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2.
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
3.
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
4.
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
5.
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
6.
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
7.
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
8.
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
9.
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
10.
Biomed Res Int ; 2019: 1438793, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30886857

RESUMO

Background: The rate of surgical site infections (SSIs) has decreased in parallel to advances in sterilization techniques. Such infections increase morbidity and hospitalization costs. The use of iodine-impregnated sterile wound drapes (SWDs) is recommended to prevent or reduce the incidence of these infections. However, there is a paucity of data regarding their use in thoracic surgical procedures. The aim of the present study was to evaluate the effectiveness of sterile wound drapes in the prevention of these infections and the effects on hospitalization costs. Methods: Perioperative iodine-impregnated SWDs have been used since January 2015 in the Thoracic Surgery Clinic of our hospital. A retrospective evaluation was made of patients who underwent anatomic pulmonary resection via thoracotomy with SWD in the period January 2015-2017, compared with a control group who underwent the same surgery without SWD in the 2-year period before January 2015. Factors that may have increased the risk of surgical site infection were documented and the occurrence of SSI was recorded from postoperative follow-up data. The cost analysis was performed as an important criterion to investigate the benefits of SWD. Results: Evaluation was made of 654 patients in the study group (n:380) using SWD, the operation time was significantly longer, and perioperative blood transfusion was significantly higher, whereas treatment costs (p=0.0001) and wound culture positivity (p=0.004) were significantly lower and less surgical wound debridement was performed (p=0.002). Conclusion: The findings suggest that the use of sterile wound draping in thoracic surgery procedures reduces surgical site infections and hospitalization costs.


Assuntos
Iodo/administração & dosagem , Campos Cirúrgicos , Infecção da Ferida Cirúrgica/prevenção & controle , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios , Estudos Retrospectivos , Fatores de Risco , Equipamentos Cirúrgicos/normas , Infecção da Ferida Cirúrgica/patologia
11.
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
12.
Surg Infect (Larchmt) ; 20(4): 292-297, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30785859

RESUMO

Background: Intra-cranial infection with Acinetobacter baumannii is a tough problem because of the presence of multi-resistance and poor drug penetration through the blood-brain barrier. Such intra-cranial infections can lead to serious complications and death. We retrospectively analyzed the culture results and clinical characteristics of patients with intra-cranial infections in our hospital and suggested intravenous (IV) meropenem and intra-thecal (IT) amikacin therapy may be effective in the management of A. baumannii infection. Case presentation: We reported four cases of post-neuro-surgical A. baumannii intra-cranial infection whose clinical futures were high fever and consciousness disturbance. Our patients were treated successfully with IV meropenem and IT amikacin. Conclusion: We presented our cases of pandrug-resistant A. baumannii intra-cranial infection that was managed successfully with a systemic provision of IV meropenem and IT amikacin. Therefore, these cases exemplify that systemic administration of IV meropenem and IT amikacin can be a good therapeutic option against A. baumannii intra-cranial infection when colistin is not available.


Assuntos
Infecções por Acinetobacter/tratamento farmacológico , Amicacina/administração & dosagem , Antibacterianos/administração & dosagem , Infecções do Sistema Nervoso Central/tratamento farmacológico , Meropeném/administração & dosagem , Procedimentos Neurocirúrgicos/efeitos adversos , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecções por Acinetobacter/patologia , Acinetobacter baumannii/isolamento & purificação , Administração Intravenosa , Adulto , Idoso , Infecções do Sistema Nervoso Central/patologia , Feminino , Humanos , Injeções Espinhais , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/patologia , Resultado do Tratamento
13.
Wound Repair Regen ; 27(3): 249-256, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30663823

