1/65. stenotrophomonas (xanthomonas) maltophilia infection in necrotizing pancreatitis.CONCLUSION: Although the therapy of infected pancreatic collections or organized pancreatic necrosis remains surgical, we have demonstrated that infected organized pancreatic necrosis can be treated endoscopically. BACKGROUND: stenotrophomonas (xanthomonas) maltophilia has been increasingly recognized as a nosocomial pathogen associated with meningitis, pneumonia, conjunctivitis, soft tissue infections, endocarditis, and urinary tract infections. This organism is consistently resistant to imipenem, a drug commonly employed in patients with necrotizing pancreatitis to prevent local and systemic infections. methods AND RESULTS: We report the first case of infected pancreatic necrosis by S. (X.) maltophilia. Our patient was treated successfully with endoscopic drainage of the pancreatic fluid collection and appropriate antibiogram-based antibiotic therapy. Endoscopic drainage has emerged as one of the treatment modalities for pancreatic fluid collections.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
2/65. Treatment of skin and soft tissue infections with cefadroxil, a new oral cephalosporin.Oral cefadroxil in doses of 0-6-1-8 g per day given on twice or three times daily schedules was effective in the treatment of thirty-six patients with infections such as abscesses, carbuncles, cellulitis, furunculosis and impetigo. staphylococcus aureus strains and beta-haemolytic streptococci, alone or in combination, were cultured from lesions before treatment. in vitro studies with test discs showed that all the organisms were sensitive to cefadroxil, but twenty-three of twenty-nine S aureus strains and one of the seven streptococci strains were resistant to penicillin g. Pre- and post-treatment laboratory tests of renal, hepatic and haematopoietic functions produced no evidence of drug toxicity. The cefadroxil dosage effective in this study is lower than that recommended for currently available oral cephalosporins, which must be given on a four times daily schedule.- - - - - - - - - - ranking = 4keywords = soft (Clic here for more details about this article) |
3/65. Use of soft contact lenses for the study of external ocular microbiology.In the diagnosis of corneal ulcers, bacterial cultures from scrapings, investigations on viral and fungal growth, as well as staining of smears from the lesion often lead to the correct diagnosis. We report four cases of corneal ulcer where all the methods mentioned failed to reveal the causative microorganism. After the patients had received various medical treatments without any clinical improvement, soft therapeutic contact lenses were fitted, worn overnight, and removed the next morning with sterile forceps. The contact lenses were cultured in blood and Mac Leod agars. growth of various bacteria was then detected. The infection subsided after the antibiotic treatment was changed according to the bacterial resistance. We conclude that, in selected cases, soft contact lenses may be used for microbiological studies.- - - - - - - - - - ranking = 6keywords = soft (Clic here for more details about this article) |
4/65. psoas abscess: the spine as a primary source of infection.STUDY DESIGN: Case report, literature review, discussion. OBJECTIVES: To emphasize the role of the spine as primary source of infection for psoas abscess. SUMMARY OF BACKGROUND DATA: spine-associated psoas abscesses increase with more frequent invasive procedures of the spine and recurring tuberculosis in industrialized countries. Diagnosis is often delayed by misinterpretation as arthritis, joint infection, or urologic or abdominal disorders. methods: We present six cases of psoas abscesses associated with spinal infections that were treated in our hospital from January to December 2001. Diagnostic and treatment concepts are discussed. RESULTS: Our data emphasize the importance of the spine as primary source of infection and suggest an increase in the incidence of secondary psoas abscess. Treatment includes open surgical drainage and antibiotic therapy. In patients with high operative risk and uniloculated abscess, a CT-guided percutaneous abscess drainage can be sufficient. It is essential to combine abscess drainage with causative treatment of the primary infectious focus. Related to the spine, this includes treatment of spondylodiscitis or implant infection after spinal surgery. Usually, several operations are necessary to eradicate bone and soft-tissue infection and restore spinal stability. Continuous antibiotic therapy over a period of 2-3 weeks after normalization of infectious parameters is recommended. CONCLUSION: The spine as primary source of infection for secondary psoas abscess should always be included in differential diagnosis. Because the prognosis of psoas abscess can be improved by early diagnosis and prompt onset of therapy, it needs to be considered in patients with infection and back or hip pain or history of spinal surgery.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
5/65. Abnormal intracerebral thallium localization in a bacterial brain abscess.A 56-yr-old man with a prior history of renal cell carcinoma had moderately intense abnormal localization of 201Tl-chloride in a solitary brain lesion which was discovered to be a bacterial abscess. The organisms isolated by culture included actinomycosis odontolyticus, peptostreptococcus and Hemophilus aphrophilus. Because of the clinical presentation, MRI characteristics and thallium scintigraphic findings, the lesion had been felt to represent either a primary or a metastatic neoplasm. This case illustrates the need for caution in the interpretation of thallium brain scintigram.- - - - - - - - - - ranking = 0.069279017780918keywords = neoplasm (Clic here for more details about this article) |
