IntroductionEnterobacter cloacae infections are common among burn victims, immunocompromised patients, and patients with malignancy. Most commonly these infections are manifested as nosocomial urinary tract or pulmonary infections. Nosocomial outbreaks have also been associated with colonization of certain surgical equipment and operative cleaning solutions. Infections of an aortobifemoral prosthesis, an aortic graft, and arteriovenous fistulae are noted in the literature. To our knowledge, this is the first isolated account of an E. cloacae infection of a femoral-popliteal expanded polytetrafluoroethylene bypass graft.Case presentationA 68-year-old Caucasian man presented with fever and rest pain in the right lower extremity five months after the placement of a vascular expanded polytetrafluoroethylene graft for femoral-popliteal bypass. Computed tomography angiography demonstrated peri-graft fluid that was aspirated percutaneously with image guidance and cultured to reveal E. cloacae. The graft was revised and then removed. The patient completed a six-week course of ceftazidime and is currently without signs of infection. There were no other reports of E. cloacae graft infections in any patients receiving treatment in the same surgical suite within a month of this report.ConclusionIsolated cases of E. cloacae infection of surgical bypass grafts are rare (unique in this setting). Clinicians should have a high index of suspicion for device contamination in such cases and should consider testing for possible microbial reservoirs. Graft removal is required due to the formation of biofilm and the recent emergence of Enterobacteriaceae producing extended-spectrum beta-lactamase in community acquired infections.
Advances in imaging technology and implant technique have led to the resurgent interest and practice of brachytherapy for the treatment of prostate cancer. Brachytherapy is a form of radiation treatment in which radioactive sources are placed directly into the tumor; it offers the advantage of maximizing the radiation dose delivered to the tumor while sparing the adjacent normal tissue. Permanent implants have become an important component of radiation delivery. Interstitial gold radioisotope (Au‐198) implants for prostate cancer were introduced at Baylor College of Medicine in 1965. The rationale for using Au‐198, instead of the two most commonly used radioisotopes, Palladium‐103 (Pd‐103) and Iodine‐125 (I‐125), is discussed, and the Baylor implant technique is compared to that used in other centers. Retrospective review divides the patient population into pre‐ultrasound versus post‐ultrasound eras. Dosimetric calculation and disease control with the Au‐198 seed implant for prostatic cancer are reviewed for the two different eras; toxicity is evaluated in the post‐ultrasound era only. In the pre‐ultrasound era, 510 patients were treated with pelvic lymph node sampling and gold seed insertion of the prostate followed by external beam radiation. In the post‐ultrasound era, 54 patients were treated definitively with ultrasound‐guided transperineal Au‐198 implant followed by external beam irradiation. A small group of 30 patients in the post‐ultrasound era were evaluated for the efficacy of Au‐198 re‐implantation for locally recurrent disease. Semin. Surg. Oncol. 13:406‐418, 1997. © 1997 Wiley‐Liss, Inc.
A 57-year-old female with Hodgkin's lymphoma, diagnosed by a cervical lymph node biopsy and surgically staged laparoscopically, is presented. Staging included a pelvic and para-aortic lymphadenectomy as well as splenectomy. Laparoscopic staging of Hodgkin's lymphoma has not been previously reported. The procedure, its limitations, and potential modifications are discussed.
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