1/10. Congenital neutropenia. Report of a case and a biorationale for dental management.Congenital neutropenia is characterized by a marked decrease in or lack of circulating PMN's in children with no prior history of drug intake. The neutropenia is persistent and the clinical course is one of early onset of severe, recurrent, and eventually fatal infections. bone marrow studies show a maturation arrest of neutrophilic precursors. Because of their greatly increased susceptibility to infection, patients with congenital neutropenia present a difficult dental management problem. A case of congenital neutropenia has been presented, as well as a biorationale for dental treatment. On the basis of reports in the literature, the following recommendations for the management of patients with congenital neutropenia are made: 1. The prevention and control of infection and the interception of dental disease before surgical intervention becomes necessary should be the overriding considerations in the management of patients with congenital neutropenia. 2. The carious breakdown of teeth should be prevented by the daily application of a 0.4 per cent stannous fluoride gel in addition to oral hygiene and limitation of sucrose intake. 3. Periodontal therapy should be palliative only, since alveolar bone loss is progressive despite frequent oral hygiene instruction and prophylaxis. The goal of periodontal therapy for patients with congenital neutropenia should therefore be a decrease in gingival inflammation to make the patient's mouth more comfortable and to slow down alveolar bone loss. Periodontal surgery is contraindicated. 4. bacteremia and subsequent septicemia should be prevented since a minor infection can become life threatening in patients with congenital neutropenia. The patient should rinse for 30 seconds and the gingival sulci should be irrigated with a phenolated antiseptic mouthwash prior to all dental manipulations of the soft tissue. This will significantly reduce the incidence of bacteremia. 5. Surgery should be avoided if at all possible because of the high risk of post-operative infection. All surgery sholld be performed in the hospital, and the patient should be given antibiotics as determined by his physician. Primary closure should be done with fine polyglycolic acid sutures to reduce the chance of infection. If postoperative infection can be prevented, wound healing will progress normally despite the complete absence of PMN's.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/10. obesity: impediment to postsurgical wound healing.PURPOSE: To provide physicians and nurses with an overview of the impact of obesity on postoperative wound healing and how preplanning protocols can minimize skin and wound care problems in this patient population. TARGET AUDIENCE: This continuing education activity is intended for physicians and nurses with an interest in reducing skin and wound care problems in their patients who are obese. OBJECTIVES: After reading the article and taking the test, the participant will be able to: 1. Identify obesity-related changes in body systems and how these impede wound healing. 2. Identify complications of postoperative wound healing in obese patients and the assessments and intervention strategies that can reduce these complications. 3. Identify skin and wound care considerations for obese patients and the role of preplanning protocols in avoiding problems.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
3/10. pyoderma gangrenosum after reduction mammoplasty.The authors report a case of pyoderma gangrenosum in a 37-year-old woman that occurred at surgical sites after reduction mammoplasty. The diagnosis was delayed, but treatment with intralesional triamcinolone resulted in complete resolution o the condition. pyoderma gangrenosum in this setting can mimic infectious causes of wound necrosis. Early recognition of its characteristics features may prevent unnecessary and ineffective treatment, thereby avoiding frustration for both patient and physician.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/10. Infection in total joint arthroplasty from distal intravenous lines. A case report.Prevention of late hematogenous infection of a total joint arthroplasty is of great importance because of the catastrophic consequences. Any situation that can lead to a bacteremia should be avoided and appropriate prophylactic antibiotics given in anticipation of a bacteremic episode. This report documents a bacteremia and total joint infection secondary to a routine intravenous line placed in an extremity distal to a total knee arthroplasty. Routine intravenous infusion lines should not be placed in extremities with proximal total joint arthroplasties. Educating both patients and physicians about the risks to a prosthetic joint is important.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/10. Infections of the cardiac suture line after left ventricular surgery.PURPOSE: Infections of the cardiac suture line after left ventricular surgery are rare but may be fatal if not diagnosed promptly and treated effectively. In order to alert physicians to this entity, we reviewed data from three patients who presented at the Cleveland Clinic Hospital and from 22 patients in the literature. patients AND methods: The three patients in the current report underwent treatment at the Cleveland Clinic Hospital. Additional cases of infection of the left ventricular suture line were identified by reviewing the English literature pertaining to surgery for left ventricular aneurysms, pseudoaneurysms, and postoperative cardiac infections. RESULTS: Infection presented on average 16 months after surgery with cardiocutaneous