Drug resistance and virulence characteristics of of Staphylococcus aureus isolated from skin sites of suppurative infections in Inner Mongolia / 中华皮肤科杂志

Objective:To analyze drug resistance, virulence and molecular epidemiological characteristics of Staphylococcus aureus ( S. aureus) isolated from skin sites of suppurative infections, and to provide an experimental basis for clinical anti-infective therapies. Methods:Swab samples from suppurative skin lesions and nasal secretions were collected from inpatients in Department of Dermatology, the Affiliated Hospital of Inner Mongolia Medical University from May 2020 to December 2020, and subjected to bacterial isolation and culture. Suspected S. aureus colonies were identified by matrix-assisted laser desorption ionization time-of-flight mass spectrometry. Drug sensitivity test was conducted by using the broth microdilution method. Virulence genes of S. aureus were amplified by PCR, and real-time fluorescence-based quantitative PCR was performed to determine the relative expression of 4 virulence genes including tsst-1, pvl, hla and clfA in S. aureus strains from different sources. S. aureus strains were genotyped by multilocus sequence typing. Drug resistance rates and detection rates of virulence genes were compared by using chi-square test or Fisher′s exact test, and measurement data among groups were compared by using t test or Mann-Whitney U test. Results:A total of 85 strains of S. aureus were isolated from 210 inpatients, including 54 isolates from skin sites of suppurative infections (case group) and 31 isolates from the nasal cavity (control group) . Drug sensitivity test showed that 14 strains of methicillin-resistant S. aureus (MRSA) were identified among 85 strains of S. aureus. The resistance rate to penicillin was the highest (90.59%, 77/85) in the 85 S. aureus strains; the resistance rates to clindamycin and erythromycin were 60.00% (51/85) and 61.18% (52/85) respectively; no strains showed resistance to rifampicin, vancomycin or linezolid. PCR showed that the detection rate of the pvl gene was 33.33% (18/54) in the case group, which was significantly higher than that in the control group (12.90%, 4/31; χ2= 4.28, P= 0.038) . Real-time fluorescence-based quantitative PCR showed that the relative expression level of the clfA gene was significantly higher in the control group (3.87[2.30, 5.94]) than in the case group (1.63[0.95, 2.62], P= 0.007) . A total of 17 ST types were identified among the 85 strains of S. aureus, and the dominant types were ST398-methicillin-susceptible S. aureus (20/71) and ST22-MRSA (9/14) . The detection rate of the virulence gene pvl was significantly higher in the ST22-MRSA strain (14/14) than in the non-ST22 MRSA strains (0, P < 0.001) . Conclusions:S. aureus strains isolated from the skin sites of suppurative infections were highly resistant to penicillin, clindamycin and erythromycin, so these antibiotics should not be used as the first-choice empiric treatment. The occurrence of cutaneous S. aureus infections may be associated with the virulence gene pvl, and the nasal colonization of S. aureus may be associated with the clfA gene.

Choque séptico con disfunción multiorgánica en paciente con pericarditis supurada y bacteriemia por Staphylococcus aureus meticilino sensible. Reporte de caso / Septic shock with multi-organ dysfunction in a patient with suppurative pericarditis and bacteraemia due to sensitive methicillin staphylococcus. Case report

RESUMEN Choque séptico con disfunción multiorgánica tiene una tasa de mortalidad mayor de 50%. Se presenta el caso de un varón que cursó con choque séptico con disfunción multiorgánica, secundario a bacteriemia por Staphylococcus aureus meticilino sensible, con foco de partida dérmico - partes blandas, quien presentó lesiones alveolo nodulares, pericarditis supurativa, lesiones embolicas a nivel dérmico, ocular y renal; recibió soporte en la unidad de cuidados intensivos, tratamiento antibiótico con oxacilina más vancomicina, pericardiectomia subtotal y drenaje pleural. Salió de alta estable para continuar tratamiento. Presentamos este caso para destacar la gravedad de la bacteriemia por Staphylococcus aureus meticilino sensible, con compromiso multiorgánico y así poder tomar medidas terapéuticas agresivas para disminuir la morbilidad y mortalidad por el mismo.

