1/97. Nonclostridial gas gangrene due to streptococcus anginosus in a diabetic patient.streptococcus anginosus was recently identified as a distinct species from the other members of streptococcus milleri group (streptococcus constellatus, streptococcus intermedius). We report a rare case of nonclostridial gas gangrene caused by S. anginosus. A 62-year-old diabetic woman was admitted with gas gangrene of the perineal area. She had been taking her oral hypoglycemia medication regularly for 10 years, but the diabetes was inadequately controlled. She was treated with surgical debridement of the necrotic tissue, insulin injection, and antibiotic therapy, and had a satisfactory clinical course.- - - - - - - - - - ranking = 1keywords = gas (Clic here for more details about this article) |
2/97. Bacterial complications of strongyloidiasis: streptococcus bovis meningitis.We report the case of a 64-year-old veteran who had streptococcus bovis meningitis as a result of a long latent strongyloides infection that became acute when he was treated with prednisone. We reviewed 38 reported cases of serious bacterial infections associated with strongyloidiasis. patients most frequently had nonspecific gastrointestinal symptoms. Of these 38 patients, 21 (55%) had meningitis, and 28 (73%) had bacteremia that was polymicrobial in 3 cases (8%). Other sites of infection included lung, bone marrow, ascites, mitral valve, and lymph node. Most infections were due to enteric gram-negative bacteria. There is one previously reported case of S bovis meningitis. Thirty-four of the patients (89%) were immunosuppressed; 21 of these (55%) were taking pharmacologic doses of adrenal corticosteroids. Thirty-three of the 38 (87%) patients died. patients with enteric bacterial infection without an obvious cause should be tested for the presence of strongyloidiasis.- - - - - - - - - - ranking = 0.16666666666667keywords = gas (Clic here for more details about this article) |
3/97. Acute onset of chorea and dystonia following a febrile illness in a 1-year-old boy.A 12-month-old boy with acute onset hemichorea and dystonia following a gastroenteritis has abnormal signal intensities of his basal ganglia on brain magnetic resonance imaging (MRI). A rigorous laboratory investigation is successful in diagnosing his rare condition. A discussion of the differential of abnormal basal ganglia on MRI is presented to help illustrate this case.- - - - - - - - - - ranking = 0.16666666666667keywords = gas (Clic here for more details about this article) |
4/97. A man with fever, rigors, and poor oral hygiene.A 62-year-old man presented to the emergency department with a one-week history of subjective fever and rigors. He had had epigastric pain for three weeks, for which he was taking ranitidine, and in the past two to three months had experienced night sweats, a nonproductive cough, nausea, vomiting, and a 30-lb weight loss. He denied dsypnea, chest pain, hematochezia, melena, or any change in bowel habits.- - - - - - - - - - ranking = 0.16666666666667keywords = gas (Clic here for more details about this article) |
5/97. Use of recruitment maneuvers and high-positive end-expiratory pressure in a patient with acute respiratory distress syndrome.OBJECTIVE: To present the use of a novel high-pressure recruitment maneuver followed by high levels of positive end-expiratory pressure in a patient with the acute respiratory distress syndrome (ARDS). DESIGN: Observations in one patient. SETTING: The medical intensive care unit at a tertiary care university teaching hospital. PATIENT: A 32-yr-old woman with severe ARDS secondary to streptococcal sepsis. INTERVENTIONS: The patient had severe gas exchange abnormalities because of acute lung injury and marked lung collapse. Attempts to optimize recruitment based on the inflation pressure-volume (PV) curve were not sufficient to avoid dependent lung collapse. We used a recruitment maneuver using 40 cm H2O of positive end-expiratory pressure (PEEP) and 20 cm H2O of pressure controlled ventilation above PEEP for 2 mins to successfully recruit the lung. The recruitment was maintained with 25 cm H2O of PEEP, which was much higher than the PEEP predicted by the lower inflection point (P(Flex)) of the PV curve. MEASUREMENTS AND MAIN RESULTS: Recruitment was assessed by improvements in oxygenation and by computed tomography of the chest. With the recruitment maneuvers, the patient had a dramatic improvement in gas exchange and we were able to demonstrate nearly complete recruitment of the lung by computed tomography. A PV curve was measured that demonstrated a P(Flex) of 16-18 cm H2O. CONCLUSION: Accumulating data suggest that the maximization and maintenance of lung recruitment may reduce lung parenchymal injury from positive pressure ventilation in ARDS. We demonstrate that in this case PEEP alone was not adequate to recruit the injured lung and that a high-pressure recruitment maneuver was required. After recruitment, high-level PEEP was needed to prevent derecruitment and this level of PEEP was not adequately predicted by the P(Flex) of the PV curve.- - - - - - - - - - ranking = 0.33333333333333keywords = gas (Clic here for more details about this article) |
