Prevalence, microbiological features, and risk factors for periprosthetic joint infections in oncologic patients following tumor resection and megaprosthetic reconstruction

Periprosthetic joint infection (PJI) after tumor resection and megaprosthetic reconstruction of bone defects is a common complication. The purpose of this study was to evaluate the prevalence of these infections, assess their microbiological profile, and identify perioperative risk factors for these complications. A single-center retrospective cohort study was conducted including 273 patients, who had undergone musculoskeletal tumor resection and megaprosthetic reconstruction. The medical records of these patients were screened for several parameters, including development of postoperative PJI. All reviewed parameters were compared between patients who developed infections and those who did not. Infection developed in 36 patients, indicating an incidence of 13.2 % (95 % confidence interval (CI): 9.4 %–17.8 %). The most common isolated pathogens in patients with PJI included coagulase-negative staphylococci (n=20; 56 %), followed by Staphylococcus aureus (n=9; 25 %). Multivariable logistic regression analysis indicated that development of PJI was associated with diabetes (odds ratio (OR): 7.64; 95 % confidence interval (CI): 1.36–42.7; p=0.020), a lower albumin level (OR: 0.10; 95 % CI: 0.02–0.49; p=0.005), and a prolonged duration of surgery (OR: 4.30; 95 % CI: 1.08–17.1; p=0.038). Our results indicate that certain parameters such as diabetes, low albumin levels, and prolonged duration of surgery are associated with a higher risk of infection.</p

Isolated Cerebral Mucormycosis Caused by Lichtheimia Species in a Polytrauma Patient

Isolated post-traumatic cerebral mucormycosis represents an extremely rare and severe disease. A case of isolated cerebral mucormycosis infection caused by Lichtheimia spp. in a 21-year-old multi-trauma patient is presented. The patient was hospitalized in the intensive care unit and underwent craniotomy due to brain injuries. Two weeks following the initial procedure, pus drained from the surgical wound was microscopically examined and cultured, yielding Lichtheimia spp. Imaging showed parietal, temporal and frontal abscesses at the right side. The patient was commenced on amphotericin B and underwent surgical debridement, while histopathological examination of the affected tissue demonstrated broad, aseptate hyphae, findings typical for mucormycetes. The patient passed away due to heavy traumatic injuries after 2 months. It is speculated that direct inoculation was the portal of entry for infection, and that high steroid use for 2 weeks following inoculation contributed to the severity of infection that developed. Isolated cerebral mucormycosis in immunocompetent hosts is an extremely rare, but severe disease. Diagnosis is established through direct microscopy, histopathology and/or cultures. PCR-based techniques are useful either to detect mucormycetes in tissues, especially when cultures are negative, or to accurately identify the fungi grown in cultures at the species level. A high suspicion index, especially in the necrotic lesions of traumas, is of the utmost importance for early diagnosis. Appropriate surgical debridement, as well as antifungal therapy, including amphotericin B, represents the treatment of choice. © 2022 by the authors. Licensee MDPI, Basel, Switzerland

Skeletal Infections Caused by Coccidioides Species

Background: Coccidioidomycosis represents an endemic and challenging disease, with rare extrapulmonary manifestations. The present review of all published cases of core and extremities osseous coccidioidomycosis aims to describe epidemiology, patients’ characteristics, symptoms as well as medical and surgical treatment options and their effectiveness. Methods: A thorough review of all published skeletal core and extremity infections due to Coccidioides species was conducted. Information regarding demographics, causative fungus, antifungal treatment (AFT), surgical management as well as the infection outcome was recorded. Results: A total of 92 cases of Coccidioides spp. skeletal infections were recorded in 87 patients. The patients’ mean age was 35.3 years. The most common site of infection was the spine (82.6%), followed by the foot (6.5%), while the predominant symptom upon presentation was pain (29.9%). Immunosuppressive conditions and/or medications were observed in 21 patients (24.1%). Regarding imaging methods, indicating diagnosis, plain X-rays or CT scans were performed in most patients (50.6%), followed by magnetic resonance imaging (MRI) (47.1%). Most cases were diagnosed through histopathology (62; 71.3%), followed by serology testing (36; 42.4%) and by cultures (35; 40.2%). In 32 cases (36.8%), Coccidioides immitis was cultured, while in the remaining 55 cases (63.2%) the fungus was not further characterized. Regarding AFT, amphotericin B was the preferred agent (52.9%), followed by fluconazole (43.3%). In most cases (78.2%) surgical treatment was also performed. Treatment was successful in 80.5% of cases. Conclusions: Skeletal core and extremity infections due to Coccidioides spp. represent a severe disease. With the available data, the combination of prolonged proper AFT with surgical intervention seems to be the optimal current therapeutic approach. © 2022 by the authors. Licensee MDPI, Basel, Switzerland

Evolution of robot-assisted general surgery in Greece and Cyprus

Robot-assisted general surgery in Greece and Cyprus coincided with a devastating financial crisis. We hereby present the evolution of the technology in this unwelcoming environment, using data provided to us by the official distributor of the Da Vinci platform in these countries. © 2018, Springer-Verlag London Ltd., part of Springer Nature

Dyspnea caused by a giant retroperitoneal liposarcoma: A case report

Liposarcomas are the most common soft tissue tumors with various histological subtypes. They usually appear in the retroperitoneal region of the abdomen, but their symptomatology remains unclear and their diagnosis, as well as treatment challenging. A case of a 55-year-old female patient with dyspnea and light diffuse abdominal pain caused by a giant retroperitoneal liposarcoma is presented. The patient had an unremarkable medical history, while the computed tomography scan revealed a large mass at the right portion of the abdomen, with its upper limits to the lower edge and the gate portion of the liver. The mass was in contact with the right kidney, the inferior vena cava and the right renal vein, causing mild dilation of the right kidney pelvis. Without any evidence of intra-abdominal metastases, the tumor was surgically resected. The histological analysis of the tumor revealed a well-differentiated liposarcoma. The patient had an uneventful recovery and was discharged on the 10th postoperative day. Until today (4 years later) she remains asymptomatic, without any signs of recurrence. The retroperitoneal liposarcoma is a clinical entity with unclear clinical symptoms and the physician should consider including it in the differential diagnosis of a majority of symptoms, such as dyspnea. © 2018, Spandidos Publications. All rights reserved