Cases reported "Bacterial Infections"

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11/50. Descending necrotizing mediastinitis: trends in a developing country.

    Descending necrotizing mediastinitis is believed to be a rare and serious complication of odontogenic and oropharyngeal infections. It is associated with a high (up to 40%) mortality rate, which can be attributed to delays in diagnosis and inadequate surgical drainage. Between May 1999 and September 2002, we treated 7 cases at our institution in New Delhi, indicating that such fulminating infections are not so rare in developing countries. In our 7 cases, a high index of suspicion and early computed tomography helped us make a rapid diagnosis and initiate prompt treatment, which resulted in a favorable outcome in 6 cases (mortality rate: 14.3%).
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12/50. Neonatal bone infarction following cord sepsis: case report.

    An unusual case of infarction of the tibia in a neonate who presented with sepsis following poor cord management at birth is reported. He was managed as for necrotizing enterocolitis and had limited debridement of infarcted limb because the parents refused amputation of the limb. This patient was a diagnostic problem. Necrotizing fasciitis and in retrospect purpura fulminans are considered as possible diagnoses and are discussed briefly.
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13/50. Is it acute omphalitis or necrotizing fasciitis? Report of three fatal cases.

    We describe 3 Costa Rican newborns that developed acute omphalitis, complicated with fulminant abdominal wall and genital necrotizing fasciitis. The emergency practitioner should be capable of distinguishing promptly between acute omphalitis and early necrotizing fasciitis. Prompt medical treatment and surgical debridement should be encouraged to decrease the high associated morbidity and mortality rates.
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14/50. Percutaneous treatment of a patient with infected necrotizing pancreatitis.

    BACKGROUND: A 50-year-old man with an acute episode of alcohol-induced chronic edematous pancreatitis and an inflammatory stenosis of the biliary tract was treated by implantation of a plastic endoprosthesis at a rural hospital in germany. Because of his worsening condition, the patient was referred to the intensive care unit of the University Hospital, Regensburg, germany. Contrast-enhanced CT revealed complete necrosis of the body and tail of the pancreas, formation of large retrogastric and paraduodenal fluid collections, and fluid along Gerota's fascia, as well as in the paracolic gutters. Antibiotic treatment was adjusted according to the results of microbiological testing after diagnostic puncture of the necrotic cavity. INVESTIGATIONS: CT scan, CT-guided fine-needle aspiration and fluoroscopy. diagnosis: Infected acute necrotizing pancreatitis. MANAGEMENT: Interventional treatment using large-bore percutaneous catheters to perform percutaneous necrosectomy, fragmentation of necrotic pancreatic tissue with a snare catheter and dormia basket, and aspiration. parenteral nutrition and antibiotics were also administered.
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15/50. debridement of periumbilical necrotizing fasciitis: importance of excision of the umbilical vessels and urachal remnant.

    The operation of a neonate with periumbilical necrotizing fasciitis consisted of (1) excision of infected skin, fat, and fascia (including the umbilicus); (2) a limited laparotomy, with ligation and excision of the umbilical vessels and urachal remnant; and (3) placement of a temporary silastic patch over the central abdominal defect. Pathological sections confirmed the spread of infection along the vessels and urachal remnant. Excision of the vessels and urachal remnant may be crucial to survival from periumbilical necrotizing fasciitis.
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16/50. Infected pancreatic necrosis possibly due to combined percutaneous aspiration, cystogastric pseudocyst drainage and injection of a sclerosant.

    This paper reports on a patient who was treated by percutaneous aspiration, instillation of a sclerosant (polidocanol) and cystogastric drainage for a post-acute pancreatic pseudocyst. Five weeks after admission to hospital for the first episode of an acute necrotizing pancreatitis, the 60-year-old man underwent a percutaneous, ultrasound-guided puncture and aspiration of a voluminous pancreatic pseudocyst. Ten days later, recurrent fluid collection led to a second puncture, combined with the injection of polidocanol (15 ml; 1%) into the cyst cavity. Since this treatment failed, a percutaneous cystogastric drain ("double--pigtail") was inserted five days later. After developing acute abdominal pain and incipient sepsis, the patient was sent for surgical intervention twelve days after the second treatment with percutaneous aspiration and injection of polidocanol. During the operation an infected pancreatic pseudocyst with extensive contaminated necrosis of the pancreas and duodenal perforation was found. Necrectomy was performed, followed by continuous lavage of the omental bursa. intensive care therapy was necessary for one week. Duodenal leakage persisted for nearly three weeks, the stopped spontaneously. The patient was discharged in quite a good state of health after 33 days of postoperative treatment. Although spontaneous development of infected pancreatic pseudocysts and pancreatic abscesses in necrotizing pancreatitis is known, a possible involvement of the drainage procedures, especially in combination with the injection of a sclerosant must be considered.
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17/50. Soft-tissue infection in lower-extremity trauma.

    Soft-tissue infection after lower-extremity trauma has not been studied in detail in light of recent data on the biology of infection. This article examines specific problems in lower-extremity trauma that allow the wound to become susceptible to wound infection. It also illustrates the various principles of wound management in lower-extremity trauma that serve to prevent infection. Two case examples are used to illustrate principles of management. Other wound problems in lower-extremity trauma are also discussed, such as rabies, necrotizing soft-tissue infection, tetanus, and diabetic foot infections.
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18/50. Increased activities of cytosol aminopeptidase and lactate dehydrogenase in serum originate from lymphocytes in necrotizing lymphadenitis.

    In three pediatric patients with necrotizing lymphadenitis, cytosol aminopeptidase activity (c-AP; EC 3.4.11.1) in serum was markedly increased to 509, 417, and 191 U/L, respectively (normal range 25-60 U/L). Lactate dehydrogenase (LD; EC 1.1.1.27) was also increased, with LD-3 predominating. The increased concentrations of c-AP and LD presumably originated from the destruction of infected, activated lymphocytes, especially T lymphocytes. Necrotizing lymphadenitis is probably caused by a lymphocytotropic virus.
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19/50. Cervical necrotizing fasciitis: an uncommon sequela to dental infection.

    Necrotizing fasciitis is a soft-tissue infection, usually polymicrobial, that causes necrosis of fascia and subcutaneous tissue while sparing skin and muscle. Although it more commonly involves the groin, abdomen, and extremities, it may also occur in the head and neck, usually secondary to dental infection. We report a case of cervical necrotizing fasciitis arising from a dental infection and review the cause, pathophysiology, diagnosis, and treatment of this potentially lethal entity. Early detection and interventions is emphasized. Extensive surgical debridement remains the mainstay of treatment. In addition, a clarification of the various eponyms it has gone under in the past is offered.
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20/50. The blind loop syndrome in children.

    Anatomical abnormalities of the small bowel that cause intestinal stagnation result in bacterial overgrowth and a blind loop syndrome (BLS). Bacterial breakdown of bile salts and deamination of protein lead to malabsorption, steatorrhea, and fat-soluble vitamin deficiencies. Four children developed BLS as a complication of necrotizing enterocolitis, jejunal atresia, gastroschisis, and biliary atresia. BLS was suggested by abdominal pain, feculent vomiting, steatorrhea, and hypoalbuminemia. Dilated, stagnant bowel loops were demonstrated in each instance by upper gastrointestinal contrast study. Positive intestinal bacterial aspirates were confirmatory. Antibiotic treatment in two patients improved symptomatology but all children ultimately required surgery. Surgical procedures consisted of blind loop resection, intestinal plication, and catheterization of the bilioenteric conduit. All patients are now asymptomatic but one child suffers from parenteral nutrition-related cirrhosis and another requires chronic antibiotic therapy.
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