BACKGROUND: We analysed the clinical, biological, radiological profiles, and therapeutic patterns of the patients who underwent a surgical lower extremity amputation (LEA) in Togo from 2010 to 2020. METHODS: Retrospective analysis of clinical files of adult patients who underwent an LEA at a single centre (Sylvanus Olympio Teaching Hospital) from 1st January 2010 to 31st December 2020. Data were analysed by CDC Epi Info Version 7 and Microsoft Office Excel 2013 software. RESULTS: We included 245 cases. The mean age was 59.62 years (15.22 SD) (range: 15-90 years). The sex ratio was 1.99. The medical history of diabetes mellitus (DM) was found in 143/222 (64.41%) files. The amputation level found in 241/245 (98.37%) files was the leg in 133/241 (55.19%) patients, the knee in 14/241 (5.81%), the thigh in 83/241 (34.44%), and the foot in 11/241 (4.56%). The 143 patients with DM who underwent LEA had infectious and vascular diseases. Patients with previous LEAs were more likely to have the same limb affected than the contralateral one. The odds of trauma as an indication for LEA were twice as high in patients younger than 65 years compared to the older (OR = 2.095, 95% CI = 1.050-4.183). The mortality rate after LEA was 17/238 (7.14%). There was no significant difference between age, sex, presence or absence of DM, and early postoperative complications (P = 0.77; 0.96; 0.97). The mean duration of hospitalization marked in 241/245 (98.37%) files was 36.30 (1-278) days (36.20 SD). Patients with LEAs due to trauma had a significantly longer hospital admission than those with non-traumatic indications, F (3,237) = 5.505, P = 0.001. CONCLUSIONS: Compared to previous decades, from 2010 to 2020, the average incidence of LEAs for all causes at Sylvanus Olympio Teaching Hospital (Lomé, Togo) decreased while the percentage of patients with DM who underwent LEAs increased. This setting imposes a multidisciplinary approach and information campaigns to prevent DM, cardiovascular diseases, and relative complications.
Amputation, Surgical , Lower Extremity , Adult , Humans , Middle Aged , Tertiary Care Centers , Togo/epidemiology , Retrospective Studies , Lower Extremity/diagnostic imaging , Lower Extremity/surgery
BACKGROUND: RAS assessment is mandatory for therapy decision in metastatic colorectal cancer (mCRC) patients. This determination is based on tumor tissue, however, genotyping of circulating tumor (ct)DNA offers clear advantages as a minimally invasive method that represents tumor heterogeneity. Our study aims to evaluate the use of ctDNA as an alternative for determining baseline RAS status and subsequent monitoring of RAS mutations during therapy as a component of routine clinical practice. PATIENTS AND METHODS: RAS mutational status in plasma was evaluated in mCRC patients by OncoBEAM™ RAS CRC assay. Concordance of results in plasma and tissue was retrospectively evaluated. RAS mutations were also prospectively monitored in longitudinal plasma samples from selected patients. RESULTS: Analysis of RAS in tissue and plasma samples from 115 mCRC patients showed a 93% overall agreement. Plasma/tissue RAS discrepancies were mainly explained by spatial and temporal tumor heterogeneity. Analysis of clinico-pathological features showed that the site of metastasis (i.e. peritoneal, lung), the histology of the tumor (i.e. mucinous) and administration of treatment previous to blood collection negatively impacted the detection of RAS in ctDNA. In patients with baseline mutant RAS tumors treated with chemotherapy/antiangiogenic, longitudinal analysis of RAS ctDNA mirrored response to treatment, being an early predictor of response. In patients RAS wt, longitudinal monitoring of RAS ctDNA revealed that OncoBEAM was useful to detect emergence of RAS mutations during anti-EGFR treatment. CONCLUSION: The high overall agreement in RAS mutational assessment between plasma and tissue supports blood-based testing with OncoBEAM™ as a viable alternative for genotyping RAS of mCRC patients in routine clinical practice. Our study describes practical clinico-pathological specifications to optimize RAS ctDNA determination. Moreover, OncoBEAM™ is useful to monitor RAS in patients undergoing systemic therapy to detect resistance and evaluate the efficacy of particular treatments.
