Infections associated with dental procedures in total hip arthroplasty.
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Dental procedures may lead to a transient bacteraemia lasting for up to 30 minutes. Of the numerous cases of total hip arthroplasty (THA) reported which have been infected from haematogenous sources, dental procedures have been involved only infrequently. We reviewed the records of 2973 patients after THA. Of the late infections identified in 52 patients, three (6%) were strongly associated with a dental procedure. Infection was diagnosed by culture from the affected joint; Streptococcus viridans was identified in two cases and Peptostreptococcus in one. One patient had diabetes mellitus and another rheumatoid arthritis, both conditions predisposing to infection. The dental operations all lasted for more than 45 minutes and no patient received perioperative antibiotics. Infection of a THA after dental procedures is more common than has been previously suspected. Patients with systemic disease, or who are undergoing extensive procedures, should be considered for prophylactic antibiotic treatment. (+info)
Superficial femoral eversion endarterectomy combined with a vein segment as a composite artery-vein bypass graft for infrainguinal arterial reconstruction.
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OBJECTIVE: The purpose of this study was to determine the results of composite artery-vein bypass grafting for infrainguinal arterial reconstruction. METHODS: This study was designed as a retrospective case series in two tertiary referral centers. Forty-eight of 51 patients underwent the procedure of interest for the treatment of ischemic skin lesions (n = 42), rest pain (n = 3), disabling claudication (n = 1), and infected prosthesis (n = 2). The intervention used was infrainguinal composite artery-vein bypass grafting to popliteal (n = 18) and infrapopliteal (n = 30) arteries, with an occluded segment of the superficial femoral artery prepared with eversion endarterectomy and an autogenous vein conduit harvested from greater saphenous veins (n = 43), arm veins (n = 3), and lesser saphenous veins (n = 2). The main outcome measures, primary graft patency rates, foot salvage rates, and patient survival rates, were described by means of the life-table method for a mean follow-up time of 15.5 months. RESULTS: The cumulative loss during the follow-up period was 6% and 24% at 6 and 12 months, respectively. The primary graft patency rates, the foot salvage rates, and the patient survival rates for patients with popliteal grafts were 60.0% +/- 9.07%, 75.7% +/- 9.18%, and 93.5% +/- 6.03%, respectively, at 1 month; 53.7% +/- 11.85%, 68.9% +/- 12.47%, and 85. 0% +/- 9.92% at 1 year; and 46.7% +/- 18.19%, 68.9% +/- 20.54%, and 53.1% +/- 17.15% at 5 years. For infrapopliteal grafts, the corresponding estimates were 72.4% +/- 7.06%, 72.9% +/- 6.99%, and 92.7% +/- 4.79% at 1 month; 55.6% +/- 10.70%, 55.4% +/- 10.07%, and 77.9% +/- 9.02% at 1 year; and 33.6% +/- 22.36%, 55.4% +/- 30.20%, and 20.8% +/- 9.89% at 5 years. CONCLUSION: The composite artery-vein bypass graft is a useful autogenous alternative for infrainguinal arterial reconstruction when a vein of the required quality is not available or when the procedure needs to be confined to the affected limb. (+info)
Infrarenal endoluminal bifurcated stent graft infected with Listeria monocytogenes.
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Prosthetic graft infection as a result of Listeria monocytogenes is an extremely rare event that recently occurred in a 77-year-old man who underwent endoluminal stent grafting for infrarenal abdominal aortic aneurysm. The infected aortic endoluminal prosthesis was removed by means of en bloc resection of the aneurysm and contained endograft with in situ aortoiliac reconstruction. At the 10-month follow-up examination, the patient was well and had no signs of infection. (+info)
Infected total hip arthroplasty--the value of intraoperative histology.
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Intraoperative histology showed a sensitivity of 100% and a specificity of 98%. These results were better than those observed for the other tests evaluated. Our data provide evidence that intraoperative histology is useful tool in the diagnosis of infected total hip arthroplasty. (+info)
Three ventriculoplasty techniques applied to three left-ventricular pseudoaneurysms in the same patient.
