ABSTRACT
An invasive beta-haemolytic Lancefield group A streptococcal (GAS) infection was diagnosed in 4 patients: a 70-year-old woman, her 71-year-old husband, a 62-year-old woman and her 43-year-old son. In the married couple the infection was caused by GAS-type TB3264M100. The woman had a pneumonia, whilst her husband developed a streptococcal toxic shock-like syndrome; he died. The other woman and her son were infected with GAS-type T6M6. The son died of a circulatory arrest due to necrotizing fascitis from a wound in his arm. His mother recovered following a severe tonsillitis. The number of invasive GAS infections has increased in the past decades. GAS infections occur mostly in isolated cases, but clusters of patients are also seen, like the two described here. The risk of an invasive GAS-infection is greatest if one has been in the neighbourhood of the index patient during the week prior to the diagnosis in that patient. According to the latest (American) guidelines, there is no reason for prophylactic treatment of the close contacts of patients.
Subject(s)
Streptococcal Infections/transmission , Streptococcus pyogenes/isolation & purification , Adult , Aged , Carrier State , Community-Acquired Infections/microbiology , Community-Acquired Infections/prevention & control , Fasciitis, Necrotizing/complications , Fasciitis, Necrotizing/microbiology , Fatal Outcome , Female , Humans , Male , Middle Aged , Pneumonia, Bacterial/microbiology , Shock, Septic/microbiology , Streptococcal Infections/prevention & control , Tonsillitis/microbiologyABSTRACT
BACKGROUND: If no complete remission on chemotherapy is reached in head and neck rhabdomyosarcoma (RMS) in children, adjuvant radiotherapy and/or surgery are indicated. This often causes severe mutilation, and the prognosis is poor. Ablative surgery, moulage technique with afterloading brachytherapy, and reconstructive surgery, called the AMORE protocol, is developed for residual or recurrent disease after chemotherapy. METHODS: Ablative surgery with preservation of important structures is followed by the embedding of a gutta-percha mold in the created tissue defect. The wound bed is irradiated with Iridium192. Within 1 week, the defect is reconstructed with a muscle transplant. Fifteen children (mean age, 5.7 years) were treated accordingly. RESULTS: All patients were discharged within 4 weeks. Eleven patients are tumor-free, with a mean follow-up period of 2.8 years. No signs of radiation sequelae were observed. CONCLUSION: The preliminary results of this new, combined treatment are encouraging, if the advanced stage of disease is considered.
Subject(s)
Head and Neck Neoplasms/therapy , Rhabdomyosarcoma/therapy , Brachytherapy , Child, Preschool , Combined Modality Therapy , Female , Gutta-Percha , Head and Neck Neoplasms/drug therapy , Head and Neck Neoplasms/radiotherapy , Head and Neck Neoplasms/surgery , Humans , Male , Radiotherapy Dosage , Rhabdomyosarcoma/drug therapy , Rhabdomyosarcoma/radiotherapy , Rhabdomyosarcoma/surgery , Treatment OutcomeABSTRACT
A retrospective study was performed to evaluate the rate of infection directly related to craniotomy. Of 246 craniotomies performed in 1981, 234 could be evaluated. The overall incidence of infection was 8.1% (19 infections in 18 patients). The infection rate was 15.2% after insertion of a ventricular shunt (seven infections after 45 ventriculostomies). Staphylococcus aureus, Staphylococcus epidermidis and Propionibacterium acnes were the most frequent isolated micro-organisms. We recommended a double-blind prospective study to evaluate the possible benefit of antibiotic prophylaxis in craniotomies.
