1/82. Compartment syndrome in a patient with X-linked agammaglobulinaemia and ecthyma gangrenosum. Case report.Compartment syndrome is a surgical emergency that requires immediate decompression. We know of no documented cases that describe ecthyma gangrenosum as a primary cause of compartment syndrome. We present a case of a baby with x-linked agammaglobulinaemia who developed compartment syndrome associated with systemic pseudomonas aeruginosa infection and ecthyma gangrenosum of the leg. He was treated by debridement and fasciotomies followed by primary closure and skin grafting and made an uneventful recovery.- - - - - - - - - - ranking = 1keywords = closure (Clic here for more details about this article) |
2/82. status epilepticus associated with cefepime.ARTICLE ABSTRACT: Cefepime is a fourth-generation cephalosporin widely used for gram-negative sepsis. The authors report two patients in whom nonconvulsive status epilepticus developed while they were on treatment with cefepime for pseudomonas aeruginosa infection. The status epilepticus resolved completely once the drug was withdrawn. Cefepime therapy can result in status epilepticus, especially if given in higher doses than required.- - - - - - - - - - ranking = 6.1604377547725keywords = drug (Clic here for more details about this article) |
3/82. Total excision of the sternum and thoracic pedicle transposition of the greater omentum; useful strategems in managing severe mediastinal infection following open heart surgery.Mediastinal sepsis following open heart surgery is a significant cause of death. Open drainage of the mediastinumalone was employed originally in management of this problem. More recently, debridement, drainage, and reclosure have been used. Various irrigation solutions, such as antibiotics and Betadine, have been advocated to control severe mediastinal sepsis. Three principles of management in patients unresponsiveness to the above techniques have proved successful in two patients with life-threatening mediastinal sepsis: (1) radical, complete excision of the sternum and adjacent costal cartilages; (2) transposition of the greater omentum on a vascular pedicle to the mediastinum; and (3) primary closure with full-thickness rotational skin flaps. The radical excision of the sternum removes residual foci of sepsis in cartilage and sternal bone marrow. The transposition of the omentum provides a highly vascular, rapidly granulating covering for the contaminated great vessels and hase been successfully to prevent recurrence of suture line bleeding of an exposed ascending aortic anastomosis site. Primary closure of the wound with full-thickness skin flaps provides a suprisingly satisfactory covering for the heart. Preoperative and postoperative measurements of ventilatory mechanics have shown relatively small ventilatory impairment after the alteration of the thoracic cage imposed by excision of the sternum. Two patients have returned to active lives. A treatment failure probably due to incomplete adherence to these guidelines also is presented.- - - - - - - - - - ranking = 3keywords = closure (Clic here for more details about this article) |
4/82. Improvement of c-reactive protein levels and body temperature of an elderly patient infected with pseudomonas aeruginosa on treatment with Mao-bushi-saishin-to.OBJECTIVE: To examine the effectiveness of Mao-bushi-saishin-to (Ma-Huang-Fu-Zi-Xi-Xin-Tang in Chinese medicine) (Tochimototenkaido Co. Ltd., Osaka, japan), one of the traditional herbal medicines, against resistant bacterial infection. SETTING: The nursing Center Himawari, Izumo, japan DESIGN, PATIENT, AND PREPARATION: Half of the standard dose of Mao-bushi-saishin-to was prescribed for 7 days to one elderly patient with fever and positive c-reactive protein (CRP) levels suffering from drug resistant pseudomonas aeruginosa. The daily standard dose of Mao-bushi-saishin-to is prepared from 1200 mg of dried extract obtained from three crude drugs, Ephedrae Herba (4 g), Asiasari Radix (3 g), and Aconiti Tuber (1 g). It is certified by the Japanese Ministry of health and Welfare. RESULTS: The patient's fever and CRP level returned to normal levels. CONCLUSIONS: In cases in which the fever does not fall in response to antibiotics for at least 3 days, half of the standard dose of Mao-bushi-saishin-to for 7 days might be worth trying to induce remission, especially for elder patients.- - - - - - - - - - ranking = 12.320875509545keywords = drug (Clic here for more details about this article) |
5/82. Treatment of nosocomial pneumonia and tracheobronchitis caused by multidrug-resistant pseudomonas aeruginosa with aerosolized colistin.Gram-negative bacilli including multidrug-resistant (MDR) pseudomonas aeruginosa are responsible for a significant proportion of episodes of nosocomial pneumonia. Since the development of new antibiotics with activity against gram-negative organisms has not kept pace with the increase in prevalence of MDR pathogens, there has been renewed interest in antimicrobial agents that had previously been used but had been abandoned because of toxic side effects. This report describes three patients with nosocomial pneumonia or tracheobronchitis due to multiresistant strains of P. aeruginosa for whom aerosolized colistin proved beneficial as supplemental therapy. Aerosolized colistin merits further consideration as a therapeutic intervention for patients with pulmonary infections due to MDR P. aeruginosa.- - - - - - - - - - ranking = 30.802188773862keywords = drug (Clic here for more details about this article) |
