Contamination risk of the surgical team through ROBODOC's high-speed cutter.

During cutting of the femoral cavity in the ROBODOC procedure, an aerosol cloud of irrigation fluid, blood, and tissue debris was seen. This cloud potentially is contaminated with bacterial and viral vectors, which is an infection risk for the surgical team. A flat and a ball cutter were tested in four standard situations macroscopically with a colored solution. In a second experiment, the cutter was exposed to a fluid contaminated with Staphylococcus aureus, and bacterial room contamination was detected using standard cultures. The aerosol cloud was seen in a 6 x 3.6-m area. Extension and concentration varied, depending on the irrigation situation. ROBODOC's high-speed cutter produces an aerosol cloud in an area in which all members of the surgical team are affected. Sufficient protection is necessary for everyone in the operating room.

Effects of adequate versus inadequate treatment of cutaneous manifestations of Lyme borreliosis on the incidence of late complications and late serologic status.

Eighty-two patients who were treated at the Department of Dermatology, Innsbruck, Austria, from 1980 to 1987 for cutaneous manifestations of Lyme disease were subjected to a clinical follow-up investigation aimed at detecting dermatologic, neurologic, and internal late complications of borreliosis. Only 54 of these patients had received adequate antibiotic treatment according to current standards. Also, their sera were investigated for the presence of immunoglobulin G (IgG) and IgM Borrelia burgdorferi antibodies by an indirect immunofluorescence assay, three different enzyme-linked immunosorbent assays, and immunoblotting. As a control, the sera of 126 healthy blood donors were investigated with the same assays. Results showed no unambiguous clinical late complications of Lyme borreliosis, even in inadequately treated or untreated patients. Seropositivity varied considerably according to the assay used; the indirect immunofluorescence assay yielded the highest scores. The proportion of seropositive results (immunofluorescence assay) was 59% in patients with erythema chronicum migrans, 69% in those with lymphocytoma cutis, and 100% in those with acrodermatitis chronica atrophicans (overall 63%); in contrast, only 31% of the blood donor control group were found to be seropositive. Seropositivity did not correlate with adequacy of treatment, interval between onset of symptoms and treatment, time span since treatment, age of patients, and presence of antinuclear antibodies. Immunoblot pattern showed high incidence of antibodies against the 29/31-kD (outer surface proteins OspA and OspB) and 55/58-kD antigens in general and against the 41-kD protein (flagellin) in patients with acrodermatitis chronica atrophicans only.