1/15. New approach for dose reconstruction: application to one case of localized irradiation with radiological burns.When localized accidental irradiation occurs, it is necessary to determine the extent to which tissues and vital organs have been damaged, mainly in the vicinity of the source. At present, biological markers cannot be used to estimate the heterogeneity of the dose distribution. An alternative is to map the absorbed dose in the different regions of the body. Using a Monte Carlo calculation code, it is possible to simulate the accident while taking into account the specific morphology of the irradiated individual and his environment, as well as the source characteristics. The calculated values are matched to the clinical signs of the lesion, particularly around the rim of the radiation-induced necrosis. This technique was applied successfully on two patients who presented very severe lesions due to acute localized irradiation after an accident that occurred at Lilo (georgia) in 1996-1997; only the most demonstrative case is presented here.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
2/15. Myonecrosis caused by edwardsiella tarda: a case report and case series of extraintestinal E. tarda infections.edwardsiella tarda is an unusual human pathogen. It is primarily associated with gastrointestinal disease, although recent reports of extraintestinal disease are broadening the current understanding of the clinical spectrum of E. tarda. A series of 11 cases of extraintestinal E. tarda infection is presented, including the first reported case of myonecrosis in an immunocompetent patient. Wound infections were the most common manifestation, and 3 of 5 patients with infected wounds had been exposed to a marine environment. One patient had bacteremia, and the remaining 5 patients developed abscesses that required surgical drainage. Four patients had E. tarda isolated in pure culture, including the patient with myonecrosis. Although it is often difficult to ascertain the contribution of E. tarda to infection when it is isolated as part of a mixed culture, this case series suggests that E. tarda is singularly capable of causing limb- and life-threatening infections.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
3/15. Clostridial myonecrosis cluster among injection drug users: a molecular epidemiology investigation.A molecular epidemiologic investigation was performed on a cluster of severe necrotizing clostridium infections in 5 injection drug users admitted to an urban community hospital. Interviews with survivors suggested a point source of infection. Pulsed-field gel electrophoresis of SmaI restriction digests was performed to determine the molecular relatedness of clinically obtained isolates and isolates obtained from heroin samples and the home environment. A common clonal strain was found in clostridium sordellii isolates from 2 socially unrelated patients and from drug paraphernalia. Clonality of a clostridium perfringens strain from another patient isolate was identical to an isolate from a syringe found in her home. Other C perfringens isolates from patients, heroin, and the environment were determined to be polyclonal. We postulate that rapid recognition and public health notification led to rapid resolution of the outbreak.- - - - - - - - - - ranking = 2keywords = environment (Clic here for more details about this article) |
4/15. Necrotizing granulomatous vasculitis associated with cocaine use.cocaine abuse may be associated with a destructive nasal and pharyngeal process felt to be due to ischemia secondary to vasoconstriction. This report is the first to document a necrotizing granulomatous vasculitis associated with nasal destruction and an oronasal fistula in a chronic cocaine user. cocaine is an environmental insult that may play a role in triggering cerebral and non-cerebral vasculitis including a necrotizing granulomatous vasculitis of the respiratory tract.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
5/15. Fatal necrotizing esophagitis due to penicillium chrysogenum in a patient with acquired immunodeficiency syndrome.Although blue-green molds of the genus Penicillium are ubiquitous in the human environment, invasive penicilliosis is uncommon and primarily encountered among immunosuppressed patients. A patient with hiv infection who died of severe necrotizing esophagitis caused by penicillium chrysogenum is reported and the relevant English language literature on human penicilliosis is reviewed. Although infectious esophagitis is commonly associated with AIDS, Penicillium esophagitis has not been described in such patients.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
6/15. Case report: subcutaneous elemental mercury injection--clinical observations and implications for tissue disposal from the histopathology laboratory.A 31-yr-old man presented to his general physician complaining of pain and swelling in the soft tissue of both hips. He initially denied knowledge of the etiology, but after elemental mercury droplets were expressed from the skin wounds by manual manipulation, he admitted that the source was self-administered sc injections. He did not provide a reason for this or give the time-frame of the injections. The areas of skin discoloration and soft tissue induration were completely excised and the wounds healed uneventfully. blood levels of mercury declined gradually after excision. Examination of the resected skin and subcutis revealed subcutaneous abscesses containing droplets of elemental mercury, released easily when the abscesses were sectioned. Sections showed dark droplets of metallic mercury associated with necrosis and microabscess formation, with areas of foreign body giant cell reaction. Disposal of the residual tissues and mercury by incineration would release the volatile elemental mercury into the atmosphere, where it would subsequently be returned to earth in rain water, be converted to methyl mercury by microorganisms, and enter the food chain. The US Environmental Protection Agency has recommended caution in consuming foods containing methyl mercury and has provided guidelines for consuming foods believed to contain increased amounts of mercury. mercury is readily available in the united states by over-the-counter sales to consumers, and in some cultures elemental mercury is used in ritualistic practices. skin injection cases are infrequent, but histopathology laboratories should recognize this phenomenon and be prepared to dispose of Hg-contaminated tissues in an environmentally sound manner.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
7/15. Operative treatment of deep burns of the scalp and skull.Traditional surgical treatment of deep burns of the scalp and skull involve the excision of necrotic bone and soft tissues with trephanation of the bone to permit granulation tissue formation and subsequent grafting. This approach prolongs wound time, adds additional trauma and, even after initial healing, necessitates secondary soft tissue and bone reconstruction. The treatment described here is an alternate and more aggressive one involving early excision of necrotic soft tissue without bone resection followed by immediate coverage with well-vascularized axial flaps from adjacent intact scalp. This method provides an optimal environment for healing and regeneration of areas of destruction to the skull. This surgical method was used in the treatment of 22 patients with deep burns of the scalp with satisfactory clinical results. bone regeneration was confirmed by roentgenological investigations.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
8/15. Vibrio sepsis in a cirrhotic patient.vibrio vulnificus should be suspected in any soft tissue infection occurring after exposure to the marine environment. Early recognition followed by appropriate antibiotic therapy and debridement of involved tissue are essential features in the treatment of these infections.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
9/15. Fatal copper storage disease of the liver in a German infant resembling Indian childhood cirrhosis.A female child of non-consanguineous, healthy German parents fell ill at the age of 7 months with a progressive liver disease leading to irreversible hepatic failure 3 months later. Histological examination revealed severe liver cell necrosis, excessive Mallory body formation and veno-occlusive-like changes associated with massive storage of copper, similar to Indian childhood cirrhosis (ICC). Chronic copper contamination of drinking water was the only detectable aetiological factor. The study illustrates that ICC most probably is an environmental disease, also occurring outside the Indian subcontinent, and is likely to be underdiagnosed in the western world.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
10/15. Vibrio hand infections: a case report and review of the literature.A case of vibrio vulnificus infection of the hand is presented. The role of Vibrio species as primary pathogens in infections associated with exposure to a marine environment is discussed.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
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