1/85. edwardsiella tarda bacteraemia--complicated by acute pancreatitis and pyomyoma.edwardsiella tarda (E. tarda) has recently become recognized as a pathogen in humans. Here we report a new case of E. tarda bacteraemia complicated by acute pancreatitis and pyomyoma. A 46-year-old female came to our emergency room complaining of sudden onset of left upper quadrant pain and vomiting for the previous few hours after drinking three bottles of wine. An abdominal computed tomography (CT) scan revealed multiple biliary stones, acute pancreatitis with extensive inflammatory change, and a large uterine myoma. fever, watery diarrhoea, and mild suprapubic discomfort with vaginal spotting were noted soon after admission. The patient's blood cultures yielded E. tarda and symptoms subsided after antibiotic therapy. fever and severe suprapubic pain with rebound tenderness developed 12 days later. Repeat abdominal CT scan revealed an enlarged uterine myoma with central necrosis. The patient subsequently underwent anterior total hysterectomy and bilateral salpingo-oophorectomy, revealing a uterine myoma with infarction and abscess formation. The patient recovered uneventfully and was discharged 1 week later.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
2/85. Lethal encephalopathy complicating childhood shigellosis.A 6-year-old girl is described who died following rapid neurological deterioration, ending in lethal cerebral oedema. Despite the absence of severe intestinal and metabolic derangement, shigella was cultured from the stool. Toxic encephalopathy is responsible for death following this rare complication of childhood shigellosis in developed countries. The pathophysiology is unknown. CONCLUSION: Lethal toxic encephalopathy can be caused by shigella despite the absence of severe intestinal and metabolic derangement. If shigelllosis is suspected, headache may be a first significant sign for the development of toxic encephalopathy. Early recognition and rapid measures to prevent brain oedema may improve outcome.- - - - - - - - - - ranking = 1.2786586660125keywords = headache (Clic here for more details about this article) |
3/85. bacillus cereus causing fulminant sepsis and hemolysis in two patients with acute leukemia.PURPOSE: hemolysis is so rarely associated with bacillus cereus sepsis that only two very well documented cases have been reported. This article reports two unusual cases of bacillus cereus sepsis with massive intravascular hemolysis in patients who had acute lymphoblastic leukemia (ALL). patients AND methods: A 20-year-old woman who was 9 weeks pregnant experienced a relapse of ALL. A therapeutic abortion was performed. During week 4 of reinduction the patient had abdominal pain, nausea, and vomiting, with severe neutropenia but no fever. Her condition deteriorated rapidly with cardiovascular collapse, acute massive intravascular hemolysis, and death within hours of the onset of symptoms. blood cultures were positive for bacillus cereus. Postmortem histologic examination and cultures revealed bacillus cereus and candida albicans in multiple organs. The second patient, a 10-year-old girl, presented with relapsed T-cell ALL. In the second week of reinduction, she had abdominal pain followed by hypotension. Again, no fever was noted. Laboratory studies showed intravascular hemolysis 12 hours after admission. Aggressive support was promptly initiated. Despite disseminated intravascular coagulation; cardiovascular, hepatic, and renal failure; and multiple intracerebral hypodense lesions believed to be infarcts, the patient recovered fully and resumed reinduction therapy. CONCLUSIONS: bacillus cereus infection can have a fulminant clinical course that may be complicated by massive intravascular hemolysis. This pathogen should be suspected in immunosuppressed patients who experience gastrointestinal symptoms and should not be precluded by the absence of fever, especially if steroids such as dexamethasone are being given. Exchange transfusion may be lifesaving in bacillus cereus septicemia associated with massive hemolysis.- - - - - - - - - - ranking = 47.726560146625keywords = abdominal pain (Clic here for more details about this article) |
4/85. Spondylodiscitis associated with bacteraemia due to coagulase-negative staphylococci.Three cases are reported of spondylodiscitis caused by coagulase-negative staphylococci in patients without osteosynthetic material. All three patients had bacteraemia associated with an infected intravascular device left in place. On the basis of this observation, it is concluded that such devices should be removed promptly in cases of prolonged or relapsing bacteraemia. Furthermore, spondylodiscitis should be suspected in patients with back pain after bacteraemia caused by coagulase-negative staphylococci.- - - - - - - - - - ranking = 32.607061284824keywords = back pain (Clic here for more details about this article) |
5/85. The use of simultaneous free latissimus dorsi tissue transfers for reconstruction of bilateral upper extremities in a case of purpura fulminans.We report a case of extensive purpura fulminans destroying the soft tissue over the posterior aspect of both elbows. Simultaneous, bilateral free latissimus dorsi muscle transfers were used to close both wounds in a single procedure. The wounds resulting from severe purpura fulminans can be extensive and limb threatening. The simultaneous transfer of 2 free flaps can provide expeditious soft tissue repair while minimizing the risk of repeat anesthesia in these critically ill patients. We found that certain details concerning planning and performing the procedure fostered its successful outcome.- - - - - - - - - - ranking = 4keywords = upper (Clic here for more details about this article) |
