with wound care only, with spontaneous healing after two months. The contralateral lesion which occurred one month later was treated with wound care and oral dapsone. Healing occurred between four and six weeks after the start of dapsone. It is suggested that this acts by limiting the necrotizing process, thus allowing earlier epithelialization. Pyoderma gangrenosum is rare, and treatment is non-surgical. It is important that it is recognized to avoid extension of the necrotizing process through ill-advised surgery.

[Sezary's syndrome. 4 cases observed at the University Hospital Center of Treichville (Abidjan, Ivory Coast)]. / Le syndrome de Sezary. A propos de 4 cas observés au Centre Hospitalier Universitaire de Treichville (Abidjan-Côte d'Ivoire).

Authors report four cases of Sezary's syndrome over a period of eight years. The frequency is 1.2 for one hundred thousand consultations registered and 1.4 for one thousand patients. Three about 4 cases are younger than literature reports. On a clinical point of view we have noted no particular point.

Ocorrência de infecçäo hospitalar em queimados / Occurrence of hospital infection in burned

Foi realizado um estudo na Policlínica Pato Branco, durante o período de 1985 a 1987, foram acompanhados 36 pacientes com diagnóstico de queimadura, estes pacientes foram divididos em dois grupos. Grupo A- representava os que fizeram uso de antibióticos (69%) B- os que näo receberam antibióticos (31%). As causas de queimadura eram as mais diversas, predominando as térmicas, e com profundidade da lesäo de I, II, III graus, extensäo variando de pequena (3%) até a grande (50%) área queimada (média de 23%). Os pacientes em estudo eram da faixa etária de 1 a 60 anos (média de idade 16) e de várias categorias, o período de internamento variou de 1 a 37 dias (média de 12 dias). O objetivo do trabalho foi demonstrar a näo ocorrência de infecçäo hospitalar sem o uso de associaçöes e em grande doses de antibióticos, a eficácia do banho com permanganato de potássio, seguida da aplicaçäo tópica de sulfadiazina de prata, bem como a importância da desinfecçäo de quarto con fenóis sintéticos, também foi fundamental a restriçäo de visitas. No decorrer do trabalho em questäo, observou-se que mesmo com uso de vários antibióticos associados e, ou doses elevadas, ocorria a infeccäo hospitalar (44%). E a medida que foi reduzido o uso de antibióticos, introduzido o banho com permanganato de potássio e intensificado os cuidados preventivos; a incidência de infecçäo diminuiu consideravelmente (91%)

Tinea profunda por Trichophyton mentagrophytes / Deep tinea due to Trichophyton mentagrophytes

É descrito um provável caso de granuloma por dermatófitos, com formaçäo de nódulos no antebraço direito, após bicada por ave de médio porte (Capella gigantea), isolando-se Trichophyton mentagrophytes, tipo zoofílico. O tratamento com permanganato de potássio e o clotrimazol tópicos foram capazes de erradicar o processo

Lavagem mecânica por imersäo no trartamento das feridas infectadas: nota prévia / Mechanical washing by immersion in treatment of infected wound: preve note

Os autores apresentam um sistema de limpeza mecânica de feridas infectadas, consistindo, basicamente, na imersäo da área lesada em soluçäo salina a 1,5% e projeçäo, sobre ela, de um jato da soluçäo, através de um sistema de hélice acionada por um motor, ou por um sistema de bomba hidráulica. O turbilhonamento da soluçäo sobre a ferida promove a sua limpeza mais rapidamente e de modo mais eficaz do que os curativos e debridamentos usuais

Pyoderma gangrenosum--a literature review.

Pyoderma gangrenosum is an ulcerative skin disorder with typical clinical characteristics. Histologic and laboratory findings are nonspecific. Pyoderma gangrenosum is associated with internal disorders including inflammatory bowel disease, paraproteinemias, leukemias, and arthritis. The pathogenesis of pyoderma gangrenosum is unknown, although a partial defect of cell-mediated immunity may exist. Treatment includes bedrest, local care, sulfonamides, sulfones, and corticosteroids.