1/5. Group A streptococcal sepsis and ovarian vein thrombosis after an uncomplicated vaginal delivery.BACKGROUND: Group A streptococcal puerperal sepsis is an uncommon peripartum infection that can quickly progress to a fulminant, multisystemic infection and life-threatening toxin-mediated shock. This infection can be asymptomatic during a short hospital stay after a routine delivery. Early treatment with antibiotics might not alter the course of tissue destruction caused by the exotoxin A. methods: literature searches were performed using the key words "puerperal infections," "streptococcal infections," "septic sacroiliitis," "postpartum septic arthritis," and "postpartum ovarian vein thrombosis." After patient consent was obtained, a report was prepared documenting the disease course, diagnosis, and treatment of a case of puerperal sepsis with multiple serious complications. RESULTS AND CONCLUSION: Puerperal sepsis occurs when streptococci colonizing the genital tract or acquired nosocomially invade the endometrium, adjacent structures, lymphatics, and bloodstream. A lack of symptoms early in the course of infection is common; later, minor somatic complaints can quickly progress to septic shock as effects of the exotoxin A are manifest. women who complain of fever, pelvic pain, or unexplained systemic symptoms in the early postpartum period should have a detailed history and physical examination. All sites of suspected infection should be cultured. If sepsis is suspected, diagnostic imaging includes chest radiographs, contrast-enhanced computed tomographic scans, or magnetic resonance imaging to rule out ovarian vein thrombosis, pelvic abscess, or sacroiliac septic arthritis. Broad-spectrum antibiotic coverage must be initiated immediately after collection of cultures. clindamycin plus a beta-lactam antibiotic is preferred for streptococcal toxic shock syndrome.- - - - - - - - - - ranking = 1keywords = collection (Clic here for more details about this article) |
2/5. psoas abscess presenting with femoro-popliteal vein thrombosis.psoas abscess is an uncommon condition with vague clinical presentation. It generally has an insidious onset and before the advent of computed tomography, few cases were reported in the medical literature. We report the case of a middle aged diabetic woman who presented with left leg swelling. Doppler ultrasound revealed thrombosis of the popliteal vein and a collection in the left groin. Computed tomography confirmed the presence of a large left iliopsoas abscess extending to the anterior compartment of the thigh complicated with thrombosis of the superficial femoral and popliteal veins. We suggest that an iliopsoas abscess should be excluded when an immunocompromised patient presents with deep vein thrombosis.- - - - - - - - - - ranking = 1keywords = collection (Clic here for more details about this article) |
3/5. How should an infected perinephric haematoma be drained in a tetraplegic patient with baclofen pump implanted in the abdominal wall? - A case report.BACKGROUND: We present a case to illustrate controversies in percutaneous drainage of infected, perinephric haematoma in a tetraplegic patient, who had implantation of baclofen pump in anterior abdominal wall on the same side as perinephric haematoma. CASE PRESENTATION: A 56-year-old male with C-4 tetraplegia had undergone implantation of programmable pump in the anterior abdominal wall for intrathecal infusion of baclofen to control spasticity. He developed perinephric haematoma while he was taking warfarin as prophylactic for deep vein thrombosis. Perinephric haematoma became infected with a resistant strain of pseudomonas aeruginosa, and required percutaneous drainage. Positioning this patient on his abdomen without anaesthesia, for insertion of a catheter from behind, was not a realistic option. Administration of general anaesthesia in this patient in the radiology department would have been hazardous. RESULTS AND CONCLUSION: Percutaneous drainage was carried out by anterior approach under propofol sedation. The site of entry of percutaneous catheter was close to cephalic end of baclofen pump. By carrying out drainage from anterior approach, and by keeping this catheter for ten weeks, we took a risk of causing infection of the baclofen pump site, and baclofen pump with a resistant strain of pseudomonas aeruginosa. The alternative method would have been to anaesthetise the patient and position him prone for percutaneous drainage of perinephric collection from behind. This would have ensured that the drainage track was far away from the baclofen pump with minimal risk of infection of baclofen pump, but at the cost of incurring respiratory complications in a tetraplegic subject.- - - - - - - - - - ranking = 1keywords = collection (Clic here for more details about this article) |
4/5. Septic deep venous thrombosis in intravenous drug users.OBJECTIVE: To review diagnostic and therapeutic experience in seven patients with septic deep vein thrombosis (DVT) after intravenous use of illicit drugs. methods: Retrospective review of medical records and prospective data collection in intravenous drug users (IVDU) who presented with a confirmed diagnosis of DVT and sepsis during a period of 18 months in a single institution. RESULTS: Of seven long-term IVDU (age 24-40 years), who had repeatedly attempted venous access to proximal veins, five had femoral DVT and one each jugular and brachial DVT. All DVT were confirmed by contrast-enhanced helical CT or ultrasonography. Median c-reactive protein (CRP) was 215 mg/l (range 76-386). Multiple blood cultures grew gram-positive bacteria in 7 of 8 patients, chiefly staphylococcus aureus, confirming an intravascular infection with continuous bacteraemia. Therapy consisted of intravenous b-lactamase-resistant penicillin until normalisation of CRP (3-4 weeks), initially combined with an aminoglycoside for a few days. The mean defervescence time was 7.4 days (range 3-12). All patients were given intravenous heparin overlapping with oral anticoagulation without major side effects. Surgical exploration of the venous vasculature was never necessary. Mean hospital stay was 25.7 days (range 10-47). CONCLUSION: Septic DVT in IVDU is a potentially life-threatening disorder that may become more frequent as the number of long-term IVDU increases. Helical CT or colour-coded Doppler ultrasound is the confirmatory imaging procedure of choice. Empirical antibiotic therapy should include a ss-lactamase-resistant penicillin since S. aureus is the most common pathogen isolated. Anticoagulation can be safely initiated once the diagnosis of DVT is confirmed. Surgery is necessary only in rare instances of septic DVT.- - - - - - - - - - ranking = 1keywords = collection (Clic here for more details about this article) |
5/5. Massive multicystic dilatation of the uterine wall with myometrial venous thrombosis during pregnancy.We present a pregnancy complicated by multicystic dilatation of the uterine wall during the second trimester, leading to massive uterine distension, anemia and preterm cesarean section. The cystic changes detected by ultrasound and magnetic resonance imaging involved the whole uterine wall surrounding the entire amniotic cavity. Histopathological examination revealed the benign nature of the cystic changes, which represented dilated and thrombosed venous lacunae. Disturbed venous drainage, combined with local thrombosis, was likely to have led to the collection of a large volume of blood in the uterine wall and the subsequent multicystic change of the myometrium.- - - - - - - - - - ranking = 1keywords = collection (Clic here for more details about this article) |