Edgar Borrero

Bacteriology of 100 consecutive diabetic foot infections and in vitro susceptibility to ampicillin/sulbactam versus cefoxitin

One of the major complications of diabetes mellitus is the occurrence of diabetic foot infection. The polymicrobial nature of diabetic foot infection has been well documented in the literature. In order to avoid amputation of the tissue affected, the ulceration and infec tion must be appropriately diagnosed and treated. This paper describes the microbiologic and clinical features obtained from 100 consecutive diabetic in fected foot patients treated with either cefoxitin or ampicillin/sulbactam.

Peripheral Pseudoaneurysms: An Eleven Year Experience:

In the past two years we have operated on an increased number of patients with peripheral pseudoaneurysm. We have observed increasing numbers of in travenous drug abusers seeking medical care. This trend may be due to the fear generated by drug abusers with the acquired immunodeficiency syndrome. Be cause of the dramatic increase in the number of patients with peripheral pseu doaneurysms, due to these patients and civilian violent injuries, we were prompted to analyze the records of the last eleven years to determine the etiol ogy, sites, and types of repairs. Our eleven-year experience with 50 pseu doaneurysms is reviewed.

Comparison of Cefuroxime and Cefazolin: Prophylaxis Against Infection in Arterial Reconstructive Surgery

A prospective randomized study of 55 patients receiving prophylaxis with cefuroxime versus 55 patients receiving prophylaxis with cefazolin against post operative wound infection was conducted from August 1986, through January 1988. Two of the cefuroxime-treated patients and 8 of the cefazolin-treated patients developed postoperative wound infections (p<0.05). There were no graft infections. Cefuroxime represents an excellent alternative to the presently used cefazolin as prophylaxis against postoperative wound infections in arterial recon structive surgery.

Revascularization Methods in Chronic Intestinal Ischemia—Case Studies

Chronic intestinal ischemia is an uncommon disease clinically, usually due to advanced atherosclerotic stenosis or occlusion of the intestinal arteries without adequate collateral blood flow to the intestine. Standard aortography with lateral views remains the definitive diagnostic procedure. Revascularization by bypass to the celiac artery for one of its branches and the superior mesenteric artery with dacron graft is recommended to avoid infarction of the bowel and its catastrophic consequences. Six patients with chronic intestinal ischemia underwent successful revascu larization. All six intestinal artery bypasses were performed by use of knitted dacron grafts and/or autogenous vein grafts. There were no postoperative com plications or deaths. One patient has subsequently died, fourteen months after discharge, from a massive hemorrhage due to an aortoduodenal fistula. The 5 patients who were still alive are gaining weight, and none has required reopera tion for an occluded graft or has developed bowel necrosis.

Inferior Vena Cava Interruption for the Prevention of Pulmonary Emboli: Advantages, Disadvantages, and Complications:

Pulmonary embolism (PE) in high-risk patients is minimized by inferior vena caval interruption by ligation, plication/clipping, intraluminal filters, or intralu minal balloons. Vena caval filter implantation is the least traumatic of all surgi cal implantation is the least traumatic of all surgical methods of preventing PE. These nonocclusive methods are preferred to minimize the possible sequelae of venous insufficiency. The prevention of septic emboli requires complete liga tion of the inferior vena cava (IVC). The transvenous approach to IVC inter ruption by intraluminal filter is particularly useful in severely ill patients. The Kim-Ray Greenfield filters are at present the most frequently used mo dalities for prevention of fatal PE when intervention is required. In a large ser ies of patients who have had the Greenfield filer implanted, there has been an operative mortality of less than 1%, with an incidence of recurrent emboli of less than 2%, and an incidence of venous stasis sequelae of approximately 20%. In general, this device has greater ease and flexibility of placement with lower mortality and morbidity rates.

Synchronous Aortic Graft-Enteric Fistulae: A Case Report and Review of the Literature

Secondary aortic graft enteric fistulae have been reported since the introduc tion of graft replacement of the abdominal aorta. Synchronous secondary aortic graft enteric fistulae are a very rare complication following abdominal aorta graft replacement. They have occurred between the graft and the duodenum and the ileum, and the duodenum and the cecum. Presented is the first reported case of synchronous secondary aortic graft enteric fistulae involving the duode num and the jejunum.

Spinal Cord Injury Following Abdominal Aortic Surgery: A Case Report

The incidence of spinal cord injury following abdominal aortic surgery is 0.25%.8 Szilagyis world literature search yielded 36 case reports, and he added 8 case reports to that number. In Szilagys series, all of the postoperative cases of spinal cord injury were observed after abdominal aortic aneurysm surgery. The incidence in cases of ruptured aneurysms was ten times greater (5 of 247 or 2%) than that noted in cases of unruptured aneurysms (3 of 1,477 or 0.2%) . No spinal cord injury occurred in the patients operated on for aorto-iliac occlusive disease, and the rarity of occurrence of this complication in aorto-iliac occlusive disease is reflected in the number of cases reported in the literature. 2,3,5,6,9 The lower extremity neurologic deficit may occur with or without bowel and bladder paralysis, and may be temporary or permanent. The object of this paper is to present a case report of spinal cord injury following surgery for aorto-iliac occlusive disease, and a discussion of the pathophysiology of this complication.

Left Hand Hemiplegia Following Right Carotid Endarterectomy

The incidence of stroke in the perioperative period following carotid throm boendarterectomy has been reported to be 1% to 10%. 1,2,3 It is generally ac cepted that neurologic deficits result from temporary cerebral ischemia during carotid occlusion, reperfusion, emboli or carotid artery thrombosis. Contralat eral extremity weakness and parathesis have been reported lasting from one hour to a few days postoperatively. We would like to report a case of complete paralysis of the left hand following right carotid endarterectomy.