|
|
|
|
|
| JACEP, 1976 Dec, 5(12), 965 - 70 The crush injury: a high risk wound; Cardany CR et al.; A standardized experimental impact injury model was developed to produce soft tissue trauma that simulated impact injuries to soft tissue overlying the cranium . An aluminum impact instrument was constructed so as to deliver a measured amount of energy to a finite area of soft tissue over a fixed foundation . Impact injury resulted in readily demonstrable changes in the morphology of the tissue and its blood flow . As measured by the distribution of fluorescein dye, the blood flow to the impact site was considerably less than that to unwounded tissue . The magnitude of this reduction in blood flow to the site of injury was proportional to the level of energy absorbed by the tissue . The injury to skin resulting from the impact was restricted primarily to the subcutaneous tissue and panniculus carnosus . Loss of adipose tissue and necrosis of skeletal muscle fibers in these layers were associated with the development of a dense inflammatory infiltrate . The structural damage to the tissue and its reduced perfusion were correlated with the tissue's increased susceptibility to infection by bacteria delivered either by direct infection or as a result of a bacteremia . The magnitude of this damage to the host's defenses is, again, directly related to the amount of energy absorbed per unit area of soft tissue . Antibiotics did suppress the growth of bacteria in these experimental soft tissue impact wounds, even when treatment was delayed eight hours . While the therapeutic efficacy of antibiotics was readily apparent in soft tissue impact wounds, the degree to which they could suppress bacteria in these wounds was less than that encountered in the treated control wounds not subjected to impact. Am J Cardiol, 1976 Dec, 38(7), 924 - 8 Candida myocarditis without valvulitis; Franklin WG et al.; Thirty-one patients with systemic candidiasis at postmortem examination were found to have Candida involvement of the myocardium without valvulitis.Retrospective examination of their clinical course demonstrated that a new conduction disturbance was seen in 10, supraventricular arrhythmias in 5,QRS changes mimicking myocardial infarction in 3, and pronounced T wave changes in 13 . Hypotension or shock was seen in 13 patients and could not be explained by coexistent bacteremia or blood loss in 8.One patient died suddenly . Of 19 patients with systemic candidiasis without myocardial invasion, 4 had minor T wave changes and one had a supraventricular arrhythmia . Candida invasion of the heart significantly complicates the clinical course in systemic candidiasis and should be suspected when a young person without preexistent heart disease has cultures positive for a Candida organism, a significant arrhythmia, conduction distrubance or other dramatic QRS change.The effect of therapy on Candida invasion of the heart is unknown. Arch Surg, 1976 Dec, 111(12), 1337 - 47 Infections complicating orthotopic liver transplantation: a study emphasizing graft-related septicemia; Schroter GP et al.; In 93 recipients of 102 orthotopic liver homografts, the incidence of bacteremia or fungemia exceeded 70% . The graft itself was usually an entry site for systemic infection after both immunologic and nonimmunologic parenchymal injury, especially if there was defective biliary drainage . The role of the homograft itself as the special infectious risk factor has prompted increased use of defunctionalized jejunal Roux limbs to reduce graft contamination . It has also stimulated very aggressive postoperative diagnostic efforts to rule out remedial mechanical complications of the transplant. Surgery, 1976 Nov, 80(5), 569 - 74 Anorexia and weight loss in the portacaval-shunted pig; Hickman R et al.; The pig shows a marked response to end-to-side portacaval shunt . Survival is short and levels of alkaline phosphatase and cholesterol fall . This study was designed to determine the role of the reduced food intake which follows the operation upon these results . In pair-fed, sham-operated pigs, survival was short and levels of alkaline phosphatase and cholesterol also fell . Sham-operated animals fed normally did not show this response . Reduced appetite has been recorded in many experimental animals after portacaval shunt, but the cause remains to be elucidated . Encephalopathy, bacteremia, peptic ulceration, or hormonal imbalance could be implicated . Similar alteration in appetite and weight loss have not been observed in children who have been treated by portacaval shunt for glycogen storage disease or hypercholesterolemia; however, the underlying metabolic disorder or the species difference may be a contributory cause. J Oral Surg, 1976 Nov, 34(11), 1031 - 4 Bacterial endocarditis of dental origin: report of case; Kraut RA et al.; Although appreciated by most practitioners, the fact that dental infection may be