1/134. purpura as a cutaneous association of sickle cell disease.A common chronic feature of sickle cell disease is the presence of painful, punched-out leg ulcers. Other cutaneous findings in patients with homozygous sickle cell disease have not been described in the literature. We present a case of a 50-year-old black woman with sickle cell disease who was admitted for acute onset of arm and hip pain. After admission she deteriorated clinically, with multiorgan failure and mental status changes. Examination of the skin revealed erythematous papules and plaques with scaly centers and purpura on the upper trunk. The clinical differential diagnosis was vasculitis versus sepsis. skin biopsy of two representative lesions was performed. hematoxylin- and eosin-stained sections showed a superficial perivascular mixed inflammatory infiltrate with numerous eosinophils and extravasated erythrocytes, some of which exhibited bizarre morphology of sickled red blood cells. These findings indicated that the patient's cutaneous lesions, possibly multifactorial in origin, could be a component of her sickle cell crisis. This case is presented as an unusual one in which evaluation of erythrocyte morphology contributed to patient management and to emphasize the importance of examining erythrocyte morphology as a part of the histologic evaluation of stained tissue.- - - - - - - - - - ranking = 1keywords = bite (Clic here for more details about this article) |
2/134. Iatrogenic staphylococcus aureus septicaemia following intravenous and intramuscular injections: clinical course and pathomorphological findings.The clinical course, autopsy and histological findings are presented from three (one 33-year-old female and two males aged 26 and 56) fatalities resulting from injection therapy which has produced staphylococcus aureus septicaemia. The autopsies were performed within 2-4 days postmortem. No primary focus other than the insertion site of the peripheral venous catheters or the intramuscular injections, representing the initial entry site of staphylococcus aureus, could be identified. Death was attributed directly to the staphylococcal infection as a result of iatrogenic injection therapy for the treatment of a non-severe underlying illness (premature labour pains, acute loss of hearing, lumbago). The forensic diagnosis of staphylococcus aureus septicaemia following iatrogenic injections has to be critically evaluated and can be established routinely in cases with delayed autopsy only when no other cause of death is revealed by autopsy, no apparent source of infection other than the insertion site can be detected and careful attention is paid to histological and bacteriological findings. All doubtful cases of nosocomial bloodstream infections with fatal outcome should undergo an immediate autopsy. In cases of very early forensic involvement microbiological investigations, including phagotyping, molecular biological characterization and identification of bacterial toxins from micro-organisms out of appropriate specimens obtained postmortem, could be efforts of potential evidential value regarding the aetiological proof. To optimize aetiopathogenetic conclusions concerning a causal relationship between iatrogenic injections and septic complications, the medicolegal investigation should also include an interdisciplinary co-operation with consultants from other relevant fields (e.g. microbiology and hygienics).- - - - - - - - - - ranking = 0.042483327132968keywords = relation (Clic here for more details about this article) |
3/134. intestinal absorption and permeability in paediatric short-bowel syndrome: a pilot study.BACKGROUND: Sugar absorption tests are an effective, noninvasive way to assess intestinal permeability. The role of intestinal barrier integrity in complications and outcome of short-bowel syndrome is not known. The purpose of the study was to evaluate whether such tests provide information on the status of intestinal mucosa of these patients. methods: Six children with short-bowel syndrome--median age, 12 months, and median small bowel length at birth, 30 cm--had a sugar test with 3-o-methyl-D-glucose, D-xylose, D-rhamnose, and melibiose approximately 2 months after operation. The melibiose/L-rhamnose ratio was used as an index of permeability, and percentages of 3-o-methyl-D-glucose and D-xylose absorbed were used as indices of absorption. parenteral nutrition requirement, bowel length, liver disease, recent sepsis, and bacterial overgrowth were recorded. RESULTS: Three patients had increased permeability, and all of them had had a recent episode of sepsis and severe liver disease. All subjects had malabsorption of 3-o-methyl-D-glucose, and five of six had malabsorption of D-xylose and L-rhamnose. The absorption of 3-o-methyl-D-glucose correlated with bowel length (r2 = 0.78; P = 0.04), whereas the absorption of D-xylose correlated with parenteral requirement (r2 = 0.66; P = 0.04) at that time. CONCLUSIONS: Increased permeability was observed in three of six patients with short-bowel syndrome associated with a recent episode of sepsis and severe liver disease. Other indices of malabsorption correlated significantly with different clinical features of the disease. A prospective larger scale study in a homogeneous population is indicated to assess at multiple points during the disease course whether the test can be helpful in the management of these patients.- - - - - - - - - - ranking = 0.10707194259407keywords = record (Clic here for more details about this article) |
4/134. Usefulness of procalcitonin in Pseudomonas burn wound sepsis model.Procalcitonin (PCT), a precursor of calcitonin, and endotoxin were determined in the burn wound sepsis model in which 21 Sprague-Dawley rats were scalded approximately 30% on their back. On day 2 post burn, the wounds were inoculated 1 x 10(8) colony-forming units of pseudomonas aeruginosa. On day 5 post burn P. aeruginosa was detected by blood culture in 10 of the 21 rats (47.6%). The mortality rate 7 days after burn was 90.5%. Significant correlations were observed between serum endotoxin levels and serum PCT levels on day 5 post burn (r = 0.860, p<0.001). It was suggested that endotoxin may induce the release of PCT and that measuring the levels of PCT may be useful in diagnosing burn wound sepsis.- - - - - - - - - - ranking = 0.042483327132968keywords = relation (Clic here for more details about this article) |
