1/93. Acute appendicitis complicated with necrotizing soft tissue infections in the elderly: report of a case.A case of acute appendicitis complicated with necrotizing soft tissue infections (NSTIs) in an extremely elderly woman (98 years-old) is reported. She was admitted to our hospital with a history of increasing pain localized in the right lower abdomen. Abdominal ultrasonography revealed appendicolithiasis and periappendiceal fluid. An appendectomy and closure of the perforated cecum was performed. On the 5th post-operative day, the patient developed skin erythemas and crepitation in the right lower quadrant. An exploration and drainage of the recent operative incision was performed under the diagnosis of NSTIs. Despite the declining overall incidence of appendicitis, it has been increasing among the elderly. The elderly patients are associated with underlying defects in immune function. NSTIs, which are characterized by rapidly progressing inflammation and necrosis of soft tissue, comprise a spectrum of disease ranging from necrosis of the skin to life-threatening infections. The most common etiology of NSTIs was post-operative infections of the abdominal wall, which primarily occurred after operations with extensive fecal contamination. NSTIs are no longer a rare post-operative complication in the elderly and initial treatment should be selected according to the condition of the patient.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
2/93. enterocolitis with pathogenic escherichia coli infection in renal transplant recipients: case reports.PURPOSE: We report three cases of enterocolitis associated with pathogenic escherichia coli infection in renal transplant recipients. methods/RESULTS: patients presented with abdominal pain and diarrhea at 1, 3 and 7 years after living-related renal transplantation. Pathogens of enterocolitis were identified by stool culture as verotoxin-2-producing O157:H7 E. coli, non-verotoxin-producing E. coli 06 and 0125. All patients were basically treated with fluid replacement with additional fosfomycin administration in the patient with O157:H7 E. coli infection. Immunosuppressive drugs were kept at maintenance doses throughout the treatment. CONCLUSION: All patients recovered uneventfully within 10 days after the onset of enterocolitis without severe complications.- - - - - - - - - - ranking = 6.063507813664keywords = abdominal pain, pain (Clic here for more details about this article) |
3/93. Vertebral osteomyelitis: a rare complication of transvaginal ultrasound-guided oocyte retrieval.OBJECTIVE: To present a case of vertebral osteomyelitis as a complication of transvaginal oocyte retrieval. DESIGN: Case report. SETTING: The IVF unit of a university-affiliated hospital. PATIENT(s): A 41-year-old woman who underwent IVF-ET treatment. INTERVENTION(s): Standard IVF-ET treatment cycles with the use of transvaginal ultrasound for oocyte retrieval and computed tomography-guided needle aspiration. MAIN OUTCOME MEASURE(s): Recovery of the patient, sequelae, and recurrence. RESULT(s): Vertebral osteomyelitis was diagnosed and treated with antibiotics. CONCLUSION(s): When severe low back pain occurs after ovum retrieval, vertebral osteomyelitis should be considered. early diagnosis requires a high index of suspicion.- - - - - - - - - - ranking = 3.5822542678851keywords = back pain, pain, back (Clic here for more details about this article) |
4/93. Infected hepatic cyst in a patient with multiple hepatic cysts: report of a case diagnosed by change of ultrasonographic findings.liver cysts are commonly observed, but infection of a liver cyst is a rare complication. Although patients have clinical symptoms, such as a high-grade fever and abdominal pain, diagnosing an infected cyst by abdominal ultrasonography, computed tomography (CT) with contrast medium and magnetic resonance imagings (MRI) is not always easy. We experienced an unusual case who had only clinical symptoms, such as high-grade fever and a right quadrant abdominal pain, but no imaging findings when admitted. Careful observation using ultrasonography once a week revealed signs of an infected cyst containing echogenic fluid 32 days after admission. We performed percutaneous transhepatic cystic drainage. When a patient has liver cysts and complains of high-grade fever and abdominal pain, liver cysts should be considered as a focus of sepsis, and we recommend repeat use of ultrasonography or CT, even if no typical findings occur the first time.- - - - - - - - - - ranking = 18.190523440992keywords = abdominal pain, pain (Clic here for more details about this article) |
5/93. liver disease, phlegmonous colitis, and gram-negative sepsis.Phlegmonous colitis, regarded as a terminal event in serious liver disease and hepatic coma, can also occur in reversible liver disease and can be the source of gram-negative sepsis. This paper presented such a case. Improved management of serious liver disease and hepatic coma should include consideration of colonic inflammation as another site of infection that must be treated to avoid complications of sepsis or peritonitis. abdominal pain and loose or diarrheal stools should arouse a suspicion of the presence of phlegmonous colitis, and should be an indication for treating it and preventing sepsis.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
