Near-fatal infection following an elective ankle-fracture fixation: less risk should not mean less vigilance / 中华医学杂志(英文版)

Surgical fixation of closed ankle fracture is traditionally viewed as having low risk for post-operative infection. Only a few cases of surgical-site confined infection have been reported. Because of the low infection risk, the necessity for perioperative prophylaxis has been questioned. We report a case of fulminant methicillin-resistant Staphylococcus aureus endocarditis occurring shortly after an elective ankle fixation surgery in an elderly woman with chronic rheumatoid arthritis. Because systemic infection was unexpected, she had been given antipyretics for postoperative fever until just before rapid clinical deterioration. A nearly fatal hematogenous infection occurred after such a procedure, indicating the necessity for being on high alert and considering the possibility of bloodstream infection.

Septal myectomy for obstructive hypertrophic cardiomyopathy: the gold standard / 中华心血管病杂志

Septal myectomy effectively and definitively relieves LVOT obstruction and cardiac symptoms in adults and children with obstructive hypertrophic cardiomyopathy (HCM). Abnormalities of the mitral valve can be addressed without the need for mitral valve replacement in almost all circumstances. Concomitant mitral valve repair for myxomatous disease requires minor modifications when performed in conjunction with septal myectomy; mitral valve replacement is rarely necessary. In experienced centers, early mortality for isolated septal myectomy is low (approximately 1%) and overall results are excellent and continue to improve in the current era. Symptomatic improvement with myectomy is expected for most; 90% of patients improve by at least one functional class, and most remain improved on late follow-up. Late survivorship is improved compared to nonoperated patients with obstructive HCM, and myectomy may be associated with reduced risk of sudden cardiac death. These results should serve as the gold standard and a basis for comparison with newer nonsurgical modalities, i. e., septal alcohol ablation.