Fungal Periprosthetic Joint Infection By Candida Glabrata – Two Stage Revisio...Queen Mary Hospital
Fungal Periprosthetic Joint Infection By Candida Glabrata – Two Stage Revision Is A Good Option.
Dr. Suryanarayan Pitchai, Dr. Kalaivanan Kanniyan , Dr. P. Ashok Kumar, Dr. Y. Subramanyam
Asian Joint Reconstruction Institute (AJRI), SIMS Hospitals, Chennai 600026, Tamil Nadu, India.
Fungal Periprosthetic Joint Infection By Candida Glabrata – Two Stage Revisio...Queen Mary Hospital
Fungal Periprosthetic Joint Infection By Candida Glabrata – Two Stage Revision Is A Good Option.
Dr. Suryanarayan Pitchai, Dr. Kalaivanan Kanniyan , Dr. P. Ashok Kumar, Dr. Y. Subramanyam
Asian Joint Reconstruction Institute (AJRI), SIMS Hospitals, Chennai 600026, Tamil Nadu, India.
Abstract—In Italy the hydatid disease is more prevalent and new cases are highlighted more frequently in Sicily, Sardinia, (Italy). Aim of this study is to put the indication in search of iaditea nature in both spleen swelling and muscle tendon.
Material and Method Patients observed during the period 2007-2009 at the Surgical Clinic III and Digestive Surgery, Policlinico G Rodolico were explored for Hydatid cyste at various sites. Diagnosis of cysts ecchinococcus occurred primarily for various four reasons either for compression of bodies involved or for eosinophilia or for instrumental investigation or for anaphylactic reaction to rupture of cysts. Biological diagnosis is based on serology rather than isolation of the parasite (indirect diagnosis);
Results Patients attended during the period 2007-2009 Hydatid cyst was found in 0.5% of all cases in liver along with 4 in the lung, 3 in splenic, 2 in the mammary and 2 in the chest wall No 2. The Surgical treatment with the complete removal of the cyst with a satisfactory postoperative course in the absence of cases of relapse of the disease and by following the therapeutic act, the assumption of mebendazole 50mg / kg / day for 3 weeks at a dose of 400mg for 4 months
Conclusions There is a need to define diagnostic methods with high specificity and sensitivity, which can provide a valid diagnostic aid for the cases clinically difficult to diagnose. And the final diagnosis must then also be based on the development of immunological methods that allow the determination of specific antibodies in the serum and their titration and / or the circulating antigen determination.
DOI:10.21276/ijlssr.2016.2.4.1
ABSTRACT- Introduction: Surgical Site Infections (SSI) still remains a significant problem following an operation
and the third most frequently reported nosocomial infections. SSI contributes significantly to increased health care costs in
terms of prolonged hospital stay and lost work days.
Objective: The current study was undertaken to identify incidence of SSI and the risk factors associated with it, and the
common organism isolated and its antibiotic sensitivity and resistance.
Material and Methods: A total number of 3211 patients admitted in general surgical wards for elective surgery in the
study period, out of which 1225 were clean and clean contaminated cases, fulfilling our study criteria. Totally 56 cases
had surgical site infections which had been taken up for this study. Wound discharges were sent for culture and sensitivity.
Results and Conclusions: The overall infection rate was 4.57%. The SSI rate was almost equal in clean surgeries and
clean contaminated ones. Superficial surgical site infections in the most commonest type and accounted for about 66.07%
of all the SSI’s and deep surgical site infection accounted for about 25% with 8.92% was organ space. The most
commonly isolated organism from surgical site infections was staphylococcus aureus followed by pseudomonas and then
E. coli. Drains, prosthesis usage and other risk factors of SSI have been identified. Most of the organisms which were
isolated were multidrug resistant. The high rate of resistance to many antibiotics underscored the need for a policy that
could promote a more rational use of antibiotics. Key-words- Surgical site infections, National Nosocomial Infections Surveillance (NNIS) risk index, Antibiotic
Management of post operative wound infectionBashir BnYunus
post operative wound infection now surgical site infection is a common post operative complication especially in developing countries and the 2nd most common nosocomial infection. it leads to prolong hospital stay among other complications
Undergraduate level presentation on Prevention of Surgical infection covering the topics of:
History
Definition
Classification
Risk factors
Surgical Site Infection (SSI)
Tetanus
Gas gangrene
PAPILLARY CARCINOMA IN THYROGLOSSAL CYST-By Dr.Juveria Majeed MS ENT.Dr.Juveria Majeed
Carcinoma of thyroglossal duct cyst is a very rare entity. Here we present a case report of papillary carcinoma in thyroglossal cyst in a 21 year old female patient and discussion regarding dilemmas in the management, whether total thyroidectomy should be done or not.
