Cases reported "Sepsis"

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1/57. Usefulness of procalcitonin in Pseudomonas burn wound sepsis model.

    Procalcitonin (PCT), a precursor of calcitonin, and endotoxin were determined in the burn wound sepsis model in which 21 Sprague-Dawley rats were scalded approximately 30% on their back. On day 2 post burn, the wounds were inoculated 1 x 10(8) colony-forming units of pseudomonas aeruginosa. On day 5 post burn P. aeruginosa was detected by blood culture in 10 of the 21 rats (47.6%). The mortality rate 7 days after burn was 90.5%. Significant correlations were observed between serum endotoxin levels and serum PCT levels on day 5 post burn (r = 0.860, p<0.001). It was suggested that endotoxin may induce the release of PCT and that measuring the levels of PCT may be useful in diagnosing burn wound sepsis.
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2/57. Congenital neutropenia. Report of a case and a biorationale for dental management.

    Congenital neutropenia is characterized by a marked decrease in or lack of circulating PMN's in children with no prior history of drug intake. The neutropenia is persistent and the clinical course is one of early onset of severe, recurrent, and eventually fatal infections. bone marrow studies show a maturation arrest of neutrophilic precursors. Because of their greatly increased susceptibility to infection, patients with congenital neutropenia present a difficult dental management problem. A case of congenital neutropenia has been presented, as well as a biorationale for dental treatment. On the basis of reports in the literature, the following recommendations for the management of patients with congenital neutropenia are made: 1. The prevention and control of infection and the interception of dental disease before surgical intervention becomes necessary should be the overriding considerations in the management of patients with congenital neutropenia. 2. The carious breakdown of teeth should be prevented by the daily application of a 0.4 per cent stannous fluoride gel in addition to oral hygiene and limitation of sucrose intake. 3. Periodontal therapy should be palliative only, since alveolar bone loss is progressive despite frequent oral hygiene instruction and prophylaxis. The goal of periodontal therapy for patients with congenital neutropenia should therefore be a decrease in gingival inflammation to make the patient's mouth more comfortable and to slow down alveolar bone loss. Periodontal surgery is contraindicated. 4. bacteremia and subsequent septicemia should be prevented since a minor infection can become life threatening in patients with congenital neutropenia. The patient should rinse for 30 seconds and the gingival sulci should be irrigated with a phenolated antiseptic mouthwash prior to all dental manipulations of the soft tissue. This will significantly reduce the incidence of bacteremia. 5. Surgery should be avoided if at all possible because of the high risk of post-operative infection. All surgery sholld be performed in the hospital, and the patient should be given antibiotics as determined by his physician. Primary closure should be done with fine polyglycolic acid sutures to reduce the chance of infection. If postoperative infection can be prevented, wound healing will progress normally despite the complete absence of PMN's.
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ranking = 0.14285714285714
keywords = wound
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3/57. Successful high dose therapy for relapsed mediastinal large B cell lymphoma following surgical repair of anterior chest wall defect.

    We describe a man with relapsed large B cell mediastinal lymphoma and associated infected large anterior chest wall defect who required high dose salvage therapy for his underlying disease. An initial mediastinotomy wound, associated with recurrent sepsis, had developed into an abscess, then fistula and eventually a large anterior chest wall defect. Safe use of salvage chemotherapy required reconstructive surgery consisting of a pedicled muscle flap. The subsequent high dose chemotherapy was carried out without complications and 15 months later the patient is alive and well.
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ranking = 0.14285714285714
keywords = wound
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4/57. Sternal osteomyelitis and mediastinitis after open-heart operation: pathogenesis and prevention.

    Sternal osteomyelitis and mediastinitis caused by Pseudomonas cepacia developed in a patient undergoing coronary artery bypass two weeks after the operation. P. cepacia bacteremia from a contaminated pressure transducer had preceded and probably caused the chest infection. While other authors have suggested that postoperative sternal osteomyelitis and mediastinitis result from local wound contamination, this case suggests the importance of bacteremia as a cause of such gram-negative infections. Since patients undergoing open-heart operation are exposed to many sources of bacteremia, prevention of severe postoperative chest infections may depend in large part on careful preoperative evaluation of each patienc antibiotic regimens, and, as shown in this patient, on very thorough periodic review of equipment sterilization and intravascular monitoring practices.
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keywords = wound
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5/57. Hematogenous cervical spondylodiscitis after severe burn injury.

    A 47-year-old man sustained a 31% TBSA burn injury. In spite of early escharectomy and mesh-graft-transplantation the patient suffered a septicaemic phase in the first week, which was treated by a specific antibiotic. Five weeks after the burn injury a cervical spondylodiscitis was diagnosed. Immediate wound debridement, ventral and dorsal spondylodesis with a tricortical bone-graft from the left iliac crest and titanium plates and specific antibiotic therapy led to the stabilization and healing of the cervical spinal column. The spondylodiscitis was microbiologically proved to be hematogenous after spread of staphylococcus aureus from the blood in the early septicaemic phase. Swab culture from the burn surface wound, infected vertebrae and blood during the septicaemic phase revealed coagulase positive S. aureus. The aetiology, predisposing factors and management of this rare, but recognized, complication of major burns are discussed. Case features of this patient are compared with the single site's reported case of hematogenous cervical spondylodiscitis after severe burn injury.
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ranking = 0.28571428571429
keywords = wound
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6/57. Successful treatment of invasive burn wound infection with sepsis in patients with major burns.

