Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 578
Filtrar
1.
BMC Infect Dis ; 21(1): 154, 2021 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-33549044

RESUMO

BACKGROUND: Streptococcal toxic shock syndrome (STSS) is an acute, multisystem and toxin-mediated disease that usually causes shock and multiple organ failure in the early stages of its clinical course. It is associated with a substantial increase in mortality rate. The disease has been associated with invasive group A Streptococcus and is rarely caused by Streptococcus mitis (S. mitis). In healthy adults, S. mitis is closely related to endocarditis but rarely related to STSS. CASE PRESENTATION: We report a case of STSS caused by S. mitis in a healthy 45-year-old woman. She presented with fever 14 h after surgery and with hypotension 24 h later, and she subsequently suffered from septic shock, low albumin, dysfunction of coagulation, acute kidney dysfunction, respiratory alkalosis and metabolic acidosis, acute respiratory distress syndrome and cellulitis of the incision. The diagnosis was obtained through clinical manifestation and blood culture examination. The patient was treated with aggressive fluid resuscitation, adequate antibiotics for a total of 4 weeks, respiratory support, and surgical debridement and drainage of the incision. She was discharged after her vital signs returned to normal and the incision healed on day 40 after surgery. CONCLUSIONS: The diagnosis of STSS is often delayed or missed, which leads to a high mortality rate. It is possible to cure patients if the disease can be identified early and treated with aggressive fluid resuscitation, adequate antibiotics and control of the source of infection. Clinicians should consider the disease in the differential diagnosis of septic shock to prevent death.


Assuntos
Choque Séptico/diagnóstico , Infecções Estreptocócicas/diagnóstico , Streptococcus mitis/isolamento & purificação , Antibacterianos/uso terapêutico , Desbridamento , Diagnóstico Diferencial , Drenagem , Feminino , Hidratação , Humanos , Pessoa de Meia-Idade , /patologia , Choque Séptico/patologia , Choque Séptico/terapia , Infecções Estreptocócicas/patologia , Infecções Estreptocócicas/terapia , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/patologia , Infecção da Ferida Cirúrgica/terapia , Resultado do Tratamento
2.
J Surg Oncol ; 123(2): 521-531, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33333594

RESUMO

BACKGROUND AND OBJECTIVES: The incidence of soft tissue complications following sarcoma surgery in the upper extremity is reportedly high. Therefore, this study assessed the National Surgical Quality Improvement Program (NSQIP) database to identify independent risk factors, while also reporting the incidence of soft tissue complications in the first 30 days after surgery. METHODS: A total of 620 patients that underwent surgical treatment for upper extremity sarcoma were included from the NSQIP database. Soft tissue complications were defined as surgical site infection, wound dehiscence, or soft-tissue related reoperations. Clinically relevant patient and treatment characteristics were selected and analyzed. RESULTS: The 30-day soft tissue complication rate was 4.7%. In the multivariable analysis, higher body mass index (p = .047) and longer operative times (p = .002) were independently associated with soft tissue complications. CONCLUSIONS: Higher body mass index and longer operative times are risk factors for soft tissue complications following upper extremity sarcoma surgery. The soft-tissue complication rate following resection of upper extremity tumors is low in this national cohort, possibly due to the relatively small tumor size and low prevalence of radiotherapy.


Assuntos
Duração da Cirurgia , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/mortalidade , Sarcoma/mortalidade , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Infecção da Ferida Cirúrgica/mortalidade , Extremidade Superior/patologia , Idoso , Índice de Massa Corporal , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Prognóstico , Sarcoma/patologia , Sarcoma/cirurgia , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/patologia , Taxa de Sobrevida , Extremidade Superior/cirurgia
3.
Trop Doct ; 50(3): 249-251, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32349607

RESUMO

Mucor is an uncommon cause of surgical site infection. We present such a case after intramedullary nailing of the femur and discuss its presentation and management.


Assuntos
Mucor/isolamento & purificação , Mucormicose/microbiologia , Infecção da Ferida Cirúrgica/microbiologia , Adulto , Evolução Fatal , Fraturas do Fêmur/cirurgia , Fêmur/microbiologia , Fêmur/patologia , Fixação Intramedular de Fraturas/efeitos adversos , Humanos , Masculino , Mucormicose/patologia , Infecção da Ferida Cirúrgica/patologia
5.
Am J Physiol Gastrointest Liver Physiol ; 318(1): G1-G9, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31604031

