1/16. F-18-fluorodeoxyglucose positron emission tomography leading to a diagnosis of septic thrombophlebitis of the portal vein: description of a case history and review of the literature.Pylephlebitis or septic thrombophlebitis of the portal vein is a serious infectious disorder. early diagnosis is difficult, due to nonspecific symptoms and signs, limitations of diagnostic modalities and the lack of familiarity of physicians with this entity. We report the history of a 73-year-old man with fever of unknown origin (FUO) in whom laboratory tests, blood and urine cultures, chest X-ray, abdominal ultrasound, and indium-111-leucocyte scintigraphy did not reveal the cause of the fever. F-18-fluorodeoxyglucose (FDG) positron emission tomography (PET) subsequently pointed to the diagnosis of pylephlebitis, which was confirmed by computed tomography (CT) and percutaneous puncture. We conclude that FDG PET allows detecting inflammatory foci in patients with FUO and offers to make the diagnosis of pylephlebitis at an early stage.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
2/16. Percutaneous treatment of a patient with infected necrotizing pancreatitis.BACKGROUND: A 50-year-old man with an acute episode of alcohol-induced chronic edematous pancreatitis and an inflammatory stenosis of the biliary tract was treated by implantation of a plastic endoprosthesis at a rural hospital in germany. Because of his worsening condition, the patient was referred to the intensive care unit of the University Hospital, Regensburg, germany. Contrast-enhanced CT revealed complete necrosis of the body and tail of the pancreas, formation of large retrogastric and paraduodenal fluid collections, and fluid along Gerota's fascia, as well as in the paracolic gutters. Antibiotic treatment was adjusted according to the results of microbiological testing after diagnostic puncture of the necrotic cavity. INVESTIGATIONS: CT scan, CT-guided fine-needle aspiration and fluoroscopy. DIAGNOSIS: Infected acute necrotizing pancreatitis. MANAGEMENT: Interventional treatment using large-bore percutaneous catheters to perform percutaneous necrosectomy, fragmentation of necrotic pancreatic tissue with a snare catheter and dormia basket, and aspiration. parenteral nutrition and antibiotics were also administered.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
3/16. Septic complications after cardiac catheterization and percutaneous transluminal coronary angioplasty.Septic complications after cardiac catheterization and percutaneous transluminal coronary artery angioplasty are distinctly uncommon. However, we have recently treated nine patients with sepsis and life-threatening complications after cardiac catheterization alone or after catheterization and subsequent percutaneous transluminal coronary angioplasty. The common denominator in all patients was either repeat puncturing of the ipsilateral femoral artery or leaving the femoral artery sheath in for 1 to 5 days after the procedure. Two patients died as a direct result of their septic complications. One death occurred in a patient in whom bacterial endocarditis with congestive heart failure developed, and the other patient had a large retroperitoneal hematoma that became secondarily infected. Infected aneurysms that were successfully treated developed in three patients. Our study suggests that colonization of the needle tract by skin flora predisposes to septic complications if repeat arterial punctures are required or if a femoral artery sheath is left in place for more than 24 hours. patients in whom sepsis develops after these procedures should be initially treated with antibiotics effective against gram-positive organisms. CT scanning or angiography should be considered for patients with persistent sepsis, septic emboli, and abdominal or flank pain. Infected aneurysms require resection or ligation because of the propensity of these aneurysms to rupture.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
4/16. Infected pancreatic necrosis possibly due to combined percutaneous aspiration, cystogastric pseudocyst drainage and injection of a sclerosant.This paper reports on a patient who was treated by percutaneous aspiration, instillation of a sclerosant (polidocanol) and cystogastric drainage for a post-acute pancreatic pseudocyst. Five weeks after admission to hospital for the first episode of an acute necrotizing pancreatitis, the 60-year-old man underwent a percutaneous, ultrasound-guided puncture and aspiration of a voluminous pancreatic pseudocyst. Ten days later, recurrent fluid collection led to a second puncture, combined with the injection of polidocanol (15 ml; 1%) into the cyst cavity. Since this treatment failed, a percutaneous cystogastric drain ("double--pigtail") was inserted five days later. After developing acute abdominal pain and incipient sepsis, the patient was sent for surgical intervention twelve days after the second treatment with percutaneous aspiration and injection of polidocanol. During the operation an infected pancreatic pseudocyst with extensive contaminated necrosis of the pancreas and duodenal perforation was found. Necrectomy was performed, followed by continuous lavage of the omental bursa. intensive care therapy was necessary for one week. Duodenal leakage persisted for nearly three weeks, the stopped spontaneously. The patient was discharged in quite a good state of health after 33 days of postoperative treatment. Although spontaneous development of infected pancreatic pseudocysts and pancreatic abscesses in necrotizing pancreatitis is known, a possible involvement of the drainage procedures, especially in combination with the injection of a sclerosant must be considered.- - - - - - - - - - ranking = 2keywords = puncture (Clic here for more details about this article) |
