1/6. Wound botulism in drug addicts in the United Kingdom.clostridium novyi has recently been identified as the causative organism responsible for the deaths of 35 heroin addicts who had injected themselves intramuscularly. We present two heroin addicts who developed C. botulinum infection following intramuscular or subcutaneous injection of heroin. Like C. novyi, this grows under anaerobic conditions and clinical presentation may be similar; however, descending motor or autonomic signs are invariably present in botulism. The prognosis is good if the diagnosis is made early and appropriate treatment commenced.- - - - - - - - - - ranking = 1keywords = prognosis (Clic here for more details about this article) |
2/6. Transient paralysis of the bladder due to wound botulism.In the last 10 years, wound botulism has increasingly been reported and nearly all of these new cases have occurred in injecting-drug abusers. After absorption into the bloodstream, botulinum toxin binds irreversibly to the presynaptic nerve endings, where it inhibits the release of acetylcholine. diplopia, blurred vision, dysarthria, dysphagia, respiratory failure and paresis of the limbs are common symptoms of this intoxication. Surprisingly and despite the well-known blocking action of the botulinum toxin on the autonomic nerve system, little attention has been paid to changes in the lower urinary tract following acute botulinum toxin poisoning. Here we report a case of bladder paralysis following wound botulism. early diagnosis and adequate management of bladder paralysis following botulism is mandatory to avoid urologic complications. Accordingly, the prognosis is usually favorable and the bladder recovery complete.- - - - - - - - - - ranking = 1keywords = prognosis (Clic here for more details about this article) |
3/6. bacteria in blood smears: overwhelming sepsis or trivial contamination.It is unusual to find microorganisms in peripheral blood smears, and their presence is frequently associated with overwhelming sepsis and consequently a poor prognosis. In this report, we demonstrate 4 cases with bacteria in blood smears. Two of them had a fatal outcome, but the other 2 were caused by a contamination either via the central venous catheter or in vitro, both without dramatic outcome. The finding of bacteria in blood smears has to be interpreted carefully, and thorough examination of peripheral blood smears may be of great importance in the early diagnosis of bacteremia; however, in vitro contamination must be excluded.- - - - - - - - - - ranking = 1keywords = prognosis (Clic here for more details about this article) |
4/6. Infected wounds and repeated septicemia in a case of factitious illness.During 19 years an assistant nurse, now 35 years old, has been repeatedly treated for several malingered and self-induced disorders escalating to self-mutilation. An ulcer of her right leg never epithelialised in spite of various local treatments and surgical intervention. During repeated attacks of self-induced septicemia altogether 11 different bacterial species were isolated; on 8 occasions rhodococcus equi. The septicemias were successfully treated with antibiotics. The underlying psychiatric problem, a borderline personality disorder, has not been possible to treat in a conventional manner. Probably due to collaboration between the plastic surgeon and the psychiatrist she has had fewer attendances and shorter hospital stays lately. Her prognosis is still dubious as regards further self-mutilation and other expressions of self-destructive behaviour.- - - - - - - - - - ranking = 1keywords = prognosis (Clic here for more details about this article) |
5/6. Treatment of infected non-unions and segmental defects of the tibia with staged microvascular muscle transplantation and bone-grafting.Fourteen patients who had an infected non-union or segmental defect of the tibia were treated with debridement and microvascular transplantation of muscle. Successful free muscle transplantation and control of the infection were achieved in all patients. The prognosis was, in general, related to the severity of the underlying osseous problems, which were categorized into types A (a tibial defect and non-union without significant segmental loss), B (a tibial defect that is more than three centimeters long and an intact fibula), and C (a tibial defect that is more than three centimeters long, involving both the tibia and the fibula). All of the six type-A patients healed without needing bone-grafting. Of the four type-B patients, all of whom had subsequent bone-grafting, reactivation of the infection occurred in two, and both ultimately had a below-the-knee amputation; the third patient had a non-union between the fibular graft and the tibia; and the fourth patient was fully weight-bearing. All of the four type-C patients also required subsequent bone-grafting; all finally healed and were able to walk with a brace. The results in the present series indicate that, in patients who have an infected tibial defect or non-union, including those that are so severe that an amputation might be considered, this method of treatment is a valid option for salvage of the limb.- - - - - - - - - - ranking = 1keywords = prognosis (Clic here for more details about this article) |
6/6. Case report. Pseudomonas puncture wound osteomyelitis in adults.Pseudomonas osteomyelitis following a puncture wound is commonly reported in children, but very few cases have been recorded in adults. We describe ten adult patients with well documented pseudomonas aeruginosa osteomyelitis consequent to puncture wounds. The disease in adults is similar to that in children with respect to bone involved, clinical features, and preferred antibiotic therapy; however, the prognosis for complete recovery without permanent sequelae seems much better in adults.- - - - - - - - - - ranking = 1keywords = prognosis (Clic here for more details about this article) |