Colorectal Neoplasms/diagnosis , DNA Mutational Analysis/methods , DNA, Neoplasm/blood , Genes, ras , Antineoplastic Agents/therapeutic use , Colorectal Neoplasms/blood , Colorectal Neoplasms/drug therapy , Colorectal Neoplasms/pathology , ErbB Receptors/antagonists & inhibitors , Humans , Monitoring, Physiologic/methods , Neoplasm Metastasis , Prospective Studies , Retrospective Studies
Introduction -Les prothèses totales de genou à plateau mobile ont été élaborées en alternative aux prothèses à plateau fixe pour lutter contre le descellement et l'usure du polyéthylène.L'objectif de ce travail était d'évaluer les résultats d'une série continue de prothèse totale de genou à plateau mobile type SCORE® implantée en première intention avec une instrumentation classique. L'hypothèse de départ était d'avoir une survie entre 90 à 100%.Matériel et méthode -L'étude a concerné 42 patients (42 genoux). L'âge moyen des patients au moment de l'intervention était de 64,5 ans. La prothèse était cimentée. La série était composée de 30 femmes et de 12 hommes. L'indication de la prothèse était une gonarthrose (n=34) et une arthropathie inflammatoire (n=8). Le score global IKS moyen était de 71 points, avec un score genou de 45 points et un score fonction de 26 points. Résultats -Au recul moyen 5 ans (3 et 7 ans) les patients étaient très satisfaits et satisfaits (32; 76%), et déçus (n=10; 24%). Le score IKS moyen de la douleur était de 45 points. La flexion moyenne était de 110°. Le score IKS global était excellent à 170 points, avec un score fonction de 75 points et un score genou de 95 points. L'axe mécanique était de 180°± 3° chez (32/42) patients. Une reprise avec changement en deux temps par une prothèse contrainte a été faite chez un patient pour sepsis. En considérant le changement de prothèse comme un échec, la survie à 5 ans était de 97,6%. Conclusion -La prothèse totale de genou à plateau mobile type SCORE® donne de très bons résultats cliniques, fonctionnels et radiologiques. La survie à 5 ans était de 97,6%
Metal-on-Metal Joint Prostheses/statistics & numerical data , Patients
Deep hand burns usually lead to joint and tendon exposure. A simple skin graft is insufficient to achieve healing. Soft tissue reconstruction represents a surgical challenge that ranges from the simplest to the most complex flaps. In some areas, microsurgery is not technically possible. Choice is then limited to pedicled distant flaps such as the abdominal wall flap-graft. We report a case of an acute burned hand with exposure of metacarpophalangeal joints from the second to the fourth radius as well as proximal inter phalangeal joints from the second to the fifth radius and extensor tendons, treated in the burns and wound care unit of the Sylvanus Olympio Teaching Hospital in Lomé. The dorsum hand and fingers were covered with a pedicled abdominal flap-graft that was severed in two stages at 22 and 29 days. We achieved good results (sensitivity S3+, useful aesthetic hand) at two-year follow up.
Les brûlures profondes de la main conduisent habituellement à une exposition articulaire et tendineuse. La reconstruction des parties molles représente un challenge chirurgical qui va de la technique la plus simple au lambeau le plus complexe. Dans certaines contrées, la microchirurgie n'est pas techniquement possible et le choix se limite à l'utilisation de lambeau pédiculé à distance, comme le lambeau-greffe abdominal; nous rapportons un cas de brûlure récente de la main avec exposition des articulations métacarpo phalangiennes du second au quatrième rayon avec de plus une atteinte des articulations inter phalangiennes proximales du second jusqu'au cinquième rayon et exposition des tendons extenseurs. Ce patient a été pris en charge dans l'Unité des brûlés et des Plaies et Cicatrisation du Centre Hospitalier Universitaire Sylvanus Olympio de Lomé. La face dorsale de la main et des doigts a été couverte par un lambeau-greffe pédiculé abdominal, qui fut sevré en 2 étapes (22ème et 29ème jour). Nous avons obtenu de bons résultats sur le plan de la sensibilité ainsi que sur l'aspect esthétique chez ce patient après deux ans de suivi.
