[REVIEW OF COMMON PATHOGENS IN THE BONE AND BLOOD CULTURES AND ANTIBIOTIC TREATMENT IN PATIENTS WITH STERNAL OSTEOMYELITIS].

AIMS: This study concentrates on microbiological data collection of deep sternal wounds to delineate early and correct antibiotic therapy. BACKGROUND: Deep sternal wound infection, mediastinitis and sternal osteomyelitis are devastating and life-threatening complications of median-sternotomy incisions after cardiac surgical procedures. The incidence of surgical wound infection in sternotomies should be similar to that in any clean surgical procedure (i.e. approximately 2%). Nonetheless, the infection rates are higher among heart disease patients, due to the fact that these patients are burdened with a high number of risk factors in comparison with the general population. RESULTS: In line with other publications, the most commonly cultured organism from deep sternal wound and blood cultures was found to be Staphylococcus. In comparison, the most commonly cultured Gram-negative organisms were Pseudomonas and all gram-negative organisms combined together represented approximately 50% of all cultures. Three dominant organisms were isolated from wound and blood cultures: Staphylococcus, Pseudomonas and Acinetobacter. We found that 40% of blood cultures were identical to prior wound cultures, in comparison to 30% of bone cultures. Furthermore, 20% of the organisms isolated from the wound and 13% of the organisms isolated from the bone later on cross over to involve the blood. CONCLUSIONS: Empiric antibiotic regimen should be broad spectrum and cover both gram-positive as well as gramnegative organisms. We demonstrate that antibiotic regimen during sepsis may rely partially on preliminary wound cultures. Furthermore, antibiotic treatment for a relatively short period of two weeks is adequate, alongside thorough surgical revision with debridement of all foreign bodies, and reconstruction with vascularized soft tissue flap (pectoral major).

Three-dimensional ultrasound demonstration of the fetal palate in high-risk patients: the accuracy of prenatal visualization.

OBJECTIVE: The aim of this research was to evaluate the ability of three-dimensional (3D) ultrasound for demonstrating the palate of fetuses at high risk for cleft palate. METHOD: Fifty-seven fetuses at high risk for cleft palate were referred for specialist ultrasound at 12-40 weeks' gestation. A detailed assessment of palate was made using both two-dimensional and 3D ultrasounds on the axial plane. Antenatal diagnoses were compared with postnatal findings. RESULTS: Cleft palate was suspected in 13 (22.8%); a normal palate was demonstrated in 38 (67%), and in six (10.2%), the palate view could not be obtained. Mean gestational age at the first visit was 27 weeks 6 days (range of 12-40 weeks 3 days). Examination after delivery revealed that one of the 38 fetuses with presumed normal palate had a cleft hard palate, and one had a cleft soft palate (false negative 5%). Among the 13 fetuses with suspected cleft palate, three had an intact palate (false-positive 23%). Sensitivity, specificity, positive predictive value, and negative predictive value of detection of palatal clefts were 71.4%, 91.9%, 62.5%, and 94.4%, respectively. CONCLUSION: Using 3D technology, we diagnosed a cleft palate in 83% of high-risk cases, with 5% false negative. 3D technology might produce some technical artifacts resulting in a 23% false-positive rate.

Left atrial myxoma and transient ischemic attack: case report.

Cardiac tumors are rare and myxomas are the most prevalent among them. Although it presents benign histology, they may be the cause of severe consequences due to intracardiac location. Nonspecific manifestations may hinder the diagnosis, which can lead to complications, such as changes in cardiac dynamics, thromboembolic events and death. This paper presents a case report of a patient in the emergency department of a high complexity hospital in Minas Gerais State, Brazil, with a clinical history of angina and 7 previous Transient Ischemic Attack (TIA), besides aphasia, right hemiparesis, dysarthria, and mouth deviation. Submitted to transesophageal echocardiography, she was diagnosed with left atrial myxoma. For the treatment of myxoma, a surgical approach was used to resect the myxoma in the left atrium. The standard surgical approach was through a median sternotomy. Cardiopulmonary bypass (CPB) with aortic and bicaval cannulation and moderate hypothermia was used. Myocardial protection was achieved by cold antegrade blood cardioplegia. The patient had notable characteristics for the diagnosis, especially the previous occurrence of seven episodes of TIA. The importance of correct clinical investigation (anamnesis, general and specific physical examination and imaging tests) is notable and a fundamental tool for the diagnosis and early treatment of neoplasia, providing good clinical outcomes.

Electrocardiographic and echocardiographic profile of patients with heart failure.

Describing and analyzing the electrocardiographic and echocardiographic profile of patients with heart failure (HF). METHODS: Documentary, retrospective, quantitative and descriptive research; data collected at the Hospital das Clinicas of Uberlandia with patients diagnosed with HF. RESULTS: 81 patients participated in this study, with the average age of 66.75 years, 4 to 6 years of formal education and family income of approximately two minimum wages. A diagnosis time of 5 to 6 years and Left Ventricular Ejection Fraction (LVEF) of 40.88±11.97% were observed. In the clinical profile, the presence of comorbidities was evident, such as systemic arterial hypertension, arterial disease and cardiac arrhythmias (82.72%, 30.86% and 35.80% respectively). CONCLUSION: Cardio Vascular Diseases (CVD) directly impacts the lives of thousands of people, presenting an important public expenditure, not to mention the scarcity of diagnostic research, which can contribute to future research and guideline development.

The role of antibiotics in rhinoplasty and septoplasty: a literature review.

