1/16. Bronchoaspiration as a possible cause in a case of tetanus. A reminder on the importance of adulthood immunizations.Although preventable by immunization tetanus still takes a large death toll, mostly in developing countries, where adult population is often unprotected and opportune medical care unavailable. We present a case of tetanus in an elderly patient with bronchoaspiration pneumonia after a near-drowning incident, in which no objective entry site could be suspected with as much temporal relation as the bronchoaspiration incident. Bronchoaspiration of organic matter and feces provides both a source of the causative agent and an adequate polymicrobial environment for the development of the disease. It is under such conditions that we propose this unusual entry site as the cause of tetanus in our patient. Special emphasis is made on the importance of adulthood immunization programs and how incidents like this one should be taken into account in the overall care provided to the elderly population.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
2/16. Rapidly progressive pneumonia due to aeromonas hydrophila shortly after near-drowning.An 87-year-old woman died of rapidly progressive pneumonia due to aeromonas hydrophila shortly after a near-drowning event. autopsy showed necrotizing pneumonia and postmortem cultures of both blood and lung revealed the organism. Fulminant pneumonia should be considered in patients of a near-drowning event.- - - - - - - - - - ranking = 6keywords = near (Clic here for more details about this article) |
3/16. Near-fatal grape aspiration with complicating acute lung injury successfully treated with extracorporeal membrane oxygenation.OBJECTIVE: In this report of a near-fatal case of grape aspiration successfully treated with extracorporeal membrane oxygenation (ECMO), we highlight the danger of feeding seedless grapes to young children and demonstrate that ECMO can provide cardiopulmonary support for cases of acquired large-airway disruption and can facilitate therapeutic intervention. DESIGN: Case report. SETTING: A tertiary pediatric intensive care unit and ECMO center. PATIENT: A healthy 14-month-old boy aspirated a seedless grape while playing at home and suffered a cardiopulmonary arrest of 15 mins in duration. He responded to advanced life support with return of cardiac output but developed intractable cardiopulmonary failure secondary to aspirated grape particles and postobstructive pulmonary edema. INTERVENTIONS: The patient was emergently transferred to the regional ECMO center and placed on venoarterial ECMO. Bronchoscopies were performed in the stable environment provided by ECMO, aspirated particles were removed from the large airways, and lung recovery was facilitated. MEASUREMENTS AND MAIN RESULTS: End-organ perfusion was restored via ECMO during a period of severe intractable cardiopulmonary failure. Pulmonary recovery occurred during a 6-day ECMO run and was facilitated by therapeutic bronchoscopy. The patient was reviewed 1 yr later and has made a full neurodevelopmental recovery, despite a 15-min out-of-hospital cardiac arrest. CONCLUSIONS: Aspiration of a seedless grape is a life-threatening event in a small child. This danger is not fully appreciated by parents in the UK. ECMO may be life saving in cases of acquired large-airway disruption resulting in severe cardiopulmonary failure, including foreign body aspiration, as long as end-organ perfusion is maintained.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
4/16. Pediatric sand aspiration: case report and literature review.Sand aspiration is a rare but life-threatening event that occurs in the pediatric and adult populations after cave-ins or near drownings. We report the case of a 10-year-old boy who suffered from aspiration of particulate matter after being buried in sand. In addition, we performed a literature review regarding similar cases and their treatment of aspiration of significant amounts of particulate matter. Treatment of the victims ranges from conservative to very aggressive. The treatment employed is dictated by the patient's current condition and the services available to the physician.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
5/16. vancomycin-induced linear iga bullous dermatosis: morphology is a key to diagnosis.vancomycin-induced linear iga bullous dermatosis (LABD) previously has been described; however, past reports have suggested that the clinical presentation is nonspecific. We present a case of vancomycin-induced LABD with a suggestive clinical presentation; specifically, groups of annularly arranged vesicles. We propose that this clinical presentation strongly suggests drug-induced LABD and should raise a clinician's suspicion of vancomycin as the offending agent. This awareness may guide the antibiotic management of the patient while the clinician awaits histopathologic correlation.- - - - - - - - - - ranking = 5keywords = near (Clic here for more details about this article) |