6/85. Acute meningococcaemia complicated by late onset gastrointestinal vasculitis.Extra-meningeal and non-cutaneous manifestations of meningococcal infection are well recognized but rare. Herein we report a little recognized complication of meningococcaemia, namely late-onset gastrointestinal vasculitis. In the case presented, the prostacycline analogue iloprost was used in an attempt to minimize incipient digital gangrene ina patient with evidence of protracted immunological phenomena. In addition, diclofenac was used to treat severe arthralgia. Withdrawal of iloprost on day 19 was associated with abdominal pain and peritonism. laparotomy demonstrated ischaemia and ulceration in the caecum, and histology revealed full thickness mucosal ulceration with a prominent vasculitic process. It is postulated that these findings were immunologically mediated, with possible rebound vasoconstriction following withdrawal of iloprost. It is also possible that NSAID use contributed to the findings via cyto-toxicity to mucosal cells.- - - - - - - - - - ranking = 23.863280073312keywords = abdominal pain (Clic here for more details about this article) |
7/85. 'Acute abdomen' with a rash.A previously fit and healthy 17-year-old male presented with the clinical symptoms and signs of an acute abdomen and with the secondary complaint of a rash. In view of the primary presenting complaint he was admitted to the surgical ward. The patient was initially booked for an emergency exploratory laparotomy, but after reassessment on the ward a clinical diagnosis of meningococcal septicaemia was made. The patient was treated medically with intravenous antibiotics and supportive therapy, and made a complete recovery. Medical causes of abdominal pain, as exemplified here, can be more life threatening than surgical causes and should be considered in all patients.- - - - - - - - - - ranking = 23.863280073312keywords = abdominal pain (Clic here for more details about this article) |
8/85. Inappropriate medical management of spinal epidural abscess.A 67 year old man with longstanding rheumatoid disease was referred to the regional spinal surgery unit with acute onset of paraparesis due to an extensive spinal epidural abscess of the lumbar spine. Ten months previously, he had started antibiotic treatment at another hospital for an epidural abscess arising at the level of the L2-3 disc space. Despite completing seven months of medical treatment with appropriate antibiotics, he had a recrudescence of acute back pain shortly after restarting methotrexate treatment. Urgent anterior spinal decompression with excision of the necrotic vertebral bodies of L1-3 was performed. The indications for the surgical management of spinal epidural abscess are reviewed.- - - - - - - - - - ranking = 32.607061284824keywords = back pain (Clic here for more details about this article) |
9/85. Pulmonary sparganosis: a case report with five years follow-up.sparganosis has a world wide distribution, but only a few patients have pulmonary involvement. The term sparganosis is defined as an infection by the larva of parasitic tapeworms of spirometra species. We present here-in a patient, who was infected by this parasite and had pulmonary symptoms. The chest roentgenography revealed diffuse multiple nodular infiltration with cavitations. bronchoscopy with a transbronchial lung biopsy was nondiagnostic. Finally, open lung biopsy was performed, and the histologic examination revealed plerocercoid larva of sparganum. The patient was treated with mebendazole 40 mg/kg/day for 6 months and his symptoms and pulmonary function improved. In the 5th year of follow-up, he presented with more progressive dyspnea and developed cor pulmonale, and finally died from pneumonia with sepsis. The objective of this report was to present a rare manifestation of sparganosis and it's clinical course. Currently, there is no known effective treatment for this disease.- - - - - - - - - - ranking = 1.7757740836256keywords = chest (Clic here for more details about this article) |
10/85. Cutaneous leucocytoclastic vasculitis associated with oxacillin.A 67-year-old man who was treated with oxacillin for one week because of staphylococcus aureus bacteremia, developed renal failure and diffuse, symmetric, palpable purpuric lesions on his feet. Necrotic blisters were noted on his fingers. skin biopsies showed findings diagnostic of leucocytoclastic vasculitis. oxacillin was discontinued and patient was treated with corticosteroids. The rash disappeared after three weeks and renal function returned to normal.Leucocytoclastic vasculitis presents as palpable purpura of the lower extremities often accompanied by abdominal pain, arthralgia, and renal involvement. Etiologic factors or associated disorders include infections, medications, collagen vascular disease and neoplasia. However, in half of the cases no etiologic factor is identified. Usually it is a self-limited disorder, but corticosteroid therapy may be needed in life-threatening cases since early treatment with corticosteroids in severe cases can prevent complications. oxacillin should be included among the drugs that can cause leucocytoclastic vasculitis.- - - - - - - - - - ranking = 23.863280073312keywords = abdominal pain (Clic here for more details about this article) |
| | Next -> |