Comparison of catheter-related infection risk in two different long-term venous devices in adult hematology-oncology patients Comparação do risco de infecção relacionada a cateteres entre dois tipos de dispositivos de longa permanência em pacientes onco-hematológicos

PURPOSE: Infection is the leading complication of long-term central venous catheters, and its incidence may vary according to catheter type. The objective of this study was to compare the frequency and probability of infection between two types of long-term intravenous devices. METHODS: Retrospective study in 96 onco-hematology patients with partially implanted catheters (n = 55) or completely implanted ones (n = 42). Demographic data and catheter care were similar in both groups. Infection incidence and infection-free survival were used for the comparison of the two devices. RESULTS: In a median follow-up time of 210 days, the catheter-related infection incidence was 0.2102/100 catheter-days for the partially implanted devices and 0.0045/100 catheter-days for the completely implanted devices; the infection incidence rate was 46.7 (CI 95% = 6.2 to 348.8). The 1-year first infection-free survival ratio was 45% versus 97%, and the 1-year removal due to infection-free survival ratio was 42% versus 97% for partially and totally implanted catheters, respectively (P <.001 for both comparisons). CONCLUSION: In the present study, the infection risk was lower in completely implanted devices than in partially implanted ones.<br>OBJETIVO: Infecção é a principal complicação relacionada ao uso de cateteres venosos de longa permanência em pacientes oncológicos e sua incidência pode variar a depender do tipo de cateter utilizado. O objetivo deste estudo foi comparar a freqüência e risco de infecção entre dois tipos de dispositivos de longa permanência. MÉTODOS: Estudo retrospectivo com 96 pacientes onco-hematológicos portadores de cateteres parcialmente implantáveis (n=55) ou totalmente implantáveis (n=42). Dados demográficos e cuidados com o dispositivo foram similares entre os dois grupos. A comparação entre os dispositivos foi realizada através da avaliação da incidência de infecção e da sobrevida livre de infecção. RESULTADOS: Em uma mediana de acompanhamento de 210 dias, a incidência de infecção relacionada ao cateter foi de 0,2102/100 cateter-dias para os dispositivos parcialmente implantáveis e de 0,0045/100 cateter-dias para os totalmente implantáveis, com uma razão de incidência de 46,7 (IC 95% = 6,2 a 348,8). A taxa de sobrevida livre de primeira infecção em um ano foi de 45% versus 97% e a taxa de sobrevida livre de retirada por infecção foi de 42% versus 97%, respectivamente para cateter parcialmente ou totalmente implantável (p<0,001 para ambas comparações). Conclusão: No presente estudo, o risco de infecção foi menor nos dispositivos totalmente implantáveis do que nos parcialmente implantáveis

Revisiting childhood herpes zoster.

Herpes zoster is rare in otherwise healthy children, but it is more common in association with immunosuppression. Maternal varicella infection during pregnancy and varicella occurring in the newborn represent risk factors for childhood herpes zoster. However, some controversies persist about risk factors, diagnosis, and the natural history of childhood disease. In a 2-year prospective study, 18 children with herpes zoster were clinically diagnosed in outpatient consultations in a hospital dermatology unit. Data about age, dermatome involvement, underlying disease, and history of previous varicella were recorded. Tzanck smears, biopsy specimens, and sera were obtained from 18, 4, and 10 children, respectively. The varicella zoster virus major envelope glycoprotein gE was detected in 16 of 18 smears and all four biopsies. Herpes simplex virus I was demonstrated in one of the smears. The established risk factors for childhood herpes zoster were only found in one child. Evidence for previous full-blown varicella and varicella with few lesions was recorded in 7 and 4 of the 17 immunocompetent children, respectively. No history of varicella was recalled in 6 of 17 cases, although a serologic clue of past varicella infection (IgM negative, IgG positive) was disclosed. Recurrent herpes zoster was diagnosed in one immunocompromised child. Zoster-associated pain was localized and the disease severity remained mild in all children. Established risk factors for childhood herpes zoster were only rarely found in our series of patients. In contrast, unrecognized varicella and varicella with few lesions were frequently recorded and may represent additional risk factors for shingles in childhood. Zosteriform herpes simplex virus infections should be differentiated from childhood herpes zoster, emphasizing the importance of precise viral identification

Understanding Interventional Bronchoscopy

Pediatric flexible bronchoscopy as a diagnostic modality has become a standard tool in the armamentarium of the modern pediatric pulmonologist. However the feasibility of interventions through flexible bronchoscopy is emerging slowly as it is limited not only by the size of the pediatric bronchoscope and its working channel but also by the demarcation lines between flexible and rigid bronchoscopy. We organize this chapter on interventional bronchoscopy into the following broad topics: Use of flexible bronchoscopy for acquisition of diagnostic material.Bronchoscopy for removal of obstructive, noxious, or damaging materials from the airway or the lung.Management of the narrowed or obstructed airway: debridement, dilation, and stenting.Use of bronchoscopy for other procedures including: sealing of fistulae and pneumothorax, control of diffuse alveolar hemorrhage, and segmental bronchography.New horizons: a discussion on recent reports on fetal bronchoscopy as a novel interventional approach