Computed Tomography Diagnosis of Patent Ductus Arteriosus Endarteritis and Septic Pulmonary Embolism

No abstract available.

Septic Knee Arthritis Caused by Staphylococcus lugdunensis After Intraarticular Injection Therapy

Staphylococcus lugdunensis is a coagulase-negative staphylococcus. However, it causes various clinically important human infections and behaves similar to Staphylococcus aureus. S. lugdunensis reportedly causes infective endocarditis, skin and soft tissue infection, bone and joint infection, septicemia, endarteritis, urinary tract infection, ocular infection, and peritonitis. There are no reports of septic arthritis by this organism in Korea. We presented a case of septic arthritis due to S. lugdunensis in an elderly patient with diabetes mellitus after an intra-articular injection.

Pulmonary endarteritis in a patient with patent ductus arteriosus and a bicuspid aortic valve

BACKGROUND: Infective endarteritis of the pulmonary artery is an unusual event. While congenital heart disease (CHD) is a risk factor, pulmonary endarteritis as a complication is a rare occurrence especially in the era of antibiotic therapy.CASE PRESENTATION: We present a case of a 43-year-old female who initially sought consultation due to fever. Physical examination revealed a continuous murmur at the second intercostal space left parasternal border. There was no petechiae or any other skin lesions noted. Transthoracic two dimensional echocardiogram showed eccentric left ventricular hypertrophy with an ejection fraction of 65%. She had a patent ductus arterioscus as well as a bicuspid aortic valve. Further interrogation revealed a vegetation at the main pulmonary artery. Patient was initially started on ceftriaxone and gentamycin. Blood cultures were positive for coagulase negative Staphylococcus aureus. Ceftriaxone was then shifted to vancomycin, which was completed for 28 days.OUTCOME: Clinical improvement was accompanied by the disappearance of the vegetation and negative blood cultures. Patient was maintained on enalapril and advised closure of the patent ductus arteriosus. She opted medical management for the time being and was discharge stable and improved.CONCLUSION: Pulmonary endarteritis is an uncommon complication of CHD. A high index of suspicion must prompt careful evaluation, combining clinical, laboratory and echocardiographic modalitites in order to provide early diagnosis and effective treatment.

Bacteriemias e infección endovascular por Campylobacter spp: nuestra experiencia en un cuarto de siglo de historia / Bacteremia and endarteritis cases secondary to Campylobacter spp. in a metropolitan hospital: Our experience along a quarter of a century

Six cases of bacteremia and one of endarteritis were identified between 1986 and 2010 in a general hospital in Chile. Five of these cases occurred during the second half of this timeframe, Campylobacterfetus predominated (5 out of 7) and the majority of the infections presented during warmer months. The mean age was 32.4 years (range 19 to 63) all had comorbidities, and main clinical manifestations included fever with diarrhea. Four patients developed hypotension and two septic shock. The latter, associated to C. fetus bacteremia, died before microbiological diagnosis. Six out of 7 patients received antimicrobial therapy. During 2004 and 2010, the rates of Campylobacter spp. positive stool cultures in the same hospital increased 4 times, suggesting an emerging profile. Bacteremia and endarteritis by Campylobacter spp. can develop in vulnerable patients and manifest as fever with or without diarrhea. Finding curved or spiral shaped gram negative rods in blood cultures leads to suspect this pathogen. Species identification is of utmost importance due to antimicrobial resistance especially in C. jejuni. Prognosis is unfavorable due to host characteristics, and case-fatality rate is high.

Se presentan seis casos de bacteriemia y uno de infección vascular por Campylobacter spp, observados en 25 años, con el fin de describir sus características clínicas. Cinco de ellos se registraron en la segunda mitad del período, en concomitancia con el incremento de este agente en el porcentaje de coprocultivos, lo que sugiere un perfil emergente. Las infecciones fueron más frecuentes en los meses cálidos, asociadas principalmente a C. fetus (5 de 7) y a co-morbilidad. La edad promedio de los pacientes fue de 32,4 años (rango 19 a 63 años) y todos tenían comorbilidades. Las manifestaciones clínicas más frecuentes fueron diarrea y fiebre (5 de 7 casos) y dos pacientes cursaron con shock séptico (28,6 por ciento). La evolución fue favorable en cinco pacientes pero los dos que presentaron shock asociado a C. fetus fallecieron (28,6 por ciento). Las bacteriemias o infecciones vasculares por Campylobacter spp., aunque infrecuentes, pueden presentarse en pacientes vulnerables y debutar como cuadros febriles, en presencia o ausencia de diarrea. La identificación de la especie involucrada es de suma importancia debido a la escasa actividad terapéutica de cefalosporinas de tercera generación y quinolonas. El pronóstico de estas bacteriemias es grave debido a las características del hospedero y a su elevada letalidad.

