1/13. A new hazard for windsurfers: needlefish impalement.Marine-related injuries and envenomations are common to the coastal physician. Needlefish injuries, which occur almost exclusively in the Indo-Pacific region, have not previously been reported along the Atlantic seaboard. This case report describes a penetrating injury to the lower extremity from a needlefish. Treatment is guided by general resuscitative procedures as well as antibiotic therapy directed against infections unique to the marine environment.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
2/13. Breaking the rules: a thoracic impalement injury.In the case of a patient with an impalement injury, the object should be removed in a controlled operating theatre environment. We report an 18-year-old man for whom this rule could not be followed. He was removed from a metal pipe transfixing his chest at the roadside.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
3/13. Reduction of chronic aggressive behaviour 10 years after brain injury.This study demonstrates the successful management of aggressive behaviour with a client 10 years post-injury in a small, residential neurorehabilitation unit. The case presented is unusual for two main reasons. First, it proved possible to significantly modify previously chronic challenging behaviour many years after brain injury had been sustained. Secondly, the rehabilitation environment in which treatment was conducted did not comprise a highly specialized neurobehavioural service, Instead, staff were specifically trained regarding the administration of the treatment programme, which was based on principles derived from behaviour modification and applied neuropsychology. Specific interventions used included those of differential reinforcement and graduated increase of expectations. Recordings made over the course of 85 weeks demonstrate a significant decrease in the frequency and severity of aggression. Successful inhibition of challenging behaviour attained a level which facilitated transfer of the client to a non-institutionalized community home. Reasons underlying the success of the intervention, and the limitations inherent in attempting to manage aggression within neurorehabilitation environments will be discussed.- - - - - - - - - - ranking = 2keywords = environment (Clic here for more details about this article) |
4/13. Bone and joint infection after traumatic implantation of scedosporium prolificans treated with voriconazole and surgery.scedosporium prolificans is an environmental mould that may cause local infection in bone and joints after traumatic implantation, or generalized infection in immunocompromised patients. The fungus is highly drug resistant, both in vitro and in vivo. We present a case of osteomyelitis and arthritis caused by S. prolificans in a 9-y-old boy whose knee had been punctured by a hawthorn spike. Treatment with different drugs was difficult and arthrodesis was necessary. Concomitantly, voriconazole was given, and after three months bone biopsies were sterile despite a high in vitro MIC-value of the fungus against voriconazole. Reversible skin depigmentation and fingernail oncholysis appeared toward the end of 17 months of voriconazole treatment. Twelve months after discontinuation of treatment, no signs of relapse were detected. CONCLUSION: Voriconazole may be a valuable adjunct to surgical treatment of bone and joint infection by scedosporium prolificans.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
5/13. Aeromonas hydrophilia infections after penetrating foot trauma.The bacterium aeromonas hydrophila is an anaerobic gram-negative bacillus commonly found in natural bodies of water and can cause infection in patients who suffer water-associated trauma or in immunocompromised hosts. The authors present 5 cases of penetrating wound trauma that did not involve any aquatic environment and developed rapidly forming infections. All patients presented with severe pain, cellulitis, ascending lymphangitis, fever, and pain on range of motion of the joint near the traumatic site. Presentation of clinical symptoms mimicked that of a septic joint or of severe streptococcal infection. All patients required surgical incision and drainage, intravenous and oral antibiotics using levofloxacin or bactrim, and local wound care. Results from cultures taken intraoperatively showed only A hydrophilia in every case. Resolution of symptoms occurred rapidly after surgery, and clinical resolution was seen within 72 hours. Each patient healed uneventfully and returned to preinjury status.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
6/13. chlorhexidine anaphylaxis: case report and review of the literature.chlorhexidine is a widely used antiseptic and disinfectant. Compared to its ubiquitous use in medical and non-medical environments, the sensitization rate seems to be low. Multivarious hypersensitivity reactions to the agent have been reported, including delayed hypersensitivity reactions such as contact dermatitis, fixed drug eruptions and photosensitivity reactions. An increasing number of immediate-type allergies such as contact urticaria, occupational asthma and anaphylactic shock have been reported. In the case report, we describe anaphylaxis due to topical skin application of chlorhexidine, confirmed by skin testing and sulfidoleukotriene stimulation test (CAST(R): cellular antigen stimulation test). The potential risk of anaphylactic reactions due to the application of chlorhexidine is well known, especially that application to mucous membranes can cause anaphylactic reactions and was therefore discouraged. The use of chlorhexidine at a 0.05% concentration on wounds and intact skin was so far thought to be safe. Besides our patient, only one other case of severe anaphylactic reaction due to application of chlorhexidine on skin has been reported. hypersensitivity to chlorhexidine is rare, but its potential to cause anaphylactic shock is probably underestimated. This review should remind all clinicians of an important potential risk of this widely used antiseptic.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
7/13. Complex cranial base trauma resulting from recreational fireworks injury: case reports and review of the literature.Two patients who sustained complex skull base trauma secondary to recreational fireworks injuries are reported. Initial assessment and management included axial and coronal computerized tomography, control of hemorrhage, debridement of wound and brain, isolation of brain from external environment, and reconstruction of the cranial base floor. Secondary orbital and facial reconstruction used available bone fragments and iliac bone graft in one patient and vascularized free tissue transfer in the other. In both patients, reconstruction of both the intracranial and extracranial compartments was successful with acceptable cosmetic result. Modification of multiple conventional approaches, along with a multispecialty surgical team, was used to deal effectively with these unique cases.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
8/13. Penetrating wounds caused by needle-fish in oceania.Needle-fish are slender silvery fish with long pointed beaks. They are commonly seen swimming beneath the surface near fringing reefs in the Indo-Pacific area. Such areas are also frequented by Melanesian villagers. The speed of needle-fish, together with their tendency to leap out of the water when bright lights are used for fishing and at other times, occasionally result in deep, penetrating injuries to swimmers, waders, and, in particular, to fishermen who are working at night from small canoes. Injuries from needle-fish are a relatively common occupational hazard of subsistence village life in oceania, and probably also for some fishermen in other coastal environments, such as those in japan and malaysia.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
9/13. Aeromonas primary wound infection of a diver in polluted waters.Two separate species of Aeromonas, A. sobria (not listed as a species in Bergey's Manual of Determinative bacteriology, 8th ed.) and A. hydrophila, were primary pathogens isolated from the leg wound of a diver conducting operations in polluted waters. This is the first recorded instance of a primary infection of soft tissue in a human caused by two species of Aeromonas, one of which was resistant to tetracycline. Because of the very rapid development of this wound infection, cytotoxicity of these organisms was examined in several biological systems. A. sobria was hemolytic for sheep erythrocytes, cytotoxic for Y-1 adrenal cells, and enterotoxic in rabbit ligated intestinal loops, whereas A. hydrophila was hemolytic and cytotoxic. Pertinent clinical, bacteriological, and environmental features of the case are presented.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
10/13. pseudomonas aeruginosa causing osteomyelitis after puncture wounds of the foot.osteomyelitis of the foot caused by pseudomonas aeruginosa has been a recognized complication of puncture wounds since 1968. This is a report of two cases, one of which had evidence that the source of the P aeruginosa was the inner sole of the footwear. Factors such as warm, moist environment, antibiotics or antiseptics directed against gram-positive flora, and serous exudates, all of which enhance the growth of P aeruginosa, should be avoided in the management of puncture wounds of the foot.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
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