Subacute subdural hematomas are a poorly individualized nosological entity, often equated clinically to chronic subdural hematomas. Yet, their neurological deterioration which is usually rapid seems to distinguish them from chronic subdural hematomas. We wanted to show this dangerousness by establishing the clinically evolving profile of the three types of subdural hematomas. This was a prospective and retrospective study of 63 subdural hematoma (18 acute, 13 subacute, and 32 chronic) patients admitted between 2012 and 2014 in the neurosurgery unit of Lomé University Hospital. Hematomas were classified according to the elapsed time after head injury and blood density on CT. The main parameter studied was the evolution of the Glasgow Coma Score (GCS) in the 3 months following the trauma, enabling to establish an evolving profile of each type of hematoma. The average age of patients was 58.1 years for chronic subdural hematomas and 47.6 years for subacute subdural hematomas. Disease duration before admission was 13.1 days for chronic against 36.6 h for subacute hematoma. The clinical profile shows acute worsening within hours during the second week for patients with subacute hematoma, while it is progressive for patients with chronic hematoma. We noted two deaths, all victims of a subacute hematoma (one operated, one patient waiting for surgery). Iso-density hematoma on CT, especially in a young person, must be considered as a predictive factor of rapid neurological aggravation suggesting an urgent care or increased monitoring by paramedics.
Craniocerebral Trauma/surgery , Hematoma, Subdural/surgery , Adolescent , Adult , Age Distribution , Aged , Dangerous Behavior , Female , Humans , Male , Middle Aged , Prospective Studies , Retrospective Studies , Tomography, X-Ray Computed , Treatment Outcome
Purpose: Hand trauma epidemiological characteristics are lacking in low and middle-income countries. The aim of the study was to determine hand trauma characteristics to be use as a framework for planning hand surgical care in our country. Material et methods: Registers in Surgical Emergency Department from 1st June 2009 to 31st May 2014 were reviewed retrospectively to determine frequency, socio-demographic of patients and clinical characteristics of hands injuries. Results: Frequency of hand trauma was 0.7% of all admissions in the Surgical emergency department. The male to female ratio was 3.4:1. Mean age was 28 years. Manual work was the most representative occupation (33.2%). Road traffic accidents were the main circumstances of hand injuries (38%). Open injuries represented 68%. Fractures, dislocation and sprains were seen respectively in 41%, 31%, and 8% of cases. Simple wounds were seen in 38 % of all patients. Conclusion: Hand trauma seemed to be of low frequency in hospital in our setting. Main injuries encountered are fractures, dislocation, and sprains
Amputation, Surgical/epidemiology , Hand/injuries , Togo
Avulsion of the distal biceps brachii tendon is an uncommon injury. This is a retrospective review of cases operated in our department by transosseous suture fixation on the radial tuberosity, using the single anterior incision. Between 2000 and 2007, a total of 10 patients with distal biceps tendon injury were included. All were men, with an average age of 39 years. The most common mechanism was passive extension against active flexion. The dominant limb was affected in all patients. Clinical diagnosis was the rule. Surgical reattachment to the radial tuberosity through the anterior approach to the elbow was performed. The preoperative period was one week in three cases, between one and three weeks in five cases, and superior to three weeks in two cases. Clinical and instrumental evaluation of the results was done. Average follow-up was 48 months. Subjective results were good in seven cases, acceptable in two cases and poor in one case. Nine patients return to their previous level activity with no limitations. The average range of motion was 0° of extension to 135° of flexion. Strength testing of the injured limbs, compared to the contralateral, using the criteria described by Baker and Bierwagen, revealed a loss of 22% of supination strength and 32% of supination endurance. There was a loss of 14% of flexion strength and 27% of flexion endurance. There were two cases of superficial surgical site infection. There were no cases of nerve damage or heterotopic bone formation. Two main factors were found to explain the poor outcomes: experience of the surgeon and a long preoperative delay. Despite the limitations of this study, we found that transosseous reattachment of the biceps' distal tendon to the radial tuberosity can restore supination. Strength and endurance for supination can be better restored by early intervention. Complications are easily avoided if surgery is performed early and by experts.
