1/11. Puncture wound during CPR from sternotomy wires: case report and discussion of periresuscitation infection risks.Performing resuscitations presents multiple infectious risks to critical care providers. Potential sources for infection include direct contact with blood and other bodily fluids and possible inoculation through needlestick injuries. In this article, we present a case of a cardiac care unit nurse who, while providing cardiopulmonary resuscitation, suffered a puncture wound to her left hand from the patient's sternotomy wires from previous cardiac surgery. The patient died despite these resuscitation efforts. He was seronegative for human immunodefiency virus, hepatitis b, and hepatitis c, and the nurse's wound healed without complications. This is the first reported case of such an injury occurring during a resuscitation. It demonstrates how a subtle, invisible, and unrecognized physical risk could cause infection in critical care providers.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/11. Tophaceous gout of the spine mimicking epidural infection: case report and review of the literature.OBJECTIVE AND IMPORTANCE: Tophaceous gout uncommonly affects the axial skeleton. The clinical presentations of gout of the spine range from back pain to quadriplegia. gout that presents as back pain and fever may be difficult to distinguish from spinal infection. We present a case of a patient with tophaceous gout of the lumbar spine who was initially diagnosed with and treated for an epidural infection. The clinical and diagnostic features of tophaceous gout of the spine are reviewed. CLINICAL PRESENTATION: A 70-year-old man presented with a 2-day history of fever and back pain. A physical examination revealed that he had flank tenderness and evidence of polyarthritis affecting the elbows, knees, and right first metatarsophalangeal joint. A magnetic resonance imaging scan of the patient's lumbar spine showed an extensive area of abnormal gadolinium enhancement of the paramedian posterior soft tissues from L3 to S1 with an area of focal enhancement extending into the right L4-L5 facet joint. INTERVENTION: A laminectomy was performed at L4-L5, and a chalky white material in the facet joint was found eroding into the adjacent pars intra-articularis. light and polarizing microscopy confirmed the presence of gouty tophus. No evidence of infection was found. CONCLUSION: Gouty arthritis of the spine is rare. Thirty-seven previous cases have been reported. When the clinical presentation includes acute back pain and fever, differentiation of spinal gout from spinal infection may be difficult. The clinical suspicion of spinal gout may lead to the correct diagnosis by a less invasive approach than exploration and laminectomy.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/11. Disruption of TCBA1 associated with a de novo t(1;6)(q32.2;q22.3) presenting in a child with developmental delay and recurrent infections.A boy with developmental delay, particularly of speech, a distinct face, antineutrophil cytoplasmic antibodies, and recurrent infections was found to have an apparently balanced de novo t(1;6)(q32.3;q22.3) translocation. Fluorescent in situ hybridisation with BAC/PAC clones and long range polymerase chain reaction products assessed in the human genome sequence localised the chromosome 1 breakpoint to a 9.8 kb segment within a hypothetical gene, LOC388735, and the chromosome 6 breakpoint to a 12.8 kb segment in intron 4 of the T-cell lymphoma breakpoint-associated target 1 (TCBA1) gene. Disruption and/or formation of TCBA1 fusion genes in T cell lymphoma and leukaemia cell lines suggests a role for this gene in tumorigenesis. The isolated mouse Tcba1 gene shows 91% amino acid sequence similarity with human TCBA1. It is expressed in fetal and adult brain and with lower levels in liver and testis. The human gene has been reported to be expressed exclusively in brain and thymus. Reduced TCBA1 expression in brain and thymus may explain at least some of the symptoms in this patient. It is concluded that germline alterations of the TCBA1 gene are associated with developmental delay and typical physical features.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/11. Hyperimmunoglobulin E syndrome (job syndrome) discovered in a patient following corrective spine surgery: case report and review of the literature.STUDY DESIGN: A case report of the hyperimmunoglobulin E syndrome (job syndrome) presenting in the context of late postoperative infection after corrective surgery for scoliosis. OBJECTIVE: To describe the clinical presentation and treatment of a patient with job syndrome, and its implications for spine surgeons. SUMMARY OF BACKGROUND DATA: job syndrome classically presents with a triad of increased serum immunoglobulin e, multiple abscesses, and pneumonia with pneumatocele formation. In recent years nonimmunologic manifestations have been described, including scoliosis, joint hypermobility, eosinophilia, and atopy. methods: A 15-year-old female presented with local swelling and fever 2 years after anterior lumbar discectomy and fusion with spinal instrumentation involving T11-L3 levels. Computerized tomography revealed paravertebral, psoas, and pulmonary abscesses. The implants were removed and antibiotic therapy instituted. Further investigation revealed features of the hyperimmunoglobulin E syndrome (job syndrome). RESULTS: The patient's symptoms resolved, as did markers of inflammation. CONCLUSIONS: job syndrome is a primary immunodeficiency often associated with scoliosis. Given the implications for surgical outcome in immunodeficient patients, the diagnosis should be considered and, blood tests instituted in patients with scoliosis with any of the associated history and physical findings of job syndrome.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/11. Evaluation of hydrocephalus shunts in the emergency room.The workup of suspected shunt malfunction requires consideration of several factors, including history, physical and neurologic examinations, and appropriate laboratory and radiologic tests. hydrocephalus is a benign condition, often compatible with normal neurologic function if properly controlled. It is therefore vital that patients with hydrocephalus have their shunts carefully maintained to avoid serious complications due to shunt obstruction and infection. By following the guidelines listed above, most shunt problems can be detected and appropriate consultation arranged.