RESUMO

Perforations, anastomotic leak, and subsequent intra-abdominal sepsis are among the most common and feared complications of invasive interventions in the colon and remaining intestinal tract. During physiological healing, tissue protease activity is finely orchestrated to maintain the strength and integrity of the submucosa collagen layer in the wound. We (Shogan, BD et al. Sci Trans Med 7: 286ra68, 2015.) have previously demonstrated in both mice and humans that the commensal microbe Enterococcus faecalis selectively colonizes wounded colonic tissues and disrupts the healing process by amplifying collagenolytic matrix-metalloprotease activity toward excessive degradation. Here, we demonstrate for the first time, to our knowledge, a novel collagenolytic virulence mechanism by which E. faecalis is able to bind and locally activate the human fibrinolytic protease plasminogen (PLG), a protein present in high concentrations in healing colonic tissue. E. faecalis-mediated PLG activation leads to supraphysiological collagen degradation; in this study, we demonstrate this concept both in vitro and in vivo. This pathoadaptive response can be mitigated with the PLG inhibitor tranexamic acid (TXA) in a fashion that prevents clinically significant complications in validated murine models of both E. faecalis- and Pseudomonas aeruginosa-mediated colonic perforation. TXA has a proven clinical safety record and is Food and Drug Administration approved for topical application in invasive procedures, albeit for the prevention of bleeding rather than infection. As such, the novel pharmacological effect described in this study may be translatable to clinical trials for the prevention of infectious complications in colonic healing.NEW & NOTEWORTHY This paper presents a novel mechanism for virulence in a commensal gut microbe that exploits the human fibrinolytic system and its principle protease, plasminogen. This mechanism is targetable by safe and effective nonantibiotic small molecules for the prevention of infectious complications in the healing gut.


Assuntos
Colágeno Tipo IV/metabolismo , Colágeno Tipo I/metabolismo , Colo/microbiologia , Enterococcus faecalis/metabolismo , Fibrinólise , Infecções por Bactérias Gram-Positivas/microbiologia , Plasminogênio/metabolismo , Infecção da Ferida Cirúrgica/microbiologia , Cicatrização , Animais , Antibacterianos/farmacologia , Antifibrinolíticos/farmacologia , Colo/efeitos dos fármacos , Colo/metabolismo , Colo/patologia , Modelos Animais de Doenças , Enterococcus faecalis/efeitos dos fármacos , Enterococcus faecalis/patogenicidade , Fibrinólise/efeitos dos fármacos , Infecções por Bactérias Gram-Positivas/metabolismo , Infecções por Bactérias Gram-Positivas/patologia , Infecções por Bactérias Gram-Positivas/prevenção & controle , Interações Hospedeiro-Patógeno , Humanos , Camundongos Endogâmicos C57BL , Plasminogênio/antagonistas & inibidores , Proteólise , Infecções por Pseudomonas/metabolismo , Infecções por Pseudomonas/microbiologia , Infecções por Pseudomonas/prevenção & controle , Infecção da Ferida Cirúrgica/metabolismo , Infecção da Ferida Cirúrgica/patologia , Infecção da Ferida Cirúrgica/prevenção & controle , Ácido Tranexâmico/farmacologia , Ativador de Plasminogênio Tipo Uroquinase/metabolismo , Virulência , Cicatrização/efeitos dos fármacos
6.
J Bone Joint Surg Am ; 101(19): 1741-1749, 2019 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-31577679

RESUMO

BACKGROUND: Local, intrawound use of antibiotic powder, such as vancomycin and tobramycin, in spinal fusion surgery has become an increasingly common prophylactic measure in an attempt to reduce rates of postsurgical infection. However, the effects of localized antibiotic delivery on fusion remain unclear. The objective of this study was to examine the in vivo effects of intraoperative local delivery of 2 antibiotics commonly used in bone-grafting surgery on spinal fusion outcomes in a rat model. METHODS: Single-level (L4-L5), bilateral posterolateral intertransverse process lumbar fusion surgery was performed on 60 female Lewis rats (6 to 8 weeks of age) using syngeneic iliac crest allograft mixed with clinical bone-graft substitute and varying concentrations of antibiotics (n = 12 each): (1) control without any antibiotics, (2) low-dose vancomycin (14.3 mg/kg), (3) high-dose vancomycin (71.5 mg/kg), (4) low-dose tobramycin (28.6 mg/kg), and (5) high-dose tobramycin (143 mg/kg). Eight weeks postoperatively, fusion was evaluated via micro-computed tomography (µCT), manual palpation, and histological analysis, with blinding to treatment group. In the µCT analysis, fusion-mass volumes were measured for each rat. Each spine specimen (L4-L5) was rated (manual palpation score) on a scale of 2 to 0 (2 = fused, 1 = partially fused, and 0 = non-fused). RESULTS: The mean fusion-mass volume on µCT (mm) was as follows: control, 29.3 ± 6.2; low-dose vancomycin, 26.3 ± 8.9; high-dose vancomycin, 18.8 ± 7.9; low-dose tobramycin, 32.7 ± 9.0; and high-dose tobramycin, 43.8 ± 11.9 (control versus high-dose vancomycin, p < 0.05; and control versus high-dose tobramycin, p < 0.05). The mean manual palpation score for each group was as follows: control, 1.46 ± 0.58; low-dose vancomycin, 0.86 ± 0.87; high-dose vancomycin, 0.68 ± 0.62; low-dose tobramycin, 1.25 ± 0.71; and high-dose tobramycin, 1.32 ± 0.72 (control versus high-dose vancomycin, p < 0.05). The histological analyses demonstrated a similar trend with regard to spinal fusion volume. CONCLUSIONS: Intraoperative local application of vancomycin, particularly at a supraphysiological dosage, may have detrimental effects on fusion-mass formation. No inhibitory effect of tobramycin on fusion-mass formation was observed. CLINICAL RELEVANCE: When spine surgeons decide to use intraoperative intrawound antibiotics in spinal fusion surgery, they should weigh the reduction in surgical site infection against a possible inhibitory effect on fusion.