6/16. Reversal of laryngotracheal separation: a detailed case report with long-term followup.Chronic aspiration is a difficult and potentially lethal problem. patients who have persistent soilage of the upper respiratory tract despite discontinuing oral intake may be offered surgical intervention to avoid life-threatening pulmonary infections. The Lindeman procedures (tracheoesophageal diversion and laryngotracheal separation) have gained popularity as surgical treatments for intractable aspiration because of their efficacy in preventing aspiration and their technical simplicity. A major downside of these procedures is the necessity for a tracheostoma and the loss of speech following surgery. Rarely, patients recover from the neurologic deficits which led to their intractable aspiration and desire reversal of their Lindeman procedure. While few "successful" reversals have been reported, detailed accounts of the long-term results of such patients are lacking. We describe a patient who underwent a laryngotracheal separation for intractable aspiration following a brainstem stroke. In the following six months he experienced significant neurologic recovery and, after careful evaluation, underwent surgical restoration of laryngotracheal continuity. Five years later he speaks fluently and has no dietary restrictions. Videofluooroscopic examination and quantitative voice analysis reveal near-normal laryngeal function.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
7/16. poisoning from aspiration of elemental mercury.BACKGROUND: Mercury and mercury compounds (inorganic and organic) can cause acute or chronic poisoning. Acute poisonings, especially with inorganic salts, are widely described, but only sparse data are available on intoxication from oral elemental mercury. We report a case of elemental mercury ingestion followed by pulmonary aspiration of the elemental mercury. CASE REPORT: A 49-year-old woman intentionally ingested about 200 mL (2709 g) of elemental mercury and aspirated during gastric lavage. A chest radiograph demonstrated small radiodense droplets in the peripheral parts of both lung fields. Whole blood mercury concentrations were 330 microg/L on day 3, 457 microg/L on day 8, and 174 microg/L on day 17. The mercury concentration in a random urine sample was 231 microg/L on day 17. The patient was treated with oral d-penicillamine on the 25th-32nd day after ingestion. A hair sample taken from near the scalp on day 31 had a mercury concentration of 1.38 microg/g. The patient demonstrated impaired memory and disturbances in verbal-logical thinking. At 6 months, she had improved clinically; her whole blood mercury concentration was 16.4 microg/L and the mercury concentration in a random urine sample was 141 microg/L. CONCLUSIONS: In this case, systemic absorption of elemental mercury, occured after the ingestion of a massive dose of elemental mercury complicated by pulmonary aspiration.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
8/16. Invasive pulmonary and central nervous system aspergillosis after near-drowning of a child: case report and review of the literature.Invasive aspergillosis is extremely rare in immunocompetent children. Here we describe the clinical, radiologic, and laboratory course of fatal invasive pulmonary and central nervous system aspergillosis in a previously healthy child after a near-drowning incident with submersion in a pond. Findings were compared with data from the literature, which is reviewed. serum aspergillus galactomannan levels were determined retrospectively and were compared with the results of routine microbiological and radiologic examinations, showing a significant diagnostic and therapeutic delay of the routine diagnostic approach in comparison with the use of the aspergillus galactomannan assay. This delay may have contributed to the fatal course. Serial determination of serum aspergillus galactomannan may be helpful in diagnosing invasive aspergillosis early in case of pulmonary disease after near-drowning and may contribute to an early appropriate treatment. Currently voriconazole, eventually in combination with caspofungin, should be considered as the drug of choice in the management of invasive aspergillosis after near-drowning.- - - - - - - - - - ranking = 7keywords = near (Clic here for more details about this article) |
9/16. Monosporium apiospermum meningoencephalitis: a clinico-pathological case.Twenty nine cases of central nervous system infection due to Monosporium apiospermum have been reported. Six of them occurred after an aspiration pneumonia following a near drowning. The case of a 53 year old man is reported: M apiospermum was isolated from cerebrospinal fluid, sputum, urine and from the mud of the ditch where the patient had fallen. Though the treatment used recommended doses of intravenous, intrathecal and intraventricular amphotericin b, it was ineffective and the patient died 97 days after the near drowning. Necropsy showed that the ventricular infectious process was more prominent distant from the antifungal ventricular source.- - - - - - - - - - ranking = 2keywords = near (Clic here for more details about this article) |
10/16. pseudallescheria boydii infection of the central nervous system.pseudallescheria boydii is a rare cause of central nervous system infection characteristically presenting as a neutrophilic meningitis or multiple brain abscesses. Factors predisposing to central nervous system infection with this fungus include immunosuppression and near drowning. The organism is infrequently cultured from fluid obtained by lumbar puncture, delaying clinical recognition and appropriate antifungal therapy. All untreated patients with P boydii infection of the central nervous system died. We describe a patient who developed a persistent neutrophilic meningitis with focal neurologic deficits due to P boydii 6 months after a freshwater aspiration pneumonia. We also review the characteristic clinical and pathologic features of previously reported cases and emphasize the importance of early detection and treatment in the management of this frequently intractable disease.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
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