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/11. Ruptured anastomotic pseudoaneurysms after prosthetic vascular graft bypass procedures.Pseudoaneurysms of prosthetic vascular grafts are a well-recognized phenomenon. In the past year we treated four patients with ruptured pseudoaneurysms, each of whom originally underwent surgery after March 1981. The main etiological factors were infection and mismatching between the physical characteristics of the prosthetic graft and the host artery. Once this diagnosis is suspected, pseudoaneurysms should be treated as an emergency. They should be resected, a new extraanatomical bypass constructed, and the wound left open.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/11. Emergency hemipelvectomy in the control of life-threatening complications.Emergency hemipelvectomy (HP) is a rare procedure. Only three incidents have been previously reported. This paper describes six additional cases, analyzes our results, and sets forth criteria for patient selection. There were five men and one woman. The median age was 38.5 years. Primary underlying diseases were sarcoma (three cases), peripheral vascular disease (one), deep vein thrombosis (one), and drug abuse (one). life-threatening peripelvic sepsis and hemorrhage were indications for emergency HP. All six patients had multiple procedures prior to definitive HP. Four classical and two modified HPs were performed. The mean operative time was 3.5 hours, the mean blood loss 2292 ml. There were no intraoperative complications. The median duration of hospitalization was 56 days. Five of six patients were saved. life-threatening peripelvic sepsis or hemorrhage associated with tumor recurrence, radiation, or failed vascular reconstruction is an indication for emergency HP. Neither age nor physical condition should be a deterrent. The patient should not be allowed to advance to a premorbid state before HP is considered, although concomitant intra-abdominal disease is a contraindication. HP is recommended in lieu of hip disarticulation. We anticipate that the need for emergency HP will increase as limb salvage procedures for extremity sarcomas and dysvascular disease become more frequent.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/11. Spinal infections in the immunocompromised host.There is an increasing population of immunocompromised patients with hiv, IV drug abuse, organ transplantation, and long-term steroid treatment developing spinal infections. delayed diagnosis because of blunted host immune response and lack of outward signs and symptoms places the treating physician at a disadvantage in the treatment of this type of disease, which presents at a later stage of development. Immunocompromised patients are infected by a different group of pathogens than their healthier cohorts (e.g., pseudomonas, gram-negative bacteria and fungal infections) because their host defenses are diminished. osteomyelitis with or with out pyomyositis and epidural abscess may occur. The overriding symptom is back pain. radiculopathy, myelopathy, and sensory loss may accompany local pain and tenderness. Plain film radiography, CT scan, MR image, and bone scan is invaluable in the diagnosis of these infections. The cornerstone of treatment is identification of the responsible pathogen, appropriate medical therapy, immobilization of the affected segment of the spine, and physical therapy to combat physical deconditioning. Psoas abscesses may require surgical debridement if they cannot be adequately drained by CT-guided percutaneous catheterization. Epidural abscesses with neurologic compromise require surgical drainage. Impingement of the spinal cord or cauda equina by collapsed osteomyelitic vertebral bodies requires surgical debridement by anterior vertebrectomy, with an autologous tricortical iliac crest strut and immobilization of the spine using external bracing or posterior instrumentation as dictated by the disease.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
9/11. Cervical spine infections.Cervical spine infections arise from a variety of etiologies including postsurgical, iatrogenic, and hematogenous routes. Clinical history, physical examinations, and diagnostic studies all play an integral role in the diagnosis and treatment of these infections. Successful treatment depends on a proper and timely diagnosis, understanding the etiology, and defining the extent to which the infectious process involves the spinal supporting and neurologic elements. Surgical treatment is required when there is abscess formation, instability, progressive kyphosis secondary to vertebral body collapse, or canal compromise with neurologic deficits.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/11. Diagnosis and management of complications of self-injection injuries of the neck.When IVDUs who lose peripheral access turn to their necks, they invite a spectrum of unique complications that require particular management and treatment. While many of these complications are infectious, other possibilities include vocal cord paralysis and needle fragment foreign bodies. work-up of these patients must include a very thorough history and physical exam, particularly of the head and neck, complete with a laryngeal exam. All patients should undergo imaging studies, including plain films, CT or MRI of the neck, and other studies as appropriate. Laboratory studies should include hiv and hepatitis serologies. Because of the risks to the surgical team, neck explorations, when indicated, should be performed under general anesthesia with strict adherence to universal precautions. Further management includes early referrals to methadone clinics, although unfortunately poor patient compliance is usual. Public campaigns aimed at prevention are useful, although limited, and should be encouraged.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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