Medical treatment or surgical intervention? A cooperative retrospective study on infective endocarditis. Timing of operation.

Background: People living with human immunodeficiency virus (HIV) (PLWH) form a vulnerable population for the onset of infective endocarditis (IE). We aimed to analyze the epidemiological trend of IE, as well as its microbiological characteristics, in PLWH during the combined antiretroviral therapy era in Spain. Methods: We performed a retrospective study (1997–2014) in PLWH with data obtained from the Spanish Minimum Basic Data Set. We selected 1800 hospital admissions with an IE diagnosis, which corresponded to 1439 patients. Results: We found significant downward trends in the periods 1997–1999 and 2008–2014 in the rate of hospital admissions with an IE diagnosis (from 21.8 to 3.8 events per 10,000 patients/year; p < 0.001), IE incidence (from 18.2 to 2.9 events per 10,000 patients/year; p < 0.001), and IE mortality (from 23.9 to 5.5 deaths per 100,000 patient-years; p < 0.001). The most frequent microorganisms involved were staphylococci (50%; 42.7% Staphylococcus aureus and 7.3% coagulase-negative staphylococci (CoNS)), followed by streptococci (9.3%), Gram-negative bacilli (8.3%), enterococci (3%), and fungus (1.4%). During the study period, we found a downward trend in the rates of CoNS (p < 0.001) and an upward trends in streptococci (p = 0.001), Gram-negative bacilli (p < 0.001), enterococci (p = 0.003), and fungus (p < 0.001) related to IE, mainly in 2008–2014. The rate of community-acquired IE showed a significant upward trend (p = 0.001), while the rate of health care-associated IE showed a significant downward trend (p < 0.001). Conclusions: The rates of hospital admissions, incidence, and mortality related to IE diagnosis in PLWH in Spain decreased from 1997 to 2014, while other changes in clinical characteristics, mode of acquisition, and pathogens occurred over this time.

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ALTERNATIVE TO THE INVERTED “Y” INCISION IN SCOLIOSIS SECONDARY TO MYELOMENINGOCELE

Coluna/Columna ◽

10.1590/s1808-185120191801178888 ◽

2019 ◽

Vol 18 (1) ◽

pp. 14-16

Author(s):

Diego Veiga Bezerra ◽

Luis Eduardo Munhoz da Rocha ◽

Dulce Helena Grimm ◽

Carlos Abreu de Aguiar ◽

Luiz Müller Ávila ◽

...

Keyword(s):

Retrospective Study ◽

Spina Bifida ◽

Postoperative Period ◽

Medical Records ◽

Surgical Intervention ◽

Case Series ◽

Material Failure ◽

Spinal Deformities ◽

Level Of Evidence ◽

Skin Conditions

ABSTRACT Objective: To evaluate the healing of the modified inverted “Y” incision in patients with scoliosis due to myelomeningocele. Methods: Retrospective study through medical records review of patients with myelomeningocele surgically treated with a modified inverted “Y” approach between January 2013 and December 2015. Results: We analyzed the medical records of six patients. Two patients progressed with skin complications in the immediate postoperative period and only one of them required surgical intervention for debridement and suturing. In another patient, it was necessary to perform two surgical reviews due to material failure without skin complications in these interventions. Conclusions: The modified inverted “Y” technique is a great alternative to traditional incision and inverted “Y” because it has good results in patients with spina bifida associated with poor skin conditions treated surgically for correction of spinal deformities. Level of Evidence IV; Case series.

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Corynebacterium Diphtheriae Endocarditis - Surgery for Some but Not All!

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849230501300205 ◽

2005 ◽

Vol 13 (2) ◽

pp. 119-126 ◽

Cited By ~ 17

Author(s):

Bashisth Mishra ◽

Rebecca J Dignan ◽

Clifford F Hughes ◽

Nick Hendel

Keyword(s):

Surgical Treatment ◽

Infective Endocarditis ◽

Medical Treatment ◽

Rare Disease ◽

Corynebacterium Diphtheriae ◽

Aggressive Disease ◽

Prosthetic Valves ◽

Immediate Surgery

Corynebacterium diphtheriae endocarditis was thought to be a rare disease. We reviewed our experience in four cases of this disease treated over a period of 10 years. Seventy cases reported in literature were reviewed. The outcome is good if cases are carefully selected for medical or surgical treatment. We conclude that infective endocarditis due to C. diphtheriae, is perhaps more common than expected. It may be recognized more frequently and on occasion may be an aggressive disease. Those patients with an abnormal valve (including prosthetic valves) should be subjected to surgery at the earliest available opportunity, whereas patients with normal valves may be carefully watched during the course of medical treatment as long as immediate surgery can occur if needed.