Elbow Injuries , Orthopedic Procedures/methods , Tendon Injuries/surgery , Adult , Female , Humans , Male , Middle Aged , Range of Motion, Articular , Recovery of Function , Retrospective Studies , Risk Factors , Rupture , Tendon Injuries/etiology , Treatment Outcome
Bilateral anterior shoulder dislocation is a very rare clinical entity. We report another case of traumatic bilateral anterior dislocation of shoulders. We discuss the mechanism of the dislocation which is unusual and the treatment.
Shoulder Dislocation , Adult , Follow-Up Studies , Humans , Immobilization , Male , Radiography , Recovery of Function , Shoulder Dislocation/diagnosis , Shoulder Dislocation/diagnostic imaging , Shoulder Dislocation/rehabilitation , Shoulder Dislocation/therapy , Shoulder Joint/physiology , Time Factors , Treatment Outcome
PURPOSE: To evaluate surgical outcomes of ipsilateral femoral neck and shaft fractures. METHODS: Between April 1997 and September 2004, 29 men and 8 women (mean age, 37 years) underwent fixation of femoral neck and shaft fractures using a dynamic compression plate plus a dynamic hip screw or screws. There were 30 femoral neck and 7 pertrochanteric fractures. Functional results were assessed according to the Friedman and Wyman classification. RESULTS: The mean follow-up period was 49 months. Of the femoral neck fractures, 34 united in a mean of 4 months; 33 of them healed anatomically and one with a 6-degree varus angulation. No osteonecrosis of the femoral head was noted. Of the femoral shaft fractures, 32 united in a mean of 6 months, 5 were non-unions (2 persisted even after revision surgery). Seven patients developed infections (5 superficial and 2 deep), which resolved with debridement and antibiotic treatment. Functional results were good in 29 patients, fair in 5, and poor in 3. CONCLUSION: The use of dynamic hip screws and compression plates for ipsilateral femoral neck and shaft fractures is reliable in achieving bone union with few complications.
Bone Plates , Bone Screws , Femoral Fractures/surgery , Femoral Neck Fractures/surgery , Fracture Fixation, Internal/methods , Adolescent , Adult , Aged , Female , Fracture Healing , Humans , Male , Middle Aged , Postoperative Complications
PURPOSE OF THE STUDY: We reviewed, at a mean follow-up of 8.2 years, clinical and radiographic results after 93 Bristow-Latarjet procedures for anterior instability of the shoulder. MATERIAL AND METHODS: There were 84 men and nine female. The average age was 23 years at the time of operative intervention. Forty-four shoulders were on the dominant side. Eighty patients practiced sports activities, with 74 patients a risk sport. Seventy-seven patients have had five or more recurrent of dislocation of the shoulder. The operations were performed by a senior surgeon. Evaluation was done by a clinician, who did not perform the operation. Clinical outcome was assessed with the Duplay score, and the satisfaction of the patients. Radiographic evaluation was done using the standard radiography of the shoulder. RESULTS: According to the Duplay scoring system, we have had 30.1% of excellent results, 43% of good results, 16.1% of fair results, and 10.8% of poor results. The mean Duplay score was 84.7 points with 19 points for the return in sports, 23 points for the stability, 21 points for the pain, and 22 points for the movement. The loss of rotation was less than 13 degrees (mean). Among the patients, 57.4% returned to their former sports activities at the same level, with 59.8% a risk sports. Five patients reported redislocation and eleven patients reported apprehension. The patients were painless in 75.8%. Forty-four patients were very satisfied or satisfied at follow-up. At review, there were radiological degenerative changes in nine shoulders: six in Samilson grade I, one grade II, and two grade III. There was no radiological evidence of loosing, migration or fracture of the coracoid screws, and no nonunion. We have had six cases of resorption of the coracoid tip. DISCUSSION: We are aware of the limitation of the study. It is a retrospective study and there is no control group. However, we believe that, in regard of our result, the Bristow-Latarjet procedure for anterior glenohumeral instability is safe and effective with good objective and subjective result, and a high degree of patient satisfaction. Radiological findings do not always correlate with the functional outcome and patient satisfaction. CONCLUSION: Although it is a non-anatomical repair, the Bristow-Latarjet procedure provides desirable functional results.
