Methicillin-Resistant Staphylococcus Aureus Following Leech Application at a Congested Flap after a Mastectomy

Medical leech therapy is a treatment for the venous congestion of tissue flaps, grafts, and replants. We report a case of methicillin-resistant Staphylococcus aureus (MRSA) following leech application at a congested flap after mastectomy. A 45-year-old woman had an invasive ductal carcinoma. Modified radical mastectomy was performed. The chest wall defect was reconstructed with a local rotation flap. On postoperative day (POD) 1, congestion and color change were observed, and 10 medical leeches were applied to the congested area. On POD 4, another 10 medical leeches were applied. On POD 12, wound necrosis progressed and a pus-like discharge appeared. A wound swab culture revealed MRSA. Debridement was carried out on POD 15. From POD 16, vancomycin and piperacillin/tazobactam were injected for 18 days. The wound culture on POD 18 also revealed MRSA. A split-thickness skin graft was performed on POD 28. MRSA has not been clearly identified in the literature as a leech enteric bacterium. Although MRSA may have come from another source, the present case raises the possibility of MRSA infections following leech application at congested flaps. When medical leeches are applied at the congestion site of a flap, an aseptic cradle will be helpful. Vancomycin irrigation may be needed if infection occurs.

The Clinical Results of Heart Valve Replacements / 대한흉부외과학회지

BACKGROUND: In spite of the improvement in the quality of artificial heart valves and surgical techniques, the incidence of the complications following valve replacement is still high. We reviewed the clinical results of the valve replacements performed in Korean University Anam Hospital during the last 26 years. MATERIAL AND METHOD: The data of 571 patients who received valve replacement between December 1976 and December 2003 were reviewed. RESULT: There were 304 cases of MVR which was the most common procedure performed. There were 122 cases of AVR, and 111 cases of AVR with MVR. Among the 47 patients who received redo operation 38 cases were redo cases including 31 cases of MVR. 32.5% of the patients who had tissue valve replacement had second valve replacement with 10.2+/-3.9 years interval. 24.3% (139/571) of the patients developed valve related complications and cerebral infarction was the highest in frequency. Atrial fibrillation was related with increased complication rates and the mechanical valve replaced group had higher hemorrhagic complication rate than tissue valve replaced group. The operative mortality was 3.68% and the most common cause of the failure was low output syndrome. The operative mortality was higher in the patient group who had valve replacement before the year 1990. The patient group who had mechanical valve replacement had higher operative mortality rate than the tissue valve group. The 5-year survival rate was 92.2% and 10 year survival rate was 85.7%. CONCLUSION: The operative mortality of valve replacement has been improved. The mechnical valve replaced patients had higher hemorrhagic complication rate than the tissue valve replaced patients and more tissue valve replaced patients received redo valve replacement.

A Case of Double Outlet Left Ventricle with subaortic Ventricular Septal Defect and Pulmonary Atresia

No abstract available.

Life Threatening Hemoptysis in Mitral Stenosis Treated by Emergency Mitral Commissurotomy

A 25-year-old 7 month pregnant woman with mitral stenosis was hospitalized because of life threatening hemoptysis dispite intensive medical treatment. Emergency mitral commissurotomy resulted in prompt cessation of hemorrhage and at nine months follows-up, the hemoptysis has not recurred. Mitral valve surgery appears to be consitently associated with rapid and sustained cessation of hemoptysis. Therefore, surgery should be considered in hemoptysis due to mitral stenosis, particulary when the danger of asphyxiation exists.