RESUMO

The effect of diabetes on postoperative outcomes following surgical management of pressure ulcers is poorly defined despite evidence showing that patients with diabetes are at increased risk for developing pressure ulcers, as well as postoperative wound complications including delayed healing and infection. This study aimed to examine the impact of diabetes on postoperative outcomes following surgical management of pressure ulcers using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. In this retrospective analysis all CPT codes with ICD-9 diagnoses of pressure ulcers were reviewed. A total of 3,274 patients who underwent surgical management of pressure ulcers were identified, of which 1,040 (31.8%) had diabetes. Overall primary outcomes showed rates of superficial and deep incisional surgical site infection (SSI) were 2.0 and 4.2%, respectively, while the rate of wound dehiscence was 2.1%. Univariate analysis of primary outcomes stratified by diabetes status showed that patients with diabetes had significantly higher rates of superficial incisional SSI (3.9 vs. 2.3%; p = 0.01), deep incisional SSI (7.0 vs. 4.3%; p = 0.001), wound dehiscence (5.2 vs. 2.7%; p < 0.001), as well as significantly higher rates of readmission (12.8 vs. 8.9%; p = 0.001). Multivariate analysis for significant outcomes between groups on univariate analysis demonstrated that diabetes was an independent risk factor for superficial incisional SSI (OR = 2.7; 95% CI: 1.59-4.62; p < 0.001), deep incisional SSI (OR = 1.85; 95% CI: 1.26-2.70; p = 0.002), wound dehiscence (OR = 4.09; 95% CI: 2.49-6.74; p < 0.001), and readmission within 30 days (OR = 1.38; 95% CI: 1.05-1.82; p = 0.02). These findings emphasize the importance of preoperative prevention, and vigilant postoperative wound care and monitoring in patients with diabetes to minimize morbidity and optimize outcomes. Future prospective studies are needed to establish causality between diabetes and these outcomes.


Assuntos
Complicações do Diabetes/cirurgia , Diabetes Mellitus Tipo 1/fisiopatologia , Diabetes Mellitus Tipo 2/fisiopatologia , Lesão por Pressão/patologia , Infecção da Ferida Cirúrgica/patologia , Cicatrização/fisiologia , Adulto , Idoso , Complicações do Diabetes/fisiopatologia , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente , Cuidados Pré-Operatórios/métodos , Lesão por Pressão/etiologia , Lesão por Pressão/cirurgia , Estudos Prospectivos , Fatores de Risco , Infecção da Ferida Cirúrgica/cirurgia
14.
J Int Med Res ; 47(1): 76-83, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30514138

RESUMO

OBJECTIVE: This study aimed to compare the results of the pectoralis major myocutaneous (PMM) flap in primary and salvage head and neck cancer surgery. METHODS: A total of 160 patients were enrolled in this study. The salvage group consisted of 30 patients who received immediate PMM flap surgery following free flap failure. In the primary group, the PMM flap was primarily chosen for 130 patients. Related information was collected and analysed. The University of Washington (UW)-Quality of Life questionnaire, version 4, was mailed to every patient. RESULTS: Partial necrosis was significantly lower in the primary group (n = 13, 10.0%) than in the salvage group (n = 7, 23.3%). Surgical site infection was found in 10 (7.8%) patients in the primary group and in six (20.0%) patients in the salvage group. The mean composite quality of life scores were 66.8 ± 20.5 and 66.2 ± 22.1 in the two groups, respectively. Differences in scores for domains of activity, mood, and anxiety were significant. Disease-specific survival and recurrence-free survival rates were not different between the two groups. CONCLUSION: PMM flap salvage reconstruction has a higher complication rate and poorer functional results, but similar survival prognosis, compared with primary surgery.


Assuntos
Neoplasias de Cabeça e Pescoço/cirurgia , Retalho Miocutâneo/cirurgia , Necrose/diagnóstico , Músculos Peitorais/cirurgia , Qualidade de Vida/psicologia , Infecção da Ferida Cirúrgica/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Neoplasias de Cabeça e Pescoço/mortalidade , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias de Cabeça e Pescoço/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Retalho Miocutâneo/efeitos adversos , Retalho Miocutâneo/transplante , Necrose/etiologia , Necrose/mortalidade , Necrose/patologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Terapia de Salvação/métodos , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/mortalidade , Infecção da Ferida Cirúrgica/patologia , Inquéritos e Questionários , Análise de Sobrevida , Falha de Tratamento
15.
Spine J ; 19(5): 880-887, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30500465