Joint Instability/surgery , Orthopedic Procedures , Shoulder Joint , Adult , Data Interpretation, Statistical , Female , Follow-Up Studies , Humans , Joint Instability/diagnosis , Joint Instability/diagnostic imaging , Male , Middle Aged , Patient Satisfaction , Radiography , Recovery of Function , Retrospective Studies , Shoulder Dislocation/complications , Shoulder Joint/physiology , Shoulder Pain/etiology , Sports , Time Factors , Treatment Outcome
PURPOSE: To retrospectively study the epidemiology and treatment of acute avulsion fractures of the tibial tubercle in 12 patients. METHODS: Records of 12 patients aged 11 to 17 (mean, 14) years with avulsion fractures of the tibial tubercle presenting to our hospital from April 1998 to September 2004 were studied. Patient age, gender, involved side, injury mechanism, clinical and radiographic records, treatment, complications, and outcomes were reviewed. RESULTS: Eight patients injured the right side, 3 the left side, and one both sides. They all engaged in sports or active play during the injury. Two fractures were type IA, one type IB, 2 type IIB, 5 type IIIA, 2 type IIIB, and one type IV. Three patients with type-I fractures and one with a type-IIB fracture were treated with closed reduction and cast immobilisation for 3 to 4 (mean, 3.8) weeks. The remaining 9 fractures were treated with open reduction and internal fixation. The mean follow-up period was 39 (range, 23-59) months. No complications were noted. Ten patients had excellent results and 2 had fair results. CONCLUSION: Closed reduction and cast immobilisation for minimally displaced fractures, and open reduction and internal fixation for displaced fractures resulted in favourable outcomes.
Tibial Fractures/epidemiology , Tibial Fractures/therapy , Adolescent , Child , Cohort Studies , Epiphyses/injuries , Female , Fracture Healing , Humans , Male , Recovery of Function , Retrospective Studies , Risk Factors , Tibial Fractures/diagnosis , Treatment Outcome
PURPOSE: To evaluate treatment results of intramedullary fixation using multiple Kirschner wires for diaphyseal forearm fractures. METHODS: Between January 2001 and January 2004, 184 patients (122 men and 62 women) with 288 displaced diaphyseal forearm fractures underwent intramedullary fixation using multiple Kirschner wires. The wires were inserted by opening the fracture site because radiographic facility for closed pinning was unavailable. The time to union, functional recovery, and the complication rates were assessed. RESULTS: 11 patients were lost to follow-up, leaving 173 whose data was analysed. In 167 (97%) of the patients the fractures united, and in 14 (8%) of them union was delayed. The mean time to union for closed fractures was 13 (range, 7-16) weeks and for open fractures it was 15 (range, 12-22) weeks. The mean time in cast was 6 (range, 3-14) weeks. In all, 34/173 (20%) had complications: superficial infection (n=13), deep infection (n=4), cross-union between bones (n=4), open fracture 'needing' a skin graft (n=2), radial nerve palsy (n=3), paraesthesia (n=1), and non-union (n=7). Among the 173 analysed patients, the infection rate was 10% and the non-union rate was 4%. 130 (75%) of the patients had the wires removed; no re-fracture occurred after wire removal. Based on the Anderson criteria, 47 (27%) of the patients attained excellent, 78 (45%) satisfactory, and 39 (23%) unsatisfactory results. In 9 (5%) of the patients, union failed (7 plain non-union and 2 due to chronic osteomyelitis). CONCLUSION: Kirschner wires are much cheaper than plates and screws, and require minimal expertise for insertion and removal. They remain acceptable for stabilising displaced diaphyseal forearm fractures in developing countries.
