Skin and wound infection by rapidly growing mycobacteria: an unexpected complication of liposuction and liposculpture. The Venezuelan Collaborative Infectious and Tropical Diseases Study Group.

OBJECTIVE: To describe 10 patients with skin and soft tissue infection caused by rapidly growing mycobacteria after cosmetic liposuction and liposculpture. DESIGN: Case series. SETTINGS: Eight private geographically separate surgical facilities from a single metropolitan area. PATIENTS: Eight patients with definite and 2 with presumptive cases of skin and soft tissue infection caused by rapidly growing mycobacteria after cosmetic surgery procedures during a 24-month period. Microorganisms were isolated from the purulent drainage obtained from wounds or fistulas in 8 cases and were identified as Mycobacterium fortuitum (3 cases) and Mycobacterium abscessus (5 cases) by routine microbiologic techniques. Acid-fast bacilli were observed on Ziehl-Neelsen-stained smears in the 2 remaining cases, but these ultimately failed to grow. In 2 of the surgical units, no apparent environmental predisposing factors were identified after thorough microbiologic environmental investigation. Clinically, all patients exhibited signs of inflammation, microabscesses, and purulent wound drainage within 24 months of abdominal and/or thigh liposuction or homologous fat tissue injection. INTERVENTION: A combined therapeutic approach including surgical drainage, debridment, and prolonged (>3 months) treatment with combined antimicrobial agents including clarithromycin was used in all cases. RESULTS: Nine of 10 patients responded to the combined therapeutic approach, and no evidence of infection was present during at least 12 months of follow-up. CONCLUSION: To our knowledge, this is the first series of patients with rapidly growing mycobacterial infections to be described after liposuction and liposculpture. Rapidly growing mycobacteria should be included in the differential diagnosis of skin and soft tissue infection after cosmetic surgery.

Fungemias por hansenula anómala en el Hospital Privado Centro Médico de Caracas / Fungemia by hansenula anomala in the Hospital Privado Centro Médico of Caracas

Se revisaron en forma retrospectiva las histórias clínicas de todos los pacientes en los cuales se aisló Hansenula anómala en los hemocultivos realizados en el Laboratorio de Microbiología del Hospital Privado Centro Médico de Caracas, en el lapso de 2 años y medio, comprendido entre agosto 1994 y febrero 1997. De 57 pacientes se obtuvo 64 hemocultivos positivos, aislándose 64 especies de Candida. Hansenula anómala se obtuvo en 15 hemocultivos de 15 pacientes diferentes, representando un 26,3 por ciento del total de pacientes, un 23,4 por ciento del total de las candidas y un 30,6 por ciento de las variedades no albicans. La Candida albicans se aisló en 15 pacientes (26,3 por ciento del total). De los pacientes que presentaron Hansenula anómala en sus hemocultivos, el 100 por ciento cumplieron con criterios clínicos de severidad. El rango de edad estaba comprendido entre 1 mes y 76 años, con una media de 43, de los cuales 6 eran masculinos y 9 femeninos. De este grupo de pacientes, 12 ingresaron con patología abdominal, siendo intervenidos quirúrgicamente 10 de estos. De los tres pacientes restantes, dos ameritaron cirugía no abdominal. Todos los pacientes recibieron antibióticos de amplio espectro, nutrición parenteral total y le fue colocado catéteres centrales. Nueve pacientes (60 por ciento) tuvieron criterios de sepsis. Los días de hospitalización oscilaron entre 7 y 101 días, con un promedio de 37. Doce pacientes ameritaron ingreso a la Unidad de Terapia Intensiva. Se inició Anfotericina B en 8 pacientes, con buena respuesta en el 100 por ciento. Seis pacientes recibieron como terapia inicial Fluconazol: 2 con respuesta satisfactoria; 1 fallecido no relacionado con la infección por Hansenula anómala y los tres restantes ameritaron cambio a Anfotericina B. Un paciente no recibió tratamiento antifúngico desconociéndose su evolución.

Dry eye in Waldenström's macroglobulinemia. Improvement after systemic chemotherapy.

Waldenström's macroglobulinemia is an uncommon cause of dry eye. We describe a case of dry eye associated with Waldenström's macroglobulinemia that responded poorly to substitutive topical treatment but improved spectacularly in response to systemic chemotherapy. As far as we know, no similar case has been reported.

Platelet function in diabetic retinopathy: levels of beta-thromboglobulin and platelet factor 4.