BACKGROUND: Prophylactic antimicrobial therapy during nasal surgery is common among surgeons worldwide, although the effectiveness of this practice is controversial. The authors reviewed the literature to evaluate the value of antibiotic prophylaxis. METHODS: A MEDLINE search was preformed using the key terms septoplasty, rhinoplasty, infections and antibiotics. The authors identified eleven studies written in English or German that addressed the effectiveness of prophylactic antibiotics, infection rate and bacteremia during nasal surgery. Due to the small number of studies statistical re-analysis was discarded. RESULTS: The articles demonstrated an overall very low incidence of bacteremia or infection. The studies failed to demonstrate a difference between patients who received antibiotic prophylaxis during nasal surgery and patients who did not; with the only exception being cases of complicated revision rhinoplasties. CONCLUSION: Our review suggests that the infection rate after elective nasal surgery is very low, making routine antibiotic prophylaxis redundant. Preventive systemic antibiotics are indicated in complicated revision rhinoplasties, prolonged placement of nasal packs and for patients who are susceptible to infections.

Anonymized Distributed PHR Using Blockchain for Openness and Non-Repudiation Guarantee.

We introduce our solution developed for data privacy, and specifically for cognitive security that can be enforced and guaranteed using blockchain technology in SAAL (Smart Ambient Assisted Living) environments. Personal clinical and demographic information segments to various levels that assures that it can only be rebuilt at the interested and authorized parties and no profiling can be extracted from the blockchain itself. Using our proposal the access to a patient's clinical process resists tampering and ransomware attacks that have recently plagued the HIS (Hospital Information Systems) in various countries. The core of the blockchain model assures non-repudiation possible by any of the involved information producers thus maintaining ledger fidelity of the enclosed historical process information. One important side effect of this data infrastructure is that it can be accessed in open form, for research purposes for instance, since no individual re-identification or group profiling is possible by any means.

Skin substitutes.

The role of skin substitutes in burn surgery and in the treatment of chronic wounds is constantly evolving. New products are regularly being developed and approved for clinical use. Studies on existing products demonstrate their effectiveness in different clinical scenarios. However, cost-related concerns, inadequate physician education, and the drawbacks that still accompany every skin substitute have resulted in limited application of these modalities. Today, burn surgeons still rely mostly on old-fashioned skin grafts. Only a few burn centers in the world actually use some of these products in their routine treatment of wounds. This review provides an up-to-date overview of the latest developments in the field of skin substitutes. We examine the major commercially available skin substitute products and their performance, and briefly review the technologies and products that are under development but have not yet become widely available.

Galactorrhea complicating wound healing following reduction mammaplasty.

Galactorrhea complicating wound healing following reduction mammaplasty occurs rarely; only isolated cases have been reported in recent years. We report the case of a 25-year-old woman who presented with delayed healing and dehiscence of surgical wounds 3 weeks following vertical scar reduction mammaplasty. During surgical debridement, spontaneous discharge of milk in the wound was noted. Serum prolactin levels were high, and she was treated with carbegoline, a dopamine agonist, which suppressed the prolactin secretion and led to rapid cessation of lactation. A second debridement and delayed primary closure were performed to achieve a satisfactory postoperative result.

Ten commandments for minimal pain during administration of local anesthetics.

Local anesthetic agents are administered before many ambulatory cutaneous operations. The injection of the local anesthetic agent is often the only painful aspect of the procedure. There are various factors that determine how painful the anesthetic administration may be. These include the preparation used, the size of the needle and syringe used, injection technique, depth of injection, attitude of the physician, and more. In this article, we present the different techniques we apply to achieve minimal pain during the injection of local anesthetics.

Necrotizing periorbital cellulitis following aesthetic rhinoplasty.

Rhinoplasty is rarely complicated with infection. We present a case of necrotizing periorbital cellulitis that developed in an 18-year-old woman following aesthetic rhinoplasty. The clinical manifestations consisted of swelling of the eyelids and necrosis of the lower eyelid regions, accompanied by high fever. Streptococcus pyogenes was isolated from the wound. The patient responded well to administration of intravenous amoxycillin/clavulanate and conservative local treatment. The infection resolved uneventfully. At 2-year follow-up, the cosmetic result was excellent.

Expanded reverse abdominoplasty for reconstruction of burns in the epigastric region and the inframammary fold in female patients.

We report the use of expanded reverse abdominoplasty in three female patients with postburn scars involving the entire epigastric region in which the inframammary folds were effaced, resulting in distortion of breast contour. In two of the patients, tissue expanders were used, and subsequently, reverse abdominoplasty was performed, thus re-creating the inframammary fold. The third patient reported to be pregnant after expanders were placed; therefore, smaller volumes of inflation for tissue expansion were necessary. We believe that this procedure is an optimal solution, both aesthetically and functionally, in respect to other reconstructive techniques in female patients with normal skin inferior to epigastric burns. The surgical technique and results are discussed.

Stensen duct rupture (sialocele) and other complications of the Aptos thread technique.

BACKGROUND: The Aptos thread technique is a mode of uplifting the flabby soft tissue of the aging face. Permanent suture material made of polypropylene monofilament with dents is used in this technique. This procedure is gaining popularity throughout the world. According to the literature, several hundred Aptos procedures have been performed, and no major complications have been reported yet. METHODS: Two adult women presented shortly after the Aptos thread insertion. They sustained devastating results. A close study was performed to understand and learn the potential complications. RESULTS: The authors present two major complications, a rare case of Stensen's duct laceration and a case of chronic inflammation mandating surgical treatment. CONCLUSIONS: Describing complications may teach plastic surgeons more about this method and how to avoid similar devastating side effects in the future.