Infected aortic bifurcation grafts: experience with fourteen patients

The experience with 14 patients with infected aortic bifurcation grafts has been reviewed. Factors which appeared to predispose to infection in 11 patients included "re-do" operations, concomitant cholecystectomy or gastrostomy, and ruptured abdominal aneurysm. A mixture of gastrointestinal organisms was responsible for the infections. The pathogenesis, presentation, and treatment varied according to whether the proximal or distal anastomosis was involved or not. Aortoduodenal communications were present in five patients; they presented with gastrointestinal bleeding or septicemia. One patient survived as a result of early, aggressive surgical therapy. Infection presented at the distal anastomosis in nine patients, either as groin abscess or false aneurysm. Conservative therapy failed in the majority of patients but apparently was successful in three of five patients in whom infection did not involve the intra-abdominal portion of the graft. When infection does involve the intra-abdominal portion of the graft, then the graft must be excised also. Revascularization often can be accomplished with extra-anatomic bypasses of prosthesis or autogenous material, depending on the characteristics of the individual patient. Regardless of the mode of presentation or the site of infection, the early institution of judicious surgical management offers the best chance of success in these patients, and temporization usually leads to failure.

Diagnostic and therapeutic vitrectomy for endophthalmitis

The introduction of a compact portable vitreous suction cutter enables the aspiration and resection of infected ocular tissues for diagnostic and therapeutic purposes. Four cases of postoperative bacterial endophthalmitis are presented in which mechanical anterior vitrectomy was performed in addition to conventional antimicrobial therapy. Three of these eyes were saved and 2 retained the possibility of useful vision. A rationale for the aggressive managements of endophthalmitis is presented.

Transient bacteremia associated with barium enema

A group of 175 patients had barium enema. Pour-plate blood cultures were obtained immediately before and after the procedure and 5, 10, 15, and 30 minutes later. Bacteremia was demonstrable in 20 (11.4%) patients. In some, blood cultures were positive for as long as 15 minutes after barium enema; all were negative at 30 minutes. Among the bacteria associated with the 20 episodes of bacteremia were Escherichia coli, Klebsiella, enterococci, Proteus morganii, Bacteroides, and Veillonella. The incidence of bacteremia among patients with ulcerative colitis, regional enteritis, rectal polyps, colonic or rectal carcinoma, nonspecific diarrhea, or other lower intestinal tract disorders was not much different from patients free of rectosigmoid disease. The results of this study suggest that a history of recent barium enema may be important in patients who have endocarditis.

Septic complications following endoscopic retrograde cholangiopancreatography

In four patients, septic complications developed following endoscopic retrograde cholangiopancreatography which required surgical intervention. The pathogenesis involves stasis in the pancreatic or biliary tree, but the source of infection is unclear. Prompt recognition and early surgical intervention should decrease the seriousness of these complications.

[Treatment of inflammatory complications of permanent implanted pacemakers]

The Authors report an experience of 165 patients who underwent to implantation of artificial pacemaker from January 1973 to December 1974 and report 16 cases of infection. They consider many surgical and biologic factors that can have caused uprinsing of infection. The Authors report the therapeutic treatment the patients underwent and conclude that the best treatment is the implantation, to another seat, of new pacemaker.

Neonatal septicemia after circumcision

Two premature infants developed septicemia after an elective circumcision employing a plastic bell apparatus. The causative organisms were Proteus and Staphylococcus aureus , respectively. Both patients responded to proper systemic antibiotic therapy. Physicians are cautioned against circumcising newborn infants who are ill or otherwise at risk.

Mortality of diabetic patients treated surgically for lower limb infection and or gangrene

A retrospective study was made to ascertain the mortality rate among 100 consecutive patients with diabetes mellitus who had undergone lower limb amputations for infection and/or gangrene in the combined medical-orthopedic service of a county hospital. The medical and orthopedic staffs functioned as equal members, and combined decision-making conferences were held regularly. The over-all mortality rate was 9 per cent, a substantial decrease from the 22 to 25 per cent previously reported in similar studies. The mortality rate among patients with below-knee procedures was 1 per cent versus the 7 to 9 per cent reported by others. Close medical-surgical liaison on a service specializing in the care of these often fragile patients with diffuse multisystem disease results in decreased mortality.