fistulae, chest wall masses, hemoptysis or other pleuropulmonary symptoms, or systemic illness with bacteremia resembling endocarditis. Staphylococci and gram-negative bacilli were the most frequent pathogens. diagnosis was often delayed and mortality was high. Left ventricular false aneurysms were identified in 15 of the 25 patients. Bleeding from sinuses in the chest wall or epigastrium or repeated hemoptysis were important clinical clues. In some instances, ill-advised surgical or instrumental procedures precipitated life-threatening hemorrhage. Treatment with antibiotics alone was insufficient. Excision of all infected sutures and Teflon pledgets and adequate debridement of the infected suture line were required to achieve cures. CONCLUSION: Since infection of the left ventricular suture line has protean clinical manifestations and may present months or years after the initial surgery, a high index of suspicion is of paramount importance in diagnosing the condition. Institution of cardiopulmonary bypass and reoperation through median sternotomy is recommended to achieve a cure.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/10. pyoderma gangrenosum in a kindred. Precipitation by surgery or mild physical trauma.Five cases of pyoderma gangrenosum occurring in a kindred are presented. Three of the cases occurred after abdominal surgery and tended to be confused with postoperative wound infections. Two cases occurred after superficial injury to the leg and were also thought to represent a peculiar form of cellulitis. None of the patients are known to have any of the underlying diseases usually associated with pyoderma gangrenosum. The cases are presented to alert the physician to this entity and to document the unusual familial occurrence.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/10. Anaerobic infection after total hip replacement. Report of three cases.In a series of 387 consecutive total hip replacements there were nine infections (2.3% infection rate). Three of the infections were caused by an anaerobic gram positive cocci, peptococcus. This is an increased incidence of infection for this previously rare pathogen. The anaerobic infections occurred despite prophylactic antibiotic coverage with Keflin. No causative factors such as hospital, operating time, operating personnel, medical disease, or blood loss could be associated with the observed anaerobic infections. Two of the anaerobic infections appeared late. This is consistent with other reports of anaerobic infections in implants. drainage after total hip arthroplasty operation must be cultured for anaerobes as well as aerobes, especially late infections in patients on prophylactic antibiotics. drainage which is sterile to aerobic culture should alert the physician to a possible anaerobic infection.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/10. Hemodialysis fistula infections caused by legionella pneumophila.legionella pneumophila was found in the infected hemodialysis fistulas of two patients. The first patient developed an infection of the fistula during acute illness with Legionnaires' pneumonia. Legionella organisms were shown to be present in the graft by direct immunofluorescent staining. The second patient developed an infection of the hemodialysis fistula 3 weeks after completing a course of erythromycin therapy for Legionnaires' pneumonia. Legionella organisms were found by direct immunofluorescence in purulent material that was obtained from the graft, and serogroup 1 L. pneumophila was isolated from the pus. The frequency with which the organism causes infection of hemodialysis access sites is unknown. Increased awareness by physicians that L. pneumophila produces extrapulmonary disease may result in more frequent detection of these infections.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/10. Bilateral serratia marcescens keratitis after simultaneous bilateral radial keratotomy.PURPOSE/methods: After bilateral simultaneous radial keratotomy, serratia marcescens keratitis, which involved multiple incisions of both eyes, developed in a 46-year-old physician. The keratitis was treated with repeated wound debridement, fortified topical antibiotics, and topical povidone-iodine. RESULTS/CONCLUSIONS: Six months after radial keratotomy, uncorrected visual acuity was R.E.: 20/25 and L.E.: 20/60, both eyes correctable to 20/20. health-care workers who undergo refractive surgery may be at increased risk of acquired postoperative infections because of their work environment. Although the occurrence of simultaneous bilateral ulcerative keratitis after simultaneous bilateral radial keratotomy is rare, it is nonetheless a real possibility, making it prudent to perform radial keratotomy on one eye at a time.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/10. A surgical wound infection due to mycobacterium chelonae successfully treated with clarithromycin.BACKGROUND: mycobacterium chelonae is an uncommon but recognized cause of chronic localized cutaneous infection at a site of penetrating trauma or a surgical wound. OBJECTIVE: The problem faced by physicians encountering an infection by M. chelonae is often response to therapy, which may be highly variable. methods: We describe an immunocompetent patient who developed a localized infection due to M. chelonae following surgery for a basal cell carcinoma of the lower leg. RESULTS: The infection responded to treatment with clarithromycin. CONCLUSION: The clinical efficacy of clarithromycin and the salient features of M. chelonae infection and its treatment are discussed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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