    OBJECTIVE: To investigate the clinical characteristics of invasive burn wound infection with sepsis in patients with major burns and to summarize the successful experiences in the treatment of such patients. methods: Eight patients with major burns, complicated by invasive burn would infection and sepsis were consecutively admitted to our hospital from September 1997 to October 1998. Among them, 6 patients developed multiple organ dysfunction syndrome (MODS) and 2 developed septic shock. The plasma concentrations of IL-6, IL-8, TNF alpha and lypopolysaccharide (LPS) were assayed before and after surgical intervention, as well as when the patient's vital signs became stable. RESULTS: The patients' conditions usually deteriorated abruptly when extensive invasive burn wound infection emerged. While multi-microbial infection was usually found, pseudomonas aeruginosa was the predominant bacteria isolated from the subeschar tissue. The plasma concentrations of IL-6, IL-8, TNF alpha and LPS before surgical intervention were significantly higher than those after surgical intervention (P < 0.05). The lowest levels of the inflammatory mediators were observed when the patients' conditions became stable, and the values were significantly lower than those before surgical intervention (P < 0.001). CONCLUSION: Since the main cause of burn wound sepsis is the presence of a large area of infected burn wound, they should be excised and covered as early as possible. LPS and pro-inflammatory mediators play an important role in the pathogenesis of burn sepsis. Although favorable results should be attributed to comprehensive treatment, we believe that early, aggressive and thorough surgical excision of infected burn wounds, followed by sound and complete coverage of the area, play a crucial role.
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ranking = 64.230685197409
keywords = wound infection, wound
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7/57. Infected cephalohematoma associated with sepsis and scalp cellulitis: a case report.

    Infected cephalohematoma is rarely complicated by sepsis. We report a case of an infected cephalohematoma caused by escherichia coli sepsis in an otherwise healthy neonate. skull X-ray revealed soft tissue swelling over parieto-temporal region but no osteolytic lesion. 99mTc bone scan showed scalp cellulitis. blood culture and scalp wound culture identified E. coli. Treatment with surgical incision and drainage and administration of antibiotics resulted in prompt improvement. The relationship of scalp cellulitis, infected cephalohematoma, and sepsis are discussed.
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ranking = 0.14285714285714
keywords = wound
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8/57. A novel approach to the problem of intestinal fistulization arising in patients managed with open peritoneal cavities.

    Open management of the peritoneal cavity is an efficacious technique for controlling fulminant intraabdominal sepsis. A significant proportion of these patients develop intestinal fistulae for which there are few good treatment options. We propose a novel technique for preventing and potentially treating intestinal fistulas that involves patching intestinal deserosalizations and fistulas with acellular dermal matrix (Alloderm) and fibrin glue. We report our experience with this technique in 2 patients who developed small bowel deserosalizations, neither of whom went on to develop fistulas. We additionally describe 1 patient who developed an intestinal fistula for whom we were able to affect closure with this technique. We propose that our method is a useful temporizing measure to prevent fistulae formation. Furthermore, we believe this technique may be a useful option for treating intestinal fistulae arising in patients managed with open abdominal wounds.
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ranking = 0.14285714285714
keywords = wound
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9/57. wound infection due to vibrio vulnificus in spain.

    vibrio vulnificus is a gram-negative rod that can cause septicaemia and skin lesions, usually in patients with underlying illnesses such as chronic liver disease or diabetes mellitus. Infections caused by this bacterium are unusual in spain. A case of skin infection due to vibrio vulnificus is reported in a patient whose abraded skin on his left leg came into contact with seawater. The patient died suddenly, probably due to septicaemia or bacteraemia caused by this organism. vibrio vulnificus infection must be considered in the differential diagnosis of septicaemia, skin lesions and wound infections, particularly when a patient reports a history of contact with seawater.
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ranking = 10.63368562814
keywords = wound infection, wound
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10/57. In vivo acquisition of ceftriaxone resistance in salmonella enterica serotype anatum.

    The emergence of resistance to antimicrobial agents within the salmonellas is a worldwide and severe problem. A case of treatment failure due to the emergence of resistance to ceftriaxone in salmonella enterica serotype Anatum was studied. S. enterica serotype Anatum and escherichia coli, both of which are susceptible to ceftriaxone, were initially isolated from a diabetic patient hospitalized for the treatment of wound and urinary tract infections. Resistant S. enterica serotype Anatum and E. coli strains were isolated concomitantly 2 weeks after the initiation of ceftriaxone therapy. The patient eventually died of a sepsis caused by the ceftriaxone-resistant salmonella. PCR, nucleotide sequence analysis, and dna-dna hybridization identified a bla(CTX-M-3) gene located on a 95.1-kb plasmid from the ceftriaxone-resistant isolates of S. enterica serotype Anatum and E. coli. The plasmid was proved to be conjugative. Molecular fingerprinting showed that the susceptible and resistant strains were genetically indistinguishable. The emergence of resistance to ceftriaxone in S. enterica serotype Anatum was due to the in vivo acquisition of a plasmid containing the bla(CTX-M-3) gene and was the cause for treatment failure in this patient.
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ranking = 0.14285714285714
keywords = wound
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