A Case of Pulmonary Artery Endarteritis due to Staphylococcus lugdunensis in Patient with Clinically Silent Patent Ductus Arteriosus / 이화의대지

Staphylococcus lugdunensis (S. lugdunensis) is an unusually virulent coagulase-negative staphylococci (CNS) and uncommon cause of infective endocarditis (IE) involving mainly native left sided valves. S. lugdunensis IE, which was described previously as "surreptitious" and "wolf in sheep's clothing", runs an aggressive course with a high rate of severe in-hospital complications. Therefore, early surgical treatment has been considered for the treatment of S. lugdunensis IE. However, we experienced a case of S. lugdunensis pulmonary endarteritis which was cured with antibiotic therapy alone.

A Case with Patent Ductus Arteriosus Complicated by Pulmonary Artery Endarteritis

Infective endarteritis in the pulmonary artery is unusual. However, congenital heart disease such as patent ductus arteriosus (PDA) could be a predisposing factor of infective endarteritis. We report a patient with PDA complicated by infective endarteritis and large pulmonary artery vegetation. After three weeks of antibiotic treatment, the patient underwent surgical closure of the PDA and removal of the vegetation.

Pulmonary endarteritis.

Pulmonary arterial endarteritis is a rare event even in patients with congenital heart disease. In this paper, the authors report two cases of pulmonary endarteritis diagnosed at autopsy. The first was a 3-month-old male infant with absence of congenital heart defect (who had had neonatal sepsis). This patient presented with pneumonia and succumbed within 36 hours of hospital stay despite appropriate antimicrobial therapy and supportive management. The second patient was a 13-month-old male child with previously undiagnosed tetralogy of Fallot who had clinical presentation of acute meningitis with convulsions and succumbed within 12 hours of hospital stay despite adequate treatment. The main autopsy findings were chronic arteritis of the pulmonary trunk and right pulmonary artery in the former and rupture of the pulmonary trunk in the latter.

A Case of Femoral Endarteritis Related to Using a Percutaneous Closure Device after Coronary Angiography

Percutaneous arterial closure devices allow earlier mobilization and discharge of patients after arterial catheterization than manual compression for achieving puncture site hemostasis. Our case is representative of Perclose(r) associated infections; our patient had a delayed presentation of a staphylococcal arterial infection that required arterial debridement and reconstruction. Physicians should be aware of this uncommon, but serious complication to expedite the evaluation and treatment of patients with suspected infections that can arise from using these devices.

Femoral Endarteritis as a Complication of Percutaneous Suture Closure Device: A case report / 대한흉부외과학회지

Percutaneous suture closure device is known as relatively safe and convenient tool, which can decrease not only bed rest period of patient but also time consuming effort of manual compression of doctor after femoral artery puncture. However [C1], there are also some reports on complication of its use. We report a 62-year-old male patient who had femoral artery endarteritis [0] with pseudoaneurysm as a complication of percutaneous suture closure device after percutaneous coronary angiography [C2]. He was treated successfully by appropriate antibiotics and vessel reconstruction using autologous saphenous vein patch.

A Case of Colonic Tuberculosis Presenting as Massive Bleeding / 대한소화기내시경학회지

Tuberculous involvement of the colon is an uncommon clinical entity. Other colonic disease which should be considered in the differential diagnosis include inflammatory bowel disease such as Crohn's disease, ulcerative colitis and colon cancer. Intestinal tuberculosis most frequently involves the ileocecal area. The common presenting symptoms are abdominal pain, fever, weight loss and malabsorption. Pathologically, tuberculous colitis may present as an ulcerative type, hypertrophic type or in combination. Massive bleeding is said to be very rare even in the ulcerative type because of an obliterative endarteritis. We report a case of colonic tuberculosis presenting with massive bleeding in 52-year-old man with alcoholic liver cirrhosis, which was diagnosed by colonoscopic biopsy and acid-fast stain.

Management of Fournier's Gangrene with PGE1 and Bilateral Superomedial Thigh Flap

Fournier's gangrene is an infective necrotizing fasciitis of the perineal, genital or perianal regions. Management of this disease has involved prompt surgical debridement with initiation of broad spectrum antibiotics and intensive supportive care. Multiple debridements orchiectomy, urinary deversion, and fecal diversion should be performed as clinically indicated. Hyperbaric oxygen therapy and topical application of unprocessed honey may prove to be useful adjuncts as new therapies. After excision of all necrotic tissue, the tissue losses have been managed by primary repair. split-thickness skin grafts, rotational or free myocutaneous flaps and omental flaps. Skin graft did not take on bare testis lacking the tunica vaginalis, and gracilis myocutanous flap was too bulky to cover the scrotal area. The progress of necrosis ceased by using intravenous PGE1 injection in the aspect of characteristic obliterative endarteritis causing cutaneous and subcutaneous vascular thrombosis and necrosis of tissue in Fournier's gangrene. We have reconstructed large scrotal defects with bilateral superomedial thigh flap in three Fournier's gangrene patients after stopping tissue necrosis with PEG1 treatment and several surgical debridements of the wounds. The use of this flap ensures a virtually normal sensation, which is important for the erotic propensity of the scrotum. Easy flap design and dissection, as well as primary closure of the donor site, are another benefits of this method.

