Necrotizing surgical site infection after tension-free vaginal tape
OBSTETRICS AND GYNECOLOGY
Authors: Connolly, TP
Abstract
BACKGROUND: Infectious morbidity after tension-free vaginal tape (FVT) treatment of urinary stress incontinence may be a potential concern. CASE: A 53-year-old obese woman with a 7-year history of urinary incontinence consented to TVT placement. Two days after discharge the patient presented with suspected cellulitis. Dicloxacillin, ciprofloxacin, ampicillin/sulbactam, and metronidazole were ineffective. Removal of the tape, surgical debridement, dressing changes, ceftriaxone, and clindamycin followed by levofloxacin and metronidazole, repeat wound debridement, and vacuum assisted closure were required. Frozen section revealed gangrenous soft tissue with areas of skin necrosis, but no fasciitis. CONCLUSION: This is the first case of necrotizing surgical site infection after TVT placement. Infectious morbidity risks need to be considered in these procedures. (C) 2004 by The American College of Obstetricians and Gynecologists.
Supravalvular aortic stenosis associated to infectious endocarditis and cerebral vascular disease in a patient with Williams-Beuren Syndrome
ARCHIVOS DE CARDIOLOGIA DE MEXICO
Authors: De Rubens Figueroa, Jesus; Marhx, Alfonso; Lopez Terrazas, Javier; Palacios Macedo, Alexis
Abstract
The Williams-Beuren syndrome is a rare genetic disease characterized by: (a) typical facial features; (b) psychomotor retardation with a specific neurocognitive profile; (c) cardiovascular condition and (d) likely transient hypocalcemia in infancy. The objective of this study was to describe the clinic evolution and diagnosis of patient with this syndrome that was associated with endocarditis caused by Streptococcus parasanguis in the ascending aorta and an aneurism located in the fronto-temporal area, which produced a parenchymal hematoma in the left lobe, and subarachnoid hemorrhage. He was treated with ceftriaxone and dicloxacillin. Then we proceeded to correct the aneurysm and perform vegetation resection in aortic arteries with supravalvular aortic stenosis correction. The evolution after one year has been favorable and is currently without neurologic sequelae. A 5-year-old male patient presented a diagnosis of supravalvular aortic stenosis. After cardiac catheterization was performed, he presented a fever and right side paresis. The echocardiogram showed multiple vegetations in the ascendant aortic arch and the supraortic arteries. The blood cultures reported S. parasanguis. The magnetic resonance showed a subarachnoid hemorrhage with an aneurysm and a hematoma. (C) 2014 Instituto Nacional de Cardiologia Ignacio Chavez. Published by Masson Doyma Mexico S.A. All rights reserved.