6/65. Necrotizing soft tissue infection from decubitus ulcer after spinal cord injury.STUDY DESIGN: A case of necrotizing soft tissue infection in a patient with spinal cord injury with extension of infection into the spinal canal and spinal cord is presented. OBJECTIVE: To review the history, risk factors, pathophysiology, diagnosis, treatment, and morbidity and mortality regarding necrotizing soft tissue infection as they relate to spinal cord injury. SUMMARY OF BACKGROUND DATA: Necrotizing soft tissue infection related to decubitus ulcers is rare. To our knowledge, this is the first report of this disease related to a sacral decubitus ulcer with extension of the necrotizing infection into the spinal canal. methods: The clinical, radiographic, and pathologic features associated with necrotizing soft tissue infection are presented. The patient presented with a late-stage necrotizing soft tissue infection requiring extensive de-bridement of necrotic tissue, which the patient underwent on admission. RESULTS: The patent died of refractory septic shock and multiple-organ failure after surgery. CONCLUSION: Necrotizing soft tissue infections from decubitus ulcers are rare and unpredictable, and ultimately have a progressively aggressive course. The case reported herein is the first report of necrotizing soft tissue infection from a decubitus ulcer in a patient with spinal cord injury with extension into the spinal canal and spinal cord.- - - - - - - - - - ranking = 11keywords = soft (Clic here for more details about this article) |
7/65. Report of an infant with noma (cancrum oris).Noma (cancrum oris) is an infectious disease that destroys the oro-facial tissues and other neighboring structures in its fulminating course. The starting point of the disease is acute ulcero-necrotic gingivitis, which results in an extensive gangrenous plaque destroying all of the soft tissues of the face. It predominantly affects children aged 2-16 years and is primarily seen in areas where the socioeconomic standards are low and there is poor hygiene, as in developing countries. We discuss possible predisposing factors in cancrum oris such as malnutrition, infectious diseases, hiv infection, and immune compromise conditions. poverty is the most important risk factor. We report the case of a 6-month-old child with noma and review the characteristic features of this disease.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
8/65. Anaerobic spondylodiscitis: case series and systematic review.BACKGROUND: Bacterial spondylodiscitis is rarely caused by anaerobic organisms. We describe two patients with lumbar vertebral osteomyelitis and discitis caused by anaerobic bacteria, including an unusual occurrence after an endodontic procedure, and review the salient clinical features and outcomes of 31 previously reported cases. methods: case reports and review of the literature. RESULTS: Median age at presentation was 65 years, with a male-to-female ratio of 2:1. The most common presenting symptoms were back pain, fever, and neurologic deficits. The lumbar spine was most frequently involved (43%); an equal number of cases involved contiguous extension or hematogenous spread. Causative anaerobes were recovered from disk space or vertebrae (13), blood (4), and/or soft tissue abscess and included bacteroides species (12), propionibacterium acnes (7), peptococcus species (4), peptostreptococcus species and clostridium species (3 each), corynebacterium diphtheroides and fusobacterium species (2 each), and unspecified anaerobes (3). CONCLUSIONS: Apart from specific antibiotic selection, medical treatment and outcomes for anaerobic spondylodiscitis are similar to those for aerobic vertebral disk infection.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
9/65. Extensive retroperitoneal and right thigh abscess in a patient with ruptured retrocecal appendicitis: an extremely fulminant form of a common disease.As a disease commonly encountered in daily practice, acute appendicitis is usually diagnosed and managed easily with a low mortality and morbidity rate. However, acute appendicitis may occasionally become extraordinarily complicated and life threatening. A 56-year-old man, healthy prior to this admission, was brought to the hospital due to spiking high fever, poor appetite, dysuria, progressive right flank and painful swelling of the thigh for 3 d. Significant inflammatory change of soft tissue was noted, involving the entire right trunk from the subcostal margin to the knee joint. Painful disability of the right lower extremity and apparent signs of peritonitis at the right lower abdomen were disclosed. Laboratory results revealed leukocytosis and an elevated c-reactive protein level. Abdominal CT revealed several communicated gas-containing abscesses at the right retroperitoneal region with mass effect, pushing the duodenum and the pancreatic head upward, compressing and encasing inferior vena cava, destroying psoas muscle and dissecting downward into the right thigh. laparotomy and right thigh exploration were performed immediately and about 500 mL of frank pus was drained. A ruptured retrocecal appendix was the cause of the abscess. The patient fully recovered at the end of the third post-operation week. This case reminds us that acute appendicitis should be treated carefully on an emergency basis to avoid serious complications. CT scan is the diagnostic tool of choice, with rapid evaluation followed by adequate drainage as the key to the survival of the patient.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
10/65. Two patterns of impalement injury to the oral cavity: Report of four cases and review of literature.Impalement injuries to the oral cavity are common, and typically resolve with minimal intervention. We encountered two distinct patterns of injury that required active intervention in four consecutive patients. The first two patients, aged 2 and 7 years, sustained injuries to the floor of mouth and subsequently developed infectious complications necessitating surgical drainage. The other two, aged 4 and 5 years, sustained injuries to the junction of the hard and soft palate, avulsing deep flaps that required repair. Neurovascular complications, despite their rarity have earned maximal discussion in the literature. We feel that traumatic lacerations and infectious complications have far more clinical relevance due to their frequency of occurrence, and should thus occupy a more prominent position in the management flow chart.- - - - - - - - - - ranking = 1keywords = soft (Clic here for more details about this article) |
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