Assuntos
Antibacterianos/administração & dosagem , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Tobramicina/administração & dosagem , Vancomicina/administração & dosagem , Animais , Relação Dose-Resposta a Droga , Humanos , Vértebras Lombares/diagnóstico por imagem , Osteoblastos/patologia , Palpação/métodos , Pós , Ratos Endogâmicos Lew , Infecção da Ferida Cirúrgica/patologia , Infecção da Ferida Cirúrgica/prevenção & controle , Microtomografia por Raio-X
7.
Curr Med Sci ; 39(5): 778-783, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31612396

RESUMO

Laparoscopic hepatectomy (LH) is a newly developed technique associated with advantages as open surgery, but the study on outcome of liver function recovery was scarce. This preliminary report was aimed to comparatively assess the short-term outcomes between LH and open hepatectomy (OH) for primary hepatocellular carcinoma (PHC). This study retrospectively analyzed the demographic data and short-term outcomes of 81 patients who underwent LH or OH for the primary treatment of PHC between Oct. 2017 and May 2018 at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (China). A total of 81 PHC patients who received major liver resection were enrolled. There were 38 (47%) patients in the LH group and 43 (53%) patients in the OH group. The operative time was significantly longer (373.53±173.38 vs. 225.43±55.08, P<0.01), and hospital stay (17.34±5.93 vs. 21.70±6.89, P=0.003), exhaust time (2.32±0.62 vs. 3.07±0.59, P<0.01) and defecation time (2.92±0.78 vs. 3.63±0.58, P<0.01) were significantly shorter in LH group than in OH group. The recovery of liver function was significantly faster in LH group, including higher serum albumin (P=0.002), higher ratio of albumin/globulin (P=0.029) and lower direct bilirubin (P=0.001) than in OH group. It is suggested that LH can serve as a fast recovery and cheap surgical procedure in the treatment of PHC, which is safe and feasible.


Assuntos
Perda Sanguínea Cirúrgica/estatística & dados numéricos , Carcinoma Hepatocelular/cirurgia , Hepatectomia/métodos , Laparoscopia/métodos , Neoplasias Hepáticas/cirurgia , Adulto , Ascite/diagnóstico , Ascite/etiologia , Ascite/patologia , Bilirrubina/sangue , Carcinoma Hepatocelular/patologia , Feminino , Hepatectomia/instrumentação , Humanos , Laparoscopia/instrumentação , Tempo de Internação/estatística & dados numéricos , Testes de Função Hepática , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Derrame Pleural/diagnóstico , Derrame Pleural/etiologia , Derrame Pleural/patologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/patologia , Estudos Prospectivos , Albumina Sérica/metabolismo , Soroglobulinas/metabolismo , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/patologia , Fatores de Tempo , Resultado do Tratamento
8.
Exp Eye Res ; 189: 107848, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31634477

RESUMO

Prophylaxis represents a keystone to reduce periocular skin and ocular conjunctiva bacterial load before surgical procedures. Despite many prophylactic agents are available the preferred perioperative ocular surface antimicrobial is still unknown. The purpose of this study was to assess the effectiveness of preoperative liposomal ozone dispersion in reducing bacterial colonization from the conjunctival sac and periocular skin in dogs, in comparison with povidone-iodine and fluoroquinolone. Twenty-two owned dogs consisting with 44 eyes in total scheduled for ophthalmic surgical procedure were enrolled for the study and divided in four groups receiving either ozone dispersion or povidone iodine in eyelid and conjunctiva, fluoroquinolone or placebo. A swab was taken before and after the antisepsis protocol evaluating total microbial count, coagulase positive and negative staphylococci. Statistical analysis revealed a significant decrease in colony forming units (CFU) for total microbial count, coagulase positive and negative staphylococci both for liposomal ozone dispersion and povidone iodine. No statistical differences were detected in median CFU for both one-day placebo and fluoroquinolone preoperative prophylactic topical therapy. The results of this preliminary study demonstrate that liposomal ozone-dispersion is as effective as povidone iodine to reduce preoperative bacterial load in ocular surface.


