Emergence of colistin and carbapenem-resistant Acinetobacter calcoaceticus-Acinetobacter baumannii (CCR-Acb) complex in a neurological intensive care unit followed by successful control of the outbreak.

BACKGROUND: Colistin and carbapenem-resistant Acinetobacter calcoaceticus- Acinetobacter baumannii complex (CCR-Acb complex) was isolated from two consecutive patients in the neurological intensive care unit (NICU). An urgent reaction to this desperate situation was required. PATIENTS AND METHODS: Screening cultures were taken from the other patients sharing the NICU with index patients and repeated periodically. NICU was closed for new admissions. Infection control precautions (ICP) such as hand hygiene, cohorting patients colonized with CCR-Acb complex, cohorting the staff caring for these patients, daily bathing with chlorhexidine gluconate impregnated clothes, using gowns when contacting with patients and patient care area, and sodium hypochlorite tablets for environmental cleaning were enforced. RESULTS: Screening cultures revealed carbapenem-resistant Acb complex in 12 out of 32 patients and 8 of them were colonized with CCR-Acb complex. NICU was opened for new admissions one month later. No further new cases with CCR-Acb complex were detected by screening cultures after 6 weeks with enforcement of ICP. Moreover, the rate of nosocomial infections caused by other multi-drug resistant Gram-negative bacilli (MDR-GNB) decreased significantly when rates before and after closing the NICU were compared. CONCLUSION: ICP were effective not only to limit the spread of CCR-Acb complex but also decreased the incidence of other MDR-GNB infections when applied adequately.

Single-stage open reduction through a medial approach and innominate osteotomy in developmental dysplasia of the hip.

We treated 15 hips (15 patients) with developmental dysplasia by a single-stage combination of open reduction through a medial approach and innominate osteotomy. The mean age of the patients at the time of operation was 20 months (13 to 30). The mean follow-up period was 9.6 years (4 to 14). At the final follow-up, 14 hips were assessed clinically as excellent and one hip as good. Radiologically, ten hips were rated as class I, four as class II and one as class III according to the criteria of Severin. No avascular necrosis was seen. No patient required subsequent surgery. Our results indicate that satisfactory results can be obtained with the single-stage combination of open reduction by the medial approach and innominate osteotomy for developmental dysplasia of the hip in a selected group of children older than 12 months. To our knowledge, no similar combined technique has been previously reported.

Liver fibrosis in unisexual murine Schistosomiasis: quantitative study and morphological changes in mice with chronic infection.

The main complication of Schistosomiasis is the development of liver fibrosis as a result of periovular granuloma in portal tract. This study was undertaken to evaluate the role of the worms in the liver, using the unisexual murine schistosomiasis model. Hepatic fibrosis and histopathological lesions were sequentially followed for 65 weeks in mice experimentally infected with male Schistosoma mansoni. Morphological study revealed that, from the 25th week post-infection, a diffuse fibrosis affected the main branches of the portal vascular system following the host inflammatory reaction, associated with the proliferation of myofibroblasts in situ. Quantitative methods confirmed that an increase of fibrotic deposit occurred during chronic unisexual infection from 25 to 50 weeks post-infection, as compared to controls (35.06 +/- 3.55% versus 27.41 +/- 2.56%) suggesting that antigenic substances secreted by adult schistosomes, in the absence of any eggs, might initiate periportal and perisinusoidal fibrous reaction. The cytokine production and the evolution of inflammation towards fibrosis involves stellate cells and myofibroblasts stimulation. This fibrotic process consequently traduces a reparative phenomenon of the liver.

Replantation in children.

The rates of survival of the amputated part and the functional outcomes were studied retrospectively after 13 replantations and 12 revascularizations in 25 children. The ages of the patients ranged from 2 to 15 years (mean, 6.4 years). The average duration of follow-up was 4.2 years (range, 2 to 7 years). The survival rate was higher after revascularization (94.6%) than after replantation (84.6%). Sensory recovery of all digits was satisfactory. The mean growth rate of replanted digits relative to contralateral digits was 80%. Functional results were rated as excellent in 11 cases, good in 8 cases, moderate in 2 cases, and poor in 1 case. In order to prevent functional and growth disturbances and due to cosmetic reasons, replantation or revascularization should definitely be tried for children.

Bilateral traumatic hip dislocation with bilateral sciatic nerve injury.

Bilateral traumatic dislocation of the hip is a rare injury. In fact, only about 50 cases have been reported previously. We report a case of traumatic bilateral posterior hip dislocation with bilateral sciatic nerve damage suffered in a traffic accident by a 65-year-old woman.

Isolated dislocation of all five carpometacarpal joints.

Fracture-dislocation of all five carpometacarpal joints is extremely rare, only ten cases having been reported since 1873. A case of isolated dislocation of all five carpometacarpal joints is presented. A good result was obtained 1 year after open reduction and internal fixation. This case is the only isolated dislocation of all five carpometacarpal joints in the English literature.

Aneurysmatic dilatation of popliteal and femoral artery due to long-standing traumatic arteriovenous fistula.

A 65-year-old woman presented with an extensive femoropopliteal aneurysm discovered after a long-standing (24 years) post-traumatic arteriovenous fistula (AVF). Her complaints began after trauma. All arterial dilatations discovered during the course of an AVF must be treated because of the risk of rupture. With the advent of arterial reconstructive procedures, the surgical approach to popliteal aneurysm became and remains excision and graft interposition or by-pass graft with concomitant aneurysm ligation. Of all available graft material the autogenous saphenous vein remains the best material for arterial reconstruction. The diagnostic technics, therapeutic procedures and possible complications are discussed with literature review. The etiology of aneurysm that develop proximal to AVF is reviewed.

Unisexual murine schistosomiasis: portal hepatitis in subacute infections.

Liver changes induced by unisexual male infection with S. mansoni were studied in mice during 2-20 weeks post-infection, in order to distinguish changes related to released worm substances from changes related to schistosome egg deposition. In subacute unisexual infection the venous wall appears as the target for inflammation which remains focal for a long time and affects limited segments of the main portal veins. Schistosomal pigment deposited in the lobule does not induce inflammatory or fibrogenic reactions.