the source of bacteremia without a history of recent dental procedures is occasionally overlooked . The case reported here illustrates what we feel is an example of such a phenomenon . The eradication of the oral foci of infection enhanced the patient's response to therapy and prompted his ultimate recovery. Dis Colon Rectum, 1976 Nov-Dec, 19(8), 702 - 4 Purulent pericarditis occurring in a patient with cecal carcinoma: report of a case; Forman MD et al.; We report the unusual concatenation of cecal carcinoma complicated by bacteremia and purulent pericarditis . The organism responsible for the pericarditis was not definitely established . The pericarditis was successfully managed by surgical drainage and antibiotic therapy . Colonic surgery followed eradication of the pericarditis. J Infect Dis, 1976 Sep, 134(3), 294 - 6 Priming of Macaca cynomolgus philippinensis with purified antigen of Brucella melitensis before injection of Rev . I vaccine; Chen TH et al.; In experiments designed for study of bacteremia and serologic response of Macaca cynomolgus philippinensis to vaccination with a soluble antigen (fraction I) of Brucella melitensis and the live Rev . I vaccine strain, fraction I and Rev . I were administered both four weeks apart and simultaneously . One of three monkeys given the vaccines four weeks apart and two of three monkeys vaccinated with fraction I and Rev . I in a single injection developed transient bacteremia, as shown by blood cultures . Both methods of vaccination induced significant titers of antibody to B . melitensis, and vaccinated monkeys were protected against subsequent challenge with a virulent strain of B . melitensis. JAMA, 1976 Aug 23, 236(8), 936 - 8 Pressure monitoring devices . Overlooked source of nosocomial infection; Weinstein RA et al.; Contaminated pressure monitoring devices recently have been implicated as a source of epidemic organisms in three outbreaks of nosocomial bacteremia, one outbreak of candidemia, and one outbreak of hepatitis . Measures necessary to prevent monitoring-related infections have not always been appreciated or taken . As a minimum, pressure monitoring devices should be sterilized between use with different patients; strict aseptic technique should be employed when setting up and using monitoring systems; and each patient's monitoring tubing, fluid, and monitoring devices should be changed at regular intervals. Am J Dis Child, 1976 Aug, 130(8), 849 - 51 Hyperpyrexia in children . Eight-year emergency room experience; McCarthy PL et al.; In an eight-year period, 100 children were seen in a pediatric emergency room with a temperature of 41.1 C or higher, hereafter called hyperpyrexia . There was a significantly greater occurrence of bacterial meningitis in the hyperpyrexia group, compared to a group of 264 children with temperatures of 40.5 to 41.0 C . Bacteremia and seizures were also more common . Children with hyperpyrexia require careful evaluation, especially of the central nervous system. N Engl J Med, 1976 Jul 22, 295(4), 185 - 9 Acute renal failure of glomerular origin during visceral abscesses; Beaufils M et al.; We studied 11 patients who had visceral abscesses and in whom acute renal failure developed . All renal biopsies showed a diffuse proliferative and crescentig glomerulonephritis . In seven patients blood cultures were repeatedly negative . Endocarditis could be ruled out in six patients . Seven patients had circulating cryoglobulins; serum complement levels were normal in seven and decreased in four; circulating immune complexes were found in the three patients studied . The evolution of the glomerulonephritis, documented by serial biopsies, closely paralleled the course of the infection . A complete recovery of renal function occurred in four cases in which a rapid and complete cure of the infection was obtained . Of five patients in whom the infection was not cured, four died, and chronic renal failure developed in one . In two patients in whom therapy was delayed, chronic renal failure also developed . Deep suppuration, even in the absence of bacteremia, may be responsible for a severe but possibly reversible glomerulonephritis with circulating immune complexes. Urol Clin North Am, 1976 Jun, 3(2), 255 - 66 The hematologic evaluation of the urologic patient; Cassileth PA; This article provides a framework for the hematologic evaluation of the urology patient . The discussion is based on an analysis of test results obtained from routine screening laboratory studies as the complete blood count and platelet count . The use of automated blood counts also provides quantitative indices of red cell morphology which facilitate the diagnosis of red blood cell disorders . To aid in categorizing hematologic disorders, abnormalities of the red blood cells, white blood cells, and platelets are discussed separately . In some circumstances where a disease process, such as bacteremia, alters more than