Assuntos
Bactérias/isolamento & purificação , Túnica Conjuntiva/microbiologia , Endoftalmite/prevenção & controle , Infecções Oculares Bacterianas/prevenção & controle , Aparelho Lacrimal/microbiologia , Ozônio/administração & dosagem , Infecção da Ferida Cirúrgica/prevenção & controle , Administração Tópica , Animais , Bactérias/efeitos dos fármacos , Túnica Conjuntiva/patologia , Modelos Animais de Doenças , Cães , Endoftalmite/microbiologia , Endoftalmite/patologia , Infecções Oculares Bacterianas/microbiologia , Infecções Oculares Bacterianas/patologia , Feminino , Aparelho Lacrimal/patologia , Lipossomos , Masculino , Procedimentos Cirúrgicos Oftalmológicos , Oxidantes Fotoquímicos/administração & dosagem , Período Pré-Operatório , Estudos Prospectivos , Infecção da Ferida Cirúrgica/microbiologia , Infecção da Ferida Cirúrgica/patologia
9.
BMJ Case Rep ; 12(9)2019 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-31540924

RESUMO

Exposure of a renal transplant through the abdominal wall is a rare event. A search of the literature reveals only six documented cases which used skin autograft for coverage, with none reported since 1981, and none which used negative-pressure wound therapy (NPWT) to prepare the recipient bed. This case report demonstrates that NPWT followed by split thickness skin graft is a reconstructive option which is feasible in patients who are at high risk for surgical complications in prolonged flap surgery.


Assuntos
Sobrevivência de Enxerto/fisiologia , Transplante de Rim/efeitos adversos , Tratamento de Ferimentos com Pressão Negativa , Complicações Pós-Operatórias/patologia , Infecção da Ferida Cirúrgica/patologia , Cicatrização/fisiologia , Idoso , Desbridamento , Feminino , Humanos , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/terapia , Procedimentos Cirúrgicos Reconstrutivos , Transplante de Pele , Retalhos Cirúrgicos , Infecção da Ferida Cirúrgica/terapia
10.
Injury ; 50 Suppl 3: 40-54, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31378541

RESUMO

BACKGROUND: Treatment of atrophic non-unions and large bone defects or infections remains a challenging task for the treating surgeon. In the herein study, we present our experience of the 'Masquelet technique' according to the 'diamond concept' for the treatment of complex long bone reconstruction procedures. METHODS: Between February 2010 and March 2015, 150 patients (mean age 51.4) with atrophic and- /or infected non-unions were included in this prospective study. All patients received autologous bone graft, a graft expander (TCP (tricalcium phosphate)) and BMP (bone morphogenic protein). Clinical and radiological parameters were assessed at 6 weeks, and at 3, 6 and 12 months. The SF-12 questionnaire was used to evaluate the subjective health of patients. RESULTS: A successful bony consolidation of the non-unions was observed in 120 (80%) cases with a median healing time of 12.1 months. The mean defect gap was 4.4cm. Initial infection was documented in 54 cases. The most frequently identified pathogen was staphylococcus epidermidis and staphylococcus aureus. A successful removal of microorganisms with subsequent healing was achieved in 39 cases (72%). The SF-12 scores of subjective physical and mental health increased from PCS 31.5 preoperatively to 36.7 one year postoperatively, while MCS increased from 45.5 to 48.7. CONCLUSIONS: Our study showed that the Masquelet technique according to the 'diamond concept' is a valid method to treat complex atrophic non-unions with large bone defects and associated infection. Following the principles of the 'diamond concept' (targeted optimization of tissue engineering and bone regeneration) a high rate of success can be expected in these difficult reconstruction cases.


Assuntos
Transplante Ósseo/métodos , Consolidação da Fratura/fisiologia , Fraturas não Consolidadas/cirurgia , Gentamicinas/uso terapêutico , Osteomielite/cirurgia , Infecção da Ferida Cirúrgica/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Feminino , Fêmur/cirurgia , Antebraço/cirurgia , Fraturas não Consolidadas/complicações , Fraturas não Consolidadas/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Osteomielite/tratamento farmacológico , Osteomielite/patologia , Estudos Prospectivos , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/patologia , Tíbia/cirurgia , Resultado do Tratamento , Adulto Jovem
11.
Med Hypotheses ; 132: 109358, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31437669

