1/4. Polymicrobial bacteremia caused by escherichia coli, edwardsiella tarda, and shewanella putrefaciens.edwardsiella tarda, a member of enterobacteriaceae, is found in freshwater and marine environments and in animals living in these environments. This bacterium is primarily associated with gastrointestinal diseases, and has been isolated from stool specimens obtained from persons with or without clinical infectious diseases. shewanella putrefaciens, a saprophytic gram-negative rod, is rarely responsible for clinical syndromes in humans. Debilitated status and exposure to aquatic environments are the major predisposing factors for E. tarda or S. putrefaciens infection. A 61-year-old woman was febrile with diarrhea 8 hours after ingesting shark meat, and two sets of blood cultures grew escherichia coli, E. tarda and S. putrefaciens at the same time. She was successfully treated with antibiotics. We present this rare case of polymicrobial bacteremia caused by E. coli, E. tarda and S. putrefaciens without underlying disease, which is the first found in taiwan. This rare case of febrile diarrhea with consequent polymicrobial bacteremia emphasizes that attention should always be extended to these unusual pathogens.- - - - - - - - - - ranking = 1keywords = water (Clic here for more details about this article) |
2/4. Acute abdomen secondary to ascaris lumbricoides infestation of the small bowel.ascariasis is a helminthic infection commonly found in tropical climates. It often propagates in communities of low socioeconomic status secondary to contamination of the soil and water supply with human feces. We present a case report of a 42-year-old Asian-Indian female presenting with a long-standing history of severe recurrent postprandial epigastric pain, requiring multiple hospital admissions. Ultrasound, computed tomography (CT), and nuclear biliary scan were negative. She underwent esophagogastroduodenoscopy that suggested ischemia. magnetic resonance angiography (MRA) and mesenteric angiography were inconclusive. As conservative treatment had been unsuccessful, a small bowel series was performed. The radiographs demonstrated characteristic findings of ascaris lumbricoides infestation. Although the prevalence, diagnosis, and subsequent treatment of an acute abdomen secondary to ascaris lumbricoides infestation is commonly seen in developing countries, clinicians in developed countries may not consider this entity when faced with a patient with similar symptoms. We frequently care for immigrants from developing countries and our own citizens who visit the countries where ascariasis is endemic. Therefore, heightened awareness of ascaris lumbricoides infection (ALI) presenting as an acute abdomen is necessary. The diagnosis requires an experienced radiologist and knowledge by the clinician of treatment options and of when a surgeon should be involved.- - - - - - - - - - ranking = 1keywords = water (Clic here for more details about this article) |
3/4. bile duct disruption by blunt trauma.The rarity of bile duct injury secondary to blunt abdominal trauma leads to frequent delays in diagnosis and inappropriate management. An illustrative case is therefore described and 94 reported cases are reviewed. In 53% of patients, operation was delayed more than 24 hours. Early clinical findings of hypovolemia and acute abdomen are related to associated injuries. Late findings are abdominal distention and jaundice due to the biliary injury. early diagnosis is facilitated by diagnostic paracentesis. patients operated on during the first 24 hours after the injury had a statistically higher incidence of bile duct injury distal to the cystic duct (p less than 0.05) and of complete ductal severance (p less than 0.05). The association of location distal to the cystic duct and complete severance was highly significant (p less than 0.001). Management should include biliary exploration. cholangiography using concentrated water-soluble contrast agents may help to find the anatomy of obscure injuries. The choice of surgical repair must be individualized according to the location and the magnitude of the injury.- - - - - - - - - - ranking = 1keywords = water (Clic here for more details about this article) |
4/4. Small bowel intussusception and brown bowel syndrome in association with severe malnutrition.Brown bowel syndrome is a rare condition characterized by deposition of lipofuscin in the smooth muscle cells of the gastrointestinal tract. The number of reported cases is small, but all are associated with malabsorptive states. Despite these small numbers, there is considerable evidence that vitamin e deficiency is important etiologically. We report here the case of a severely malnourished [body mass index 11.7 kg/m (2): normal range 20-25 kg/m (2)] 31-yr-old black male with a longstanding history of alcohol abuse, who was on anti-tuberculosis therapy. The patient presented with an acute abdomen and was found, at operation, to have a mid-ileal intussusception. Histological examination of the resected specimen demonstrated lipofuscin accumulation consistent with brown bowel syndrome, but no tumor. Subsequent investigations revealed no significant quantities of vitamin E in the blood and pancreatic steatorrhea. However, deficiency of other fat-soluble (vitamin a and D) and water-soluble vitamins (vitamin C and thiamine) also were detected. This report supports the association of brown bowel syndrome with vitamin e deficiency but cannot exclude the compounding effects of protein calorie malnutrition, multiple vitamin deficiencies, and chronic alcohol toxicity.- - - - - - - - - - ranking = 1keywords = water (Clic here for more details about this article) |