Cases reported "Pseudomonas Infections"

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1/74. Severe complications of ulcerative colitis after high-dose prednisolone and azathioprine treatment.

    We report a rare case of ulcerative colitis (UC) associated with methicillin-resistant staphylococcus aureus (MRSA) and pseudomonas aeruginosa infections in multiple organs, and with compressive fracture from osteoporosis after the administration of high-dose prednisolone and azathioprine. A 25-year-old man had been treated with high-dose prednisolone for UC. He suddenly experienced severe lumbago, which prevented him from walking. Plain X-ray demonstrated compressive fractures of the thoracic and the lumbar vertebrae, which were thought to be due to osteoporosis as a side effect of the high-dose prednisolone. At this admission, in another hospital, he also had a bloody discharge from the rectum, and azathioprine was started; however, the patient's condition still did not show any improvement. The total doses of azathioprine and prednisolone he had received were 3150 mg and more than 15,000 mg, respectively. Considering the presence of the serious complications, surgical intervention was the treatment selected. culture study revealed MRSA in the feces and nasal cavity, and P. aeruginosa in the feces and urine. vancomycin hydrochloride and gentamicin were administered, and were effective, with a subsequent negative culture study. Subtotal colectomy with mucus fistula was performed. After the operation, culture studies remained negative. Major steroid side effects such as bone fracture and osteoporosis should be considered as an indication for surgery in UC patients. MRSA and P. aeruginosa are a menace, especially for UC immunosuppressed patients on steroid or immunosuppressive therapy. When these bacteria are detected, there should be prompt and adequate antimicrobial therapy against the organisms and the immunosuppressive therapy should be immediately discontinued. We conclude that surgical therapy should be considered in the earlier stage for patients with intractable UC, rather than continuing long-term administration of steroid or azathioprine, which may lead to serious complications.
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2/74. Treatment of chronic osteomyelitis of the lower extremity using free flap transfer.

    Between 1987 and 1995, 25 patients with chronic osteomyelitis of the lower extremity were treated by transfer of muscle or musculocutaneous flap. The subsequent follow-up extended over more than three years. Five patients developed a recurrence. Two were reoperated on and healed completely; in two an amputation had to be performed; and in one the infection persists. recurrence occurred mainly in patients in whom the bone cavity could not be filled completely with muscle.
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3/74. Long-term antibiotic treatment in geriatric diabetic foot infection.

    A case report involving a 77-year old diabetic patient with an arterial foot ulcer and subsequent osteomyelitic infection is presented. Due to the patient's ineligibility for surgical intervention, long term antibiotic treatment based upon multiple culture, bone biopsy, radiograms and isotope scanning was initiated. Complete resolution of the osteomyelitis defined by subjective as well as objective criteria was achieved after three months of antibiotic treatment. The common and atypical characteristics of the geriatric population coupled with treatment plan involving a multidisciplinary approach resulted in maintaining foot function and pain-free ambulation in this 77-year old patient.
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4/74. Total excision of the sternum and thoracic pedicle transposition of the greater omentum; useful strategems in managing severe mediastinal infection following open heart surgery.

    Mediastinal sepsis following open heart surgery is a significant cause of death. Open drainage of the mediastinumalone was employed originally in management of this problem. More recently, debridement, drainage, and reclosure have been used. Various irrigation solutions, such as antibiotics and Betadine, have been advocated to control severe mediastinal sepsis. Three principles of management in patients unresponsiveness to the above techniques have proved successful in two patients with life-threatening mediastinal sepsis: (1) radical, complete excision of the sternum and adjacent costal cartilages; (2) transposition of the greater omentum on a vascular pedicle to the mediastinum; and (3) primary closure with full-thickness rotational skin flaps. The radical excision of the sternum removes residual foci of sepsis in cartilage and sternal bone marrow. The transposition of the omentum provides a highly vascular, rapidly granulating covering for the contaminated great vessels and hase been successfully to prevent recurrence of suture line bleeding of an exposed ascending aortic anastomosis site. Primary closure of the wound with full-thickness skin flaps provides a suprisingly satisfactory covering for the heart. Preoperative and postoperative measurements of ventilatory mechanics have shown relatively small ventilatory impairment after the alteration of the thoracic cage imposed by excision of the sternum. Two patients have returned to active lives. A treatment failure probably due to incomplete adherence to these guidelines also is presented.
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5/74. brain abscess related to metal fragments 47 years after head injury. Case report.