SUMMARY Septic Septic shock with multi organ dysfunction is associated with a mortality above 50%. We present here the case of a young male patient who presented with septic shock and multi organ dysfunctions secondary to methicillinsusceptible Staphylococcus aureus from a skin and soft tissue infection presenting with alveolar-nodular pulmonary lesions, purulent pericarditis and septic embolic lesions on the skin, eyes and kidneys. The patient was admitted to the ICU receiving antibiotic coverage with oxacillin and vancomycin, subtotal pericardiectomy and pleural drainage, and was discharged clinically stable. We present this case to draw attention to the severity of S. aureus bacteremia to initiate prompt aggressive therapeutic measures to ameliorate associated morbidity and mortality.

Complications of surgical treatment of lumbar stenosis in the early postoperative period / Complicações do tratamento cirúrgico da estenose lombar no período pós-operatório imediato / Complicaciones del tratamiento quirúrgico de la estenosis lumbar en el período postoperatorio temprano

ABSTRACT Objective: To analyze the structure of degenerative lumbar stenosis surgical treatment complications and to analyze their effect on the results and indications for revision operations. Methods: Between 2009 and 2013, 513 patients with lumbar stenosis of degenerative etiology were surgically treated. There were 205 men, 308 women, aged 23 to 74 years. The main clinical manifestations were persistent compression radiculopathy, chronic pain in the back and lower limbs, and difficulty walking. The intensity of the pain was assessed by the VAS. At the time of hospitalization, VAS was 55-90 points. Results: Of the 513 operated patients, 65 (12.67%) had complications in the early postoperative period (up to three months after the operation); intraoperative complications occurred in 26 (5.1%) patients; intraoperative dura mater injury occurred in 24 (4.67%); pulmonary embolism (PE) occurred in 2 (0.39%) patients; 39 patients had early postoperative complications; acute radiculopathy occurred in 22 patients (4.28%); and 17 patients (3.31%) had surgical wound complications. Conclusions: Liquorrhea, postoperative hematomas and acute radiculopathy had no negative effect on the results of treatment in any of the cases. In the early postoperative period, 4 (0.77%) deaths were recorded intraoperatively and in 2 (0.39%) cases, intraoperative PE occurred. Two cases (0.39%) resulted in sepsis and multiple organ failure. In eight (1.55%) patients, the results of the treatment were unsatisfactory: in 4 (0.77%) cases due to death, and in a further 4 (0.77%) due to elimination of the system by the spinal column as a result of suppuration. Level of Evidence IV; Therapeutic studies - Investing the results of treatment.

