1/26. 5: Hospital-in-the-home treatment of infectious diseases.1. A growing range of infections can be safely and effectively treated with parenteral antimicrobial therapy at home, including cellulitis, pyelonephritis, pneumonia, endocarditis, osteomyelitis, septic arthritis and deep abscesses. 2. patients may be admitted to HITH directly from the emergency department or after a period of in-hospital care; they must be thoroughly assessed for suitability, including clinical stability and social circumstances, and both patient and carer consent must be obtained. 3. patients should be medically reviewed weekly at the hospital to monitor progress of therapy and check for possible complications, including adverse drug reactions. 4. Antibiotic selection should be based on appropriate prescribing principles rather than purely dosing convenience. 5. Innovative dosing regimens, including once-daily aminoglycosides, continuous-infusion beta-lactams (eg, flucloxacillin), once- or twice-daily cephalosporins (eg, cephazolin) and oral fluoroquinolones (eg, ciprofloxacin) provide effective therapy for a wide range of infections that would have previously required in-hospital care. 6. Appropriate use of HITH leads to improved patient and carer satisfaction, efficient in-hospital bed use and possibly some financial efficiencies. Not all patients receiving intravenous antibiotics need to be in hospital- - - - - - - - - - ranking = 1keywords = abscess (Clic here for more details about this article) |
2/26. Total C4B deficiency due to gene deletion and gene conversion in a patient with severe infections.Deficiencies of the early components of the classical complement pathway impair the actions of innate and humoral immunity and may lead to increased susceptibility to infections. We have studied the genetic basis of total C4B deficiency in a Finnish patient with recurrent meningitis, chronic fistulas and abscesses. The maternal chromosome carried a four-gene deletion including the C4B gene, and a conversion from C4B to C4A gene was found on the paternal chromosome resulting in complete deficiency of C4B. In the converted C4A gene, mutation screening did not reveal any amino acid changes or prominent mutations, yet a large number of nucleotide variations were found. Further, the patient was heterozygous for structural deficiency of mannan binding lectin (MBL) associating with medium levels of serum MBL. Our data provides new information on the genetic instability of the C4 gene region, and on the association of homozygous C4B deficiency and variant MBL genotype with increased susceptibility to recurrent and chronic infections. Importantly, plasma therapy induced a prompt clinical cure with long-term effects.- - - - - - - - - - ranking = 1keywords = abscess (Clic here for more details about this article) |
3/26. Deep neck infection as the main initial presentation of primary head and neck cancer.OBJECTIVES: Primary head and neck cancer and deep neck infection are not uncommon, but deep neck infection as the initial presentation of primary head and neck cancer is rare and these patients risk potential misdiagnosis. MATERIALS AND methods: The records of 301 patients with deep neck infection and 3,337 patients with primary head and neck cancers from 1990 to 2002 were retrospectively reviewed. patients with primary head and neck cancers who had deep neck infection as their initial presentation were enrolled. RESULTS: Seven patients were identified (six men and one woman). The median age was 64 years. All patients presented with painful, erythematous neck swelling and all image studies showed abscess formation. Four abscesses received needle aspiration and three received surgical drainage, which yielded malignant cells in four specimens. The primary origins of malignancies were the nasopharynx (two patients), oropharynx (two patients), hypopharynx (one patient), parotid gland (one patient) and maxillary sinus (one patient). All patients had stage IV disease. Only three patients could receive curative therapy and only one patient was disease-free after three years. CONCLUSION: We suggest that detailed history-taking, complete examination of the ENT field and pathological study of the infected tissue must be performed for patients with deep neck infection to enable early detection and prompt treatment of any underlying malignancy.- - - - - - - - - - ranking = 2keywords = abscess (Clic here for more details about this article) |
