ABSTRACT
Primary mucosal melanoma is a rare disease, with a worse prognosis than cutaneous melanoma. We present a patient with primary melanoma of the stomach and small intestine, with good outcome after radical surgical excision and adjuvant ipilimumab therapy.
Subject(s)
Gastrointestinal Neoplasms/diagnosis , Melanoma/diagnosis , Aged, 80 and over , Antineoplastic Agents, Immunological/therapeutic use , Chemotherapy, Adjuvant/methods , Female , Gastrectomy/methods , Gastrointestinal Neoplasms/pathology , Gastrointestinal Neoplasms/therapy , Humans , Ipilimumab/therapeutic use , Melanoma/pathology , Melanoma/therapy , Neoplasm Recurrence, Local/pathology , Neoplasm Recurrence, Local/therapy , Stomach Neoplasms/diagnosis , Stomach Neoplasms/pathology , Stomach Neoplasms/therapyABSTRACT
From 1,246 specimens collected from 13 Greek hospitals, 266 vancomycin-resistant enterococci strains were isolated from 255 patients (20.5%). The VanA phenotype was present in 82 (30.8%) strains, the VanB phenotype in 17 (6.4%) strains, the VanC1 phenotype in 152 (57.1%) strains, and the VanC2/C3 phenotypes in 15 (5.6%) strains. When only VanA and VanB phenotypes were considered, the overall prevalence was 7.5%. Eighty-six isolates exhibiting the VanA or VanB phenotype were analyzed by pulsed-field gel electrophoresis (PFGE), and 46 PFGE groups were found.
Subject(s)
Enterococcus faecalis/genetics , Gram-Positive Bacterial Infections/epidemiology , Anti-Bacterial Agents/pharmacology , Bacterial Proteins/genetics , Electrophoresis, Gel, Pulsed-Field , Enterococcus faecalis/drug effects , Greece/epidemiology , Hospitals, District , Hospitals, University , Humans , Molecular Epidemiology , Peptide Synthases/genetics , Random Allocation , Vancomycin/pharmacology , Vancomycin Resistance/geneticsABSTRACT
OBJECTIVE: To determine the frequency and type of nosocomial infections (NIs) (especially surgical-site infections [SSIs]), risk factors, and the type and duration of antibiotic use among surgical patients in Greek hospitals. DESIGN: Two point-prevalence studies. SETTING: Fourteen Greek hospitals. PATIENTS: Those in the hospitals during two prevalence surveys undergoing surgery during their stay. RESULTS: In the 1999 survey, 129 of 1,037 surgical patients had developed 148 NIs (14.3%). A total of 1,093 operations were registered, and 49 SSIs (4.5%) were found. In the 2000 survey, 82 of 868 surgical patients had developed 88 NIs (10.1%). A total of 902 operations were registered, and 38 SSIs were detected (4.2%). The median length of stay (LOS) for surgical patients without SSI was 10.0 days (range, 1-19 days); for patients who developed SSI it was 30 days (range, 1-52 days; P < .001). The median LOS prior to surgery for patients without SSI was 1 day (range, 0-4 days); for patients who developed SSI it was 3 days (range, 0-7.5 days; P < .001). Among 30 possible risk factors studied, wound class, LOS prior to surgery, and central venous catheterization were independent predictors of SSI. Median durations of prophylactic antibiotic therapy were 4 days (range, 1-14 days) and 6 days (range, 1-16 days) in the 1999 and 2000 surveys, respectively. CONCLUSION: Surgical patients in Greek hospitals suffered higher rates of SSI than did surgical patients in other developed countries while prophylactic antibiotics were used excessively.
