1/9. Pott's puffy tumor and epidural abscess arising from dental sepsis: a case report.OBJECTIVE: To present an unusual case of two uncommon cranial complications of frontal sinusitis: Pott's puffy tumor and epidural abscess arising from frontal sinusitis of dental origin, and also two systemic complications of sinusitis: septicemia and empyema, all occurring in an immunocompetent patient. STUDY DESIGN: A 21-year-old man presented with a scalp swelling and epidural abscess. magnetic resonance imaging and computed tomographic scans revealed unilateral opacification of the frontal sinus and an epidural abscess with a direct connection to the scalp abscess. Further history revealed that his symptoms occurred coincidentally with a tooth extraction 2 months before, and he was hospitalized soon after the tooth extraction for sepsis and a lung abscess. methods: A combined neurosurgical and otolaryngologic approach was required to treat the sinusitis and the associated epidural and scalp abscess. RESULTS: Cultures returned as streptococcus intermedius from all three sites. The patient was free of disease at the 3-month follow-up. CONCLUSIONS: Odontogenic maxillary sinusitis is well documented; however, there is little reported of frontal sinusitis arising from dental disease. The prevalence of sinusitis of dental origin will be reviewed, including the microbiology of this particularly virulent organism that persisted despite earlier treatment with ampicillin. Also, the current thoughts on management of these cases will be discussed with particular reference to local therapy for sinusitis in addition to systemic treatment with antibiotics.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
2/9. Severe Staphylococcal sepsis in adolescents in the era of community-acquired methicillin-resistant staphylococcus aureus.OBJECTIVE: More than 70% of the community-acquired (CA) staphylococcal infections treated at texas Children's Hospital are caused by methicillin-resistant staphylococcus aureus (MRSA). Since September 2002, an increase in the number of severely ill patients with S aureus infections has occurred. This study provides a clinical description of severely ill adolescent patients and an analysis of their isolates using molecular methods. methods: We identified adolescent patients meeting criteria for severe sepsis requiring admission to the PICU. Patient records were reviewed, and isolates were obtained for susceptibility testing and dna extraction. Isolates were tested for the presence of virulence genes (cna, tst, lukS-PV, and lukF-PV) and enterotoxin genes (sea, seb, sec, sed, seh, and sej) by polymerase chain reaction. Genomic fingerprints were determined by repetitive-element polymorphism polymerase chain reaction and pulse-field gel electrophoresis. SCCmec cassette type was determined. RESULTS: Fourteen adolescents with severe CA S aureus infections were identified between August 2002 and January 2004. All were admitted to the PICU with sepsis and coagulopathy. Twelve patients had CA-MRSA infections; 2 had CA methicillin-susceptible Staphylococcus aureus (MSSA) infections. The mean age was 12.9 years (range: 10-15 years). Thirteen patients had pulmonary involvement and/or bone and joint infection; 10 patients had > or =2 bones or joints infected (range: 2-10); 4 patients developed vascular complications (deep venous thrombosis); and 3 patients died. All isolates were identical or closely related to the previously reported predominant clone in Houston, texas (multilocus sequence type 8, USA300), and carried lukS-PV and lukF-PV genes as well as the SCCmec type IVa cassette (12 MRSA isolates) but did not contain cna or tst. Only 1 strain carried enterotoxin genes (sed and sej). CONCLUSIONS: Severe staphylococcal infections in previously healthy adolescents without predisposing risk factors have presented more frequently at texas Children's Hospital since September 2002. CA MRSA and clonally related CA MSSA characterized as USA300 and sequence type 8 have been isolated from these patients.- - - - - - - - - - ranking = 0.5keywords = extraction (Clic here for more details about this article) |
3/9. Acquired-transient factor x deficiency associated with anticardiolipin antibodies in a child with extensive burns.The article presents the case of an 18-month-old boy with major scald burns complicated by acquired F-X deficiency. On the 15th day of hospitalization, the patient developed sepsis and fever. He also exhibited bruxism, especially during the febrile episodes, which his permanent teeth to luxate and become mobile. Pedodontists decided that all the child's teeth should be extracted to ensure proper development of the jaw with growth. Twelve hours later, he developed a leukemoid reaction, which was attributed to infection with another aerobic organism or development of anaerobic bacteremia after teeth extraction. Twenty-four hours after the extractions, the burn wounds began oozing and there was extensive gingival bleeding and epistaxis. Coagulation parameters were assessed immediately. disseminated intravascular coagulation was detected initially and was successfully treated with fresh-frozen plasma transfusions, but bleeding from the burn wounds and nasal/oral mucous membranes continued. Further testing revealed the diagnosis of acquired isolated F-X deficiency linked with antiphospholipid antibodies. Treatment with plasmapheresis, steroids, and intravenous immunoglobulin was successful. Hypertrophic scar formation was the only issue during 7 months of follow-up.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