one of the formed elements of the blood, this speparate analysis approach is less appropriate . Nevertheless, this division is generally useful in arriving at the correct interpretation of hematologic abnormalities . Within each category of abnormal test results, a variety of etiologies is listed . Elaboration is reserved for the entities commonly seen in hospitalized patients . For a more detailed discussion of the common disorders or for a more inclusive listing of the less common disorders, the bibliography lists a selection of useful references. Pediatrics, 1976 Jun, 57(6), 861 - 8 Bacteremia in children: an outpatient clinical review; McCarthy PL et al.; In a 20-month period, 1,783 children seen in the pediatric outpatient department had blood cultures performed and 117 (6.5%) of these children had bacteremia . Two thirds of the isolates were Diplococcus pneumoniae and Hemophilus influenzae b . Ninety-three percent of children with H . influenzae b bacteremia and 20% of children with pneumococcal bacteremia had soft tissue involvement at the initial visit . Most children with positive blood cultures (102) were previously well and beyond the newborn period and many (46) had seemingly trivial illnesses initially: upper respiratory tract infection, fever of unknown origin, otitis media, and diarrhea . In the absence of soft tissue infection, the latter three diagnoses correlated best with bloodstream invasion . Nineteen children had persistent bacteremia and five developed soft tissue complications not noted initially . Two factors, age between 7 and 24 months and temperature between 39.4 and 40.6 C, showed increased specificity for bacteremia but were sensitive only for pneumococcal disease . A temperature larger than or equal to 40.5 C showed more specificity for bacteremia than lesser fevers . A white blood cell count greater than 20,000/cu mm was poorly sensitive, and pulmonary infiltrates were neither specific nor sensitive for positive blood cultures . Five bacteremic children had aseptic lymphocytosis in the cerebrospinal fluid . Two days of intravenous antibiotic therapy and eight days of oral therapy were adequate for pneumococcal bacteremia without soft tissue involvement . This therapy may not be without soft tissue involvement . This therapy may not be ideal, however, since other routes and duration of therapy were not evaluated. J Pediatr, 1976 Jun, 88(6), 1032 - 4 Early diagnosis of neonatal bacteremia by buffy-coat examination; Faden HS; This study demonstrates the value of the buffy-coat smear examination in the early diagnosis of neonatal bacteremia . It is inexpensive, easy to perform, and relatively efficient . In most situations large numbers of bacteria could be seen in each positive smear . Unfortunately, the presence of a positive buffy-coat smear was often associated with a poor prognosis; more than one half (four of seven) of infants with positive smears died. Infect Immun, 1976 May, 13(5), 1473 - 8 Fusobacterium necrophorum infection in mice as a model for the study of liver abscess formation and induction of immunity; Abe PM et al.; A mouse model is described in which intraperitoneal injection of Fusobacterium necrophorum results in chronic liver abscesses . Viable bacterial counts from mouse lung, liver, and spleen were obtained after whole organ homogenization . From 2 h to 5 days postchallenge, liver was found to contain more bacteria than lung on a per gram basis . Bacterial counts from liver and spleen were about the same during the first 8 h; thereafter liver was found to contain more bacteria . By day 13, though bacterial counts were equivalent in the three organs, abscesses were only observed in liver . This predilection for the liver may be due to a nutritional and/or microenvironmental factor(s) . Blood cultures of infected mice revealed a general lack of bacteremia . Extended immunization with formalin-killed cells was found to protect mice against F . necrophorum infection. Circulation, 1976 Apr, 53(4), 676 - 9 The incidence of bacteremia in pediatric patients following tooth extraction; Peterson LJ et al.; Procedures which produce bacteremias may lead to bacterial endocarditis in the susceptible patient . Recent work has suggested that bacteremia does not occur in children following extraction of teeth as it does in adults . One hundred and seven children were divided into four groups . Group I, which consisted of children who had nondiseased primary teeth extracted, had 35% positive blood cultures . Group II consisted of children who had diseased primary and permanent teeth removed . The incidence of positive blood cultures was 53% . Group III, which consisted of patients who had extractions of nondiseased permanent teeth, had a 61% incidence of positive blood cultures . Group IV served as a negative control . Bacteremias do occur in children following the extraction of normal and diseased primary and permanent teeth . Therefore, the