RESUMO Objetivo: Analisar a estrutura das complicações do tratamento cirúrgico da estenose lombar degenerativa e analisar seu efeito nos resultados e indicações para operações de revisão. Métodos: Nos anos de 2009-2013, 513 pacientes com estenose lombar de etiologia degenerativa foram tratados cirurgicamente. Havia 205 homens, 308 mulheres com idades entre 23 e 74 anos. As principais manifestações clínicas foram radiculopatia por compressão persistente, dor crônica nas costas e membros inferiores, dificuldade para andar. A intensidade da dor foi avaliada pela EAV. No momento da hospitalização, a EVA foi de 55 a 90 pontos. Resultados: Entre os 513 pacientes operados, 65 (12,67%) tiveram complicações do pós-operatório imediato (até três meses após a operação ocorreram complicações intraoperatórias em 26 (5,1%) pacientes. A lesão intra operatória da dura-máter ocorreu em 24 (4,67%); embolia pulmonar (EP) ocorreu em dois (0,39%) pacientes, 39 pacientes com complicações pós-operatórias precoces, radiculopatia aguda em 22 pacientes (4,28%) e 17 pacientes (3,31%) com complicações da ferida. Os hematomas pós-operatórios e a radiculopatia aguda tiveram efeito negativo sobre os resultados do tratamento em nenhum caso. No período pós-operatório imediato, 4 (0,77%) dos óbitos foram registrados no período intra operatório e em dois (0,39%) casos o PE intra operatório. Em dois casos (0,39%) foram motivo de sepse e falência múltipla de órgãos, sendo que em oito (1,55%) pacientes foram encontrados resultados insatisfatórios: em quatro (0,77%) devido à morte - e em quatro devido à remoção dos sistemas da coluna por causa de supuração. Nível de Evidência IV; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Objetivo: Analizar la estructura de las complicaciones del tratamiento quirúrgico de la estenosis lumbar degenerativa y analizar su efecto sobre los resultados y las indicaciones para las operaciones de revisión. Métodos: En 2009-2013 513 pacientes con estenosis lumbar de etiología degenerativa fueron tratados quirúrgicamente. Hubo 205 hombres, 308 mujeres, de 23 a 74 años. Las principales manifestaciones clínicas fueron radiculopatía por compresión persistente, dolor crónico en la espalda y las extremidades inferiores, y dificultades para caminar. La intensidad del dolor fue evaluada por EVA. En el momento de la hospitalización, la EVA tenía 55-90 puntos. Resultados: Entre los 513 pacientes operados, 65 (12,67%) tuvieron complicaciones en el período postoperatorio temprano (hasta tres meses después de la operación); hubo complicaciones intraoperatorias en 26 (5,1%) pacientes; lesión duramadre intraoperatoria ocurrió en 24 (4,67%); embolia pulmonar (EP) se presentó en dos pacientes (0,39%); hubo 39 pacientes con complicaciones postoperatorias tempranas; en 22 (4,28%) radiculopatía aguda y en 17 (3,31%) complicaciones en la herida. Conclusiones: Liquorrea, hematomas postoperatorios y la radiculopatía aguda no tuvieron efecto negativo en los resultados del tratamiento en ninguno dos casos. En el período postoperatorio temprano se registraron cuatro (0,77%) muertes intraoperatorias y en dos (0,39%) casos se trató de una PE intraoperatoria. Dos casos (0,39%) resultaron en sepsis y falla orgánica múltiple. Se observaron resultados de tratamiento insatisfactorios en ocho (1,55%) pacientes: en 4 (0,77%) - debido a la muerte, y en cuatro (0,77%) - debido a eliminación del sistema por la espina dorsal debido a supuración. Nivel de evidencia IV; Estudios terapéuticos - Investigación de los resultados del tratamiento.

Clinical outcomes of subcutaneous multiple inflammation and calluses induced by facial injection lipolysis / 中华医学美学美容杂志

Objective To explore the treatment protocols and the occurrence and developmental rule of subcutaneous multiple inflammation and indurations by facial injection lipolysis,and to summarize the treatment experience.Methods Six cases of subcutaneous indurations were females patients with facial injection lipolysis,and the lesions increased slowly after about one month.The local temperature raised and pinching pain appeared in the facial area.The other secondary post-traumatic swelling and scleroma areas were treated with piercing or cutting,spread to the surrounding tissues.Red scleroma became osmosis,by local open decompression,debridement,irrigation and drainage lasting almost 3 months.The area had burst out mucoid funicular materials gradually.Results The facial injection lipolysis caused regionally red swelling and scleroma gradually with 1 month of continuous irrigation drainage.The red scleroma area was limited with debridement again after maturation,closed incision after discharge mucus-shape substance by its organization.In the redness induration period,pathological results showed the homogeneous materials without structure could be seen in the fibrous tissue,with surrounding hyperemia,hemorrhage associated with inflammation.Festering burst period showed that local tissue presented suppurative inflammation,multiple abscesses and granuloma formation.Conclusions Conservative treatment can lead to swelling,bursting and developing into deep tissues.Surgical treatment can spread redness scleroma area and lead to a large area of skin depression,soft tissue scar and deformity.

Steatocystoma multiplex suppurativa: case report of a rare condition

Abstract Steatocystoma multiplex is a rare genetic disorder characterized by the presence of hamartomatous malformations at the junction of the pilosebaceous duct. It consists of encapsulated cystic lesions in the dermis, with adjacent sebaceous gland. When associated with inflammation, resembling hidradenitis, it is called steatocystoma multiplex suppurativa, a condition rarely reported. This is the first case of steatocystoma multiplex suppurativa reported in the Brazilian literature. Female patient, 23 years old, with papular and nodular cystic lesions that started in the armpits and groin, later spreading to the trunk, lower limbs, anticubital fossa, face and scalp. The presence of papular-nodular lesions associated with disseminated hidradenitis-like lesions in flexural areas and the histopathological diagnosis of steatocystoma defined the diagnosis of steatocystoma multiplex suppurativa.