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A 59-year-old male patient underwent surgery for triple-vessel coronary artery disease and left-ventricular aneurysm in 1994. Four months after coronary artery bypass grafting and classical left-ventricular aneurysmectomy (with Teflon felt strips), a left-ventricular pseudoaneurysm developed due to infection, and this was treated surgically with an autologous glutaraldehyde-treated pericardium patch over which an omental pedicle graft was placed. Two months later, under emergent conditions, re-repair was performed with a diaphragmatic pericardial pedicle graft due to pseudoaneurysm reformation and rupture. A 3rd repair was required in a 3rd episode 8 months later. Sternocostal resection enabled implantation of the left pectoralis major muscle into the ventricular defect. Six months after the last surgical intervention, the patient died of cerebral malignancy. Pseudoaneurysm reformation, however, had not been observed. To our knowledge, our case is the 1st reported in the literature in which there have been 3 or more different operative techniques applied to 3 or more distinct episodes of pseudoaneurysm formation secondary to post-aneurysmectomy infection. We propose that pectoral muscle flaps be strongly considered as a material for re-repair of left-ventricular aneurysms. (+info)
Ultrasonic enhancement of antibiotic action on Escherichia coli biofilms: an in vivo model.
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Biofilm infections are a common complication of prosthetic devices in humans. Previous in vitro research has determined that low-frequency ultrasound combined with aminoglycoside antibiotics is an effective method of killing biofilms. We report the development of an in vivo model to determine if ultrasound enhances antibiotic action. Two 24-h-old Escherichia coli (ATCC 10798) biofilms grown on polyethylene disks were implanted subcutaneously on the backs of New Zealand White female rabbits, one on each side of the spine. Low-frequency (28.48-kHz) and low-power-density (100- and 300-mW/cm2) continuous ultrasound treatment was applied for 24 h with and without systemic administration of gentamicin. The disks were then removed, and the number of viable bacteria on each disk was determined. At the low ultrasonic power used in this study, exposure to ultrasound only (no gentamicin) caused no significant difference in bacterial viability. In the presence of antibiotic, there was a significant reduction due to 300-mW/cm2 ultrasound (P = 0.0485) but no significant reduction due to 100-mW/cm2 ultrasound. Tissue damage to the skin was noted at the 300-mW/cm2 treatment level. Further development of this technique has promise in treatment of clinical implant infections. (+info)
Pacemaker lead extraction with the laser sheath: results of the pacing lead extraction with the excimer sheath (PLEXES) trial.
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OBJECTIVES: The purpose of this study was to evaluate the safety and effectiveness of pacemaker lead extraction with the excimer sheath in comparison to nonlaser lead extraction. BACKGROUND: Fibrotic attachments that develop between chronically implanted pacemaker leads and to the venous, valvular and cardiac structures are the major obstacles to safe and consistent lead extraction. Locking stylets and telescoping sheaths produce a technically demanding but effective technique of mechanically disrupting the fibrosis. However, ultraviolet excimer laser light dissolves instead of tearing the tissue attachments. METHODS: A randomized trial of lead extraction was conducted in 301 patients with 465 chronically implanted pacemaker leads. The laser group patients had the leads removed with identical tools as the nonlaser group with the exception that the inner telescoping sheath was replaced with the 12-F excimer laser sheath. Success for both groups was defined as complete lead removal with the randomized therapy without complications. RESULTS: Complete lead removal rate was 94% in the laser group and 64% in the nonlaser group (p = 0.001). Failed nonlaser extraction was completed with the laser tools 88% of the time. The mean time to achieve a successful lead extraction was significantly reduced for patients randomized to the laser tools, 10.1 +/- 11.5 min compared with 12.9 +/- 19.2 min for patients randomized to nonlaser techniques (p < 0.04). Potentially life-threatening complications occurred in none of the nonlaser and three of the laser patients, including one death (p = NS). CONCLUSIONS: Laser-assisted pacemaker lead extraction has significant clinical advantages over extraction without laser tools and is associated with significant risks. (+info)
Emergence of related nontoxigenic Corynebacterium diphtheriae biotype mitis strains in Western Europe.
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We report on 17 isolates of Corynebacterium diphtheriae biotype mitis with related ribotypes from Switzerland, Germany, and France. Isolates came from skin and subcutaneous infections of injecting drug users, homeless persons, prisoners, and elderly orthopedic patients with joint prostheses or primary joint infections. Such isolates had only been observed in Switzerland. (+info)