1/4. psoas abscess associated with infected total hip arthroplasty.A 65-year-old man with a left uncemented total hip arthroplasty performed 11 years previously was admitted with a history of progressive low back pain, left hip pain, and sepsis that had begun 6 months earlier. On physical examination, a gross, fluctuant mass was palpated in the left thigh. A computed tomography (CT) scan revealed a 6.5 x 3 cm left retrofascial psoas abscess communicating with the hip joint. The patient underwent irrigation and debridement of the hip with removal of the components. The psoas abscess was drained through the iliopsoas bursa. A residual psoas abscess was drained percutaneously under CT guidance. Cultures isolated escherichia coli, and the patient responded to 6 months of ciprofloxacin therapy. After 1 year, the patient had no evidence of infection. Pathways of infection spread, diagnosis, and treatment of a patient with this rare association are discussed with a review of the literature.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/4. Infectious complications of old nonfunctioning arteriovenous grafts in renal transplant recipients: a case series.Occult infection of old nonfunctioning arteriovenous grafts (AVGs) is frequent among hemodialysis patients. It is a risk factor for bacteremia and serious AVG-related infection. Immunocompromised patients are at increased risk of dissemination of occult AVG infection. We present a series of five renal transplant recipients who developed acute life-threatening infections that originated in their old nonfunctioning AVGs. Their presenting symptoms were noticeably varied. In two patients, infection of the AVG was characterized by local physical signs of infection around the AVG. In three patients, no physical signs of AVG infection were detected by physical examination. Among these, two presented with bacteremia, and one presented with failure to thrive. Detection of AVG infection in the absence of local signs of infection requires a high index of suspicion. Surgical resection and antimicrobial treatment led to a complete cure in four of these patients. One patient developed recurrent bacterial endocarditis and died. Old nonfunctioning AVGs are potential sources of serious infection in renal transplant recipients. Renal transplant recipients with old nonfunctioning AVGs who present with unexplained bacteremia, fever of unknown origin, or failure to thrive should be investigated for occult AVG infection. Screening for occult infection of the old nonfunctioning AVG may be considered before kidney transplantation, especially if the candidate gives a history of previous bacteremia or fever of unknown origin.- - - - - - - - - - ranking = 3keywords = physical (Clic here for more details about this article) |
3/4. Permanent articulated antibiotic-impregnated cement spacer in septic shoulder arthroplasty: a case report.We report a case of a patient with an infected shoulder hemiarthroplasty in whom a permanent antibiotic-impregnated cement spacer was employed with satisfactory results. This method of treatment has limited applications and would not be appropriate in all cases of septic shoulder joint arthroplasties. However, its use may represent a valid alternative in low physical demand patients who are unwilling to undergo major surgery or when inadequate bone stock is present.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/4. Retained rear-tip extenders in redo penile prosthesis surgery: a case for heightened suspicion and thorough physical examination.INTRODUCTION: penile prosthesis infection is a dreaded complication that can occur after primary inflatable penile implants. Redo prosthesis operations and salvage procedures have become increasingly popular after these inflections. These operations, however, have higher rates of re-infection as compared to primary implants. AIM: We describe a patient who was referred for repeat redo penile prosthesis surgery in whom retained rear-tip extenders harboring purulent fluid was discovered during physical examination. RESULTS: The patient underwent exploration and two rear-tip extenders were removed. He later underwent redo prosthesis insertion and the device remains fully functional and infection free at follow-up. CONCLUSION: This case conveys the importance of a thorough physical examination and raises the index of suspicion for retained prosthesis fragments in patients with recurrent penile prosthesis infections.- - - - - - - - - - ranking = 6keywords = physical (Clic here for more details about this article) |