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Biomedical subjects

J C Melo

Publications and source records attributed to J C Melo.

At least 19 recordsLinked to original sources
PubMed1991

A unique inlet [the ascending aorta] for extra-anatomic bypass of infected arterial prostheses.

Infection is the most dreaded complication associated with implantation of a prosthetic arterial graft. The reported incidence of primary graft infection varies from 1.3% to 6.0%, with a mortality rate from this complication as high as 75%. Although remote bypass followed by complete removal of the infected prosthesis has proven to be a satisfactory method of treatment, in certain instances remote bypass alone is not feasible and other modes of surgical treatment must be employed. Such conservative methods of management of infected aorto-iliac-femoral prosthesis sometimes irradicate infection. The only certain cure, however, is obtained by totally removing the graft. And the success of extra-anatomic axillofemoral techniques has led to its extended use. The addition of a cross-limb on an axillo-unilateral femoral graft to form an axillobilateral femoral graft was described by Sauvage and Wood, reasoning that the higher flow rate in the axillary limb of the axillobilateral femoral graft would result in an improved patency rate compared with that of axillounilateral femoral grafts. Additionally, both medial (obturator foramen) and lateral extra-anatomic remote bypass of infected femoral prosthesis have been used, successfully. The current case illustrates the complexity of management, once sepsis occurs. It further focuses on groin, retroperitoneal and bilateral axillo-femoral tract infection with prolonged (apparently innocuous) graft exposure and finally points out the utility of the ascending aorta as an alternative extra-anatomic inlet to perfuse the lower extremities.

Aged↗
PubMed1988

Infectious complications in four long-term recipients of the Jarvik-7 artificial heart.

This article describes the infectious complications that occurred among four of the longest-term recipients of the Jarvik-7 artificial heart. Infection arising from the drive lines, with spread to the mediastinal periprosthetic space, was the major limiting factor in long-term use of the device in these patients. Periprosthetic infections were due to coagulase-negative staphylococci, Staphylococcus aureus, Pseudomonas aeruginosa, and other Pseudomonas species. Other infectious complications incurred by some of the patients included pneumonia, empyema, urinary tract infection, and intravascular line sepsis with Candida. Intensive antimicrobial therapy for prolonged periods seemed to suppress but not to eradicate infection and was accompanied by the appearance of multiresistant bacterial strains. Complications of antimicrobial therapy included diarrhea secondary to overgrowth with Clostridium difficile in two patients. Use of the current device for more than 30 days should be considered extraordinary and should be reserved for patients for whom no other form of life support is available.

Adult↗
PubMed1987

Splenic abscess due to Clostridium septicum in a patient with multiple myeloma.

Solitary abscesses of the spleen may occur as a consequence of septicemia from various septic foci, particularly intra-abdominal sites. A variety of causative organisms, including the clostridia, have been isolated. We have described a patient with multiple myeloma who had a solitary splenic abscess due to Clostridium septicum and who failed to survive despite seemingly appropriate treatment. Clinicians should be alert to this complication, which demands immediate splenectomy and appropriate antibiotic therapy.

Abscess↗
PubMed1984

Acute synovitis caused by an organism of the Rhodochrous taxon.

A 36-year-old man with systemic lupus erythematosus developed synovitis of the right wrist caused by an organism of the Rhodochrous taxon. The capacity of this pathogen to produce a granulomatous inflammatory reaction in human tissues is discussed. The isolate was sensitive to chloramphenicol, gentamicin, carbenicillin and colistin in in-vitro tests and the infection responded promptly to treatment with chloramphenicol.

Actinomycetales↗
PubMed1983

The protean manifestations of Legionnaires' disease.

The protean manifestations of Legionnaires' disease are described in an analysis of 12 sporadic cases. Two forms of the disease have been delineated. One variant (Group A) consisted of six patients who had a mild form of non-progressive pneumonia with minimum extra-pulmonary involvement. Six patients (Group B) were differentiated by rapidly progressive pulmonary infiltrates, severe hypoxia and respiratory failure, plus a higher frequency of band neutrophils and extra-pulmonary manifestations. Particularly notable were evidence of severe myositis (elevated creatinine phosphokinase and lactate dehydrogenase), anaemia, and neurological findings which included alterations in the sensorium, meningitis, and convulsions. Cerebrospinal fluid (CSF) abnormalities were seen frequently in patients with neurological manifestations, and necropsy findings in one patient suggested that the Legionnaires' bacillus was capable of producing a fatal leucoencephalitis. Renal findings included haematuria, proteinuria and oliguric renal failure. Hepatic transaminases (SGPT, SGOT) were elevated in six patients and serum bilirubin was abnormal in five. Alkaline phosphatase values were normal to minimally elevated. The gastrointestinal symptoms commonly considered to be a frequent initial manifestation of Legionnaires' disease were rare in this series. Recommendations for instituting empirical therapy, based upon recognition of a clinical syndrome which should suggest the diagnosis of Legionnaires' disease, are included.

