Assuntos
Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Bacteriúria/tratamento farmacológico , Complicações Infecciosas na Gravidez/tratamento farmacológico , Adulto , Antibacterianos/administração & dosagem , Bacteriúria/diagnóstico , Estudos de Coortes , Feminino , Humanos , Testes de Sensibilidade Microbiana , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Resultado do TratamentoRESUMO
The full spectrum of invasive Haemophilus influenzae disease has not been documented previously in Africa. This 1-year prospective study was designed to determine the epidemiology of invasive Haemophilus influenzae disease in Cape Town children. During this period, 142 children with invasive disease were hospitalized; 85 (59.9%) presented with meningitis, 35 (24.6%) with pneumonia and 22 (15.5%) with other diseases. No cases of epiglottitis were seen. Sixty per cent of cases were male and 40% female. The median age of the children was 9 months, with a range of 1-144 months, and 65.5% were aged < 12 months. Neurological dysfunction was noted in 40% and 18% of children with meningitis on admission and discharge, respectively. The overall case fatality rate (95% confidence intervals) was 9.2% (4.9-15.7), and for meningitis, pneumonia and septicaemia it was 4.7% (1.2-16.4), 14.3% (4.6-31.8) and 40% (8-78.1), respectively. Serotype b accounted for 86.5% of all cases, 97.3% of cases of meningitis, 71.4% of cases of pneumonia, 50% of cases of septicaemia, all cases of arthritis and cellulitis and none of mastoiditis. The incidence rates (95% confidence intervals) for all invasive type b infections were 169 (122-198) and 47 (39-57) per 100,000 population for children < 1 and < 5 years, respectively. For meningitis the rates were 112 (84-148) and 34 (25-40) per 100,000, respectively. Rates for mixed race and white children were similar, but those for black children were more than double those rates.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Infecções por Haemophilus/epidemiologia , Haemophilus influenzae , Distribuição por Idade , Artrite/epidemiologia , Artrite/microbiologia , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Criança , Pré-Escolar , Feminino , Infecções por Haemophilus/etnologia , Infecções por Haemophilus/microbiologia , Infecções por Haemophilus/mortalidade , Haemophilus influenzae/classificação , Humanos , Incidência , Lactente , Tempo de Internação , Masculino , Pneumonia/epidemiologia , Pneumonia/microbiologia , Estudos Prospectivos , Grupos Raciais , Estações do Ano , Sorotipagem , Distribuição por Sexo , África do Sul/epidemiologiaRESUMO
The latex agglutination test (Wellcogen) was evaluated specifically in cases of 'septic unknown' meningitis, with CSF findings characteristic of bacterial meningitis but with no bacterial organisms grown on CSF culture or seen on microscopy after Gram staining. In only 4 (12%) of 33 cases of 'septic unknown' meningitis were antigens identified in the CSF. This kit contains for the first time reagents for the detection of serogroup B Neisseria meningitidis antigens and was also evaluated for this bacteria. Only 6 (27%) of 22 serogroup B N. meningitidis cases were identified.
Assuntos
Antígenos de Bactérias/líquido cefalorraquidiano , Testes de Fixação do Látex , Meningite Meningocócica/líquido cefalorraquidiano , Meningite/líquido cefalorraquidiano , Kit de Reagentes para Diagnóstico/normas , Estudos de Avaliação como Assunto , HumanosAssuntos
Pâncreas/lesões , Ferimentos não Penetrantes/cirurgia , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , RupturaAssuntos
Cisto Pancreático/cirurgia , Pseudocisto Pancreático/cirurgia , Colangiopancreatografia Retrógrada Endoscópica , Diagnóstico Diferencial , Drenagem , Humanos , Masculino , Mediastino/cirurgia , Pessoa de Meia-Idade , Pseudocisto Pancreático/diagnóstico , Tomografia Computadorizada por Raios XAssuntos
Úlcera Duodenal/tratamento farmacológico , Hormônio do Crescimento/uso terapêutico , Úlcera Péptica Hemorrágica/tratamento farmacológico , Úlcera Gástrica/tratamento farmacológico , Estresse Fisiológico/complicações , Antiácidos/uso terapêutico , Transfusão de Sangue , Esquema de Medicação , HumanosRESUMO
There were 68 thyroids with oncocytic cell changes among thyroid specimens from 2476 thyroid operations performed between 1969 and 1978. In 12 instances there were merely Hürthle cell nests, in 13 there was an oncocytic carcinoma and in 43 oncocytic adenoma. Thyroidectomy was the preferred treatment for Hürthle-cell carcinoma. Five patients were no longer suitable for radical operation, in one there was a recurrence. If there is a potentially malignant oncocytoma, hemithyroidectomy should be performed and careful follow-up is necessary. There was no recurrence maximally 82 months postoperatively.
Assuntos
Adenoma/diagnóstico , Neoplasias da Glândula Tireoide/diagnóstico , Adenoma/patologia , Adenoma/cirurgia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , TireoidectomiaRESUMO
The traumatic mediastinal emphysema occurs along with severe combined injuries. A typical feature is the subcutaneous emphysema as well as crackling sounds and frequently a pneumothorax. The radiography of the chest shows air in the mediastinum surrounding the mediastinal structures. The pleura drainage could be done as an emergency performance in cases of pneumothorax. In cases of an increasing subcutaneous and mediastinal emphysema as well as circulatory failure a cervical mediastinotomy should be carried out. The tracheobronchial tree should be examined bronchoscopically for possible ruptures. Esophagus injuries will be detected by the distribution of a contrast fluid. Even a thoracotomy may be necessary.
Assuntos
Enfisema Mediastínico , Acidentes de Trânsito , Drenagem , Esôfago/lesões , Humanos , Masculino , Enfisema Mediastínico/complicações , Enfisema Mediastínico/terapia , Pneumotórax/complicações , Fraturas das Costelas/complicações , Ruptura , Enfisema Subcutâneo/complicações , Traqueia/lesõesRESUMO
Clinical signs of an acute penetrating wound of the heart not always are clear. Because of hemorrhage and reduced cardiac output during heart tamponade venous pressure not necessarily must be increased. If by pericardiocentesis an aspiration of blood is possible, diagnosis of a penetrating heart wound is of high probability; otherwise there is no diagnostic value of a negative pericardiocentesis. Only in a case of a very small cardiac wound pericardial drainage can be used as a sole therapeutic proceeding; clinical observation is mandatory and an emergency operation at all time must be possible. In most cases immediately thoracotomy with suture of the cardiac wound should be performed. Attention is necessary because of an injury of a coronary artery. Following this principle prognosis is good if the patient is reaching clinical treatment alive. Lethal outcome in 2 of our 12 reported cases in one of them is caused by refusing immediate surgical intervention by the patient himself, in the other by development of ischemic cardiac necrosis involving a papillary muscle after suturing a cardiac wound.