Lessons Learnt from an Atypical Mycobacterium Infection Post-Anterior Cruciate Ligament Reconstruction

Infections following anterior cruciate ligament reconstruction are rare, with no previous reports citing Mycobacterium abscessus as the culprit pathogen. A 22-year-old man presented twice over three years with a painful discharging sinus over his right tibia tunnel site necessitating repeated arthroscopy and washout, months of antibiotic therapy, and ultimately culminating in the removal of the implants. In both instances, M. abscessus was present in the wound cultures, along with a coinfection of Staphyloccocus aureus during the second presentation. Though rare, M. abscessus is an important pathogen to consider in postoperative wounds presenting with chronic discharging sinuses, even in healthy non-immunocompromised patients. This case illustrates how the organism can cause an indolent infection, and how the removal of implants can be necessary to prevent the persistence of infection. Coinfection with a second organism is not uncommon and necessitates a timely change in treatment regime as well.

Suppurative Meckel Diiverticulum in a 3-Year-Old Girl Presenting with Periumbilical Cellulitis / 대한소아소화기영양학회지

Meckel diverticulum (MD) is one of the most common congenital gastrointestinal anomalies and occurs in 1.2-2% of the general population. MD usually presents with massive painless rectal bleeding, intestinal obstruction or inflammation in children and adults. Suppurative Meckel diverticulitis is uncommon in children. An experience is described of a 3-year-old girl with suppurative inflammation in a tip of MD. She complained of acute colicky abdominal pain, vomiting and periumbilical erythema. Laparoscopic surgery found a relatively long MD with necrotic and fluid-filled cystic end, which was attatched to abdominal wall caused by inflammation. Herein, we report an interesting and unusual case of a suppurative Meckel diverticulitis presenting as periumbilical cellulitis in a child. Because of its varied presentations, MD might always be considered as one of the differential diagonosis.

Neumostomía con sonda de balón en colecciones purulentas del pulmón / Neumostomy with a balloon catheter in supurative lung collections

Introducción: el desarrollo de los antimicrobianos provocó que el drenaje externo dejara de realizarse en pacientes con absceso de pulmón, en quienes la resección pulmonar es la opción ante el fracaso médico. En los últimos años, la neumostomía ha resurgido por la necesidad de asistir a enfermos con un marcado deterioro físico que impide una intervención quirúrgica resectiva. Objetivo: caracterizar a los pacientes con supuración pulmonar tratados quirúrgicamente mediante drenaje percutáneo externo y neumostomía con sonda de balón (método de Monaldi) practicados con anestesia local. Métodos: se realizó un estudio descriptivo longitudinal retrospectivo en el período de 1995 a 2012 en el Hospital Universitario Comandante Manuel Fajardo. El universo estuvo conformado por 8 pacientes a los que se les practicó el método de Monaldi. En todos los casos se utilizaron sondas de goma de balón de 24 unidades F, de tres ramas. Resultados: cuatro pacientes padecían de absceso del pulmón y el resto de bullas enfisematosas voluminosas infectadas. Todos los casos tuvieron resolución de la colección infectada en un período inferior a las 2 semanas, y no hubo complicaciones ni mortalidad quirúrgica. Conclusiones: el drenaje percutáneo con anestesia local utilizando sondas de balón es un instrumento adecuado para el tratamiento de colecciones pulmonares en enfermos con deterioro físico por el cuadro infeccioso. Con él se logra la resolución de la lesión pulmonar, y es efectivo tanto en los abscesos pulmonares como en las bullas enfisematosas infectadas(AU)

Introduction: with the advent of the antibiotic therapy, external drainage ceased to be performed in lung abscess patients for whom the pulmonary resection is the choice. In the last few years, pneumostomy has reemerged due to the need of giving assistance to patients with remarkable physically deterioration that hinders resective surgery. Objectives: to characterize patients with pulmonary suppuration and surgically treated by means of external percutaneous drainage with balloon catheter pneumostomy (Monaldi method) using local anesthesia. Methods: retrospective, descriptive and longitudinal study of eight patients, who underwent Monaldi method-based surgery, conducted from 1995 through 2012 at Manuel Fajardo university hospital. Three branch twenty-four F unit balloon rubber catheters were used in all these cases. Results: out of the eight, four had been diagnosed with lung abscess and the other four had large septic emphysematous sacs. The infected collection was eliminated in all these patients in less than 2 weeks with no complication and no surgical death. Conclusion: The percutaneous drainage with local anesthesia using balloon catheter as an instrument was adequate and useful in the treatment of septic lung collections in patients with very poor physical condition. This method manages to eliminate the pulmonary lesion and is good for both pulmonary abscesses and infected emphysematous sacs(AU)

