The saga of brucellosis: controversy over credit for linking Malta fever with goats' milk.
Explore the source record for details and available documents.
Animals↗
Biomedical subjects
D J Vassallo
Publications and source records attributed to D J Vassallo.
Antibiotic irrigation and conservative surgery for major aortic graft infection.
PURPOSE: Traditional surgical treatment for panprosthetic aortic graft infection entails radical excision of the graft, aortic stump closure, and extraanatomic revascularization of the lower limbs. This carries an early mortality rate of 24% to 45%. Amputation rates range from 11% to 37%. Multiple operations and prolonged hospital stay are usual. We have developed a more conservative management technique with the aim of improving outcome. METHODS: We describe an innovative method of treating the condition with prolonged, high-dose, local antibiotic irrigation therapy, systemic antibiotic treatment, surgical debridement, and graft conservation in a prospectively studied series of 10 patients. RESULTS: The actual 30-day patient survival rate is 90%, the 1-year survival rate is 80%, and the 4-year survival rate is 67%. Two patients died because of graft infection, and the third died, uninfected, of an unrelated cause. No limbs have been amputated. Only two patients required a second operation. Mean postoperative hospital stay was 32 days. The seven survivors have been closely followed up with regular computed tomography or indium scanning and clinical examination and appear to be free from infection at a mean of 61 months after cessation of irrigation therapy. CONCLUSION: The technique appears to represent a significant improvement in the management of this major complication of vascular surgery.
Adult↗
The International Red Cross and Red Crescent Movement and lessons from its experience of war surgery.
This article describes the evolution, motivation and structure of the International Red Cross and Red Crescent Movement, and its contribution to international humanitarian law. It explains the respective roles of its three components: the National Societies, the International Federation of Red Cross and Red Crescent Societies, and the International Committee of the Red Cross (ICRC). It highlights the ICRC's experience of war surgery and emphasises the relevance of this for the military medical services, especially for the training of military surgeons and anaesthetists.
First Aid↗
Necrotising fasciitis of the leg as a complication of ischiorectal abscess.
This case report describes the rare complication of necrotising fasciitis of the right thigh and calf after drainage of an ischiorectal abscess. The important early symptoms and signs of this life threatening infection, and the need for urgent treatment with aggressive surgical debridement and broad spectrum antibiotics, are emphasised in order to facilitate early recognition and prompt initiation of the appropriate therapy in future cases.
Abscess↗
The centenary of the sinking of the Mediterranean Fleet flagship, HMS Victoria. What was the role of Malta fever?
This article commemorates the centenary of the tragic loss of the battleship HMS Victoria and 358 of her crew, together with the Commander-in-Chief of the Mediterranean Fleet, Vice-Admiral Sir George Tryon, as a result of an enigmatic order by Tryon himself. It also investigates the medical aspects and explores the contention that Tryon was suffering from Malta or Mediterranean fever (Brucellosis).
Brucellosis↗
Introduction of a partial shift system for house officers in a teaching hospital.
OBJECTIVES: (1) To introduce a partial shift system to reduce the hours of work of preregistration house surgeons to an average of 64 a week to comply with the New Deal for junior doctors; (2) to test linking the partial shift concept to an existing structure of "on call" firms. DESIGN: Formal assessment after three months of a pilot partial shift system for eight house surgeons on three firms instituted on 1 November 1991, followed by questionnaire and interview evaluation at three and six months of a revised system implemented on 1 February 1992. SETTING: Department of general surgery at St Bartholomew's Hospital, London. SUBJECTS: 24 house surgeons attached to three surgical firms. RESULTS: In eight weeks each house surgeon worked one week (five shifts) of night duty, one week of "cover" (afternoon and evening) duty, and six weeks of normal daytime hours. Each weekday a house surgeon from the firm on call worked an extended daytime on call shift until 10 pm. Weekend duties were split between two house surgeons from the firm on call. A computer generated graphical display of the rota was used to facilitate leave planning. Average working hours were reduced to below 64 per week, including prospective cover, without detriment to patient care and educational standards. Within the shift system individual house surgeons could be on call with their own firm by day and at weekends. Opinions were equally divided among junior staff as to their preference for either on call or partial shift systems. CONCLUSIONS: The principles of this partial shift system are generally applicable and the model can readily be adopted by district general hospitals.
Attitude of Health Personnel↗
The corps disease: brucellosis and its historical association with the Royal Army Medical Corps.
Brucellosis (also known as Malta, Mediterranean or Undulant Fever) has aptly been nicknamed the Corps Disease because of the major role played by the Royal Army Medical Corps in elucidating its nature and discovering its mode of spread, thus leading to its prevention and eradication. This history of brucellosis, incorporating a complete bibliography of all references to the disease in the Journal of the Royal Army Medical Corps from 1903 to 1992, documents the fascinating story of this association.
Brucellosis↗
Conservative treatment of major aortic graft infection.
Major infections of Dacron aortic grafts involving the proximal anastomosis or the whole graft are rare but lethal. Traditional surgical treatment involves radical excision of the graft and extra-anatomic revascularisation of the lower limbs, and carries a forbidding mortality and complication rate. This paper describes an alternative conservative approach used on four patients, three of whom appear to have been successfully treated by continuous antibiotic irrigation of the prosthesis without removal of the graft, whilst the fourth died 42 months later of recurrent graft infection. This is the first time that prolonged survival has been reported following conservative treatment of major graft infection. The authors believe this method may offer substantial advantages over the traditional surgical treatment for this dreaded complication of aortic surgery.
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