RESUMO
Stenotrophomonas maltophilia is an aerobic Gram-negative bacillus that usually causes infection in immunocompromised patients. We present the case of an immunocompetent patient with a distal necrosis of the second and third fingers of the right hand caused by S. maltophilia infection. The patient underwent antibiotic therapy with trimethoprim/sulphamethoxazole on the basis of the susceptibility tests and underwent surgical debridement of the necrotic tissues, including of the distal phalanx bone, and further reconstruction with Atasoy flap. Stenotrophomonas maltophilia is emerging as an important cause of skin infection in immunoresponsive patients. Several community-acquired infections have been reported, however, as far as we are aware of, our case represents the first report of a digital wound of intact skin caused by community-acquired S. maltophilia infection in an immunocompetent patient.
Assuntos
Dedos/microbiologia , Dedos/patologia , Infecções por Bactérias Gram-Negativas/diagnóstico , Úlcera Cutânea/diagnóstico , Úlcera Cutânea/microbiologia , Stenotrophomonas maltophilia/isolamento & purificação , Antibacterianos/uso terapêutico , Desbridamento , Infecções por Bactérias Gram-Negativas/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Necrose/diagnóstico , Necrose/microbiologia , Necrose/terapia , Úlcera Cutânea/terapia , Stenotrophomonas maltophilia/efeitos dos fármacos , Resultado do TratamentoRESUMO
The implantable cardioverter defibrillator (ICD) is the treatment of choice for life-threatening arrhythmias. Usually, the device is placed, by a subclavian access, on the upper portion of the pectoralis major muscle. As a result, the visibility of the device and the wide subclavian scar create an important aesthetic deformity, especially in young women, evolving in a relevant psychosocial distress. The authors report their experience with subpectoral ICD implantation. Between January 2001 and December 2011, approximately 30 consecutive female patients underwent submuscular ICD implantation or substitution, performed in collaboration with the cardiology team. No significant complications, except 1 case of wound dehiscence and 2 cases of caudal dislocation of the device, were observed. At 6 and 12 months' follow-up, no significant difference between preoperative and postoperative breast symmetry and volume was noticed. The combined approach aims at reducing the visible signs of the procedure and improving the psychological outcomes.
Assuntos
Arritmias Cardíacas/cirurgia , Desfibriladores Implantáveis/psicologia , Estética , Músculos Peitorais/cirurgia , Adulto , Arritmias Cardíacas/psicologia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Satisfação do Paciente/estatística & dados numéricos , Inquéritos e Questionários , Resultado do TratamentoRESUMO
Basal cell carcinoma of the nipple areola complex in female patients is an extremely rare tumor with a malignant clinical behavior. The Authors present the case of a Basal cell carcinoma of the nipple areola complex in a Caucasian woman, evaluated by clinical and histological findings. Our clinical experience suggests that Basal cell carcinoma of the nipple areola complex has a local aggressive behavior with an higher metastatic potentiality compared to basal cell carcinoma of common sites. However, an accurate tissue sparing excision may be successful in the long term.