RESUMO

BACKGROUND CONTEXT: Postoperative vertebral osteomyelitis (PVO) after spinal surgery is a clinical challenge. However, there is a paucity of evidence regarding the most likely etiologic organisms to guide the choice of empirical antibiotic therapy, and previous reports of treatment outcomes for PVO are scarce. PURPOSE: To compare the microbiology, clinical characteristics, and outcomes of pyogenic PVO with native vertebral osteomyelitis (NVO). STUDY DESIGN: Retrospective comparative study. PATIENT SAMPLE: Patients with microbiologically proven vertebral osteomyelitis from three university-affiliated hospitals in South Korea between January 2005 and December 2015 with follow-up of at least 12 months after completion of antibiotics or until the patient was transferred. Patients who had a spine operation in the same location within 1 year of diagnosis, and all patients with remnant implants at the time of the vertebral osteomyelitis diagnosis, were defined as having PVO. The remainder of the patients was considered to have NVO. Spinal operations included discectomy, laminectomy, arthrodesis, and instrumentation for stabilization of the spine. OUTCOME MEASURES: Overall mortality, neurologic outcomes, treatment failure, and relapse of infection. METHODS: Demographic data, comorbidities, presenting symptoms, microbiological data, radiographic characteristics, laboratory data (including white blood cell counts, erythrocyte sedimentation rate, and C-reactive protein), surgical treatment, and neurologic outcomes for each patient were reviewed from electronic medical records and analyzed. Mortality rate, treatment failure, and relapse of infection were calculated for the two groups. Factors associated with treatment outcome were evaluated using univariate and multivariate logistic regression analyses. RESULTS: The study evaluated 104 patients with PVO and 441 patients with NVO. In PVO, the most common isolate was Staphylococcus aureus (34%, n=35), followed by coagulase-negative staphylococci (31%, n=32). In NVO, the most common isolates were S. aureus (47%, n=206) and streptococci (21%, n=94). Of the staphylococci, the proportion of methicillin-resistant strains was significantly higher in PVO than that in NVO (75% vs. 39%, p<.001). The proportion of patients with gram-negative bacilli was 14% in PVO and 20% in NVO. Pre-existing or synchronous nonspinal infection was observed more frequently in NVO than in PVO (33% vs. 13%, p<.001). Although the duration of antibiotic use was similar in both groups, surgery for infection control was performed more frequently in PVO. The mortality rate was similar in both groups. However, the treatment failure and relapse rates at 12 months were higher in the PVO group (23% vs. 13%, p=.009; 14% vs. 7%, p=.028, respectively). Methicillin-resistant S.aureus was significantly associated with treatment failure or relapse via logistic regression (odds ratio 3.01, 95% confidence interval [1.71-5.32], p<.001; odds ratio 2.78, 95% confidence interval [1.40-5.49], p=.003). CONCLUSIONS: Coverage of methicillin-resistant staphylococci should be considered when prescribing empirical antibiotics for PVO. Although surgery was performed more often in PVO than NVO, the treatment failure and relapse rates at 12 months were higher in PVO.


Assuntos
Procedimentos Neurocirúrgicos/efeitos adversos , Osteomielite/patologia , Coluna Vertebral/cirurgia , Infecções Estafilocócicas/patologia , Infecção da Ferida Cirúrgica/patologia , Adulto , Idoso , Antibacterianos/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteomielite/tratamento farmacológico , Osteomielite/etiologia , Osteomielite/microbiologia , Coluna Vertebral/microbiologia , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/patogenicidade , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/microbiologia
17.
Wound Repair Regen ; 27(2): 190-195, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30548524