RESUMO

BACKGROUND: Surgical site infection (SSI) remains a hazardous complication after vascular surgery. In this pilot study we investigated the inguinal microbiome in skin biopsies using histology and 16S-23S rDNA Next Generation Sequencing (NGS). Our hypothesis was that causative microorganisms of SSI are present in the inguinal microbiome. METHODS: Data on surgical site infections and skin samples from the Percutaneous in Endovascular Repair versus Open (PiERO) trail were evaluated. Two patients with SSI were matched for age and comorbidity to eight matching patients of the PiERO trial. All patients were treated for an abdominal aortic aneurysm with endovascular repair. Nasal and perineal cultures were taken preoperatively to detect Staphylococcus aureus carriage. After disinfection with chlorhexidine, groin biopsies were taken to identify bacteria in deeper skin layers. All samples were subjected to histological analysis and culture-free 16S-23S rDNA NGS. RESULTS: Staphylococcus aureus species were cultured in 5 out of 20 preoperative nasal and perineal swaps. Histology detected only a few bacteria. NGS of the 16S-23S rRNA regions identified DNA of bacterial species in all biopsies (20/20). Most identified genera and species proved to be known skin flora bacteria. No relation was found between SSIs and the preoperative microbiome. CONCLUSION: In this pilot study, an innovative analysis of the preoperative microbiome using 16S-23S rDNA NGS did not show a relation with the occurrence of a surgical site infection. No pathogenic bacterial species were present in the inguinal skin after disinfection with chlorhexidine.


Assuntos
Aneurisma da Aorta Abdominal/microbiologia , Aneurisma da Aorta Abdominal/cirurgia , Sequenciamento de Nucleotídeos em Larga Escala , Microbiota/genética , Infecção da Ferida Cirúrgica/microbiologia , Infecção da Ferida Cirúrgica/patologia , Idoso , Antibacterianos/farmacologia , Biópsia , Clorexidina/farmacologia , Comorbidade , Virilha/patologia , Humanos , Masculino , Projetos Piloto , RNA Ribossômico 16S/genética , RNA Ribossômico 23S/genética , Staphylococcus aureus , Infecção da Ferida Cirúrgica/prevenção & controle
12.
Oral Oncol ; 97: 23-30, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31421467

RESUMO

BACKGROUND: It is unclear whether postoperative wound infections after head and neck cancer surgery are associated with cancer progression. METHODS: Patients undergoing surgery for oral cancer from 1998 to 2011 were reviewed. Univariable analyses and multivariable were performed. Propensity scores were used to create matched cohorts for infection and non-infection groups. Neutrophil-to-lymphocyte ratios (NLR) were determined prior to surgery and at the time of infection. RESULTS: Of 551 patients with oral cancer treated with surgery, 98 developed wound infections (18%). Tumor factors associated with wound infections included higher T and N category, extranodal extension, depth of invasion, lymphovascular and perineural invasion (p < 0.02 for all). On univariable analysis, wound infection was a predictor for recurrence free survival (p < 0.001), locoregional control (p = 0.01), and distant control (p < 0.001). Wound infection was not a predictor of overall survival (p = 0.88), recurrence free survival (p = 0.17), locoregional control (p = 0.79) or distant control (p = 0.18) on multivariable analysis. Using a propensity score matched cohort of 83 patients with and without infection, wound infection was not associated with recurrence free survival (p = 0.21), overall survival (p = 0.71), and locoregional control (p = 0.84), although there was a trend towards increased distant metastases (p = 0.10). Patients with wound infection had a greater preoperative NLR as well as a greater rise in the NLR after surgery, but these were not associated with survival or recurrence. CONCLUSIONS: Patients with wound infections have more adverse pathologic features. However, wound infection was not associated with poorer cancer outcomes although a trend towards increased distant metastases should be investigated.


Assuntos
Linfócitos/patologia , Neoplasias Bucais/patologia , Recidiva Local de Neoplasia/patologia , Neutrófilos/patologia , Infecção da Ferida Cirúrgica/patologia , Intervalo Livre de Doença , Feminino , Humanos , Contagem de Linfócitos/métodos , Masculino , Pessoa de Meia-Idade , Boca/patologia , Neoplasias Bucais/cirurgia , Prognóstico , Pontuação de Propensão , Estudos Retrospectivos
13.
ANZ J Surg ; 89(9): 1041-1044, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31368164

RESUMO

BACKGROUND: This study investigates the incidence of post-operative complications and risk factors of sentinel lymph node biopsy (SLNB) in melanoma patients. METHODS: A retrospective cohort study was conducted at a single cancer institution on 408 consecutive SLNBs. RESULTS: Fifty-five post-operative complications occurred in 39 (9.5%) patients and included: wound infection in 24 (5.9%), seroma and lymphorrhea in 15 (3.7%), wound dehiscence in seven (1.7%), lymphocele in six (1.5%) and others in three (0.7%). Univariate analysis failed to identify possible risk factors (i.e. gender, age, lymph node region, number of excised lymph nodes, Breslow index, pT levels, comorbidities, length of surgery and hospital stay). Metastatic sentinel nodes occurred in four of 135 (3%) patients with thin melanoma (Breslow <1 mm) and in 68 of 262 (25.9%) patients with Breslow >1 mm. CONCLUSION: For patients with thin melanoma in whom the incidence of lymph node metastasis is low, the reported post-operative morbidity of almost 10% of SLNB highlights the need for careful patient selection.