susceptible pediatric patient who is to undergo a dental extraction procedure must be given prophylactic antibiotics. Ann Intern Med, 1976 Mar, 84(3), 254 - 60 Pneumococcal pneumonia: capsular polysaccharide antigenemia and antibody responses; Coonrod JD et al.; Capsular polysaccharide was detected in the serum in 19 of 46 patients with pneumococcal pneumonia . Antigenemia was strongly associated with bacteremia and with infection by low-numbered serotypes . During antibiotic therapy, the concentration of polysaccharide in the circulation declined progressively, but circulating antigen remained detectable in two thirds of cases for 2 weeks or longer . The development of measurable type-specific antibody was delayed in patients with antigenemia . It is not known whether this delay was due to diminished antibody production or to neutralization of antibody by circulating antigen . Despite effective antibiotic therapy many patients with antigenemia had a severe and protracted illness; this may have been related to diminished availability of antibody early in the infection. Acta Otolaryngol, 1976 Mar-Apr, 81(3-4), 242 - 3 Bacteremia after tonsillectomy and adenectomy; Van Eyck M; 40% of negative hemocultures become positive immediately after tonsillectomies and/or adenectomies . This bacteremia is asymptomatic and remains no longer than one hour. Surg Gynecol Obstet, 1976 Feb, 142(2), 173 - 6 Colonoscopy associated bacteremia; Dickman MD et al.; Fifty-two patients undergoing uneventful diagnostic colonoscopy with or without polypectomy and biopsy were evaluated for evidence of bacteremia during and after the procedure . In only two instances was bacteremia noted . Positive findings were noted in patients with carcinomatosis and severe liver involvement . These data suggest that routine prophylactic antibiotic coverage is unnecessary in uncompromised patients . Further studies are warranted when patients have either severe liver involvement or impairment of normal host defense mechanisms. Bol Med Hosp Infant Mex, 1976 Jan-Feb, 33(1), 227 - 31 {Absence of bacteremia after dental extractions}; Navarrete F et al.; A study was made on 100 subjects of both sexes between the ages of 3 and 15 years to detect the presence of bacteria in the circulation after performing dental extractions . Two groups were formed of 42 and 57 subjects respectively . One of these groups was subjected to preoperative antisepsis of the region to be operated on, the rest of the conditions were similar for both groups . All the patients were submitted to a preoperative gingival smear and 5 c.c . of blood taken for cultures . Two postoperative blood cultures, one immediately after the operations and another 24 hrs . later were also done in all patients . All the extracted teeth presented severe infections at the root level and some showed complicated infection such as osteomyelitis . All blood cultures performed 24, 48, 72 hrs . and 21 days after the operation, were negative; therefore, there is no justification based on the study, to assume the existance of focal infection related to the presence of bacteremia. Gastroenterology, 1976 Jan, 70(1), 20 - 1 Does bacteremia follow colonoscopy? Norfleet RG, Mulholland DD, Mitchell PD, Philo J, Walters EW. In order to determine the risk of bacteremia from colonoscopy, we cultured blood specimens from 40 patients the day before laxative and enema preparation; right after such preparation; and 15 min, 1 hr, and 4 hr after colonscopy . Bacteremia was not induced by either the vigorous preparation or the colonscopy which, in 27 patients, included polypectomy, biopsy, and/or fulgurations . On the basis of our data, we conclude that the risk of bacteremia following colonoscopy is small, and we doubt the need of antibiotic prophylaxis for those with susceptible hearts. Oral Surg Oral Med Oral Pathol, 1976 Jan, 41(1), 18 - 23 Infected total hip replacement after dental procedures; Rubin R et al.; Three cases are reported in which there was a worrisome association between dental work and an infected total hip replacement . The patients had long asymptomatic intervals subsequent to implantation of prosthetic hip joints . After dental procedures, infections became apparent in these hips . Such infections carry an enormous and crippling morbidity . The potential complications of transient bacteremia in the patient with a cardiac valvular prosthesis are appreciated and the importance of prophylactic antibodies for dental work in such patients is well known . Although we emphasize that there is no proof that the infections in our patients were metastatic from the mouth, the sequence of events is suggestive . We recommend prophylactic antibiotics for dental work in the patient with a total hip replacement.
|
© 2005
Transgalactic Ltd (manufacturer of Bioscreen C software) |
Privacy Statement | P.O. Box
1393, 00101 Helsinki, Finland,
Last modified: May 25, 2005
| ||||||
