RESUMO
In 2015, an outbreak involving a highly virulent zoonotic outbreak strain of Streptococcus agalactiae serotype III, multilocus sequence type 283 occurred in Singapore with increased neurologic complications, septic arthritis, and spinal infections in healthier patients. We report a case of a successful dual kidney transplant from a deceased donor with infective endocarditis and disseminated infection with the same strain of S agalactiae and we review the current literature.
Assuntos
Antibioticoprofilaxia/métodos , Endocardite Bacteriana/prevenção & controle , Transplante de Rim/efeitos adversos , Complicações Pós-Operatórias/prevenção & controle , Infecções Estreptocócicas/prevenção & controle , Streptococcus agalactiae/genética , Idoso , Antibacterianos/uso terapêutico , Surtos de Doenças , Endocardite Bacteriana/microbiologia , Endocardite Bacteriana/transmissão , Feminino , Humanos , Transplante de Rim/métodos , Masculino , Pessoa de Meia-Idade , Tipagem de Sequências Multilocus , Complicações Pós-Operatórias/microbiologia , Sorogrupo , Infecções Estreptocócicas/microbiologia , Infecções Estreptocócicas/transmissão , Doadores de Tecidos , Resultado do TratamentoAssuntos
Ergotamina/efeitos adversos , Infarto/induzido quimicamente , Rim/irrigação sanguínea , Vasoconstritores/efeitos adversos , Ergotamina/uso terapêutico , Humanos , Infarto/diagnóstico por imagem , Rim/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/tratamento farmacológico , Medicamentos sem Prescrição/efeitos adversos , Medicamentos sem Prescrição/uso terapêutico , Tomografia Computadorizada por Raios X , Vasoconstritores/uso terapêuticoRESUMO
OBJECTIVES: Autogenous arteriovenous (AV) accesses are the preferred choice for the delivery of haemodialysis (HD). With an increase in the prevalence of end-stage renal disease and in the life expectancy of these patients, the quality and availability of superficial vessels can be limited and reduced with time. The use of prosthetic AV accesses may therefore become necessary for the delivery of HD. A new early cannulation vascular prosthesis (GORE® ACUSEAL Vascular Graft) has been introduced, developed to hinder suture line and cannulation needle bleeding. The authors report their experience with this new conduit at a London teaching hospital. METHODS: Between May 2011 and June 2013, 52 patients underwent 55 procedures where the ACUSEAL® prosthetic AV access was utilized to facilitate HD. The majority of procedures involved the placement of prosthetic brachio-axillary accesses or prosthetic axillo-axillary chest accesses. RESULTS: The 1-year primary and secondary patency was found to be 46% and 61%, respectively. Successful cannulation of the newly placed AV access was performed with 24 hours of surgery in 40 patients (73%). Tunnelled vascular catheters were required in only 10 (18%) patients. Six (11%) of the patients in the study suffered early complications, and 9 (16%) patients developed AV access infection. CONCLUSIONS: These results show that, while providing patency results that compare favourably to those published for other types of regular prosthetic accesses, the conduits are amenable to very early cannulation with few cannulation-related complications. This leads to a dramatic reduction in the need for temporary or tunnelled catheters.