Assuntos
Linfonodos/cirurgia , Melanoma/secundário , Complicações Pós-Operatórias/epidemiologia , Biópsia de Linfonodo Sentinela/efeitos adversos , Neoplasias Cutâneas/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Itália/epidemiologia , Excisão de Linfonodo/efeitos adversos , Linfonodos/patologia , Metástase Linfática/patologia , Linfocele/etiologia , Linfocele/patologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/patologia , Estudos Retrospectivos , Fatores de Risco , Seroma/etiologia , Seroma/patologia , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/secundário , Deiscência da Ferida Operatória/etiologia , Deiscência da Ferida Operatória/patologia , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/patologia
14.
Ann Surg Oncol ; 26(12): 3883-3891, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31346895

RESUMO

BACKGROUND: Breast surgery is considered a clean surgery. However, surgical-site infection (SSI) rates are currently higher than predicted. Postoperative drains remain in situ for several days, with inevitable bacterial colonization and increased SSI risk. METHODS: This randomized controlled trial from October 2016 to January 2018 analyzed patients undergoing breast cancer surgery. The patients were randomized to either the standard drain care group or the antiseptic dressing group (3M® Tegaderm® CHG). Drain samples taken on postoperative days (PODs) 7 and 14 were cultured as standardized in the laboratory. Colonization rates and SSI were compared between the two groups. RESULTS: The study enrolled 104 patients with 167 surgical drains. The patients' clinical characteristics were similar in the two groups, with no statistically significant differences. Bulb fluid cultures at postoperative week (POW) 1 were positive for 42.9% of the control group and 28.9% of the antiseptic group (p = 0.06). Cultures from the POW 2 assessment were positive for 79.7% of the control group versus 54.9% of the antiseptic group (p = 0.001). Cultures from drain tubes were positive for 79.8% of the control group and 50.7% of the antiseptic group (p = < 0.001). In 11 patients, an SSI developed, 3 (5.8%) from the intervention and 8 (15.4%) from the control procedure (p = 0.11). CONCLUSION: The study findings demonstrated that the use of antiseptics at the drain exit site significantly reduced bacterial colonization of the closed drainage system in breast cancer surgery. Semi-permeable occlusive chlorhexidine-impregnated dressings provide an opportunity to test simple, safe, and low-cost interventions that may reduce drain bacterial colonization and SSI after breast surgery.


Assuntos
Bandagens/estatística & dados numéricos , Neoplasias da Mama/cirurgia , Clorexidina/uso terapêutico , Drenagem/métodos , Mastectomia/efeitos adversos , Cuidados Pós-Operatórios , Infecção da Ferida Cirúrgica/prevenção & controle , Anti-Infecciosos Locais/uso terapêutico , Neoplasias da Mama/patologia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/patologia
15.
PLoS One ; 14(6): e0217079, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31170179

RESUMO

Post-operative surgical site infections (SSI) present a serious threat and may lead to complications. Currently available dressings for SSI lack mucoadhesion, safety, efficacy and most importantly patient compliance. We aimed to address these concerns by developing a bioactive thiolated chitosan-alginate bandage embedded with zinc oxide nanoparticles (ZnO-NPs) for localized topical treatment of SSI. The FTIR, XRD, DSC and TGA of bandage confirmed the compatibility of ingredients and modifications made. The porosity, swelling index and lysozyme degradation showed good properties for wound healing and biodegradation. Moreover, in-vitro antibacterial activity showed higher bactericidal effect as compared to ZnO-NPs free bandage. In-vivo wound healing in murine model showed significant improved tissue generation and speedy wound healing as compared to positive and negative controls. Over all, thiolated bandage showed potential as an advanced therapeutic agent for treating surgical site infections, meeting the required features of an ideal surgical dressing.


Assuntos
Bandagens , Materiais Biocompatíveis/química , Materiais Biocompatíveis/farmacologia , Nanopartículas/química , Compostos de Sulfidrila/química , Infecção da Ferida Cirúrgica/tratamento farmacológico , Óxido de Zinco/química , Antibacterianos/química , Antibacterianos/metabolismo , Antibacterianos/farmacologia , Materiais Biocompatíveis/metabolismo , Materiais Biocompatíveis/uso terapêutico , Sobrevivência Celular/efeitos dos fármacos , Células HeLa , Humanos , Muramidase/metabolismo , Porosidade , Pele/efeitos dos fármacos , Pele/patologia , Staphylococcus aureus/efeitos dos fármacos , Infecção da Ferida Cirúrgica/patologia , Infecção da Ferida Cirúrgica/fisiopatologia , Cicatrização/efeitos dos fármacos
16.
ANZ J Surg ; 89(5): 557-561, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30968538