Altered platelet function has been reported in diabetic patients. This article reports plasma levels of beta-thromboglobulin and platelet factor 4 as measures of in vivo platelet activity in diabetic and control groups. Both beta-thromboglobulin and platelet factor 4 were significantly higher in diabetics than in controls (p < 0.01). The levels observed were not significantly affected by age, sex, diabetes type or whether the diabetic had nonproliferative or proliferative retinopathy, but beta-thromboglobulin levels were significantly higher in diabetics of less than 10 years standing than in those who had suffered diabetes for over 20 years (p < 0.05).

Bilateral metastatic endophthalmitis in diabetics.

A case of bilateral metastatic endophthalmitis in a diabetic patient is presented. Most cases from the literature are secondary to fungal sepsis, but few cases of metastatic bacterial endophthalmitis have been reported. In this diabetic patient urine and blood cultures were negative for fungi and positive for Escherichia Coli. The outcome was disappointing, the enucleation of both globes being necessary. The aim of the report is to outline that metastatic endophthalmitis should be counted among the possible complications of bacterial sepsis, especially in diabetics because of their susceptibility to infection.

Ocular penetration and pharmacokinetics of cefotaxime: an experimental study.

Cefotaxime levels in the cornea and the aqueous humour were assayed after local topical application and subconjunctival injection in healthy and infected corneas. The results in infected corneas were analysed pharmacokinetically. The absorption and elimination of cefotaxime within 2 hours after topical administration are adequately predicted by a two-compartment model in which one compartment represents the cornea and the other the aqueous humour, with the elimination taking place from the latter. The transfer coefficient kc (cornea-aqueous) was estimated as 1.452 h-1 and the return transfer coefficient kca (aqueous-cornea) as 0.287 h-1. After subconjunctival injection the levels measured exhibit bi-exponential kinetics, with the apparent absorption constant Ka = 3.816 h-1.

Treatment of diabetic neovascular glaucoma by panretinal ablation and trabeculectomy.

The efficacy of treating diabetic neovascular glaucoma by panretinal cryotherapy and trabeculectomy was studied over post-operative periods of 6-24 months in 26 selected eyes (8 acute cases and 18 chronic cases). The only complications attributable to surgery were slight hyphemas. Mean pre-operative intraocular pressure (IOP) among the acute cases was 48.8 +/- 9.9 mmHg. After 1 year, IOP was under control (IOP less than or equal to 22 mmHg) in 6 eyes (75%) (2 patients needed hypotensive drugs and another required surgery again). Among the chronic cases, pre-operative IOP was 30.1 +/- 2.1, while a year after surgery IOP was under control (IOP less than or equal to 22 mmHg) in 14 patients (77%) (5 of these needed hypotensive medication and 2 a second operation). The visual acuity (VA) of 66% of the chronic cases was unaltered a year after surgery. The VA of 63% of the acute cases was better a year after surgery. The VA of the 8 patients re-examined 2 years after surgery had deteriorated in spite of their IOP being under control.

Natural evolution of massive vitreous hemorrhage in diabetic retinopathy.

A study of 131 eyes with massive vitreous hemorrhage of diabetic origin showed that 3 months after the hemorrhage visual acuity had improved in 34 eyes (25.9%), was unchanged in 82 (62.6%), and had worsened in 15 (11.4%). The number of eyes improving between 3 and 6 months post-hemorrhage was the same as the number whose visual acuity worsened, 19 (14.5%). After 6 months, the proportion of worsening eyes was much greater than that of improving eyes, so that 2 years post-hemorrhage, 48.8% of the 86 eyes remaining in the study had visual acuity of below hand-movements standard, and 29.1% visual acuity better than hand-movements standard, as against respectively 22.1% and 38.2% of the original 131 eyes 6 months post-hemorrhage.

[Calcifications in leukokorias: ultrasonic study]. / Calcifications dans les leucocories: étude échographique.

We have performed an ultrasound study of 46 eyes with Leucocoria. The results obtained demonstrate that 20 eyes (43.5%) were affected by retinoblastoma. Of these, 17 eyes (85%) showed calcifications and 3 eyes (15%) did not show calcifications. In the remaining 26 eyes, in 6 cases there were intraocular calcifications, and in two of these the calcifications were found within the pathological intraocular mass showing retinoblastoma. The eyes with intraocular calcifications were diagnosed as: uveitis, retrolental fibroplasia, Coats disease, retinal dysplasia. Because of these, we conclude that, although the existence of calcifications is a meaningful datum, there are uncalcified retinoblastomas and calcifications in entities other than retinoblastoma.