Characteristics of infections in patients undergoing staged implantation for sacral nerve stimulation.

OBJECTIVES: To review clinical and surgical factors in patients who have undergone staged sacral nerve stimulator implantation and to determine whether there are any identifiable risk factors for infection. METHODS: A retrospective chart review was performed on 76 consecutive patients undergoing staged implantation for sacral nerve stimulation for voiding dysfunction. Patients with postprocedural wound infections (after Stage 1 or Stage 2) were compared with those without infections with regard to demographic factors and surgical characteristics, such as operative time and duration of exposed lead wire. Organisms cultured were also documented. RESULTS: Lead infection occurred in 9 of 76 patients (12%). All cultures grew Staphylococcus aureus. Of 9 patients with lead infection, 6 had organisms sensitive to their perioperative antibiotic. Forty-five patients had an implantable pulse generator implanted, and 5 infections occurred (11%). Four cultures grew S. aureus (all sensitive to the perioperative antibiotic given), whereas one grew Pseudomonas. The only significant difference in clinical/surgical characteristics between infected and noninfected patients was a longer operative time for Stage 2 in infected patients. In addition, 3 patients with infection had one or more known risk factors for wound infection (steroid use, severe psoriasis, recurrent skin abscess). CONCLUSIONS: Apart from known risk factors for surgical wound infections, the only variable we could identify that might increase the risk for infection is a longer operative time for Stage 2. S. aureus was the organism most commonly cultured. Often it was sensitive to the perioperative antibiotic prophylaxis.

Clear cell papulosis in Hispanic siblings.

BACKGROUND: Clear cell papulosis is a rare condition that has been reported in 14 children, all but 1 of whom are of Asian descent. It was first described in 1987 and is thus named because of the presence of clear cells in the epidermis. OBSERVATION: We describe the cases of 3 Hispanic children in the United States with clear cell papulosis. All 3 patients presented with multiple grouped, oval, hypopigmented macules and flat papules in the suprapubic area and trunk. Histopathologic examination revealed characteristic clear cells within the basal layer and Malpighian layer. CONCLUSIONS: Clear cell papulosis is a unique entity with most cases reported in patients of Asian heritage. The characteristic cells have histologic and immunohistochemical similarities to Paget cells and Toker clear cells of the nipple, although the exact relationship to these cells is not clear. The natural history of clear cell papulosis is unknown; thus, continual surveillance for development of extramammary Paget disease is suggested.