Actinomycosis is an indolent, slowly progressive, suppurative infection caused by gram-positive branching bacteria of the genus Actinomyces. The organism is a member of the oral and gastrointestinal microflora of humans. The disease actinomycosis most commonly occurs in 3 body regions: cervicofacial (55% of patients), abdominopelvic (20%), and pulmonothoracic (15%). Involvement of other parts of the body is uncommon and usually secondary to a lesion in one or the other of the above sites. Extremity disease can occur by secondary involvement through direct extension or hematogenous spread. However, primary actinomycosis of an extremity is very rare. A case of primary actinomycosis of the foot in a Hispanic male and a literature review with an emphasis on primary actinomycosis of the extremity are presented in this article.

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The Fontan operation is performed to correct complex cardiac malformations characterized by single ventricle physiology. Following the procedure, the systemic venous blood fl ows directly into the lungs without passing through the single ventricle. Consequently, the Fontan circulation requires passive venous fl ow to the lungs, making it imperative for the pulmonary vascular resistance to be kept low in order to maintain adequate pulmonary blood fl ow and cardiac output. Given that the pulmonary circulation is important for a successful Fontan physiology, it would be intuitive that a single lung Fontan operation would do poorly because of the major loss in pulmonary vascular bed and the subsequent increase in pulmonary vascular resistance. The authors present a 14-year-old adolescent who was born with tricuspid atresia, pulmonary atresia, and right ventricular hypoplasia who underwent a successful Fontan operation into a single right lung, the left pulmonary artery being hypoplastic and disconnected from the right pulmonary artery. The authors describe the perioperative anesthetic management of the single lung Fontan operation and further discuss the perioperative treatment of elevated pulmonary vascular resistance.

Summary Background:  Adequate tissue oxygenation is required for effective white blood cell function and bactericidal activity. Decreased tissue oxygenation has been shown to be a risk factor for perioperative wound infections. Regional anesthetic techniques result in a functional sympathetic block and may increase tissue oxygenation. The purpose of the current study is to prospectively evaluate changes in tissue oxygenation using a non‐invasive near‐infrared spectroscopy (NIRS) device following caudal epidural block in infants and children. Methods:  Following standard anesthetic induction and general anesthesia with an endotracheal tube or laryngeal mask airway, the NIRS sensors were placed on two sites. One sensor was placed at a site affected by the caudal block (lower extremity), and the other sensor was placed on the arm, a site unaffected by the caudal block (upper extremity). The NIRS value was recorded at baseline and then again at 15, 30, and 45 min after the block. The caudal block was performed, after anesthetic induction and NIRS sensor placement, using bupivacaine 0.25% with epinephrine 1 : 200 000 or ropivacaine 0.2% with epinephrine 1 : 200 000 at a dose of 1 ml·kg−1. The inspired oxygen concentration after induction was held constant at 30%, and anesthesia was maintained with sevoflurane at 1 MAC. No other pharmacologic agents were administered. Results:  Following the caudal epidural block, there was a statistically significant increase in the tissue oxygenation from the affected site. The NIRS value increased from a baseline of 83 ± 4 to 87 ± 3 at 15 min (P = 0.0001 vs baseline), 88 ± 4 at 30 min (P < 0.0001 vs baseline), and 87 ± 4 at 45 min (P < 0.0001 vs baseline). No change was noted on the unaffected site (upper extremity). Conclusion:  There was a statistically significant increase in tissue oxygenation as measured by NIRS following caudal anesthesia in infants and children. Although the magnitude of the change was less, this study confirms the results of previous studies in adults showing an increase in tissue oxygenation following regional blockade.