4/9. Extraction of a chronically infected endocardial screw-in pacemaker lead by pigtail catheter and wire loop via the femoral vein.A 71-year-old woman was admitted after partial removal of an infected pacemaker system. Septicemia and subclavian vein thrombosis were present. With combined use of a pigtail catheter and a wire loop originally developed for endoscopic polypectomy, the infected catheter was pulled into the inferior vena cava. Counterclockwise rotation of the pigtail catheter following its fixation to the electrode by the wire loop allowed removal of the tip of the endocardial screw-in electrode from the myocardium and its extraction. Open heart surgery was avoided and the source of chronic infection was removed.- - - - - - - - - - ranking = 0.5keywords = extraction (Clic here for more details about this article) |
5/9. Fatal acute bacterial myocarditis after dentoalveolar abscess.A 19 year old woman presented with chest pain after a dental extraction for a dentoalveolar abscess. Electrocardiographic and serum isoenzyme changes were consistent with acute anterior myocardial infarction. At autopsy bacteria were demonstrated, within the myocardium in the absence of a myocardial abscess or endocarditis. This case illustrates the occurrence of isolated acute bacterial myocarditis after a dental extraction.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
6/9. Infected left atrial myxoma with bacteremia simulating infective endocarditis.A 58-year-old man had intermittent fever of eight months' duration following a dental extraction. There were no abnormal cardiac auscultatory findings. Multiple blood cultures yielded streptococcus mutans. Treatment for infective endocarditis was initiated; however, an echocardiogram suggested the presence of a left atrial myxoma. The diagnosis was confirmed by angiography and the infected tumor was removed successfully. Differentiating features between left atrial myxoma and mitral valve endocarditis may not be obvious clinically, and bacteremia does not preclude atrial myxoma as a diagnostic possibility. We therefore suggest that all cases of infective endocarditis be evaluated by echocardiography to elucidate lesions such as large vegetations or left atrial myxoma, both of which may require urgent operative intervention.- - - - - - - - - - ranking = 0.5keywords = extraction (Clic here for more details about this article) |
7/9. Multiple systems organ failure: II. The effect of infusion of amino acids and glucose.amino acids and dextrose infusion were given for short periods of time to a young man whose basal state is characterized in the previous paper in this series, and their effects were documented in terms of plasma concentrations and splanchnic extraction. The basal state measurements show in the acute trauma state and its subsequent starvation state a largely balanced splanchnic extraction of amino acids but at a decreasing rate. Amino acid (FreAmine) infusion at low rates on this background produced a large increase in extraction of a largely balanced mixture of amino acids but a minimal change in glucose release. The septic state is characterized in both the basal and amino acid infusion state by splanchnic extraction of an unbalanced mixture of amino acids which is deficient in branched-chain amino acids and in relative excess of glucogenic amino acids with increased glucose release and increased utilization of amino acids for gluconeogenesis. In early sepsis this state can largely be repaired by exogenous amino acid infusion but in late sepsis can only be partially repaired. The data suggest that the patient in late sepsis should have a branched-chain rich amino acid mixture and that the hepatic failure of sepsis is strongly associated with peripheral release of an unbalanced mixture of amino acids secondary to enhanced branched-chain catabolism. Infused glucose produces a large increase in the plasma glucose but also improves the balance of the splanchnic amino acids extracted. The statistical validity of the preceding statements are examined in detail in the manuscript.- - - - - - - - - - ranking = 2keywords = extraction (Clic here for more details about this article) |
8/9. Perforation of the sigmoid colon by an orthopedic nail: report of a case.Clinical features and radiographs are presented of a patient whose sigmoid colon was perforated by an orthopedic nail entering the peritoneal cavity via the left acetabulum. The patient was successfully treated by extraction of the nail and closure of the colonic defect.- - - - - - - - - - ranking = 0.5keywords = extraction (Clic here for more details about this article) |
9/9. Gentamicin extraction from an anuric patient by combined haemodialysis and charcoal haemoperfusion.A 39-year-old woman who developed acute renal failure following intra-abdominal sepsis was treated with gentamicin. Her serum concentrations reached potentially toxic levels. Combined haemoperfusion and haemodialysis removed approximately 70% of the given drug and the patient made a complete recovery.- - - - - - - - - - ranking = 2keywords = extraction (Clic here for more details about this article) |