Conservative care of pathologic fracture by osteoradionecrosis of mandible: report of two cases

The main pathogenesis of osteoradionecrosis is the initial radiation cellular kill, plus the progressive tissue hypoxia owing to endarteritis, plus late expressions of lethal mutations in stromal cells. Its treatment comprised (1) avoidance of local physical, chemical & biological irritants, (2) wound irrigation, (3) antibiotics & analgesics, (4) superficial sequestrectomy, (5) hyperbaric oxygen therapy, (6) resection and reconstructive surgery, and (7) supportive therapy for systemic condition. Because of the cumulative effect of radiation therapy, it is important to manage the osteoradionecrosis conservatively & continuously, with emotional & physical support. The authors think that conservative care is more essential to the patient of poor systemic condition, than the aggressive resection & reconstructive surgery. We report two cases of pathologic fracture by osteoradionecrosis of mandible that were cared conservatively in the department of dentistry, Wonju Christian Hospital. The contents of treatment are continuous wound dressing, medications (antibiotics and analgesics) in acute infection, incision and drainage on new abscess, emotional support (stress management), proper nutritional and physical supports (exercise and physical therapy). The prognosis of continuous conservative care is relatively favorable.

A Case of Partial Hypopituitarism and Central Diabetes Insipidus Developed after Tuberculous Meningitis / 대한내분비학회지

Complications related to tuberculous menngitis (TBM) is frequently encountered in medical field during, just after treatment and long time later. Hypothalamo-pituitary dysfunctions such as diabetes incipidus, dwarfism, hypogonadism, growth failure, and hypopituitarism are one of rare complication secondary to TBM and of which obesity with hypogonadism is most commonly documented. Several pathologic mechanics like a granuloma in hypothalamus, or pituitary stalk, organization and progressive scarring of the purulent exudate in the basal cistern or progressive obliterative endarteritis that supplying the hypothalamo-hypophyseal system is well-defined in hypothalamopituitary dysfunction in neurotuberculosis. We recently experienced a diabetic patient with short stature and sexual infantilism who shows polyuria and polydipsia. Detailed endocrinological evaluation showed partial hypopituitarism and central diabetes incipidus secondary to tuberculous meningitis. Polyuria and polydipsia was improved with dDAVP and height increased 5 cm for 11 month with HGH, libido increased with oxadrolone but his extemal sexual characteristics was not changed until now. We present this case with a review of literature.

Estenose aórtica supravalvar complicada por endarterite aórtica e formaçäo de aneurisma micótico / Supravalvar Aortic Stenosis Complicated by Aortic Endarteritis and Mycotic Aneurysm Formation

Paciente do sexo masculino, 11 anos, portador de estenose aórtica supravalvar, tendo como complicaçäo aneurismas micóticos em aorta ascendente secundários a endocardite bacteriana. Os aneurismas foram diagnosticados através de ecocardiograma-controle ao término de tratamento clínico da endocardite, aparentemente sem intercorrências. A angiografia confirmou o diagnóstico, tendo sido os aneurismas ressecados cirurgicamente. Após 6 meses de cirurgia, o paciente continua bem

Endoarterite infecciosa pós-coarctaçäo de aorta em menino de 11 anos / Infectious Endoarteritis After Aortic Coarctation in an Eleven-Year-Old Boy

The authors describe an unusual case of infectious endo-arteritis after aortic coarctation. Clinical and echocardiographic aspects and the excellent surgical results are enhanced

Os autores descrevem um caso infreqüente de endoarterite infecciosa pós-coarctação de aorta em um menino de 11 anos de idade. Peculiariedades do quadro clínico, o aspecto ecocardiográfico e o excelente resultado cirúrgico são destacados

Subacute bacterial endarteritis associated with patent ductus arteriosus: A case report / 대한흉부외과학회지

No abstract available.

Cistopatía posradiación: análisis de 467 pacientes / Posradiation cistopaty: analysis of 467 patients

Análisis retrospectivo de 467 expedientes clínicos de pacientes radiadas por padecer cáncer ginecológico. Como resultados se señalan la mayor incidencia de complicaciones en mujeres operadas como parte de su tratamiento, sin establecer en la mayoría de los casos una correlación entre las características del tratamiento aplicado y la aparición de complicaciones.