Cases reported "Suppuration"

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1/11. Cannula related suppurative thrombophlebitis in the burned patient.

    Suppurative thrombophlebitis is a well recognised and potentially fatal complication of intravenous cannulation in burns patients. We report a case of an Afro-Caribbean patient with noninsulin-dependent diabetes who developed signs of systemic sepsis two weeks after a 14% total body surface area flame burn. Despite an initial paucity of clinical signs at the cannulation site, exploratory venotomy revealed frank suppuration within the long saphenous vein from the ankle to the groin. This was treated successfully by total excision of the vein and its tributaries and delayed wound closure. Following this, a retrospective analysis of the measured clinical parameters and blood tests revealed no obvious, missed pointers to the impending sepsis other than a dramatic increase in the overall daily insulin requirement. This had doubled over a 48-h period, preceding the clinical diagnosis by three days. The relevant literature and guidelines for management are reviewed.
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ranking = 1
keywords = wound
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2/11. Clinical applications for maggots in wound care.

    Maggot debridement therapy (MDT) was first introduced in the US in 1931 and was routinely used there until mid-1940s in over 300 hospitals. With the advent of antibacterials, maggot therapy became rare until the early 1990s, when it was re-introduced first in the US, and later in israel, the UK, germany, sweden, switzerland, ukraine and thailand. Sterile maggots of the green bottle fly, Lucilia (Phaenicia) sericata, are used for MDT. Up to 1000 maggots are introduced in the wound and left for 1 to 3 days. MDT could be used for any kind of purulent, sloughy wound on the skin, independent of the underlying diseases or the location on the body for ambulatory as well as for hospitalized patients. One of the major advantages of MDT is that the maggots separate the necrotic tissue from the living tissue, making a surgical debridement easier. In 80 to 95% of the cases, a complete or significant debridement of the wound is achieved. As therapy progresses, new layers of healthy tissue are formed over the wounds. The offensive odor emanating from the necrotic tissue and the intense pain accompanying the wound decrease significantly. In a significant number of patients, an immediate amputation can be prevented as a result of MDT. In other cases, a more proximal amputation could be avoided. It is also possible that in patients with deep wounds, where septicemia is a serious threat, this can be prevented as a result of MDT. The majority of patients do not complain of any major discomfort during the treatment. Psychological and esthetic considerations are obvious. Maggots can occasionally cause a tickling or itching sensation. Approximately 20 to 25% of the patients with superficial, painful wounds, complain of increased pain during treatment with maggots, and are treated with analgesics. MDT has been proven to be an effective method for cleaning chronic wounds and initiating granulation. It is a simple, efficient, well tolerated and cost-effective tool for the treatment of wounds and ulcers, which do not respond to conventional treatment and surgical intervention.
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ranking = 13
keywords = wound
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3/11. The use of a hydrofibre dressing in fulminating necrotizing fasciitis.

    This article describes a case of necrotizing fasciitis in a 52-year-old man with previously undiagnosed diabetes. Treatment involved massive debridement and subsequent dressing of the open surgical wound. A modern hydrofibre dressing (Aquacel) was inserted intraoperatively and subsequently continued postoperatively. wound healing occurred over 3 months and the patient was discharged with no disability. The dressing managed the exudate level and kept the wound moist. It also was well tolerated by the patient, was comfortable and easy for the nurses to remove and apply.
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ranking = 2
keywords = wound
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4/11. Pyogenic granuloma of the cornea after penetrating keratoplasty.

    An 81-year-old man with metastatic prostate carcinoma underwent a penetrating keratoplasty for phlyctenular keratitis. Two years later he developed a fleshy, vascular mass in the superotemporal corneal graft wound, at the site of prior graft sutures. An excisional biopsy of the mass was performed to rule out metastatic carcinoma. Histopathological findings were consistent with pyogenic granuloma. To our knowledge there have been no prior case reports illustrating pyogenic granuloma as a late complication of penetrating keratoplasty.
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ranking = 1
keywords = wound
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5/11. mycobacterium chelonae-Mycobacterium abscessus complex clear corneal wound infection with recurrent hypopyon and perforation after phacoemulsification and intraocular lens implantation.

