Prise en charge chirurgicale des gynécomasties dans le service de chirurgie plastique de Strasbourg (à propos de 71 patients opérés de 1999 à 2009)

STRASBOURG-Medecine (674822101) / SudocSudocFranceF

Infections following the application of leeches: two case reports and review of the literature

<p>Abstract</p> <p>Introduction</p> <p>Since the 1980s, leeches have been ingeniously used in the management of venous flap congestion. The presence of anticoagulative substances in their saliva improves the blood drainage. Their digestive tract contains several bacterial species, the main ones being <it>Aeromonas hydrophila</it> and <it>Aeromonas veronii</it> biovar sobria, which contribute to the digestion of ingested blood. These bacteria can be the cause of infections.</p> <p>Case presentation</p> <p>We report two cases of septicemia related to <it>Aeromonas veronii</it> biovar sobria that presented after leeches had been applied to congested transverse rectus abdominis myocutaneous flaps for delayed mammary reconstructions.</p> <p>Patient number 1 was a 55-year-old Caucasian woman who underwent a delayed breast reconstruction procedure. On the sixth postoperative day she showed a clinical presentation of septicemia. <it>Aeromonas veronii</it> biovar sobria was identified in the patient’s skin and blood bacteriological samples. Her fever ceased after 4 days of antibiotic treatment.</p> <p>Patient number 2 was a 56-year-old Caucasian woman who underwent a delayed breast reconstruction procedure. On the seventh postoperative day we noticed that she showed a clinical presentation of septicemia. <it>Aeromonas veronii</it> biovar sobria was identified in the patient’s blood cultures and local bacteriological samples. An antibiogram showed resistance to amoxicillin/clavulanic acid. Her fever ceased on the eleventh postoperative day after 4 days of antibiotic treatment.</p> <p>Conclusion</p> <p>The rate of infection after application of leeches is not negligible. The concentration of <it>Aeromonas</it> inside the digestive tracts of leeches largely decreases when the patient is under antibiotic therapy. These germs are sensitive to third-generation cephalosporins and fluoroquinolones and resistant to amoxicillin/clavulanic acid. We recommend preventive treatment based on classical measures of asepsis and on oral antibioprophylaxy with a fluoroquinolone during the whole period of treatment by leeches.</p

Incidence and risk factors for thromboembolic events in pediatric-onset inflammatory bowel disease: A French population-based study

International audienceIntroduction: Patients with inflammatory bowel disease (IBD) are at higher risk of thromboembolic events (TE). In pediatric-onset IBD, more data on incidence and risk factors of venous (VTE) and arterial events (ATE) at the population level are needed to guide thromboprophylaxis.Methods: All patients aged ≤ 16 years diagnosed with Crohn's disease (CD) or ulcerative colitis (UC) between 1988 and 2011 in the prospective EPIMAD population-based registry were followed until 2013. Every TE occurring during the follow-up period was included.Results: A total of 1,344 patients were included: 1,007 with CD and 337 with UC, and a median diagnosis age of 14.3 years. After a median follow-up of 8.3 years, 2 (0.15 %) ATE and 15 (1.1 %) VTE occurred at median age of 20.4 years. The global incidence rate of thromboembolic events was 1.32 per 1000 person-years. Periods of active disease (HR=8.4, p = 0.0002), the 3-month-period following surgery (HR=16.4, p = 0.0002) and hospitalization (HR=21.7, p &lt; 0.0001) were found to be associated with an increased risk of VTE. A lower rate of VTE was found in patients treated with 5-aminosalicylates (HR=0.1, p = 0.002).Conclusion: The risk of TE was low in this population. VTE were strongly associated with active disease, surgery and hospitalization