6/82. hemoptysis following left ventricular aneurysm repair: a misleading clinical sign.We report on a 66-year-old man with severe hemoptysis following coronary artery bypass grafting and repair of a left ventricular septal defect after acute myocardial infarction. Initial diagnosis was delayed by misleading clinical symptoms and radiologic studies. Due to subfebrile temperature and sputum culture positive for pseudomonas aeruginosa, he had been treated with antibiotics before reoperation. At reoperation, replacement of all foreign material and reconstruction of the ventricular repair with bovine pericardium resulted in reinfection with the same organism despite prolonged antibiotic therapy after 6 months. Removal of the pericardial tissue with direct suture closure of the ventricles and interposition of omentum led to complete healing of the infection without reoccurrence after 2 years.- - - - - - - - - - ranking = 1keywords = closure (Clic here for more details about this article) |
7/82. Aerosolized amikacin in the treatment of Pseudomonas pneumonia in the nursing home setting.Studies have shown that aerosolized aminoglycosides represent a safe and effective means of treating pneumonia due to Pseudomonas sp. Aerosolized aminoglycosides have been shown to improve clinical outcome, with less risk of nephrotoxicity relative to parenteral aminoglycosides. Apparently, less drug resistance is associated with the use of aerosolized aminoglycosides. Cost factors favor aerosolized delivery methods. The full recovery experienced by the patient in this case study suggests that aerosolized amikacin may be a safe, efficacious, and cost-effective means of treating pseudomonal pneumonia in geriatric patients. Controlled clinical trials should be conducted to further investigate this treatment regimen.- - - - - - - - - - ranking = 6.1604377547725keywords = drug (Clic here for more details about this article) |
8/82. ciprofloxacin-induced acute renal failure in a patient with cystic fibrosis.Acute renal failure is a rare adverse reaction of antibiotic therapy with quinolones seldom seen in young patients. We report an 18-year-old young woman with cystic fibrosis who experienced a pronounced decline in renal function after oral treatment with ciprofloxacin for 3 weeks. Withdrawal of the drug led to normalization of renal function after 10 days.- - - - - - - - - - ranking = 6.1604377547725keywords = drug (Clic here for more details about this article) |
9/82. Continuous beta-lactam antibiotic therapy in a double-lung transplanted patient with a multidrug-resistant pseudomonas aeruginosa infection.BACKGROUND: It is well known that the bactericidal effect of beta-lactam antibiotics is closely related to the time which the serum concentration of the antibiotic remains above the minimal inhibitory concentration of the target pathogen. Thus, the optimal administration of beta-lactam antibiotics would be the continuous infusion of the drug. methods: We present a case report with a critically ill double-lung transplanted patient with pneumonia due to a multidrug-resistant pseudomonas aeruginosa who received continuously 8 g meropenem/24 hr. Based on a previous pharmacokinetic study showing that continuous infusion of meropenem is at least equivalent to intermittent administration this case report is reported to demonstrate the clinical efficacy of continuous infusion. RESULTS: c-reactive protein and pneumonia decreased rapidly when clinical conditions were improved significantly. Continuous administration of meropenem did not interfere with cyclosporine, no side effects were seen, and the patient's renal function was not impaired during the whole period of treatment. CONCLUSION: The continuous administration of beta-lactam antibiotics is a powerful application in critically ill patients to intensify antimicrobial therapy.- - - - - - - - - - ranking = 36.962626528635keywords = drug (Clic here for more details about this article) |
10/82. vacuum-assisted closure in the treatment of a 9-year-old child with severe and multiple dog bite injuries of the thorax.The vacuum-assisted closure (VAC; KCI International, San Antonio, TX) device is a negative pressure dressing, which we have used in the treatment of wounds with devitalized or infected tissues. Although introduced in plastic and reconstructive surgery, its use has extended to orthopedic and cardiothoracic surgical practice in the treatment of infected joint replacement and sternal wound infections, respectively. Although the VAC is becoming more widely used in surgical practice, only a small number of case reports exist in addition to the original case series by Argenta and Morykwas in 1997. Previously, the device was described in treating single wounds in adult patients. We report a case where it was successfully used to treat multiple dog bite injuries in a 9-year-old child.- - - - - - - - - - ranking = 5keywords = closure (Clic here for more details about this article) |
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