Hematogenous Septic Arthritis of the Hip in Extensive Burn

In the patient with extensive burn injury, the occult site of infection such as septic arthritis is easy to be overlooked because a painful hip joint may be confused for painful burn wounds around pelvic area. We describe a extensive burned young adult who experienced a septic hip joint with methicillin resistant Staphylococcus aureus bacteremia A 22 year old male who had full thickness burns of whole body (90%) presented with fever, groin pain, and immobility of right hip joint about 3 months after injury. The physical findings, radiographic findings and bone scan were diagnostic for a septic arthritis. Septic arthritis in the extensive burns may be misdiagnosed for painful burn wounds. Hematogenous septic hip arthritis by sustained bacteremia is rare, but clinical examination combined with appropriate laboratory and radiographic studies can lead to prompt diagnosis and treatment.

The P-pouch: a New Ileal Reservoir Used in Restorative Proctocolectomy

PURPOSE: To evaluate the effectiveness of a P-pouch configuration with a reservoir and recycled segment in restorative proctocolectomy. METHODS: There were 11 patients who underwent the P-pouch procedure. They were compared with healthy eight-control subjects. The P-pouch configuration was constructed using one firing of a 10 cm GIA stapler to form a 12-cm reservoir. Following that, the distal ileum (15+/-0.5 cm) was anastomosed to the proximal portion of the pouch. Pouch function was studied 23.3+/-4.4 months after ileostomy closure. We measured the frequency and amount of stool. The postprandial plasma peptide YY (PYY) response and the scintigraphic studies using 99m-Tc sulfur colloid were used to study transit. RESULTS: In the patient group, daily stool frequency and volume were 5.2+/-0.3 and 423.5+/-23.7 g, respectively. Stool seepage and pouchitis occurred in 45.5 % and 9.1%. In contrast to other pouch procedures, the postprandial increment of plasma PYY was similar the P-pouch patients and healthy controls (P>0.05). The integrated increment of plasma PYY for 180 minutes following meals was also not decreased in 9-pouch patient group compared with the healthy controls (1,050.0+/-127.8 pmol/l vs. 1146.0+/-150.0 pmol/l, P>0.05). Small intestinal transit time for healthy controls and the patient group averaged 89+/-21 and 117+/-12 minutes (P>0.05). The capacity of the ileal pouch was 372+/-22 ml, and the efficiency of ileal reservoir evacuation was 76 %. CONCLUSIONS: The P-pouch is a new and improved simple modification of the well-established J-pouch procedure, constructed using a single firing of a GIA stapler.