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Early Surgical Intervention for Infective Endocarditis

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849230201000403 ◽

2002 ◽

Vol 10 (4) ◽

pp. 298-301 ◽

Cited By ~ 1

Author(s):

Hong Sheng Zhu ◽

Pei Yan Yao ◽

Jia Hao Zheng ◽

A Thomas Pezzella

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Heart Disease ◽

Infective Endocarditis ◽

Complex Disease ◽

Surgical Intervention ◽

Elective Surgery ◽

Postoperative Bleeding ◽

Arterial Embolization ◽

Early Surgical Intervention

Infective endocarditis remains a serious and complex disease with significant morbidity and mortality. Sixty cases of infective endocarditis were retrospectively reviewed, consisting of 41 males and 19 females aged 7 to 50 years (mean, 30 years). Congenital heart disease was diagnosed in 19 of the patients and rheumatic heart disease in 41. Congestive heart failure occurred in 36 and systemic embolism in 8 cases. Blood cultures were positive in only 21.7% of the cases, while vegetations were detected by 2-dimensional echocardiography in 70%. Elective surgery was performed in 57 patients and emergent operation for systemic arterial embolization and/or intractable congestive heart failure in 3 patients. Two patients required reoperation for postoperative bleeding. All but 2 patients had been followed up for 6 to 160 months with no evidence of reinfection. Three patients with mechanical valve implantation later died of intracranial bleeding due to over-anticoagulation. The remaining 55 resumed normal activity. The encouraging outcomes were the result of an aggressive diagnostic approach and early surgical intervention.

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Isolated Duodenal Crohn's Disease: A Case Report and a Review of the Surgical Management

Case Reports in Surgery ◽

10.1155/2013/421961 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Faruk Karateke ◽

Ebru Menekşe ◽

Koray Das ◽

Sefa Ozyazici ◽

Pelin Demirtürk

Keyword(s):

Crohn’S Disease ◽

Case Report ◽

Gastrointestinal Tract ◽

Crohn's Disease ◽

Medical Treatment ◽

Immunosuppressive Therapy ◽

Surgical Management ◽

Surgical Intervention ◽

Surgical Options ◽

Crohn’S Diseases

Crohn's disease may affect any segment of the gastrointestinal tract; however, isolated duodenal involvement is rather rare. It still remains a complex clinical entity with a controversial management of the disease. Initially, patients with duodenal Crohn' s disease (DCD) are managed with a combination of antiacid and immunosuppressive therapy. However, medical treatment fails in the majority of DCD patients, and surgical intervention is required in case of complicated disease. Options for surgical management of complicated DCD include bypass, resection, or stricturoplasty procedures. In this paper, we reported a 33-year-old male patient, who was diagnosed with isolated duodenal Crohn’s diseases, and reviewed the surgical options in the literature.

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Ocular Cysticercosis — A Profile

Tropical Doctor ◽

10.1177/004947550303300327 ◽

2003 ◽

Vol 33 (3) ◽

pp. 185-188 ◽

Cited By ~ 9

Author(s):

Anuradha Chowdhary ◽

Rajlakshmi Bansal ◽

Kirti Singh ◽

Varinder Singh

Keyword(s):

Retrospective Study ◽

Medical Treatment ◽

Surgical Excision ◽

North India ◽

Age Group ◽

Common Site ◽

Referral Centre ◽

Tertiary Referral ◽

Tertiary Referral Centre ◽

Ocular Cysticercosis

A retrospective study was conducted on all histopathologically proven cases of ocular cysticercosis spanning a decade in a tertiary referral centre of North India. The symptomatology, presentation, complications and treatment therapies of 18 of these patients are discussed. The most common age group to be affected was 11–20 years (50%), while the most common site involved was subconjunctival (78%), followed by lid (11%). Spontaneous extrusion was documented in three cases. Medical treatment with albendazole under the cover of corticosteroids was found to be a useful adjunct to surgical excision.

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Does Hydrogen Peroxide Mouthwash Improve the Outcome of Secondary Post-Tonsillectomy Bleed? A 10-year Review

Otolaryngology ◽

10.1016/j.otohns.2005.04.002 ◽

2005 ◽

Vol 133 (2) ◽

pp. 202-205 ◽

Cited By ~ 11

Author(s):

Irumee Pai ◽

Stephen Lo ◽

Satsuki Brown ◽

Abbad G. Toma

Keyword(s):

Hydrogen Peroxide ◽

Retrospective Study ◽

Study Design ◽

Broad Spectrum ◽

Pediatric Patients ◽

Surgical Intervention ◽

Control Group ◽

Intravenous Antibiotics ◽

The Common

Objective: To determine whether hydrogen peroxide (H2O2) mouthwash influences the outcome of secondary post-tonsillectomy hemorrhage in children. Study Design: Ten-year retrospective study of all children with secondary post-tonsillectomy hemorrhage. Setting: Tertiary otolaryngology center. Results: Of the 156 patients, 59 received H2O2 and 97 did not. All patients received broad-spectrum intravenous antibiotics. The average rehospitalization duration due to hemorrhage was 1.7 days (H2O2 group) and 1.6 days (control group). In the H2O2 group, 8.5% required surgery, compared with 10.3% in the control group. Further hemorrhage episodes requiring readmission occurred in 3.4% of the H2O2 group and 3.1% of controls. There was no difference between the 2 groups in rehospitalization duration ( P = 0.49), rate of surgical intervention ( P = 0.85), and rate of readmission with further hemorrhage ( P = 0.92). Conclusion: Hydrogen peroxide mouthwash does not improve the outcome of secondary post-tonsillectomy hemorrhage in pediatric patients. Significance: This study does not support the common practice of treating post-tonsillectomy hemorrhage with H2O2.

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