4/26. Hyperimmunoglobulin E syndrome (job syndrome) discovered in a patient following corrective spine surgery: case report and review of the literature.STUDY DESIGN: A case report of the hyperimmunoglobulin E syndrome (job syndrome) presenting in the context of late postoperative infection after corrective surgery for scoliosis. OBJECTIVE: To describe the clinical presentation and treatment of a patient with job syndrome, and its implications for spine surgeons. SUMMARY OF BACKGROUND DATA: job syndrome classically presents with a triad of increased serum immunoglobulin e, multiple abscesses, and pneumonia with pneumatocele formation. In recent years nonimmunologic manifestations have been described, including scoliosis, joint hypermobility, eosinophilia, and atopy. methods: A 15-year-old female presented with local swelling and fever 2 years after anterior lumbar discectomy and fusion with spinal instrumentation involving T11-L3 levels. Computerized tomography revealed paravertebral, psoas, and pulmonary abscesses. The implants were removed and antibiotic therapy instituted. Further investigation revealed features of the hyperimmunoglobulin E syndrome (job syndrome). RESULTS: The patient's symptoms resolved, as did markers of inflammation. CONCLUSIONS: job syndrome is a primary immunodeficiency often associated with scoliosis. Given the implications for surgical outcome in immunodeficient patients, the diagnosis should be considered and, blood tests instituted in patients with scoliosis with any of the associated history and physical findings of job syndrome.- - - - - - - - - - ranking = 2keywords = abscess (Clic here for more details about this article) |
5/26. Pelvic abscess complicating transcervical embryo transfer.A severe pelvic infection resulting in a tuboovarian abscess after transcervical embryo transfer is reported. The case is unique in that the recipient was an agonadal woman who had not undergone prior transvaginal aspiration. Although rare, pelvic infection after embryo transfer may occur in spite of normal precautions.- - - - - - - - - - ranking = 5keywords = abscess (Clic here for more details about this article) |
6/26. Infection of fetal scalp electrode monitoring sites.Complications caused by placement of a fetal scalp electrode include trauma, hemorrhage and infection. Infections are usually localized and self-limited, but they can occasionally lead to serious complications, such as osteomyelitis, sepsis and death. The recommended treatment for a scalp abscess is incision and drainage, followed by appropriate antibiotic therapy. If a serious infection is suspected, the infant should be hospitalized, blood cultures obtained and intravenous antibiotic therapy initiated.- - - - - - - - - - ranking = 1keywords = abscess (Clic here for more details about this article) |
7/26. Use of patients' sera for immunoperoxidase demonstration of infectious agents in paraffin sections.Using patients' sera diluted from 1:10 to 1:1,000 as the primary antibodies in indirect immunoperoxidase staining, the authors visualized a variety of infectious agents in formalin-fixed, paraffin-embedded tissue sections. The target lesions included 1) pyoderma caused by staphylococcus aureus, 2) cryptococcal infection, 3) dermal sporotrichosis, 4) colon ulcer caused by amebic dysentery, 5) cutaneous leishmaniasis, and 6) chronic liver abscess containing ova of ascaris lumbricoides. The infectious agents were clearly identified in the respective lesions. paraffin sections of other kinds of infectious lesions served as controls to clarify the specificity of the immunostaining. While the sera of patients with bacterial and fungal infection showed a wide range of cross-reactivity against bacteria and/or fungi, those with parasitic infection exhibited a relatively good specificity for the pathogen. Almost no immunoreactivity of endogenous human IgG in the paraffin sections was demonstrated under the conditions of this study. This approach can be used in diagnostic pathology, particularly when specific heteroantisera or monoclonal antibodies are unavailable.- - - - - - - - - - ranking = 1keywords = abscess (Clic here for more details about this article) |
8/26. sepsis caused by periurethral abscess.The author presents an unusual case of general sepsis of the organism caused by periurethral abscess in a 38 years old man. The aetiology is discussed.- - - - - - - - - - ranking = 5keywords = abscess (Clic here for more details about this article) |
9/26. Management of an infected graft in the ascending aorta by an omental pedicel graft and irrigation with povidone iodine.An infected graft in the ascending aorta was managed by use of an omental pedicel graft and local irrigation with a dilute suspension of aqueous providone iodine. This conservative approach is an alternative to the high risk procedure of graft replacement. The large abscess cavity associated with the aortic prosthesis was diagnosed by computed tomography.- - - - - - - - - - ranking = 1keywords = abscess (Clic here for more details about this article) |
10/26. Ultrasound imaging of residual limbs: new use for an old technique.The use of ultrasound for diagnosing problems in the residual limb of an individual with an amputation has not been documented in the literature. We present a case where this modality was particularly useful in the diagnosis of an extensive abscess in the distal stump. Ultrasound imaging of compromised residual limbs is useful in the diagnosis of stump infections with infected muscle tissue and deep fluid collection. This technique can help shorten the course of intravenous antibiotics by clarifying the need for surgical intervention.- - - - - - - - - - ranking = 1keywords = abscess (Clic here for more details about this article) |
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