Cases reported "tetanus"

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1/181. Favourable prognosis of prolonged coma associated with large doses of diazepam in severe tetanus.

    A report is made of five tetanus patients who were treated with large repetitive doses of diazepam and became comatose. The period of impaired consciousness varied from thirteen to twenty-one days. None had significant respiratory depression, and full recovery occurred in all. It is proposed that diazepam-induced prolonged coma should be regarded as a side-effect rather than a toxic effect and should caution rather than contra-indicate further use of large doses of the drug in the management of tetanus. ( info)

2/181. Localized tetanus in a child.

    The majority of physicians in practice today in developed countries have never seen a case of tetanus. The last pediatric case reported in canada occurred in 1992. We present the case of a child who had localized tetanus despite previous partial immunization. ( info)

3/181. tetany, tetanus or drug reaction? A case report.

    An 8-year-old child was given perphenazine to prevent vomiting after surgery and developed an acute dystonic reaction; There were features of both tetany and tetanus without any of the classical features of extrapyramidal disturbance. The diagnostic difficulties are discussed. The reaction was treated successfully with i.v. diazepam. The prescribing of anti-emetics after surgery is examined critically with special reference to children. ( info)

4/181. Bronchoaspiration as a possible cause in a case of tetanus. A reminder on the importance of adulthood immunizations.

    Although preventable by immunization tetanus still takes a large death toll, mostly in developing countries, where adult population is often unprotected and opportune medical care unavailable. We present a case of tetanus in an elderly patient with bronchoaspiration pneumonia after a near-drowning incident, in which no objective entry site could be suspected with as much temporal relation as the bronchoaspiration incident. Bronchoaspiration of organic matter and feces provides both a source of the causative agent and an adequate polymicrobial environment for the development of the disease. It is under such conditions that we propose this unusual entry site as the cause of tetanus in our patient. Special emphasis is made on the importance of adulthood immunization programs and how incidents like this one should be taken into account in the overall care provided to the elderly population. ( info)

5/181. Generalized tetanus in a patient with a diabetic foot infection.

    tetanus is a preventable disease that continues to affect people in the united states due to poor immunization practices in our health care system. A 57-year-old man with type 2 diabetes mellitus, hypertension, and end-stage renal disease with many hospital admissions came to the hospital emergency department because of a blackened great toe. He denied pain in the toe or knowledge of foot injury. The patient also complained of temporomandibular tenderness accompanied by inability to open his mouth completely. The man's problems progressed to generalized tetanus and required a long hospitalization. clostridium tetani can flourish in the anaerobic environment of a diabetic foot infection. Practitioners should be aware of tetanus as a rare but potentially serious complication of diabetic foot infections. ( info)

6/181. tetanus after a resection for a gangrenous perforated small intestine: report of a case.

    We report herein the case of a 75-year-old man who developed severe tetanus 24 h after the resection of a gangrenous perforated small intestine. It seemed that the tetanus was caused by a spillage of the intestinal contents harboring clostridium tetani; however, this was not identified by a culture. The diagnosis of tetanus was made only when opisthotonus in this patient became evident and normal tetanus treatment proved to be successful. ( info)

7/181. The silent period after magnetic brain stimulation in generalized tetanus.

    The cortical silent period has not previously been studied in tetanus. Transcranial magnetic brain stimulation in a patient with generalized tetanus revealed enlarged electromyographic (EMG) responses and absence or reduction of the late phase of EMG silence following the motor evoked potential in sternomastoid and biceps brachii muscles. Following clinical recovery, the silent period returned to normal. This observation is interpreted as evidence of impaired inhibitory mechanisms at multiple levels of the nervous system, including the cortex, in generalized tetanus. ( info)

8/181. The use of magnesium sulphate in the intensive care management of an Asian patient with tetanus.

    tetanus, a potentially fatal but largely preventable disease through immunisation, is rare in singapore. Timely diagnosis and appropriate intensive care management is essential to ensure survival. We aim to report the management of such a patient with magnesium sulphate. This has not been reported locally. By maintaining serum magnesium at 3 to 4 mmol/l we were able to control sympathetic overactivity by day 6, stop neuromuscular blockade by day 7 and wean off ventilator by day 11. Aminoglycoside-induced hypomagnesemia was also demonstrated, necessitating an increase in magnesium sulphate infusion rate to maintain serum magnesium at therapeutic level. ( info)

9/181. Fatal tetanus in a drug abuser with "protective" antitetanus antibodies.

    tetanus is a rare disease in the united states. From 1995-1997, the average annual incidence of tetanus was 0.15/1,000,000 population. Injecting-drug users, particularly those who use heroin, are among the highest risk population for acquiring tetanus. We present a case of an injecting-drug user who was seen in the emergency department with worsening diffuse midthoracic back pain and spasms. He subsequently developed acute respiratory failure and central nervous system hypoxic injury. serum obtained before administration of tetanus immune globulin showed a tetanus antibody titer greater than 16 times the level considered protective. Because of limited human data on the minimum protective level of neutralizing antibody, as well as reports of tetanus among individuals with "protective" antibody titers, the diagnosis of tetanus should not be excluded solely on the basis of antitetanus titers. ( info)

10/181. Blink reflexes and the silent period in tetanus.

    Abnormalities of the silent period (SP) and blink reflexes occur in diseases that interfere with inhibitory pathways, such as tetanus and stiff-person syndrome (SPS). The SP is abnormal in tetanus but not in SPS. Studies of the blink reflex in tetanus are limited. In this report, a patient with generalized tetanus is described. The masseteric-and mixed-nerve SP was absent or truncated. In contrast to SPS, blink reflex studies revealed no bilateral R1 component, and a discrete R3 was only present ipsilateral to right supraorbital stimulation. This reflects the distinct inhibitory pathways underlying these disorders. ( info)
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