Piometra senil benigno gigante en útero bicorne / Giant Benign Senile Pyometra in Bicornuate Uterus

La piometra es una acumulación de pus en la cavidad endometrial. Aparece cuando existe una estenosis del orificio cervical debida a procesos malignos de cuerpo uterino o de cérvix, tras tratamientos con cirugía o radioterapia y por atrofia senil. Se presenta el caso de una paciente de 84 años remitida al Servicio de Urgencias Hospitalarias del Hospital Universitario Basurto, en Bilbao, España por el médico de la residencia donde se encuentra institucionalizada debido a que presentaba fiebre mantenida desde hacía dos semanas, sin focalidad aparente, diagnosticada como infección urinaria y tratada con amoxicilina-clavulánico. Por los exámenes imagenológicos se diagnosticó piometra en útero bicorne. Fue sometida al drenaje del piometra por vía vaginal, bajo anestesia general, tras dilatación mecánica del canal cervical. Se puso tratamiento con ertapenen. La evolución fue satisfactoria. Por lo poco común del caso se decidió su presentación.

Pyometra is an accumulation of pus in the endometrial cavity. It occurs when there is a stenosed cervical os as a result of malignant growths in the uterus or cervix, surgery or radiation therapy and senile atrophy. We present the case of an 84-year-old female patient referred to the Emergency Service of the Basurto University Hospital in Bilbao, Spain by the doctor of the nursing home where she is institutionalized because of a two-week history of continued fever without apparent cause. She was diagnosed with urinary tract infection and treated with amoxicillin/clavulanate. Based on the imaging tests, a pyometra in bicornuate uterus was diagnosed. She underwent drainage of the pyometra via the vaginal route, under general anesthesia, after mechanical dilation of the cervical canal. Treatment with ertapenen was prescribed. Progression was satisfactory. Given the rarity of this case, we decided to present it.

Sepsis, armas d fuego y microscopios: implicacones de la sepsis en las revoluuciones de la medicina de los siglos xvi y xix / Sepis, firearms and microscopes: iplications of sepsis in the meddicine revolution in the xvi and xix centuries

El dogma galénico "Pus bonum et laudabile" fue el paradigma reinante en el manejo de heridas por casi dos mil años y estimuló el uso de tratamientos que favorecían la supuración, lo cual promovió una gran cantidad de muertes en los hospicios y en los campos de batalla debido a la sepsis. En el presente trabajo se analizará, desde una mirada kuhniana, el gradual proceso del derrocamiento de dicho dogma, desde el impacto que tuvo la entrada de las armas de fuego al combate en el siglo XIV y sus implicaciones en el desarrollo de la cirugía de guerra, hasta el nacimiento de la era microbiológica en el siglo XIX. Se observará también la evolución de las técnicas quirúrgicas, desde el desbridamiento hasta la amputación, y cómo éstas tuvieron gran impacto para reducir la incidencia y mortalidad del shock traumático y del shock séptico. En este marco de referencia se analizará la profunda ruptura epistemológica que se dio gracias a la sepsis en el siglo XIX en el campo de la microbiología, además de los paulatinos avances desde el siglo XVI que permitieron el desarrollo de la cirugía moderna. De este modo, se verá cómo todos estos avances impulsados por la sepsis tuvieron un profundo impacto en el desarrollo de la medicina contemporánea.

