Cases reported "Staphylococcal Infections"

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1/17. Infectious keratitis after photorefractive keratectomy in a comanaged setting.

    A 48-year-old man had simultaneous bilateral photorefractive keratectomy (PRK). The surgeon who performed the PRK did not see the patient in follow-up, and there was confusion regarding the comanaging doctor. Therefore, the patient was not examined immediately postoperatively. Several days later, he was hospitalized for an unrelated, painful orthopedic problem and heavily sedated. Seven days after the PRK, an ophthalmologist was consulted for ocular irritation and discharge. Examination showed bilateral, purulent conjunctivitis and severe infectious keratitis in the left eye. The patient was treated with periocular and topical antibiotics. Corneal cultures yielded staphylococcus aureus. The keratitis resolved slowly, leaving the patient with hand motion visual acuity. A corneal transplant and cataract extraction was performed 15 months later, resulting in a best corrected visual acuity of 20/400 because of glaucomatous optic nerve damage. Severe infectious keratitis may occur after PRK. Poor communication between the surgeon, comanaging doctor, and patient may result in treatment delay.
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2/17. Septic arthritis of the hip associated with atopic dermatitis. A case report.

    We report a case of septic arthritis of the hip associated with atopic dermatitis. A 15-year female felt a pain in the right hip with unknown cause on May 11, 1998. The pain subsequently became aggravated, and she was admitted to our hospital on May 18. She has had atopic dermatitis since 4 years of age. She showed generalized dermatitis with desquamation and numerous scratch marks. A culture of both skin and joint fluid revealed staphylococcus aureus. physical examination revealed tenderness in Scarpa triangle and restricted range of motion. Immunological serology showed an increase in eosinophils and immunoglobulin e, and a decreased reaction of lymphocyte blastoid transformation. Computed tomography (CT) and MRI showed a joint effusion in the right hip. She was diagnosed as having septic arthritis of the hip. Intravenous drip of cefazolin of 2g was started on the first day of hospitalization and joint irrigation was done on the second day. CRP became negative at 4 weeks, but joint effusion was shown on CT. Additional joint irrigation with Amicamycin (200 mg) was done. As the joint fluid culture became negative, range of motion exercises were started at 6 weeks. She was discharged with a long-leg brace applied at 8 weeks. At 13 months after onset, she had complete relief of the pain and normal activities of daily living. No destructive changes in the hip were found on X-ray examination or MRI. In the present case, an abnormal immune system associated with atopic dermatitis as well as the habit of scratching eruptions may have led to hematogenous spread of skin infection, and caused septic arthritis of the hip.
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3/17. Iliopsoas abscess in the neonate.

    Iliopsoas abscess (IPA) is rare, especially in the neonatal period. The major presenting symptoms of IPA are leg or groin swelling, limitation of leg motion, and pain. The etiologies of IPA in many cases remain unknown, and the etiologic agent in many cases is staphylococcus aureus. ultrasonography and computed tomography are useful in diagnosing this disease. Antibiotics therapy and appropriate drainage are effective, and the prognosis is good. The authors present a neonatal case of IPA and discuss clinical symptoms, etiologic agents, methods of diagnosis and therapy, and prognosis.
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4/17. Weak symptoms of bacterial endophthalmitis after a triamcinolone acetonide-assisted pars plana vitrectomy.

    PURPOSE: To report a case of endophthalmitis after triamcinolone acetonide (TA)-assisted par plane vitrectomy (PPV). methods: A 60-year-old Japanese man developed endophthalmitis after TA-assisted PPV for diabetic macular edema. Preoperative visual acuity was 20/200. Four days after surgery, endophthalmitis associated with anterior chamber hypopyon was noticed; the patient's vision had deteriorated to hand motion. In spite of severe cell infiltration, the ciliary injection and ocular pain were not significant. RESULTS: The additional PPV with irrigation of cefazolin (40 microg/ml) and gentamicin (8 microg/ml) was performed. endophthalmitis resolved soon after this treatment. staphylococcus epidermidis was detected in the intravitreous samples. The patient's visual acuity improved to 20/100. CONCLUSION: endophthalmitis may be a complication of TA-assisted PPV with unique signs and symptoms.
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5/17. Use of the Alfieri edge-to-edge technique to eliminate left ventricular outflow tract obstruction caused by mitral systolic anterior motion.