6/93. Indications for laparotomy in infection with verotoxigenic escherichia coli.Verotoxigenic types of escherichia coli have emerged as serious and important human pathogens. The clinical disease most frequently manifests as a painful form of bloody diarrhea, which can progress to life-threatening systemic microangiopathic hemolytic anemia, known as the hemolytic-uremic syndrome (HUS). Three children with hemorrhagic enteritis due to verotoxigenic E. coli are presented to illustrate the unique diagnostic, therapeutic, and operative management dilemmas associated with this disease. When contemplating surgery, one should seek to determine the anatomic and transmural extent of the disease.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
7/93. Intestinal bleeding and occlusion associated with shiga toxin-producing escherichia coli O127:H21.We report a case of a nine-year old boy with vomiting, abdominal pain and fever, who underwent surgery with a diagnosis of appendicitis in Mendoza and from whom a shiga toxin-producing escherichia coli (STEC) O127:H21 strain was recovered. Forty-eight hours after surgery he presented bilious vomiting and two episodes of intestinal bleeding. Laboratory findings included: hematocrit, 35%; blood urea nitrogen, 0.22 g/L. The urinary output was normal. The following day physical examination showed an alert mildly hydrated child, without fever but with distended and painful abdomen. The patient was again submitted to surgery with a diagnosis of intestinal occlusion. Bleeding and multiple adhesions in jejunum and ileum were found. The patient still had tense and painful abdomen and presented two bowel movements with blood; hematocrit fell to 29% and blood urea nitrogen rose to 0.32 g/L. STEC O127:H21 eae(-)/Stx2/Stx2vh-b( )/E-Hly( ) was isolated from a stool sample. He was discharged after 10 days of hospitalization and no long-term complications such as HUS or TTP were observed. This is the first report, to our knowledge, on the isolation of E. coli O127:H21, carrying the virulence factors that characterize STEC strains, associated to an enterohemorrhagic colitis case. This serotype was previously characterized as a non-classic enteropathogenic E. coli (EPEC). STEC infections can mimic infectious or noninfectious pathologies. Therefore an important aspect of clinical management is making the diagnosis using different criteria thereby avoiding misdiagnoses which have occasionally led to invasive diagnostic and therapeutic procedures or the inappropriate use of antibiotics.- - - - - - - - - - ranking = 8.063507813664keywords = abdominal pain, pain (Clic here for more details about this article) |
8/93. Toxin-mediated haemolytic uraemic syndrome without diarrhoea.A 52-year-old previously healthy man was admitted to the hospital with haematuria, painful micturition and fever. Laboratory investigation showed the presence of a haemolytic uraemic syndrome (HUS), characterized by haemolysis, renal insufficiency and mental disturbances. A urinary tract infection caused by a verotoxin-producing E. coli other than O157:H7 was diagnosed. Treatment of this infection resulted in his complete recovery from the illness. Both the search for a focus outside the gastrointestinal tract and the search for verotoxin genes by specific polymerase chain reaction can be crucial in a patient with HUS without preceding diarrhoea.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
9/93. escherichia coli chest-wall hemorrhagic cellulitis associated with central-line placement.cellulitis is a common clinical entity. Hemorrhagic cellulitis is distinctly unusual and is most frequent in compromised hosts. In normal or near normal hosts, hemorrhagic cellulitis may rarely complicate gram-negative sepsis. Usually, hemorrhagic cellulitis occurs below the waist. The differential diagnosis includes invasive streptococcal infection, mixed aerobic and anaerobic infection, gram-negative sepsis, and gross gangrene. We present the first-known case of escherichia coli chest-wall hemorrhagic cellulitis associated with a central line in a patient with renal failure.- - - - - - - - - - ranking = 0.17414048269936keywords = chest (Clic here for more details about this article) |
10/93. Fatal emphysematous pyelonephritis with gas in the spinal extradural space in a patient with diabetes.BACKGROUND: Emphysematous pyelonephritis (EP) is a rare but life-threatening condition of the upper urinary tract, characterized by the presence of gas in the renal parenchyma and perirenal space. The vast majority of patients with EP (90%) are known to have diabetes, with escherichia coli being the most common causative pathogen. CASE REPORT: We present a case of fatal bilateral EP in a patient with diabetes, with an unusual radiological finding of gas around the spinal cord and in the psoas muscle, with renal parenchymal sparing. Our case serves as an important reminder of this life threatening entity in diabetic patients, which is not well recognized by clinicians because of its rarity.- - - - - - - - - - ranking = 0.053137890017842keywords = upper (Clic here for more details about this article) |
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