6/97. Thoracic empyema associated with recurrent colon cancer: report of a case and review of the literature.Many types of infections associated with colorectal cancer have been reported. Here, we describe a rare case of thoracic empyema that was observed during immunotherapy for recurrent colon cancer. culture of the pleural fluid yielded streptococcus bovis, which is known to be associated with gastrointestinal lesions, especially colorectal malignancies. The possible correlation between these two clinical entities-empyema and colon cancer-is discussed.- - - - - - - - - - ranking = 0.16666666666667keywords = gas (Clic here for more details about this article) |
7/97. A rare case of primary group A streptococcal peritonitis.Primary Group A streptococcal peritonitis is a rare clinical entity that is almost always associated with underlying disease. Group A streptococcus commonly causes upper respiratory tract infections and cutaneous infections such as impetigo and erysipelas. However, Group A streptococcus has rarely been associated with gastrointestinal infections. This is a case report describing a previously healthy adult male who developed primary Group A streptococcal peritonitis. Diagnostic laparoscopy resulted in identification of peritonitis without an identifiable intra-abdominal source. Appropriate antibiotic therapy was instituted. culture of blood, sputum, urine, and urethra were all pathogen free. The patient made a complete recovery and was dismissed from the hospital on oral clindamycin and cephalexin. To the best of our knowledge this report represents the only documented case of primary Group A streptococcal peritonitis in a male patient without any significant past medical history.- - - - - - - - - - ranking = 0.16666666666667keywords = gas (Clic here for more details about this article) |
8/97. A case of toxic shock-like syndrome presenting with serious hypoproteinaemia because of a protein-losing gastroenteropathy.A 37-year-old man was admitted to our hospital because of toxic shock-like syndrome (TSLS) induced by streptococcus pyogenes. After the pathogenic bacteria had been eradicated, serious diarrhoea appeared and a protein-losing gastroenteropathy developed. An immunohistochemical study of the biopsy specimens of both small and large intestines revealed the infiltration of t-lymphocytes, predominantly CD8 cells, into the lamina propria of affected mucosa, villus atrophy and crypt hyperplasia. Considering these histological findings, some immunological mechanism which lead the activation of cytotoxic t-lymphocytes may play an important role in the pathogenesis of this rare intestinal manifestation of TSLS.- - - - - - - - - - ranking = 0.83333333333333keywords = gas (Clic here for more details about this article) |
9/97. Superior mesenteric artery aneurysm.A 38-year old woman with mid-epigastric pain, diarrhea, and weight loss, underwent resection of a superior mesenteric artery aneurysm and primary repair of the artery. Pathological examination showed degenerative atherosclerotic changes, marked medial and intimal thickening, and vegetations. Microbiological studies demonstrated Streptococcus viridans as the infecting organism of this mycotic aneurysm. The patient made a good recovery and remained well after 3 years.- - - - - - - - - - ranking = 0.16666666666667keywords = gas (Clic here for more details about this article) |
10/97. Band infection with splenoportal venous thrombosis: an unusual but severe complication of gastric banding.BACKGROUND: Band infection after gastric banding is a relatively rare complication. In most cases, it is manifested by abdominal pain associated with fever, and/or an abscess surrounding the access port. The treatment of choice consists of band removal and antibiotic therapy, and is usually effective. methods: Among the 322 patients having undergone gastric banding in our department, we report a 31-year-old woman who developed an infection of the band complicated by splenic and portal vein thrombosis 21 months after gastric banding. RESULTS: BMI was 40.9 kg/m2 when she underwent gastric banding. Postoperative course was uneventful, and excess weight loss reached 105% after 18 months. An abdominoplasty combined with bilateral mammoplasty and thigh dermolipectomy were performed. About 3 weeks later, she developed an otitis with fever and left upper abdominal pain. Despite antibiotics, pain and fever persisted. The operative wounds showed no sign of infection, and there was no sign of peritonitis. Computerized tomography showed a left subdiaphragmatic abscess surrounding the catheter and thrombosis of the splenic and portal veins. Treatment consisted of band removal, antibiotics and heparin. Recovery was uneventful with complete resolution of the thrombosis. CONCLUSIONS: Late band infection after gastric banding is rare, and is usually secondary to band erosion. Our case demonstrates that severe band infection can be caused by any infection causing bacteremia. Prompt band removal along with antibiotic therapy is the treatment of choice. Rapid treatment of any infection is mandatory in patients with a gastric band. antibiotic prophylaxis during surgical and dental procedures could be useful in these patients.- - - - - - - - - - ranking = 1.6666666666667keywords = gas (Clic here for more details about this article) |
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