1/7. Sterile inflammation associated with transradial catheterization and hydrophilic sheaths.In 1999, we noted the development of inflammation and/or abscesses at the site of radial access in a group of patients. Over a 3-year period, we noted this inflammation in 33 patients out of 2,038 (1.6%) who had catheterization via the radial approach. The radial abscesses occurred in 30 patients out of 1,063 (2.8%) in whom we could confirm the use of a hydrophilic-coated sheath, but in no patient for whom we can document that an uncoated sheath was used. No infectious agent could be implicated, and the time course for the development of the abscess, typically 2 to 3 weeks, seemed long for a bacterial infection. Later patients had biopsies, and granulomatous reactions were seen in most. Additionally, a few of the biopsies showed an amorphous extravascular substance consistent with the catheter coating. All patients had good long-term outcomes.- - - - - - - - - - ranking = 1keywords = bacterial infection (Clic here for more details about this article) |
2/7. Distinct mutations in IRAK-4 confer hyporesponsiveness to lipopolysaccharide and interleukin-1 in a patient with recurrent bacterial infections.We identified previously a patient with recurrent bacterial infections who failed to respond to gram-negative LPS in vivo, and whose leukocytes were profoundly hyporesponsive to LPS and IL-1 in vitro. We now demonstrate that this patient also exhibits deficient responses in a skin blister model of aseptic inflammation. A lack of IL-18 responsiveness, coupled with diminished LPS and/or IL-1-induced nuclear factor-kappaB and activator protein-1 translocation, p38 phosphorylation, gene expression, and dysregulated IL-1R-associated kinase (IRAK)-1 activity in vitro support the hypothesis that the defect lies within the signaling pathway common to toll-like receptor 4, IL-1R, and IL-18R. This patient expresses a "compound heterozygous" genotype, with a point mutation (C877T in cDNA) and a two-nucleotide, AC deletion (620-621del in cDNA) encoded by distinct alleles of the IRAK-4 gene (GenBank/EMBL/DDBJ accession nos. AF445802 and AY186092). Both mutations encode proteins with an intact death domain, but a truncated kinase domain, thereby precluding expression of full-length IRAK-4 (i.e., a recessive phenotype). When overexpressed in HEK293T cells, neither truncated form augmented endogenous IRAK-1 kinase activity, and both inhibited endogenous IRAK-1 activity modestly. Thus, IRAK-4 is pivotal in the development of a normal inflammatory response initiated by bacterial or nonbacterial insults.- - - - - - - - - - ranking = 5keywords = bacterial infection (Clic here for more details about this article) |
3/7. Lumps and bumps: late postsurgical inflammatory and infectious lesions.Late postsurgical infectious or inflammatory complications after facial surgery present a difficult challenge. These complications occur at least 2 weeks after surgical procedures and are often attributable to unique causes, in contrast to complications within the first postoperative week. The most worrisome complications in this period are caused by mycobacterial infections, because these infections can be severe and require a protracted treatment course. A high degree of suspicion is required early in presentation because these lesions can be subtle and similar to other infectious or inflammatory lesions. The authors discuss the clinical manifestations and diagnostic and treatment rationale for late postoperative infectious and inflammatory lesions. The authors also demonstrate and compare the clinical manifestations of mycobacterial infections, bacterial infections, and sterile inflammatory reactions. In addition, the treatment rationale for mycobacterial infections is reviewed. Late postoperative infections caused by mycobacteria are reported with increasing frequency in the cosmetic literature. These cases illustrate diverse challenges in the identification and treatment of late postoperative lesions.- - - - - - - - - - ranking = 4keywords = bacterial infection (Clic here for more details about this article) |
4/7. Cutaneous complications of artificial hair implantation: a pathological study.Five patients who developed severe cutaneous complications after artificial hair implantation were subjected to a scalp biopsy. The pathology showed the presence of hyperplastic epidermal proliferations that produced infundibulum-like structures around the implanted fibers in the superficial dermis. A dense acute inflammatory infiltrate surrounded the artificial fibers in the superficial dermis. In the deep dermis a granulomatous infiltrate was present whereas in the hypodermis the inflammatory infiltrate was sparse and the fibers were embedded in fibroplasia. The pathology of a patient who did not present any skin inflammation after artificial hair implantation showed similar pathological features but the absence of acute inflammation suggesting that bacterial infections play a major role in the development of the cutaneous complications of hair implantation. Since definitive treatment of the infections is ineffective until the fibers are removed from the scalp, surgical treatment was required in 2 of our patients.- - - - - - - - - - ranking = 1keywords = bacterial infection (Clic here for more details about this article) |
5/7. Multiple granulomatous inflammation in the minor salivary glands: a proposed new entity, allergic granulomatous sialadenitis.We report a patient who presented with multiple small submucosal nodules with granulomatous inflammation in the minor salivary glands of the oral cavity. A 43-year-old woman presented with a 1-week history of multiple small submucosal nodules in her oral cavity after having taken medicine for abdominal pain. The patient did not have a history of fever, rectal bleeding, skin lesions or arthritis, but did have a history of drug allergy and bronchial asthma. Histopathological examination of the submucosal nodules showed sialadenitis with marked infiltration of lymphocytes, eosinophilic cells, macrophages and Langhans-type or foreign-body-type multinucleate giant cells. The macrophages tended to be aggregated and appeared to have caused immature granuloma formation without caseous necrosis. Degranulated eosinophilic cells were numerous. sarcoidosis, Crohn's disease, tuberculosis and atypical mycobacterial infection were not identified by medical examination. Three weeks after discontinuing the medication the patient was seen again at a follow-up visit. Multiple submucosal small nodules and other symptoms were not evident at that time. This case report may represent a new entity of salivary gland disease that we tentatively refer to as 'allergic granulomatous sialadenitis'.- - - - - - - - - - ranking = 1keywords = bacterial infection (Clic here for more details about this article) |
6/7. Demonstration of purulent bacterial intracranial infections by computed tomography.Computed tomography is shown to be an important modality in both diagnosis and management of cerebral infections. Representative findings from CT scans of patients with purulent bacterial infection of the meninges, cerebrum, ventricles, and adjacent structures are presented. Material is taken from 2,645 CT scans done in a 1 year period at the Hospital of the University of pennsylvania. It is hoped that the use of CT will lead to a decrease of morbidity and mortality in entities such as brain abscess and subdural empyema.- - - - - - - - - - ranking = 1keywords = bacterial infection (Clic here for more details about this article) |
7/7. The acute manifestations of ocular cicatricial pemphigoid: diagnosis and treatment.Seven patients with ocular cicatricial pemphigoid displayed acute inflammatory activity that could not be attributed to secondary bacterial infections, trichiasis, or lagophthalmos secondary to symblepharon. This acute inflammatory activity was manifested either as a localized conjunctival mound that was ulcerated and intensely hyperemic or as diffuse and intense conjunctival hyperemia and chemosis. acute disease activity developed shortly after conjunctival biopsy in three patients and appeared spontaneously in the other four patients. Conjunctival biopsy specmens disclosed a heavy infiltrate of polymorphonuclear leucocytes within and beneath the conjunctival epithelium in addition to the chronic inflammatory cells typically found in this condition. The acute manifestations of ocular cicatricial pemphigoid cause rapid shrinkage and scarring of the conjunctiva. Systemic corticosteroids suppressed the acute disease activity and prevented additional scarring in all five patients treated.- - - - - - - - - - ranking = 1keywords = bacterial infection (Clic here for more details about this article) |