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Femoral artery infections associated with percutaneous arterial closure devices.

Hemostasis obtained by manual compression after femoral artery catheterization results in consistently low rates of major complications. A rare complication of femoral artery catheterization is arterial infection. Its occurrence after diagnostic angiography using manual compression has not been reported. We report two cases of femoral arterial infection after uneventful diagnostic catheterization in nonimmunocompromised patients using the Perclose percutaneous arterial closure device. Our cases are representative of Perclose associated infections, with delayed presentation of a staphylococcal arterial infection requiring arterial debridement and reconstruction. This article indicates that Perclose use carries a risk of severe arterial infection. Surgeons should be aware of the potential infectious complications associated with Perclose use and the need for aggressive treatment.

Abscess↗

Infective endocarditis and access site infections in patients on hemodialysis.

Infective endocarditis has been a subtle and very often lethal complication of hemodialysis. Thirty-five episodes have been described to date. Antecedent infections, particularly those involving the access site, access manipulation, and dental work appear to predispose to IE. Once IE is acquired, factors associated with mortality are involvement of two or more valves, infection caused by enterococci, antecedent infection, steroid therapy, infection in the first year post-access insertion and patient age over 46. The incidence of access infection with the arteriovenous fistula is significantly less than that associated with the arteriovenous cannula. Staphylococci are the most common organisms in access infections and in IE. Gram-negative bacilli and particularly Pseudomonas aeruginosa are a frequent cause of access infection but an unusual cause of IE. Access removal may be madatory in the successful management of IE in patients on hemodialysis.

Adult↗

Pathology of the liver in leukaemia and lymphoma. A study of 110 autopsies.

Histopathological findings in the liver in a series of autopsies on 110 patients suffering from leukaemia or lymphoma were reviewed. No treatment had been given to 23 patients, 50 had received chemotherapy alone, 23 chemo- and radiotherapy and 14 underwent bone marrow transplantation. The 23 untreated patients showed neoplastic infiltration in 10 (44%) and fibrosis in 16 cases (70%). The 14 bone marrow recipients showed mainly acute necrosis, zonal in six (43%) and focal in one (7%), and cholestasis in five (36%), together with marked siderosis in 11 (79%). Patients receiving chemotherapy or chemo-/radiotherapy showed similar changes consisting of neoplastic infiltration in 14 (28%) and in five (22%) cases respectively, and fibrosis in 31 (62%) and 17 (74%) cases respectively. Steatosis was seen in 70% of cases in the chemo-/radiotherapy group and in 50% of cases in the other groups. Infections were seen in all groups, particularly in the chemotherapy group (four fungal and two bacterial including one tuberculosis) and in the chemo-/radiotherapy group (one fungal and one bacterial). Cytomegalovirus infection was seen only in the bone marrow transplant group.

Adolescent↗