Extirpative Cultures Reveal Infectious Pubic Bone Osteomyelitis in Prostate Cancer Survivors With Urinary-Pubic Symphysis Fistulae (UPF).

OBJECTIVE: To examine the infectious features of patients with urinary pubic symphysis fistula (UPF) and their association with osteomyelitis. METHODS: We conducted a review of our quality improvement database for 36 patients with UPF undergoing bone resection and extirpative surgery from October 2012 to January 2019. An assessment of bone and urine cultures was carried out along with surgical, radiologic, and demographic data. We analyzed descriptive statistics and used Fisher Exact Tests and unpaired Welch t tests to assess for associations with positive bone cultures. RESULTS: In our cohort, 33 patients (91.7%) had positive bone cultures with the 3 most common organisms being candida (22.0%), enterococcus (18.0%), and pseudomonas (10.0%). There was a correlation between positive preoperative urine culture and positive bone culture (P <.01), with 63.0% of those with positive urine cultures growing the same organism on bone culture. CONCLUSION: In this series, 91.7% of patients undergoing extirpative surgery for UPF at our institution have positive bone cultures at time of pubic bone debridement. Additionally, we demonstrate a statistically significant correlation between positive urine cultures and positive bone cultures in these patients. This supports the need for a multidisciplinary approach including infectious disease, orthopedic surgery and reconstructive urology in order to address this complex clinical condition.

Xanthogranulomatous pyelonephritis with nephrocutaneous fistula due to Providencia rettgeri infection.

We describe what is to our knowledge the first case of xanthogranulomatous pyelonephritis combined with nephrocutaneous fistula caused by Providencia rettgeri. Surgical extirpation including nephrectomy and fistulectomy was successfully performed. The strain was identified by 16S rRNA gene sequencing in both renal tissue and pus culture from the fistula.

Cryopreserved arterial homografts vs silver-coated Dacron grafts for abdominal aortic infections with intraoperative evidence of microorganisms.

OBJECTIVE: The gold standard for the treatment of abdominal aortic infections remains controversial. Cryopreserved arterial homografts and silver-coated Dacron grafts have both been advocated as reasonable grafts. Direct clinical or experimental comparisons between these two treatment options have not been published before. This study compared cryopreserved arterial homografts and silver-coated Dacron grafts for the treatment of abdominal aortic infections in a contaminated intraoperative field. METHODS: From January 2004 to December 2009, 56 patients underwent in situ arterial reconstruction for an abdominal aortic infection. Patients with negative intraoperative microbiologic specimens were excluded. We compared 22 of 36 patients (61%) receiving cryopreserved arterial homografts (group A) vs 11 of 20 (55%) receiving a silver-coated Dacron graft (group B). Primary outcomes were survival and limb salvage; secondary outcomes were graft patency and reinfection. Direct costs of therapy were also calculated. RESULTS: Thirty-day mortality was 14% in group A and 18% in group B (P >.99), and 2-year survival rates were 82% and 73%, respectively (P = .79). After 2 years, limb salvage was 96% and 100%, respectively (P = .50), whereas graft patency was 100% for both groups. Major complications were an aneurysmal degeneration in group A and graft reinfection in group B (n = 2). Median direct costs of therapy (in US $) were $41,697 (range, $28,347-$53,362) in group A and $15,531 (range, $11,310-$22,209) in group B (P = .02). CONCLUSIONS: Our results show comparable effectiveness between cryopreserved arterial homograft and silver-coated Dacron graft in the contaminated operative field with respect to early mortality and midterm survival. Graft-inherent complications, aneurysmal degeneration for homografts, and reinfection for silver graft, were also observed. The in situ arterial reconstruction with homografts is nearly three times more expensive than with silver graft.

[Fistula between the urinary bladder and large bowel due to sigmoid tuberculosis]. / Fistulisation vésicale d'une tuberculose sigmoïdienne.

A sigmoid tuberculosis is very rare. We report a case of sigmoid pseudotumoral tuberculosis with a fistulization into the urinary bladder in a 10-year-old girl. The diagnosis of tuberculosis was made by histopathological examination of the surgical specimen after segmental colectomy. Surgery completed by antitubercular chemotherapy gave a good result.

Clostridium septicum and malignancy.

BACKGROUND: Clostridium septicum is known to be associated with malignancy or immunosuppression. It has a variable clinical presentation and is associated with a high mortality. The aim of the present study was to review the experience at St George Hospital, Sydney, over a 10-year period, with particular reference to the association of this condition with colorectal cancer. METHODS: The records of five patients with blood culture-proven Clostridium septicum infection, among a larger group of 31 patients with clostridial infections, presenting to St George Hospital between 1990 and 2000 were reviewed. RESULTS: Associated malignancy was found in four (80%) of the patients with Clostridium septicum infection. Two infections were related to colorectal cancer, two to haematological malignancies and one to radiation-induced recto-urethral fistula. Those patients who had colorectal cancer presented with septicaemia and vague abdominal symptoms. CONCLUSIONS: Clostridium septicum infections have a strong association with malignancy. When this infection occurs without an obvious underlying aetiology there should be a high index of suspicion about associated malignancy. In the absence of haematological malignancy a colonoscopy is warranted. Early diagnosis and aggressive treatment is essential in order to improve prognosis.

Internal fistula formation: an unusual complication of mycetoma.

This paper reports 2 hitherto undescribed complications of mycetoma, urinary extravasation and expectoration of mycetoma grains due to cutaneo-urethral and cutaneo-pleuro-bronchial fistulae, respectively. The first patient had an infection with Actinomadura madurae which started in the foot and had spread progressively to involve the whole limb, anterior abdominal wall, perineum and urethra. The second patient had Madurella mycetomatis infection of the hand and, in spite of extensive treatment, the infection had spread to the axilla, chest wall, lung and bronchial tree. Both patients died of the sequelae of these complications. The pathogenesis of these unusual complications is discussed.

[Uretero-intestinal fistulas]. / Fistules urétéro-intestinales.

Reporting their experience of these seldom described fistulas, the authors specify their etiological modalities, mainly the infected stones, the multiple clinical symptomatology and specify the various locations between the ureter and the enteral duct from the duodenum to the anal channel at any point.