The galenic dogma "Pus bonum et laudabile" was the dominant paradigm in wound management for nearly two thousand years and it encouraged the use of treatments that favored the suppuration, which promoted a large number of deaths in hospices and in the battle fields due to sepsis. In this work we will analyze, from a Kuhnian view, the gradual overthrowing process of this dogma, from the impact of the entry of firearms into combat in the fourteenth century and their implications for the development of war surgery, to the birth of the microbiological era in the nineteenth century. The evolution of surgical techniques from debridement to amputation, and how they had a great impact in reducing the incidence and traumatic shock and septic shock mortality, will also be observed. In this framework we will analyze the profound epistemological rupture that occurred due to sepsis in the field of microbiology during the nineteenth century, in addition to the gradual progress that since the sixteenth century have enabled the development of modern surgery. In this way, we will see how all these advancements motivated by sepsis had a profound impact on the development of contemporary medicine.

Pileflebite mesentérica secundária à diverticulite / Mesenteric pylephlebitis secondary a diverticulitis

Pileflebite é uma complicação incomum das infecções intra-abdominais e está associada à alta mortalidade. A patogenia ainda não está esclarecida. O diagnóstico permanece difícil e frequentemente é tardio, uma vez que a clínica é inespecífica e é necessário um elevado grau de suspeição. Na maioria dos casos, o prognóstico é favorável. O fator mais importante é a precocidade no diagnóstico e a imediata antibioticoterapia específica. Relatamos um caso de um paciente com diagnóstico de pileflebite mesentérica secundária à diverticulite colônica.

Pylephlebitis is a uncommon complications of intraabdominalsuppuration and associated with high mortality. The pathogenic is not clear and diagnosis remains delay because of its nonspecific symptoms and is necessary high clinical suspicion. In the major of cases the prognostic is favorable. The most important determinants for the prognosis is earlydiagnosis and adequate medical. We report a case of patient with diagnosis of mesenteric Pylephlebitis secondary a colonic diverticulitis.

Bronquiectasia: uma Abordagem de Conjunto / Bronchiectasis: a Joint Approach

Tem sido observado um aumento da prevalência demanifestações clínicas de bronquiectasia, com destaqueespecial para as bronquiectasias adquiridas. A despeito dosfatores de risco para infecção bacteriana serem importantespara o surgimento de manifestações bronquiectásicas pormuitos agentes bacterianos, tais infecções ocasionadas pelohemófilo, pneumococo, estafilococo e pseudômonasparecem ter papel fundamental no desenvolvimento dasupuração broncopulmonar, por predispor à presença demicroorganismos reconhecidamente patogênicos. Para odevido entendimento da patogênese da doença tem-se oseguinte espectro de manifestações: produção exageradade escarro mucopurulento, dispnéia e sibilância associadas,rinorréia purulenta, expectoração purulenta, episódios deescarros sanguinolentos, manifestações de letargia,confusão mental e alterações cardiopulmonares significativas.O tratamento é clínico, na maioria dos casos, visto quea indicação cirúrgica estará restrita a um número pequenodaqueles. O controle dos sintomas, a melhora da qualidadede vida dos pacientes e a prevenção da progressão dadoença devem ser os objetivos do tratamento médico...

It has been observed an increased prevalence of clinicalmanifestations of bronchiectasis, with particular emphasison acquired bronchiectasis. Despite the risk factors forbacterial infection be important for the emergence of manybronchiectasis manifestations by several bacterial agents,such infections, caused by Haemophilus, Pneumococcus,Staphylococcus and Pseudomonas, seem to perform a keyrole in the development of bronchopulmonary suppuration,which is predisposed by the presence of pathogenicallyknown microorganisms. In view of understanding this diseasepathogenesis, the following spectrum of events is cited:overproduction of mucopurulent sputum, combination ofdyspnea and wheezing, purulent rhinorrhea, purulentexpectoration, episodes of bloody sputum, symptoms oflethargy, confusion and significant cardiopulmonary changes.The treatment is clinical in most cases, since the indicationfor surgery will be restricted to a small number of patients.The control of symptoms, improvement of patients’ quality oflife and prevention of disease progression are supposed tobe the goals of the medical treatment...