    The authors report a case of symptomatic brain abscess in a 51-year-old man who presented with personality changes and generalized seizures. He had survived a grenade explosion injury during the korean war 47 years previously. Computerized tomography scanning revealed multiple conglomerate rim-enhancing lesions and metallic foreign bodies in the right frontal lobe. The mass was totally removed and pseudomonas aeruginosa was isolated from microbial cultures. Retained foreign bodies in the brain, whether bone or metal, should be removed at the time of injury if at all possible. If this cannot be accomplished, patients with such retained foreign bodies should be carefully monitored for life.
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keywords = bone
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6/74. One-bone forearm formation using vascularized fibula graft for massive bone defect of the forearm with infection: case report.

    Massive long-bone defects of greater than 6 cm are difficult to treat with conventional bone grafts, and other methods are sometimes recommended, such as vascularized bone grafts or bone transport using the Ilizarov external fixator. The combination of local infection with a massive bone defect exacerbates the problem, and provides an even more negative prognosis. The authors treated a large bone defect of the forearm with local infection, using a one-bone forearm formation with a large vascularized fibula graft. They attached an adequate amount of muscle fascia to the vascularized fibula, which was useful not only for coverage of the skin defect, but also for treatment of the local infection. Twenty months after surgery, elbow and hand functions were maintained, and the patient had no disturbance of hand function in daily activities, although rotation of the forearm was sacrificed.
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ranking = 15
keywords = bone
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7/74. Malignant otitis externa in an infant with selective iga deficiency: a case report.

    The occurrence of malignant otitis externa (MOE) in infancy is rare. We report a case of MOE in a neonate who was later identified to have selective iga deficiency. She was successfully treated with oral ciprofloxacin, but developed external auditory canal stenosis, a deformed pinna, persistent facial nerve palsy, temporal bone erosion and hearing loss. No cases of MOE in selective iga deficiency have been reported in literature. This is also the first report on the use of ciprofloxacin in infants with MOE.
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8/74. Malignant otitis externa--a high index of suspicion is still needed for diagnosis.

    Malignant otitis externa is a destructive inflammatory process of the petrous temporal bone which if untreated leads to osteomyelitis of the skull base and can be fatal. It is more common in immunocompromised and elderly insulin-dependant diabetic patients and is caused by infection with Pseudomonas species. Despite a range of laboratory and radiological tests it still remains difficult to diagnose, particularly in the early stages when it can be treated medically. We describe three cases which presented to this department in the past twelve months. In all cases the diagnosis was made clinically and confirmed per-operatively. Interestingly all three cases were relatively young patients who did not have an immunocompromised status and were not diabetic.
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9/74. pseudomonas aeruginosa sacroiliitis and osteomyelitis of pelvic bones after radical prostatectomy.

    A 66-year-old diabetic man presented with acute incapacitating pelvic pain 6 weeks after radical prostatectomy. Symphysis pubis biopsy showed chronic osteomyelitis, and culture grew pseudomonas aeruginosa. Despite a 7-week course of intravenous piperacillin and ceftazidime, he returned 6 months later with the same symptoms. Imaging studies and biopsy indicated right sacroiliitis and persistent pseudomonas osteomyelitis of the pelvic bones. He refused surgical debridement and was successfully treated with the same antibiotics for 8 more weeks. We emphasize the importance of bone biopsy and culture to expedite effective intravenous antibiotic therapy.
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ranking = 6
keywords = bone
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10/74. Atypical hemophagocytic lymphohistiocytosis following bacterial tonsillitis in acute lymphoblastic leukemia.

    We report a rare case of a cute lymphoblasticleukemia (ALL) who developed dyspnea, neurological disturbance with illusions, pancytopenia, phagocytosis and coagulation disturbances following bacterial tonsillitis. The values of soluble interleukin-2 receptor (sIL-2R), IL-6 and IL-8 were also elevated. Her clinicolaboratory findings were similar to hemophagocytic lymphohistiocytosis (HLH), which is a cytokine disease induced by activated T cells and macrophages. Atypical HLH following bacterial tonsillitis should be kept in mind in leukemia patients.
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keywords = macrophage
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