Transposition of greater omentum in deep sternal wound infection caused by methicillin-resistant Staphylococci, with differing clinical course for MRSA and MRSE.

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) and Staphylococcus epidermidis (MRSE) are an increasing problem in deep sternal wound infections (DSWI) after cardiac surgery. METHODS: Between 2005 and 2009, recalcitrant methicillin-resistant Staphylococcus was found in 21 patients with complicated DSWI, and a transposition of the greater omentum (TGO) was finally performed. A positive microbial culture at the time of procedure was present in all patients. The hospital course was reviewed discretely for MRSA and MRSE. RESULTS: Median patient age was 72.3 years (range 60.8-79.7); 76 % of patients were male. Time from the first sternal revision until consecutive open wound therapy due to re-infection and total hospital stay was longer for MRSA compared to MRSE (38 vs. 14 days, P = 0.003, and 141 vs. 91 days, P = 0.007, respectively). The period from cardiac surgery to TGO was likewise prolonged for MRSA (78 vs. 55 days, P = 0.045), whereas in-hospital mortality and one-year mortality rate did not differ. CONCLUSION: TGO remains a good treatment option for DSWI type IV. Microbial findings determine the clinical course; nevertheless in-hospital mortality remains low for both MRSA and MRSE infection.

Catamenial pneumothorax.

Catamenial pneumothorax is a rare entity of spontaneous, recurrent pneumothorax occurring in synchrony with the menstrual cycle. The etiology is not completely known, but in most cases it is associated with thoracic endometriosis and/or diaphragmatic fenestrations. We report a case of a 35-year-old woman with three episodes of catamenial pneumothorax. The surgical findings were thoracic endometriosis and diaphragmatic holes. She underwent resection of the affected part of the diaphragm and pleurodesis via a mini-thoracotomy and videothoracoscopy assistance.

A comparative study of invasive and oscillometric methods of arterial blood pressure measurement in the anesthetized rabbit.

INTRODUCTION: The aim of this project was to evaluate the reliability and accuracy of direct, using the central ear artery (CEA), and oscillometric, using limb-cuffs, methods of arterial blood pressure (AP) measurement in the anesthetized rabbit. METHODS: New Zealand rabbits were anesthetized using a xylazine-ketamine-isoflurane protocol. Using the abdominal aorta (ABA) as direct "gold standard" for AP measurements, ABA pressure readings, via femoral artery catheterization, were compared with those made simultaneously from the ascending aorta after median sternotomy. Thereafter, direct CEA as well as forelimb-(FL) and hindlimb-(HL) cuff oscillometric readings were compared with those made simultaneously from ABA. RESULTS: The blood pressure in the ABA correlated with that from ascending aorta. Furthermore, CEA correlated with the ABA readings. Nevertheless, at high pressures, their divergence from "true" pressure tended to increase. Oscillometric readings at the FL site correlated well with "true" pressure while those at the HL site did not. Their divergence tended to increase at high pressures when using the FL site, while it varied when using the HL site. The accuracy of measurements was moderate for the FL site while poor for the HL site. DISCUSSION: Our results suggest that the CEA can be readily used with high reliability and accuracy for direct AP measurements in the anesthetized rabbit. On the other hand, the FL-cuff oscillometric method should only be used for the evaluation of AP at low and normal pressure ranges.