Adolescent↗
PubMed1982

Serratia keratitis transmitted by contaminated eyedroppers.

Serratia marcescens keratitis developed in three patients after keratoplasty. Two patients were using prednisolone sodium phosphate eyedrops and the third was using 0.5% timolol maleate eyedrops. All three cases resolved after treatment with topically and subconjunctivally administered antibiotics. Although S. marcescens was isolated from the outer grooves of the bottletops and from the inner surfaces of the eyedropper caps, it was not cultured from the solutions in the bottles. Moisture collecting in the dead space between the cap and bottle was apparently a culture medium for Serratia. When eyedrops were expressed into the patient's eyes, the eyes were inoculated with Serratia from the contaminated liquid flowing down the eyedropper shaft.

Aged↗
PubMed1981

Branhamella catarrhalis pneumonia: report of two cases and review of the literature.

Branhamella (Neisseria) catarrhalis is a saprophytic inhabitant of the human oropharynx with the capacity to cause infection, particularly in immunodeficient hosts. There have been 2 cases of Branhamella catarrhalis pneumonia reported in the literature. Two additional cases are described and the subject reviewed. An 80-yr-old woman with chronic lymphocytic leukemia presented with left lower lobe pneumonia. Gram stain of transtracheal aspirate revealed intraleukocytic and extraleukocytic gram-negative diplococci, and a beta-lactamase producing strain of Branhamella catarrhalis was cultured. Therapy with erythromycin resulted in resolution of symptoms and eradication of the organism. A 64-ye-old alcoholic man presented with fever and multiple seizures. Chest roentgenogram revealed left lower lobe pneumonia. Cultures of endotracheal aspirate and blood grew a strain of Branhamella catarrhalis sensitive to penicillin. Penicillin treatment resulted in resolution of pulmonary infiltrate and eradication of the organism. The potential for Branhamella catarrhalis to produce pneumonia and the choice of antimicrobial therapy is discussed. It is emphasized that this organism should not be assumed to be a "normal" isolate and that penicillin may be ineffective in the treatment of Branhamella catarrhalis infections.

Aged↗
PubMed1981

Typhoid fever.

Explore the source record for details and available documents.

Humans↗
PubMed1980

Bacteroides fragilis perinephric abscess.

Although urinary tract infection caused by Bacteroides fragilis has been recognized since the turn of the century it is not frequently recognized in clinical practice. Only a small number of significant upper urinary tract infections in which Bacteroides fragilis has had a significant pathogenic role have been reported previously. The use of systemic metronidazole in the treatment of this rare and unusually refractory form of urinary tract infection is described.

Abscess↗
PubMed1980

Splenic abscess.

Fourteen cases of splenic abscess are reported and 159 cases previously cited in the literature are reviewed. The incidence, predisposing factors, pathogenesis, clinical features, bacteriology and radiologic findings are discussed. Infective endocarditis was the most common single antecedent infection. Hemoglobinopathies, non-penetrating abdominal trauma, and gastrointestinal malignancy appear to predispose the spleen to abscess formation. Emphasis is placed on clinical features and radiologic findings to aid practitioners in diagnosing this uncommon but often fatal infection. Also emphasized is the necessity for prompt surgical intervention when splenic abscess is suspected. An approach to the antimicrobial therapy in different clinical settings is outlined.

Abscess↗
PubMed1980

Strongyloidiasis in immunosuppressed hosts. Presentation as massive lower gastrointestinal bleeding.

Two cases of massive lower gastrointestinal hemorrhage in immunosuppressed patients were due to complicated infestation with Strongyloides stercoralis. The very high mortality of disseminated strongyloidiasis may in part be attributed to delays in diagnosis and treatment resulting from the complex life cycle of this nematode. Successful therapy in the cases presented consisted of reduction of corticosteroid dosage, use of thiabendazole in excess of that recommended for uncomplicated infestation, parenterally administered nutrition, multiple transfusion of blood products, and vigorous supportive management. Emphasis is given to proper categorization of patients and measures designed to prevent, detect, and treat hyperinfection in patients in whom immunosuppression is anticipated.

Adult↗