Estudio clínico y microbiológico de los micetomas observados en el Hospital de Infecciosas Francisco J. Muñiz en el período 1989-2004 / Clinical and microbiological study of mycetomas at the Muñiz Hospital of Buenos Aires between 1989 and 2004

Se presentan las características clínicas, microbiológicas y los resultados del tratamiento de 76 casos de micetomas observados en el período 1989-2004 en el Hospital Muñiz. Cuarenta y nueve fueron varones y 27 mujeres, con una edad promedio de 43,4 años. La mayor parte de los pacientes adquirió la infección en nuestro país, las provincias más afectadas fueron Santiago del Estero con 31 casos y el Chaco con 11; 8 enfermos procedían del exterior, 6 de Bolivia y 2 de Paraguay. El promedio de evolución de la enfermedad fue de 9,2 años. Las localizaciones más comunes fueron las de los miembros inferiores: pies 63, tobillos 3 y rodillas 2. Se comprobó compromiso óseo en 48 casos y adenomegalias en 5. Fueron identificados los siguientes agentes causales: Madurella grisea 29 casos, Actinomadura madurae 26, Scedosporium apiospermum 5, Nocardia brasiliensis 5, Acremoniun spp. 4 (Acremonium falciforme 2, Acremonium kiliense 1 y Acremonium recifei 1), Madurella mycetomatis 3, Fusarium solani 2, Nocardia asteroides y Streptomyces somaliensis 1 caso cada uno. Los tratamientos más frecuentemente utilizados fueron ketoconazol o itraconazol en los micetomas maduromicósicos y la asociación de cotrimoxazol con ciprofloxacina o amicacina en los micetomas actinomicéticos. La amputación del miembro afectado se realizó en 6 casos, 25 pacientes alcanzaron la remisión clínica completa y 34 presentaron mejorías importantes.

This work presents clinical, microbiological and outcome data collected from 76 patients with mycetomas at the Muñiz Hospital from 1989 to 2004. Forty-nine patients were male and 27 female; the mean age was 43.4 years. The majority of the patients acquired the infection in Argentina: the most affected provinces were Santiago del Estero with 31 cases, and Chaco with 11; 8 cases came from other countries (Bolivia 6 and Paraguay 2). The mean evolution of the disease was 9.2 years. The most frequently observed sites were: feet 63 cases, ankles 3, and knees 2. Forty-eight patients had bone lesions and 5, adenomegalies. The following etiological agents were identified: Madurella grisea 29 cases, Actinomadura madurae 26, Scedosporium apiospermum 5, Nocardia brasiliensis 5, Acremonium spp. 4 (Acremonium falciforme 2, Acremonium kiliense 1, Acremonium recifei 1), Madurella mycetomatis 3, Fusarium solani 2, Nocardia asteroides 1 and Streptomyces somaliensis 1. The main drugs used in the treatments were ketoconazole and itraconazole for maduromycotic mycetomas, and cotrimoxazole associated with ciprofloxacin or amikacin for actinomycetic mycetoma. Six patients had to undergo amputation, 25 cases achieved complete clinical remission and 34 showed remarkable improvement.

Uso do enxerto ósseo vascularizado de fíbula no tratamento de infecçöes ósseas graves no membro superior / Use of vascularized graf in the treatment of severe bone infections of the upper extremities

Os autores relatam sua experiência no tratamento de nove pacientes portadores de processos infecciosos graves nos ossos do membro superior, com o enxerto ósseo vascularizado de fíbula. Os pacientes foram operados entre 1985 e 1991 e o seguimento médio foi de 29,5 meses. As perdas ósseas segmentares variaram de 6 a 10 cm, com média de 7,8 cm. A viabilidade do enxerto ósseo foi testada através de cintilografia e de monitores de pele. Houve sobrevida do enxerto e sucesso na reconstruçao em 88,8 por cento dos pacientes.

Traitement chirurgical de l'infection dans l'osteite et la pseudarthrose infectee post-fracturaires

The authors report their experiment in treating osteitis and septic non-union. - The problem of fractured osteitis is relatively simple, the fracture being united. Different surgical methods are considered together, all having in common the excision of infected and necrotic tissue. Opinions are divided between supporters of "closed" treatment with "irrigation-drainage", and "open" treatment with cicatrization by a second intention. The latter being favored by most of the participants. Directed antibiotherapy remains a valuable addition; its utilization locally is discussed. - The treatment of septic "non-union" is more complicated in respect to healing. Different methods are examined with ' osteo-muscular decortication, used alone, led to healing in 17 out of 20 cases of non-union. It constitutes the first and formes treatment for non-union. Isolated, it is reserved for non-union without loss of osseous matter. A PAPINEAU intervention is the method of choice for septic non-union with loss of osseous matter. It was used once or twice in 51 cases and led to union and drving in 75% of the cases. Negative re-results were most often the apanage of diaphysaric resections. Inter-tibio-fibular grafting was only used in 8 cases, usually after the failure of other methods. It allowed union in 6 cases. It retains a non-negligible place after failure of a PAPINEAU intervention, which it can complete in case of insufficient solidity. Of 101 observations of septic non-union, 6 patients underwent amputation. This is most often the result of major traumatologic damage and deficient techniques. Its place should be more and more reduced. The authors conclude by recalling the importance of preventing post-operatory-infection, not by gross means but by rigorous measures in the organization, hygiene and education of hospital staff