5/16. Puncture wound osteochondritis of the foot caused by CDC group Vd.A case of puncture wound osteochondritis of the foot caused by CDC group Vd is presented because of the unusual nature of the infecting organism. This organism may be confused with pseudomonas aeruginosa, the usual pathogen responsible for this type of infection, but does not have a similar antimicrobial susceptibility profile. For this reason, it is important to obtain appropriate culture specimens and to identify and test the susceptibility of bacterial isolates from cases of puncture wound-associated osteochondritis so that optimal therapeutic regimens can be determined.- - - - - - - - - - ranking = 2keywords = puncture (Clic here for more details about this article) |
6/16. Complications of deep puncture wounds of the foot.Eleven cases of deep puncture wounds of the foot and their complications are reviewed. More than half of the patients had foreign materials introduced at the time of the injury which was not completely removed initially. The morbidity with these "simple puncture wounds" may be quite prolonged. The authors conclude that attention to details when the patient is first seen in the emergency room or the physician's office and aggressive treatment of these wounds will prevent serious sequelae in many instances.- - - - - - - - - - ranking = 6keywords = puncture (Clic here for more details about this article) |
7/16. Supracallosal interhemispheric arachnoid cyst: resolution after intracystic hemorrhage and infection.A case of a large, symptomatic, supracallosal interhemispheric arachnoid cyst is presented. Positive contrast-enhanced computed tomographic (CT) cystography after stereotactic puncture and aspiration demonstrated lack of communication between the cyst and the subarachnoid space or ventricular system. A cystoperitoneal shunt was successful in relieving the patient's symptoms for 5 years. A delayed shunt infection after gynecologic surgery necessitated removal of the shunt, and was complicated by asymptomatic intracystic hemorrhage. Thereafter, serial CT and magnetic resonance imaging scans showed eventual disappearance of the cyst.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
8/16. Human aeromonas infections: a review of the literature and a case report of endocarditis.Our patient, with cirrhosis and chronic renal failure, represents an example of the susceptibility of a compromised host to aeromonas infections. This patient, however, differs from previously reported cases in at least two important aspects. First, it is possible that her portal of entry was a fresh A-V fistula puncture site rather than an intestinal site. The temporal relationship of exposure to flood water prior to the onset of sepsis lends support to this possibility. Epidemiologic investigation of the dialysis center failed to reveal aeromonas isolates from cultures of the water supply, machinery, or other patients. Second, this case is unique in that our patient developed a destructive aortic valve endocarditis resulting in valvular perforations and acute aortic insufficiency. Furthermore, this infection was initiated on what appears to have been a previously normal valve. Based on a review of the literature and the virulence demonstrated by A. hydrophila in our patient, we conclude that organisms of the genus aeromonas are capable of inducing serious human infection. Such infections are more likely to occur in compromised hosts. A. hydrophila has accounted for the majority of reported infections.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
9/16. Real time (US) scanning of palpable lesions in the soft tissues (muscles and tendons) of the extremities.The results of real time ultrasound (US) examination of palpable lesions located in the muscle and tendon area of the extremities are reported in a series of 67 patients. The US appearance of various lesions is described. The contribution of real time US (B mode) during muscular contraction to the diagnosis and the results of diagnostic fine needle punctures (FNP) and their value are discussed.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
10/16. gallium scintigraphy in a case of septic cavernous sinus thrombosis.Septic cavernous sinus thrombosis, a relatively uncommon disease entity, frequently can be fatal. early diagnosis is imperative in order that appropriate treatment be instituted. A 59-year-old woman who was admitted to our institution with complaints of diplopia, blurred vision and fevers that developed following a tooth extraction is presented. Initial CT and lumbar puncture on the day of admission were totally normal. A repeat CT performed 48 hours after admission, on the same day as gallium imaging, demonstrated findings consistent with cavernous sinus thrombosis. gallium imaging demonstrated intense uptake in the left cavernous sinus and left orbit as well as moderately increased activity in the right cavernous sinus and orbit, confirming infection. The patient was treated with antibiotics, and repeat CT and gallium imaging were performed ten days later, both of which demonstrated near total resolution of the disease process. Conceivably, if gallium imaging had been initiated on the day of admission it may have been the first study to demonstrate an infectious process in the cavernous sinus. gallium imaging should be considered as a diagnostic tool in the noninvasive workup of this entity.- - - - - - - - - - ranking = 1keywords = puncture (Clic here for more details about this article) |
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