Temporary cosmetic painted prostheses in anophthalmic surgery: an alternative to early postoperative clear conformers.

PURPOSE: To evaluate the use and safety of temporary, cosmetic, painted prostheses as an alternative to clear conformers immediately post removal of eye or socket surgery in children and adults. PATIENTS AND METHODS: A 2-year, two-centre, retrospective audit of 54 patients undergoing enucleation, evisceration, secondary implant or socket reconstruction receiving a temporary painted prosthesis as an alternative to clear conformers immediately post surgery. Patient questionnaire and review of clinical notes was conducted for all patients. RESULTS: We reviewed 54 consecutive patients (22 females, 32 males, mean age 18.6 years, range 6 days to 82 years) who received cosmetic painted prostheses from January 2009 to December 2010. Procedures included: evisceration with primary implant (5), enucleation with primary implant (37), secondary implant (9), dermis fat graft (2) and fornix reconstruction with buccal graft (1). Complications included: pyogenic granuloma (2), mucous discharge (2) and exposure (2). All adults found their prosthesis comfortable, and no problems were reported by the parents of the children included in this study. In all, 46 patients (88% of respondents) returned to normal activities within 2 weeks. The temporary prosthesis fell out at least once in 25% of cases. In all, 90% of respondents expressed a definite preference towards the painted shell over a clear shell. CONCLUSION: Temporary cosmetic painted prostheses placed immediately after removal of the eye or socket surgery are well tolerated and preferred to standard clear shells. Painted prostheses, matched to the contralateral iris are a valuable option in anophthalmic surgery as an alternative to traditional clear conformers.

An outbreak of respiratory disease in horses associated with Mycoplasma felis infection.

Lower respiratory tract disease developed in a group of racehorses in training between two and six years of age. Disease was observed in 22 of 25 horses for which full records were available. Seroconversion to Mycoplasma felis was demonstrated by indirect haemagglutination assay in 19 of 22 paired sera and high titres (> or = 64) were found in convalescent sera from the three remaining horses. Evidence of respiratory viral infection was confined to seroconversions to equine herpesvirus-4 in two of the horses. Tracheal wash samples, taken from four horses with visibly increased tracheal mucopus, contained more than 10(4) colony forming units/ml M felis and high proportions of neutrophils. This is the first description of an outbreak of lower respiratory tract disease in horses in training associated with M felis infection.

Staphylococcus aureus bacteremia in patients with Hickman catheters.

PURPOSE: Determination of outcome and prognostic variables associated with Staphylococcus aureus bacteremia in patients with Hickman catheters. PATIENTS AND METHODS: At the University of Washington Medical Center, 37 patients with Hickman catheters and S. aureus bacteremia were studied by retrospective chart review. Clinical features associated with each episode of infection were determined, and the relationships among clinical features, therapy, and outcomes were explored. RESULTS: Only 18% of all Hickman catheter-associated S. aureus bacteremias and only 10% of those cases with exit site infections were cured without catheter removal. In seven of 41 episodes (17%), death or bacteremic relapse occurred. The best prognosis was found in infections with a low blood culture colony count (less than 1 colony/mL). CONCLUSION: Hickman catheter-associated bacteremia due to S. aureus has a worse prognosis than other Hickman catheter-associated bacteremias. Early catheter removal should be considered except in cases with a remote, noncatheter focus of infection or in infections with no catheter-related physical signs and blood culture colony counts of less than 1/mL.

Endobronchial granulocytic sarcoma causing acute respiratory failure in acute myelogenous leukemia.

Infiltration by leukemic cells may occur in many organs. When localized masses caused by myeloid leukemic infiltration occur, they are called granulocytic sarcomas. Such tumors may be mistaken for primary carcinomas. In this report, we describe a 63-yr-old man with acute myelogenous leukemia who developed progressive atelectasis of the left lower lobe of the lung. Bronchoscopy revealed a fungating endobronchial tumor completely obstructing the left lower lobe bronchus and partially occluding the left upper lobe bronchus. Biopsies from this lesion showed an endobronchial granulocytic sarcoma. Despite chemotherapy, the patient developed progressive hypoxemia and died.