Extensive sino-orbital zygomycosis after heart transplantation: a case report.

BACKGROUND: Zygomycosis is an opportunistic fungal infection mainly affecting patients with diabetes mellitus, immunodeficiency, and malignancies. The majority of cases in which it has been reported as a posttransplantation complication have been after renal or liver transplantation. There are few instances of rhino-sinusitis and orbital mucormycosis complicating heart transplantation. CASE REPORT: A 38-year-old diabetic man who had undergone heart transplantation returned to the transplantation follow-up clinic 20 days after a successful operation with unilateral periorbital swelling, nasal discharge, and multiple cranial nerve dysfunctions. Multidisciplinary investigations resulted in detection of mucormycosis in the paranasal sinuses and the orbital space, as well as a thrombosis of the cavernous sinus. Surgical ablation of the infected parts, along with antifungal treatment and adjustment of immunosuppressive maintenance, restricted extension of the craniofacial involvement. Allograft function remained undisturbed. CONCLUSION: Early detection of opportunistic infections in transplant recipients plays a big role in preventing dissemination. Fungal infections, including zygomycosis, should be considered for recipients, especially those with risk factors, such as diabetes, who present with local unusual manifestations. Sinonasal and orbital mucormycosis, if diagnosed in timely fashion, can be managed to reduce mortality. Although devastation of one-side facial and ophthalmic structures was inevitable in this case, the overall outcome was acceptable.

Management of femoral artery pseudo-aneurysms in Iran: a single centre report of 50 cases.

The aim of this study was to review the aetiology and surgical technique of treatment of all femoral artery pseudo-aneurysms that had presented to our centre during the previous 9 years and to compare the results of infected femoral artery pseudo-aneurysms and other kinds of pseudo-aneurysm. This retrospective case-note study consists of all femoral pseudo-aneurysms that have been managed in Sina hospital from 1996 to 2005. The intravenous injection of drugs (n = 26), arterial access for angiography (n = 17), trauma (n = 6) and vasculitis (n = 1) were the causes of pseudo-aneurysms. Surgical repair was indicated for all patients; however, routine surgical repair techniques were modified in some patients. Two deaths and one amputation occurred in intravenous drug abusers. The most frequent cause of femoral artery pseudo-aneurysm formation in our hospital is intravenous injection of drugs, which is associated with higher mortality and morbidity than other causes. In contrast to previous reports, our experience shows that triple vessel ligation (common, superficial and deep femoral arteries) can be a safe treatment for infected femoral artery pseudo-aneurysms. In addition, our results did not show the safety of common femoral artery ligation as a treatment of choice. However, it is recommended, due to the better results of elective extra-anatomic bypass than emergent extra-anatomic bypass. Repair of post-angiographic pseudo-aneurysms by interrupted sutures or patch angioplasty is associated with good results. Surgical repair of traumatic pseudo-aneurysms should be determined per case and can vary from local control to extra-anatomic bypass.