Successful knee replacement surgery India by experienced highly qualified surgeons & latest advanced surgical techniques with the help of Tour2india4health.
Abstract—In Italy the hydatid disease is more prevalent and new cases are highlighted more frequently in Sicily, Sardinia, (Italy). Aim of this study is to put the indication in search of iaditea nature in both spleen swelling and muscle tendon.
Material and Method Patients observed during the period 2007-2009 at the Surgical Clinic III and Digestive Surgery, Policlinico G Rodolico were explored for Hydatid cyste at various sites. Diagnosis of cysts ecchinococcus occurred primarily for various four reasons either for compression of bodies involved or for eosinophilia or for instrumental investigation or for anaphylactic reaction to rupture of cysts. Biological diagnosis is based on serology rather than isolation of the parasite (indirect diagnosis);
Results Patients attended during the period 2007-2009 Hydatid cyst was found in 0.5% of all cases in liver along with 4 in the lung, 3 in splenic, 2 in the mammary and 2 in the chest wall No 2. The Surgical treatment with the complete removal of the cyst with a satisfactory postoperative course in the absence of cases of relapse of the disease and by following the therapeutic act, the assumption of mebendazole 50mg / kg / day for 3 weeks at a dose of 400mg for 4 months
Conclusions There is a need to define diagnostic methods with high specificity and sensitivity, which can provide a valid diagnostic aid for the cases clinically difficult to diagnose. And the final diagnosis must then also be based on the development of immunological methods that allow the determination of specific antibodies in the serum and their titration and / or the circulating antigen determination.
DOI:10.21276/ijlssr.2016.2.4.1
ABSTRACT- Introduction: Surgical Site Infections (SSI) still remains a significant problem following an operation
and the third most frequently reported nosocomial infections. SSI contributes significantly to increased health care costs in
terms of prolonged hospital stay and lost work days.
Objective: The current study was undertaken to identify incidence of SSI and the risk factors associated with it, and the
common organism isolated and its antibiotic sensitivity and resistance.
Material and Methods: A total number of 3211 patients admitted in general surgical wards for elective surgery in the
study period, out of which 1225 were clean and clean contaminated cases, fulfilling our study criteria. Totally 56 cases
had surgical site infections which had been taken up for this study. Wound discharges were sent for culture and sensitivity.
Results and Conclusions: The overall infection rate was 4.57%. The SSI rate was almost equal in clean surgeries and
clean contaminated ones. Superficial surgical site infections in the most commonest type and accounted for about 66.07%
of all the SSI’s and deep surgical site infection accounted for about 25% with 8.92% was organ space. The most
commonly isolated organism from surgical site infections was staphylococcus aureus followed by pseudomonas and then
E. coli. Drains, prosthesis usage and other risk factors of SSI have been identified. Most of the organisms which were
isolated were multidrug resistant. The high rate of resistance to many antibiotics underscored the need for a policy that
could promote a more rational use of antibiotics. Key-words- Surgical site infections, National Nosocomial Infections Surveillance (NNIS) risk index, Antibiotic
Management of post operative wound infectionBashir BnYunus
post operative wound infection now surgical site infection is a common post operative complication especially in developing countries and the 2nd most common nosocomial infection. it leads to prolong hospital stay among other complications
Undergraduate level presentation on Prevention of Surgical infection covering the topics of:
History
Definition
Classification
Risk factors
Surgical Site Infection (SSI)
Tetanus
Gas gangrene
PAPILLARY CARCINOMA IN THYROGLOSSAL CYST-By Dr.Juveria Majeed MS ENT.Dr.Juveria Majeed
Carcinoma of thyroglossal duct cyst is a very rare entity. Here we present a case report of papillary carcinoma in thyroglossal cyst in a 21 year old female patient and discussion regarding dilemmas in the management, whether total thyroidectomy should be done or not.