Needle aspiration as therapeutic management for suppurative cervical lymphadenitis in children / 소아과

PURPOSE: This study aimed to evaluate the usefulness of the needle aspiration alternative to open surgical drainage of children with suppurative cervical lymphadenitis requiring surgical drainage. METHODS: From January 1998 to June 2008, we retrospectively reviewed 38 children treated with needle aspiration as management with suppurative cervical lymphadenitis instead of open surgical drainage. RESULTS: All 38 children underwent only 1 puncture. Two patients (5.2%) out of 38 patients experienced reformation of an abscess and all recovered completely after re-treatment with antibiotics. Minor complications were detected in 2 patients (5.2%). One complication originated from remnant necrotic tissue and the other involved formation of a small scar in two patients, which resolved spontaneously. There were no major complications. CONCLUSION: Needle aspiration can be a simple, safe, and effective alternative procedure to open surgical drainage of children with suppurative cervical lymphadenitis requiring surgical drainage.

Recuento histórico y análisis epistemológico de la sepsis secundaria a lesiones y su control quirúrgico. Desde el papiro de Edwin Smith hasta el pus bonum et laudabile / Historical recount and epistemological analysis of the sepsis derived from wounds and its surgical control: From thepapyrus of Edwin Smith to the "pus bonum et laudabile".

La sepsis como complicación temible del trauma ha acompañado al hombre a través de la historia en especial en la antigüedad. En el presente trabajo se analiza la evolución histórica del controlquirúrgico de la sepsis desde el Antiguo Egipto hasta la Edad Media. Se describe cómo los diferentes tratamientos tuvieron una evolución paradójica: empezando desde una relativa cura apiógena de los egipcios y alejandrinos, hasta el irrefrenable deseo de ver supurar la lesión, típico en la EdadMedia. También se exponen las causas de la ambigüedad de los griegos a la hora de promover o limitar la supuración, sustentadas en el humoralismo clásico, y cómo esta concepción fue la semilla del dogma galénico “la pus es buena y laudable”, dogma que marcó la pauta del cuidado de las heridas durante más de mil años, y que fue responsable, junto con la pérdida de valiosos conocimientos quirúrgicos en el Medioevo, del establecimiento de la cauterización como tratamiento de elección para muchos tipos de lesión. Finalmente, se presentan las razones epistemológicas del fracaso del intento de derrumbar el dogma galénico durante el siglo XIII.

Sepsis, as a fearsome complication of trauma, has accompanied mankind throughout history, particularly in the Antiquity. In this article the historical evolution of surgical sepsis control and of the importance of suppuration is reviewed, from the Ancient Egypt through the Middle Ages. The evolutionof different therapeutic approaches for wounds is described, from the non-suppurative healing of the Egyptians and Alexandrians to the irrepressible desire of seeing wound suppuration that was common in the Middle Ages. The causes of the ambiguity of Greeks concerning the promotion or limitation of suppuration are presented. They were based on the classical theory of Humoralism. This conception became the framework of the Galenic dogma expressed as the “good and laudable pus”, which served as the basisfor wound care during more than one thousand years. It was responsible, together with the loss of valuablesurgical knowledge during the Middle Ages, of the establishement of cauterization as the treatment of choice for different types of lesions. The epistemological reasons for the failure to overthrow the Galenic dogma duringthe XIII Century are also discussed.

A Case of Onycholysis with Subungual Suppuration Secondary to Paclitaxel / 대한피부과학회지

Paclitaxel is one of the taxoid-antineoplastic agents. These agents are used in the treatment of breast, lung and ovary cancer. Nail changes due to treatment with the taxanes (mainly docetaxel) are reported in 30~40 percent of patients. Paclitaxel is not commonly associated with dermatological reactions, although localized skin reactions and tissue necrosis following extravasation have been reported. Reports of the incidence of nail changes associated with paclitaxel is noted as the pigmentation or discoloration of the nail bed, vary from 2~20%. We report a patient with onycholysis and subungual suppuration during treatment with paclitaxel.

Determination of CSF LDH and ?2-m levels for differentiating viral meningitis from purulent meningitis in pediartic patients / 国际检验医学杂志

Objective To explore the significance of LDH and ?2-m concentration in CSF in differentiating viral meningitis from purulent meningitis in pediartic patients.Methods Kinetic method was performed to detect the LDH concentration in CSF in 45 patients with purulent meningitis and 49 patients with viral meningitis and 22 healthy children of control group respectively.On the other hand,radioimmunoassay(RIA)was used to detect the concentration of ?2-m.Results The concentrations of LDH in CSF in purulent meningitis group(26.15?12.17)U/L were higher than that in viral meningitis group(8.76?4.94)U/L significantly(P