RESUMO

Surgical site infections represent one of the most common surgical complications. Negative pressure wound therapy is considered an effective wound management system, based on the principle that a negative pressure inside the wound can suction fluids and approximate wound edges. With the negative pressure wound therapy systems commercially available it is assumed that the pressure inside the wound is stable at the set values. We conducted a prospective experimental study to investigate this. The negative pressure level achieved inside the dressing was investigated at a standard distance from the pad of suction and at specific times in patients with surgical site infections. Pressure measurements were performed in 28 dressings in 14 patients admitted to the Emergency Surgery Department between April 2016 and June 2017. In general, the machine was set at a pressure of -100 mmHg. Negative pressure was measured with a portable pressure reader in the dressing sponge at a distance of 0, 1.5, and 3 cm from the suction pad at the time of dressing change at 24 and 48 hours. The data suggest that there is a significant decrease in negative pressure at both 1.5 and 3 cm from the suction pad at 48 hours from the dressing change (p = 0.0001 and p < 0.0001, respectively). This preliminary study shows with statistical significance that the pressure inside the sponge of a negative pressure wound therapy system decreases after 48 hours, confirming that the pressure inside the system is not the same as the pressure reported by the machine and, instead of being stable, changes overtime.


Assuntos
Tratamento de Ferimentos com Pressão Negativa , Pressão , Infecção da Ferida Cirúrgica/patologia , Infecção da Ferida Cirúrgica/terapia , Ferimentos e Lesões/patologia , Ferimentos e Lesões/terapia , Exsudatos e Transudatos/metabolismo , Humanos , Tratamento de Ferimentos com Pressão Negativa/instrumentação , Estresse Mecânico , Sucção , Propriedades de Superfície , Tampões de Gaze Cirúrgicos , Infecção da Ferida Cirúrgica/metabolismo , Cicatrização
18.
Eur J Trauma Emerg Surg ; 45(2): 207-212, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29340736

RESUMO

PURPOSE: Periprosthetic joint infections (PJI) after hemiarthroplasty for geriatric femoral neck fractures are a devastating complication that results in serious morbidity and increased mortality. Identifying risk factors associated with early infection after HA for hip fractures may offer an opportunity to address and prevent this complication in many patients. The aim of this study was to evaluate preoperative risk factors for early PJI after HA in hip fracture patients. METHODS: From January 2010 to December 2015, 312 femoral neck fractures (AO/OTA 31-B) in 305 patients were included in this single-center, retrospective study. PJI was defined according to the Centers for Disease Control (CDC) definition of deep incisional surgical site infection. Early infection referred to a postoperative period of 4 weeks. Binary univariable and multivariable regression analysis with backward elimination was applied to identify predictors of PJI. RESULTS: Median age of all patients was 83.0 (IQR 76-89) years. We identified 16 (5.1%) early PJI which all required surgical revision. Median length of in-hospital stay (LOS) was 20.0 (IQR 10-36) days after PJI compared to 10.0 (8-15) days without deep wound infection. In-hospital mortality was 30.8 vs. 6.6%, respectively. Preoperative CRP levels (OR 1.009; 95% CI 1.002-1.018; p = 0.044), higher BMI (OR 1.092; 95% CI 1.002-1.189; p = 0.044) and prolonged surgery time (OR 1.013; 95% CI 1.000-1.025; p = 0.041) were independent risk factors for PJI. Excluding infection following major revision due to mechanical complications identified preoperative CRP levels (OR 1.012; 95% CI 1.003-1.021; p = 0.007) and chronic glucocorticoid therapy (OR 6.314; 95% CI 1.223-32.587; p = 0.028) as risk factors, a clear trend was seen for higher BMI (OR 1.114; 95% CI 1.000-1.242; p = 0.051). A cut-off value at CRP levels ≥ 14 mg/l demonstrated a sensitivity of 69% and a specificity of 70% with a fair accuracy (AUC 0.707). CONCLUSION: Preoperative serum CRP levels, higher BMI and prolonged surgery time are independent predictors of early PJI. Excluding PJI secondary to major revision surgery revealed chronic glucocorticoid use as a risk factor apart from preoperative CRP levels.


