IntroductionIn Greece, fusidic acid and clindamycin are commonly used for the empiric therapy of suspected staphylococcal infections.MethodsThe medical records of children examined at the outpatient clinics or admitted to the pediatric wards of the University General Hospital of Larissa, Central Greece, with community-associated staphylococcal infections from January 2003 to December 2009 were reviewed.ResultsOf 309 children (0-14 years old), 21 (6.8%) had invasive infections and 288 (93.2%) skin and soft tissue infections (SSTIs). Thirty-five patients were ≤30 days of age. The proportion of staphylococcal infections caused by a community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) isolate increased from 51.5% (69 of 134) in 2003-2006 to 63.4% (111 of 175) in 2007-2009 (P = 0.037). Among the CA-MRSA isolates, 88.9% were resistant to fusidic acid, 77.6% to tetracycline, and 21.1% to clindamycin. Clindamycin resistance increased from 0% (2003) to 31.2% (2009) among the CA-MRSA isolates (P = 0.011). Over the 7-year period, an increase in multidrug-resistant CA-MRSA isolates was observed (P = 0.004). One hundred and thirty-one (93.6%) of the 140 tested MRSA isolates were Panton-Valentine leukocidin-positive. Multilocus sequence typing of 72 CA-MRSA isolates revealed that they belonged to ST80 (n = 61), ST30 (n = 6), ST377 (n = 3), ST22 (n = 1), and ST152 (n = 1). Resistance to fusidic acid was observed in ST80 (58/61), ST30 (1/6), and ST22 (1/1) isolates.ConclusionIn areas with high rate of infections caused by multidrug-resistant CA-MRSA isolates, predominantly belonging to the European ST80 clone, fusidic acid and clindamycin should be used cautiously as empiric therapy in patients with suspected severe staphylococcal infections.

IntroductionAchondroplasia is a musculoskeletal disorder associated with short stature. Despite an estimated prevalence of 1:25,000 in the general population, there is little literature concerning the diagnostic and treatment challenges faced by doctors dealing with a heart operation on a patient with this condition.Case presentationWe present the case of a 41-year-old Caucasian man of Greek ethnicity with achondroplasia, who underwent bypass heart surgery.ConclusionsThe surgery was successful and did not present particular difficulties, showing that heart surgery can be safely performed on people with achondroplasia.

Lymphangioleiomyomatosis (LAM) is a rare disease that occurs predominantly in females between the ages of 30 and 50 years and is clinically characterized by progressive dyspnoea on exertion, recurrent pneumothoraces, abdominal and thoracic lymphadenopathy, as well tumors-like angiomyolipomas and lymphangiomyomas. We present the case of a 42-year-old woman, who developed recurrent pneumothoraces and was subsequently diagnosed with LAM. Although pneumothorax is a common complication of the disease, its optimal approach to treatment and prevention remains unclear. Chemical or surgical pleurodesis are often performed in order to prevent recurrence, but may predispose to perioperative complications in the event of future lung transplantation.

Accessory fissures represent a variation of the normal lung anatomy. Incomplete development or even the absence of the major or minor fissures can lead to confusion in distinguishing adjacent lobes. This report aims to present a rare intraoperative finding of an anatomic malformation of the right lung in a 19-year old male patient with recurrent pneumothorax who underwent a surgical repair. An accessory fissure which was separating the superior segment of the lower lobe from the basal segments gave to the whole lung the unique image of a four-lobed one. A profound knowledge of the accessory fissures, even if they are incidentally discovered, is of pivotal importance for the thoracic surgeon and leads to optimal operative assessment and strategic planning.

While aneurysms of the internal mammary artery (IMA) complicate occasionally surgical procedures employing median sternotomy, or are associated with direct thoracic trauma, mycotic pseudoaneurysms of the vessel are rarely reported in the literature. We herein report a case of a 22-year-old man who developed a mycotic internal mammary artery pseudoaneurysm secondary to staphylococcal chest wall abscesses and was effectively treated by coil embolization. Additionally, the report provides a brief review focusing on the current state of treatment options for internal mammary artery aneurysms.