Infected aortic endograft with an unusual microbe, Burkholderia cepacia.

With the growing use of endovascular aortic repair for aortic aneurysm pathology, multiple cases have been reported of associated endovascular graft infections. Explantation of the infected endograft and the revascularization procedure performed should be individualized with attention to the offending organism. We present the cases of two patients who underwent endovascular aortic repair with the same endograft and developed a graft infection with Burkholderia cepacia, a gram-negative organism with low virulence. Both endografts cultured Burkholderia cepacia complex; however, the organisms were genetically tested and found to be separate, unrelated strains. Both patients underwent successful explantation and revascularization procedures without any surgical-related complications to date.

Ligation of Common Iliac Artery Mycotic Aneurysm in a Neonate and Review of the Literature.

BACKGROUND: Mycotic aortoiliac aneurysms in neonates are rare. Surgical treatment has traditionally been the standard of care, but recent case reports have suggested that endovascular management of mycotic iliac aneurysms may also be safe and effective. In this case, we describe successful management of a mycotic aortoiliac aneurysm in a neonate with exploratory laparotomy and ligation of the left common iliac artery. METHODS: A full-term infant boy of uncomplicated delivery was transferred to our institution on day 2 of life after a barium enema concerning for small left colon syndrome. An umbilical artery catheter had been placed for monitoring but was removed before transfer. During his hospital course, he developed left leg edema and fever. He was found to have a mycotic aneurysm of the left common and internal iliac arteries, causing common iliac venous compression. A repeat ultrasound revealed the aneurysm measured a maximum of 12 mm in diameter and 26 mm in length. RESULTS: Treatment was delayed until the patient was clinically stable. He was monitored with serial ultrasounds, which showed no significant increase in aneurysmal size. A review of the literature supported the perception the aneurysm posed an impending risk to the patient. On day 16 of life, the neonate underwent ligation and excision of the left common iliac artery aneurysm. CONCLUSION: Our experience found ligation of the common iliac artery to be safe and effective, establishing that surgical reconstruction is not required.

Traumatic Aorto-Cisterna Chlyi Fistula with Treatment of Aortic Pseudoaneurysm with CT-Guided Thrombin Injection.

BACKGROUND: Only 3 cases of aorto-cisterna chyli fistula have been described in the literature but none with a resulting pseudoaneurysm (PSA). METHODS: A 68-year-old man presented following a motor vehicle collision. Imaging revealed a retroperitoneal hematoma with enhancement of the cisterna chyli, representing an aortic to cisterna chyli fistula. Three days later, computed tomography angiography showed resolution of the fistula, but revealed a PSA. The patient underwent arteriography that confirmed the PSA, and then a computed tomography-guided thrombin injection was performed. Follow-up imaging showed resolution of the PSA. RESULTS: Only 3 cases of aorto-cisterna chyli fistula have been described. We hypothesize that this fistula was caused from his L2 vertebral body fracture, which avulsed the lumbar artery and injured the cisterna chyli. The cisterna chyli provided an outflow tract for the aortic injury. We believe this type of fistula follows a benign clinical course. Aorto-cisterna chyli fistula is rare, and reports point to spontaneous resolution. Our case is unique in that the patient progressed from a fistula to a PSA. Options for treatment of this PSA include covered stent graft, open repair, coil embolization, or thrombin injection. CONCLUSIONS: This case report describes an extremely rare diagnosis and the natural history of this aorto-cisterna chyli fistula. Furthermore, the resulting aortic PSA was successfully treated with computed tomography-guided thrombin injection, which in the appropriate setting, should be considered an acceptable option.

Gluteal Fascial Advancement for Pilonidal Cyst Disease: A 10-year Review.

Elective excision of noninfected pilonidal cysts has historically been plagued by a high rate of complications, such as wound breakdown and recurrence. Debate remains regarding the most effective method of wound closure. We previously reported a small group of patients (n = 17 out of 83 patients) in which a novel technique decreased wound complications and recurrence. The purpose of this article was to build on that prior study by evaluating the utility of the gluteal fascial advancement method to decrease complications over a 10-year period. All patients who underwent elective pilonidal cyst excision from 2008 to 2015 were retrospectively reviewed (n = 150); this was added to the data from 2004 to 2007. Patients were divided into two cohorts: those who underwent elective excision with simple closure (n = 172) and those who underwent bilateral gluteal fascial advancement flaps (n = 61). Primary end points included recurrence and dehiscence. Overall demographic characteristics were statistically comparable between groups. The rate of recurrence was not significantly different between groups. However, wound closure using bilateral gluteal fascial advancement flaps was associated with a significantly lower rate of dehiscence when compared with standard primary closure (12% vs 40%, P < 0.001). The use of bilateral gluteal fascial advancement flaps is a superior method for closing elective pilonidal cyst excisions.

Effects of task interdependence on the relationship between helping behavior and group performance.

The authors examine whether task interdependence moderates the relationship between the helping form of organizational citizenship behavior (OCB) and group performance. In a laboratory study, 62 groups with 3 members each completed a card-sequencing activity in which the level of task interdependence among group members was manipulated. Independent evaluators assessed helping by viewing videotapes of the groups' interactions during the sequencing activities. Performance was measured as a combined function of group speed and accuracy. Two prior field studies reported contradictory results regarding the impact of helping on group performance. Results from this study suggest that task interdependence may explain these results, and that the relationship between helping and group performance depends on the level of task interdependence required of group members.

Organizational citizenship behavior and performance evaluations: exploring the impact of task interdependence.

The influence of task interdependence on the importance attributed to organizational citizenship behavior (OCB) in evaluations of employee performance was investigated in 3 studies. In Study 1,238 undergraduates were exposed to a task interdependence manipulation and a unit-level performance manipulation and provided citizenship ratings. In Study 2,148 master of business administration students were exposed to a task interdependence manipulation and then rated the importance of OCB in their evaluations of employee performance. In Study 3,130 managers rated the task interdependence in their unit of principal responsibility and the importance of OCB in their overall evaluations of employee performance. The results suggest task interdependence may affect the importance attributed to OCB by evaluators. Implications of these results are explored.