RESUMO

BACKGROUND: Knee arthroscopy is a common orthopaedic procedure and often involves insertion of a needle through skin into a joint. This needle insertion can create epithelial tissue cut-outs possibly containing commensal bacteria that can be flushed into the joint, and potentially lead to post-arthroscopy septic arthritis. This study aims to assess the frequency of epithelial tissue cut-out creation on insertion of different needle sizes at different angles to the skin. METHODS: Using an ex-vivo porcine limb tissue model, needles of various gauge (14-23G) were inserted at angles of 90, 60, 45 and 30° to the skin surface. Ten passes were undertaken at each angle. Needle lumen contents were then examined for solid tissue cut-out. RESULTS: Two hundred and eighty needle passes were performed resulting in 70 tissue cut-outs (25%) containing solid material. This was more common amongst lower gauge needles. 8 of the 70 (11.4%) tissue cut-outs contained macroscopic evidence of epithelium. The overall rate of epithelial tissue cut-out was 2.9%. The 23G needle had the lowest rate of tissue cut-out creation, occurring twice out of 40 passes (P = 0.002). Neither of these contained macroscopic epithelial tissue. CONCLUSION: Hypodermic needle insertion through skin into a joint can create epithelial tissue cut-out. Epithelial tissue cut-out occurs more frequently with use of lower gauge needles. This study suggests use of a 23G needle during arthroscopy, inserted either at 60 or 90° to the skin, to reduce epithelial tissue cut-out and any potential contribution to post-arthroscopy septic arthritis.


Assuntos
Artrite Infecciosa/etiologia , Artroscopia/efeitos adversos , Epitélio/patologia , Articulação do Joelho/cirurgia , Agulhas/efeitos adversos , Infecção da Ferida Cirúrgica/etiologia , Animais , Artrite Infecciosa/patologia , Modelos Animais de Doenças , Desenho de Equipamento , Falha de Equipamento , Articulação do Joelho/patologia , Infecção da Ferida Cirúrgica/patologia , Suínos
17.
Toxicol Pathol ; 47(4): 504-514, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30975045

RESUMO

Bacterial infections are a common complication after surgical procedures. Therefore, local delivery of antibiotics has been developed, including the use of biodegradable polymers. A newly developed product for prevention of surgical site infections is a polymer-lipid encapsulation matrix loaded with doxycycline, named D-PLEX100 (D-PLEX). We evaluated the toxicity and safety of D-PLEX using a sternal surgical defect model in rabbits. D-PLEX was tested with three different concentrations of doxycycline in comparison to sham-operated control after administration into the sternal surgical defect and on the ventral side of the sternum in New Zealand White (NZW) rabbits, following 15 months of exposure. No mortality or abnormal clinical findings were attributed to D-PLEX, and clinical pathology assays were normal. Histological examinations revealed no treatment-related adverse findings in any of the examined tissues, including the osseous and surrounding soft tissues. It has been shown that D-PLEX gradually degraded until complete disappearance after 9 months, and mainly during the first 3 months, in parallel to normal bone formation. In addition, the administration of D-PLEX did not affect sternal bone strength. This study adds to the growing data on preclinical safety studies utilizing biodegradable materials and provides information on the expected normal reaction to biodegradable materials in the sternum of NZW rabbits.


Assuntos
Antibacterianos/toxicidade , Doxiciclina/toxicidade , Portadores de Fármacos/química , Esterno/cirurgia , Infecção da Ferida Cirúrgica/tratamento farmacológico , Animais , Antibacterianos/sangue , Antibacterianos/química , Antibacterianos/uso terapêutico , Preparações de Ação Retardada , Relação Dose-Resposta a Droga , Doxiciclina/sangue , Doxiciclina/química , Doxiciclina/uso terapêutico , Feminino , Masculino , Coelhos , Esterno/patologia , Infecção da Ferida Cirúrgica/patologia , Análise de Sobrevida , Resistência à Tração , Toxicocinética
18.
Surg Infect (Larchmt) ; 20(6): 460-464, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30942663

RESUMO

Background: Post-operative central nervous system infection (PCNSI) caused by multi-drug-resistant/extensively drug-resistant (MDR/XDR) Acinetobacter baumannii is a severe complication. This study aimed to analyze the clinical presentation and treatment of this disorder. Patients and Methods: A retrospective study that recruited patients having PCNSI caused by MDR/XDR Acinetobacter baumannii was performed at our institute. The patients' demographic information and clinical data were recorded and analyzed. To analyze treatment, we assigned patients to different groups according to whether they had intraventricular/intrathecal injection of antibiotic agents or cerebrospinal fluid (CSF) drainage therapy. Results: Twenty-four patients were included. The risk factors were classified into two categories: environmental factors (intensive care unit stay, tracheal intubation or tracheotomy, positive culture of MDR/XDR Acinetobacter baumannii from other samples) or infectious approaches (CSF drainage, incision CSF leakage). Cerebrospinal fluid sterilization was achieved in 13 patients (54.2%) and the 30-day mortality was 50%. In the seven patients having intraventricular/intrathecal injection of antibiotic agents, the CSF sterilization rate was 71.4% (5/7) and 30-day mortality was 28.6% (2/7), compared with 47.1% (8/17; p = 0.27) and 58.8% (10/17; p = 0.18) in patients having only intravenous antibiotic agents. In 19 patients having CSF drainage therapy for PCNSI, the CSF sterilization rate was 63.2% (12/19) and 30-day mortality was 42.1% (8/19) compared with 20% (1/5; p = 0.08) and 80% (4/5; p = 0.13) in the remaining patients. Conclusions: The risk factors for PCNSI caused by Acinetobacter baumannii can be classified in two categories: environmental factors or infectious approaches. Both intraventricular/intrathecal injection of antibiotic agents and CSF drainage are helpful for CSF sterilization.