Bone Wires , Fracture Fixation, Intramedullary/methods , Radius Fractures/surgery , Ulna Fractures/surgery , Adolescent , Adult , Aged , Developing Countries , Female , Humans , Male , Middle Aged , Radiography , Radius Fractures/diagnostic imaging , Togo , Treatment Outcome , Ulna Fractures/diagnostic imaging
OBJECTIVE: The aim of this study was to analyse the current practice of postoperative venous thromboembolism (VTE) prophylaxis among anaesthetists, nurse anaesthetist and general surgeons in Togo. METHOD: A total of 160 questionnaires were distributed to anaesthetists and surgeons with varying subspeciality interests. RESULTS: One hundred and three (64%) (3 anaesthetists, 51 nurse anaesthetists and 49 surgeons) returned the questionnaire. Of these, 16% thought that VTE was as common in Togo as in the western countries. Selective VTE prophylaxis was used by 78% of the prescriptors. In order of frequency, indications for selective VTE prophylaxis were obesity, increased risk of VTE related to surgery and past medical history of VTE. Orthopaedic surgery, caesarean section and vascular surgery were most frequently considered as high-risk surgery for VTE event. When prophylaxis was indicated, low molecular weight heparin was prescribed by 87% of prescriptors. In most cases, VTE prophylaxis duration was less than a week. In 92% of institutions, there was no written protocol for VTE prophylaxis. VTE-related morbidity was reported by 34% of the prescriptors over the past year, and 30% of these cases were fatal; 60% of the prescriptors observed these complications one week after the surgery. CONCLUSION: The practice of VTE prophylaxis in Togo is not sufficient. It is necessary to promote the training of practitioners, particularly of physicians.
Anesthesiology , Data Collection , Thoracic Surgery , Thromboembolism/prevention & control , Thromboembolism/surgery , Developing Countries , Humans , Togo
PURPOSE OF THE STUDY: Many methods have been proposed for treatment of displaced humeral shaft fractures in adults. This study was designed to evaluate the anatomical and functional results of patients treated by retrograde intramedullary nailing through the lateral condyle. MATERIALS AND METHODS: Sixty-three fresh traumatic fractures of the humerus were treated between January 2000 and January 2003. Five patients were lost to follow-up. The AO classification and the Hackethal classification modified by De La Caffinière were used. Outcome was assessed according to the modified Stewart and Hundey classification. RESULTS: We had 23 very good results, 26 good results, five passable results and four bad results. The bad results were three cases of non-union and one case with poor function (stiffness of elbow and shoulder). Mean delay to union was ten weeks four days. There were no cases of iatrogenic radial nerve palsy or pin migration. CONCLUSION: Retrograde intramedullary nailing is a reliable method, easy to perform and of low economic cost. We propose it for all types of displaced shaft humeral fractures.
Fracture Fixation, Intramedullary/methods , Humeral Fractures/surgery , Adolescent , Adult , Aged , Female , Fracture Fixation, Intramedullary/adverse effects , Fracture Healing , Fractures, Ununited/etiology , Humans , Humeral Fractures/classification , Humeral Fractures/physiopathology , Male , Middle Aged , Prospective Studies , Range of Motion, Articular/physiology , Treatment Outcome
In 1976, Popovich et al. described a technique of peritoneal dialysis using bottled dialysate. Later Oreopoulos et al. modified the technique by using plastic bags. But peritonitis still is a major and potentially serious complication of peritoneal dialysis. We have evaluated a) microbiologic diagnostic methods for infectious peritonitis, b) incidence of etiologic agents, and c) the evolution during antimicrobial treatment. Eighteen patients with chronic renal failure of diverse causes were followed from initiation of the CAPD program since January 1981 until June 1988. There were 80 episodes of infectious peritonitis during 17 patient-years of dialysis with an overall incidence of peritonitis of 4.7 episodes/patient-year. The total volume centrifuged technique and culture of sediment showed a sensibility of 85% in 73 episodes where cultures were obtained. The 59.1% of episodes of peritonitis were caused by gram negative bacilli; 11.6% were due to Acinetobacter calcoaceticus and Gram positive cocci accounted for 37.3%. These results are different from those found in other countries because most of our patients had received antimicrobial agents which probably changed their body flora, some did not have manual ability, others were of bad hygienic habits and finally, all of them had frequent contact with hospital environment. The species most frequently isolated were coagulase negative staphylococci (12.8%), probably from patients' skin flora. (ABSTRACT TRUNCATED AT 250 WORDS)