    A 68-year-old woman with concentric left ventricular hypertrophy, prosthetic valve endocarditis with aortic root abscess, and sepsis had aortic root replacement with an aortic allograft. On weaning from cardiopulmonary bypass, she had hemodynamic instability caused by systolic anterior motion of the mitral valve, which resulted in a left ventricular outflow tract obstruction; the peak pressure gradient across the left ventricular outflow tract was 130 mm Hg, and there was moderately severe (3 ) mitral regurgitation. After reinstitution of cardiopulmonary bypass, a central Alfieri edge-to-edge stitch was placed between the anterior and posterior leaflets of the mitral valve. This reduced the gradient across the left ventricular outflow tract to 10 mm Hg and eliminated the mitral regurgitation, which enabled successful separation from cardiopulmonary bypass.
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6/17. Management of infection about total elbow prostheses.

    Deep infection was a complication after twelve (7.3 per cent) of 164 primary total elbow replacements. Two additional patients who had an infection about an elbow prosthesis were referred for treatment after total elbow replacement elsewhere. A statistical analysis of all of these primary total elbow arthroplasties, including the two in patients who were referred from outside institutions, identified preoperative factors that placed a patient at significant risk for subsequent infection. The risk factors included a previous operation on the elbow, a previous infection in the region of the elbow, psychiatric illness, class-IV rheumatoid arthritis, drainage from the wound after operation, spontaneous drainage after ten days, and reoperation for any reason. Three modes of treatment were used for patients who had an established infection: debridement and salvage of the implant, resection arthroplasty, and arthrodesis. After early operative debridement and suppression of the infection with long-term antibiotic therapy, three patients were able to retain the prosthesis, with restoration of range of motion and function of the upper extremity. One prosthesis was reimplanted after a six-week course of intravenous administration of antibiotics.
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7/17. Good visual outcome after endophthalmitis in an eye previously treated successfully for amblyopia.

    A child with an extensive periorbital hemangioma developed an endophthalmitis caused by staphylococcus aureus after her second strabismus surgical procedure. Treatment with vitrectomy and intraocular antibiotics and steroid resulted in preservation of her eye. Despite previous successful treatment for amblyopia in that eye, her visual acuity improved from hand motion during the acute episode of endophthalmitis to 20/40 -2.
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8/17. Humeral lengthening for septic neonatal growth arrest.

    A 9-year-old girl was treated by humeral lengthening for a 8.5 cm deficit caused by a septic arthritis 2 days after birth. A Wagner distraction apparatus was used after an osteotomy was done distal to the deltoid insertion. Six centimeters of length were gained. A second lengthening of about 7.5 cm is planned at the end of the patient's growth. No complications were encountered; by dividing the lengthening into two procedures, none are anticipated. At 1-year follow-up, there was a full range of shoulder, elbow, and hand motion; the humeri were virtually the same length.
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9/17. Lunate osteomyelitis in a patient with bilateral Kienbock's disease.

    Kienbock's disease, which is osteonecrosis of the carpal lunate bone, was described by Peste in 1843 and by Kienbock in 1910. Histologic studies of affected lunate bones have revealed avascularity, osseous necrosis, fragmentation, and fibrous proliferation. The disease most often occurs between the ages of 20 to 40 years, and the onset is usually insidious. There may be a history of a single episode or repetitive trauma, although this is not the rule. The patient usually will present with pain and decreased motion of the wrist. X-ray will reveal sclerosis of the lunate of varying degrees. There are many theories of how the inciting event of avascular necrosis takes place. There are several reports in the American literature of unilateral disease complicated by osteomyelitis, but to our knowledge there are no reports of bilateral Kienbock's with one side complicated by osteomyelitis.
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10/17. Echocardiographic findings after tricuspid valvectomy.

    Resection of the tricuspid valve without prosthetic replacement has successfully been performed in patients with tricuspid valvular endocarditis. Using M-mode, two-dimensional, and Doppler echocardiograms, we studied four patients who underwent tricuspid valvectomy. All patients had previous history of intravenous drug abuse and staphylococcal endocarditis with tricuspid valvular involvement. In all patients, M-mode and two-dimensional echocardiograms showed that the tricuspid valve was absent. The right ventricle was dilated, and the interventricular septum had paradoxical motion in each patient. In each patient the right atrium was dilated, and with each ventricular systole, it expanded and its short axis increased by 20 to 33 percent. This caused shift of the interatrial septum toward the left atrium, with compression of its cavity. Doppler echocardiographic studies showed retrograde flow during systole in the right atrium, inferior vena cava, and hepatic vein. Echocardiographic findings in patients with tricuspid valvectomy correlate with the pathophysiologic findings of this condition.
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