Assuntos
Antibacterianos/uso terapêutico , Fraturas do Colo Femoral/cirurgia , Hemiartroplastia/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Infecção da Ferida Cirúrgica/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Feminino , Hemiartroplastia/efeitos adversos , Mortalidade Hospitalar , Humanos , Masculino , Razão de Chances , Estudos Retrospectivos , Fatores de Risco , Infecção da Ferida Cirúrgica/patologia , Resultado do Tratamento
19.
Mycopathologia ; 184(1): 107-113, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29948438

RESUMO

This report describes a case of invasive Exophiala dermatitidis infection after double lung transplantation in a 76-year-old man. After thoracotomy, the patient's wound showed dehiscence with purulent secretion. The black yeast was isolated from cultures taken from the wound, and species identification was confirmed by sequence analysis of the internal transcribed spacer (ITS-S2) region. The results of the susceptibility testing showed voriconazole as the most active drug. Despite adaptation of the antifungal therapy the clinical condition worsened, and the patient died. In addition, we evaluated the fungicidal activity of antiseptics towards E. dermatitidis and aimed to provide a brief literature review of previously reported infections caused by this rare fungus. To the best of our knowledge, this is the first report of a rapidly progressing invasive fungal infection with E. dermatitidis originating from a colonized wound after lung transplantation.


Assuntos
Exophiala/isolamento & purificação , Hospedeiro Imunocomprometido , Infecções Fúngicas Invasivas/diagnóstico , Transplante de Pulmão , Feoifomicose/diagnóstico , Infecção da Ferida Cirúrgica/diagnóstico , Idoso , Antifúngicos/administração & dosagem , Antifúngicos/farmacologia , DNA Fúngico/química , DNA Fúngico/genética , DNA Espaçador Ribossômico/química , DNA Espaçador Ribossômico/genética , Exophiala/classificação , Exophiala/efeitos dos fármacos , Exophiala/genética , Evolução Fatal , Humanos , Infecções Fúngicas Invasivas/microbiologia , Infecções Fúngicas Invasivas/patologia , Masculino , Testes de Sensibilidade Microbiana , Feoifomicose/microbiologia , Feoifomicose/patologia , Análise de Sequência de DNA , Infecção da Ferida Cirúrgica/microbiologia , Infecção da Ferida Cirúrgica/patologia , Voriconazol/administração & dosagem , Voriconazol/farmacologia
20.
J Orthop Surg Res ; 13(1): 321, 2018 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-30558614

RESUMO

BACKGROUND: Wound infections after posterior spinal surgery are a troublesome complication; patients are occasionally forced to remove the internal fixation device, which can lead to instability of the spine and injury to the spinal cord. The purpose of this study was to evaluate the efficacy of modified vacuum-assisted closure (VAC) for treating an early postoperative spinal wound infection. METHODS: We conducted a retrospective study of 18 patients with wound infections after posterior spinal surgery from 2014 to 2017 at a single tertiary center. All patients included in the study received modified VAC treatment (VAC combined with a closed suction irrigation system, CSIS) until the wound satisfied the secondary closure conditions. Detailed information was obtained from the medical records. RESULTS: Wound size decreased significantly after 1 week of the modified VAC treatment. Three patients were treated with VAC three times and one patient received the VAC treatment four times; the remaining patients received the VAC treatment twice. The patients had excellent wound beds after an average of 8 days. The wound healed completely after an average of 17 days, and the average hospital stay was 33 days. There was no recurrence of infection at the 1-year follow-up. CONCLUSIONS: This study demonstrates that VAC combined with a CSIS is a safe, reliable, and effective method to treat a wound infection after spinal surgery. This improved VAC procedure provides an excellent wound bed to facilitate wound healing and shorten the hospital stay.


Assuntos
Infecções Bacterianas/terapia , Tratamento de Ferimentos com Pressão Negativa/métodos , Fusão Vertebral , Infecção da Ferida Cirúrgica/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções Bacterianas/patologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sucção/métodos , Infecção da Ferida Cirúrgica/patologia , Irrigação Terapêutica/métodos , Resultado do Tratamento
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