Kidney Failure, Chronic/therapy , Peritoneal Dialysis, Continuous Ambulatory/adverse effects , Peritonitis/etiology , Adult , Aged , Cephalothin/therapeutic use , Drug Resistance, Microbial , Female , Gentamicins/therapeutic use , Humans , Male , Microbiological Techniques , Middle Aged , Peritonitis/drug therapy , Retrospective Studies
In 1976, Popovich et al. described a technique of peritoneal dialysis using bottled dialysate. Later Oreopoulos et al. modified the technique by using plastic bags. But peritonitis still is a major and potentially serious complication of peritoneal dialysis. We have evaluated a) microbiologic diagnostic methods for infectious peritonitis, b) incidence of etiologic agents, and c) the evolution during antimicrobial treatment. Eighteen patients with chronic renal failure of diverse causes were followed from initiation of the CAPD program since January 1981 until June 1988. There were 80 episodes of infectious peritonitis during 17 patient-years of dialysis with an overall incidence of peritonitis of 4.7 episodes/patient-year. The total volume centrifuged technique and culture of sediment showed a sensibility of 85
in 73 episodes where cultures were obtained. The 59.1
of episodes of peritonitis were caused by gram negative bacilli; 11.6
were due to Acinetobacter calcoaceticus and Gram positive cocci accounted for 37.3
. These results are different from those found in other countries because most of our patients had received antimicrobial agents which probably changed their body flora, some did not have manual ability, others were of bad hygienic habits and finally, all of them had frequent contact with hospital environment. The species most frequently isolated were coagulase negative staphylococci (12.8
), probably from patients skin flora. (ABSTRACT TRUNCATED AT 250 WORDS)
A 50 year old woman while undergoing severe treatment for rheumatoid arthritis, developed anaerobic meningitis. The cerebrospinal fluid (CSF) sample was transported and cultivated aerobically and anaerobically. After 48 h at 37 degrees C the anaerobically incubated plate, the enriched fluid thioglycollate medium and the anaerobic culture medium yielded luxuriant growth of an anaerobic Gram negative bacillum. The biochemical and antimicrobial susceptibility patterns were consistent with those for Bacteroides distasonis. Most of the strains of the 5 species included in the Bacteroides fragilis group (B. fragilis, B. vulgatus, B. ovatus, B. thetaiotaomicron and B. distasonis) are resistant to penicillins, cephalosporins of first generation and aminoglycosides. Anaerobic polyresistant flora from an intraabdominal focus (chronic cholecystitis) might have been selected by treatment with gentamicin and cephalotin, and proliferated into meningeal dissemination. It is important that CSF from immunocompromised patients with acute or chronic pulmonary, intraabdominal or cranium-facial infectious processes be transported and cultured in aerobic and anaerobic conditions. These patients must be treated with an initial therapeutic scheme that includes an effective antibiotic for the anaerobic microorganism that may be involved.
Bacteroides Infections/complications , Meningitis/etiology , Bacteroides/drug effects , Bacteroides/isolation & purification , Bacteroides Infections/cerebrospinal fluid , Drug Resistance, Microbial , Female , Humans , Meningitis/cerebrospinal fluid , Microbial Sensitivity Tests , Middle Aged
A 50 year old woman while undergoing severe treatment for rheumatoid arthritis, developed anaerobic meningitis. The cerebrospinal fluid (CSF) sample was transported and cultivated aerobically and anaerobically. After 48 h at 37 degrees C the anaerobically incubated plate, the enriched fluid thioglycollate medium and the anaerobic culture medium yielded luxuriant growth of an anaerobic Gram negative bacillum. The biochemical and antimicrobial susceptibility patterns were consistent with those for Bacteroides distasonis. Most of the strains of the 5 species included in the Bacteroides fragilis group (B. fragilis, B. vulgatus, B. ovatus, B. thetaiotaomicron and B. distasonis) are resistant to penicillins, cephalosporins of first generation and aminoglycosides. Anaerobic polyresistant flora from an intraabdominal focus (chronic cholecystitis) might have been selected by treatment with gentamicin and cephalotin, and proliferated into meningeal dissemination. It is important that CSF from immunocompromised patients with acute or chronic pulmonary, intraabdominal or cranium-facial infectious processes be transported and cultured in aerobic and anaerobic conditions. These patients must be treated with an initial therapeutic scheme that includes an effective antibiotic for the anaerobic microorganism that may be involved.