Successful knee replacement surgery India by experienced highly qualified surgeons & latest advanced surgical techniques with the help of Tour2india4health.
Hip & Knee Replacement Infections: Lawsuit Informationlawsuitlegal
Joint implant patient? Post-surgical complications suffered by hip & knee replacement patients have have been caused by the forced-air warming blanket used during your operation. Hip and knee infections are among claims made in recent lawsuit complaints brought against 3M and their Bair Hugger patient warming device.
If you suffered a deep joint infection, it can require multiple revision surgeries to ex-plant the contaminated device, result in loss of mobility, amputation and even death.
In the following guide we rundown the case infection lawsuit attorneys are making against in court, what some of the important research on the matter says, and review the case against liability being made.
If you suffered a serious infection post-surgery, we encourage you to come forward and share what happened, adding your voice to the ongoing investigation. Review the information in the guide, and then share what happened with our Bair Hugger attorneys to learn your legal options now.
basic arthroscopy set up,positionnig and portals .this presentation is for education purpose only .all the copyrights are owned by original authors and not by me.
During my time at Great Yarmouth College of Further Education, I completed a research project where I discussed what effect binge drinking is having on the NHS.
Frank Jermusek | Abaco Club is Sold in BahamasFrank Jermusek
Frank Jermusek is owner and President of Northco Real Estate Services. Here is a slide show reporting on the sale of the Abaco Club, a 534-acre golf club and residential community in Great Abaco, The Bahamas. While the terms of sale were not disclosed, it was an all-cash deal that should inject some momentum into the local economy.
10. Risk factors
Surgical technique
Single most effective method of ↓ infection
1st gen. cephalosporin
Allergy vancomycin / clindamycin
30-60 min before incision
(peak serum bone conc. within 20 min)
Repeat every 4 hrs & bleed >1,000 ml
Discontinue 24 hrs after surgery
Prophylactic antibiotic
13. Post operative management
• Bacteremia: oral > GI > GU procedure
• Avoid in first 3-6 mo (high incidence)
AAOS & ADA 1997
• First 2 yrs, specific risk factor for all pts ATB prophylaxis
• After 2 yrs consider in high risk pts
Recommended regimens (before procedure 1 hr)
• Cephalexin, cephradine, amoxicillin 2 g. oral
• Cephalosporin 1 g / ampicillin 2 gm IV / IM
• Clindamycin 600 mg oral (allergy to penicillin)
• Clindamycin 600 mg IV / IM (allergy to penicillin)
Risk factors
Advisory statement. J Am Dent Assoc, 1997
14. Potential risks of hematojenous
total joint infection
• All patients for the first 2 years after joint replacement
• lmmunocompromised / immunosuppressed patients
- Inflammatory arthropathies - Drug-induced immunosuppression
- Rheumatoid arthritis - Radiation-induced immunosuppression
- Systemic lupus erythematosus
• Patients with comorbidity conditions
- Previous prosthetic joint infections - HIV infection
- Poor nutrition - Insulin-dependent diabetes
- Hemophilia - Malignancy
Advisory statement. J Am Dent Assoc, 1997
18. Microbiology
• Methicillin-resistant organism vancomycin
Ries MD, J Arthroplasty, 2001
• Rifampicin = good biofilm & tissue penetration
improve success when use ĉ other synergistic agent
Zimmerli W, JAMA, 1998