Assuntos
Infecções por Acinetobacter/patologia , Acinetobacter baumannii/efeitos dos fármacos , Antibacterianos/uso terapêutico , Infecções do Sistema Nervoso Central/patologia , Farmacorresistência Bacteriana Múltipla , Procedimentos Neurocirúrgicos/efeitos adversos , Infecção da Ferida Cirúrgica/patologia , Infecções por Acinetobacter/tratamento farmacológico , Infecções por Acinetobacter/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções do Sistema Nervoso Central/tratamento farmacológico , Infecções do Sistema Nervoso Central/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/mortalidade , Análise de Sobrevida , Resultado do Tratamento , Adulto Jovem
19.
Injury ; 50 Suppl 1: S45-S49, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31003703

RESUMO

Pin tract infection in external fixation (ExFix) is a frequent finding which can eventually lead to loosening, osteomyelitis and loss of fixation. Its diagnosis is based on high empiricism and low validity, although it is possible to distinguish between minor and major infection. The first is limited to soft tissues, whereas the latter includes bone involvement. The rate of infection after conversion of external fixation to intramedullary nailing (IMN) is not well known. Unfortunately, papers referring to infection after the conversion of ExFix to intramedullary nailing (IMN) are of evidence level IV or V. It is suggested that conversion of ExFix to IMN should be carried out in a 2 step regimen. The time interval of 2 step regimen is uncertain although some authors have recommended to occur within 9 days. There is no consensus as to which prophylaxis protocol should be applied prior to conversion. In order to throw more light into this important issue, registries capturing important related parameters to the development of infection should be established.


Assuntos
Antibioticoprofilaxia/estatística & dados numéricos , Fixadores Externos/efeitos adversos , Fixação Intramedular de Fraturas , Fraturas Ósseas/cirurgia , Osteomielite/cirurgia , Complicações Pós-Operatórias/microbiologia , Fixadores Externos/microbiologia , Consolidação da Fratura , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/patologia , Humanos , Osteomielite/prevenção & controle , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/cirurgia , Reoperação/estatística & dados numéricos , Infecções dos Tecidos Moles/patologia , Infecções dos Tecidos Moles/prevenção & controle , Infecção da Ferida Cirúrgica/patologia , Infecção da Ferida Cirúrgica/prevenção & controle
20.
Mycopathologia ; 184(2): 283-293, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30903581

RESUMO

The incidence of deep fungal infection due to non-albicans Candida species (especially Candida glabrata) has significantly increased in recent decades. Candida glabrata is an opportunistic pathogen of low virulence which mainly invades the gastrointestinal, genitourinary, and respiratory tracts, but has rarely been reported as complication of articular surgery in the literature. We present a case of knee fungal arthritis caused by C. glabrata after a minimally invasive arthroscopic surgery. In this case, the patient's knee got infected after arthroscopic treatment for a recurrent popliteal cyst, and she was unable to be cured by either debridement or antifungal drugs. Mycological and molecular identification of the necrotic tissues isolate revealed C. glabrata as etiologic agent. We originally planned to conduct a debridement once again, but it was found that the articular cartilage was extensively damaged during the operation. Besides, the magnetic resonance imaging of the affected knee also showed that the infection had invaded the subchondral bone. So we treated this case with a two-stage primary total knee arthroplasty with an antibiotic-laden cement spacer block. After a 10-month follow-up, the patient had completely recovered and has not experienced any recurrence to date. In addition, we review 21 cases of C. glabrata-induced infectious arthritis described to date in the literature.


Assuntos
Artrite Infecciosa/diagnóstico , Artrite Infecciosa/patologia , Candida glabrata/isolamento & purificação , Candidíase/diagnóstico , Candidíase/patologia , Idoso , Idoso de 80 Anos ou mais , Antifúngicos/administração & dosagem , Artrite Infecciosa/microbiologia , Artrite Infecciosa/terapia , Artroscopia/efeitos adversos , Candidíase/microbiologia , Candidíase/terapia , Desbridamento , Feminino , Humanos , Incidência , Articulação do Joelho/microbiologia , Articulação do Joelho/patologia , Masculino , Pessoa de Meia-Idade , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/microbiologia , Infecção da Ferida Cirúrgica/patologia , Infecção da Ferida Cirúrgica/terapia , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...