5/134. waterhouse-friderichsen syndrome secondary to capnocytophaga canimorsus septicemia and demonstration of bacteremia by peripheral blood smear.waterhouse-friderichsen syndrome caused by capnocytophaga canimorsus septicemia was fatal in a previously healthy 47-year-old woman. The patient died suddenly in less than 12 hours after presentation, in spite of supportive measures, including ventilation, antibiotic coverage, pressor therapy, and multiple transfusions of blood products. The diagnosis of infection due to an unusual organism was suspected earlier in the course of management after review of the peripheral blood smear. The importance of the findings in the blood smear and their correlation with infection due to this organism are discussed.- - - - - - - - - - ranking = 0.042483327132968keywords = relation (Clic here for more details about this article) |
6/134. mycobacterium tuberculosis infection in pediatric liver transplant recipients.OBJECTIVES: To study the incidence, clinical presentation, management, complications and outcome of tuberculosis in pediatric liver transplant recipients. methods: A retrospective review of the medical records of children who underwent liver transplantation between 1991 and 1998. RESULTS: mycobacterium tuberculosis infection occurred in 6 of 254 (2.4%) children undergoing liver transplantation between 1991 and 1998. cough, pyrexia and poor appetite were common presentations; one-half had normal chest radiographs. The median time to confirmation of diagnosis was 8 months (range, 1 to 17 months). Tests contributing to diagnosis included: Ziehl-Neelsen (ZN) stain (2 patients), M. tuberculosis polymerase chain reaction (1 patient), Mantoux test (1 patient) and histopathology (4 patients). family health screening was productive for 4 patients. Duration of treatment varied from 9 to 18 months. isoniazid-induced hepatitis was observed in 2 patients but resolved with dose reduction. Two patients died while receiving treatment, one of klebsiella spp. septicemia and the other of pulmonary hemorrhage. CONCLUSIONS: Tuberculosis after liver transplantation has a significant morbidity and mortality. Pretransplantation a personal and family history of tuberculosis must be sought, and screening of patients and their families should be considered. Standard regimens incorporating isoniazid and rifampin are effective, but regular monitoring of liver function is essential to detect drug-induced hepatotoxicity.- - - - - - - - - - ranking = 0.10707194259407keywords = record (Clic here for more details about this article) |
7/134. pasteurella dagmatis septicaemia in an immunocompromised patient without a history of dog or cat bites.We report a rare case of pasteurella dagmatis septicaemia in a 66-year-old immunocompromised patient, without a history of cat bites, dog bites or scratches.- - - - - - - - - - ranking = 6keywords = bite (Clic here for more details about this article) |
8/134. Complications of transrectal aspiration biopsy of the prostate.Four cases of coli-sepsis, one with a fatal outcome have been observed after more than 14 000 transrectal aspiration biopsies (TAB) of the prostate performed at Karolinska Sjukhuset with Franzen's apparatus. A few cases of transient febrile reaction and urinary contamination after TAB of the prostate have also been recognised. One of the patients with sepsis and two with febrile reactions belonged to a relatively small group of patients referred from the Department of rheumatology. These observations prompted the present study. The records of all the patients referred for TAB of the prostate from the Department of rheumatology were reviewed. Four complications (three patients with febrile reaction and growth of E. coli in the urine and one case of sepsis) were observed after 63 biopsies in 51 patients (6.3%). The patient with sepsis and two other patients with complications belonged to a group of 32 patients with proven rheumatic disease (chronic polyarthritis): 42 biopsies had been performed in this particular group of patients, bringing the incidence of complication to 7.1%. For comparison the records of 294 patients from the Department of urology submitted to TAB of the prostate were also reviewed. Complications in the form of transient febrile reactions were found in five cases after 508 biopsies (1.0%). In addition, three cases of coli-sepsis not belonging to the above-mentioned groups are briefly described as case reports. patients with rheumatic disease (chronic polyarthritis) seem to run a higher risk of complications after TAB of the prostate. sepsis from E. coli is a rare but serious complication which can develop into, often fatal, endotoxin shock. TAB of the prostate should therefore be restricted to cases with clinical suspicion of prostatic malignancy.- - - - - - - - - - ranking = 0.21414388518813keywords = record (Clic here for more details about this article) |
9/134. carbenicillin in acute renal failure.Three septicaemic patients with acute renal failure required carbenicillin. Septicaemia was caused by Pseudomonas in 2 patients and by serratia marcescens in the third. Therapy in the first 2 patients was complicated by massive gastro-intestinal and uterine bleeding. Septicaemia in the third patient was initially uncontrolled owing to inadequate serum levels of carbenicillin, despite increased dosage as renal function improved. The problems and indications for the use of carbenicillin in renal failure are discussed and the possible relationship to bleeding diathesis is considered.- - - - - - - - - - ranking = 0.042483327132968keywords = relation (Clic here for more details about this article) |
10/134. Early sepsis, obstructive jaundice and right-sided diaphragmatic hernia in the newborn.A male newborn was admitted to our Unit because of early sepsis and shock. He required antimicrobial therapy and mechanical ventilation and initially did well, although he exhibited jaundice and cholestasis. During the second week he deteriorated, with radiological opacification of the right hemithorax and pleural effusion, and did poorly in spite of antibiotical therapy and drainage of the effusion. In the third week, the X-ray suggested some bowel loops in the right hemithorax. A right-sided diaphragmatic hernia was confirmed by a CT-scan, and surgery was performed with good outcome. The association of delayed-onset right-sided CDH following early sepsis and obstructive jaundice has not been published before, and illustrates a scarcely known form of presentation of this condition.- - - - - - - - - - ranking = 1keywords = bite (Clic here for more details about this article) |
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