    We report a clear corneal wound infection occurring in a 74-year-old man caused by a member of the mycobacterium chelonae-Mycobacterium abscessus complex, presenting as crystalline keratopathy with recurrent hypopyon. This led to perforation after phacoemulsification with posterior chamber intraocular lens implantation. Only after corneal biopsy of the incision was the causative organism isolated and found to be sensitive to clarithromycin and ciprofloxacin. Despite aggressive therapy, a full-thickness corneal perforation developed, requiring emergent cyanoacrylate glue to preserve ocular integrity. Both the difficulty and delays in obtaining a correct diagnosis led to severe ocular morbidity. Infectious lamellar keratitis limited to the clear cornea phacoemulsification incision is rare, but some unusual organisms such as atypical mycobacteria may be encountered.
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ranking = 134.48690328215
keywords = wound infection, wound
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6/11. Pathogenic infection caused by coagulase negative multiple drug resistant Staphylococcus.

    staphylococcus epidermidis is becoming increasingly important as a cause of clinical illness. In the past, its presence in the wound, blood and urine culture was generally dismissed as contamination and went undocumented. However, more recently its pathogenic role is being recognized notably in bacterial endocarditis, postcardiotomy endocarditis, bacteraemia secondary to colonised prosthetic heart valves, postsurgical wound infection and urinary tract infection. The ability of the organism to cause local sepsis in superficial tissues is a matter of debate. A case of pyogenic infection due to multidrug resistant coagulase negative staphylococci is reported here.
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ranking = 27.89738065643
keywords = wound infection, wound
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7/11. Pyogenic vertebral osteomyelitis after transcolonic gunshot wound.

    Recently, pyogenic vertebral osteomyelitis has been documented following transcolonic passage of bullets lodging in or near the vertebral column. It is becoming more recognized that foreign body missiles are not as sterile as was once thought--especially after passage through the gastrointestinal tract--and that this condition contributes to the incidence of infection in such bone injuries. In this article the problem of deciding on and implementing proper initial treatment and management of vertebral injuries caused by foreign body missiles is illustrated and discussed.
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ranking = 4
keywords = wound
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8/11. Advanced hidradenitis suppurativa of the vulva. A report of three cases.

    Advanced suppurative hidradenitis resulting from chronic, progressive, inflammatory involvement of apocrine sweat glands often fails to respond to conservative treatment. Extensive surgical excision of all the infected areas with aggressive postoperative wound care in two of three patients provided relief from this debilitating disease. skin grafting promoted wound healing in addition to improving cosmetic results. Advanced chronic hidradenitis suppurativa of the vulva should be treated with surgery, and conservative management is justifiable only if preparatory to surgical excision.
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ranking = 2
keywords = wound
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9/11. Treatment of purulent wounds and fistulae with an adhesive wound irrigation device. A multicentre trial of 100 patients.

    There has been little change in the treatment of established wound infection for many years. This paper describes an adhesive wound irrigation device designed to facilitate the care of discharging wounds or fistulae normally requiring several changes of dressings daily. We report the use of this device in a selected group of 100 patients and discuss briefly the methods of irrigation available. The device described offers certain practical advantages over conventional wound dressing and has proved acceptable to the patient.
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ranking = 37.89738065643
keywords = wound infection, wound
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10/11. Clenched fist injury: a pitfall for patients and surgeons.

    Clenched fist injuries or human bite-fight wounds are the result of an impact of the fist with the opponent's teeth, with perforation of the skin and joint. Severe septic arthritis of the third metacarpal joint of the dominant hand often occurs. The consequences, medical and legal, on the long run are important.
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ranking = 1
keywords = wound
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