19. Differential diagnosis
• Periprosthetic fx
• PF problem
• Aseptic loosening
• Soft tissue disruption
A painful knee is infected until proved otherwise
Insall, 1981
• Instability
• RSD
• HO
• Arthrofibrosis
20. Clinical history Physical examination Radiography Hematologic
studies
Radionuclide studies
Aspiration
Diagnosis
Fundamental of diagnosis
* * * High index of suspicion * * *
Pathology
21. Diagnosis
History
• Pain = most common presenting symptom
• Typical = rest / night / persistent / progressive pain
• Progressive stiffness
• Hx of prolong postop drainage, ATB treatment
Physical examination
• Swelling, effusion, warmth, erythema, tenderness
• Painful range of motion
• Persistent wound drainage
strongly suggestion early aggressive Rx
22. Diagnosis
• Swab wound not recommend
• Empirical ABO for wound drainage mask symptoms,
affect subsequent C/S, predispose for drug resistant
• Diagnosis in early postop period
– ESR, CRP limit value
– Typically by arthrocentesis
23. Aspiration
• Leucocyte count & differentiation
• Gram strain (sens 97%, spec 26%) (
• Culture for aerobic & anarobic bacteria
>1,700/ml3, PMN > 65% (sens 94-97%, spec 88-98%)
Trampuz A, Am J Med, 2004
• Ongoing ATB stop for several wks before aspiration
24. Mark Coventry Award Paper
“Synovial WBC count is an excellent test for diagnosing
infection within 6 wks after 1oTKA
with an optimal cut-off 27,800 cells/mm3 and 89% PMN”
Sens 84%, spec 99%, PPV 94%, NPV 98%
Craig J. Della Valle
Presented at the Knee Society Specialty Day Meeting
March 13, 2010, New Orleans
Diagnosis of early post-operative infection following TKA:
The utility of synovial fluid cell count and differential
26. Guideline for ESR & CRP
1. Normal ESR & CRP reliable for the absence of infection
2. CRP more useful than ESR for monitoring
3. Use with other tests for the diagnosis of infection
Spangehl MJ, JBJS, 1999
31. Intraoperative tissue frozen section
• Widely use
• Result depend on
Adequate & representative tissue obtaining
Accurate interpretation by skilled pathologist
> 5 PMN/HPF at least 5 fields Sens 100%, spec 96%
>10 PMN/HPF at least 5 fields Sens 25%, spec 98%
Feldman DS, JBJS, 1995
Della Valle CJ, JBJS 1999
32. Reliable predictor for infection
• >10 PMN/HPF: sens 84%, spec 99%, PPV 89%, NPV 98%
• 5-10 PMN/HPF: need other test to differentiate
• <5 PMN/HPF: infection was highly unlikely
Lonner Jh et al, JBJS,1996
Intraoperative tissue frozen section
35. Definite diagnosis
At least one of the following
1. Same organism from c/s ≥ 2 specimens by aspiration /
deep tissue from surgery
2. Intraarticular tissue histopathology = acute inflammation
3. Gross purulence at the time of surgery
4. Actively discharging sinus tract
Hansen, CORR, 1994
36. At least one of the following
1. Open wound / sinus tract communicate ĉ joint
2. Systemic signs / symptoms ĉ pain & purulent fluid
3. At least 3 of 5
ESR > 30 mm/hr
CRP >10 mg/L
Frozen section > 5 PMN/HPF
Preoperative aspiration c/s ≥ 1 +ve
Intraoperative c/s ≥ 1 +ve
Spangehl MJ, JBJS, 1999
Definite diagnosis
37.
38. Type1 Type2 Type3 Type4
Timing Positive
intraop C/S
Early
postoperative
infection
Acute
hematogenous
infection
Late (chronic)
infection
Definition Same
organism
≥2 from C/S
Occurring within
first month after
surgery
Hematogenous
seeding of
previously
well-functioning
prosthesis
Chronic
indolent
clinical course;
present >1
month
Segawa &Tsukayama classification
* * * Guide to treatment * * *
“Classify on the basis of clinical presentation”